A new law to privatise healthcare in Egypt will undermine access to and availability of health services, particularly for those without health insurance and those who are poor, Amnesty International said today.
On June 23, President Abdel Fattah el-Sisi ratified Law No. 87 of 2024 on Health Facilities, which was passed by the Egyptian parliament on May 20, allowing the private sector to operate and manage public health facilities on a for-profit basis. The law does not include price controls, giving private investors and the government the discretion to determine prices on a case-by-case basis.
Millions of Egyptians, including those who are uninsured or cannot afford expensive private healthcare services, currently rely on the country’s public healthcare facilities. However, the Egyptian parliament rushed to adopt this law in just one month, without sufficient consultation with stakeholders and despite serious concerns expressed by doctors’ unions. According to the law itself, implementing regulations were to be issued within one month of the law’s implementation, but to date there has been no announcement of their completion.
“The new law is another blow to people’s social and economic rights, which have continued to deteriorate under President Al-Sisi’s government, which has seen record inflation and a soaring cost of living with no end in sight. Instead of protecting people’s right to health amid the ongoing economic crisis, the government is trying to evade its obligations at the expense of the poorest people who will be most affected,” said Mahmoud Shalaby, Egypt researcher at Amnesty International.
“The Egyptian government cannot simply hand over the keys to its struggling public health system to the private sector without clear regulations to ensure that everyone living in the country has access to affordable, quality health care.”
The Egyptian government cannot simply hand over the keys to its struggling public health system to the private sector without clear regulations to ensure that everyone living in the country has access to affordable, quality health care.
Mahmoud Shalaby, Egypt researcher for Amnesty International
According to the Egyptian Ministry of Health and Population (MoHP) estimates for 2023, only 66% of Egyptians are covered by public health insurance, leaving millions of people likely uninsured. Those covered by public health insurance include students, public and private sector workers, widows, and pensioners. There are no official figures on how many people have private health insurance in the country, but rising poverty levels in Egypt, especially since the massive devaluation of the currency, have prevented many from accessing private health insurance.
Under international law, States have an obligation to protect the right to health, including to ensure that privatization of the health sector does not pose a threat to the availability, accessibility, acceptability and quality of health care, especially for marginalized groups. According to the Special Rapporteur on the right of everyone to the highest standard of physical and mental health, privatization of health care often poses significant risks to the equitable availability and accessibility of health care for the poor and other marginalized groups and can lead to increased out-of-pocket expenses.
Amnesty International spoke to three experts: Mona Mina, former vice president of the Egyptian Doctors’ Union; Ahmed Hussein, a former union official; and a member of a local medical NGO, who spoke on the condition of anonymity. Amnesty International also reviewed several expert reports on the new law and Egypt’s health-care system.
The uninsured and the poor are left to fend for themselves.
The new law allows the private sector, through public-private partnerships, to establish new public health facilities and manage and operate existing public health facilities under the Ministry of Health, which controls 80 percent of public hospitals in the country and just under half of all hospitals. The law excludes primary health care centers and, according to the law itself, should not affect medical and emergency services, disaster services, blood surgery and plasma collection, or communicable diseases.
The new law does not address the risk that people, including the uninsured and poor, will be unable to pay for their health care if new private management increases the prices previously charged on a not-for-profit basis.
In 2018, President Al-Sisi ratified a bill guaranteeing universal health insurance for all Egyptians. Following Al-Sisi’s directive, the government announced a goal of expanding it to all 27 governorates by 2028, but as of 2023, the new system had only been implemented in six governorates.
“The price increases for health services in public hospitals will likely result in higher costs for treatment and will affect even those with public health insurance,” Mona Mina told Amnesty International.
According to the World Bank, Egypt’s already high out-of-pocket expenses (OOP) – costs that individuals are responsible for paying and may or may not be reimbursed – are burdening the country’s poorest people and pushing many families below the poverty line.
Unclear public-private relations
The new law stipulates that public hospitals run by the private sector must allocate a certain percentage of their total medical services to those who are covered by public health insurance, universal health insurance, or who are eligible for state-funded treatment. However, the law does not specify what percentage of services must be reserved for these categories of patients. This means that there is no safeguard against these for-profit public hospitals reserving a large proportion of their services for paying patients, depriving those who cannot pay. The law does not provide any safeguards to ensure that discrimination does not occur based on patients’ insurance or ability to pay out of pocket.
In light of these concerns, the Egyptian Doctors’ Union urged President Al-Sisi in May 2024 not to ratify the law, citing threats to staff working in public hospitals.
The new law requires the private sector to retain only 25 percent of the staff working in public hospitals and allows them to lay off up to 75 percent of the staff if hospital management is transferred to the private sector.
The Egyptian government needs to put in place and enforce a strong regulatory framework and legislation to ensure that the poorest and most vulnerable groups have equal access to quality health care in public hospitals run by the private sector, and ensure that meaningful consultations are held with stakeholders, including health workers.
background
On October 2, 2023, President Al-Sisi said that due to the government’s insufficient management of public hospitals, it is possible for the government to build hospitals and transfer their management to the private sector.
Egypt’s public health care system is plagued by a shortage of public hospital beds, with just 1.4 beds per 1,000 people, well below the global average of 2.9 beds per 1,000 people.
Since 2014, the Egyptian government has failed to meet its constitutionally mandated target of allocating at least 3 percent of GDP to health care.
