Reality or hype? The Egyptian healthcare ‘revolution’ post Arab Spring
| Oct 17, 2012
Since the 1960s, Egypt's health profile has grown to be more like developed countries, with longer life expectancy and higher productivity. Yet despite health programs to tackle Poliomyelitis, tuberculosis, viral hepatitis B/C and bilharziasis being offered at no cost to patients, disease rates for cancer, diabetes, heart and chronic respiratory are still high.
Before the Arab Spring uprising last year, the government put forward a vision to overhaul the healthcare system by 2025. They asked for international recognition and support for government-funded programs to address key diseases, but the reform process was slow. It didn’t help that expenditure was mainly out of pocket (only around half of the population had insurance). Primary healthcare as seen in the West did not exist despite a high ratio of trained medical staff to patients. High volumes of medicine were being sold but price freezes for new therapies meant that prescriptions were mainly for locally produced generics. And although there was international recognition from the IMF for health-related Millennium Development Goal programs to tackle, for example, the hepatitis C epidemic (more sufferers than North America), there was no comprehensive community awareness of how to prevent disease or any properly funded thrust toward improving outcomes.
Moving forward, democracy has had – at least superficially – a profound impact on healthcare funding. The health committee, led by Prime Minister Kamal al-Ganzouri, has agreed on health reform plans. The most crucial changes include allocating over $115 million to provide primary healthcare in villages, free medical treatment from hospitals and subsidized treatment of children under six who are not covered by health insurance, enhancing family planning services at a national level and institutionalizing/strengthening consumer protection.
The Ministry of Health also committed to working in partnership with pharma companies on social welfare programs and improving outcomes, while a recent deregulation of imports means that manufacturers of medical devices have a particular opportunity in the market.
But does the reality measure up with the rhetoric, and will the risk balance with return for pharma companies? Well, the healthcare market here is expected to grow 15% in the medium term, it’s the most populous country in the Middle East and a diverse range of opportunities exist in primary, secondary and tertiary care. These include collaborative community, national, regional and international educational programs aimed at prevention of disease and the creation of model/mobile clinics to ensure early detection of diseases like breast and cervical cancer.
There are also opportunities to prevent and control hepatitis C infection. Currently, the estimated prevalence of HCV-positive individuals is around15% in Egypt which is the highest worldwide, and the absolute number of cases i higher than North America and Latin America combined.. That means almost 11.5 million people have been infected with the virus, yet Egypt has less than 200 hepatologists. Not everyone remains infected but the Egypt Demographic and Health Survey (EDHS) reported that 9.8% of those that do continue to be untreated . To date, implementation largely has been limited to care and treatment of approximately 20,000 patients. Although this program was slated for expansion before the revolution, government funding only covered 40% of total costs of the screening and treatment programs, with the remaining 60% being paid by insurance companies and patients. And although competition has driven down treatment costs, barriers still hampered efforts to reach a greater proportion of HCV-infected persons. Health insurance plans should make a difference, as should additional programs to increase community awareness and education. These will be aimed at preventing HCV infection in healthcare settings, ensuring a safe blood supply, establishing surveillance and monitoring to track the effectiveness of control programs and providing care and treatment.
However, the downside is that international and local pharma companies with on-the-ground manufacturing facilities get a market access edge. International companies operating under license also have many disadvantages, such as the lack of quality and innovation offered by local partners. In addition, political turmoil has resulted in an economic slowdown and strikes. .Most importantly the government has to yet follow through with their promises. The plan before the revolution was to ensure all of the population would be covered by health insurance as soon as possible but this will cost $80B , which is four times the current budget..The early estimate was that this could be achieved in nine years, that then became twenty years and now everyone is wondering whether the reality will ever live up to the hype.
If you are looking to develop your portfolio in Egypt, I would be interested to hear your view on the challenges and opportunities offered. Drop me a line or leave a comment against this blog.