Egypt misses healthcare targets as population ails

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• Egypt spends 1.2% GDP on health
• Insufficient healthcare facilities
• Rising diabetes and cancer rates

Egypt is failing to meet its healthcare spending targets, exacerbating deteriorating living standards that are leading to a rising number of illnesses and health problems.

Egypt’s parliament approved legislation in 2018 to achieve universal health coverage by 2030, pledging to expand provision to include the 50 percent of Egyptians lacking insurance, according to a 2023 Canadian academic paper.

That follows clauses in the 2014 constitution specifying the government must spend at least 3 percent of gross national product (GNP) on healthcare and increase this steadily to reach “international standards”.

GNP is similar to, but broader than, GDP and includes money generated by citizens living abroad.

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Yet for the financial year 2024-25, Egypt will spend only 1.2 percent of GDP on healthcare, Egyptian media reported.

Since the mid-1970s, wealthier Egyptians have relied increasingly on private healthcare due to neoliberal reforms that ultimately reduced funding and access to public medical care.

So-called out-of-pocket payments – those made directly by the patient or their families – represented 62 percent of Egypt’s healthcare spending in 2022, the Canadian academics estimate. That compares with 39 percent in countries of similar wealth.

The World Health Organization recommends a minimum two primary healthcare facilities per 10,000 people; Egypt has 0.5 and this will fall to 0.4 by 2035 unless the country builds 20,300 new primary healthcare facilities by then, Unicef forecasts.

In terms of hospital beds per population, Egypt has less than half the WHO recommended amount and requires an extra 199,000 by 2035 to meet the organisation’s target.

The Egyptian pound’s plunging value has hiked the cost of imported medicine upon which the country relies, the 2023 Canadian paper notes.

Egypt’s annual headline inflation was 33 percent in March, easing from 38 percent last September, which was the highest this century.

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“The government has failed to meet its constitutional obligations on healthcare and education spending, which in concert with a prolonged series of economic crises and a number of historic inflationary spikes, has left the population in an extremely difficult position,” said Timothy Kaldas, deputy director of The Tahrir Institute for Middle East Policy. “That has had a cumulative, negative impact on public health.”

According to the International Diabetes Federation, nearly 11 million people, or about a fifth of Egypt’s adult population have diabetes, up from 7.3 million in 2011.

Cancer rates have increased to 166 per 100,000 people in 2022 from 127 in 2007.

“The quality of food that Egyptians can afford to eat has deteriorated over the last several years,” said Kaldas.

“Even eggs, which were a cheap source of fat and protein, have become unaffordable for many families. This has long-term implications for the health of children, for their productivity in the future, and the cost to the health system to take care of them should any health issues arise as they grow older.”

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Nearly half of Egyptian children under five were anaemic in 2021, Unicef estimates.

“There’s a growing dietary dependence on carbohydrates and sugar because such foods are cheaper, which also has negative health consequences,” said Kaldas. “There’s a whole array of issues that must be examined more holistically if we want any kind of inclusivity in Egypt’s economic model.”

Life expectancy low

Egyptian life expectancy was 70 years in 2021, the most recent World Bank data shows. Among Arab countries, that is the seventh lowest, according to Statista, below Iraq and Syria which have endured prolonged, deadly conflicts this century.

In 2020, Egypt spent $151 per person on private and public healthcare, the World Bank estimates – less than Iraq ($202), Morocco ($187) and Tunisia ($222).

Egypt’s public external debt – money borrowed in foreign currencies – was $110 billion in 2022, having more than trebled over the preceding decade. Egypt’s interest payments will equate to 66 percent of government revenue in 2024.

To help ease its parlous finances, in March Egypt sealed multibillion-dollar agreements with the European Union, the International Monetary Fund and the UAE that include additional borrowing.

“The leadership likely feels it’s getting bailed out and escaping more or less unscathed from this latest crisis that it itself precipitated, but that’s not true for the Egyptian public,” added Kaldas.

“The realistic best-case scenario for the average Egyptian in the short to medium term is that the deterioration in their standard of living will slow down, not that it will reverse.”