Islam Anan, CEO of Accsight LLC and Lecturer of Health Economics and Policy, Ain Shams University, Cairo, Egypt

In the light of the latest global healthcare changes including the COVID-19 situation, the common budgetary constraints, and the evolution of value and efficiency concepts, it was evident that the Egyptian healthcare system (HCS) needed a different approach to tackle the new challenges faced. As the most populous country in the Middle East and with its fragmented healthcare system, Egypt has been undergoing a great deal of transformation lately.

Egypt vision 2030 for health is to move from fragmented system-centric care to unified patient-centric care reaching ultimately to public-centric care focusing on disease prevention and the general well-being of Egyptians through numerous public health programs.

To reach the public-centric care, the Egyptian HCS is transforming to firstly optimize the current system-centric care before 2024, reaching efficiency through 4 pillars: healthcare governance, organizational restructure, digitization and finally automation. This transformation started by issuing new legislation, forming new bodies, and splitting responsibilities across different specialized authorities, instead of having centralized HCS through the ministry of health and population (MOHP). The Pharmaceutical and Drug Administration file moved from the MOHP to a new authority with equal power, reporting to the prime minister. The Egyptian Drug Authority (EDA) regulates, implements and monitors the quality, efficacy and safety of medical preparations and supplies, as stipulated by the provisions of the law establishing the authority, including but not limited to registration, pricing, promotion, and pharmacovigilance).

Similarly, other functions were split and cut from the MOHP; the health technology assessment (HTA), procurement, supply and warehousing and formed The Egyptian Authority for Unified Procurement, Medical Supply and Management of Medical Technology (UPA) reporting as well to the PM. The file of healthcare facilities quality, accreditation and inspection as well as capacity building was split from the MOHP to form the General Authority for Healthcare Accreditation and Regulations (GAHAR) which is an independent authority under the direct supervision of His Excellency President Abdel Fattah El Sisi.

After the formation of these different bodies in 2019-2020, the health service providing and budgetary holding functions inside the MOHP are currently going through a transformation and a new body: the Universal Health Insurance Authority (UHIA) was formed reporting to the MOPH minister and responsible for the budget and purchase of medical technology. The General Authority for Healthcare (GAH) was also formed as the service providing body: both bodies (UHIA and GAH) form the Universal health insurance organization (UHIO) which is the new insurance system to cover all the Egyptian population by 2030, and currently operating in 2 governorates.

The split between budget of health technologies (HT), assessment, procurement, service providing, and quality audit is the first step towards efficient system-centric care without conflicts in decisions, and with more transparency which will lead to the next step to be patient-centric care where there is an integration between Access (making the HT available at dispensing units) and reach (utilizing the accessed HT by patients).

This transition to integration needs 8 steps to ensure that governance and separation of entities will not put more bureaucracy and increase turnaround time (TAT) (Anan. I 2015):

1. Forming a supreme health council from the members of all the entities with the head of counsel to be elected every 4 years;  
2. Research and data center: responsible for data generation to assess the health outcome and to make sure data migration from one entity to another is robust and maintained;
3. Prioritization plan: prioritize coverage plans based on budget and strategic disease burden to make sure money flow and funds are matching the Egyptian HCS needs;
4. Treatment protocols flowchart: ensuring unified treatment guidelines across different HC bodies;
5. Unique Patient ID: all insured patients are traceable without double counting;
6. Health Information System: connecting all HC units for optimum resources utilization along with a robust universal IT system to make sure that all the different bodies can see each other, and no delay in functions / less turnaround time for processing;
7. Primary Care Physicians (PCP) Development Plan: continuous education programs for optimizing their utilization and freeing time to the over-utilized specialists, and retention of the current PCP since after COVID Egypt is witnessing many resignations and migration request to Europe; and
8. HTA Unit: to be functioning independently and with a strategic active role - not only advisory but to contribute to the economical strategic planning of the health council.