Development Health Care Sector in Egypt

By Eng. Amr ElSaharty
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Development Health Care Sector in
Egypt
July 2020

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Contents
1. Introduction...................................................................................... 3
2. Vison and Mission ............................................................................ 4
3. External Enviroment......................................................................... 5
3.A. PESTLE Analysis ............................................................................. 5
3.B. Opportunities and Threats ............................................................ 6
4. Interneal Enviroment ....................................................................... 7
4.A. Strength and Weakness................................................................. 7
5. Strategic Objective ........................................................................... 8
6. Public Private Partnership(PPPs) Strategy ......................................... 9
6.A. Forms of government private contracts include ......................... 10
6.B. Typical PPP drivers ...................................................................... 10
6.C. Features of common PPP models in healthcare.......................... 11
6.D. The three most common PPPs business models in healthcare... 12
6.E. Key conditions for PPPs project success ..................................... 13
6.F. Role of PPPs ................................................................................ 14
6.G. Regional Using PPPs .................................................................. 15
6.H. Healthcare geographic region using PPPs .................................. 16
6.I. Universal health insurance .......................................................... 16
7. Balanced Score Card....................................................................... 17
8.References ...................................................................................... 20

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Introduction
Governments today face a wide range of complex healthcare challenges
spurred by changing demographics, a growing burden of chronic
disease, rising healthcare costs, more informed patients and rapidly
changing healthcare technologies. Healthcare systems are increasingly
strained and are struggling with how to expand access and deliver high
quality healthcare services all while controlling costs. These pressures
will only increase as countries seek to implement Universal Health
Coverage, and achieve the aim of Sustainable Development goal to
ensure healthy lives and promote wellbeing for all at all ages by 2030.
Additional investment in health will be needed in many countries,
particularly in developing countries where healthcare infrastructure
remains inadequate, and facilities lack the necessary management skills
and patient care workforce to address the growing demands of caring
for their population.
Public Healthcare
Public health coverage is offered through the Ministry of Health, which
operates a series of medical facilities providing free health services.
There are two main quasi-governmental insurers. The Health Insurance
Organization (HIO), is the largest public health-care payer, along with
the Curative Care Organization (CCO). Their services are provided under
the form of basic coverage. The HIO covers 60% of the population,
including employees, students, and widows through premiums
deducted from employee salaries and employer payrolls. The
organization operates its own network of medical facilities and at times
contracts with private healthcare providers. The Curative Care
Organization (CCO) offers inpatient and outpatient care in specific
governorate through contracts with other entities and individuals. Many
mosques and churches also operate their own subsidized or free clinics,
especially in the large cities.

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Private Healthcare
There are also private insurance options and a network of private
healthcare providers and medical facilities. The private sector includes
for-profit clinics, hospitals, and pharmacies. The private medical sector
is deemed superior to the public services, in terms of quality. Statistics
show that the private sector is the initial choice of a healthcare provider
in Egypt, even among the lowest income groups.
2. Vision and Mission
Vision
Health insurance will be provided to all Egyptians citizens
To achieve security, health and well-being to serve the individual
and society.
Mission
To ensure the provision of quality health services and to promo to
health lifestyles and environmental practices
To Implement E-Health system to improve the access efficiency,
effectiveness, and quality of clinical and business processes utilized
by healthcare organizations, medical personnel, practitioners,
patients, and consumers in an effort to improve the health status
of patients.

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3. External environment
3.A. PESTEL analysis
Political Factors
Political stability
Level of corruption especially levels of regulation in Healthcare
sector.
Interference in Hospitals industry by government
Intellectual property protection
Industrial safety regulations in the Healthcare sector
Tax policy
Economic Factors
Unemployment rate
Inflation rate
Interest rates
Economic growth rate
Education level
Business cycle stage (ex. prosperity, recession, recovery)
Infrastructure quality in Hospitals industry
Social Factors
Class structure, hierarchy and power structure in the society
Culture
Higher population growth
Health awareness issues
Attitudes (health, environmental consciousness)
Technological Factors
Rate of technological diffusion
Impact on value chain structure in Healthcare sector

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Improved health information technology (home care, remote
medical services, remote training, electronic medical record)
Environmental Factors
Higher risks and diseases resulting from environment pollution
Higher air pollution in cities in which the hospitals are located
Legal Factors
Consumer protection and e-commerce
 Employment law
 Health and safety law
 Data Protection
3.B. Opportunities and Threats
Opportunity
 Investment in the health insurance sector to increase medical
reimbursement rates allowing physicians to subscribe more, and
to cover all citizens
 Improve awareness of safety and health
 Enhance infrastructure of network
 Improving the quality of healthcare service provision
 Increase salaries of medical staff
 Increase opportunities
 Developing human resource management in the health sector
 Developing the pharmaceutical sector
 Implement Ecosystem continuity of care have the potential to
enhance health outcome by improving medical diagnosis, data
base treatment decisions and self-management of care as well as
supporting health workforce

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Threats
Workers strikes due to the low salaries offered
High cost of medical care project
Adoption of e-Health or Ecosystem systems often requires
cooperation among Ministries and government bodies that might
not be in place
Staff resistance
Reforms of stopped when significant investments are needed
because of economic crisis
Large and growing population
Political instability
4. Internal environment
4.A. Strength and Weakness
Strength
Largest healthcare market
Large pool skilled doctor
Growing pharmaceutical market
Capacity of innovation in e-Health to produce significant cost
savings and operational benefits to the traditional healthcare
system
Inherent relationship between cost and mass production costs
shared with non-health services
Policies and strategies in place for support of e-Health services
Weakness
Government limited its spending on the sector
Lack good infrastructure of network
Lack of medicines
Water pollution
Week of management of medical equipment

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no proper care of patient’s people
High initial costs for investment
Costly physicians training sessions
Inefficiency, and quality of the human resources
Low business R&D expenditures
lack of health professionals
 Lack of accurate data about prevalence of different diseases
5. Strategic Objectives
- Better life in healthy environment
 Ensure that Health insurance reach all citizens in Egypt about
by 50% by end of 2025.
 Auditing and control Public and private sectors in the service
about 90% yearly by MOH.
- Health care services and facilities.
- Medical devices, equipment, and hospital supplies manufacturers.
- Medical insurance, medical services and managed care.
- Pharmaceuticals & Related Segments.
 Eliminate the lack of medicines by 65% by end of 2025.
 Enhance Infrastructure quality in Hospitals industry by 80% by
end of 2025.
 Increase education level by 60% by end of 2025.
 Increase Health awareness by 67% by end of 2025.
 Improving the level of quality service in the public sector to be
in the same efficiency to the private sector by 75% by end of
2025.
 Training health care staff by 85% end of 2025.
- Creating or participating in a digital health ecosystem can allow
payers to take advantage of their central position in the
healthcare landscape and expand in new directions.

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 Development infrastructure of network by 100% by end of
2025.
 Centralization database for all citizen data by 75% by end of
2025.
 Smart card for health insurance for each citizen to have history
profile by 80% by end of 2025.
 Enhance access to healthcare information of medical
information and health management by using mobile
application by 85% by end of 2025.
- Implementation of phase one of the comprehensive digital system for
health insurance project in Governorates of (Port Said, South Sinai,
Ismailia, Suez, Luxor, Aswan, and Qena) end of 2023 by using smart
cards.
 Port Said, Ismailia, Suez by 100% by end of 2020
 South Sinai, Luxor, Aswan, and Qena by 100% by end of 2023
6. Public Private Partnership(PPPs) Strategy
Based on external and internal analysis from the point of view the most
suitable strategy PPPs strategic to use in Health sector and this model is
using in many countries suggest that several important factors are
required for a successful PPPs project. The main factors that may affect
the success of PPPs in the market are changes to the contract with the
payer for the health care services, stable economic and legal conditions,
appropriate allocation of risk, enough experience on both sides, use of a
reputable and competent private partner, and sufficient initial capital.
It is an approaches to addressing public health problems through the
combined efforts of public private and development organizations
complimenting each other by contributing or sharing their core
competency.

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The fundamental aspects of PPPs policy framework are the use of
performance based contracts under which the private sector provides
public services over contract duration and is paid by the Public Sector,
end user or a hybrid of both. Output requirements are specified by
Ministry of health while input is the responsibility of the private sector.
Figure (1) How PPP help
6.A. Forms of government private contracts include
- The Government secures new infrastructure which becomes
Government assets at the end of contract life
- Project and performance tasks are allocated to the party best able to
manage or mitigate
- The transfer of risk from the public to the private sector
6.B. Typical PPP drivers
In healthcare governments should focus between PPPs to
address a range of health system challenges.
-Need for new and upgraded old infrastructure.
- Cash flow constraints.

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- Need for improved management skills to improve quality and cost
efficiency of healthcare delivery.
- Need for stronger and more efficient procurement and supply chain.
- Need for additional services and skills (ex. specialty services, expanded
service capacity).
6.C. Features of common PPP models in healthcare
-PPPs in healthcare provide opportunities for governments to leverage
private sector resources and expertise, to enable investment in large-
scale projects that advance national and local public health goals, such
as improving quality of service delivery, and expanding access to care.
- The governments could engage the private sector to deliver services
through healthcare PPPs to achieve one or more functions:
Design: design of the project, including design of the infrastructure
and care delivery model.
Build: construction or renovation of facilities included in the
project.
Finance: financing of the project.
Maintain: maintenance of hard infrastructure (facilities as well as
equipment as applicable).
Operate: supply of applicable equipment, IT and delivery,
management of nonclinical services.
Deliver: delivery and management of specified clinical and clinical
support services.

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6.D. The three most common PPPs business models in
healthcare

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Figure (2) Key components institutional framework for PPPs
6.E. Key conditions for PPPs project success
 Legal and regulatory framework: That hat supports public-private
partnerships will facilitate private investment in public-private
partnership projects, reduce transaction costs, ensure appropriate
regulatory controls, and provide legal and economic mechanisms
to enable resolution of contract disputes. Consequently, the strong
legal and regulatory framework for public-private partnership,
which defines the "rules of the game" for private investors, will
reduce the risks of the project and ensure its success.
 Governments and public authorities need to be prepared to act as
a competent match over the life of the PPP project
 Transparency.
 Contract completeness, flexibility and governance.
 The Integration between healthcare sectors with other
government sectors.
 Stakeholder participation.

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 Political situation.
 Taxes.
 Risk allocation: Risks are allocated to the party that could best
manage them at the lowest cost. Some of the key risks that needs
to be allocated and managed to ensure the success of PPP projects
are:
 Construction and Completion Risk
 Operating Risks
 Demand Risk
 Force Majeure and Change in Law
 Political and Regulatory Risk and Expropriation and
Nationalization Risk
 Environmental Risk
 Tenor and Refinancing Risk
 Currency Exchange Risk
 Interest Rate Risk
6.F. Role of PPPs
Key challenges PPPs benefits
 Most public healthcare institutions
have outdated medical equipment
and lack access to latest equipment
and technology.
 Insufficient number and quality of
healthcare professionals remains a
major challenge for public service
providers.
 Private healthcare systems are not
accessible and affordable to all.
 Operations and maintenance in public
health care institutions lack
competence and accountability.
 Affordability and willingness to pay by
users make the sector not as
profitable as other sectors like
transportation.
 Development and maintenance of
new infrastructure (including
equipment’s).
 Accountability: Availability of
infrastructure ensured through
performance based operations &
maintenance contracts.
 Latest technology: Takeover of
existing infrastructure hospitals and
bringing in private sector
management techniques.
 Value for money considerations:
Enabling public access to services for
free or nominal for the low income
group.
 Capacity building: Training of health
care providers (doctors, nurses,…).

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6.G. Regional Using PPPs
The above statistics shows that highest investment area for PPPs is
information and communications technology (ICT) and electricity
projects. These are followed by road projects in terms of total project
budget since 1990. Latin America and the Caribbean (LAC) region have
the highest investment number and amount. Brazil is the top
contributor and influencer in Latin America, where more than half of the
investment in the continent, also %20 of whole global investment is
being obtained.
Figure (3) Infrastructure PPPs Developing database projects regions 1985-2015
Indictors show the provision of infrastructure and related services in
developing Middle East and North Africa(MENA).

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6.H. Healthcare geographic region using PPPs
 A growing number of middle and low income countries are
exploring PPP projects in the health care field.
 Nearly 600 healthcare infrastructure projects globally.
 Public-private partnerships in the health care field include public-
private partnerships in hospitals and health centers that are
operating, under construction, under development, or in pre-
development stages.
 Over 60% of infrastructure projects identified are in Europe and
5% of Middle East and North Africa.
Figure (4) Healthcare infrastructure projects by geographic region (May 2017)
(Source: IJGlobal Project Finance and Infrastructure Journal estimates)
6.I. Universal health insurance
 The phases of implementing the comprehensive health insurance
system for the governorates of the Republic, the system covers all
family members and also provides health care to those who are
unable, as the first Phase includes the governorates of Port Said,
Ismailia, Suez, South Sinai, Luxor and Aswan, while the second
phase includes Matrouh, the Red Sea and Qena North Sinai, the
third phase includes Alexandria, Beheira, Damietta, Sohag and Kafr
El Sheikh, the fourth phase Beni Suef, Assiut, Minya, New Valley

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and Fayoum, and the fifth phase in Dakahlia, East, West, and
Menoufia, and the sixth phase in Cairo, Giza, and Qalyubia.
 The value it will be the contribution in health insurance, 5% of the
citizen's monthly income, by 1% for the worker and 4% for the
employer, and he added that the categories from which the
subscription was collected are 3 categories, workers in the
government, the public business sector, and the private business
sector.
 0.75 pound of each cigarette pack.
 15% of the value of each unit sold of non-tobacco products.
 20 Pound from each driving license renewal.
7. Balanced Score Card
Goals Objective Target Time Bound
Year 1 Year 2 Year 3 Year 4 Year 5
Better life in
healthy
environment
Health
insurance all
citizen target
by 50% by end
of 2025
50% 10% 10% 10 % 10 % 10 %
Auditing and
control Public
and private
sectors in the
service about
90% yearly by
MOH
90% 90% 90% 90% 90% 90%
Eliminate the
lack of
medicines by
65% by end of
2025
65% 13% 13% 13% 13% 13%
Enhance
Infrastructure
quality in
Hospitals
industry by
80% by end of
2025
80% 16% 16% 16% 16% 16%
Increase
education level
60% 12% 12% 12% 12% 12%

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by 60% by end
of 2025
Increase Health
awareness by
67% by end of
2025
67% 13.4% 13.4% 13.4% 13.4% 13.4%
Improving the
level of quality
service in the
public sector to
be in the same
efficiency to
the private
sector by 75%
by end of 2025
75% 15% 15% 15% 15% 15%
Training health
care staff 85%
by end of 2025
85% 17% 17% 17% 17% 17%
- Creating or
participating in
a digital health
ecosystem can
allow payers to
take advantage
of their central
position in the
healthcare
landscape and
expand in new
directions.
Development
infrastructure
of network by
100% by end of
2025
100% 35% 25% 15% 15% 10%
Centralization
database for all
citizen data by
75% by end of
2025
75% 30% 10% 10% 10% 5%
Smart card for
health
insurance for
each citizen to
have history
profile by 80%
by end of 2025
80% 15% 15% 10% 15% 25%
Enhance access
to healthcare
information of
medical
information
and health
management
by using mobile
application by
85% by end of
2025
85% 35% 15% 15% 10% 10%

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Implementation
of phase one of
the
comprehensive
digital system
for health
insurance
project in
Governorates
of (Port Said,
South Sinai,
Ismailia, Suez,
Luxor, Aswan,
and Qena) end
of 2023 by
using smart
cards
Port Said
Governorate
Phase one
100% 100% - - - -
South Sinai,
Luxor, Aswan,
and Qena by
100% by end of
2023
100% - 45% 55%

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8. Reference
https://www.greengrowthknowledge.org/national-documents/sustainable-development-
strategy-egypt-vision-2030
https://www.drishtiias.com/to-the-points/paper3/ppp-investment-model
https://en.wikipedia.org/wiki/Public%E2%80%93private_partnership
https://www.google.com/search?q=Key+components+institutional+framework+for+PPPs&t
bm=isch&ved
https://blogs.worldbank.org/ppps/decade-ppps-latin-america-and-caribbean-what-have-we-
learned
https://link.springer.com/referenceworkentry/10.1007%2F978-1-4614-6419-8_7-1#Sec8
https://www.care.gov.eg/EgyptCare/Index.aspx

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