Is the health sector being prepared for a major overhaul, asks Karim El-Khashab With the Health Ministry, the centre of a series of ongoing controversies, undergoing disputes over new healthcare legislation and the fall out from the scandal concerning contaminated blood bags, praise for its efforts at reducing child mortality rates came as welcome relief. Last week Save the Children organisation cited Egypt in its annual report as having achieved more progress than any other state, reducing infant mortality rates by 68 per cent over the past 15 years. Iraq was bottom of the league table. The report measured a sharp increase in infant fatalities following the 2003 invasion. In 2005, 122,000 children died before the age of five. The majority of deaths were among infants aged less than one month. Samia Abdel-Rahman, who heads the Egyptian ministry's child health department, was happy with the recognition of efforts that, over the years, had aimed at ridding Egypt of life- threatening conditions such as polio, and combating other diseases caused by inadequate healthcare during pregnancy, malnutrition and unsanitary conditions. "We are currently in the middle of our last push, in coordination with the World Health Organisation [WHO], to declare Egypt free of polio," she said. The ministry has extended healthcare provision in rural areas, opening clinics equipped to provide antenatal care for both mother and child. It has also, in coordination with WHO and Save the Children, spearheaded schemes to provide better nutrition in schools. The bill of health for Egypt's child mortality reduction programmes is unlikely to assuage critics of what is viewed by many as the creeping privatisation of healthcare. Earlier this month, parliament passed a law, recommended by Prime Minister Ahmed Nazif, that effectively splits the health insurance agency into two. One branch will oversee the management of healthcare provision while the second, organised as a holding company, will oversee the dispensing of health services. It is the latter that assumes responsibility for healthcare at the point of use, in hospitals and clinics, as well as the distribution of subsidised medicines. Health Minister Hatem El-Gabali says the change was long overdue. "No one agency can be expected to manage finances and provide the services while at the same time supervise the process," he said. Under the new system, health insurance payments will be income-linked. Ministry officials estimate the average amount will be LE10 which they argue is well within the range of average citizens. Opposition MPs were quick to charge that the changes were a first step in the privatisation of healthcare, pointing out that the creation of a holding company always comes in advance of sell- offs. Hani Abdel-Moneim, who works at Al-Qasr Al-Aini Hospital in Cairo and who was previously employed at the Ministry of Health, thinks the fears of the opposition are well-founded. "The aim is clearly to throw the burden onto the private sector and cut staff numbers at hospitals, claiming that it is hospital employees who are actually burdening the health service," he told Al-Ahram Weekly. The initiatives, he says, are not really new, echoing proposals made as part of an EU initiative to improve healthcare in Egypt before the present minister took office. Abdel-Moneim criticises the involvement of donor agencies in determining healthcare policies. "What works in Europe doesn't automatically work here," he says. "There is absolutely no intention to privatise healthcare in Egypt," insists El-Gabali. "It is the right of all citizens to receive healthcare, and that cannot be tampered with." Yet Osama Omar, a doctor at a newly refurbished hospital in Shebin Al-Kom in Menoufiya, argues privatisation by stealth is already happening. At the hospital where he used to work the health authorities, in partnership with the EU, introduced family doctors to hospitals and clinics in three governorates. At the hospital where Omar worked, millions of pounds-worth of new equipment were installed and operations began to be conducted for free in the governorate and surrounding villages. It did not take long for the ministry to cancel the operations and doctors were ordered only to collect information from patients for the family doctor programme. "There was no logical reason for ending the operations," Omar says, "unless terminating them was part of a larger plan." Omar claims that the clinics that had been revamped by the programme were about to be sold off to doctors at knockdown prices, to be turned into private practices. "This is how privatisation will occur," he says. "First they will upgrade facilities and then sell them off to the doctors they know for next to nothing." While the Ministry of Health endorses such moves, Omar believes it is the ministry's EU advisor who is pushing the privatisation process. Imam Mohamed Moussa, head of the Central Agency for Logistical Aid and Projects at the Health Ministry which supervises the partnership with the EU, dismisses Omar's allegations as baseless. "The project was halted because demand on these clinics and hospitals was incredibly low, and at times they were operating at less than two per cent of capacity," he says. They were now in the process of examining how to better allocate resources before continuing with the project. Yet doctors in the two other governorates where the project was being conducted also report that the cancelling of the service had come as a surprise. They, too, say they know of cases in which upgraded facilities are being sold. Whatever the intentions of the ministry regarding privatisation, most doctors predict that the health system is in for a major shake-up, pointing out that the sector has received much higher increases in spending than in previous years.
