334 C. Gutenbrunner & B. Nugraha
• Summarize the discussion of the draft recommendations in a workshop with stakeholders, including voting on priority level for each recommendation.
• Prepare the final report, with a long- and shortlist of recommendations and an executive summary.
RESULTS Health system information
The highest cause of mortality in Egypt is cardiovascular diseases( 46 %), followed by non-communicable dieseases( NCDs)( 11 % communicable maternal, perinatal, and nutritional conditions and 19 % other communicable diseases), cancer( 14 %) and injuries( 5 %)( 6). The burden of disease in terms of disability-adjusted life years( DALYs) is highest in cardiovascular diseases and diabetes, followed by other NCDs, neuro-psychiatric conditions, cancer and unintended injuries( 1).
Disability rates in Egypt are reported to be very low( 0.7 % of the total population). This is the second lowest value reported in the Arab region( range 0.6 – 4.9 %)( 7), are are much lower than the average from international comparative data( 8). Thus, the figures seem unrealistic and the method of data collection should be further elucidated. The employment rate of persons with disabilities is half that of the healthy population( 21 % vs. 40 %)( 7). According to these statistics, the major causes of disability are congenital abnormalities( 51.9 %), followed by injuries / accidents( 13.9 %), old age( 9.4 %), epidemic and other diseases( 6.9 % and 6.8 %), and birth-related conditions( 5.4 %). The disabilities related to neurological and mental health conditions are not mentioned in this survey.
The healthcare system in Egypt has been called“ pluralistic”, as it includes many different public and private providers( 9). The main service provider is the MOHP; however, some public health services are provided by private institutions, the armed forces and n-governmental organizations( NGOs).
The health insurance system in Egypt is also highly segmented. As determined through site visits, health insurance in Egypt is based on 7 different laws, and covers women with responsibility for their family, farmers, pre-school children, school children( approximately 60 % of all children), governmental workers( some non-governmental workers are insured by their companies), pensioners and widows. The overall coverage of public health insurance in 2015 amounts to 58 % of the total population. However, 72 % of total health spending is still paid by induviduals( 10). New law on health insurance drafted by MOHP states that coverage should reach 100 %; however, due to the political situation, this law has not yet been adopted by the national parliament.
The workforce of rehabilitation professionals consists mainly of physical medicine, rheumatology and rehabilitation doctors, and physiotherapists. In addition, some speech and language therapists are available. Other rehabilitation professionals, such as occupational therapists, prosthetists and orthotists, are not regularly trained in Egypt.
There is scarce information about existing rehabilitation services. There are 2 main reasons for this: first, there is no clear definition of a rehabilitation service; and, secondly, there is no systematic statistical approach. Shafshak( 11) reports that 195 MOHP hospitals and 18 university hospitals have special departments for Physical and Rehabilitation Medicine( PRM). In addition, it is mentioned that PRM departments exist in internal security and armed forces hospitals. However, their role in healthcare and its structure are not described in detail. Furthermore, the paper mentioned 60 physiotherapy and rehabilitation centres run by the Ministry of Social Affairs. These centres have at least one MD and a physiotherapist. Overall, these data are not sufficient to estimate whether the needs of persons with chronic health conditions experiencing disability are sufficiently covered.
Recently, a Health Sector Reform Program has been started by Egyptian government, with the aims of expanding the social insurance coverage from 47 % in 2003 up to universal coverage, reorganizing services aiming at service provision through a holistic family health approach to strengthen management systems, and developing a domestic pharmaceutical industry( 10).
The new constitution of the Arab Republic of Egypt places health at a high level of priority on the national agenda( 10). In Article 18 of the constitution the right to health, among others, is guaranteed as follows:
•“ Every citizen has the right to health and integrated healthcare according to good quality standards, and the state guarantees the preservation of public health services, and works to raise efficiency and geographical spread of fair facilities.
• The state is committed to the establishment of comprehensive health insurance for all Egypwww. medicaljournals. se / jrm