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