Professional Documents
Culture Documents
Egipto
Egipto
Egypt
WHO-EM/ARD/037/E
Egypt
World Health Organization 2010 ©
The designations employed and the presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply
that they are endorsed or recommended by the World Health Organization in preference to
others of a similar nature that are not mentioned. Errors and omissions excepted, the names
of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify
the information contained in this publication. However, the published material is being
distributed without warranty of any kind, either expressed or implied. The responsibility for
the interpretation and use of the material lies with the reader. In no event shall the World
Health Organization be liable for damages arising from its use.
Publications of the World Health Organization can be obtained from Health Publications,
Production and Dissemination, World Health Organization, Regional Office for the Eastern
Mediterranean, P.O. Box 7608, Nasr City, Cairo 11371, Egypt. tel: +202 2670 2535, fax: +202
2765 2492; email: PAM@emro.who.int. Requests for permission to reproduce, in part or in
whole, or to translate publications of WHO Regional Office for the Eastern Mediterranean –
whether for sale or for noncommercial distribution – should be addressed to WHO Regional
Office for the Eastern Mediterranean, at the above address: email: WAP@emro.who.int.
Document WHO-EM/ARD/037/E
Design and layout by Pulp Pictures
Printed by WHO Regional Office for the Eastern Mediterranean, Cairo
Contents
Abbreviations 5
Section 1. Introduction 7
5
Section
1
Introduction
Section 1. Introduction
The Country Cooperation Strategy (CCS) The CCS takes into consideration the
reflects a medium-term vision of WHO for work of all other partners and stakeholders in
technical cooperation with a given country health and health-related areas. The process
and defines a strategic framework for is sensitive to evolutions in policy or strategic
working in and with the country. The CCS exercises that have been undertaken by
process, in consideration of global and the national health sector and other related
regional health priorities, has the objective partners. The overall purpose is to provide a
of bringing the strength of WHO support at foundation and strategic basis for planning
country, Regional Office and headquarters as well as to improve WHO’s contribution
levels together in a coherent manner to to the Member States for achieving the
address the country’s health priorities and Millennium Development Goals (MDGs).
challenges. The CCS, in the spirit of Health
The CCS for Egypt is the result of analysis
for All and primary health care, examines
of the health and development situation and
the health situation in the country within
of WHO’s current programme of activities.
a holistic approach that encompasses
During its preparation key officials within
the health sector, socioeconomic status,
the Ministry of Health as well as officials
the determinants of health and upstream
from various other government authorities,
national policies and strategies that have a
United Nations agencies, nongovernmental
major bearing on health.
organizations and private institutions
The exercise aims to identify the health were consulted. The critical challenges for
priorities in the country and place WHO health development were identified. Based
support within a framework of 5 years in on the health priorities of the country, a
order to have stronger impact on health strategic agenda for WHO collaboration was
policy and health system development, developed.
strengthening the linkages between health
and cross-cutting issues at the country
level. This medium-term strategy does not
preclude response to other specific technical
and managerial areas in which the country
may require WHO assistance.
9
Section
2
Country Health and
Development Challenges
Section 2. Country Health and Development Challenges
13
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
Source: UNDP Human Development Report 2008; World Bank report 2007; Egypt Human Development Report, 2008
climate for investment and private sector reductions in poverty, from 13% to 5% in
development specific priorities. urban metropolitan centres and from 22% to
12% in rural areas (Table 2).
Gross domestic product (GDP) is
estimated to be US$ 89.4 billion (2005). 2.2 Health status of the
Average growth fell from 4.6% in 1997–1998 population
to 3.0% in 2001–2002. GDP per capita in
2005 was US$ 1207. Agriculture accounts 2.2.1 Health indicators
for 14% of GDP, industry 30% and services Egypt has recorded major achievements in
56%. The major export is petroleum and improving the health status of its population
petroleum products (28.7%). as reflected in the marked reductions in the
Poverty has declined over the past few 2007 crude death rate (6.2 per 1000 live
decades with the Millennium Development births in 2007); infant mortality rate (19.2 per
Goal Second Country Report for Egypt 1000 live births); under-5 death rate (23.3
suggesting that as a national average the per 1000 live births); and maternal mortality
MDG commitment to halve poverty by 2015 rate (44.6 per 100 000 live births).
will be realized. A World Bank-supported 2.2.2 Burden of disease
Poverty Alleviation Study carried out in 2002
showed that poverty incidence fell from Egypt, like many other developing countries
19.4% in 1995–1996 to 16.7% in 1999–2000. faces a dual disease burden: a persistent
though much diminished communicable
Although poverty in Egypt had been disease burden and a large and rapidly
characterized by its rural nature, it recently growing noncommunicable disease burden
has become a predominantly Upper Egypt including mental health-related diseases
phenomenon, with poverty increasing (Table 3). Lifestyle factors and risk-taking
in rural and urban areas in Upper Egypt behaviours such as smoking, substance
governorates. The MDG Second Country abuse, lack of exercise, overconsumption
Report noted that between 1995 and 2000, of fatty and salty foods, non-use of seat
poverty in Upper Egypt increased from belts and nonobservance of traffic rules
29% to 34% in rural areas and from 11% contribute to a significant proportion of the
to 19% in urban areas. During the same overall mortality and morbidity.
period Lower Egypt experienced significant
14
Country Cooperation Strategy for WHO and Egypt
1987–1988 1999–2000
Overall, the age-adjusted mortality burden most to the burden of disease are:
in Egypt declined by more than 10% in the cardiovascular disease (19.5%); digestive
ten years between 1990 and 1999. There diseases (10%); neuro-psychiatric disorders
was a substantial decline in the contribution (9.9%), injuries (8%); and chronic respiratory
of infectious diseases and an increase in the diseases (6.6%).
mortality burden for cardiovascular diseases,
respiratory infections and other digestive 2.2.3 Communicable diseases
diseases. Communicable diseases have largely
Regarding the burden of disability, been controlled in Egypt; however diarrhoeal
neuro-psychiatric and digestive disorders are diseases, acute respiratory infections and
the leading causes of disability accounting hepatitis are still reported from health
for 19.8% and 11.5% respectively of the facilities. With high coverage rates for routine
non-fatal burden, followed by chronic immunization, vaccine-preventable diseases
respiratory diseases (6.9%), injuries (6.7%) have shown a remarkable decline in the
and cardiovascular diseases (5.6%). In terms past decade. Egypt experienced in 2007 a
of specific conditions, osteoarthritis, injuries nationwide measles and rubella outbreak.
and asthmatic bronchitis are the leading This was the result of accumulation of
causes of disability. susceptibility to those two diseases. When
the needed financial resources had been
The total burden of disease and injury in available, the Ministry of Health developed
Egypt in 1999 amounts to 172 disability- an action plan to conduct a massive national
adjusted life years (DALYs) lost per 1000 vaccination campaign for measles and
population. The disease groups contributing rubella in two phases for the target age
15
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
group of 1–20 year olds. The first phase, In 2003, a sample of 200 000 persons
which targeted the age group of 10–20 seeking work abroad were screened and the
year olds, was successfully implemented prevalence of hepatitis B infection was found
in 2008 as indicated in the international to be 1.25% and hepatitis C, 6.5%.
monitors’ reports, while the second phase
Tuberculosis is considered to be the third
will to take place in 2010. Egypt joined the
most important communicable disease
regional rotavirus surveillance network and
problem after schistosomiasis and hepatitis
launched the national rotavirus surveillance
C. Egypt ranks among countries with mid/low
programme in 2006; the incidence rate
level of tuberculosis incidence. It is estimated
of rotavirus in children under five years
that 11 cases per 100 000 population
old is 36.4 % and the case fatality rate
are developing active pulmonary smear
is zero. With regard to meningitis due to
positive tuberculosis and 24 per 100 000 are
Haemophilus influenzae type B, the Ministry
developing all types of tuberculosis annually.
of Health conducted surveillance in sentinel
The case detection rate for smear positive
sites in Egypt during period 1999–2004 in
tuberculosis was 59% in 2006, while treatment
collaboration with NAMRU-3, in which an
success rate is 79% for cases registered in
estimated 300–500 cases of meningitis were
2005. The population standardized average
registered annually due to Haemophilus
age for tuberculosis is 38 years with most
influenzae type B. The Ministry of Health
cases in the age group of 35–64 years.
will plan another survey to determine the
prevalence rate of Haemophilus influenzae The Ministry of Health indicates a total of
type B. 2393 cases of HIV/AIDS from 1986 up to the
end of August 2008 (1534 HIV infections +
Egypt has been polio free since 2006. The
859 AIDS cases), with 1059 deaths up to
neonatal tetanus incidence rate is 0.06 per
the end of August 2008. The prevalence
1000 births. There were no reported cases
of HIV/AIDS among 15–49 year-olds is
of diphtheria. The incidence rate for typhoid
approximately 0.03%. According to UNAIDS,
and meningococcal meningitis was 10 and
Egypt appears to be at a low epidemic level.
0.26, respectively, per 100 000 population.
The primary mode of HIV transmission is
Prevalence of Schistosoma mansoni infection
through sexual contact. Mother-to-child
decreased from 14.5% in 1995 to 0.9% in
transmission is thought to be negligible.
2007, and the prevalence of Schistosoma
Epizootic outbreaks of avian influenza were
hematobium infection decreased from 5.4%
reported in Egypt with 20 human cases and
in 1995 to 0.6% in 2007.
5 related deaths confirmed in 2007. Most
Hepatitis B and C continue to be a public human cases of influenza A/H5N1 in Egypt
health problem in Egypt with data suggesting had exposure to backyard poultry.
their incidence, particularly hepatitis C,
may be increasing. A 1996–1997 survey of 2.2.4 Chronic noncommunicable
individuals aged two years or older indicated diseases
the overall prevalence of anti-HCV and The prevalence of hypertension and
HBsAg was 18.9% and 4.5%, respectively. diabetes mellitus in the adult population
16
Country Cooperation Strategy for WHO and Egypt
17
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
The high level of stunting seen in Upper approximately 40 000 poultry farms lacking
Egypt appears to be due to insufficient biosecure production systems, there is
household food security, inadequate feeding threat of a major outbreak in the country’s
and caring practices, and high infection poultry industry. With reduction in poultry
rates. As noted in the MDG Second Country intakes as part of the normal diet (poultry
Report, girls in poor families show a higher accounting for approximately 55% of the
prevalence of all types of under-nutrition as per capita animal protein consumption)
well as higher infant and child mortality rates, highly pathogenic avian influenza holds the
a result of gender discrimination in the family. potential of becoming a serious food security
issue.
As indicated in the UN Common Country
Assessment 2005 (CCA), approximately 75% 2.3.3 Drinking-water
of the population benefit from food subsidy
programmes to fulfil their basic food needs. Approximately 100% of the urban
These programmes provide basic supplies population and 97% of the rural population
including bread, sugar, oil, rice, lentils and have access to improved drinking-water
tea at less than a quarter of market price. supply. 99% of the urban population have
piped water in their homes and 74% of the
Egypt depends on cereals as its population in rural areas have a household
most important food staple, with wheat connection; 6% drink water from public
constituting 55% of food consumption taps while the remainder drink water from
requirements. With local production wheat covered wells.
and coarse grains not satisfying the level of
demand, Egypt depends on importing 50% Despite the impressive coverage rates for
of the food required to feed the population. rural areas, the level of service still leaves
room for considerable improvement. It is
A further issue related to nutrition and reported that a large percentage of the
food security has been the spread of a highly rural piped water systems perform badly.
pathogenic avian influenza which moved Systems sometimes supply water less than
across Asia and into the Middle East in early a few hours per week; the water quality in a
2006. The poultry industry had expanded number of systems also needs improvement.
rapidly over the past 25 years with low-
cost poultry meat becoming increasingly 2.3.4 Sewerage and sanitation
available, particularly to the poor. Each day, The percentage of population with access
large numbers of live birds move between to improved sanitation facilities, one of the
communities the length of the Nile Valley, MDG indicators has seen a steady increase
bought by traders and slaughtered in local from 50% in 1990 to 66% in 20061. Coverage
markets and with some kept in backyards in urban areas increasing from 68% in 1990
for slaughter at home. With many of the to 79% in 2000 and rural areas from 37% to
1 The UN Statistical Division’s MDG indicators database reports lower figures than those in the 2007/2008 Human
Development Report country fact sheet; 54 % of population having access to improved sanitation in 1990 and 70 %
for 2004 (http://hdrstats.undp.org/countries/data_sheets/cty_ds_EGY.html)
18
Country Cooperation Strategy for WHO and Egypt
47%. In terms of sewage systems, coverage of public health services as well as being
is 62% in urban areas. Cairo has the best the major provider of the inpatient-based
sewerage service in the country with about curative system. The Ministry of Higher
97% of the buildings connected. Sewerage Education is responsible for medical
service rates in small rural towns average education as well as service delivery and the
less than 11%. Health Insurance Organization (HIO) is both
an insurer/financier and provider of care to
2.3.5 Air pollution employees, students, widows, pensioners
Air pollution in Egypt, especially in Cairo and the newborn (covering about 45% of the
and Alexandria, has been of concern for a Egypt’s population). Care also is provided by
number of years. Particulate matter is the the ministries of defense, transport, aviation,
most common air pollutant in urban and electricity and interior, the Teaching Hospital
industrial areas. The few epidemiological Organization, Curative Care Organization,
studies of air pollution in Egypt have indicated other public sector organizations,
a significant increase in chest problems for nongovernmental organizations, private
those exposed to high levels of particulate in hospitals and clinics.
the residential industrial areas. Furthermore, Egypt’s wide network of public,
particulate matter and lead pollution have nongovernmental organization and private
been recognized as the most deleterious health facilities allow good geographic
agents to health in Cairo’s environment. High accessibility (Table 4). The public sector’s
levels of lead were recorded in the major health care infrastructure comprises varied
Egyptian cities during the 1980s and 1990s. types of health facilities providing a broad
However, lead was completely phased out array of services and levels of care. The
from petrol distributed in Cairo, Alexandria Ministry of Health primary health care
and most of the cities of Lower Egypt in late facilities provide for: maternal and child
1997, and consequently, lead concentration health services; communicable diseases
in the atmosphere of Cairo city centre and control; environmental health services; health
residential areas decreased markedly during education; parasitic and endemic diseases
the years 1997–2002 reaching less than 30% control; school health services; curative and
of those recorded during the early 1990s. emergency care (general practitioner level);
2.4 Health systems and family planning; and dental care.
services With regard to secondary and tertiary care,
2.4.1 Health service delivery there are 139 619 hospital beds in the country,
of which 33 063 are in Cairo, 10 930 in Giza,
The health care system in Egypt is quite and 10 092 in Alexandria. The vast majority
complex with a large number of public of these beds are in the public sector which
entities involved in management, financing appears to have excessive capacity and low
and the provision of care. The Ministry of occupancy rates, less than 50%.
Health is responsible for overall health and
population policy including the provision
19
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
Table 4. Different types of health facilities for primary health care (2007)
Government-owned hospitals are the only Existing control measures are fragmented
choice available to low-income groups who and do not provide complete coverage for the
constitute the majority of Egypt’s population. country. There is often a lack of coordination,
These hospitals are however, hampered by even within ministries and authorities.
the huge demand and the government’s
HIV/AIDS
failure to keep up with escalating costs,
financial shortages, inefficient use of available Although there is an active national AIDS
resources, and ineffective management.This programme, which includes voluntary testing
has led to a lack of public confidence with and counselling services and the provision of
people turning to the private sector. antiretroviral therapy, Egypt faces a number
of challenges in maintaining a low prevalence
The private sector in Egypt plays an
of HIV/AIDS. These include: a weak system
important role in delivering health care. It
of prevention and surveillance for sexually
manages private clinics as well as specialized
transmitted diseases; poor access to
hospitals where people pay relatively high
reproductive health information; an influx of
fees for what they consider better services.
refugees from Sudan and the neighbouring
The private sector network includes
Horn of Africa; the large number of Egyptians
general practitioners, specialists, dentists,
working abroad who may return home with
psychiatrists, laboratories, pharmacists,
HIV infection; pervasive fear and stigma; and
etc. Competition in the private sector has
low condom demand and use.
induced the private hospitals to provide
optimum care and over the years this sector Injury prevention and control
has become highly rated in the Region.
Mortality, morbidity and disability
Chemical safety caused by injuries are an emerging health
problem. In 1991, the Ministry of Health
The infrastructure for dealing with chemical
agreed to examine the impact of injuries
safety in Egypt is limited. An integrated
on the population to evaluate the problem.
chemical safety programme, implemented
Following the recommendations of this
in a coordinated manner among the different
study, and to further evaluate the magnitude
responsible authorities, does not yet exist.
20
Country Cooperation Strategy for WHO and Egypt
21
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
care, family planning clinics, and the maintained by other organizations, such as
introduction of youth-friendly and pre- the HIO and the armed forces, is limited. The
marriage clinics. laboratory support for surveillance needs
strengthening.
Integrated management of childhood
illness (IMCI) focuses on three components: The Ministry of Health has an active
1) improvement in the quality of health programme for control of infections in
services delivered to children; 2) improving hospitals and other health care facilities
the quality of the health information system, which is in need of additional resources to
supervision, drug availability, organization of cover all governorates and to provide the
work in health facilities and strengthening of necessary consumable supplies of good
the referral system; and 3) improving family quality to hospitals.
practices where progress has been slow
Tropical disease control
compared with the other two components.
Currently, IMCI is being implemented in Egypt has achieved low endemicity
19 out of 26 governorates, in 102 out of of intestinal schistosomiasis and almost
246 districts and in 1912 out of a total of eliminated urinary schistosomiasis following
approximately 4500 health facilities in the the successful implementation of a strategy
country. The results of evaluation activities, based on repeated, regular treatment with
such as follow-up visits and an IMCI health anthelminthics of school-age children, the
facility survey, have shown the positive effect highest risk group. Treatment is provided
of IMCI on improving the performance of through the primary school health system
health providers and health facilities. and other ongoing health or education
programmes.
Surveillance activities and infection
control In order to sustain low endemicity and to
ensure the elimination of at least the urinary
Egypt maintains a national system
form of schistosomiasis, new strategies
for surveillance of 26 communicable
based on sensitive surveillance tools need
and endemic diseases, covering all
to be adopted to prevent resurgence and
districts in the country. A STEPwise
recrudescence. School-based deworming
approach for surveillance of risk factors
campaigns need to be continued in
for noncommunicable diseases is under
uncovered areas, particularly in Upper Egypt.
development. The coordination of
surveillance activities for communicable Although regularly decreasing, the number
and noncommunicable diseases including of new leprosy cases in Egypt remain high
traffic injuries lies with the Epidemiological with 887 new cases reported in 2007. To
Surveillance Unit, which was established in sustain the integrated approach in diagnosis
the Ministry of Health in 1999. and delivery of multidrug therapy to persons
with leprosy, additional resources are
Ensuring comprehensive coverage of
required and the integrated referral system
reported data remains a problem, as reporting
strengthened, especially at peripheral levels.
by the private sector and from facilities
22
Country Cooperation Strategy for WHO and Egypt
Prevention of disabilities and rehabilitation the various levels of the health care system.
activities remain the main challenges in The management skills of staff need to
elimination of leprosy. upgraded and an appropriate information
system developed to facilitate performance
2.4.2 Pharmaceuticals and monitoring and evaluation.
biologicals
Concerns have been expressed regarding
Egypt produces over 90% of the expected impact of the WTO agreement
the pharmaceuticals it consumes. on TRIPS on the national pharmaceutical
Pharmaceuticals account for just over industry and on access to medicines. National
one-third of all health spending, of which laws and by-laws have been updated to
approximately 85% is private expenditure. prepare for expected developments.
Publicly produced medicines are heavily
subsidized, which to a considerable extent Egypt is one of the four countries in the
accounts for their overuse. There is a Region that is a major producer of vaccines.
great need to promote the rational use of The goal of the Region is to become self
medicines and to train health professionals sufficient in its need for quality-assured
in this regard. There is also a need to improve vaccine. However only about 18% of the
communication between pharmacists vaccines that are utilized in the Region are
and doctors to facilitate the prescribing of manufactured locally and none meet the
generic medicines. WHO vaccine pre-qualification requirements
of assured quality. The technical capacity
There are a number of problems facing of the national regulatory authority for
the pharmaceutical services. The laws and vaccines in Egypt is still weak and needs
regulations covering different aspects of the to be strengthened to meet functional
work of the Secretariat for Pharmaceutical requirements.
Affairs in the Ministry of Health, such as
licensing of pharmaceutical firms to produce 2.4.3 Health workforce
medicines, registration of medicines and
inspections are outdated and need revision. The numbers of physicians, dentists,
There are problems connected with storage pharmacists and nursing and midwifery
and transportation of medicines and with personnel are above the regional average
maintenance of up-to-date inventories at (Table 5).
Physicians 28.3
Dentists 4.2
Pharmacists 16.7
Nursing and midwifery personnel 35.2
Source: The work of WHO in the Eastern Mediterranean Region. Annual report of the Regional Director 2009.
23
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
The Ministry of Higher Education is for and the production of these categories
responsible for medical education. However, of health personnel. However, there are
there does not appear to be an effective problems with the quality of training, which
mechanism of coordination between the needs to be more skills-oriented and less
Ministry of Higher Education and Ministry theoretical.
of Health to ensure that the training and
production of doctors takes into account 2.4.4 Financing
the needs of the health system, including Egypt has pluralistic
and complex
preventive, curative and promotive aspects. financing mechanisms: tax-based financing;
Information on human resources remains health insurance; and fee-for-service through
fragmented. Concerns have also been out-of-pocket expenditures. Tax based
expressed about the relevance of the revenues mainly support four major publicly
curriculum as well as of the quality of training organized and managed services: Ministry
imparted in medical schools. of Health facilities; university hospitals;
To address these concerns, a medical Defence ministry hospitals; and some Health
education reform initiative has been Insurance Organization services such as
undertaken between the Faculty of Medicine school health.
in Alexandria and WHO to pioneer reforms Egypt is a low health care spender
in health professions education institutes in compared to countries of similar levels
Egypt. Among the initiative’s focuses are: of economic development. Public health
the adoption of national standards based on expenditure, low compared to other countries
prepared regional standards; establishment in the Region, has slowly increased from
a national accreditation system that will 5.9% in 1997 to 7.4% of total public
enable medical school graduates in Egypt expenditure in 2001. Health insurance, which
to meet the global standards for medical has existed since 1964, covers about half of
education and practice; continuous quality the population, particularly civil servants,
improvement in medical education; and the government retirees, students and pre-
preparation of guidelines and practical tools school children. Those covered with health
on how to plan, implement and evaluate insurance can choose to go either to private
reform interventions. or public hospitals for services. A significant
The Ministry of Health is involved in the proportion of population, approximately
production of technicians and nurses who 50%, pay out-of-pocket at the point of
staff primary health care facilities. The service in public and private health facilities.
technical departments in the Ministry of To achieve universal coverage, Egypt is
Health indicate their requirements for various rolling out a new insurance scheme, currently
categories of technicians and nurses and the being piloted in Suez Governorate, based
Ministry of Health then negotiates with the on a ‘family physician model’ which will
schools of nursing and technical institutes for separate financing from service provision.
their production. This mechanism provides While the Government has embarked on
an effective balance between the needs social health insurance as stated above, it
24
Country Cooperation Strategy for WHO and Egypt
will be faced with a series of challenges in the 2.5 Main national health policy
near future, as a) the expenditure in health is orientation and priorities
relatively low, about 4% of GDP; b) the out-
of-pocket expenditures is comparatively 2.5.1 Health sector reform
high, about 50%; and c) the premium in the programme and Healthy
current health insurance is considered to Egyptians 2010
be too low, and has been set without any
The principal national health policy
systematic actuarial studies. In addition,
orientation and priorities have been
the United States Agency for International
articulated through the government’s health
Development (USAID), one of the significant
sector reform programme and Healthy
contributors to the health sector, will be
Egyptians 2010.
withdrawing its assistance from the health
sector in 2009 as a result of the Egypt’s The health sector reform programme,
significant progress in improving health initiated in 1997 and due to continue through
status; and it is unclear what will be the 2018, reflects five guiding principles:
implications of global severe financial crisis. Universality: covering the entire
Government will therefore need to mobilize population with a basic package of
additional internal and external resources priority services. Every person in the
to invest in health if it is to ensure universal country will have the same access to
access to basic health services without the and benefits from basic health care.
risk of severe financial consequences. Quality: improving and assuring the
standards of health care and facilities,
2.4.5 Governance
enhancing diagnostic and clinical
The governance of Egypt’s complex effectiveness, and updating medical
health system requires further strengthening. and nursing education and training.
Health policies and strategies often are Professional and ethical treatment,
not supported by evidence and regulatory public satisfaction and trust should
mechanisms are not well developed. The characterize the health care system.
health system remains highly centralized Equity: financing for health care
despite efforts being made to decentralize to services is based on ability to pay, while
governorate and district levels. Coordination the provision of services is based on
within the Ministry of Health and with other need. All regions of the country and
related agencies and ministries remains people of all income levels will have a
weak. fair share in the health system.
Efficiency: allocating and mobilizing
human and infrastructure resources
for health care based on population
needs and cost-effectiveness. The
government and citizens will obtain the
best health value for money.
25
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
26
Country Cooperation Strategy for WHO and Egypt
A second input to the national health such as; identify national official responsible
agenda, Healthy Egyptians 2010, focuses for International Health Regulations,
on disease prevention and health promotion coordination and collaboration with different
priorities and includes the development ministries and organizations (agriculture,
of strategies aimed at behavioural airports, food safety, environment affairs,
change. Crafted by the Ministry of Health tourism, local administration, interior) to
in collaboration with the United States implement IHR, carry out a number of
Department of Health and Human Services training courses and workshops for health
and USAID, Healthy Egyptians 2010 care providers including the Quarantine
programmes use evidence-based data to staff to raise their competence, assess the
establish targets to measure progress over capacity and surveillance preparedness in
a specified time. different sites in order to comply with annex
A1 of IHR ,an action plan is prepared to
2.5.2 National application of implement surveillance and response in the
the International Health governorates as well as a contingency plan
Regulations (2005) according to annex A1, and modification of
Egypt is a party to International Health some regulations and legal procedures had
Regulations 2005 (IHR) and since then been done in order to comply with IHR.
several activities had been accomplished
27
Section
3
Development Cooperation
and Partnerships
Section 3. Development Cooperation and Partnerships
31
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
reproductive health. The Ministry also has strategic plan and identifies funding gaps
agreements with other agencies that have an which are brought to the attention of the
impact on health including UNICEF, which donor community.
continues to support efforts to maintain
Egypt’s polio free status, micronutrient 3.5 Harmonization of
programme, and women and child health- international cooperation
related issues, as well as UNAIDS, UNDP Despite the efforts to align international
and ILO. cooperation with the national health agenda,
there remains inadequate coordination
3.3 National ownership
between the substantial number of
The national health agenda, the basis for programmes funded by bilateral or
bilateral and multilateral cooperation, has multilateral donors/development agencies
been articulated through the government’s and existing national programmes funded by
health sector reform programme and the government. To address these concerns
Healthy Egyptians 2010, both of which are and to better harmonize international
government initiatives reflecting nationally cooperation, a Donors’ Advisory Group was
perceived needs and rooted in a national established to serve as a coordinating body
policy formulation process. between the Government of Egypt and the
donors to the various sectors.
3.4 Alignment of international
cooperation with the A subgroup of the Donors’ Advisory Group
national health agenda serves as a coordinating body between
the Ministry of Health and donors that are
Bilateral and multilateral agreements active in the field of health. This subgroup
between the Ministry of Health and other coordinates relations between the donors
governmental institutions and the donor and the Ministry of Health and among the
community including UN agencies are donors themselves. It also supports the
reviewed by the parties prior to their signing Ministry of Health in developing a strategic
to ensure their compliance to national policy plan to demonstrate gaps in external support
and the long-term national health strategic and to coordinate action to fill the gaps
plan. The agreements are reviewed and identified. The subgroup’s effectiveness,
approved by the parliament. as seen by some of its members, has been
Within the Ministry of Health, the limited by confusion over the principles of
Department of Projects coordinates all its establishment, unclear terms of reference
health and population projects and aid and a lack of leadership attributed in part to
flows to the Ministry with a view towards a rotating chair.
preventing overlap and duplication and
3.6 UN reform status and
ensuring more effective mobilization and
process
utilization of resources. The Department
maintains a projects map that reflects the The UN country team operates within the
availability of funds supporting the long-term “deliver as one” framework guided by the
32
Country Cooperation Strategy for WHO and Egypt
UN Common Country Assessment (CCA) life and increasingly fulfilling all their
and UN Development Assistance Framework human rights
(UNDAF). firmly establishing democratic
institutions and practices and a
The CCA, seen as a planning tool to culture of human rights through active
support Egypt’s national development citizenship.
priorities, adopts a nationally owned twin-
track strategy for UN system assistance. Though envisaged as cross-cutting, the
The twin-track strategy supports: 1) projects UNDAF places less emphasis on health
and programmes to help Egyptian citizens than had been suggested in the CCA. The
improve their quality of life and individual role of WHO as the lead technical support
welfare through better social services, agency in health is recognized within the UN
including health nutrition and education; country team. Those agencies with health-
and 2) the government and its institutions related programmes, including UNICEF,
to perform their duties more adequately UNFPA and WFP, continue to seek out and
in the pursuit of realizing the millennium actively engage in partnerships with WHO. In
development goals and the protection of some cases, these agencies have expressed
established human rights norms. interest in making greater use of WHO’s
regional technical expertise.
The UNDAF strives to place human rights
at the centre of United Nations system 3.7 Managing for results and
activities in Egypt, a key aspect of which is mutual accountability
the country team’s efforts to apply a human mechanisms
rights based approach to development.
Flowing from the twin-track strategy, the The Government of Egypt employs number
UNDAF focuses on five cross-cutting of mechanisms for ensuring accountability.
priorities identified by the UN country team, All international cooperation between the
the government and development partners: government and the international donor
community is monitored and evaluated
improving the state’s performance
at the political, inter-ministerial and
and accountability in programming,
operational levels. At the political level
implementing and coordinating actions,
parliament ensures compliance with national
especially those that reduce exclusion,
policy and strategies; parliament reviews
vulnerabilities and gender disparities
implementation and performance through
reduction in unemployment and
the government’s annual disbursement
underemployment, and elimination of
reports and the Central Agency for
the worst forms of child labour
Accounting’s monitoring report. At the inter-
reduction in regional human
ministerial level, technical and financial
development disparities, including
monitoring and evaluation is conducted
reducing the gender gap, and improving
by the Central Agency for Accounting on a
environmental sustainability
regular quarterly and annual basis. This is
improving women’s participation in the
supplement by ad hoc missions to ensure
workforce, political sphere and in public
33
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
the optimal utilization of funds and their combined with its recognized role as public
adherence to the programmes and strategic health adviser to the Ministry of Health
plans. Finally, at the operational level, the places greater demands on WHO in terms of
technical monitoring and evaluation to technical support and as a voice to advocate
measure impacts within the Strategic plans for health.
is carried out by the projects themselves and
the Ministry of Health programmes that host To fulfil its technical support role, WHO
those projects. must develop alternative ways of working
to enhance the level and scope of its
3.8 Implications of the new aid technical cooperation with government
environment for WHO and development partners. Within this new
environment, the ability of the country office
The new aid environment which can be to draw greater support from the Regional
characterized by a greater consensus for Office and headquarters becomes critical.
supporting Egypt’s national health agenda
34
Section
4
Current WHO Cooperation
Section 4. Current WHO Cooperation
37
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
health development in Egypt through its polio eradication and filarial elimination;
unique position as the public health adviser environment-friendly schools (with the
to the Ministry of Health, its role in promoting Ministry of Education); injury control and
action-oriented intersectoral collaboration in prevention (with different Ministry of Health
health-related programmes and the use of departments, Ministries of Interior, Transport,
WHO collaborating centres. Youth and Sports, Education and mass
media); and controlling avian influenza (with
4.2.1 Advisory role the Ministry of Agriculture, FAO, NAMRU-3
As public health adviser to the Ministry of and WFP).
Health, WHO has coordinated inputs to the
4.2.3 WHO collaborating centres
health sector through the donor’s forum on
health sector reform which includes but is not WHO relies, in part on a network of
limited to the World Bank, USAID, European collaborating centres to supplement its
Union. WHO has undertaken similar roles in: own technical expertise. Current WHO
the National High Committee for Avian collaborating centres in Egypt are as follows.
Influenza Control United States Naval Medical Research
the tripartite alliance (with Ministry of Unit No. 3 (NAMRU-3) as a centre for
Health and NAMRU-3) for control of AIDS and emerging infectious diseases
emerging infectious diseases and the Faculty of Medicine, Suez Canal
programme for strengthening epidemic University, as a centre for research and
response and infection control development in medical education and
strengthening bilateral collaboration health sciences
with the primary donors to ensure that Theodor Bilharz Research Institute,
their input supports the government’s Ministry of Health, as a centre for
national strategic health approaches. schistosomiasis control
Ain Shams University Hospitals, as a
4.2.2 Coordination role centre for training for mental health
WHO continues to take an active role in research and training
fostering cooperation among UN agencies, National Nutrition Institute, Ministry of
working successfully with the UNICEF Health, as a centre for research and
in routine immunization activities, polio training on nutrition with emphasis on
eradication and IMCI expansion, with assessment of nutrition status and iron
UNHCR and UNFPA in the displaced Iraqis deficiency anaemia
programme, and with UNICEF, UNAIDS,
4.3 Resources
UNFPA, IOM, UNESCO, UNDP and Ministry
of Health in HIV/AIDS control. The office of the WHO Representative
is located on the grounds of the Ministry
WHO has been successful in initiating
of Health. The WHO office consists of
several activities in the area of promoting
four rooms. The strategic health agenda
action-oriented intersectoral collaboration
outlined in the CCS places great demands
in health-related programmes including:
on the WHO country office in providing
38
Country Cooperation Strategy for WHO and Egypt
quality advocacy and technical support. With technical advice. The use of contractual
only two permanent technical staff, the WHO arrangements thus is an interim solution until
Representative and a national professional the issue of staff shortages is resolved.
officer, the country office is stretched to meet
The lack of office space and shortage of
the requirements for implementing the health
technical staff have been identified as issues
agenda as well as providing the necessary
in the previous Egypt CCS (2004–2010).
visibility for the work of WHO.
The situation has been reviewed further
As noted previously, WHO supplements during the current CCS process with realistic
its in-country technical expertise by making measures proposed to resolve what has
use of WHO collaborative centres in proven to be a chronic problem.
Egypt. Nevertheless, WHO’s effectiveness
Addressing the lack of adequate space
will depend on increasing its permanent
and the shortage of staff will remove
in-country technical staff. Recently the
significant constraints to the implementation
country office has considered contractual
of the strategic agenda described in section
arrangements with additional credible
5. However, if the current staff shortages
institutions to compensate for the shortage
in the WHO country office persist, it may
of staff. However, such arrangements
be required to revisit the agenda for WHO
require technical oversight by WHO staff to
support to make the necessary adjustments.
ensure quality and when necessary provide
39
Section
5
Strategic Agenda
for WHO Cooperation
Section 5. Strategic Agenda for WHO Cooperation
5.1 Guiding principles and with multiple opportunities for engaging with
policy framework for WHO countries.
work in countries In view of the above WHO must respond
The guiding principles and overall policy to important challenges if it is to realize its
framework for work of WHO as the world’s potential for effective action in the future.
health agency, are set out in the Eleventh In health crisis, WHO has to act rapidly in
General Programme of Work, WHO Medium- order to be an effective partner among the
term Strategic Plan as well as statements of numerous other agencies working with
regional priorities. governments.
The Eleventh General Programme of Work WHO will provide clearer understanding
(2006–2015) proposes the following agenda of health equity and health-related human
for all stakeholders, and not just WHO. rights. WHO will lead by example in
Investment in health to reduce poverty mainstreaming gender equality building this
Building individual and global health into all its technical guidance and normative
security work. WHO will do more to focus attention
Promoting universal coverage, gender and action on ensuring that countries have
equality, and health-related human sufficient human resources for health, and
rights work to keep this concern at the forefront
Tackling the determinants of health of national and international policy. WHO
Strengthening health systems and will work with ministries of health to
equitable access strengthen health systems and to build their
Harnessing knowledge, science and understanding of what can realistically be
technology done by working with other sectors. WHO
Strengthening governance, leadership will engage more systematically with civil
and accountability society and industry, including international
health care and pharmaceutical industries.
In fulfilling its role in implementing
the above agenda, WHO’s comparative The core functions of WHO will guide
advantages lie in its neutral status and the work of the Secretariat, influence
nearly universal membership, its impartiality approaches for achieving the strategic
and its strong convening power. WHO’s objectives, and provide a framework for
role in tackling diseases is unparalleled. assuring consistency and output at global,
WHO has a large repertoire of global regional and country levels. The core
normative work. WHO promotes evidence- functions of WHO are:
based debate, and has numerous formal Providing leadership on matters critical
and informal networks around the world. to health and engaging in partnership
WHO’s regionalized structure provides it where joint action is needed
43
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
44
Country Cooperation Strategy for WHO and Egypt
45
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
46
Country Cooperation Strategy for WHO and Egypt
Assist the Ministry of Health in the and plans for healthy diets and
implementation of the national control physical activity, based on the WHO
strategy for viral hepatitis through Global Strategy on Diet, Physical
strong advocacy and promotion Activity and Health, especially through
with other sectors and international thematic initiatives such as control of
partners, epidemiological research micronutrient malnutrition and reducing
and assistance in the establishment of consumption of sugar and saturated fat.
norms and standards for hepatitis case Support the Ministry of Health in
management. improving monitoring and promoting
Support efforts to strengthen the community and multisectoral efforts on
planning and management of national food safety.
disease prevention and control Provide norms, standards and
programmes at all levels, with emphasis guidelines to support the health sector
on providing full coverage to poor and in influencing policies in other sectors
vulnerable sections. relating to water quality, sewage and
Assist the ongoing government sanitation, air quality and hazardous
initiatives for eradication of neglected wastes.
tropical diseases such as filariasis,
schistosomiasis and helminthiasis. 5.3.5 Strengthening health sector
Provide technical support for cooperation and partnerships
developing national action plans and Assist the Ministry of Health by helping
meet the requirements of the IHR for to build institutional capacity for
the establishment and strengthening leadership on partnerships for health
of alert and response systems in development, and for mobilizing internal
epidemics and other public health and external resources.
emergencies of international concern. Strengthen the convening role of WHO
to support the government in bringing
5.3.4 Addressing social together development partners for
determinants of health dialogue.
Provide technical support in Support and engage partners in
environmental risk assessment and addressing health issues through more
developing mitigation strategies, giving strategic and effective forums, such as
special attention to raising awareness the Donor Advisory Group.
among children and youth through Participate actively in making health
schools and setting approaches. more prominent in the formulation of
In partnership with the United Nations the UNDAF and its implementation
Country Team, assist in promoting and through “delivering as one” and the
developing multisectoral strategies development partners forum.
47
Section
6
Implementing the Strategic Agenda:
Implications for WHO
Section 6. Implementing the Strategic Agenda: Implications for WHO
51
Country Cooperation
Country Cooperation Strategy
Strategy forfor
WHOWHO
and and
YemenEgypt
support, there is urgent need to address needs, the Regional Office should develop
the severe limitations of the WHO office an interim strategic roadmap to support the
in the Ministry of Health. To alleviate the country in dealing with strategic priorities
crowded conditions, additional office space outlined in section 5. The Regional Office
is required to accommodate: the current is also expected to facilitate the networking
staffing and the two additional full-time staff between Egyptian health institutions and
noted above; a meeting room; reception area experts and the regional and global partners.
or waiting room; a working library; archives
All technical collaboration from the
and documentation; and general storage.
Regional Office should be strictly channelled
WHO needs to actively engage with the through the country office. This issue is vital to
Ministry of Health to identify alternative ensure proper coordination and partnership
accommodations that will provide a working development with external support partners
environment that is more conducive to that collaborate with the country office.
effective performance. It cannot be over-
The presence of so many international
emphasized that the office space and a more
and external partners in Egypt provides
appropriate alternative should be found as
a good opportunity to develop innovative
soon as possible.
and pioneering health development
6.2 Implications for the approaches. In full collaboration with the
Regional Office and country office programme, the Regional
headquarters Office and headquarters should support
such initiatives. WHO headquarters is also
Implementation of the CCS will have expected to participate in the development
significant implications for the Regional of the roadmap mentioned above for
Office. As the host country of the Regional respective programmes and to make its
Office, Egypt has always expected to key technical staff available to support the
receive substantial technical support from national programme in Egypt.
the Regional Office. This expectation is
increasing. To effectively respond to country
52
www.emro.who.int