Egypt’s Healthcare System:

A Snapshot (February 2021)

In Partnership with

School of Business

OVERALL HEALTHCARE FACILITIES

Number of Hospitals Number of Beds

Private Sector Public Sector Total Private Sector Public Sector Total
2,000
1,782 140,000
1,800 124,686 128,344
1,599
1,600 120,000
1,400 652
658 100,000
1,200
1,000 80,000 92,599
103,432
800 60,000
600 1,130
941 40,000
400
200 20,000 35,745
21,254
- -
2009 Source: CAPMAS 2019 2009 Source: CAPMAS 2019

Meanwhile, between 2009 and 2019, the number of beds

Between 2009 and 2019, the total number of hospitals in
Egypt increased by 11% from 1,599 to 1,782 mainly due to
a 20% increase in the number of private sector hospitals.
During that period, the share of the private sector increased
from 58.8% to 63.4%.
in private sector hospitals jumped by 68% in tandem
with a 10% decline in public sector beds during the
same period, leaving the total number largely stable (3%
growth. The private sector accounted for 28% of the total
number of beds in 2019 up from 17% in 2009. This can be
explained by smaller private hospital sizes as well as
higher concentration of beds in public hospitals.

DETAILS OF HEALTHCARE FACILITIES

Hospitals by Governorate Beds per 1,000 Population by Governorate
Kafr El-Sheikh, 47 Damie�a, 35
Alexandria Tota l Beds in 2019 Popul a�on i n 2019 Beds per 1,000 Popula�on
133 Port Said, 18 South Sinai 1,085 105,953 10.2
Global
2 Ca i ro 28,854 9,788,739 2.9
Average
3 5
Al exa ndria 11,908 5,299,718 2.2 (2.9)
7 Red Sea 830 372,862 2.2
Beheira 4 South
Da mie�a 2,734 1,539,075 1.8
6 Sinai, 10
68 New Va lley 418 249,399 1.7
1 Suez As s iut 7,246 4,587,577 1.6
26
Gha rbeya 7,227 5,146,411 1.4
Matrouh, 8 Fayoum North Is mailia 1,898 1,352,548 1.4
21 Sinai, Menoufeya 6,018 4,441,717 1.4
Beni Suef, 28 Da qahleya 8,986 6,679,368 1.3
16 National
Giza Healthcare facilities are highly Suez
Ma trouh
989
575
749,657
461,847
1.3
1.2
Average
159 (1.3)
Menia, 54 concentrated in Cairo, Alexandria, Qa l youbeya
Sha rqeya
6,835
8,167
5,792,066
7,401,700
1.2
1.1
Daqahleya & Giza which together North Si nai
Port Sa i d
503
800
463,975
764,499
1.1
1.0
Assiut, 73 represent 45.1% of the total As wa n
Gi za
1,601
8,176
1,532,400
8,915,164
1.0
0.9
number of beds and 46.3% Ka fr El -Sheikh
Soha g
2,992
4,155
3,478,267
5,193,052
0.9
0.8
New Valley, 13 Sohag, 56
Qena, 30 of hospitals in Egypt. Beheira 5,072 6,404,210 0.8
Luxor 982 1,296,540 0.8
Beni Suef 2,328 3,288,219 0.7
Luxor, 20 Meni a 3,812 5,745,212 0.7
Qena 2,000 3,302,894 0.6
Fa youm 2,153 3,747,942 0.6
Tota l 128,344 98,101,011 1.3
1: Cairo, 355 Source: CAPMAS (2019 data)
2: Daqahleya, 178
Red Sea, 20
3: Gharbeya, 101 With the exception of South Sinai and Cairo, all
4: Menoufeya, 82
5: Sharqeya, 77 governorates fall well below the global average of
Aswan, 31
6: Qalyoubeya, 71
7: Ismailia, 52
2.9 beds per 1,000 population; while several
governorates fall below the national average of 1.3.
Source: CAPMAS (2019 data)
 DETAILS OF HEALTHCARE FACILITIES (CONT’D)
Breakdown of Hospital Beds by Entity (%)
One-Day Therapeu�c
Railways, Surgery ,
Other Bodies, 2,761 357 Founda�on, 652
Specialized Medical Centers, 234
of which: General
24,310 Tumor Centers, 790
Ministry of Authority
Health, For Health
37,003 Insurance, General
7,197 Secretariat,
4,541

Universi�es, General
Educa�onal
28,168 Secretariat
of Mental Hospitals &
Private Ins�tutes,
Sector, Health,
5,055
35,745 5,841
Source: CAPMAS (2019 data) Source: CAPMAS (2019 data)

Number of Primary Healthcare Units Number of Labs

Primary Care Medical Units Health Child Care Health Urban Health Licensed: ~12K
Units (Rural) (Urban) Offices Units Clinics Centers Unlicensed: ~70K
4,398 441 332 141 93 53
Source: El Watan News citing Secretary General
Source: CAPMAS (2019 data) of the Daqahleya Doctors Syndicate

NUMBER OF PATIENTS AND ADMISSION CASES

No. of outpatients in clinics of public & central hospitals in 2019

6
5.4
Millions

5 4.8
4.3
3.9 3.7 Despite ranking fourth in terms of
4
3.2
2.9 2.8
population size, Daqahleya had
3 2.6 the highest number of outpatients
2.3 2.3 2.1
2.0 1.8 in public & central hospitals which
2 1.7
1.5
may be due to Mansoura University
1.0
1 0.8 0.7 0.7 0.7 0.6 0.6 Hospital serving all the Delta region.
0.5 0.4 0.3 0.3

Source: CAPMAS

Cases of admissions in public & central hospitals in 2019

160 145.4
Thousands

140 132.5
120 The number of admission cases in
100 public & central hospitals has a
80 moderately strong correlation (0.6)
60 51.7 50.0 49.7 45.2 with population, meaning that
38.4 34.8 34.7
40 26.4 23.0 21.9 21.4 19.6 around 60% of the number of
20 13.5 11.2 11.1 8.4 admission cases can be explained
2.4 2.0 0.7
0 by the governorates’ population
*
size.

Source: CAPMAS
*The reported data grouped some governorates together without providing a further breakdown for these governorates during that year.
 OVERVIEW OF HUMAN RESOURCES IN HEALTHCARE

Healthcare Staff in 2019

122,948 227,452 9,847 ~120,000

Doctors Nurses Medicine University Egyptian Doctors

of which 93,012 of which 205,183 Graduates Working Abroad (~49%)*
in the public sector in the public sector (1.6% of total higher of which 65K in KSA
(76%) (90%) education grads) Source: CAPMAS (2019 data)
*Source: Al-Masry Al-Youm citing the Doctors Syndicate

3.9
Physicians per 1,000 Population: EGYPT IS HALF THE GLOBAL AVERAGE

2.6 2.5 2.4 2.3 2.2

1.8
1.6
1.3 1.3
1.0 0.9 0.8 0.8 0.7

Euro United Saudi UAE Jordan Brazil Turkey & World MENA Tunisia Arab South Egypt India Morocco
Area States Arabia Algeria Region World Africa
Source: World Bank (2017 data)

HEALTH EXPENDITURE/ ECONOMICS

3.6 mn patients treated at the state expense
Treatment Cost at the State Expense (in EGP mn) inside Egypt in 2019, of which:
EGP mn Inside Egypt (Le� Axis) Abroad (Right Axis) Gynecological
12,000 33.0 35 (Women), 2% Surgery, 2%
10,363 Ophthalmic (Eyes), 2%
10,000 30
Orthopedics (Bones), 3%
25 Neurosis, 3%
8,000
20 Urinary Tracks, 3%
6,000
12.4 15 Tumors, 9%
4,000 2,477 10
Abdominal,
2,000 5 76%
0 0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Source: CAPMAS Source: CAPMAS

Implemented Investments in the Healthcare Sector (in EGP bn) Current Health Expenditure (% of GDP)
20
EGP bn

18 Public Private Egypt World

16
14 9.3 9.9 9.8 9.9 9.9 9.8
9.1 9.6 9.4 9.4 9.4 9.5
12
10 8.7
8 5.5 5.3 5.4 5.6
6 4.0 4.1 4.7 4.9 5.0 4.9
2.4 2.4 3.0 9.8 4.5 4.4 4.2 4.4
4 1.4 1.9 2.4
2 3.7 3.7 3.5 4.8 5.2
3.2 3.2 2.9 2.7 3.4
0

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Source: Central Bank of Egypt (CBE) Source: World Bank

Total implemented investments in the healthcare sector have increased Despite increasing investments, Egypt’s percentage of
by 1.5 folds between 2015/16 and 2018/19 in nominal terms. current health expenditure to GDP is half the global average.
Egypt’s out-of-pocket health expenditure stood at 62.3% of
health expenditure in 2018.
 MERGERS AND ACQUISITIONS

Banking &
Tech & Telecoms
Finance
EGP 37.3 bn
32

Healthcare Pharma
19 EGP 14.4 bn
Top 3 M&A Sectors Top 3 M&A Sectors
in 2020 in 2020
# of Transactions Value Banking &
Infrastructure*
Finance
6
EGP 6.4 bn

With the increasing need and interest in the healthcare sector especially in light of the COVID-19 pandemic, and with
stakeholders around the world realizing how vital investing in the sector is, the healthcare and pharma sectors came in
second in terms of number and value of M&A transactions in Egypt in 2020, respectively. Another mega merger awaiting
regulatory approval would see Cleopatra Hospitals Group (CHG) acquire Alameda Healthcare**. The combined group is
expected to hold around 15% of Greater Cairo’s commercial bed capacity.

Source: Enterprise.press
*Building materials, oil and gas and real estate also recorded 6 M&As each in 2020.
**A UAE company that owns and operates Dar El Fouad 6 of October, Dar El Fouad Nasr City, As-Salam International hospital in addition to AsSalam International Hospital Katameya which is expected to commence operations in H1 2021.
It is worth noting that on December 30th, the Egyptian Competition Authority’s (ECA) said that its preliminary decision was to not approve the merger but the final decision is yet to be announced.

NATIONAL PROJECTS/ INITIATIVES

Since 2018, the government has launched a number of public health initatives in Egypt at a total cost of EGP 14.2 bn. This has
helped in building a database covering more than 70 mn Egyptians.

Treatment of Elimination Early detection Improving Women Early detection Ending patients’
chronic diseases of Hepatitis of anemia, obesity maternal & Health & treatment of waiting lists
& kidney failure C Virus & stunting neonatal health hearing loss

• Launched in • Launched in • Launched • Launched in • Launched in • Launched in • Total cost:

June 2020 October 2018 in 2020 early 2020 July 2019 September 2019 EGP 6 bn

• Total cost: • Total cost: • Total cost: • Total cost: • Total cost:
EGP 1.5 bn EGP 5.5 bn EGP 350 mn EGP 112 mn EGP 610 mn • More than • 700K patients
1 mn babies have so far
• 24 mn screened • 70 mn screened • Targets screening • 12 mn ladies tested benefited
• 22.5 mn school
& given free meds • 2.2 mn given 2.5 mn/ year tested from it
students tested
free meds

Source: Statement by Health Minister Hala Zayed in February 2021

 GLOBAL BENCHMARKING: EGYPT LAGS BEHIND
Increased investments into the sector over the past few years are yet to yield results, with Egypt still lagging behind global averages
when it comes to key health-related indicators as shown below.

Non-Arab Countries:

Beds/ 1K people 2.9 8.0 5.2 2.9 2.8 2.1 0.5

Physicians/ 1K people 1.6 4.2 3.9 2.6 1.8 2.2 0.8

Expenditure (% of GDP)* 9.8 11.4 10.1 16.9 4.1 9.5 3.5

Healthy Life Expectancy** 64 71 68 66 68 65 60

Arab Countries:

Beds/ 1K people 2.2 2.2 1.5 1.4 1.4 1.0 N/A

Physicians/ 1K people 2.5 1.3 2.3 0.8 2.4 0.7 1.8

Expenditure (% of GDP) 6.4 7.3 7.8 4.9 4.2 5.3 6.2

Healthy Life Expectancy 64 67 68 63 66 64 66

Source: World Bank (2017 data)
*Current health expenditure % of GDP (2018 data)
**Source: World Health Organization (2019 data)

CHALLENGES AND OPPORTUNITIES

• Brain drain and immigration of doctors

• High cost of physicians’ training
• The gradual roll out of the comprehensive • Low healthcare staff compensation
health insurance system • Weak healthcare system governance
• Initiatives advancing public health in Egypt • Role of the health ministry as a provider
• Increased political will to develop the sector not as a regulator
• Large market size (demand) • Poor efficiency and readiness of primary
• Large pool of highly trained doctors and care units
pharmacists • Poor service quality of public hospitals
• Growing pharmaceutical market above • Absence of a fully-integrated database
global rates • Absence of a knowledge-based strategy
• Increasing role of the private sector • Lack of an all-encompassing law
• Low labour costs governing all players
• Digital transformation efforts • Low government healthcare expenditure
• Improving infrastructure & mega projects that is below global averages
• Progressing investment climate and • Inequality when it comes to receiving
legislative reforms medical services
• High initial cost for investing in the sector
including land price

Source: The Egyptian Center for Economic Studies (ECES), WHO white paper, Multiples Group & Fitch Ratings.

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 OVERVIEW OF EGYPT’S UNIVERSAL HEALTH INSURANCE LAW NO. 2 OF 2018

People in Need
KEY HIGHLIGHTS Government shall cover health
OF THE LAW expenses for those in need
Subscrip�on (30-35% of the popula�on).
Coverage plan subscrip�on
will be compulsory for
Egyp�ans living in Egypt. New Database
A database shall be established
to include the necessary data
Hospital Choice for those covered by the law.
Ci�zens have a free choice
to go to any chosen hospital
within the network. System Valua�on
An actuarial valua�on of the
system shall be undertaken at
Coverage least once every 4 years.
System covers all diseases
& injuries excluding those
offered freely by the state. Family Unit
Family is the new
health insurance unit
instead of individuals.

STAGES OF IMPLEMENTATION THREE NEW AUTHORITIES

According to the law’s ini�al plan, the system was to be
applied gradually on six stages between 2019 and 2032
as follows.*

2019 Universal
Healthcare Accredita�on &
Health Insurance Quality Control
Authority
Authority Authority
Port Said, Suez,
1 Ismailia, North
Sinai, South Sinai**
In charge of the Managing the contracts with Supervisory agency in
insurance scheme private & public medical charge of accredita�on
Aswan, Luxor, Qena,
Matrouh, Red Sea 2 service providers & quality control

Alex, Beheira, LAW VIOLATION PENALTIES

3 Damietta, Sohag,
Kafr El Sheikh The law criminalizes the following viola�on cases:

4
Assiut, New Valley, Not submi�ng Assis�ng
Fayoum, Minya, Beni Suef employees’ par�cipants to
subscrip�ons not pay their
within 30 days contribu�on
Dakahlya, Sharkeya, of collec�on
5 Gharbeya,
Menoufia
Illegally
Not subscribing facilita�ng Providing claims
Cairo, Giza, Qalyubia
6 to the Authority
on behalf of
employees
the a�ainment
or selling of
for medical
services that
did not take
medica�on
place

Hindering work
2032 Providing
incorrect
of Authority
employees with
statements
Judicial Police
*The system was introduced on a pilot basis in Port Said in July 2019.
power
In February 2021, the President announced that GoE is planning to
to cover the en�re country in 10 years instead.
**According to latest updates, the 1st phase now includes Port Said,
Luxor, Ismailia, Aswan, Suez and South Sinai. The rest is yet to be announced.
 SOURCES OF FUNDING

A. COPAYMENTS BY THE INSURED UPON RECEIVING B. CONTRIBUTIONS

MEDICAL SERVICES

1% of total salary* plus

3% for non-working wives
Employee
1% for each dependant
10%** of 10% (Max 5% of fees Premium
EGP 100* medicines of EGP 750 (Max of EGP 4% of employees’
per home visit Max of EGP 1K per case) 300 per �me) total monthly salary
Employer
(Min of EGP 50/mo.)
X-Rays, Premium
Home Visits Medica�on Check Ups & Inpa�ent Care
Examina�ons

All items exclude chronic diseases and tumors whose pa�ents are en�rely exempt from fees. *5% in cases of freelancers, Egyp�ans working abroad, laborers
*Fixed amounts men�oned above shall increase by 7% annually. subject to the Comprehensive Insurance Law No. 112 of 1980 &
**To be increased to 15% by the 10th year of applica�on of the law. individuals subject to the Social Insurance Law No. 108 of 1976.

2% of total monthly pension for pensioners and widows.

C. OTHER SOURCES OF FUNDING

In addi�on to the copayments and contribu�ons, sources of funding of the system also include the following premiums, taxes and service fees.

New
Service
Providers
An amount ranging between
Highway Toll EGP 1K- 15K for
EGP 1 from vehicles hospitals & centers
passing in plus EGP 1K for
highways. each bed during Cigare�es Tax
Percentage of
licensing. EGP 0.75 on every
pack sold in the
Revenues domes�c market (to be
0.25% of total revenues of increased every 3
all companies & en��es. years by EGP 0.25 to
reach EGP 1.5).

Other Tobacco
Products Tax
10% per sold unit
of other tobacco
products.
Licenses Fees
EGP 20 for issuing/
renewing driver licenses
EGP 50-300 annually
for issuing or renewing
licenses of vehicles.
ROI
The return on the
Authori�es’ investments &
accepted grants, gi�s,
loans & dona�ons.
Excise Stamp
EGP 5 on the applica�ons
presented to any of the
three Authori�es.

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