In the Arab Republic of Egypt, the role of the government in guaranteeing the respect, protection and fulfillment of the right to health for all citizens has been underlined in the constitution, where it is announced to be a fundamental right. There has been, however, no realization of the right to health thus far, as most of its fundamental principles, namely availability, accessibility, acceptability and quality of healthcare facilities and services, participation, equity and accountability, have not been fulfilled.
Without doubt, health experts have a crucial role in dealing with technical issues that arise in a health system. Nevertheless, the risk prevails that the supremacy of experts in health systems may develop a scheme that is impersonal and “top-down” . It has been underlined by the WHO that healthcare systems need to take the views of the people highly into consideration; “not as statistics or targets of interventions, but as full and equal partners” in the process of improving health and well-being . This empowerment of the people would guarantee that the health system is established to serve them efficiently, since they are the ones who are most familiar with shortcomings in existing systems.
Following our research work on the needs, wishes and expectations of different Egyptians about the healthcare system and before building a new healthcare system structure, strong foundations must be laid out to support it. In this context, we are presenting some of the most important foundations upon our work relies.
Avoiding generic systems
Although healthcare systems applied around the world are great for study and reference, it is important to note that no system can be implemented “as is” with marked success in Egypt. When considering a pre-conceived model as “the best fit for Egypt”, it does not only restrict the creative process but it also dismisses the peculiarities and specificities of the Egyptian situation. The other extreme is equally unacceptable: re-inventing the wheel without taking into account other nations’ failures and accomplishments.
Satisfaction of every individual
Any minorities that are not satisfied with a proposed system will not comply with it and consequently, it will be difficult to identify their needs. It is not a matter of simple luxury to condition the success of a healthcare system on its capacity to satisfy all. Similar to writing a new constitution, a healthcare system should highlight the areas of common needs and expectations, but should also allow a true representation of all, with all their differences. This social contract that is the healthcare system cannot function without all stakeholders being part of its formulation and ending with their approval.
A successful healthcare system must be designed to be sustainable and independent from changing politics. Achieving this is definitely not an easy task when it relies on a top yet unfixed policy maker, like a minister of health, to address healthcare system reforms. We believe that the system should arise from the people to reach policy makers who are responsible for making it happen and regulating it. The protection of a healthcare system by its primary stakeholders in a truly democratic country is the safest and surest way of guaranteeing its continuity without interruptions, falls or midway loss of direction.
When you know your term as “minister of health” will not exceed a couple of years and that the work you want to accomplish will take much more than that, the smartest thing to do is to shift to the co-pilot seat and bring the “People” in front of the steering wheel. This way, no matter how much the co-pilot changes, the plane will still go for the same goal, in the same direction. The “people” will make sure it does so.
Inspired by a story told by Agnes Binagwaho, Minister of Health of Rwanda
Opting for “quick wins”
The first years of implementing a healthcare system are the most critical in its lifetime, yet, it takes up to decades for results do be evident. Upon directly involving the primary stakeholder in the formulation of a healthcare system, the delivery of a set of “quick wins” that people can directly see and feel, is an important measure to guarantee a long life for a healthcare system. These “quick wins” reflect this plan being “on the right track”. A plan that projects too much into the future without satisfying the direct, immediate needs of a failing healthcare system will fail before it even starts.
By empowering non-experienced citizens to lead the changes they want to see in their healthcare system, by opening many channels of direct communication and feedback provision, citizens become a motor in the process instead of an obstacle the process has to confront. They become more aware of the available resources, more vigilant to poor quality or waste of resources. With this notion in mind, patients can be involved in a number of areas including monitoring and quality control, premium collections, system improvement, cost-containment, etc.
D.M. Dror, A.S.Preker, Social Reinsurance: A new approach to sustainable community health financing, The International Bank for Reconstruction and Development / The World Bank and the International Labour Organization, 2002, P. 1