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Health as an Instrument for Comprehensive Development
H.E. Dr. Ismail Sallam, Minister of Health & Population,
addressed AmCham Egypt's monthly luncheon on May 7 on the topic
of "health as an instrument for comprehensive
development." Dr. Sallam emphasized the centrality of
health care - particularly holistic, preventive health care - in
all aspects of social and economic development. "Hospitals
and treatment of illnesses are only 20 percent of health
care," he said. The real challenges, and the top priorities
of the ministry, are "prevention and promotion."
Likening health to the foundation of a house, the minister
pointed out that "without health, people are unable to
work, to listen, to communicate."
Health care produces a tremendous return on initial
investments. "Nothing [else] can produce as much,"
Sallam said, asserting that LE 1 invested in health can produce
a return of LE 30 after 10 years. "The holistic approach
is the only way to deliver health," he added.
Moreover, health is crucial to social stability. "When
we talk of economic reform or Open Door policies, we must
remember that the most important considerations for any society
are stability and security," Sallam said. "The worst
problems arise when there is a lack of balance between [health
care] and reform."
The ministry's basic approach is "elimination of
disparities," including those between rich and poor, rural
and urban, Upper Egypt and Cairo. The ministry is also careful
to consider people with special needs.
Touching on gender issues, the minister noted that the most
basic problems are found in rural areas. The ministry has set up
1,000 women's health clinics, which not only provide health
care, but also deal with educational and social issues,
including reproductive health. "In fact, the clinics are for
everyone, but the main issue is to get women advancing,"
Sallam said. As women have become involved in the clinics'
women's clubs, their husbands have begun listening to them and
turning to them for advice, he said.
Sallam also discussed the ministry's efforts to reduce
waiting times for public health care. "We used to have the
poor in a queue for years," he said. "Now the ministry
has taken a direct approach to ensure that the basic needs of
poor people are met. The screening process has been simplified.
Anyone who accepts standing in a queue for a government hospital
is poor."
According to the minister, who is himself a heart surgeon,
there is currently no waiting list for cardiovascular surgery,
and the ministry has greatly improved the cost-effectiveness of
its programs in this field.
Sallam said that health services in remote parts of the
country have also been greatly improved, with 460 mobile clinics
run by private groups providing care all over Egypt.
The ministry has completed 2,700 clinics for primary health
care in the last five years. "Around Africa, efforts to
deal with Aids and malaria have been hindered not by lack of
money but because there has been no vehicle for programs in the
community," the minister said. "And this is because
there has been no primary health care."
The ministry is currently tacking the problem of
registration. "In the next three years, a comprehensive
system of registration will emerge," Sallam said.
"There will be a number for every house and a file for
every family."
The minister also cited the example of Healthy Egyptians
2010, a program based on a successful U.S. model, Healthy People
2000. In order to utilize resources most effectively, the
program - which the ministry is implementing in cooperation
with the U.S. Department of Health - specifically targets
anti-smoking campaigns, safe motherhood and childhood, and
accident/emergency care.
The ministry is counting on help from the private sector and
NGOs. With 85 percent of the population living on incomes of
around $1,500 per year, most Egyptians "can't afford
private hospitals," he said. "We shall seek to see
these people insured - with a role for the private sector, and
less of a burden on the public sector."
NGOs could also take over the burden of some of the
government's work. The health ministry agreed, for example, to
allow a group of Egyptian doctors from the United States to run a wing of a
government hospital.
"The future is for the private sector," Sallam
said. However, he warned against hasty privatization as an end
in itself. "People say privatization is a target," he
noted. "But I must deliver health wherever there is no
delivery."
The ministry has, however, already had some success in
developing "centers of excellence" for health care,
where employees receive fair pay, depending on their work.
"For example, we recognize that doing 20 operations is
different from doing 100 operations," Sallam explained.
"Some are now earning LE 20,000 per month. We're happy to
be clearing the waiting lists and seeing better utilization and
occupancy rates."
Finally, the minister turned to pharmaceutical policy.
"The health ministry is trying to do some tuning," he
said. "Pharmaceutical strategy can't be seen alone. It is
part of health strategy." As in other areas, the ministry
considers insurance an urgent necessity to cover the costs of
pharmaceuticals. "We have to make sure that underprivileged
groups also get their pharmaceuticals," Sallam said.
Defending the health ministry's record on regulating drugs,
Sallam said that conflicts between local producers and
multinationals had been greatly exaggerated in the press.
"We are supporting our pharmaceutical industry," he
acknowledged. But while there is some competition between
multinationals and the Egyptian industry, "we're not in
conflict. The Ministry of Health is there to regulate issues
between the two."
The ministry's role, Sallam explained, is to "ensure
sustainability." If companies were allowed to produce
pharmaceuticals on a purely free-market basis, "essential
drugs would otherwise be unavailable or intermittently
available."
This pharmaceutical policy is consistent with the ministry's
overall approach. "We'd like to have free-market
interaction, but we must protect the social balance,"
Sallam said. "Pricing is done fairly, but with social
components in mind." These social components," he
added, "are the most important part for the stability and
sustainability of any economic program."
In the question and answer session that followed, the
minister elaborated on how the health ministry coordinates with
the industry in the process of research. "The process of
approving new drugs is transparent," he stressed,
explaining that pricing is based on benchmarking against other
countries.
Multinational companies, however, have not invested in
research in Egypt. "How much research have you done in
Egypt? Nothing," Sallam said. Multinationals are essential
for progress, he said. "We are just asking that we all work
together, even with the local industry."
On the sensitive issue of intellectual-property rights,
"we must ensure that intellectual property will help
us," Sallam said. If protection of multinationals' patent
rights appears to be "affecting patients' interests or the
local industry's interests," he warned, "this will
affect people's views."
In order to solve the problem, he concluded, "all of us have
to work together to pass an intellectual-property law in the safest
way."
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