Abstract
Under its existing primary care strategy-universal access to comprehensive primary care through government and public sector delivery and financing of services-Egypt has made substantial progress in some aspects of primary care in recent decades. Deficiencies exist,
however, particularly in routine provision of care to individuals and families by public providers, in disparities of care that exist across regions and socio-economic groups, and in prospects for the sector to respond well to emerging health challenges.
An examination of these deficiencies reveals a chronic shortfall between the promised comprehensive care and funding available to pay for that care; lack of appropriate incentives to improve efficiency and quality, and of mechanisms to introduce the incentives; fragmented and inefficient organization of services; and insufficient capacities in financing, management, planning, and research.
Egypt's current primary care strategy is not well-suited to remedy these problems, and so this paper proposes development of a new strategy, key components of which are a defined basic primary care package; adequate funding levels and mechanisms to provide them; new methods of organizing the financing and delivery of care to obtain efficiency, quality, and patient satisfaction; and improving system capacities. It suggests a new role for government and new approaches, including separating financing of services from their provision and reorganization and integration of care delivery. Two models for organization of services are presented.
This proposed primary care strategy and approaches must be reviewed for their suitability to the regions and demographics of the country, and to the broader health sector reform taking place in Egypt, and field-tested and refined before they can be implemented on a national scale. Nevertheless, several fast-track elements are recommended here that can be financed and implemented in the near term, which will contribute to reform regardless of the final strategy.