The Egyptian health system is diverse with a wide range of health care providers complementing each other in serving all people in the country. The Government is committed to providing universal health care to poor and unprivileged population groups but the quality of the governmental health service is often not as good as the private clinics. For workers, some agencies have an agreement with the National Health Insurance System to provide insurance for their employees, some have their own medical department or hospital, while others have agreements with private health insurance systems or don‘t provide health insurance to employees at all. Usually the health insurance for workers covers the employee and his family and they pay a certain percentage of the price of the whole monthly medication costs.

What happens if you need to see a doctor?
Due to the diversity of health care providers there is a personal freedom of choice when seeking care according to the patient’s needs and ability to pay. In general, the role of family doctor is not so clear and patients can go directly to any specialist or consultant in his of her private clinic without a referral. However, the patient will have to pay out of pocket. Patients who have health insurance - whether through the national health insurance or a private one - should follow the rules of referral used by their insurance provider to be able to see the consultant or the specialist. For example, a school child with diabetes with national health insurance will get a referral from his school doctor to visit the national committee of specialists in his region for the prescription of insulin.

Who decides what medicines a doctors can prescribe?
Theoretically, the Ministry Of Health - which controls everything related to practicing medicine in Egypt and gives licenses for the medical and pharmaceutical industry - provides a yearly updated drug index of medications present and registered in the Egyptian market. However, there are numbers of imported and unregistered drugs in the Egyptian drug index being prescribed and sold to patients. Moreover, it’s up to doctors own decision which guidelines to follow or medicines to prescribe. In cases of reported mistakes by doctors, there is an ethical committee in the Egyptian medical syndicate (where all the doctors should be registered to get their medical license) that takes over the investigations with the doctor and decides the appropriate discipline.

Practically, what is it like to live with type 1 diabetes in Egypt?
Living with type 1 diabetes in Egypt is affected by two main factors: the social and the financial level of people living with diabetes. Insulin is available in almost all the pharmacies in Egypt and it is one of the ‘‘Over The Counter“ drugs like most of the drugs in the Egyptian market. Some types of mixed insulin are of low price and more affordable for low income people, however the other types of insulin are expensive to afford without a good health insurance coverage.

The social level plays an important role in patient‘s access to health care as the number of health care centers, hospitals and pharmacies is very low in the rural areas compared to big cities and urban areas. The financial level is a major determinant of people’s access to health care as the salaries of most of the employees in Egypt are not enough to afford their monthly diabetes supplies. For example, it costs about 25% of my monthly salary to get my monthly supplies for diabetes. There is a high percentage of unemployment (26% among youth) and a scary percentage of poverty (about 50%) in Egypt in general.

For students and school children with type 1 diabetes, the National Health Insurance System covers insulin and the student pays nothing for NPH, mixed and short acting insulins and only 60% of the price of other types of insulin which are usually not available in the pharmacies of the National Health Insurance System. A glucometer for newly diagnosed and 25 test strip per month is covered and funded by the National Health Insurance System. That means that patients have to pay out of pocket if they run out of test strips. Patients will face another problem if he/she cannot find the test strips of the glucometer provided by the National Health Insurance System in the public pharmacies. In that case a patient will have to buy a backup glucometer with available test strips. Insulin pumps are neither present nor covered by the health insurance in Egypt.

What about getting admitted to hospital?
Admission to the hospital takes place either through the Emergency Room (ER) in the case of emergency or accident, or through a referral from a consultant or a specialist from an outpatient clinic or a home visit done by that consultant/specialist.

How does diabetes care vary throughout Egypt?
The best health care centers are present in the big cities and the health care service that people need to pay for is of better quality than the free one. In addition, the number of doctors, pharmacies and health care centers in rural areas is less than that in urban areas. Recently, centers of excellence for diabetic foot and screening for diabetes complication have been established throughout the country, which is a practice that needs to be generalized.

Thank you to Dr. Mohamed Shabeen in Egypt for supplying this information for our map.