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 underprivileged 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 monthly medication costs.

What happens if you need to see a doctor?
Due to the diversity of health care providers, there is 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 or her private clinic without a referral. However, the patient will have to pay out of pocket. Patients who have health insurance - whether through 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 living with diabetes who has 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 decisions on 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?
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 good health insurance coverage.

The salaries of most of the employees in Egypt are not enough to afford their monthly diabetes supplies. It can cost someone more than 50% of their salary to get the basic diabetes supplies. There is also a high percentage of unemployment (7.5% among youth) and nearly one-third of Egyptians fall below the poverty line, considering that the minimum salary in Egypt is 2700 EGP (148 USD).

The National Health Insurance System covers insulin, a glucometer for newly diagnosed and 25 test strips per month, and the checkups required (like blood tests). People with diabetes apply again for college student’s insurance that offers fixed inulin supply per month and covers totally or partially the checkups required (like blood tests).

If employed, people apply for insurance based on the job. The insurance varies according to the job if it's private insurance or governmental, but generally, it covers the insulin and not necessarily the regular checkups or the test strips. If unemployed, people apply for state fund medication, but it’s not easy to get and doesn't cover everything. So the most common cases pay for their supplies and needs on their own expenses.

The National Health Insurance System often does not provide enough quantity of supplies and patients have to pay out of pocket if they need any extra supplies more than the fixed amount of supplies given to them. The people who pay for their private insurance can find better services and support for their diabetes. Also, all of these insurances don’t support any kind of technological evolution in diabetes treatment, no pumps nor CGMs (freestyle libre 1 and Medtronic supplies are available in Egypt).

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

How does diabetes care vary throughout Egypt?
The best health care centers are present in the big cities (like Cairo and Alexandria) 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, some centers of excellence for diabetic foot and screening for diabetes complications 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. Thanks to Eman Diab for supporting with updates.