Health care needs in the Middle East and Africa are rising in tandem with the growing number of people suffering from non-communicable diseases, such as diabetes and heart disorders, that need constant treatment and monitoring. Added in are now the acute challenges of the Covid-19 pandemic, and the pressures it is placing on health systems.
The search for solutions to improve access and quality is bringing the public and private sectors together to develop additional routes for improving health outcomes for patients. It could not come at a more critical time. In Egypt, the region’s most populous nation with 100 million people, non-communicable diseases have grown by 20% over the past decade, and now account for more than 80% of deaths in the country. In Morocco, they grew by 15% over the same period. Diabetes-related illnesses are a huge concern, with the Eastern Mediterranean region registering the highest diabetes rates in the world.
Governments lack the capacity to meet the surge in health care demand and, in response, they are encouraging private operators to take an expanded role. For example, as part of implementing its landmark 2018 Universal Health Insurance Law, the Egyptian government has been engaging with the private sector to build out capacity in order to reach its goal of universal health coverage for all by 2030. Likewise, new laws in some countries and new investments are shifting the landscape toward integrated services that can improve care coordination and quality by bringing hospitals, pharmacies and primary care together in one system.
IFC, the division of the World Bank Group that invests in the private sectors across emerging markets and has an active portfolio of $20bn, is working with providers to advance the goals of better health care. Recently, we approved a $125m investment package that will extend health care services in Egypt and Morocco. Unveiled in February, the investment creates a new entity, Humania North Africa, tasked with building and operating three hospitals and a medical tower which will add 600 hospital beds and 240 outpatient clinics to the system.
There is little doubt about the demand for these additional services. In Morocco, health care services for women and children are sorely lacking, and there is a big shortage of health care workers, who number 1.51 per 1,000 population, well below the ratio of 4.45 per 1,000 recommended by the World Health Organization (WHO).
Humania North Africa is owned by Bait Al Batterjee, a leading health care conglomerate whose facilities collectively provide 2,500 beds and employ 12,000 people in Egypt, Saudi Arabia, the UAE, and Yemen. By combining Bait’s three decades of experience with the IFC’s six decades of local knowledge and presence, we expect to create a centre of excellence that lifts up the whole region.
Just as important as tapping into the private sector to expand capacity will be raising the bar on the quality of health care. For example, while most all Egyptians have affordable access to a health care facility, many such facilities are inadequately equipped, with medications out-of-stock, not enough specialty doctors, and weak protocols for managing chronic diseases. A 2018 global study on health care published by The Lancet medical journal found that 63,000 Egyptians died from receiving poor quality care in 2016, double the number who died from lack of access to care. To tackle this issue, IFC has created an advisory service, the IQ-Healthcare Tool, that is being deployed to several hospitals in the region to improve the overall quality of care.
We know there will be challenges. For example, recruiting medical staff. Humania’s business model differs from that typically seen in the region in which doctors work part-time in several facilities. Humania instead hires its doctors as full-time employees and, exceptionally, links pay to their performance rather than to how many patients they bring in. The stability helps with patient care, and the salary structure rewards doctors for doing good medicine.
Nurses, too, will be hired to work full-time, which will allow for more uniform training standards and continuous education. We hope this will also make the health care facilities less infection-prone by avoiding nurses having to constantly move between hospitals, a practice that can increase the spread of infections, an issue we will need to pay more attention than ever to in the post-COVID-19 era.
One encouraging aspect of Egypt’s nascent national insurance programme is that it gives patients the choice of going either to the public or private facilities for service. As more private facilities are covered by national insurance schemes in Egypt, and we expect elsewhere in the region too, they can serve a wider spectrum of the population, including low-income segments.
Despite these dark days for global health, we are hopeful for the future. We want to unleash the power of private health in a positive way. Our hope is that our Humania project, by demonstrating its viability as a business model while raising overall health care outcomes, can serve as a role model for the region.
Ashruf Megahed, Manager, Manufacturing, Agribusiness, Services Middle East and North Africa, IFC
