Preface

In August 2008, the EIPR’s Health and Human Rights Program organized a roundtable discussion for a group of public-health policy experts to give them the opportunity to exchange views on public and total health expenditure and its impact on health systems and citizens’ health. Participants explored ways of improving the status quo and guaranteeing citizens’ rights to integrated, humane health care.

The EIPR adopts a rights-based approach grounded in international treaties that uphold the right to life and health as two fundamental human rights that must be respected and protected by the state. The right to health is not fulfilled by the mere provision of medical treatment and preventive health-care services but guarantees the right of every person to a standard of living adequate to ensure every individual’s health and welfare. State parties to international conventions are obligated to respect, protect and enable the right of every person to the highest attainable standard of physical and mental health.

In recent decades, governments around the world have reformed and restructured their health systems. They have developed new insurance systems and ways of offering basic health-care services, and the administration of government health services has been decentralized to make it more efficient and equitable. Nevertheless, many of these efforts have had disappointing results².  Patients still complain of poor services; doctors still complain of low salaries; and state budget drafters still complain of resource shortages and rising health costs. Some countries, among them Egypt, have attempted reform through ministerial decrees and other policy changes; others have been struggling to implement plans on the ground; and still others are standing still, unsure of the next step.

What concerns the EIPR’s Health and Human Rights Program, in addition to analyzing and monitoring health policies and measures, is assessing the impact of these policies on citizens’ health in light of their right to comprehensive health care. (It should be noted that over the last two years, the state has increasingly shirked its fundamental role to provide and fund insured, equitable and fair health care for all citizens.)

Health expenditure—both public (government) spending and total spending on health—thus acquires exceptional importance when attempting to evaluate health systems and policies. In turn, a review of government spending in various sectors, among them health care, requires a reasonable degree of transparency and access to information and data. As the International Budget Partnership states, the budget “is a government’s plan for how it is going to use the public’s resources to meet the public’s needs. Transparency means all of a country’s people can access information on how much is allocated to different types of spending, what revenues are collected, and how international donor assistance and other public resources are used.” ³

In this context, the EIPR organized the roundtable to discuss the mechanisms of public and total health expenditure and its sources, disbursement and results. We seek to visualize and elaborate a general course that can be offered as a holistic alternative to the violations of Egyptians’ right to health that currently exist on the ground. This process will be aided if we adopt an approach that sees the health system as a means of achieving a particular end, evaluate our health system based on the concrete results of policies and identify problems using indicators such as equitability, access and efficiency—all of which are quantitative and qualitative indicators of the right to health. Through this dialogue we hope to understand the political context of the health system in order to reform it, as well as understand that alternatives will undoubtedly entail moral and legal choices and challenges.

The roundtable featured two primary speakers: Abd al-Fattah al-Gebali, the head of the Economic Research Unit at the Ahram Center for Political and Strategic Studies and a former consultant to the finance minister, examined public spending on health care; Dr. Alaa Ghanaam, the director of the EIPR’s Health and Human Rights Program and the former director-general of policies and strategies in the Health Ministry’s Health Sector Reform Program, examined total health expenditure as reflected in Egypt’s National Health Accounts. 

To put these two talks in a broader context and facilitate a better understanding of the issues raised by the debate, we have added an introduction presenting the basic facts, figures and background relevant to discussions of health expenditure.
 
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[2] Marc Roberts, William Hsiao, Peter Berman and Michael Reich, Getting Health Reform Right: A Guide to Improving Performance and Equity. Oxford University Press, 2004.

[3]  International Budget Partnership, op. cit.