108319_Macros 1 AFRICAN DEVELOPMENT BANK OPPORTUNITIES FOR SOCIAL HEALTH PROTECTION IN EGYPT Presented at the Egypt Medical and Healthcare Conference, Cairo, February By: Gehane El Sokkary –Socio-Economist AfDB Egypt Field Office

108319_Macros 2 According to the UN Research Institute for Social Development: Social protection is concerned with preventing, managing, and overcoming situations that adversely affect people’s well being. Social protection consists of policies and programs designed to reduce poverty and vulnerability by promoting efficient labor markets, diminishing people's exposure to risks, and enhancing their capacity to manage economic and social risks, such as unemployment, exclusion, sickness, disability and old age. Social protection initiatives are varied and may include one or a combination of the following: Conditional or unconditional cash transfers, Microfinance, Employment programmes Social insurance and social assistance Social protection in health is a key instrument to address poverty, income security and access to health services. It reduces financial barriers to access health care, moving towards universal coverage (i.e. universal health protection). Initiatives are based on solidarity, providing access to health services at an affordable cost. What is Social Protection? What is Social Health Protection?

108319_Macros 3 From a macro-perspective: Growth and Development: Individuals are the core of a nation. Healthy individuals are productive, thereby promoting growth and human capital development, leading to a nation’s development. Poverty Reduction: It contributes to halving poverty, which is one of the MDG Goals. Human Rights: It is a basic human right, as per the ILO Convention. Social stability: It reduces inequalities and intergenerational poverty thereby contributing to social cohesion and peace, necessary for economic growth. Encourages risk-taking and creativity: out of pocket expenditure on health is a serious drain on incomes and a source of insecurity. If that is removed, families and individuals can give priority to other sectors, taking risks that otherwise they could not have afforded to take. The Importance of Social Health Protection

108319_Macros 4 Importance of Social Health Protection for Egypt A) Socio-Economic Indicators:  Poverty incidence.  Chronic and intergenerational poverty.  Rich-Poor Gap  Unemployment and informal employment  Increased pollution  Out of pocket health expenditure 72% in 2008/9 and on the increase B) Need for continued economic growth C) Continuation of the Health Sector Reform D) Demand for Social Equity

108319_Macros How is Social Health Protection Applied? 5

108319_Macros There is no “One size fits all” …..each context is unique It combines contribution based financing with tax-financed subsidies. It relies on a shift towards enhanced risk-sharing and risk-pooling, i.e. increasing the share of prepayment in total health expenditure and reducing the reliance on out-of-pocket-payments It presumes the creation of “fiscal space” from wasted expenditures. 6 Guiding Principles: Health Financing Reform

108319_Macros 7  Initiative launched at the G8 Summit in 2007, and included:  WHO  WB  ILO  AfDB  Bilaterals: Germany, France, Switzerland and Spain  Promotes health financing reforms which rely on performance and results.  Based on pre-payment and financial risk-pooling, to ensure equitable access to essential quality health services at affordable prices.  Main features:  Contributions based on capacity to pay;  benefits based on needs;  verification mechanisms for service delivery are established to ensure quality of services, including community participation  Central pooling enables re-distribution of revenues to support poorest regions.  Implemented in Ghana, Burundi, Rwanda etc Global Initiative: Providing for Health (P4H)

108319_Macros 8 AfDB Operational in Egypt since 1974, and with a diverse portfolio in different sectors. Two financing windows: Public/Private; Financial and non-financial assistance. New Human Development Strategy with three areas of focus: Improving competitiveness Promoting value for money, accountability and voice in service delivery Supporting safety nets and social protection mechanisms Country Strategy Paper for Egypt Potential areas of collaboration with Egypt: Promoting use of e-health applications Enhancing human capital development through accreditation, capacity building of medical professional, technical staff, service providers, etc Provision of social health protection and social insurance Studies and best practices How can African Development Bank assist?

108319_Macros Thank you 9