This report reflects interviews and plans available when it was prepared in March 2026, before the trial launch then announced for Minya.
As the announced April 2026 date for the trial launch of universal health insurance in Minya approaches, questions about the system’s readiness to expand are intensifying. Beneficiaries in first-phase governorates report delays in treatment approvals and restrictions on funding medicines and medical devices. Their complaints concern chronic and critical conditions, including kidney failure and cancer, for which waiting for an administrative decision can become part of the daily burden of illness.
The announced second-phase plan covers five governorates: Minya, Damietta, Kafr El-Sheikh, Matrouh and North Sinai. Its estimated cost is EGP 115 billion, with a target population exceeding 12 million. The figures of 290 primary-care facilities and 26 secondary- and tertiary-care facilities refer to preparations in Minya, rather than the combined total across all five governorates. The Healthcare Authority outlined these preparations in its announcement of decisions from its 95th board meeting in early March 2026. These are planning and preparation figures; they do not establish that every facility is already operational.
The timetable announced in July 2025 anticipated launching the second phase in Matrouh that September, followed by North Sinai in December and two further governorates in early 2026, with the fifth joining later. The proposed April 2026 start in Minya falls about seven months after the previously announced beginning of the second phase as a whole. A change in the order and timing of governorates must therefore be distinguished from a claim that Minya itself is seven months late against a previously fixed launch date.
Established under Law No. 2 of 2018, the system is designed to be introduced geographically in stages. Trial operations began in Port Said in July 2019, followed by a launch in Ismailia, Luxor and South Sinai on 16 February 2021. The first-phase governorates also include Suez and Aswan. Funding comes from contributions by insured people and employers, Treasury payments for those unable to pay, and other legally specified resources. Contracting private providers is a mechanism for purchasing and delivering care; it is not, by itself, a funding source equivalent to insurance contributions.
In a presentation at an actuarial conference in Dubai in February 2026, the Universal Health Insurance Authority reported 5.2 million beneficiaries in participating governorates and a registration rate of 82 percent. Expansion projections envisage a beneficiary population of around 18 million, alongside plans to extend coverage over the following years towards 2030 or 2032, depending on the timetable cited. These are targets, not coverage already achieved. Registration totals alone also cannot measure continuity of treatment or patients’ satisfaction with the care they receive.
Between the medicine and the funding decision
In March 2026, Port Said MP Ahmed Farghaly submitted four parliamentary requests for information about complaints within the system. They included replacing Prograf with an alternative known as Adoport for kidney-transplant patients, insufficient dialysis capacity, and additional costs some patients face when receiving care from private providers, including medicines, tests and blood transfusions. He also criticised the refusal to fund continuous glucose monitors and insulin pumps for children without litigation, and inadequate coordination in exceptional cases involving chronic diseases and cancer. These remain allegations and complaints raised by the MP; they do not independently establish drug-related harm in every case.
Prograf and Adoport contain tacrolimus, an immunosuppressant with a narrow therapeutic range. UK medicines-regulator guidance requires specialist supervision and careful therapeutic monitoring when switching between brands. This does not mean every generic alternative is unsafe. It does mean that the switching process and follow-up are essential considerations that cannot be reduced to the price of a pack.
Mohamed Hassan, a beneficiary in Port Said who has kidney failure, says patients were surprised when the supply of medicines they regularly received in dialysis units to control high phosphate levels stopped. He tells Zawia3 that Rengel, a medicine used to manage phosphate levels, had been dispensed regularly before its supply was abruptly interrupted in December 2025. The explanation patients received, he says, was its cost, approximately EGP 2,000 to EGP 2,500 per pack.
“This decision puts patients under a major financial burden, especially as most cannot work because of their health. If the medicine is expensive for the insurer, how can a patient without a stable source of income afford it?” Hassan asks. He points to the risks associated with high phosphate levels, including severe bone pain, persistent itching and effects on the parathyroid glands, which can damage patients’ general health and quality of life.
He calls on the authorities to reconsider the interruption and provide the medicines people with kidney failure need. Regular treatment, he stresses, is a medical necessity, not an optional expense that can be postponed or transferred to the patient.
Mahmoud Fouad, head of the Right to Medicine Association, says universal health insurance faces fundamental challenges in making medicines and treatment available for people with serious and chronic conditions. Complaints about administrative approvals and funding decisions, he notes, have appeared not only during trial operations but also in governorates where the system has been fully implemented, including Port Said, Ismailia, Suez and Luxor.
Some kidney-failure patients struggle to obtain appropriate treatment because of medicine shortages and limited dialysis capacity, he says. Growing reliance on contracted private centres may impose additional burdens, whether through longer waits or costs associated with particular services, including blood transfusions in some cases.
“Shortages of certain essential medicines, particularly cancer treatments and immunosuppressants after organ transplantation, are partly connected to delayed deliveries caused by outstanding debts owed by purchasing bodies, disrupting supply chains,” Fouad tells Zawia3. “This crisis is not confined to universal health insurance; it extends across the pharmaceutical sector.”
He adds: “Some patients complain about original medicines being replaced by generics. This may be connected to pharmaceutical-market conditions and import difficulties, alongside cost pressures. Although generic medicines are medically approved, the reluctance of some patients and doctors to accept them creates mistrust and affects the treatment experience.”
Fouad believes the greatest difficulties arise in advanced conditions such as kidney failure, organ transplantation and heart disease, where treatment needs and costs are higher than for basic services, which operate more consistently. He also highlights continuing controversy over the lack of coverage for devices such as insulin pumps and continuous glucose monitors for children, despite their use internationally, in the absence of a clear funding decision within the system.
He recommends a comprehensive and transparent assessment of the first phase before the second expands into governorates with larger populations and different economic circumstances. Financing and oversight mechanisms also need review to prevent further costs falling on patients. People pay higher contributions under the new system than under the old one, he says, raising their expectations of service quality and availability.
For Fouad, success requires addressing medicine availability, supply-chain performance and oversight of providers, alongside periodic evaluation of the experience. These are necessary to achieve the system’s central objective: fair and safe healthcare for everyone.
Financial burdens and bureaucratic procedures
Alongside complaints about the comprehensive system, Alexandria MP Mohamed Gibril, the Mostaqbal Watan Party’s parliamentary-affairs secretary in the governorate, submitted a request for information on 2 February 2026 concerning the Health Insurance Organization’s failure to provide services to workers and pensioners despite collecting contributions. His request concerns the traditional health-insurance system, not the Universal Health Insurance Authority. It cannot, on its own, serve as evidence about the new system’s first phase, although it illustrates wider problems with access to care.
Gibril said the organisation collects full insurance contributions from salaries and pensions while failing to provide the corresponding care. He described this as a violation of social-insurance and pensions legislation and social-protection principles, calling for services to be restored without delay and for accountability among company management and insurance officials responsible for shortcomings.
As universal health insurance has been introduced gradually, accumulated contributions have become a financial burden for many beneficiaries in first-phase governorates. A Zawia3 investigation published in February 2025 documented people unexpectedly discovering substantial debts after receiving no advance explanation of how contributions were calculated or what payment obligations applied to them. In some cases, arrears reached tens of thousands of pounds.
The consequences were not solely financial. Beneficiaries described being unable to complete essential government transactions, including renewing driving licences and obtaining official documents, until the debt was paid or a repayment arrangement agreed. Some turned to borrowing or other difficult financial solutions, according to the testimonies collected.
These arrears were linked to insufficient public information, complications in coordination between institutions, and problems affecting informal workers or people whose deductions were irregular. The result was a gap between collecting contributions and ensuring that the insured person could actually obtain healthcare.
Dr Eirene Saeed, a member of parliament’s Health Committee and head of the Reform and Development Party’s parliamentary bloc, says the state has moved towards instalment arrangements rather than requiring all arrears to be paid at once. She argues that full cancellation would be difficult to reconcile with fairness among contributors. Informal workers present a particular challenge because there is no direct payroll-deduction mechanism, making the link between access to services and payment a principal means of securing contributions.
Article 40 of Universal Health Insurance Law No. 2 of 2018 identifies contributions from insured people and their dependants as a source of the authority’s resources. A person with more than one job must contribute on all the income concerned. The head of a household must also pay the prescribed contributions for a non-working wife or one without a stable income, and for children and other dependants. Contributions for children and dependants continue until employment, or marriage in the case of daughters, under the article’s wording.
The article requires covered employers to contribute four percent of an insured employee’s contribution wage each month, subject to a minimum of EGP 50, for sickness, treatment and occupational-injury insurance. The law distinguishes regular insurance contributions from payments made when receiving a service. Its exemption for people unable to pay and those with chronic diseases or cancer concerns service co-payments under the relevant conditions; the Treasury pays insurance contributions for people classified as unable to pay. Exemption from a co-payment is therefore not a blanket exemption from regular contributions for everyone with a chronic illness.
Other resources include returns on invested funds and reserves, domestic and external grants, loans contracted by the government for the authority, and gifts, subsidies, donations and bequests accepted by its board. The law also specifies other resources, including levies associated with tobacco products, cigarettes, toll roads and vehicle-licence renewals.
Saeed tells Zawia3 she has not received direct complaints establishing that patients were formally charged additional costs within the system. She acknowledges, however, that some may pay out of pocket to bypass waiting times or procedural complications. Waiting lists and faulty equipment can lead people to seek tests or treatment elsewhere to obtain care more quickly.
“The main complaints identified since implementation began have involved patients moving between hospitals and insurance bodies to obtain approvals, shortages of certain medicines and supplies, equipment faults and insufficient technicians,” she says. “These sometimes lead to postponed services or repeated medical procedures.”
She attributes some approval delays, including for chemotherapy and surgery, to bureaucracy arising from the institutional separation between the body financing and purchasing care and the bodies delivering it. The main problem, in her view, is coordination and connection between institutions rather than the referral system itself, which she describes as a normal arrangement used in other countries.
Medicine and supply shortages, she adds, extend beyond universal health insurance to Egypt’s pharmaceutical market more broadly. She cites dependence on imports for more than 95 percent of pharmaceutical raw materials, making supply chains vulnerable to changes in international economic conditions and affecting availability and pricing.
Asked about readiness for the second phase, Saeed says implementation is behind schedule but Egypt cannot afford to retreat. The difficulties are not limited to infrastructure. They also concern weak links and coordination between the legally established institutions, particularly the Healthcare Authority as a service provider and the Universal Health Insurance Authority as purchaser and funder. Patients experience that institutional complexity as delays in securing approvals.
“In the first phase, government hospitals carried most of the load, while private-sector participation was relatively weak,” she says. “That is one of the shortcomings, because the philosophy of universal health insurance is based on multiple providers: government, private and university facilities.”
Saeed doubts that nationwide coverage can be achieved by 2030 under the proposed timetable, given current implementation delays. She connects the second phase’s success to resolving procedural weaknesses, strengthening institutional integration and expanding private and university participation, so that care becomes more efficient and patients face fewer burdens.
Separated institutions, fragmented care
Karim Tarek, a researcher in universal health-coverage systems, says assessment in Egypt still prioritises quantity over quality. Official reporting emphasises investment volumes, beneficiary totals and paid claims as evidence of success, while service quality and patients’ experience receive less attention.
Despite improvements to infrastructure and the adoption of quality standards, operational challenges persist, he tells Zawia3. He attributes recurring problems, such as delayed treatment approvals and difficulties obtaining medicines or devices, primarily to piecemeal complaint handling that resolves individual cases without addressing underlying causes.
“One of the main challenges is the institutional structure, which separates financing, service provision, oversight and quality,” Tarek says. “This has produced a degree of fragmentation, with each body pursuing its own objectives without enough integration to ensure the system works efficiently as a whole. Some bodies may consequently carry costs that available funding does not cover, and patients may face additional expenses in some cases.”
He argues that management has increasingly adopted an economic and investment focus, emphasising expenditure control and financial sustainability, sometimes at the expense of patients’ rights and care quality. Some shortages also reflect external factors, such as import difficulties or increased demand, rather than funding decisions alone. The absence of clear mechanisms to manage those pressures, he says, makes them more severe.
Tarek links additional charges paid by patients, particularly at contracted private facilities, to delayed payments by the insurer. In his account, some providers seek the difference from patients to keep services running. He considers this evidence of a problem in the financing and contracting cycle, rather than merely isolated misconduct.
He believes the issue is not an absence of rules, but weak governance and oversight of implementation. Protecting patients’ rights requires functioning monitoring and accountability, he says, rather than relying solely on responses to individual complaints.
“The regulatory framework provides mechanisms to monitor contracted facilities,” Tarek adds. “In practice, however, implementation remains inadequate. Oversight appears irregular in some governorates and does not always ensure providers meet the required standards.”
Success in the second phase, he argues, will depend on more than buildings and equipment. Public understanding of the new system, the geographical distribution of services and the availability of trained staff all matter. Differences in poverty levels between governorates may also affect implementation. Addressing these problems requires higher health spending, stronger governance and sustainable policies that prevent recurring crises, rather than temporary remedies.
Governance and Minya’s readiness
Patient complaints and the first phase’s operational difficulties have intensified questions about preparations for expansion. In March 2026, Hussein Gheita, an MP representing the Egyptian Social Democratic Party, submitted a request for information to the government and Health Ministry about preparations to introduce the system in Minya from April, the date announced at that time.
He noted that a governorate with more than six million residents requires extensive preparation. Hospitals and health units must be developed and accredited to quality standards, sufficient medical and technical staff must be available, and infrastructure and equipment, including intensive-care beds, imaging and laboratory services, must be ready.
Gheita asked the government to clarify the number of qualified facilities, their actual operational readiness, the geographical distribution of services, and plans for staffing and operation. These details, he argued, are essential if comprehensive care is to be delivered efficiently from the outset.
Dr Alaa Ghannam, head of the right-to-health unit at the Egyptian Initiative for Personal Rights, considers expansion the state’s real test. The first phase involved relatively small governorates with comparatively better health infrastructure, which helped implementation. Minya’s population approaches the combined population of the first-phase governorates. It therefore requires a much higher degree of preparedness in both infrastructure and service organisation, particularly in villages and rural areas.
“Starting the second phase under the current economic conditions is itself a positive step,” he tells Zawia3. “But it remains a major challenge that will genuinely test the system’s capacity to expand and remain sustainable. Its success will only become clear when it is implemented in larger governorates.”
On staffing, Ghannam argues that distribution is a greater problem than absolute numbers: doctors are concentrated in Cairo and Alexandria while other regions face relative shortages. Integrating university hospitals, he believes, could improve access, particularly in Upper Egypt, by drawing on existing facilities and personnel.
He regards referral arrangements as a central part of organising care under universal health insurance. They need effective implementation through digital systems and training for family doctors, however, so that referral does not become a bureaucratic obstacle delaying treatment. Delays or inadequate capacity at contracted hospitals, he says, are primarily management problems.
“Good governance is the cornerstone of the system’s success,” Ghannam adds. “The absence of clear mechanisms, including patients’ rights committees, boards of trustees and transparent data, makes it difficult to assess performance or hold officials accountable.” Every complaint, he argues, requires a clear and transparent response, because silence or a lack of explanation weakens confidence.
He says the next phase should prioritise governance, accurate and accessible data, and a shift from reports listing achievements to meaningful assessments that acknowledge problems and address them. That would support the system’s sustainable development rather than merely document its expansion.
Ghannam continues to see universal health insurance as an essential means of securing treatment, particularly for people unable to pay, in principle. He acknowledges that implementation still faces difficulties, requiring continuous monitoring and evaluation as the programme grows.
A dispute over priorities
Dr Mohamed Hassan Khalil, head of the Right to Health Committee and a leading member of the Egyptian Socialist Party, sees deep structural weaknesses in both the design and implementation of the programme. These, he argues, raise serious questions about readiness for the second phase on the announced schedule. He criticises the decision to leave major population centres such as Cairo and Alexandria until later stages as evidence of misplaced priorities. Subsequent changes intended to accelerate the timetable, he says, have not been matched by a comparable increase in implementation speed.
“Actual coverage remains limited compared with the target,” Khalil tells Zawia3. “What has been achieved over recent years is not proportionate to the stated aim of comprehensive coverage within a short period. That raises doubts about whether the system can realistically be completed under the current timetable.”
He says coverage has not reached every resident of governorates where implementation has been announced. In some cases, he argues, it has mainly involved transferring existing beneficiaries from the old system and adding limited groups, leaving sections of the population outside coverage, particularly in rural areas and among more vulnerable communities. He also criticises the new contribution and co-payment arrangements as imposing heavier financial burdens than the previous system.
Operationally, Khalil believes the system lacks essential resources, notably funding, personnel and infrastructure. In his assessment, government health spending remains below constitutional and international benchmarks, affecting the availability of medicines and supplies and contributing to delayed or reduced services.
He connects doctor shortages and emigration, low pay and a declining number of government-hospital beds with recurring complaints about approvals, medicine shortages and patients having to pay extra. These difficulties, he argues, stem directly from insufficient funding and distorted spending priorities.
Achieving universal coverage, in his view, requires more than geographical expansion. It demands integrated reform: increased government health spending, improved conditions for healthcare workers, stronger infrastructure and a review of legislation governing equitable access. Protecting the right to health therefore requires reconsidering current policies to secure fair and sustainable services for everyone.
As the Health Ministry prepares for the announced April 2026 trial in Minya, continuing complaints about treatment approvals, administrative procedures and additional costs place service quality at the centre of the expansion debate. Healthcare and pharmaceutical specialists and parliamentarians interviewed for this report differ on aspects of the system, but identify overlapping priorities: stronger governance and oversight, reliable supplies and staffing, better coordination and, for some, wider participation by private and university providers. The question is whether these operational weaknesses can be addressed so that geographical expansion translates into timely, fair and sustainable care.
