{"id":17377,"date":"2025-08-19T18:18:58","date_gmt":"2025-08-19T16:18:58","guid":{"rendered":"https:\/\/zawia3.com\/?p=17377"},"modified":"2026-10-24T15:04:43","modified_gmt":"2026-10-24T13:04:43","slug":"privatisation","status":"publish","type":"post","link":"https:\/\/zawia3.com\/en\/privatisation\/","title":{"rendered":"Egypt\u2019s Hospital Concessions: Who Protects Patients When Private Operators Take Over?"},"content":{"rendered":"

The Egyptian Ministry of Health is moving to offer around 40 health facilities to the private sector over the next few months as part of implementing the law granting the management and operation of government hospitals to the private sector. According to government<\/span> sources<\/span><\/a>, these include hospitals already operating in a number of governorates and a number of hospitals under construction in the new cities, in a step that has sparked wide controversy in medical and social circles, as it comes within a broader trend of strengthening the private sector’s role in delivering public services, especially in light of the funding challenges facing the state.<\/span><\/p>\n

While the government says it seeks through this step to improve the quality of health services, attract new investment to the sector and ease the financial burden on the state budget, fears are growing among citizens, especially those on limited incomes, of a possible decline in access to free or subsidised treatment and a rise in the cost of health services.<\/span><\/p>\n

The government’s privatisation plan is based on<\/span> Law<\/span><\/a> No. 87 of 2024 on regulating the granting of public utility concessions for health facilities, legislation ratified by President Abdel Fattah El-Sisi on 23 June 2024 and published in issue 25 (bis) of the Official Gazette, bringing it into force. The law aims to establish an organised legislative framework for the mechanism of assigning the construction, operation, management and development of public health facilities to private-sector entities or investors through the concession system, which is considered one of the tools of public\u2013private partnership for developing services and improving their efficiency.<\/span><\/p>\n

The law allows the competent authorities to conclude concession contracts with specialised companies or entities to build and operate public hospitals and provide healthcare services, with strict controls to ensure the quality of service and protect patients’ rights, while affirming that the state will continue to supervise and monitor those facilities.<\/span><\/p><\/blockquote>\n

On the other hand, the law explicitly excluded from the application of its provisions primary healthcare centres and units and family health centres, which represent the first level of public health service delivery, because of their particular nature and their direct link to preventive health and basic community services. The law also excluded blood operations and plasma collection activities, which remain subject to the provisions of Law No. 8 of 2021 regulating this sensitive sector, except for those of these activities considered complementary services falling within the scope of the concession, at the discretion of the competent authorities.<\/span><\/p>\n

Earlier, lawyer and rights advocate Khaled Ali filed a<\/span> lawsuit<\/span><\/a> before the State Council demanding the annulment of the law and the suspension of its implementation pending a ruling on its constitutionality. In his lawsuit, Khaled Ali argued that the law opens the door to privatising a vital sector that touches on the constitutional right to health and carries risks that threaten to weaken the ability of poor groups to obtain treatment, and he called for a halt to all procedures related to offering hospitals to the private sector until the law’s conformity with the provisions of the Constitution is confirmed, especially with regard to guarantees of equality and citizens’ right to accessible and safe health services, away from the logic of profit.<\/span><\/p>\n

 <\/p>\n

Recommended reading:<\/b> Who Bears Responsibility for the Suffering of Harmal Oncology Centre Patients after Privatisation?<\/b><\/a><\/p>\n

<\/span>Who Will Treat Millions of the Poor?<\/b><\/h1>\n

The talk of privatising government hospitals coincides with official<\/span> figures<\/span><\/a> pointing to a marked expansion of the umbrella of free health services over the last ten years, in tandem with escalating economic crises, particularly within the framework of the presidential initiatives and the Universal Health Insurance system, which primarily aimed to expand free medical services for the poor and those entitled to them. This raises concerns about the extent to which these plans can continue as the state moves toward assigning the management of some hospitals to the private sector. According to government data, Egypt saw a large increase between 2014 and 2024 in the number of citizens benefiting from free health services: the number of insured people<\/span> rose<\/span><\/a> from 54 million citizens in 2014 to around 70 million in 2024, a growth rate of 29.6%.<\/span><\/p>\n

In parallel, poverty rates in Egypt have grown markedly in recent years, directly affected by the burden of economic decisions and waves of inflation. According to data from the Central Agency for Public Mobilisation and Statistics, the poverty rate rose from 27.8% in 2015 to 32.5% in 2017\/2018, following the floating of the exchange rate and the lifting of fuel subsidies. Although poverty rates recorded their<\/span> first<\/span><\/a> marked decline, to 29.7% by 2019\/2020, driven by the expansion of social protection programmes such as “Takaful and Karama”, the upward trend clearly re-emerged in the following years. Official and unofficial<\/span> estimates<\/span><\/a> showed the poverty rate rising again to 32.5% in 2022,<\/span> reaching<\/span><\/a> 33.3% in 2023, amid expectations that it will exceed the 36% threshold by 2025, given continuing high inflation rates, which reached 42.6% in rural areas, and the decline in the purchasing power of low-income households.<\/span><\/p><\/blockquote>\n

In light of this, the state launched several large-scale health initiatives, most notably the<\/span> initiative<\/span><\/a> “100 Days of Health”, which from June 2023 to January 2024 provided around 60.1 million free medical services, including preventive and therapeutic examinations in all governorates. In addition, 16.4 million citizens benefited from the initiative for early detection and free treatment of chronic diseases and kidney disease, while the suffering of more than 2.5 million cases that had been on waiting lists for surgery and treatment was ended during the same period.<\/span><\/p>\n

Despite the official figures speaking of the expansion of the Universal Health Insurance system, this system still faces wide<\/span> criticism<\/span><\/a> over the slowness of its implementation and its effectiveness on the ground. While government data indicate that the governorates of Port Said, Luxor, Ismailia, South Sinai, Aswan and Suez saw around 3 million medical and therapeutic services provided in the first quarter alone of the 2024\/2025 fiscal year, benefiting more than 870,000 citizens, this figure remains limited compared with the size of the population and the scope of actual need for health services, particularly in poor and most marginalised areas.<\/span><\/p>\n

Added to this, the presidential initiatives, despite their enormous scale on paper, having recorded the provision of more than 218 million medical services to around 94 million citizens through 3,527 health units up to 2024, remain temporary initiatives that treat crises within specific campaigns without offering radical solutions to the structural crises in the sector, such as staff shortages, dilapidated infrastructure and disparities in service quality between governorates.<\/span><\/p>\n

With regard to the health sector’s infrastructure, the<\/span> data<\/span><\/a> issued by the Central Agency for Public Mobilisation and Statistics showed that the number of hospitals in Egypt, both government and private, rose from 1,673 hospitals in 2014 to 2,700 hospitals in 2024, an increase of 61.4%. The number of government hospitals remained relatively stable at around 664 until 2021, while the number of government beds rose to 88,597 in the same year, amid continuing demands to increase capacity to meet the growing demand for health services.<\/span><\/p>\n

Likewise, the number of university hospitals<\/span> increased<\/span><\/a> from 88 hospitals in 2014 to 125 hospitals by 2023, and these hospitals provided their services to more than 24.5 million patients during the 2023-2024 fiscal year. In terms of treatment at state expense, around 20.4 million citizens benefited over the past ten years from 33.9 million treatment decisions, at a total cost of EGP 114.2 billion, according to Ministry of Health data.<\/span><\/p>\n

Despite this quantitative expansion, public health experts believe that the absence of guarantees in the new privatisation contracts threatens to shrink the scope of these free services, particularly as the management of hospitals is left to market considerations and the profitability of private institutions, without clarity on oversight and accountability mechanisms.<\/span><\/p>\n

 <\/p>\n

Recommended reading:<\/b> The Repercussions of Abolishing the Mandatory Assignment of Doctors in Egypt<\/b><\/a><\/p>\n

<\/span>Aborting Plans to Develop the Health System<\/b><\/h1>\n

Dr Mohamed Hassan Khalil, coordinator of the Right to Health Campaign and a cardiology consultant, says that since the issuance of the January 2014 Constitution, which obliged the state to allocate a minimum of no less than 3% of gross national product to government spending on health, hopes had been pinned on improving the healthcare system and approaching the international standards recommended by the World Health Organization, estimated at around 6% of gross domestic product, roughly equivalent to 15% of the state’s general budget. However, reality over the past years revealed a glaring gap between these constitutional obligations and the actual reality of spending, which remained low and even declined in some periods.<\/span><\/p>\n

He adds, in a statement to <\/span>Zawia3<\/b>: “In the three years following the adoption of the Constitution, government spending on health rose slightly to reach 1.7% of gross domestic product, far below the constitutional minimum, before the ratio declined again with the implementation of the economic reform programme in cooperation with the International Monetary Fund in 2016, which imposed contractionary policies that weakened social allocations, foremost among them health.”<\/span><\/p><\/blockquote>\n

According to the official data that Khalil refers to in his conversation with us, government spending on health reached its lowest level in the 2024-2025 draft budget, where it did not exceed 1.17% of gross domestic product, an extremely small share, especially when compared with the averages of Africa, the world’s poorest continent, let alone global rates, which reflects a serious imbalance in public spending priorities.<\/span><\/p>\n

Added to this is a deeper problem related to the composition of health financing sources in Egypt: direct out-of-pocket spending by citizens accounts for around 71% of total health spending, compared with a global average of no more than 19%, which means that illness in Egypt turns into a heavy economic burden that pushes families toward poverty when they face health crises, according to Khalil.<\/span><\/p>\n

As for the components of healthcare, Dr Mohamed Hassan Khalil believes that they have seen a marked deterioration in indicators of the availability of hospital beds and medical staff. In the 1960s, the number of beds reached 22 beds per 10,000 citizens, while this rate has now shrunk to just 8.1 beds, compared with a global average of 29 beds.<\/span><\/p>\n

Speaking to Zawia3, the coordinator of the Right to Health Campaign affirms that the situation is no better with regard to doctors and nurses, as the ratios have fallen to around half the global rate as a result of the large-scale migration of medical talent abroad, fleeing low wages, a poor working environment, difficulty in obtaining training and the absence of job security. Official figures estimate that between 120,000 and 150,000 Egyptian doctors work abroad, a figure close to the total number of doctors working inside the country, which portends a structural crisis in the availability of medical staff.<\/span><\/p>\n

<\/span><\/p>\n

Regulatory Laws or Burdens Weighing on Citizens?<\/b><\/h1>\n

On the legislative front, Khalil notes that the Universal Health Insurance Law No. 2 of 2018 is among the most prominent changes. Despite the positive amendments made to it compared with its first drafts, practical implementation went against the promises: the new health insurance continued to cover fewer than 4.5 million citizens until the end of 2023, only about 4.2% of the population, while the goal was to cover 100% by 2030, according to government statements.<\/span><\/p>\n

The biggest problem in the new law, according to Khalil, lies in loading additional burdens onto citizens, whether through financial contributions when receiving services or by transferring the burden of insuring children and wives to the head of the household, as well as reducing employers’ obligations. Likewise, the past years have seen the imposition of new taxes and fees to fund the insurance, most notably on cigarettes and tobacco and on car licence renewals, which increases the tax burden without real guarantees of improving the level of services.<\/span><\/p><\/blockquote>\n

He adds: “As for the latest government strategy for developing the health system, it was manifested in the issuance of the law granting concessions for the management of health facilities to the private sector in May 2024, which allows state hospitals to be leased to Egyptian or foreign investors for periods of up to 15 years, portending a gradual transformation of government hospitals into profit-making entities, with an unspecified proportion of beds allocated to health insurance patients and treatment at state expense, which threatens to weaken the ability of poor groups to obtain the service.”<\/span><\/p>\n

Dr Mohamed Hassan Khalil warns that this trend toward privatising healthcare, whether through leasing or partnerships with the private sector, does not address the core of the problem, namely weak government spending, eroding health infrastructure and a shortage of medical staff, but may instead lead to further discrimination in access to treatment and worsen the crisis of health justice.<\/span><\/p>\n

Despite some positives, such as improved indicators of maternal and child mortality and the expansion of early detection initiatives such as the 100 Million Healthy Lives campaign, these, in his view, remain limited and closer to seasonal propaganda campaigns that do not address the roots of the crisis related to the weakness of the comprehensive health system and the lack of sustainability in the provision of services. He affirms that Egypt has a long-established medical legacy, but privatisation policies and weak funding are aborting this history, stressing the need to return to the principles of health justice enshrined in the 2014 Constitution and to ensure the state’s commitment to bearing primary responsibility for financing and securing treatment for all citizens, away from the logic of profit.<\/span><\/p>\n

The system faces accumulated<\/span> crises<\/span><\/a>, foremost among them weak infrastructure, underfunding and the deteriorating conditions of medical staff, along with the economic pressures facing the state as a whole. Despite the constitutional text obliging the government to raise health spending to no less than 3% of gross national product, official data indicate that actual spending does not exceed 1.2%, a figure far from meeting the sector’s growing needs, at a time when chronic diseases are spreading and poverty rates are rising.<\/span><\/p>\n

In addition, it suffers from an acute human resources crisis: thousands of doctors and nurses leave Egypt every year in search of better working conditions, given low salaries and the poor capabilities of government hospitals. This reality has left public health institutions unable to keep pace with the growing demand for medical services, especially in poor areas and rural regions. At the broader economic level, the government faces mounting pressures because of the financial crisis, rising debt and falling revenues, which pushes it to search for solutions that reduce the burden of public spending without the need to inject huge investments from the public treasury.<\/span><\/p>\n

<\/span><\/p>\n

How Should We Read the Repercussions of Hospital Privatisation?<\/b><\/h1>\n

The government’s plan to privatise government hospitals is consistent with a new investment and legislative environment that<\/span> is being<\/span><\/a> carefully prepared to attract foreign capital to the health sector, which raises questions about the direct relationship between opening the door to international companies to invest in health and the issuance of the law granting concessions for the management and operation of public health facilities to the private sector in mid-2024.<\/span><\/p>\n

In recent years, Egypt has seen a number of major foreign companies enter the healthcare sector, most notably the Humania<\/span> group<\/span><\/a>, which is run by the Saudi German company in partnership with European financing institutions and which<\/span> launched<\/span><\/a> an international hospital project in Cairo with a huge capacity, in addition to the<\/span> investments<\/span><\/a> of the British fund (CDC) in the Alfa medical group, and deals announced by the Egyptian sovereign fund in cooperation with the American Concord to establish specialised health funds with capital of hundreds of millions of dollars.<\/span><\/p><\/blockquote>\n

These investments come in an official context calling for strengthening the role of the private and foreign sectors in providing medical services, which culminated in the issuance of Law No. 87 of 2024, which for the first time regulates assigning the management and operation of government hospitals to the private sector, whether local or foreign, through concession contracts of up to 15 years covering the construction, operation and development of public health facilities. While the government says the law provides a transparent framework that ensures the continued provision of health services to citizens and protects the rights of groups unable to pay, specialists believe that the current provisions lack real legal guarantees restricting the logic of the market and profitability, especially in the absence of clear oversight mechanisms or binding requirements setting the proportions of beds allocated to free or subsidised treatment in these hospitals after their privatisation.<\/span><\/p>\n

Researchers warn that foreign companies, despite their promises of technology transfer and improved efficiency, may gradually push toward transforming public health institutions into purely commercial entities, particularly amid economic crises and rising poverty rates, which threatens to reduce the opportunities of millions of citizens to obtain affordable health services on which the most vulnerable groups had relied.<\/span><\/p>\n

In this context, health affairs researcher Karim Tarek expresses his concerns about the repercussions of the hospital privatisation plan, stressing that the real problem lies not only in the principle of assigning management to the private sector, but in the absence of clear guarantees protecting the citizen’s right to treatment.<\/span><\/p>\n

He tells Zawia3: “I have seen the news about offering more than 40 hospitals to the private sector, whether through management or operation, for periods ranging from three to fifteen years, but we face two main problems that we have expressed repeatedly before.” He explains that the first of these problems relates to the lack of clarity about the mechanism that ensures the continued provision of treatment services to citizens at state expense in these hospitals after their management passes to the private sector, saying: “There are no real guarantees that these hospitals will remain committed to providing affordable treatment services to the most vulnerable groups, and there is no clear oversight body to monitor performance or hold the new institutions accountable in the event of shortcomings.”<\/span><\/p>\n

The second problem, according to Tarek, is the possibility of laying off workers in those hospitals at a rate that may reach 75% of the total workforce, based on the operator’s assessment, which raises legitimate fears about the fate of these employees and their professional future, especially in the absence of any announced plans to provide alternatives for them.<\/span><\/p>\n

The researcher specialising in health affairs affirms that the existing objection does not target the idea of private-sector management of hospitals in itself, but focuses on the lack of transparency, weak oversight and the absence of legal obligations guaranteeing improved medical services without loading additional financial burdens onto citizens. He cites the experience of Harmal Hospital, which, according to rights reports, saw delays in dispensing medicines and providing treatment to some patients after contracting with private entities to manage it, considering that “this incident represents an early warning of what the rest of the hospitals may witness if the expansion of privatisation continues without clear controls”.<\/span><\/p>\n

He adds: “There is still a large gap in official information about the hospitals offered for privatisation, the number of patients benefiting from free treatment in them and the volume of services provided to low-income groups, all factors that make it difficult to assess the extent of the decision’s impact in the near term, not to mention the impossibility of measuring the real social and economic impact before sufficient time has passed, which deepens our fears of absent oversight and weak accountability.”<\/span><\/p>\n

 <\/p>\n

Editorial correction: The first version of the report stated that the Constitution obliged the state to government spending on health of no less than 3% of gross domestic product; in fact, Article 18 of the 2014 Constitution stipulates a share of no less than 3% of gross national product.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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