The undersigned organizations have followed the Prime Minister’s decree No. 1063 for the year 2014, issued last month, which obligates all hospitals, public or private, to provide emergency and trauma patients with free treatment for up to 48 hours. The cost of such an arrangement, according to the decree, is covered from the budget allocated to state-funded patient treatment.

The organizations signatory to this statement reaffirm the importance of activating Article 18 of the Egyptian Constitution, which criminalizes denial of any form of medical treatment to any person in emergency or life-threatening situations. However, the realization of this right in the form of a decree by the Prime Minister, unsupported by clear mechanisms or bylaws casts a lot of doubts on the seriousness and effectiveness of this decree’s enforcement. The undersigned organizations believe that this right should be governed by a detailed legislation accompanied by bylaws that provide specific answers to fundamental questions to ensure that the decree fulfills its objectives.

The decree does not make clear what is meant precisely by emergency and trauma cases. Is there a specific definition or a binding list of such cases? What is the set of services covered by the decree and what are the clinical and administrative guidelines followed in each case? Is there a standard pricing system that all medical facilities will commit to, particularly investment-sector hospitals, and what is the reimbursement mechanism? What mechanisms would be used to prevent intermediaries, whether within or from the outside of the healthcare system, from profiteering, and to protect against the creation of false demand for the service by service providers? What are the guarantees that all medical facilities are equipped to receive and provide service to such cases, especially public sector and public business-sector hospitals? What is the coordination mechanism among emergency services providers, the ambulance service, and the central operations room for emergency care services? And finally, what is the agency charged with monitoring the enforcement of this decree and that can provide recourse in situations when it is not enforced?

In the absence of clearly communicated answers to these questions, this decree will end up like many of the poorly-deliberated decisions taken by the government which do not lead to the concrete realization of rights. This will only widen the gap of distrust between citizens and the policies and practices of the government, and such decisions will remain political decisions that lack any real enforcement mechanisms.

The undersigned organizations stress the need to find an alternative framework for decision-making and for the governance of the health sector to form the basis for creating strategic themes and radical interventions for the reform of health sector, starting by comprehensive strategic planning and including all stakeholders: medical providers, users of health facilities and government officials. Only then will there be an effective and sustainable impact on the health system, instead of its continued deterioration through the isolated efforts and partial solutions.

Signatories:

• Association of Health and Environmental Development
• The Egyptian Initiative for Personal Rights
• Egyptian Center for Economic and Social Rights
• Association of Health Care Workers