Statement by the Committee for the Defense of the Right to Health (no. 8) 

The Committee for the Defense of the Right to Health welcomes the Egyptian government's response to objections put forward by the Council of State and Egyptian civil society organizations to a draft Presidential Decree on the establishment of an Egyptian Emergency Medical Services Agency (EMSA). The final version, Presidential Decree (No. 139/2009), was issued on 3 May 2009 containing significant improvements made by the government to the original draft.

The government has not made any public announcement, to date, on the establishment of the new agency or the issuance of the new Decree, which was published in the Official Gazette on 4 May 2009 and entered into force the following day. The new agency will act as a national regulator and service provider for ambulatory care in all 28 governorates.  

The first draft of the Presidential Decree was published in some newspapers in October 2008, shortly after which the Committee for the Defense of the Right to Health, a coalition of more than 20 Egyptian non-governmental organizations, released a statement containing a detailed account of its objections to it. The Committee considered the original draft to be a de facto privatization of the free emergency services by transferring control to a profit-making entity under the pretext of improving and elevating the service. In its previous statement the Committee had endorsed the position of the Council of State, whose legislative department had submitted similar objections when the draft was first presented to it for an advisory opinion, before returning it to the Ministry of Health with a request for the amendment of a number of its provisions.

The view of the Committee for the Defense of the Right to Health is that the Decree, in its final form, is largely in compliance with the demands of the Committee to ensure the right of Egyptians, as well as non-Egyptians residing in Egypt, to access emergency medical services free of charge. In order to stress the non-profit nature of the new agency, Article 1 of the Decree now stipulates that the EMSA is "among public service authorities."

More importantly, the revised Decree includes a new provision which states that the first objective of the agency is "to provide free medical emergency services to all citizens and residents of the Arab Republic of Egypt, irrespective of their curative or insurance schemes, in the case of accidents, disasters or emergencies or any other conditions to be determined by the Board of the Agency." This provision is radically different from the original proposal of the Ministry of Health, which stated that "the Agency provides its services to all individuals [..] and has the right to recover the costs it bears in exchange for the service delivery."

In line with the same approach to maintain the public-service nature of the emergency agency, the final Decree states that the budget of the new agency be prepared "along the same lines of the public state budget" instead of the formulation of the original text, which stated that the budget should follow "the pattern of commercial budgets." The final text also deletes the language related to the enjoyment by the agency of "technical, financial and administrative independence" and its management through its own financial and administrative bylaws.

The original attempt by the government to privatize the emergency medical service sector, turning it into a profit-making project that collects fees for services, had come as a surprise, even against the background of the general tendency of the current government towards the privatization of health services in general. The World Bank and other donor agencies, which encourage the state to withdraw from providing health care services and instead purchase them from the private sector, nonetheless agree that the limited role left for the state should be restricted to four areas, which are policy formulation, defining quality criteria and monitoring their implementation, compulsory vaccinations and ambulatory care.

In its final version the Presidential Decree also sought to reduce the authority exercised by the Minister of Health over the board of the EMSA. The decree states that the Chair of the agency be appointed by the Prime Minister and not the Minister of Health as was the case in the original draft. The appointment is made upon a recommendation by the minister. Two further provisions were also removed from the draft of the decree, one of which accorded  the minister "the authority to supervise, monitor and instruct the agency" as well as the right to dissolve its board, while the other entitled the minister to the endorsement of the agency's budget and balance of profits and losses via a ministerial decree.

On the other hand, the Committee for the Defense of the Right to Health warns against the expansion in the interpretation of article 7(5) of the Presidential Decree, which gives the EMSA board the right to specify a fee in exchange for some special services provided by the agency in cases other than accidents, disasters and emergencies. The Committee demands that the board, upon its appointment, immediately publicize those special services and their cost in full transparency to ensure that the provision is not used as a back door to burden citizens with financial obligations that would be a violation of the text and substance of the Presidential Decree. In its previous statement the Committee had stressed that despite the fact that current ambulance regulations stipulate free transportation of patients inside the city, patients are compelled to pay transportation fees across cities and governorates. Such fees sometimes amount to hundreds of pounds classified as administrative dues, a practice that has to be completely abolished upon the formation of the new agency. 

While the Committee for the Defense of the Right to Health celebrates this victory over the attempt to privatize emergency medical services, it commits itself to continue its struggle against the privatization of health services and the transformation of government and health insurance agencies from public-service providers into profit-making private companies, which would leave them prey to exploitation by private medical insurance companies.  

The text of the Presidential Decree is available at http://eipr.org/campaigns/ambulance.pdf