The Health Care Employment Market In Egypt By Dr. Mohamed Kamal MD, Quality Manager MBA, TQMD (AUC)
What is the labour market for health workers • The labor market for health professionals is derived from and directly connected to the market for health and medical services The process for delivering health-care services requires the input of health workers, along with other inputs, such as medicines, equipment and other health-care supplies. Clinics and hospitals have a demand for health workers in order to produce health services, which are demanded by purchasers of health care.
This point is often overlooked. The demand for health services is linked to the willingness of the government, patients, health insurers and other purchasers of health care, such as donors, to fund health services.
Egypt’s Health Care System • Public/Private/ Social Health Insurance NHS style government/public health system • Social Health Insurance (employer based and school children) Private Sector • % of GDP spent on Health: 6.3% (Canada: 10%) in 2006 – WHO estimates • Private expenditure on health as % of total expenditure on health (58.6%) – WHO estimates
The growing gap between the supply of health care professionals and the demand for their services is recognized as a key issue for health and development worldwide. Policy-makers, planners and managers continue to seek effective means to recruit and retain staff. One way to achieve this is to develop and implement effective incentive schemes.
What is the Labour Market? • Local? • Regional? • International? • Today’s labour market? • Tomorrow’s labour market? • The labour market in 30 years from now?
What Does the Labor Market Need? • Knowledge: Most up to date and Relevant education and learning • Skills: to use the knowledge and to mitigate and manage the challenges of work and life • Attitude: Positive – to work and develop individually, within groups and communities and probably within the world as a whole.
What are the Skills needed? • Strong thinking, communication, entrepreneurial skills, adaptability, labour market skills, problem solving, decision making, team work, responsibility and interpersonal skills Can this be a negative edge in traditional hierarchical work structures?
Human Resource Challenges in Egypt Egypt’s Health reforms in hospitals and the Family Health Model require changes in staff skills and mix. Workforce distribution poorly allocated: Between urban and rural areas Between primary, secondary, and tertiary care Among different specialties New management skills due to increasing complexity of health systems. The need` for linking training programs to actual staffing needs. 10
Do you know who this is? IMHOTEP Egyptian Born 27th century BCE Considered to be the first achitect, engineer and PHYSICIAN!
Future Outlook of Healthcare Industry • It is a unique industry!! : • The healthcare industry includes : Establishments ranging from small-town private practices of physicians who employ only one medical assistant Busy inner-city hospitals that provide thousands of diverse jobs. Combining : Medical hi-tech Human touch Communication tools Diagnostic facilities Treats and administer care around the clock to the need of million of all social classes of people and to the widest age group from intra-uterine to terminally elderly ill .
Outlook of HC employment : • In US; Healthcare will generate 3.2 million new wage and salary jobs between 2008 and 2018, more than any other industry, largely in response to rapid growth in the elderly population. In Egypt; Many job openings should arise in all healthcare employment settings as a result of the new strong movement towards investment and/or stimulation package for this sectors. Also the big NGO organizations. • New comers from abroad • THE EXPECTED INCREASE OF HEALTH BUDGUT TO 12% WITHIN 4 YEARS
The healthcare Opportunities • Medical tourism • the private-public partnerships • new legislation and the strong contribution of the non-governmental organization in the field of healthcare
Sustain its growth pace • There is a believe that healthcare industry is expected to sustain its growth pace in near future owing to the escalation of the burden of diseases. And inappropriate demographic balance which will create demand for better healthcare facilities.
GDP Growth & health conscious : • These countries have become more health conscious, leading to an increase in the usage of more expensive therapies and high innovative products.. A wide range of economic and structural reforms were adopted in the region while public and private investment projects were launched to pursue economic diversification and human capital development as well as investment in oil and gas, infrastructure, and other economic sectors.
Employment Demand for tele-medicine expert / data transfer & management expert / IT expert / healthcare economists / actuarial expert / Hi-tech maintenance will rise due to the fast growing of healthcare insurance sector including the social and the private one. Hospitals will be the slowest growing segment within the healthcare industry because of efforts to control hospital costs and the increasing use of outpatient clinics and other alternative care sites
Optimistic future : • The pharmaceutical industry, information technology and distribution are expected to grow. Moreover, biotechnology and R&D are expected to grow but at a lower rate.
According to the Egypt Human Development Report13, health professionals are concentrated in urban centres, such as Cairo and Alexandria, and Upper Egypt. • Study results reveal that, in these areas, private and parastatal health facilities are practically non-existent. Available public health facilities, in turn, are often poorly equipped, causing stress and frustration to health professionals. Moreover, these health facilities do not offer possibilities for further professional training and specialization
Example of Egypt Workforce Analysis Results Results of Workforce Assessment in one of the Pilot Governorates 21
Current Staff Profile Staff Composition 22
Current Staff Profile Registered vs. Actually Working Staff 23
The composition of nurse supply in selected EMRO countries (2005) • All nurses in countries of the region with the exception of Egypt, Yemen and Afghanistan have a minimum of 2 years post secondary education. • If the definition of nurses is restricted to qualified nurses (nurses who have at least 2 years of post-secondary/ high school education) then the ratio in Egypt drops to 0.18 nurses per 1000 population, which is an extremely low ratio by any standards.
Different types of nurses • There are 3 types of nurse education and predominantly three types of nurses in Egypt today: • High school nursing education which (referred to as secondary level school in Egypt) • Technical institute nursing education (2 years of post high school education) • University nursing education (4 years of post high school education)
-Conservative culture: women don't want to become nurses or work as nurses in Egypt The problem of the nurse image as a barrier for women to become nurses seems to be no longer an issue (except perhaps in Upper Egypt to a limited extent) -Government don't pay nurses enough to attract them to work with great workload Few nursing schools- not enough nurses being produced Nurses leave Egypt to work in the the Arabic/Persian Gulf
Past • Sporadic Unplanned Training. • Multiple Level of Education • Absence of Practice Law. • Inadequate Appearance. • Non coordinated Efforts for Improvement. • Limited Cooperation between MoH and MoEd. • Maldistribution
THE NURSE WE NEED • Upgrading nurses' knowledge, performance and attitude to comply with International standards capable of working in the region and internationally, consequently reflecting positively on nurses image.Building their knowledge and performance excellence on research evidence, community needs and international connections.
Current Status of Workforce Qualification • 201,669 Total numbers of nurses registered in Syndicate till Year 2006 • 6,2 % Bachelor Degree • 0.9 % Technical Institute Degree • 85 % Secondary Technical Institute Degree • 7.9 % Others
Current Status of Nursing Workforce With Respect to Int. Standards = Ratio of Nurses to population 0.27% = Number of nurses in registry 204,000 = Deficiency based on international standards 38,000 = Required nurses by 2020 242,000 = Required nurses by 2020 taking in consideration drop out rate of 4% 260,000
Conclusion of Current Status – Statistics 2008 Current Nursing No. 204,000 Nurses MOH 165,000 nurse Others 39,000 nurses Current No. of Nursing School 240 Nursing Schools No. of Nursing School Graduates Annually 6500 Nurses No. of Nursing Faculties Graduates 1200 Nurses No. of Technical Institutes Graduates 1000 Nurses Annual dropout Ratio (MOH Nursing) 4% from the total workforce Considering Total No. of Beds - MOH Primary Health Care 96,000 beds 5199 facilities International ratio 45,000 (-) nurse 51,987 (+) nurse
2,447 Figure Illustrating Deficiency in Some Governorates • Total • Def Primary • Def Curative • 1,842 • 1,760 • KSh • DK • Sohag • Luxor • Qena
Manpower Distribution • Nurse/Patient Ratio 1:250 • Physician/Patient Ratio 1:400 • Year 2005 • Nurse/10000 Population for Enrolled 14.82 • Nurse/10000 Population for incharge 13.36 • Year 2003
Why does anyone work in the public sector? • Nurses prefer the public sector after they get married because of much less work demands, no one can fire you, you have health insurance and pension benefits, and better hours(Nurse 5) • **The private sector presence is strongest in Cairo and Alexandria; however it is not as prevalent in rural governorates and therefore, it is not always a viable option for a nurse depending on her geographical location
“If we continue to do things the way we did we will remain where we are”. Stephen Covey
Where do nurses work? • About 80% of nurses are employed by the public sector in 2008 (with some dual employment) • Salary levels are determined by the central government as part of overall public sector payment structure
National Demand for Nurses • Bifurcated Demand • Public sector demand- • The salary of a nurse in the public sector: LE 165 for a Diploma level nurse (nurse with high school nurse) LE 250 for a Bachelor level nurse (nurse with 4 years of post high school university education). With incentives,, the salary of a nurse in the public sector rarely exceeds LE 1000. Private demand for nurses –The salary of a nurse in the private sector: -starting salaries advertised at LE 800 and -up to LE 7000 for qualified and experienced bachelor level nurses in private hospitals in Cairo and Alexandria
The supply of nurses- willingness to work • MOHP sources believe that there is (leakage); 7000 nurses exit the market for various reasons (work abroad, stay home or work in another sector) • The resultant increase of 3000 nurses every year to the nurse labor force is believed to be lower than what is needed. (MOHP Director of Nursing) 4% leakage is an educated guess by the director of nursing- no data!
Education Output Projection Expected number of Graduates Number of Institutes Year 21,000 2020 60 12,000 40 2015 10,000 2012 30 3906 25 2010 1394 2009 12 Data Includes post primary and post secondary
Future Outlook - Employment : • Demand for dental care will rise due to greater retention of natural teeth by middle-aged and older persons, greater awareness of the importance of dental care, and an increased ability to pay for services. Dentists will use support personnel such as dental hygienists and assistants to help meet their increased workloads. • -