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 nonexistent. 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
Health Professionals in Egypt?
20
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
Why is there a shortage of nurses
in Egypt and globally
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)
Shortage according to Economists and
the rest of the world
-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
On the Road to Professionalism:
Future
Past, Present and
 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
Total numbers of nurses registered in Syndicate till
Year 2006
201,669
Bachelor Degree
6,2
%
Technical Institute Degree
0.9
%
Secondary Technical Institute Degree
Others
85
7.9
%
%
Current Status of Nursing Workforce
With Respect to Int. Standards
=
0.27%
=
204,000
Deficiency based on international
standards
=
38,000
Required nurses by 2020
=
242,000
=
Ratio of Nurses to population
260,000
Number of nurses in registry
Required nurses by 2020
taking in consideration drop out
rate of 4%
Conclusion of Current Status –
Statistics 2008
Current Nursing No.
204,000 Nurses
MOH
165,000 nurse
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
4% from the total
workforce
(MOH Nursing)
Considering
Total No. of Beds - MOH
International ratio
Others
39,000 nurses
Primary Health Care
96,000 beds
5199 facilities
45,000 (-) nurse
51,987 (+) nurse
Numbers of Faculty of Nursing Graduates From 2003 to 2008
Alarm!!
Graduation
Year
Graduates
Numbers
2003
2175
2004
2379
2005
2352
2006
2302
2007
1287
2008
1200
Figure Illustrating Deficiency in Some Governorates
Total
Def Primary
Def Curative
6,577
4,591
4,006
2,973
2,102

1,058
1,760
KSh

1,842

Qena
1,581
890
487

2,447
360 206 471

DK

Sohag

Luxor



Manpower Distribution


Nurse/Patient Ratio
Physician/Patient Ratio
1:250
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 demandThe 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
Number of
Institutes
60
40
30
25
12
Data
Includes post primary and
post secondary
Expected number of
Graduates
Year
21,000
2020
12,000
2015
10,000
2012
3906
2010
1394
2009
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.
-
Continuing Education and
Performance
Holland
Hull U
North
Spanish
Training through Foreign
Experts
Spain
Thailand
Overseas travel
Central Cont Education
2500/year
Maintain performance
On site training Hosp and PHC
10,000/year
Nursing Fellowship Program
30% of workforce
Hospital nurses
5% PHC
Gaps are challenging

The most significant gaps the developing
countries will face are : retaining the best
healthcare providers. Adaptation of the very
advanced technology The new model of distant
treatment will make earnings for the ordinary
physicians very difficult and most of the well
trained doctors and nurses and hi-technicians will
spend their productive lives outside our countries,
most properly in Europe and in turkey.
Challenges
Glaring gaps and inequities in health persist both within and
between countries, underscoring our collective failure to share
the dramatic health advances equitably.
 At the same time, fresh health challenges loom. New infectious,
environmental, and behavioural risks, at a time of rapid
demographic and epidemiological transitions, threaten health
security
 of all. Health systems worldwide are struggling to keep up, as
they become more complex and costly, placing additional
demands on health
.




Professional education has not kept pace with these
challenges,
largely because of fragmented, outdated, and static
curricula
that produce ill-equipped graduates.
The problems are systemic: mismatch of competencies
to patient and population needs; poor teamwork;
persistent gender stratification of professional status;
narrow technical focus without broader contextual
understanding;
episodic encounters rather than continuous care;
 predominant hospital orientation at the expense of
primary care; quantitative and qualitative imbalances in
the professional labour market; and weak leadership to
improve health-system performance. Laudable efforts
to address these deficiencies have mostly floundered,
partly because
of the so-called tribalism of the professions—ie, the
tendency of the
various professions

Regional markets
Egyptian Nurses working in the Gulf

In 2007, Egypt had a general unemployment rate of
11.2%, male unemployment rate of 7.10% and female
unemployment rate of 24.3%. Therefore, training
nurses for export could be an opportunity because of
the benefit to the Egyptian economy
In addition to remittances, if nurses who leave are required to
pay certain taxes to support nurses’ education in Egypt and
compensate the government for the free education they
received, this could also be useful for the health sector.
It would also make sense for the government in this case to
encourage and regulate private nursing education..


Medical Tourism Government acted already
Private sector opportunities
Government acted already Privatization and tax
allowances
Pull

Increasing demand for health professionals in Gulf
countries
Much higher salaries for all groups of health
professionals in receiving countries
Better practical education and career opportunities in
receiving countries
Supply of health professionals

Between 2001 and 2008, the number of nursing
staff increased by almost 24,000 (from 83,879 to
107,717); the number of pharmacists increased by
about 8500 (from 3,375 to 11,953); and the number
of physicians increased by roughly 11,000 (from
40,422 to 51,491). The number of dentists increased
the least, with 3,000 more in 2008 compared to
2001, from 5,770 to 8,85612. The total increase of
medical staff did not result, however, in equal
health coverage across the country.
New 2003 labor regulations

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
it seems important to examine
the effect of the new labor law on employment, in particular on
informal
employment. Theoretically, one would expect the new law to
enable
employers to hire and fire workers more easily and hence to
enable them
to hire more workers formally. In the following section we test
the hypothesis
that the introduction of the new labor law has led to more
formal
private employment.
4.
Remmember

? Treat people with disrespect. Keep them
waiting unnecessarily. Steal their thunder by
using their ideas without giving them credit. Say
one thing then do the complete opposite. Break
promises regularly.
There are, however, quite a few common traits when it comes
to being professional. This includes the following:

1. Competence. You’re good at what you do – and you have the
skills and knowledge that enable you to do your job well.
2. Reliability. People can depend on you to show up on time,
submit your work when it’s supposed to be ready, etc.
3. Honesty. You tell the truth and are upfront about where
things stand.
4. Integrity. You are known for your consistent principles.
5. Respect For Others. Treating all people as if they mattered is
part of your approach.

6. Self-Upgrading. Rather than letting your skills or knowledge become
outdated, you seek out ways of staying current.
7. Being Positive. No one likes a constant pessimist. Having an upbeat
attitude and trying to be a problem-solver makes a big difference.
8. Supporting Others. You share the spotlight with colleagues, take time to
show others how to do things properly, and lend an ear when necessary.
9. Staying Work-Focused. Not letting your private life needlessly have an
impact on your job, and not spending time at work attending to personal
matters.
10. Listening Carefully. People want to be heard, so you give people a chance
to explain their ideas properly.

The more you put into practice the points listed above, the better
your chances will be to create a positive reputation for yourself.
This can ultimately translate into raises and promotions, chances
to work on more assignments that you enjoy, less likelihood of
being downsized when layoffs are being considered, and the
respect of peers and senior management.
You also benefit from feelings of increased self-worth and
dignity. Plus you keep yourself marketable for the future. All in
all, some very good reasons to as professional as possible.
Other Staff Requirements
Staff Type
Current
Required
GAP
Ratio
Dentists
92
45
47
2.0
Pharmacists
287
117
170
2.5
Admin Staff
1707
1128
579
1.5
Dentistry
73
10
63
7.3
Lab.
107
49
58
2.2
Radiology
221
16
205
13.8
Medical Technicians
68
What are typical causes of high
turnover?

Stress on the job:






Shift rotation
Mandatory overtime
Physical demands
Safety issues
Psychological demands
Aging workforce / retirement
Factors cited as contributing to high turnover of RNs







Poor pay and benefits
Poor relationships with physicians
Lack of voice in patient care issues
Mandatory overtime and lack of scheduling
flexibility
Patient load and pace of work due to understaffing
Lack of access to supervisors and mentors
Documentation requirements
Challenges and opportunities



Labour mobility in the region is structurally
driven by demographic, social and economic
differentials between labour abundant and
resource abundant countries. While the causes
of
labour mobility can be perceived as challenges to
the development of the region (for instance,




high population growth resulting in high youth
unemployment), migration can be an importantpillar
for local and national development policies, when
mainstreamed into national development
plans. Thus, migration and labour mobility can be part
of a solution to development imperatives
that is consistent with local governance and social
models, while allowing individuals to achieve
their full potential for the growth and development of
the region.
Egyptian Marketing?
Selling
Public Relations
Advertising
Promotion
(Almost) Anything Can be Marketed
Consumer
Goods
and
Services
BusinesstoBusiness
Marketing
Not-ForProfit
Marketing
Idea,
Place,
People
Marketing
 BE
THE CHANGE YOU WANT
TO SEE IN THE WORLD
GHANDI