Nana Abuelsoud, RESURJ member from Egypt.
On July 1st of 2019, Egypt launched the first pilot steps within the new social health insurance (SHI) in Port Said governorate, as part of a 15-year plan towards a universal health coverage. Over the past years, policy briefs, consultative meetings, and eventually a constitutional acknowledgment of the ‘right to health’ articulated a political will to secure the right to health for everyone. Yet, securing a right does not necessarily mean fulfillment.
ٍIn the 60s, the Health Insurance Organization (HIO) came to life, with remarkable advancements over time for some groups, including; school students, female heads of households, pensioners and female widowers , but still implicitly excluding others. As of January 2018, the new Social health insurance law marks the frutiation of decades of conceptualizing without citizen participation, authenticating a single voice and further marginalizing others.
Article 1 of SHI lists Family Planning services as services aiming to plan childbirths, using birth control technologies, inter alia reproductive education, protection from sexually transmitted infections, prenatal consultation, infertility treatment.
By now, we have had access to a handful of conceptual glimpses of how the new healthcare system is going to function:
1) Linking payments and benefits to a national identity card,
2) Setting ‘Family’ as a distribution unit (previously it was on individual basis),
3)Establishing the Universal Healthcare Authority: a separate entity to oversee the implementation of SHI, and
4) A separate funding pool. While SHI claims universality, it leaves us decoding accountability and responsibility towards that system, especially with an unmapped informal sector, made up mostly by women.
Over the past months, media coverage released a series of photographs of officials in press conferences, high level events and roundtables delivering the greatest news of #Healthforall. In reality, an added SHI tax has made it to major economic sectors, with an incomplete analysis of how those of us who fall out of the clean-cut categories are going to either benefit and/or contribute to this new healthcare system.
What is different about these almost-transformative health commitments from past initiatives is; previous health insurance schemes were and are catering for certain groups; through a dispersed system of formalities and bureaucracy. The new move through SHI is a coverage per ‘Family’,rather than ‘household’ which could have been a more inclusive concept. This is not the first time (and sadly, probably not the last) we face the concept of “Family” as an institution that seems too rigid (nuclear heteronormative family) and at the same time, too broad to operationalize and generalize (Which family structure? extended, single parenting, grandfamilies or else?)
In addition to this, access to SHI healthcare services is only granted to those with identification documents. Therefore, leaving unregistered women or girls on the geographical, social and political peripheries for not owning a birth certificate nor a national identity card.
Why don’t we need Family?
SHI defines Family to be a group of individuals made up of a husband and a wife or more and dependents. This definition is not even attempting universality. There is a teen mother, who is also a widow or single parenting. Another is a woman heading her household in an extended family, and she is divorced. Or a grand aunt raising a child. In reality there are countless structures of families, all of which are legitimate and valid -they have always been, but not institutionalized similarly to a heteronormative nuclear utopian form of what a family is, to be constitutional.