P O L I C Y B R I

P O L I C Y B R I E F No. 02 / February 2021

Healthcare Improvement in Border Cities: Halayeb & Shalateen, the South-East of Egypt

Ohoud Wafi Peer Reviewer: Sarah Atef*

EXECUTIVE SUMMARY:

Border cities have always had high rates of poverty. Improving access to healthcare services in border cities especially in the era of the current COVID-19 pandemic was one of the Egyptian government’s goals. This brief suggests policies that aim to improve the affordability and accessibility of healthcare services in the MENA region, by focusing on the Egyptian example, especially the Triangle of Halayeb and Shalateen as border cities.

CONTEXT AND SCOPE:

At a time when healthcare policy in Egypt is witnessing high-level attention, with many presidential initiatives have been launched, such as (1) the presidential initiative for “100 Million Health” to detect chronic diseases, (2) the initiative to detect anaemia, stunting, and obesity, (3) the model hospitals initiative and (4) the women's health initiative; the situation continues to worsen as we move south. Geographically remote cities do not enjoy the same attention as the central cities and those closest to Greater Cairo. What are the challenges that Al Shalateen Central Hospital faces in a city amidst a border dispute, and to what extent can the level of healthcare services provided in the Halayeb, Shalateen, and Abu Ramad triangle be measured and evaluated? The city of Shalateen is located in the Halayeb Triangle on the Egyptian-Sudanese border, and it has been considered an Egyptian-Sudanese legal conflict zone, since 1956 [1].

Sarah Atef is a Monitoring and Evaluation Consultant for the World Bank projects with the Ministry of Health & Population. [1] The city of Shalateen is located in the Halayeb Triangle on the Egyptian-Sudanese border and is considered an Egyptian- Sudanese legal conflict area. The Halayeb Triangle consists of the cities of Halayeb, Shalateen and Abu Ramad. P O L I C Y B R I E F No. 02 / February 2021

The population in Shalateen consists of multiple tribes and some expatriates from neighboring governorates or even from Sudan. The population is about 27 thousand and its area is 20.5 thousand km2. Even today, the people of Shalateen rely heavily on traditional medicine and resort to supervision [2] most of the time to obtain their

Halayeb & Shalateen & Halayeb medicine. They have relied on nature and instinct for years, believing in the blessing of the family of Al-Bayt (the house of the Prophet Muhammad).

Shalateen is administratively affiliated with the Red Sea Governorate. This administrative affiliation has resulted in the Egyptian state institutions’ keenness, in

the recent period, to provide some health and educational services to the city, given Healthcare Improvement in Border Cities: inBorder ImprovementHealthcare that it is considered a conflict zone in which the Military Intelligence plays a fundamental role, and also because it is an area in which the Egyptian state hopes to invest in tourism and strengthen taking advantage of its natural resources, especially for gold exploration, in light of Egypt's 2030 vision.

The health services problems have exacerbated in the recent period in Egypt due to the outbreak of the Covid-19 pandemic, the health situation has also deteriorated more than before in the Halayeb Triangle (southeast of Cairo).

Hospitals geographically surrounding the city of Shalateen swapped roles to receive patients from the far southeast of Egypt, as cases requiring surgical intervention and treatment were often transferred to Hurghada Hospital, or other hospitals closest to Shalateen, the nearest is about five hours away.

Looking at the health service providers already existing in Shalateen and Halayeb, we find that there is only one hospital, and it is Al Shalateen Central Hospital, which was opened after its last renovation in May 2017 to serve the people of the south of the Red Sea for EGP 100 million. Opening this hospital was considered as a message from President Al-Sisi's government on the Egyptian state’s keenness to improve health services in Shalateen, similar to the state’s plan in various governorates, and to have the leadership in providing services to its inhabitants. It also proved its ability to allocate larger amounts for the development of that hospital, by raising the hospital’s . [2] Al-Ashraf, alone Sharif, is a title given to those whose lineage traces back to the Prophet Muhammad, through the marriage of Imam Ali bin Abi Talib with Mrs. Fatima al-Zahra, the daughter of the Messenger of God. This marriage resulted from the birth of Hassan 2 and Hussein. And genealogists were unanimously agreed to limit the honorable people to the descendants of Imams Al-Hassan and Al-Hussein, the Prophet of God. Then these pure descendants were divided into twelve tribes, six of which were the offspring of Hassan and six were descendants of Hussein. P O L I C Y B R I E F No. 02 / February 2021

development budget by about EGP 30 million (since the proposed budget was EGP 70 million, but the actual cost increased to EGP 100 million).

According to the Egypt Projects website, it includes the hospital building that was constructed, built and equipped in a year and a half, three operating rooms, an

Halayeb & Shalateen & Halayeb intensive care room, a nursery section for children, a section for obstetrics and gynecology, outpatient clinics, a section for CT scans and another for tele-radiology, analysis laboratories, blood bank laboratories and 40 beds for various departments and specialties and all required clinics, where there are clinics of "orthopedics,

ophthalmology, and internal medicine," and dentistry, three operating rooms, an Healthcare Improvement in Border Cities: inBorder ImprovementHealthcare intensive care room, a section for nurseries for children, a section for obstetrics and gynecology, a department for dialysis, outpatient clinics, a section for CT scans and

another for television rays.

Wafi Ohoud

Al-Shalateen Central Hospital – 11 Feb 2021

The Red Sea Governorate announced in 2017 that Al-Shalateen Hospital has signed contracts with several universities’ hospitals to provide the necessary medical teams, _ 3 P O L I C Y B R I E F No. 02 / February 2021

as the hospital needs about 150 medical staff, including doctors and nurses. We note the reluctance of medical staff to travel to Shalateen to work in a hospital as a result of (1) the geographical long distance – 12 hours by bus, (2) the transportation costs to and from Shalateen are high and there is a lack of affordable and suitable

Halayeb & Shalateen & Halayeb transportation, (3) the lack of a suitable financial incentives, (4) failure to provide services that encourage doctors to move to Shalateen with their families, (5) the inability of doctors to open private clinics to improve their income in Shalateen due to the simplicity of the financial situation for many of the region's residents, unlike the case in the central cities, and (6) the doctors' residency is often not readily available

Healthcare Improvement in Border Cities: inBorder ImprovementHealthcare for them.

Referring to the inhabitant community, its testimony indicates the absence of doctors who are appointed most of the time, and who are already registered in the official hospital records.

Additionally, when medical teams move to work in the hospital, neither the Directorate of Health Affairs nor the Ministry of Health pay enough attention to preparing them with regard to the cultural aspect of the population and the special nature of the city, which leads in many cases to a collision with the residents. This reflects the lack of technical control over the crews assigned to Al-Shalateen Hospital and reflects poor management. Furthermore, we notice a severe shortage of health equipment in the medical units of the villages administratively attached to the city, which is the matter that the Health Administration supervises in Shalateen. For example, there are no sterilization devices, which causes dentists to refuse to see patients. In addition to the absence of doctors from these units, they are satisfied with visiting the units closest to them and the easiest to reach. Without real supervision from the health administration.

The mismanagement appear in these examples, except that it escalates in the Central Hospital to reach clear cases of corruption. Back in July 2017, right after the hospital opened, it was announced that an anesthesia machine had been stolen from the .

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operating room at Shalateen Central Hospital, and its price ranged from EGP 200 to 250 thousand, but the results of the investigations have not been announced until today. The problems of mismanagement and centralization of the decision clearly appear from the above.

Halayeb & Shalateen & Halayeb The Ministry of Health is only able to suggest solutions, but without real control over their implementation. The real enforcement authority rests in the hands of the local health administration, which in turn does not have the necessary capabilities. On the other hand, it was approved last February to allocate a plot of land to build a hospital

for the people of Halayeb. Healthcare Improvement in Border Cities: inBorder ImprovementHealthcare This reflects the state’s increase in financial allocations to the region, while increasing promises to provide health services. But with the continued mismanagement and the absence of solutions to the reluctance of the doctors that we enumerated, it is feared that the new hospital building will also become a building devoid of doctors and services, and even subject to theft and looting.

POLICY ALTERNATIVES:

• Fixing the Healthcare Administration in Shalateen:

The local administration supervises all medical units in the villages that are administratively attached to the city. But in reality, these units do not work as intended, and although they are renewed and re-equipped from time to time, many of them still do not have the equipment that doctors need, for example, there are no sterilization devices, which causes dentists to refuse to see patients. In addition to the absence of doctors from these units, they are satisfied with visiting the units closest to them and the easiest to reach.

• Enhance the cultural knowledge of medical convoys:

Medical convoys have been a lifeline in recent years in Shalateen, Halayeb, and Abu Ramad, especially as they bring doctors with rare specialties in the entire Halayeb Triangle. University hospitals, non-governmental associations, and some government

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agencies have sought to send medical convoys from time to time to the Triangle, and the Health Administration in the Red Sea has implemented several protocols, including one between the Assiut Heart Institute and Imbaba to transfer patients. But by talking with the people of the Triangle, we note that most of the medical teams

Halayeb & Shalateen & Halayeb that come with these convoys deal arrogantly and condescendingly with the people and residents of the Triangle and are keen to photograph them in rows in front of the

convoy’s cars waiting to be examined to publish these pictures at a later time.

Healthcare Improvement in Border Cities: inBorder ImprovementHealthcare

Wafi Ohoud

Al-Shalateen Central Hospital

RECOMMENDATIONS:

Enhance the quality of health services in Shalateen, Halayeb and Abou-Ramad needs:

• Improving health infrastructure in the triangle, especially the health units.

• Increasing the number of doctors working for the national hospitals there and government clinics under the authority of the Ministry of Health.

• Stop sending doctors who are serving as part of their semi—mandatory system unless they are from the region itself, or at least from the same governorate of The Red-Sea.

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• Providing all the needed facilities for the doctors to work in this region.

• Increasing the salaries of the medical teams who serves in this region due to geographical distance.

• Applying all the monitoring and evaluation tools on the medical teams in the Halayeb & Shalateen & Halayeb region and include the proper manner of treating the patients in the system of evaluation.

• Organizing the support of the civil society in the region, to make sure that they cover all the needed health aspects and to insure the complementary rule of the

Healthcare Improvement in Border Cities: inBorder ImprovementHealthcare State and the civil society.

• Enhance the role of the ”Community Health Workers” in the Southeast and encourage them to help the local community to understand the importance of the Medical Health support instead of just relying on the local alternative medicine.

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