Egypt- Emerging pharma market? Part 2
In part 1 of this article (see https://www.reutersevents.com/pharma/market-access/egypt-emerging-pharma...), we examined some basics about Egypts emerging pharmaceutical market. So today, lets take a look at Egypts unique healthcare landscape.
What are the unique healthcare dynamics in Egypt that must be understood by pharma executives?
In Egypt, the per capita expenditure on health is in the range of 50-60 US$. Two-thirds of this expenditure is private and almost all is out of pocket. Meanwhile, 100 tablets of aspirin will cost an average citizen almost 16% of his/her monthly personal disposable income! Modern western drugs therefore are only realistically accessible to a small fraction of the population who can afford it. In a country of almost 75 million inhabitants, at best 7 to 8 million will have access to new branded medicines offered by the innovative pharmaceutical industry.
In spite of the very poor quality of public healthcare, it provides some basic services such as:
Clinical diagnosis and recommendation for treatment (but no drugs) to those who cannot afford private clinic visits.
Primary care services such as child immunization, contraception and womens health services.
Coverage of medication and treatment of selected health care problems, such as malignancies or Hepatitis C (HCV) treatment.
HCV is a special peculiarity. As healthcare authorities were fighting another epidemic in the country (schistosomiasis), the use of parenteral therapy in the sixties and seventies with non-disposable syringes has spread HCV (see Lancet 2000; 355: 887891). Currently, the estimated prevalence of HCV positive individuals is 15% in Egypt. The healthcare authorities have introduced a program for providing diagnosis and treatment for HCV, which currently covers approximately 20,000 patients and is slated for expansion.
Almost every doctor in Egypt has a dual practice: (1) a public sector job in Ministry of Health, University Hospital, Armed Forces Health Care facilities, etc. and, (2) a private practice usually in a clinic of their own.
Consequently, pharmaceutical promotion is oriented accordingly. Medical representatives in Egypt work two shifts. In the morning/afternoon, they cover institutions and hospital accounts. In the evening, they visit doctors in the private clinics. To make the average 8-10 evening calls, usually a medical representative will work from 7 to 11 pm! Egypt is one of the few countries in the world where you can actually make a promotional call to a private clinic at 1 or even 2 am, as the busy private physicians will continue to see their patients after midnight!
In our next installment, we will focus on regulatory and pricing issues for pharmaceuticals in Egypt.