A qualitative study of the government's implementation of the Universal Health Coverage in Egypt: stakeholders' perspective.

BACKGROUND: Egypt has made significant strides in strengthening its healthcare system, guided by Vision 2030 and aligned with the United Nations' Sustainable Development Goals (SDGs). Despite progress, challenges persist, including a high burden of non-communicable diseases, strained resources and a fragmented health system. The Universal Health Insurance System (UHIS), launched in 2018, aims to address these issues by providing equitable access to quality health services while ensuring financial protection. OBJECTIVE: This study explores stakeholders' perspectives on implementing Universal Health Coverage (UHC) in Egypt, focusing on the relationships and resources required, successes and challenges and its impact on citizens' access to care. METHODS: A qualitative, cross-sectional study was conducted between 2021 and 2022, involving in-depth interviews with eight key stakeholders from government bodies and international organizations. Data were analyzed using thematic content analysis to identify critical themes underpinning Egypt's UHC implementation. RESULTS: Stakeholders highlighted that strong political will, alignment with the SDGs and existing infrastructure, including digital systems and healthcare education programs, were pivotal in launching UHC. This study's key contribution is to provide qualitative insights from these key stakeholders, demonstrating how their experiences with the Port Said pilot implementation revealed successes in increased service accessibility and improvements in governance. However, challenges remain, including financial sustainability, workforce shortages and gaps in public awareness and cultural adaptation. While infrastructure and governance reforms have enhanced health service access, further efforts are needed to sustain and scale these improvements nationally. CONCLUSIONS: Egypt's UHC reforms demonstrate the potential to transform health outcomes, aligning with goals of equity and financial sustainability. The study's findings provide specific policy recommendations and implications, highlighting the need to focus on the financial sustainability of the system, reform governance and prioritize public awareness for effective execution. Lessons from the Egyptian experience, particularly the phased rollout, serve as valuable insights for other countries. Maintaining momentum requires adaptive strategies integrating global best practices to ensure UHC's long-term success.