The ILO and UNHCR jointly assessed the feasibility of including refugees and asylum-seekers in Egypt’s Universal Health Insurance scheme.

In 2018, the Universal Health Insurance (UHI) law was enacted as part of the Government of Egypt’s commitment to progress towards universal health coverage. The new scheme was implemented in phases between 2019 and 2023. Refugees’ access to healthcare was regulated through a Memorandum of Understanding (MoU) signed between the Ministry of Health and Population and UNHCR. This MoU granted refugees and asylum-seekers from all nationalities access on a par with nationals to health services financed through the Ministry of Health and Population. 

The ILO and UNHCR jointly assessed the feasibility of including refugees and asylum-seekers in Egypt’s UHI scheme. The feasibility study evaluated the provision of healthcare services to the refugee and asylum-seeker populations, their contributory capacity, the costs associated with their inclusion, as well as practical steps to include them. Among other things, the study:

• found that UHI established a legal framework to extend social health protection to the entire population, offering a pathway to including refugees in the UHI scheme on a par with nationals;
• proposed cost policy options for refugee inclusion based on socio-economic status. Various scenarios were considered to assess which refugees could pay contributions;
• highlighted the need for greater focus on the informal economy, in which a significant share of refugee households is likely to work. In particular, the mechanisms to identify, enrol and collect contributions from workers in the informal economy need to be strengthened and the vulnerability assessment currently in use needs to be reviewed.

The feasibility study led to a series of engagements by the government, development partners and donors to build consensus on the findings and on the way forward. The Government of Egypt worked with ILO, UNHCR and UNICEF to design a pilot for the inclusion of refugees and asylum-seekers in two governorates and established a Technical Working Group to discuss the practical and operational steps to including refugees, as well as build in evaluation mechanisms to learn from the forthcoming pilots in the two governorates.  

Find out more about this case study:

• Improving social health protection for refugees in Egypt through their inclusion in the Universal Health Insurance (UHI) scheme.
• Feasibility study on the enrolment of refugees and asylum seekers in the Egyptian Universal Health Insurance Scheme (UHIS)