Expertise France

Expertise France is the public agency for the design and implementation of international technical cooperation projects. The agency works alongside partner countries to advise and support them in strengthening public policies across the main areas of public action: 

-          Democratic, economic and financial governance;

-          Peace, stability and security;

-          Climate, biodiversity and sustainable development;

-          Health and human development.

In these fields, Expertise France carries engineering and project implementation missions to build capacities, mobilise technical expertise, and acts as a project integrator involving both public and private expertise. 

In the health sector, Expertise France contributes to strengthening health systems in close collaboration with partner countries, supporting them in implementing the priorities set out in their national health plans. EF’s key priorities include strengthening health systems and combating diseases, enhancing global health security, promoting population health through the “One Health” approach, and advancing French expertise, training, research, and innovation.

The project

Context
Egypt has undertaken a major transformation of its health system through the establishment of the Universal Health Insurance System (UHIS). After its deployment in six governorates of Phase 1 (Port Said, Luxor, Ismailia, South Sinai, Suez and Aswan), the health insurance system covers 5.1 million insured people (~80% of the population of these governorates). The Arab Republic of Egypt will launch Phase 2 of the reform in 2026 in the following governorates: Minya, Kafr El Sheikh, Matrouh, North Sinai, and Damietta.

Since the reform strongly relies on functional and resilient primary healthcare, the rehabilitation and modernization of Primary Health Care Centers (PHCCs) have become a priority to ensure equitable access to essential services and to support the transition toward preventive and community-based care. 

Primary Health Care Centers (PHCCs) play a central role in the deployment of the Universal Health Insurance System (UHIS), as they represent the first point of contact for citizens accessing higher levels of care. However, a large proportion of these facilities suffer from outdated infrastructure, obsolete medical equipment, weak governance and coordination mechanisms, inconsistent standards of care, insufficient digital capacity, shortages of qualified staff, and low public trust in PHCCs services particularly in underserved and high-vulnerability areas. Addressing these gaps is essential for PHCCs to function as effective first points of contact, build patient trust, and deliver consistent, high-quality services.

In addition, gender inequalities continue to influence health outcomes and access to care. While maternal mortality has significantly declined—reaching 17 deaths per 100,000 live births in 2023—disparities remain in ensuring equitable access to safe and respectful maternal health services. The rate of caesarean sections has sharply increased in recent years, reaching 72% of all births according to the 2021 Egypt Family Health Survey (EFHS)—one of the highest levels in the world. Nearly one in four women (25%) reports having experienced physical violence at least once since the age of 15 (EFHS 2021), highlighting the importance of strengthening gender-based violence (GBV) prevention and response services within the health sector.

Moreover, Egypt also hosts around 9 million migrants, refugees, and asylum seekers from more than 130 countries (IOM, 2023), including approximately 900,000 registered with UNHCR by the end of 2024. In certain governorates—such as Aswan—these communities face additional barriers to accessing primary healthcare, related to language, legal status, and the availability of adapted services. Addressing these differentiated needs, while reinforcing decentralized health governance, improving quality of primary healthcare and strengthening frontline staff capacities, is essential to ensure that the UHIS reform contributes to equitable and inclusive access to healthcare for all.

The Egyptian government places great importance on improving the quality of care in primary health facilities, especially in vulnerable areas. This commitment was reaffirmed with the launch of the MoHP “Acceleration Plan” on 12 May 2025 and identification of high-priority “red zones”. The plan aims to enhance service delivery, particularly for women and children. It aims to achieve several objectives: expanding family planning coverage, reducing contraceptive methods discontinuation and increasing the use of long-acting ones, improving attendance at antenatal care and child growth monitoring visits, empowering families—especially women—to make informed decisions regarding reproductive health and family life, and promoting exclusive breastfeeding up to 6 months and continued breastfeeding up to two years.

The project is expected to be funded by the European Union, with Agence Française de Développement (AFD) managing the hard component (infrastructures) and Expertise France overseeing the soft component (technical assistance).

Purpose and specific objectives of the project

Overall objective 
The overall objective of the programme is to improve the quality of primary healthcare services in vulnerable areas of Egypt, with a particular focus on the needs of women and children, as well as migrants and refugees.

AFD will be responsible for the infrastructure component of the programme, corresponding to Specific Objective 1. Expertise France will be in charge of Specific Objectives 2 and 3. The technical assistance will primarily target the governorate level, where most activities will be implemented. However, the interventions are designed to inform and strengthen national level strategies, such as the establishment of local health steering committees, the development of retention strategies, the analysis of task-shifting and the introduction of health simulation education.

Specific objectives 
Specific Objective 1 (AFD): Improve the availability and quality of resilient and energy-efficient health infrastructure

In line with Egypt’s National Health Strategy (NHS) 2024–2030 and the National Strategic Framework for Health Sector Adaptation to Climate Change 2024–2030, the programme will support the rehabilitation of selected primary health centers in targeted areas.

-          Result 1.1: Needs and gaps in resilient and energy-efficient primary healthcare infrastructure are identified and prioritized.

-          Result 1.2: The selected PHCCs are rehabilitated to meet standards of climate resilience, energy efficiency, and quality of care, and institutional capacities are strengthened.

Specific Objective 2 (Expertise France): Strengthen the availability, accessibility, and quality of primary healthcare services for women, children, and vulnerable migrant populations

The programme will contribute to improving the provision of quality primary healthcare services in underserved areas by strengthening local health governance, improving the availability, accessibility and quality of primary healthcare services for vulnerable populations. In addition, the project aims to enhance access to quality, adapted primary healthcare services for migrants and refugees in Aswan Governorate, through close collaboration with international and non-governmental organizations. 

-          Result 2.1: Local health governance is strengthened to ensure effective coordination of primary health care and UHIS deployment.

-          Result 2.2: The availability, accessibility, quality, and inclusiveness of primary healthcare services are improved to meet the needs of populations in vulnerable areas.

-          Result 2.3: Community health promotion is strengthened, and the demand for family and women’s health services is increased.

Specific Objective 3 (Expertise France): Increase the availability, skills, and retention of primary healthcare personnel, as well as governance actors, to deliver quality and equitable services in underserved areas.

The programme focuses on strengthening the human resources. It supports better workforce planning, skills development, staff retention, and leadership capacity to drive effective change. A specific component focuses on modernizing nursing and midwifery education to ensure a continuous pipeline of competent professionals aligned with primary healthcare and UHIS requirements, through curricula revision aligned with the universal health insurance priorities, introduction of innovative pedagogical approaches and creation of simulation laboratories.

-          Result 3.1: Frontline health workers and the quality of gender-sensitive services are enhanced. 

-          Result 3.2: The capacities of local health governance structures and community actors are enhanced.

-          Result 3.3: Nursing and midwifery training institutions are reinforced.