In this week&rsquo;s edition, we discuss the importance of healthy food to prevent kidney failure amid soaring dialysis costs and the government&rsquo;s focus on exporting produce Egyptians cannot consume
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<h2 dir="ltr">Prevention Over Dialysis, but Who Pays for It?</h2>
The Ministry of Health has <a href="https://www.youm7.com/story/2024/3/10/%D8%A7%D9%84%D8%B5%D8%AD%D8%A9-%D8%B2%D9%8A%D8%A7%D8%AF%D8%A9-%D8%B3%D8%B9%D8%B1-%D8%AC%D9%84%D8%B3%D8%A9-%D8%A7%D9%84%D8%BA%D8%B3%D9%8A%D9%84-%D8%A7%D9%84%D9%83%D9%84%D9%88%D9%89-%D9%84%D9%84%D8%AC%D9%87%D8%A7%D8%AA-%D8%A7%D9%84%D9%85%D8%AA%D8%B9%D8%A7%D9%82%D8%AF%D8%A9-%D9%85%D8%B9-%D8%A7%D9%84%D9%88%D8%B2%D8%A7%D8%B1%D8%A9/6498800">announced</a> a price jump from <a href="https://manassa.news/news/17003">EGP500</a> to EGP625 for each kidney dialysis session. Around <a href="https://www.masrawy.com/news/news_egypt/details/2024/4/3/2562655/%D8%A7%D9%84%D8%B5%D8%AD%D8%A9-%D8%AA%D9%83%D8%B4%D9%81-%D8%B9%D8%AF%D8%AF-%D9%85%D8%B1%D8%B6%D9%89-%D8%A7%D9%84%D8%BA%D8%B3%D9%8A%D9%84-%D8%A7%D9%84%D9%83%D9%84%D9%88%D9%8A-%D9%81%D9%8A-%D9%85%D8%B5%D8%B1">59,000</a> Egyptians require this medical treatment <a href="https://www.kidney.org/patients/peers/dialysis#:~:text=In%2Dcenter%20treatment%20time%20is,placing%20needles%20needed%20for%20hemodialysis.">three times a week on average</a>. As kidney failure is associated with chronic diseases resulting from an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339665/">unhealthy lifestyle</a>, government support for prevention is the most viable policy.&nbsp;
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1716794408imageEd 72_2-2 EN.png" alt="" width="405" height="203">
The state <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9337895/#B9">subsidizes</a> dialysis for most patients, and 39,000 patients receive treatment in government hospitals. Despite this, many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539246/">families</a> still have to pay for treatment costs in whole or part, with the rest covered by health insurance. Uninsured individuals <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539246/">spend</a> up to 21% of their gross income on health care.
<h3 dir="ltr">Kidney disease prevails among Egyptians</h3>
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1716788342imageEd 72_1 EN.png" alt="" width="405" height="404">
Kidney failure is <a href="https://data.who.int/countries/818">the fourth</a> most common cause of death among women in Egypt and the eighth in men. Despite the prevalence of the disease and its high mortality rate, as well as its spread among women in the lower-income brackets, the government overlooks the urgency of preventative health care. Medical research has <a href="https://journals.ekb.eg/article_40003.html">concluded</a> that the high rate of <a href="https://ejhm.journals.ekb.eg/article_15130.html">obesity</a> that affects 46% of Egyptian women is the most severe determinant of chronic kidney disease.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1716788418imageEd 72_3-3 EN.png" alt="" width="405" height="405">
<h3 dir="ltr">Healthy food baskets and checkups require funding</h3>
Medical experts <a href="https://www.medicoverhospitals.in/ar/%D9%85%D9%82%D8%A7%D9%84%D8%A7%D8%AA/%D9%85%D8%B1%D8%B6-%D8%A7%D9%84%D9%83%D9%84%D9%8A%D8%A9">insist</a> that maintaining a healthy weight is crucial for prevention, but most Egyptians cannot afford a nutritionally balanced diet. Egyptians <a href="https://globalnutritionreport.org/resources/nutrition-profiles/africa/northern-africa/egypt/">consume</a> less than half the recommended allowance of healthy food groups (fruits, vegetables, legumes, nuts, and whole grains). Vegetable protein (legumes), which most low-income Egyptians rely on, has <a href="https://www.foodtodayeg.com/Section-163/%D8%B5%D9%86%D8%A7%D8%B9%D8%A7%D8%AA-%D8%BA%D8%B0%D8%A7%D8%A6%D9%8A%D8%A9/%D8%A7%D8%B1%D8%AA%D9%81%D8%A7%D8%B9-%D9%87%D8%A7%D8%A6%D9%84-%D9%81%D9%8A-%D8%A3%D8%B3%D8%B9%D8%A7%D8%B1-%D8%A7%D9%84%D8%A8%D9%82%D9%88%D9%84%D9%8A%D8%A7%D8%AA-%D8%A8%D9%86%D8%B3%D8%A8%D8%A9-30-%D9%88%D8%B2%D9%8A%D8%A7%D8%AF%D8%A9-%D9%81%D9%89-%D8%A7%D9%84%D8%B7%D9%84%D8%A8-%D8%B9%D9%84%D9%89-%D8%A7%D9%84%D9%81%D9%88%D9%84-%D8%A7%D9%84%D9%85%D8%B3%D8%AA%D9%88%D8%B1%D8%AF-%D9%85%D8%B9-%D8%A7%D9%82%D8%AA%D8%B1%D8%A7%D8%A8-%D8%B4%D9%87%D8%B1-%D8%B1%D9%85%D8%B6%D8%A7%D9%86-35878#:~:text=%D9%88%D9%83%D8%B4%D9%81%20%D8%B9%D8%B2%D8%AA%20%D8%B9%D8%B2%D9%8A%D8%B2%D8%8C%20%D8%B9%D8%B6%D9%88%20%D8%B4%D8%B9%D8%A8%D8%A9%20%D8%A7%D9%84%D8%AD%D8%A7%D8%B5%D9%84%D8%A7%D8%AA%20%D8%A7%D9%84%D8%B2%D8%B1%D8%A7%D8%B9%D9%8A%D8%A9%20%D8%A8%D8%BA%D8%B1%D9%81%D8%A9,%D9%88%D8%AA%D8%B5%D9%84%20%D9%81%D9%8A%20%D8%A8%D8%B9%D8%B6%20%D8%A7%D9%84%D8%A3%D8%B5%D9%86%D8%A7%D9%81%20%D8%A5%D9%84%D9%89%2060%25%20%D8%AE%D9%84%D8%A7%D9%84%20%D8%B4%D9%87%D8%B1.">increased</a> in price by an average of 30%.
Health guidelines <a href="https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/prevention#:~:text=Early%20kidney%20disease%20may%20not,kidney%20damage%20if%20left%20untreated.">also recommend</a> annual screenings to prevent chronic kidney disease, but low-income citizens cannot afford regular exams and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390800/">rarely</a> receive subsidized early screening for the disease.
Since dialysis represents a significant cost burden and is bound to experience further price hikes, prevention is more <a href="https://www.ncbi.nlm.nih.gov/books/NBK53914/">cost-effective</a> than treatment in the long run. The government should, therefore, address the lifestyle factors that lead to chronic kidney disease by promoting regular screenings for chronic diseases among vulnerable groups <a href="https://100millionseha.eg/diseases/post/details/80">subsidized</a> by the Ministry of Health. Above all, policymakers should secure people&rsquo;s access to healthy foods.
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<h2>Vast Uninhabited Farmland and the Gains Go Abroad</h2>
The head of the Farmers&rsquo; Syndicate <a href="https://www.shorouknews.com/news/view.aspx?cdate=08052024&amp;id=108a41f4-99d0-4472-bf7b-08873509afaf#:~:text=%D9%88%D9%84%D9%81%D8%AA%20%D8%A5%D9%84%D9%89%20%D8%A3%D9%86%20%D9%85%D8%B5%D8%B1%20%D9%87%D9%8A,%D8%A7%D9%84%D8%AA%D9%82%D9%86%D9%8A%D8%A7%D8%AA%20%D8%A7%D9%84%D8%AD%D8%AF%D9%8A%D8%AB%D8%A9%20%D9%81%D9%8A%20%D8%B9%D9%85%D9%84%D9%8A%D8%A9%20%D8%A7%D9%84%D8%B1%D9%8A.">stated</a> that Egypt has increased its cultivated land area despite limited water resources by relying on groundwater and modern irrigation methods. Although land reclamation is essential, the horizontal expansion of agricultural land alone cannot achieve the kind of development that the country needs. Land reclamation projects in uninhabited areas lack community engagement and are cut off from the local countryside. They focus solely on export targets without attention to biodiversity and the localization of smart agriculture technologies.
<h3 dir="ltr">Agriculture divorced from local rural communities</h3>
Agricultural reclamation projects <a href="https://journals.ekb.eg/article_178789.html">offer</a> an essential opportunity for developing uninhabited areas. It helps establish integrated communities that promote agricultural industries, bring in more hard currency and meet the local market's needs. However, current projects fail to achieve comprehensive development, mainly because they are divorced from rural communities and marginalize small farmers.
The government primarily <a href="https://aps.aucegypt.edu/en/articles/1337/mega-projects-in-agriculture-and-transport-is-this-what-we-need">invests</a> in megaprojects, aiming to increase Egypt&rsquo;s farmland to 3.3 million feddans. It targets big businessmen with substantial capital. Small farmers have obtained no more than 10% of the 500 million feddans offered under the <a href="https://aps.aucegypt.edu/en/articles/1337/mega-projects-in-agriculture-and-transport-is-this-what-we-need">&ldquo;1.5 Million Feddans</a>&rdquo; project because they could not meet the eligibility conditions for this project, among others.
The terms of allotment under the new agricultural reclamation projects <a href="https://aps.aucegypt.edu/en/articles/1337/mega-projects-in-agriculture-and-transport-is-this-what-we-need">limit</a> eligibility to companies with a minimum of 10 individuals and a maximum of 23 &mdash;an impossible threshold for small farmers. The price per feddan in these projects ranges from EGP18,000 to EGP45,000, which similarly exceeds their capacity.
The national <a href="https://egy-map.com/project/%D9%85%D8%B4%D8%B1%D9%88%D8%B9-%D8%A5%D9%86%D8%B4%D8%A7%D8%A1-100-%D8%A3%D9%84%D9%81-%D8%B5%D9%88%D8%A8%D8%A9-%D8%B2%D8%B1%D8%A7%D8%B9%D9%8A%D8%A9">100,000 Greenhouses</a> project <a href="https://aps.aucegypt.edu/en/articles/1317/sustainability-of-health-insurance-and-the-challenges-of-agricultural-greenhouses">aims</a> to make agricultural produce available throughout the year and stabilize the local vegetable and fruit market. It also aims to boost food security and save water. Yet, the terms of the project excluded <a href="https://aps.aucegypt.edu/en/articles/1317/sustainability-of-health-insurance-and-the-challenges-of-agricultural-greenhouses">small farmers</a> from the outset: the National Company for Protected Agriculture collects 60% of the greenhouse renter&rsquo;s income from the crop revenues.
In addition, the <a href="https://aps.aucegypt.edu/en/articles/1317/sustainability-of-health-insurance-and-the-challenges-of-agricultural-greenhouses">greenhouses</a> are incredibly costly to operate&mdash;about EGP2 million before the last currency devaluation. Consequently, this project, which began in 2018, has not achieved its objectives. Its revenues from agricultural exports declined between 2021 and 2022.
<h3 dir="ltr">Fruits of Reclaimed Land Not for Local Consumption</h3>
The president <a href="https://www.skynewsarabia.com/business/1713468-%D8%A7%D9%84%D8%B3%D9%8A%D8%B3%D9%8A-%D9%86%D9%81%D9%83%D8%B1-%D8%B2%D8%B1%D8%A7%D8%B9%D8%A9-%D9%85%D8%AD%D8%A7%D8%B5%D9%8A%D9%84-%D8%B1%D8%A8%D8%AD%D8%A7-%D8%A7%D9%84%D9%82%D9%85%D8%AD">has explained</a> that the government steered the new reclamation projects toward cultivating profitable crops for export. This policy aims to export &ldquo;clean,&rdquo; pesticide-free crops from medium and large companies by <a href="https://www.cabinet.gov.eg/News/Details/74831">allocating</a> tracts to cultivate exportable high-quality produce that meets international standards.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1716788679imageEd 72_4 EN.png" alt="" width="405" height="404">
This policy <a href="https://misrelzraea.com/%D8%A7%D9%84%D8%A3%D8%B1%D8%A7%D8%B6%D9%8A-%D8%A7%D9%84%D9%85%D8%B3%D8%AA%D8%B5%D9%84%D8%AD%D8%A9-%D9%88%D8%AE%D8%B7%D8%A9-%D8%A7%D9%84%D8%AF%D9%88%D9%84%D8%A9-%D9%84%D9%84%D8%AA%D9%88%D8%B3%D8%B9/">is inconsistent</a> with statements by Ministry of Agriculture officials, who claim that the key objective of the new projects is to expand the production of strategic crops such as barley and wheat. Meanwhile, they mainly produce crops for <a href="https://www.sis.gov.eg/Story/248930/%D8%A7%D9%84%D8%AA%D9%82%D8%B1%D9%8A%D8%B1-%D8%A7%D9%84%D9%86%D9%87%D8%A7%D8%A6%D9%8A-%D9%84%D8%B5%D8%A7%D8%AF%D8%B1%D8%A7%D8%AA-%D9%85%D8%B5%D8%B1-%D8%A7%D9%84%D8%B2%D8%B1%D8%A7%D8%B9%D9%8A%D8%A9-%D8%AE%D9%84%D8%A7%D9%84-%D8%B9%D8%A7%D9%85-2022?lang=ar">export.</a> Citrus crops, for example, <a href="https://www.capmas.gov.eg/Pages/Publications.aspx?page_id=5104&amp;YearID=23541">accounted</a> for 19.2% of the total production of reclaimed land in 2021/22. The gap between statements and reality raises concerns over food security at a time when most Egyptians <a href="https://aps.aucegypt.edu/en/articles/1368/lack-of-transparency-and-protein">cannot afford</a> the reclaimed land&rsquo;s produce.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1716788735imageEd 72_5-5 EN.png" alt="" width="405" height="203">
The government lags in <a href="https://jalexu.journals.ekb.eg/article_267688.html">implementing</a> the Strategic Vision for the Development of Agriculture 2030, which aims to combat <a href="https://aps.aucegypt.edu/en/articles/973/policy-paper-egypts-climate-water-nexus-risks-and-sustainability-pathways-to-adaptation">climate fluctuations</a>. Decision-makers ignore that improving small farmers' lives and <a href="https://carnegieendowment.org/research/2023/10/climate-change-in-egypt-opportunities-and-obstacles?lang=en">supporting</a> them as they cope with the repercussions of global warming is crucial for the success of agricultural policies and inclusive development.
<img style="display: block; margin-left: auto; margin-right: auto;" src="https://api-aps.aucegypt.edu/uploads/tinymce/1716788806imageEd 72_6 EN.png" alt="" width="405" height="405">
The government should shift its focus to:
<ul>
<li dir="ltr" role="presentation"><a href="https://www.ifad.org/en/web/latest/-/story/opportunities-challenges-and-limitations-of-climate-smart-agriculture-the-case-of-egypt">Climate-smart agricultural interventions</a> to improve productivity per acre in the Nile Valley and the Delta.</li>
<li dir="ltr" role="presentation">Effective communication between farmers and policymakers to localize sustainable<a href="https://www.youtube.com/watch?v=8e9V-OTV3X0"> smart agriculture</a> that saves <a href="https://www.fao.org/climate-smart-agriculture-sourcebook/en/">energy and water</a> within a framework that preserves and develops local rural communities.</li>
<li>Community development in reclaimed desert lands; the government should learn from projects carried out under former President Hosni Mubarak, which offered <a href="https://www.sciencedirect.com/science/article/abs/pii/S0016718509000694">decent opportunities</a> for graduates but were not sustainable because they did not build an integrated community. </li>
</ul>
<hr>
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<div style="text-align: justify;">"Adasa" is a weekly policy digest by Alternative Policy Solutions. "Adasa" provides an analysis of a select number of policy developments and their effect on inclusive development and socioeconomic change.</div>

عدسة

Adasa

الوصول إلى الرعاية الصحية والتغطية

Health Care Access and Coverage

الغذاء والتغذية

Food and Nutrition

زراعة

Agriculture

إتاحة الدواء

Access to Medicine

السياسات الاقتصادية

Economic Policies

حماية اجتماعية

Social Protection

الفشل الكلوي يقتل الملايين والحكومة تقوم بتصدير منتجاتها الزراعية

Kidney Failure Kills Millions as the Government Exports its Healthy Produce

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