The population growth in Egypt: from health perspective challenges to comprehensive solutions

Введение

Египет занимает четырнадцатое место в мире по численности населения, занимая первое место среди арабских стран и третье место среди африканских стран после Нигерии и Эфиопии. Население Египта составляет примерно 1,3% от населения мира. Темпы прироста населения увеличились с 2,05% в период между переписями 1996 и 2006 годов до 2,56% в период между переписями 2006 и 2017 годов, что превышает ежегодный прирост населения мира и многих развивающихся ^стран1 .

По оценкам Организации Объединенных Наций, население мира увеличивалось в среднем на 1,23% в год в период с 2000 по 2010 год. В Индии, второй по численности населения стране, за тот же период ежегодный темп прироста составил 1,64%, в то время как в Китае, самой густонаселенной стране, ежегодный темп прироста с 2000 по 2010 год составил 0,5% ² .

Egypt’s population grew by about 24.7 million people (roughly 30% increase) from 2010 to early 2023. This illustrates the scale of population growth during this period and its impact on health, the economy, and other areas. Additionally, there is an imbalance between population growth and economic growth in Egypt³.

Numerous research studies have emphasized that economic growth should be three times the rate of population growth to create enough jobs for the new generation. This means that Egypt’s population growth rate, which was 2.56% between 2006 and 2017, requires an economic growth rate exceeding 7.5% annually for citizens to truly benefit from development [1].

Population demographics

The demographic trends in Egypt over the past few decades have shown significant progress. There has been a notable improvement in healthcare, evidenced by lower mortality rates and higher life expectancy at birth. Since the 1960s, Egypt has experienced a substantial decline in death rates. The crude death rate fell from 16.9 per 1000 people in 1960 to 7.3 in 2021, and infant and child mortality rates have also decreased rapidly⁴.

The infant mortality rate dropped from 141 per 1,000 live births during 1965–1969 to 25 per 1,000 live births in 2017–2021; additionally, under-five child mortality decreased from 243 per 1,000 live births to 28 per 1,000 live births in 2021⁵. The maternal mortality rates also dropped from 174 deaths per 100,000 live births during 1992–1993 to 49 deaths in 2021. Due to these improvements in death rates, life expectancy in Egypt reached 74.1 years for females and 69.7 years for males in 2022⁶.

The fertility rates have also declined, with the number of births dropping from 2.7 million in 2014 to 2.183 million in 2022; the total fertility rate decreased from 3.5 children per woman in 2014 to 2.85 in 2021, and further to 2.76 in 2022; family planning coverage increased to 66.4% in 2021, up from about 58.5% in the 2014 survey; if current fertility rates of 2.76 children per woman continue, Egypt’s population is projected to reach 117 million by 2030 and 157 million by 2050⁷.

Egypt experienced a significant drop in birth rates over the past years, from 30.3 live births per 1000 people in 2013 to 21.1 in 2022. Despite this decline, the current birth rates, which exceed two million births annually, still present a major challenge across various economic, social, environmental, and health sectors⁸.

Migration

The number of migrants from Egypt was estimated at around 1.4 million according to the 1976 population census, representing 3.6% of the total population; the 2006 census reported that international migration from Egypt had reached 3.9 million migrants, making up 5.4% of the population; by the 2017 census, there was a significant increase in the number of migrants abroad, reaching 9.5 million, which accounts for 10% of the population; estimates indicate that the highest migration flows from Egypt are directed to the Gulf countries compared to other Arab nationalities; however, Egyptian labor in the Gulf countries faces fierce competition in the job market with the Asian labor, and these countries are also tending to replace foreign labor with domestic workforce⁹.

Egypt has also become an attractive destination for certain nationalities. According to a report by the International Organization for Migration (IOM), the number of residents in Egypt has reached 9 million migrants and refugees, equivalent to 8.7% of the Egyptian
population¹⁰.

Most Egyptian migrants are concentrated in Arab countries, where their number reached 7 million in 2017, making up 68.4% of all Egyptian expatriates. However, due to current issues in Arab nations caused by security instability in Libya, Iraq, and the war in Yemen, along with falling global oil prices, the number of Egyptians abroad has dropped to 4.9 million, representing 54.6% of the total Egyptian expatriates¹¹ [2].

Population characteristics

Both the dependency ratio for the young (the population under 15 years old divided by the population aged 15–64) and the dependency ratio for the elderly (the population 65 years and older divided by the population aged 15–64) have increased from about 51 and 6%, respectively, in 2011 to 55 and 8% in 2021, the overall dependency ratio (the combined population under 15 years old and 65 years and older divided by the population aged 15–64) rose to approximately 61.6% by 2022. This increase is due to higher birth rates and a growing elderly population caused by longer average lifespans; to fully benefit from the demographic dividend, the dependency rate needs to decrease, which can be achieved by lowering overall birth rates¹².

Egypt has a large youth population that tapers at the top, as of July 1, 2021, approximately 34.3% of the population is under 15 years old, and youth aged 15 to 29 make up 25% of the total population, offering Egypt an opportunity to benefit from the potential demographic dividend. The percentage of people aged 60 and over increased from 6.9% in 2011 to 8.2% in 2021, and this group is expected to grow to 10.6% by 2030 (Fig. 1). This shift indicates changes in the population structure, which can lead to various health and social challenges. The rise in the percentage of those over sixty means greater health and social needs for this group, resulting in higher healthcare and pension costs. This, in turn, requires additional investments in health infrastructure¹³. 

Health-related challenges

As of 2025, Egypt’s Central Agency for Public Mobilization and Statistics (CAPMAS) announced that the Egyptian population had exceeded 107 million¹⁴, and was classified by the World Bank as a lower-middle-income country with a Gross National Income per Capita reaching $3,000 in 2020. Although the country has experienced economic growth, especially in the manufacturing sector, it still faces challenges such as high public debt, sluggish exports, and the impact of regional conflicts and political unrest¹⁵. These factors were augmented by the population growth and negatively influence healthcare delivery, infrastructure setup, and future planning, leading to significant challenges such as:

• Health system financing: According to the Egyptian Constitution of 2014, the government’s health expenditure should be at least 3% of the gross domestic product (GDP). Egypt’s healthcare system heavily relies on out-of-pocket payments, accounting for 62% of total health expenditure, compared to 39% in other lower-middle-income countries. Government health spending accounts for approximately one-third of the total health spending. The Universal Health Insurance System (UHIS), introduced in 2018, aims to expand coverage and reduce both out-of-pocket and catastrophic health expenditures; however, it has only reached six governorates out of the 27 Egyptian governorates by 2025, covering approximately 3.1 million people. Although the national health budget has increased nearly 10-fold since the fiscal year 2014/2015, this increase has been absorbed by several challenges, such as the repeated devaluation of the Egyptian Pound, the dedication of resources to set up the new UHIS kick-off, and the progressive population growth¹⁶.
• Access to healthcare services: The healthcare system in Egypt includes multiple providers of health services, with evident disparities between governorates. The average national bed capacity is 11.09 per 10,000 people, which is significantly lower than the international standard of 30 per 10,000 people; Only nine governorates exceed the national average, and just two are close to the global standard. The health workforce is also impacted similarly; over the last decade, the number of physicians has decreased from 11.3 per 10,000 people in 2011 to 9.3 per 10,000 people in 2022, and the number of nursing staff has declined from 21.3 per 10,000 people to 19.9 per 10,000 in 2022¹⁷. The defective health services in some areas usually encourage people to self-medicate due to the presence of a high number of community pharmacies [3].
• Disease threats: The past decade has shown a rise in the incidence and prevalence of non-communicable diseases (NCDs). 29.5% of people have high blood pressure, 15.5% have high blood glucose levels, 35.7% are obese, and 22.7% are tobacco smokers. Eighty-six percent of deaths are due to NCDs with cardiovascular diseases being the leading cause, accounting for 43.9%, followed by cancers, which represent 14.8% of deaths. Breast and liver cancers are the highest incident cancers (48.7 and 22.7/100,000 population). Despite national efforts, school children (6–12 years) still suffer from anemia, obesity, and stunting, reaching 9.4, 8.7, and 3.8% respectively¹⁸.

The path to comprehensive solutions

According to Article 41 of the Egyptian Constitution, which states that the government is committed to implementing a population program aimed at balancing population growth with available resources, maximizing investment in human development, and improving people’s characteristics within the framework of sustainable development, and in light of emerging and ongoing demographic changes and shifts, despite these challenges related to population growth, the Egyptian government has taken several actions to curb the rise in birth rates and has implemented measures to lessen the impact of population growth on different sectors, particularly the health sector, through various initiatives.

• Global leadership in Policies and Strategies: Cairo hosted the first International Conference on Population and Development (ICPD) in 1994. During the conference, 179 governments agreed that the goal of any population policy should be to ensure reproductive rights and choices for people, rather than focusing solely on demographic targets. They also adopted a Program of Action aimed at empowering women and girls for their own benefit, as well as for the benefit of their families, communities, and nations¹⁹. In 2023, after three decades, President El-Sisi directed the Egyptian Ministry of Health and Population (MoHP) to organize the Global Congress on Population, Health and Development (PHDC) on an annual basis, which represents a significant opportunity and an essential platform for researchers, policymakers, and decision-makers from around the globe to address the population dilemma²⁰.
• National Strategies: The National Population and Development Strategy (2015–2030) was launched in November 2014 with the goal of improving citizens’ quality of life by balancing population growth and economic development. It also aims to enhance population characteristics, reshape Egypt’s population distribution, and achieve social justice and harmony by reducing developmental gaps between regions. The strategy includes four pillars: increasing access to family planning and reproductive health, promoting youth and adolescents’ health and civic engagement, advancing women’s economic empowerment, strengthening girls’ education, and finally, media. During the PHDC 2023 conference, the MoHP launched the National Population Strategy (2023–2030), which highlights the state’s latest efforts to address the overpopulation crisis. This strategy has been developed in light of the Sustainable Development Goals (SDGs), Egypt’s Vision 2030, the Egyptian Constitution, the National Strategy for Population and Development, and the National Project for Family Development. The strategy is built around seven pillars: ensuring reproductive rights, investing in human capital, empowering women, promoting education and learning, leveraging communication and media for development, addressing climate change and population dynamics, and governance of the population sector. It focuses on key areas such as economic empowerment, service provision, cultural and educational awareness campaigns, and digital transformation²¹.
• National Projects: In 2019, Egyptian President Abdel Fattah El Sisi launched the Descent Life initiative, also known as the National Project for the Development of the Egyptian Countryside, called “Haya Karima” or “Decent Life”. It mainly aims to address the social determinants of health and improve the living conditions and daily lives of people in thousands of villages and rural areas by promoting cooperation and unity among government institutions, private sector entities, civil society, and development partners in Egypt. Additionally, it enhances medical services, expands educational opportunities, and creates job opportunities²².

In 2022, the government established the National Project for Development of Egyptian Family (NPDEF), as a comprehensive development initiative that extends beyond family planning and healthcare. It covers five areas, including promoting the economic independence of women. Furthermore, the NPDEF’s efforts align with Article 41 of Egypt’s 2014 constitution, which mandates the implementation of a population program aimed at balancing demographic growth with available resources and maximizing investments in human resources²³.

• Universal Health Coverage Expansion: In 2018, Egypt achieved a significant milestone in healthcare reform with the introduction of the Universal Health Insurance Law, aimed at revolutionizing the
  nation’s health system and advancing Universal Health Coverage (UHC). This law designates families as the primary unit for enrollment and establishes family health units and centers as the initial point of service for insured individuals. Aligned with the SDGs principle of inclusivity, Egypt’s UHC reform seeks to ensure equitable access to high-quality healthcare for all citizens, addressing critical health priorities and promoting health equity. The reform’s overarching goal is to break the cycle of poor health and poverty at both individual and societal levels by providing accessible, quality healthcare services, thereby improving health outcomes and alleviating the financial burden of medical costs on households. This, in turn, supports poverty reduction and fosters economic growth. The Universal Health Insurance (UHI) system aims to secure sustainable funding for healthcare while reducing out-of-pocket expenses through a comprehensive overhaul of the health financing system. Implementation is planned across six phases, targeting all Egyptian governorates with a comprehensive package of quality health services and financial protection by 2032, with strategies to expedite the rollout within a decade. The UHI law introduces a purchaser-provider split, supported by the establishment of three independent organizations in mid-2019: the Universal Health Insurance Authority (UHIA) to procure services, the Egypt Healthcare Authority (EHA) to deliver services, and the General Authority for Healthcare Accreditation and Regulation (GAHAR) to oversee accreditation and regulation²⁴.
• Public Health Initiatives: For several decades, the Egyptian people suffered the double burden of both communicable and NCDs. Since 2018, the government has launched a series of innovative public health interventions aimed at eliminating several infectious diseases and reducing the impact of multiple NCDs. Through these initiatives, Egypt has been recognized by the World Health Organization (WHO) as the first country to achieve the gold tier certificate on the path to eliminating hepatitis C virus (HCV) [4] together with elimination of Measles and Rubella in 2023 [5], followed by the certificate to achieve hepatitis B control targets in 2024²⁵and the elimination of malaria in 2025²⁶. In addition, the MoHP is driving robust early detection programs for six cancers, including breast, liver, prostate, colorectal, lung, and cervical cancer. Parallelly, screening for NCDs such as diabetes mellitus and hypertension, along with their risk factors like dyslipidemia and sequelae such as renal impairment, is also ongoing. On the other hand, several screening programs are ongoing to detect rare diseases early and the leading causes of disabilities²⁷. Special focus on improving nutritional indicators for school children has been ongoing since 2019, with annual screening for anemia, obesity, and stunting leading to remarkable improvements: anemia decreased from 42.3% in 2019 to 9.4% in 2024, obesity from 12.7% in 2019 to 8.7% in 2024, and stunting from 6.9% in 2019 to 3.8% in 2024. At the forefront of this effort is the 1000 Golden Days program, which started in 2017 and aims to improve the health indicators of pregnant women and newborns, address the high fertility rate through indirect interventions, encourage families to have better pregnancy spacing, promote breastfeeding, reduce malnutrition among newborns and children, and support overall mental health. In 2023, the program was upgraded to a national presidential initiative with comprehensive national plans and indicators aligned with the NPDEF²⁸.

The national project for human development

In July 2024, the Egyptian Prime Minister appointed the Minister of Health and Population as his deputy for human development for the first time ever. This decision truly demonstrates the national commitment to human capital. The government announced the launch of the national project for human development under the slogan “Bedaya” or “A New Beginning for Human Development.” The goal of that ambitious Presidential Initiative is to create a pathway for the Egyptian people toward self-development, health, education, sports, culture, and behavior, in order to nurture a healthy, educated, empowered, capable, aware, cultured, and ethical citizen for society. The project supports Egypt’s Vision 2030 and the United Nations (UN) SDGs by addressing poverty, gender equality, and economic growth, it complements initiatives like Haya Karima, which target rural development and financial inclusion, especially for women-led businesses; the WHO’s Director-General, Tedros Adhanom Ghebreyesus, praised Bedaya for its comprehensive vision, especially its focus on cross-sectoral collaboration and women/youth empowerment²⁹.

Achieved targets

The exerted national efforts during the past decade have led to significant changes in several indicators, which are paving the way toward a better containment of population growth in line with the improvement of people’s social and health characteristics. The total fertility rate in 2021 was 2.85 births per woman, and it declined to 2.1 births per woman in 2023 (Fig. 2). Meanwhile, the usage of family planning methods increased from 66.4 percent in 2021 to 75 percent in 2023, the illiteracy rate among people aged 10 and above decreased from 25.8 percent in 2021 to 12.6 percent in 2023, educational enrollment rose from 94 percent in 2021 to 98 percent in 2023, the youth unemployment rate dropped from 16.5 percent in 2021 to 12 percent in 2023, the percentage of children in the labor market declined from 4.9 percent in 2021 to 2 percent in 2023, the percentage of child marriages decreased from 15.8 percent in 2021 to 8 percent in 2023³⁰. 

Conclusion and way forward

Despite the challenges posed by population growth and its impact on health, which hinder progress in improving access to high-quality health services, impede the expansion of the UHC program, and significantly affect morbidity and mortality rates in Egypt, national efforts succeeded in mitigating these effects and made significant advancements in many health indicators. The national health strategy 2024–2030 has set several ambitious targets, including increasing life expectancy to 75 years by 2030 and reducing maternal mortality, neonatal mortality, and mortality rates below five years old. Achieving those targets will complement the national goal to reduce the fertility rate to 1.6 births per woman by 2030, aligned with increasing the human development index to be among the top 30 countries by 2030. Achieving these targets requires extensive parallel work on the subnational levels to strengthen the role of governorates in implementing population strategies and human development plans, mobilize religious and community leaders to support behavioral change and positive social transformation related to population and development, increase access to all health services, especially reproductive health services for girls and adolescents, particularly in underserved areas.