Author Archives: Greg Simpson

A Ray of Hope on Health Care from an Unlikely Source


Health care professionals in Egypt conduct a stakeholder analysis to help spell out governance principles for Egyptian hospitals.

A hip replacement in the United States, paid for out-of-pocket (i.e., without health insurance), would cost anywhere from $11,000 to $125,000, depending on what hospital you go to, according to a 2013 survey of 100 hospitals featured on National Public Radio.  And that was among the hospitals that, when asked, could actually produce a quote – 40 of the 100 hospitals surveyed couldn’t quote a price at all.

Those fortunate enough to have insurance don’t need to worry about price-shopping.  When I go to my primary care physician, I pay a $20 co-pay.  (Under our previous insurance, provided by my wife’s former employer, it was $10.  Why the difference?  Who knows?)  I have no idea how much my insurance company pays the doctor.  I suppose I could find out, but… honestly?  There’s really no compelling reason for me to do so.  It’s $20 no matter who I see.

And it turns out that, even if there were more incentive for me to price-shop, more expensive hospitals aren’t necessarily better hospitals, according to a 2014 study.

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Asking the Right Questions to Promote Entrepreneurship in MENA

Entrepreneurship is increasingly touted as a key ingredient to economic growth, job creation, and expanding opportunity, particularly for youth and women, in the Middle East and North Africa region. As a result, the number of initiatives supporting entrepreneurship in the region has increased exponentially, particularly following the Arab Spring.

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Sesame Street, Swine Flu, and Unintended Consequences in Egypt

Zabbaleen boys in Mokattam Village in 2009. (Photo: Wikipedia)

“The law is not feeding me.”  That was the quote that really caught my eye.  At CIPE we talk about “Democracy that Delivers,” but I have never seen such a fundamentally honest and genuine expression of the concept – a democracy will not work unless it is delivering in tangible ways for its citizens.

“The law is not feeding me.”

The source was a black market pig farmer quoted in a fascinating article on a garbage collection crisis in Egypt in Monday’s Washington Post.  (And no, I didn’t know there was such a thing as a black market pig farmer, either.)  It seems that pigs raised by Cairo’s Coptic Christian Zabbaleen community used to consume a significant portion of the city’s garbage.  Reacting to the global swine flu epidemic in 2009, the Egyptian government slaughtered all of the country’s pigs and, from then on, banned ownership of trash-fed pigs.  This usurped the livelihood of the Zabbaleen – and resulted in a city-wide backlog of unconsumed, uncollected garbage.  To make matters worse, in the current economy, government-contracted sanitation firms are being short-changed by a full half of their fees and have had to cut back service accordingly.

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Expanding Opportunity for Young Entrepreneurs in Jordan

One size does not fit all in economic development, and while the focus in developing countries is often on integrating into the global economy and attracting large-scale foreign investment, it is easy to overlook the potential resources to expand economic opportunity that exist right at home.  I’m speaking of creating opportunities for entrepreneurship and the growth of small business. In Jordan, hard hit by the global financial crisis, CIPE’s partner the Young Entrepreneurs Association is leading a drive to lower barriers to entry for would-be entrepreneurs in an effort to expand economic opportunity to a broader cross-section of Jordan’s citizens — particularly its youth, who are increasingly realizing that they will not be able to rely on the state for a job as in generations past.

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A Big Push for the Smallest of Enterprises

The street vendor is a ubiquitous feature of urban life virtually everywhere in the world.  Food served from a battered cart, jewelry on rickety table, local souvenirs laid in neat rows on a blanket (ready to be pulled up by the corners at the first sign of the police).

Street vendors are often viewed as an urban nuisance even in the most developed of economies – recall Mayor Rudy Giuliani’s war on vendors, legal or otherwise, in New York City in the 1990s.  The Federation of Economic Development Associations (FEDA), a grassroots federation of small and medium-sized enterprises (SMEs) in Egypt, knew that this would be an issue that would capture attention when its launched its own program aimed at this unlikely group of small business owners.

Still, FEDA has sparked public debate on the issue in Egypt at a level it didn’t expect.  It earned significant print and broadcast media coverage – most recently, a spot on Nile Life TV’s popular Every Night program.  Every Night is seen nationwide in Egypt and by satellite throughout the MENA region.


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Acknowledging Egypt’s Elephant in the Room

It’s funny when a survey is released how everyone becomes an amateur statistician.  I’m guilty of it, too – the first thing I do when I get a survey is flip with a skeptical eye to the methodology page. Of course, methodology is an important element of understanding a survey’s data.  But often, methodology is attacked to distract attention from the elephant in the room – the uncomfortable truth that a survey can reveal.

CIPE Egypt, in cooperation with the Ahram Center for Political and Strategic Studies (ACPSS), recently released a survey of nearly 800 Egyptian small- and medium-sized enterprises (SMEs) about their experiences with corruption (results here).  Corruption is endemic in all aspects of Egyptian life.  Transparency International’s 2008 Corruption Perceptions Index ranks Egypt at 115 out of 180, and Global Integrity’s 2008 assessment of institutional integrity rates Egypt as Very Weak.  CIPE’s survey was intended to get feedback from SMEs about the corruption they face in the course of doing business, with an eye toward opportunities for targeted reform.

I attended CIPE’s public release of the survey in Cairo (more in CIPE’s latest OverseasREPORT here).  While there were more than a handful of methodological nitpickers, the majority of participants and panelists – including business associations, owners of SMEs, media, academics, and representatives of the Egyptian government – engaged in a serious discussion on the issue of corruption in Egypt and how to tackle it.  The result was a remarkably open and frank discussion of a topic that was once taboo. 

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