Guide to Licensing Private Hospitals and Convalescent Homes

The health system in Egypt seeks to enhance the level of medical care services provided for patients and recipients of treatment for citizens to be healthy. Every citizen has the right to receive the necessary medical care to recover from diseases or epidemics they might get through the medical care provided by doctors and medical facilities in which treatment is received. 

Medical facilities are either public or private, and medical services have to be provided within a legal framework. Here, we shall discuss private medical facilities and explain the documents and papers required for licensing private hospitals and convalescent homes, licensing procedures, required controls, the licensing authority, and the penalties imposed in case of a violation.

Differences and similarities between private hospitals and convalescent homes

There is a great similarity between a private hospital and a convalescent home in terms of the required documents, procedures and licensing authority. We shall explain their description and the similarities below:

A Private Hospital: 

Private hospital is a fully equipped medical facility operating as per the regulations of the Ministry of Health and Population, has several specializations, and is equipped to accommodate patients for treatment after medical examination and diagnosis. It is managed and supervised by a licensed physician. The private hospital has to be licensed by the competent authority in the Ministry of Health and Population as per the relevant laws and regulations, and established by a Presidential Decree.

A Convalescent home: 

Convalescent home is a medical facility prepared for patients to receive medical care and accommodation after completing treatment in the hospital. Therefore, it is called the convalescence/ recovery period from diseases, and it is under the supervision of a licensed physician, and it is usually the same physician in whose name the license is issued.

What are the Required Documentation for the Licensing?

• A copy of the ownership contract of the hospital or the convalescent home; or a notarized or dated lease contract at the Notary Public.
• A stamped certificate of registration of the facility with the competent medical syndicate.
• A copy of the certified contract concluded between the facility manager and the license applicant, provided that a copy of an amended contract shall be submitted whenever the facility manager is changed.
• Stamped technical drawing approved by a union engineer, measuring 1/150, indicating the location the details and content of each hospital floor.
• A statement of medical and operating equipment.
• A statement of the complementary departments of the hospital or convalescent home (physiotherapy department, radiology, medical laboratory, denture laboratory, and pharmacy).
• A payment receipt for registration fees paid to the competent syndicate.

The license application for a medical facility (private hospital / convalescent home) is submitted to the competent health affairs directorate, and must include the following:

1. For Private Hospitals:

• Hospital name.
• Name of the owner of the hospital premises.
• Address.
• Phone number.
• Name of the hospital owner in whose name the license application is submitted.
• Name of the hospital director and his/her physician license number.
• Specializations available at the hospital.
• Name of the technical director in charge of the hospital and his/her physician license number.
• Number of resident doctors and nurses.
• Available departments and their license numbers (physiotherapy department, radiology, medical laboratory, denture laboratory, and pharmacy).

2. For Convalescent Homes:

• Name of the Convalescent Home.
• Name of the owner of the premises.
• Address.
• Phone number.
• Name of the Convalescent Home owner in whose name the license application is submitted.
• Name of the director and his/her physician license number.
• Name of the technical director in charge of the hospital and his/her physician license number.
• Number of resident doctors and nurses.
• Available departments and their license numbers (physiotherapy department, radiology, medical laboratory, denture laboratory, and pharmacy).
• A hazardous materials and waste handling license 
• A proof of contracting or subscribing to a waste incinerator if the facility does not have a waste incinerator.
• A proof of the existence of fire extinguishers or a receipt for their purchase.
• Copies of the professional licenses for working physicians, nursing staff and the technical director in charge.
• Approved health certificates for kitchen staff or those who provide ready-made meals to patients.
• Payment receipt of the union fees (1/1000) of the value of the facility in favor of the Medical Professions Union.

3. For medical devices and equipment

 imported from abroad for use within the medical facility, the following must be submitted:

• The Company's Investment Prospectus.
• Submission of an initial inspection by representatives of the Ministry of Health and Population at the Investors Services Center to declare the project establishment.
• The concerned party’s acknowledgement that the released medical devices and equipment are disposed of only for the designated project purposes.

License Procedures You Need to Know:

• Submit a license application to the competent health affairs directorate to obtain initial approval.

The permanent committee to examine the license applications submitted for the establishment of a medical facility, its management, changing its activity, or transferring its management, shall be formed of:

• Committee Chairman: First Undersecretary of the Ministry.
• Membership: Undersecretary of the Ministry for Therapeutic Medicine, Director General of Non-Governmental Treatment Institutions, Director General of Medical Licensing, Head of the Drug Policy Center, Director of the Pharmacy Department at Non-Governmental Treatment Institutions and the Legal Advisor.

A committee to inspect the relevant medical facility (private hospital - convalescent home) shall be formed of:

• The competent Health Administration Director or the Regional Medical Director.
• The competent Director of the Free Medical Treatment Department.
• An engineer from the Health Affairs Directorate or a delegated engineer from the Housing Directorate.

• The license applicant shall undertake not to make any change in the technical management or ownership of the facility or to employ non-Egyptian workers except after obtaining explicit and written approval from the Permanent Committee. If this is violated, the license shall be annulled.
• Follow up on the completion of the medical facility’s equipment and staffing (physicians and nurses) with utmost accuracy and quality, otherwise the medical facility’s license shall not be issued.

After verifying the accuracy of the data in the application, the competent sub-syndicate sends the application to the Egyptian Medical Syndicate, which sends the medical facility registration certificate (license) within two months from the date of submitting the above documents.

What is the Licensing Committee?

After getting the license, the facility owner shall submit a request to the committee for discussion within two weeks, specifying the accommodation fees and services provided by the facility (pursuant to the provisions of Law No. 51 of 1981, as well the rules regulating hospitals subject to the Investment Law) and supported by the required documents. The Committee completes its work within one month from the date of submitting the request, and sends the recommendation to the competent governor.

The Licensing Committee consists of:

• Chairman: Head of the Central Administration for Therapeutic Care.
• Membership: Director General of Non-Governmental Treatment Institutions, Director General of Medical Licensing, Head of the Egyptian Medical Syndicate or his representative, Head of the Central Administration for Dentistry, and two representatives of private medical facilities.

The committee may choose a rapporteur from among its members, and may seek the assistance of whomever it deems to be experienced. The medical facility shall put the price list in an apparent place, and notify the Syndicate and the competent Health Affairs Directorate to register it.

The percentage of resident physicians, nursing staff and technicians that must be available in the medical facility shall be specified by a Ministerial Resolution, provided that they all have relevant licenses.

The licensing authority for medical facilities:

The Free Medical Treatment Department in the competent Health Affairs Directorate

License Cancellation Cases

• If the licensee requests to cancel the license
• If the activity is stopped for a period exceeding one year without notifying the sub-syndicate, the competent sub-department, and the competent department of the Health Affairs Directorate.
• If the facility is relocated, rebuilt, or modified in a manner that violates the provisions of the law and executive decisions.
• Practicing an activity other than the activity for which the license was issued 
• If a permanent closure or removal order of the medical facility is issued.
• If a violation is repeated despite the imposition of the legally prescribed penalties.
• If the working staff; whether physicians or other medical profession workers, do not have the relevant licenses.

Rules and Restrictions for licensing a medical facility (a private hospital):

• The medical facility must be managed by a physician licensed to practice medicine.
• The physician may own more than one private medical clinic, but may not manage more than one medical facility other than private clinics. 
• The medical facility shall abide by the Code of Ethics of the Medical Profession, especially in advertising and publicity media, so that the facility shall not be advertised except after the approval of the Ministry of Health. The advertisement may not include methods of diagnosis or treatment. If the physician advertisement for himself or his activity must be approved by the Ministry of Health.
• If the Technical Director is changed, the competent health directorate in the governorate and the competent sub-syndicate must be notified in order to close the facility administratively until a new Director is appointed
• The medical accommodation and the performance of medical services have to fulfill the health and medical conditions pursuant to the Ministerial resolutions.
• The necessary conditions for licensing the operation of the medical facility must be available.
• The Permanent Committee determines the classification of private hospitals according to the hotel services provided therein.
• The provisions of the Minister of Health Resolution No. 291 of 1980 and its amendments, regarding the collection, storage and distribution of blood (if there is a blood center in the medical facility) shall be observed.
• There must be an intensive care unit where surgical operations are performed.
• The operating room, dialysis unit and patient accommodation rooms must be equipped pursuant to the regulations and resolutions issued by the Minister of Health, to ensure good accommodation and good treatment of patients.

Licensing of Clinics within Medical Facilities

For an outpatient clinic in the medical facility, the following conditions must be fulfilled:

• The clinic must have a private entrance.
• There must be waiting areas equipped with the required amenities and a sufficient number of bathrooms attached therein.
• There must be a number of examination rooms equipped with appropriate diagnostic and treatment equipment.
• The owner of the medical facility may not add any data on the sign or the prescription contradicting or violating the data in the license.

Other Restrictions You Need to Know:

Inspection of the medical facility must be conducted annually in order to ensure that the legally required conditions are monitored. In case of a violation, the facility manager must be notified and asked to remove it within a maximum period of thirty days. In case of grave breach, the competent governor may, after consulting the competent health authority, close the facility for the period he deems appropriate, and it shall not be reopened until the cause for closure has been removed.

If the medical facility is rented: 

The lease contract does not end with the death of the tenant or his leaving the property, but his heirs and partners have the right to use it as they may deem. The tenant or his heirs may also assign it to a licensed physician, provided that the lease contract entitles him to continue occupying the rented property.

If the facility owner dies:

The heirs shall have the right to the license for a period of twenty years from the date of death, provided that they submit an application within six months from the date of death and appoint a licensed physician as a Director, and then notify the administrative authority and the Syndicate of such appointment.

In case of changing the facility director:

The owner has to notify the competent health directorate in the governorate and the competent sub-syndicate of the new Director within two weeks by a registered mail with acknowledgment of receipt or hold the facility activities until this matter is resolved; otherwise, the competent authority shall close the facility administratively until the new Director is appointed.

Patient Reports

The medical facility must keep all reports for each patient, indicating the surgeon in charge of the surgical operation, a description of anesthesia material and method, the medications used, changes in pulse and pressure, and methods of treating disorders that occur to the patient, in order to ensure legal accountability for errors.

A license is granted to private hospitals or dialysis centers only if they are located in a separate building or have a private entrance to the hospital or medical center.

Hospital discharge reports: 

Medical facilities must provide a medical report to the patient upon discharge, and a copy must be kept at the facility. If the report is related to surgery, it must include the following:

• Diagnosis before and after surgery and the steps of performing that surgery.
• Type of anesthesia and medications used, and a statement of the eradicated parts removed during the surgery.
• Complications – if any – and other observations.

Qualifications of the Surgeons (who performs surgical operations, endoscopic exploration and special surgeries)

• They have to be specialized in the relevant surgical field.
• They must complete the training period and obtain a training certificate in the same specialty.
• The medical facility in which the surgery is performed must be well-equipped for emergency cases that require intensive care or high-level surgical intervention.
• The names of the licensed physicians must be recorded in a special register.

The facilities licensed to perform surgical operations within have to fulfill the following conditions pursuant to the provisions of Law No. 153 of 2004. In addition to a minimum level of medical equipment, they must include:

• An efficient anesthesia device with a suitable ventilator.
• Spare tubes and oxygen cylinders, and devices that help provide more than one source of oxygen.
• Holter monitor/ ECG
• Pulse Oximeter
• Blood pressure meter (sphygmomanometer) to measure blood pressure on regular basis every 5 minutes.
• A defibrillator monitor for ventricular defibrillation, and the necessary medications to perform cardiopulmonary resuscitation.
• A suction device.

Recovery Rooms Characteristics:

Recovery rooms are essential in private hospitals, and they must include the following:

• A Holter monitor or ECG and a ventricular defibrillator.
• A Pulse Oximeter
• An artificial respirator.

If there is more than one operating room in the hospital, each room must have an anesthesiologist. The anesthesiologist may not be assigned to work in more than one operating room at the same time.

The physician appointed in the medical facility (private hospital) must be:

• Egyptian
• Registered in the Egyptian Medical Syndicate’s records

Non-Egyptians may work in medical facilities in Egypt under the following conditions:

• Physicians who are permitted by the Medical Professions Law on the condition of reciprocity and the approval of the competent authorities.
• Licensed foreign expert physicians whose type of experience is not available in Egypt; provided that prior approval is obtained from the Minister of Health and the Egyptian Medical Syndicate. The license of foreign experts shall not exceed 3 months, and is registered in a special register of the Medical Syndicate after paying the indicated fees.

In all cases, the salaries, wages and benefits granted to Egyptian doctors must not be less than those granted to their foreign counterparts working in the same medical facility.

Penalties imposed on medical facilities for violating the rules and regulations of the Ministry of Health and Population:

• Whoever assumes the management of a medical facility after a closure order or an administrative decision has been issued to that effect before the reason for the closure has ceased to exist; shall be punished by imprisonment for a period not exceeding one year and a fine ranging from a minimum of ten thousand pounds to a maximum of twenty thousand pounds; or by one of these penalties.
• If the medical facility practices the activity before obtaining the license, it shall be closed by a decision from the competent medical authority, and the judge may impose a fine ranging from a minimum of ten thousand pounds to a maximum of fifty thousand pounds, and the activity shall not be practiced until after obtaining the license.
• Whoever obtains a license by fraud or by exploiting the name of a physician shall be punished by imprisonment and a minimum fine of twenty thousand pounds; or by one of these penalties. The physician who permitted his/her name to be exploited shall also be punished the same. In addition, the violating facility shall be closed and its license shall be cancelled. The judge may order the closure of the facility even if it is contested and the ruling is appealed.

• In all cases, the ruling to closure order shall be executed even if the medical facility owner or a third party objects to judgment execution, without prejudice to the application of another more severe penalty stipulated by another law.
• In the event of violating the provisions of the law, the perpetrator shall be punished with a fine ranging from a minimum of two hundred pounds to a maximum of twenty thousand pounds. If the violation is not removed within the prescribed period, the judge may, upon the request of the competent medical authority, rule to close the facility permanently or for the period specified in the ruling which shall be executed immediately even if it is objected to or appealed.
• The judgment to close the facility shall be executed even if other activities are being carried out there, provided that the condition of the facility does not allow for the closure to be limited to the part where the violation occurred. In the professional violation is repeated, the hospital may be placed under the supervision of the Ministry.