The kingdom’s health care system needs urgent help

Theodore Karasik underscores how the Saudi health system needs a shot in the arm

With half the Saudi population under 15 younger than 25, there is a massive need for proactive, preventive health care, especially given the prevalence of smoking and, regardless of gender, the high daily calorie intake and inactivity. Faisal Al Nasser / Reuters
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Saudi Arabia’s inability to deal with certain diseases became clear when a new outbreak of the Mers Coronavirus was recently reported. It has killed almost a dozen people in the past week and infected dozens more.

Mers and other new diseases test the Saudi health system. In recent years, we have seen scores of outbreaks – H1N1 (swine flu), H7N9 (avian flu) and Bovine Spongiform Encephalopathy, also known as mad cow disease. Then there is the fear of Ebola.

It is vital for the kingdom to contend with such disease vectors especially because of the Haj. It is the world’s biggest annual religious pilgrimage and when millions have congregated in Mecca, it is one of the largest gatherings in the world. During the Haj, the Saudi health care system jumps into action. The ministry of health prepares dozens of hospitals with a bed capacity in excess of 5,000. Moreover, about 150 healthcare centres in the vicinity of the Haj are equipped with the latest emergency management medical systems and staffed with nearly 20,000 specialised personnel to provide state of the art health care to all pilgrims free of charge.

Along the pilgrimage route, there are primary medical centres operated by the health ministry, the Saudi National Guard, the Internal Security Forces and the ministries of defence and aviation. They provide 24-hour free medical care.

If they can do this during the Haj, they should be able to do it the rest of the year too. Perhaps it is time to expand this capability across the kingdom. The valuable lessons learnt from the annual exercise should be a help.

The Saudi health system started on a very small scale almost 100 years ago. After the health ministry was formed in 1951 and the oil boom of the 1970s, the system moved quickly into its current shape. It was modelled on the publicly financed health care system of the United Kingdom.

For administrative purposes, the 13 geographic regions of the country are divided into 19 health regions, each with its own regional directorate of health. But there are problems. Health care remains pretty distinct between urban and rural areas in terms of delivery capability, but there aren’t enough professionals in either.

The concept of primary healthcare centres (PHC) began in earnest several decades ago. From the 1980s, evidence-based medicine techniques gave doctors and health practitioners greater decision-making powers in terms of the remedies they could offer to patients. Today, the kingdom has more than 2,000 PHCs. The role of rural PHCs has been critical though some of the services offered in the more remote corners of the country remain limited even to this day.

But as with education, health care is all about demographics. With half the Saudi population under 15, there is a massive need for proactive, preventive health care, especially given the prevalence of smoking and, regardless of gender, the high daily calorie intake and inactivity.

Currently, there are well over 410 hospitals in the country and 60,000 beds. More than half are run by the health ministry, roughly 40 are run by other government entities – the defence and aviation ministries, education ministry, the National Guard – and the rest are operated by the private sector.

Meanwhile, many PHCs are overburdened, especially the ones that serve huge populations of 100,000 people. Add to this the regional variation in the number of PHCs per 100,000 population and a huge variance in the spectrum of services they offer and it is clear that health care is a lottery in Saudi Arabia.

Along with everything else, health specialists say that the Saudi system has failed to keep up with changes in the workforce. Expats feature among the large numbers of recipients of health care but this is not at the state’s expense. For those millions of foreign workers and their dependents living in Saudi Arabia, health care at privately owned for-profit facilities are paid for by their employer or by the individual themselves.

One of the biggest issues mentioned repeatedly by those who have either received health care or delivered it in Saudi, is the lack of dissemination of information by providers. High rates of staff turnover, a lack of communication and coordination among health care facilities, and a stressful work environment contribute to high levels of dissatisfaction.

Quality levels of care and capability are already available, especially in cardiovascular surgery but the systemic failures often negate the excellence that exists. Saudi health managers point towards the health ministry’s unfortunate lack of decision-making authority and the fact that efforts to improve quality of care remain disjointed and uncoordinated overall.

Clearly, Saudi Arabia is in the middle of transitioning from a society with high birth and mortality rates, relatively short life expectancy and a high prevalence of communicable disease to one characterised by low mortality rates, longer life expectancy and high prevalence of chronic disorders.

Its healthcare system needs to track the changes. Clearly, it needs urgent care from King Salman and his advisers.

Dr Theodore Karasik is an analyst on the Gulf, specifically the kingdom of Saudi Arabia. He is based in Dubai