Health Care System in Saudi Arabia: An

Overview

• The government of Saudi Arabia has given high priority to the development of health care services @ all levels: primary, secondary & tertiary.

• As a consequence, the health of the Saudi population & health services have improved greatly in terms of quantity & quality.

• According to the World Health Organization (WHO), the Saudi health care system is ranked 26th among 190 of the world’s health systems.

• Brief overview of health services development:

• Health services in Saudi Arabia have ↑’d & improved significantly during recent decades.

• The first public health department was established in Mecca in 1925 based on a royal decree from King Abdulaziz : Responsible for sponsoring & monitoring free h/c for the population & pilgrims through establishing a # of hospitals & dispensaries.

• The MOH (Ministry of Health) was established in 1950 under another royal decree.

• 20 years later, the 5-year development plans were introduced by the government to improve all sectors of the nation, including the Saudi health care (h/c) system.

• Since then, substantial improvements in h/c have been achieved in KSA.

• Current structure of health services:

• Currently the MOH is the major government provider & financer of h/c services in KSA.

• Total of 415 hospitals (58,126 beds) in Saudi Arabia according to 2010 statistics.

Contributing factors to the significant improvements in health indicators: The advancement in health services Improved & more accessible public education Increased health awareness among the community

Better life conditions

Despite the multiplicity of h/c service providers, there is NO coordination or clear communication channels among them >>> *waste of resources & *duplication of effort

To overcome this & to provide the population with affordable, organized, & comprehensive h/c >>> In 2002 the Council of Health Services, headed by the Minister of Health & including representatives of other government & private health sectors, was established .

• The aim of this Council: To develop a policy for coordination & integration among all h/c services authorities in KSA.

• However, significant progress has yet to be achieved in this area.

• Public health care system (MOH):

• According to the Saudi constitution, the government provides all citizens & expatriates working within the public sector with full & free access to all public h/c services.

• The Responsibilities of MOH:

Managing, planning & formulating health policies

Supervising health programs

Monitoring health services in the private sector

Advising other government agencies & the private sector on ways to achieve the government’s health objectives.

• The MOH supervises 20 regional directorates-general of health affairs in various parts of the country.

• Each regional health directorate has a # of hospitals & health sectors & every health sector supervises a number of PHC centers.

The role of these 20 directorates includes:

Implementing policies, plans & program of MOH

Managing & supporting MOH health services

Supervising & organizing private sector services

Coordinating with other government agencies & other relevant bodies

• Levels of Health Care Services:• Primary, Secondary & Tertiary.

• PHC centers supply 1˚ care services, both preventive & curative >>> referring cases that require more advanced care to public hospitals ( 2˚ level of care), >>> cases that need more complex levels of care are transferred to central or specialized hospitals ( 3˚ level of h/c).

• Transition to PHC services:• In 1980, a ministerial decree was issued to

establish PHC centers which aimed to focus on the 8 elements of the PHC approach:

Educating the population about prevailing health problems & the methods of preventing & controlling them;

Provision of adequate supply of safe water & basic sanitation;

Promotion of food supply and proper nutrition; Provision of comprehensive maternal & child h/c;Immunization of children against major

communicable diseases; Prevention & control of locally endemic diseases; Appropriate treatment of common diseases &

injuries; Provision of essential drugs

Transition to PHC services

Levels of health care services

Tertiary health care

SecondaryHealth care

PrimaryHealth care (PHC)

• Health services in the pilgrimage (hajj) season:

• Health care services in the hajj season provide free of charge preventive & curative care for all pilgrims, irrespective of their nationality.

Preventive care includes: health education programs, vaccination &

chemoprophylaxis for all pilgrims via quarantine services @ airports & land ports.

The provision of emergency & curative services: takes place through a network of h/c facilities.

• E.g., in 2009 : 2.3 million pilgrims:• There were 21 hospitals,(of which 7 seasonal),• A total of 3408 beds & 176 beds for emergency

admissions.• 157 PHC centers,(of which 119 seasonal)• On average, each PHC center treated 4734 pilgrims.• The total workforce recruited to work in these

facilities during 2009 was 17,886• On average, each physician treated about 612

pilgrims, while each nurse treated about 372.

• These free of charge services for all pilgrims >>>> considerable pressure on the h/c budget.

• One suggestion: to introduce a seasonal health insurance for all international pilgrims

• Challenges for h/c reform:1. Health workforce, 2. Financing & expenditure,3. Changing patterns of diseases,4. Accessibility to h/c services,5. Introducing the cooperative health

insurance scheme, 6. Privatization of public hospitals, 7. Utilization of electronic health (e-health)

strategies & the development of a national system for health information.

• Challenges for h/c reform:1. Health workforce: Shortage of local h/c professionals i.e., physicians,

nurses & pharmacists. The majority are expatriates >>> high rate of turnover

& instability in the workforce The budget for training & scholarships has ↑’d &

many MOH employees have a chance to pursue their studies abroad which could:

1. Improve the skills of current employees2. Raise the quality of health care 3. ↓ rate of turnover among h/c professionals However, such efforts may not be enough to solve the

challenges.

• Challenges for h/c reform:

• More medical colleges & training programs need to be established around the country.

• New laws & regulations to develop & reorganize medical human resources by the MOH are urgently required.

2. Reorganization & Restructuring of the MOH: The public health sector is overwhelmingly

financed, operated, controlled, supervised & managed by the MOH.

Serious & well-planned steps should be taken to separate these multiple roles.

Possible solutions include: Giving more authority to the regional directorates Applying the cooperative health insurance scheme Encouraging the privatization of public hospitals.

3. Decentralization of Health Services & Autonomy of Hospitals:• To meet ↑’ing pressure on the MOH, more autonomy has

been given to the regional directorates in: planning, recruitment of professional staff, formulating agreements with health services providers (operating companies) & some limited financial discretion

• MOH standardized an autonomous hospital system for 31 public hospitals >>>> expected to:

Raise the efficiency of their performance in both medical & managerial functions,

Achieve financial & administrative flexibility Apply quality insurance programs Simplify the contractual process with qualified h/c

professionals

Decentralization of Health Services & Autonomy of Hospitals:

• Giving more autonomy to hospitals >>>> will:

*Help the transition to full privatization of public hospitals in KSA.

*It gives public hospitals more experience in the management of their budgets, h/c quality & workforce.

4. Health Insurance in Saudi Arabia• Funding h/c care services is a central challenge

faced by the MOH• The Council for Cooperative Health Insurance was

established by the government in 1999 .• The main role of this Council is to: introduce,

regulate & supervise a health insurance strategy for the Saudi h/c market to meet the growing population demands for h/c & to ensure the quality of services provided.

• The implementation of a cooperative health insurance scheme was planned over 3 stages:

1) First stage: Was applied for non-Saudis & Saudis in the private

sector, in which their employers pay for health cover costs.

2) Second stage: To be applied for Saudis & non-Saudis working in the

government sector. The government will pay the cooperative health

insurance costs for them. 3) Final stage: Will be applied to all other employees & other

groups , i.e., pilgrims .

• Only the first stage has been implemented to date

• The government is now working systematically to apply the remaining 2 stages

5) Privatization of public hospitals:• Steps to implement a privatization strategy have

been initiated >>>> a # of public hospitals are likely to be sold or rented to private firms over the next few years.

• Expected advantages of hospitals privatization Assist in speeding up decision-making, Reducing the government’s annual expenditure

on h/c, Producing new financial sources for the MOH,Improving h/c services .

Expected disadvantages of hospitals privatization: Privatized hospitals will focus on attracting

patients, even those who may not require hospital-level care.

People with health coverage may prefer to access big hospitals directly instead of via PHC centers or community hospitals.

Private companies are likely to focus their activities within cities & larger communities.

Public hospitals will not be able to absorb enough of the h/c market compared with private companies, unless they upgrade @ all levels.

• If the government does not apply adequate control over the h/c market >>> expenditure on h/c may ↑ dramatically as a result of higher pricing & profit-seeking behavior

6) Accessibility to Health Services:The current MOH statistics indicate that there is a

maldistribution of h/c services & h/c professionals across geographical areas.

Many do not have access to h/c facilities, esp. those living in remote areas.

• In order to improve accessibility to health care services: 1) A strategy for the redistribution of h/c services,

should be adopted by the MOH. 2) The MOH should coordinate with other sectors, i.e.

transport, water & power companies & social security services in order to develop services for people with the greatest needs in deprived areas .

7) Patterns of diseases:• The change in disease patterns: communicable noncommunicable diseases in KSA

>>>challenge that needs > attention from the MOH.

There is an alarming ↑ in the prevalence of chronic diseases (DM, HTN, & heart diseases, CA, genetic blood disorders & childhood obesity).

Tx of such diseases is costly & may even be ineffective.

Early prevention is the most effective way to ↓ the prevalence of chronic diseases & costs & difficulties associated with Tx in the later stages of disease.

8) Promotion & Prevention Programs for Crises:• Practical plans & procedures should be developed &

implemented to meet national crises in KSA, i.e., wars, earthquakes, fires & explosions @ petroleum factories.

• Caring for people affected by road accidents consumes a significant proportion of the MOH budget; (in 2002 about SR 652.5 million),which could be used to develop the h/c system & improve services.

• Plans to manage such issues need to be comprehensive & well-coordinated among the related sectors in order to be achievable.

9) e-Health & National Health Information Systems

• There is underutilization of electronic h/c systems in KSA.

• Implementation of e-health & electronic information systems has already started in many hospitals & organizations (i.e. KFSH&RC & university hospitals,…)

• However, these systems are not connected to each other or to other private or specialized health organizations.

A high level of coordination among different h/c providers & with other sectors is needed to enhance the use of e-health strategies & to launch a comprehensive national system for health information.

• New strategy for health care services:

• To meet the challenges of the Saudi h/c system & to improve the quality of h/c services the MOH has set a national strategy for h/c services that was approved by the Council of Ministers in April 2009.

• A 20-year timeframe is expected for achieving the objectives of this strategy.

• This National Strategy focuses on: Diversifying funding sources; Developing information systems; Developing the human workforce; Activating the supervision & monitoring role of the

MOH over h/c services; Encouraging the private sector to take its position

in providing h/c services; Improving the quality of preventive, curative &

rehabilitative care; Distributing h/c services equally to all regions.

In order to address these challenges & continue to improve the status of the Saudi

h/c system>>> the MOH & other related sectors should coordinate their efforts to implement & ensure the success of the new h/c strategy.