Regional profile – Qatar


On the road to superhealthcare

Although Qataris already enjoy a high standard of healthcare, the State of Qatar is
looking to improve it by implementing a major healthcare reform programme. When
Middle East Health visited Qatar earlier this year we discovered a healthcare system in
a state of transformation with an outcome envisioned to provide some of the best
quality healthcare in the world. Callan Emery reports.



Qatar nationals and expatriates enjoy free healthcare of a standard comparable to the high quality of the industrialised world. This is reflected in their longer life expectancy which has risen significantly in the past several years and is now considerably higher than the regional average. But this benevolent healthcare system is feeling the pressure of a fast expanding population and cannot continue as it is. For this reason coupled with incredible new found wealth from massive oil and gas reserves, Qatar has embarked on an extraordinary healthcare reform programme.

The State of Qatar is currently witnessing not only a major expansion of its healthcare resources and improvement of its facilities, but also the laying down of a new regulatory framework which will see fundamental changes in the provision and funding of healthcare in the emirate.

In addition to this, Qatar has partnered with several leading international healthcare institutions – educational and clinical – which are establishing branches in the emirate, including the likes of New York’s Weill Cornell Medical College and Canada’s University of Calgary Faculty of Nursing. These partnerships will foster a new movement towards premier medical education and much needed clinical research in the region.

Background

Qatar, an independent emirate, is a member of the Gulf Co-operation Council (the other countries include Saudi Arabia, Bahrain, Oman, Kuwait and the United Arab Emirates). It is a relatively small country of just 11,400 sq km of desert land on a peninsula protruding into the Persian Gulf between Saudi Arabia and the UAE. Its capital is Doha. In 2007 Qatar’s GDP, as estimated by the Economist Intelligence Unit, was US$59.1 billion. The emirate’s oil and gas reserves are responsible for nearly 62% of this figure. With a small population of some 928,000 (CIA World fact Book 2008 estimate) – more than 80% of whom live in Doha – Qataris enjoy one of the highest per capita incomes in the world.

The emirate is governed by the Al Thani family headed by Emir Hamad bin Khalifa al- Thani, who is Chief of State, Minister of Defence and Commander-in-Chief of the Armed Forces. Hamad bin Jasim bin Jabir al-Thani is Prime Minister. The Council of Ministers is appointed by the Chief of State. There is a legislative Advisory Council or Majlis al-Shura which has 35 appointed members. Preparations are underway for a new 45-member Majlis al- Shura; Qataris will elect twothirds of the Majlis al-Shura, the Emir will appoint the remaining members.

Qatar at a glance

● Life expectancy at birth m/f (years): 77/77
● Healthy life expectancy at birth m/f (years, 2003): 67/64
● Probability of dying under five (per 1,000 live births): 11
● Probability of dying between 15 and 60 years m/f (per 1,000
population): 72/64
● Total expenditure on health per capita (Intl $, 2005): 1,283
● Total expenditure on health as % of GDP (2005): 4.1

Figures are for 2006 unless indicated. Source: World Health Statistics 2008


State of health

Although Qataris and expatriates enjoy a high standard of healthcare and have a life expectancy – 77 years for both males and females (WHO 2006) – way above the regional average, the population is nonetheless increasingly succumbing to the “diseases of affluence” and modernisation – that is obesity, diabetes, cardiovascular diseases, stroke and cancer – diseases that are prevalent in the industrialised world. Road traffic injuries are also an increasing burden.

Qatar is also being swept along in the developmental boom which is being experienced by several other GCC countries and will experience growing pressure on its healthcare system, as are countries such as the UAE and Saudi Arabia, as it tries to contend with factors such as a rapid population growth. Over the next two decades the population of GCC countries is expected to double and the number of people aged 65 and more to increase more than seven-fold. Increasing affluence will also exacerbate the burden as people’s lifestyles change, their standard of living improves and they demand better quality health services. Also, in an ageing population, an increasing prevalence of non-communicable diseases will become increasingly costly to treat and manage.

A recent report by McKinsey & Co projected that healthcare in the region would grow a staggering 240% in the next 20 years, which will be spurred on, in particular, by a massive demand for cardiovascular treatment – expected to increase some 419% in the next 20 years – and diabetes. After Saudi Arabia and UAE the report placed Qatar third on the list in terms of growth in healthcare as these countries try to match the demands on their healthcare resources.

As in other countries on the Arabian Peninsula, Qatar has an exceedingly high percentage of neonatal deaths due to congenital abnormalities, which is largely a consequence of the high rate of consanguinity in the local population. New research facilities currently being developed will put considerable resources into studying this phenomenon. The state has also recently introduced a sophisticated neonatal genetic screening programme in an effort to reduce congenital defects in neonates.

National Health Authority

There are essentially three national bodies which influence the direction of healthcare in Qatar, the National Health Authority (NHA), The Hamad Medical Corporation (HMC) and The Qatar Foundation. The NHA, which was established under Emiri Decree in 2005, is responsible for directing the healthcare reform programme by setting goals and objectives for the country; designing national healthcare policies; regulating the industry; and monitoring progress. The Qatar Foundation, alongside playing a much larger culture and education development role, is providing financial support to several of the initiatives within the programme.

The NHA makes clear in a strategy document entitled: “Caring for the future: Qatar’s health and wellness 2010,” that it aims to promote public health, encourage healthy lifestyles, provide communitybased primary care and ensure the highest-quality care is available in tertiary medical facilities, which are also expected to carry out relevant research projects.

The NHA does not provide clinical services, but instead is tasked with regulating public institutions and the private sector. The Hamad Medical Corporation (HMC) has traditionally had this responsibility. There is currently a transition process taking place to transfer some of these responsibilities to the NHA.

Emergency helicopter

The National Health Authority (NHA) will introduce a 24-hour helicopter emergency medical service – named LifeFlight – in Qatar beginning September. This follows a
day-time only trial of the service since October last year.
 


Key challenges

The National Health Authority has outlined three key challenges it faces in implementing healthcare reforms. The NHA says it must confront and overcome:

● Premature death and catastrophic injury from road trauma, workplace accidents, and infant and early childhood mortality

● Early onset of preventable long-term conditions, particularly those where genetic factors may make the local population more vulnerable, such as certain forms of cancer and diabetes

● Lifestyle diseases that reduce life expectancy and quality of life, such as obesity, cardiovascular disease and respiratory disease related to smoking, and stress related mental illness

In the strategy document, released in the third quarter last year, the NHA outlines a range of objectives for 2008 and beyond including, among several others, the establishment of a central database to house key NHA data and the development of a national health IT strategy, including an Electronic Medical Record, which, according to a spokesperson at HMC, is “well advanced”. It is a long and comprehensive list of objectives which is indicative of the enormous investment Qatar is making to improve healthcare and the multifaceted challenges it faces in implementing these reforms.

Among other strategic initiatives, the NHA will also be responsible for the regulation of drugs, the development of a rapid response strategy in case of a large scale emergency and the drawing up of a plan for a future health insurance system.

Fortunately, the Qataris are working with what the American’s call a “green fields” scenario. With enormous newfound wealth the emirate is now i the enviable position of being able to rebuild its entire healthcare system almost from scratch, which is incredibly advantageous as they can incorporate the latest designs, technologies and concepts into their buildings, communication systems and regulatory framework.

To do this they have established strategic partnerships with leading institutions in the United States, Canada, Europe and Australia, which can provide the expertise and guide them on this road to what will, by the looks of it, be a country that will offer superlative healthcare to all who live there.

Healthcare institutions

Following is an outline of the key institutions involved in healthcare in Qatar.

Primary Health Care

An important aspect of the NHA led healthcare reform is a new vision of primary healthcare, one which puts preventative medicine at the forefront. There are plans to establish the 23 primary health care centres currently operated by HMC as a separate entity and to ensure that primary care is resourced to take a much stronger role in the nation’s health care provision overall. At the same time, in line with trends across the world, HMC has developed a home care programme that is in the pilot phase, but will soon be fully launched to support the care of acute, sub acute and long term patients at home.

Health insurance

As with several other countries in the GCC which offer free healthcare to nationals and expatriates, the cost of providing this care is escalating as the population grows, placing an increasingly heavy burden on government. Qatar, as have countries such as Saudi Arabia and the United Arab Emirates, is exploring ways to relive this burden through the provision of a national health insurance programme.

Although private health insurance is available, it is not yet mandatory for residents of Qatar. Nonetheless , it appears that the groundwork for a national healthcare insurance scheme is being put in place. In March Qatar’s Peninsula newspaper reported that the Qatar Islamic Insurance Company (QIIC), the lone Islamic insurer, and headed by one of the Al Thani family, Sheikh Abdullah bin Thani Al Thani, was establishing a medical insurance department “with the aim of expanding QIIC medical cover business”.
 


Hospital network

The NHA says in its strategic planning document, that it wants to establish a decentralised, integrated hospital network.

“At present, virtually all public hospital care is provided by a single organisation, the Hamad Medical Corporation,” says the NHA.

The NHA notes that within a system of smaller integrated hospitals, it sees a future in which HMC is the main general medical institution serving Doha. It will house a level-three trauma centre as well as the main general hospital – Hamad General Hospital.

As well as the hospital expansion programme in Doha, new hospitals are under construction for the growing residential population at Al Wakra, south of Doha, and Dukhan, on the west coast. Dukhan will provide health services for a large industrial complex and port which is being developed there. Near Dukhan is the site of one of the largest oil fields in the world.

SickKids partners with Hamad Medical Corporation

The expertise of The Hospital for Sick Children (SickKids) in Toronto, Canada
is being shared with the Hamad Medical Corporation (HMC), which is building a
new paediatric hospital in Doha, Qatar.

Physicians, educators, scientists and administrators from SickKids visited Qatar
between February and June to provide a wide range of advice on paediatric surgical
and medical services, inter-professional practices, health records, nursing, infection
control and research.

Cathy Séguin, SickKids’ vice-president of International Affairs, said: “The
primary goal is to help Hamad Medical Corporation build a state-of-the-art paediatric
health facility that reflects the standards of excellence that this partnership
represents.”

SickKids International was established to extend the reach of the hospital globally.
Expertise from all disciplines in paediatric health care, education and research at SickKids is harnessed to counsel, transfer knowledge, advise and mentor. SickKids
International provides advisory services aimed at building sustainable capacity with
its partners with the ultimate goal of improving global children’s health.

Those advisory services will be factored into the new hospital, which is scheduled to
open in 2011. The SickKids International team that has visited Doha is now in the
process of analysing HMC’s current operations, which includes their clinical care,
education, research and support services. Recommendations will be developed and
considered by HMC in the development of the new children’s hospital.

Ann Chang, SickKids nurse educator and project director for the Qatar partnership,
said: “We have learned so much from our time in Qatar. We are thrilled that we
were selected to assist Hamad Medical Corporation with their plans to build the
best children’s hospital in the region.”
 


Hamad Medical Corporation

The HMC comprises five hospitals and provides about 90% of health services in Qatar, although with the proposed establishment of a new Primary Care Corporation, private hospitals, and Qatar Foundation’s new hospital and biomedical research centre Sidra, this is expected to change. Currently, HMC’s resources are overstretched and there is an urgent need for more facilities. Hamad’s Emergency Department, for example, sees more than 1,000 people a day.

Remarkably, all HMC hospitals achieved the highly respected Joint Commission International accreditation in 2007, becoming the first hospital group in the Middle East to do so.

Hamad Medical City

In an effort to expand its healthcare facilities HMC is developing Hamad Medical City, adjacent to its existing hospitals in Doha.

Hamad Medical City will include a new children’s hospital, a cardiology hospital, a new women’s hospital, a rehabilitation hospital and a skilled nursing facility for longterm care. A nurses hostel and married staff accommodation is also located on the campus. When Middle East Health visited earlier this year most of the building structures were complete, awaiting final interior design and fit out.

A spokesperson from the Strategic Planning Depart - ment explained that HMC is establishing strategic partnerships with some of the world’s leading healthcare institutions thus enabling Qatar, although a small country, to deliver world class care.

The new children’s hospital is being developed in partnership with the Hospital for Sick Children in Toronto. In a similar way, the Emergency Department is being supported by the University of Pittsburgh Medical Centre, USA.

HMC has established a number of partnerships in other spheres, which include Heidelberg University Children’s Hospital in Germany. This has enabled HMC to develop and offer a comprehensive Neonatal Screening Service for 32 diseases. It has also established partnerships with a number of education institutions such as the University of Calgary which offers degree and postgraduate training in nursing; the College of the North Atlantic for preliminary nursing and other health care skills development; Deakin University Australia for post graduate nurse education and New York’s Weill Cornell Medical College for the training of doctors. All these institutions have built or are building campuses in the emirate.

Foetal medicine

According to a recent report in the Peninsula newspaper Hamad Medical Corporation (HMC) will become the first hospital in GCC to introduce Foetal Endoscope Surgery unit.

Foetal edoscopic surgery is performed on foetuses requiring surgery while still in the womb.

Professor Yves Ville, Head of Foetal Medicine, University of Paris, which is collaborating with HMC on the project, was quoted as saying: “The surgery is mainly used in case of identical twins when placental separation becomes necessary. It is also used when there is a hole in the diaphragm of the foetus and growth of lungs gets obstructed. Using the foetal endoscope, we introduce a plug into the foetus and thus the viscera are pushed down helping in lung growth.”

As part of the collaboration Prof Ville has been training HMC doctors for the past three years on foetal medicine.
 


Weill Cornell Medical College Qatar

Weill Cornell Medical College Qatar (WCMCQ) is part of Weill Cornell Medical College in New York City, one of the leading clinical and medical research centres in the United States. WCMCQ was established under the terms of a 2001 agreement between Cornell University and the Qatar Foundation.

The WCMCQ campus is located at the Qatar Foundation’s Education City. The 1,000 hectare Education City, a large part of which is currently under construction on the outskirts of Doha, is home to other highly reputed institutions such as Carnegie Mellon University-Qatar, Georgetown University of Foreign Service in Qatar, Texas A and M University and the Virginia Commonwealth School of the Arts in Qatar, among others. Northwestern University will also be offering a mass communication and journalism degree programme later this year.

Middle East Health spoke to Mike Vartigans, Director of Public Affairs at WCMCQ. Vertigans explained that the six-year MD degree course incorporates a two-year premed programme and a fouryear medical programme.

Medical students are taught by resident and visiting Cornell and Weill Cornell faculty. Video conferencing facilities are available to enable students and faculty to share learning experiences with colleagues in the US.

Students graduate with a Cornell M.D. degree and then apply for residencies. Students recently graduated this year are doing residencies in the United States and at Hamad Medical Corporation.

Vertigans pointed out that faculty is appointed by Cornell in the US and the student admissions process is set by Weill Cornell with a Committee of Admissions sitting in New York. Students in Qatar face the same stringent tests as those applying to enter the medical college there. Acceptance is based on a “needs-blind admission” process and admission is purely on academic merit.

WCMCQ accepted its first students in 2002 and the medical school, in a landmark achievement for Qatar, celebrated the inaugural graduation of its first medical doctors in May this year.

Vertigans added that the capacity target per class is around 50 students, but stressed there is potential for growth.

“Funding for non-national students is provided by the Qatar Foundation in the form of a loan with various reimbursement options,” Vertigans explained. These include a service in kind arrangement where physicians can come back to the country for an agreed period of time in the healthcare system. For Qataris, tuition fees are provided by the Government.”

Biomedical research

Qatar Foundation and the Weill Cornell Medical College in Qatar (WCMCQ) launched their biomedical research programme in June this year. The research will target diseases common in the Gulf region such as diabetes, heart disease and cancer.

Dr Javid Sheikh, Deputy Dean for the Medical School and Vice Dean for Research at WCMCQ said the programme will focus on developing sustainable local research capacity while targeting the disease areas important in the Gulf region.

The Peninsula newspaper reported that the programme has established two broad research themes: a genetic and molecular medicine research programme with the focus on personalised medicine, gene therapy for cancer, and stem cell research; and a women and children's health research programme with the focus on maternal foetal medicine and the neurogenetic disorders of the newborn.

The research team at WCMCQ work closely with Qatar Foundation, Hamad Medical Corporation, the National Health Authority, Sidra Medical and Research Center, Qatar
Science and Technology Park and their colleagues in the parent campus at WCMC in New York.
 


Sidra

Sidra Medical and Research Center is also being built at Education City. It is due to open in 2011 and will become the teaching hospital for WCMCQ. It is also expected to play a central role in biomedical research in the region.

The building has been designed by renowned architect Cesar Pelli and the artists’ impressions make clear that this will be a facility with cutting-edge technology. At the unveiling of the architectural plans in 2007, Pelli remarked that the centre will become “one of the most important medical and research centres in the world”.

The centre will essentially be three hospitals in one – paediatric, women’s and adult hospital – each divided by a towering atrium. The biomedical research facility will be situated in a separate building to the side of the hospital and be connected by an enclosed walkway.

Terry O’Donovan, Sidra’s Public Relations and Marketing Project Director, explained that Sidra has three missions – to provide patient care, medical education and biomedical research.

“Regarding patient care, its primary focus will be on specialty care for women and children. It will also offer select medical and surgical services for adults.”

Sidra will also play a key role as a teaching hospital for students of WCMCQ.

Research will be carried out in collaboration with WCMCQ and HMC and will focus on thee core areas: pregnancy and infertility; developmental and preventative medicine for children; and women’s health.

Sidra will be an all-digital facility with plans to make it “wireless, filmless and virtually paperless”. It will also make use of the latest technology including medical robotics, computer-aided surgery and diagnostics, and advanced digital imaging.

Qatar Science and Technology Park

Qatar Science and Technology Park (QSTP), also located at Education City, comprises 45,000 sq metres of office and laboratory space in a $300 million complex which is due to open this year. It was established to help entrepreneurs launch start-up technology companies in Qatar through grants and investment, training programmes, and a business incubator.

One of its programmes includes a robotic surgery centre, which is envisaged to become a centre of excellence for training and simulation in robotic surgery in the Middle East. The centre is being jointly developed by the Qatar Foundation and Imperial College London.

PCL reconstruction

Qatar’s Orthopaedic and Sports Medicine Hospital, Aspetar, in April became the first hospital in Qatar to carry out a double bundle arthroscopic posterior cruciate ligament(PCL) reconstruction. The operation was led by Aspetar’s Chief of Surgery, Craig R Bottoni, MD, who developed this new surgical technique in 2003 and has used it in over 100 operations prior to Aspetar.

Dr Bottoni, assisted by Nebojsa Popovic, MD, and Mohammed Al Ateeq, MD, reconstructed the PCL with a donated ligament (allograft). The two bundles of the PCL
are separately reconstructed, thus restoring the anatomical structure and stability to the knee. The use of this technique has been shown by biomechanical testing to better re-create the native posterior cruciate ligament function.

Dr Bottoni said: “This is a relatively new technique but we believe it facilitates graft passage and makes a difficult operation slightly less challenging. It is our intention at Aspetar to become a PCL referral centre for the region.”
 

University of Calgary, Faculty of Nursing

Following an intensive search and review of top North American nurse education programmes, The University of Calgary was selected as Qatar’s preferred partner for the development of nurse education and research in the emirate.

The University of Calgary is one of Canada’s top ten research intensive universities and has an international reputation for excellence in medical and engineering research.

The university says that with generous funding from the State of Qatar, it intends to become the world leader in nurse education within the next 10 years.

The Qatar campus is the first ever branch campus of the University of Calgary. The University of Calgary Qatar (UC-Q) offers three programmes all leading to a Bachelor of Nursing degree.

The “Regular Track” programme is for high school graduates and is comprised of 40 classes (normally four years for fully admitted students). The Post Diploma track is for holders of a recognised Nursing Diploma and is comprised of 15 classes (two years), and the Accelerated Track is for holders of another Bachelor's degree from a recognised university and is comprised of 26 courses (2.5 years). The campus enrolled its first students in the autumn of 2007.

“Our steady-state target intake is 100 students per year,” said Walid Al Banna, the Manager of Marketing Services, University of Calgary Qatar. On 8 April this year, UC-Q and HMC signed two agreements which will enable nursing students at UC-Q in Doha, as well as those at the University of Calgary campus in Canada to further develop their expertise at HMC hospitals.

The agreements provide the framework for future clinical and programme developments between HMC and UC-Q.
 

Private healthcare

Al Ahli Hospital in Doha is Qatar’s first major private hospital. It opened it doors in November 2004. The multispecialty hospital is still being expanded and when complete
will have 250 beds.

Speaking to Qatar’s Peninsula newspaper in May this year Abdulwahed Al Mawlawi Managing Director and CEO of the Al Ahli Hospital said there was “great scope for private healthcare facilities in the country with the rapid growth in the population”.

“The private sector can play an important role in meeting the demand for more healthcare facilities in the country," he said. He called on the National Health Authority to give more weight to this sector.

He told the newspaper the major challenges facing the private health sector was the recruitment of well qualified staff and keeping up with rapidly changing technology.
 


Aspetar

Aspetar, Qatar’s sophisticated and technologically advanced Orthopaedic and Sports Medicine Hospital opened in April last year. The hospital has attracted some of the world’s leading orthopaedic doctors and sports medicine specialists to its staff to provide treatment for orthopaedic and athletic injuries that is comparable to the best in the world.

For this reason the hospital has already in its first year attracted several leading sports people, such as Didier Domi, a former French international footballer who plays for Olympiakos in Greece. He visited the facility for a few weeks for rehabilitation. Selim Ben Achour, a Kuwaiti national soccer player, also used the facility recently.

Aspetar has the following departments:
● Sports Medicine Clinical Department
● Orthopaedic Surgical Department
● Guest Services
● Exercise and Sports Science
● Radiology and Laboratory
● Research and Education Centre
● Rehabilitation

■ The Sports Medicine Department is directed by Dr Hakim Chalabi, who has substantial experience in sports medicine and was previously the Chief Medical Doctor of Paris Saint Germain Football team. The department includes physicians from Italy, Canada, France, Spain and New Zealand who provide a wide range of expertise and experience.

■ Orthopaedic Surgery The Orthopaedic Surgery department has a clinical focus on musculoskeletal injuries and sub-specialties. Its facilities include:

● Four digital operating theatres linked to an education centre
● 50 in-patient beds in two wards
● Six-bed Intensive Care Unit ■ Rehabilitation The rehabilitation facility has exclusive male and female areas and offers the following:
● Physiotherapy
● Hydrotherapy
● Thalassotherapy
● Relaxation
● Strength and conditioning
● Functional rehabilitation

There are more than 40 professionals on the rehabilitation team, including 30 physical therapists, five fitness instructors, and four hydrotherapists.

The hospital says outpatients can be treated for post-operative management of acute and chronic conditions and sport-specific rehabilitation. Patients receive advice on preventing injury and enhancing performance, and maintaining and improving general body condition when recovering from injury.

Aspetar also has two sports podiatrists, who specialise in diagnosing and treating foot and ankle disorders. They use biomechanical evaluation and gait analysis, and can prescribe and oversee the manufacture of orthoses.

■ Clinical papers The physicians at Aspetar have published a number of peer-reviewed clinical research papers, which are available online at the Aspetar website: www.aspetar.com

Qatar University

Qatar University (QU) is Qatar’s leading institution of higher education, with 60 active academic programmes. The QU Pharmacy Program was initiated to help meet the country’s growing demand for qualified pharmacists.

Dr Peter J. Jewesson, Qatar University Pharmacy Program Professor and Director, said: “The mission of the pharmacy school is to prepare our students to provide optimal pharmaceutical care and to advance the science of pharmacy for Qatar, the Middle East and the world.”

The pharmacy programme began in 2006 and offers two degrees, a five-year Bachelor of Science in Pharmacy degree, and a six-year Doctor of Pharmacy (PharmD) degree for select graduates pursuing advanced clinical training.

Superhealthcare

As with many of the new healthcare projects in the region, it is still early days for these remarkable developments in Qatar. Nonetheless, with such ambitious vision and the money to support it, it is good to see the groundwork, indeed the physical structure, for much of it already in place. It leaves you in no doubt that Qatar is genuinely well on the road to providing superhealthcare to all who reside there in the emirate.
 

Key Websites

■ National Health Authority - www.nha.org.qa
■ Hamad Medical Corporation - www.hmc.org.qa
■ Weill Cornell Medical College - Qatar - www.qatar-med.cornell.edu
■ Sidra - www.sidra.org
■ Aspetar - www.en.aspetar.com
■ University of Calgary Qatar - www.ucalgary-qatar.ca
■ Qatar Science and Technology Park - www.qstp.org.qa
■ Qatar University - www.qu.edu.qa
 



 Date of upload: 23rd July 2008

                                  
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