Regional profile – Oman
In July 2000, the World Health Organisation’s World Health Report ranked
Oman first in healthcare delivery efficiency and use of financial
resources among 191 national systems. Oman also figured among the top
ten of the world’s most effective healthcare systems overall. That’s no
small vindication for a nation that in 1970 had just two hospitals and
although the Sultanate is an uppermiddle income country with a GDP per
capita of around US$7,900 (2002), offering healthcare to its small
population of 2.5 million is hampered physically and financially by its
relatively large size and difficult terrain. Oman’s population is
scattered over large areas of sparsely populated settlements, many with
fewer than 500 inhabitants. That said, expenditure on healthcare has
made quantum leaps. As of 2004, the Ministry of Health (MoH) accounted
for 5.6% of government expenditure. With 3.5% of GNP (as of 2004) going
to health, the results are impressive: 56 government hospitals, 166
government health centres, clinics and dispensaries, 13.9 doctors and
35.2 nurses and midwives per 10,000 population. Life expectancy today
stands at an average of almost 74 years compared to 49 in 1970, and
infant mortality per 1,000 is down from 118 to 16.2 (2004). Oman’s
healthcare system today is a public model, with health services
predominantly financed and provided by the government which accounts for
95% of all hospitals, 80% of doctors, 94% of nurses and 83% of other
paramedic professionals. Although there are 631 private clinics in the
country, just 20% of these provide limited specialty care.
Despite a relatively low expenditure of $218 per person per year, much
lower per capita than other countries in the world with a similar income
level, international agencies considered Oman’s health outcomes
‘remarkable’, according to the World Bank 2001 Report.
Mohamed Hasan Ali, Undersecretary for Planning, Ministry of Health,
attributes much of this success to the development, over time, of a set
of incremental polices and strategies that had, at their core, the right
of all citizens to free health services delivered through a system with
primary health as its cornerstone. Priority was given to the
construction of a basic health infrastructure which currently reaches
100% of urban and 94% of rural families. Health services were also
provided, though mobile teams, to people living in isolated areas. Human
resource needs were addressed by importing health workers from other
countries to meet immediate need as well as longterm plans to develop an
indigenous human resource.
services were decentralised, creating 10 self-contained health regions
comprising certain districts. This encouraged local responsibility,
community involvement and self reliance.
Having achieved its early goals, Oman is now facing a new set of
problems. A fast growing population – which could double within 25
years, the increasing demand for human resources within the health
service and a changing health profile are all challenging the MoH to
balance quality of service with cost control.
In the early 1970s infant mortality, pneumonia and maternal deaths were
commonplace leading the health service to focus on curative, rather than
preventative medicine. With the modern age have come modern ailments
such as occupational stress, hypertension, heart disease, diabetes,
obesity and asthma.
Dr Ibrahim Abdel Rahim, WHO representative in Oman, calls this trend a
‘demographic and epidemiological shift’. The MoH estimates that at least
10% of the population is diabetic. Chronic complaints like these place a
sustained demand on healthcare resources. In addition, while the average
life expectancy in Oman has increased, healthy life expectancy has
Financial sustainability of the current healthcare system in the face of
increasing demand and rising costs is an issue that will certainly have
to be addressed. Estimates show that by 2020 the MoH would need to
double its current spending to maintain national health development.
But looking ahead, the MoH is already shifting its focus from curative
to preventative medicine, not least by launching a number of ‘healthy
living’ educational programmes in schools and health regions.
Sustaining and developing a growing number of health professionals is
also a priority. Between 1990 and 2001, MoH staff grew more than 45% to
17,000 – making it the biggest civil service ministry after the Ministry
Sultan Qaboos University (SQU) produces an average of 100 doctors a year
– almost 90% of these go to work for MoH – but developing specialists is
a longterm procedure. The number of doctors has doubled from 1,441 in
1990 to 3,397 in 2001. Allocations to the Directorate General of
Education and Training accounted for RO2.8mn (US$7.3 million) in 2001 --
2% of the total MoH outlay.
The MoH has 16 training institutes; 13 of which are nursing institutes.
In 2001, 239 staff were being trained overseas. The Oman Specialised
Nursing Institute was opened the same year to develop specialists in
branches such as surgery, intensive care and neonatal care.
Nationalisation has also given impetus to capacity building. Omanis
account for 56% of MoH staff.
As with most healthcare systems, cost is an issue. Providing a free, but
accessible, health service necessitates efficient use of resources.
Decentralising the system went some way towards this, making local
regions responsible for their own budgets and introducing
accountability. A number of hospitals have been made autonomous. A
referral system is also being worked out, tying the people of one area
to a particular network of hospitals and health centres.
Privatisation is entering Oman. A number private hospitals are
patronised by expatriates whose privileges at government hospitals are
limited and Omanis willing to pay high fees to avoid waiting lists. The
ministry has also extended soft loans and technical support to the
private sector. The MoH Directorate of Health Establishment aims to
monitor standards in private clinics through the formation of the
Private Sector Health Establishments Committee.
Insurance is another route taken by many and certainly an option for
Oman. According to Mohamed Hasan Ali, the ministry is mobilising
financial resources from insurance companies for specified health
services and has introduced nominal user fees. Other immediate
strategies include the establishment of new health centres where they
are needed and closure of those that are under-utilised.
The ministry has expanded the primary care network and is reconfiguring
the hospital sector. Better hospital management procedures are being put
in place along with computerised information systems.
“The performance of Oman’s governmentfinanced healthcare system so far
has shown a remarkable degree of success in the pursuit of its goals for
health development. While Oman faces new challenges on its path towards
achieving sustainable health development, I am confident that the
process of planning, management and organisation adopted by the
government to meet these challenges will contribute to ensure the
ongoing success of its healthcare delivery system,” declared Mohamed