Regional profile – Oman

Rapid progress

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 13 physicians.

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.

Health 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 declined.

Financial sustainability

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 of Education.

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 Hasan Ali.

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