Saudi Arabia Report
Creating a sustainable
healthcare system
Although Saudi Arabia is a relatively wealthy country per capita – the country has the world’s largest oil reserves and is the world’s largest exporter of oil – it nonetheless has been facing a mounting financial burden from healthcare expenditure in its effort to sustain its national healthcare system, a system which has provided free basic healthcare to all its citizens and foreign residents. Realising that such a system is unsustainable in the face of a growing and ageing population, the government has, over the past few years, initiated measures to reform it. Middle East Health reports.
The Kingdom of Saudi Arabia
(KSA) has the largest population
of the Gulf Co-operation
Council (GCC) countries,
estimated in 2008 to be around
28 million, including around
5.5 million foreigners.
Despite its relatively high
GDP per capita wealth –
US$14,653 in 2006 according
to the Saudi Arabia Health
Statistical Yearbook – the
kingdom, which aspires to
provide healthcare on a par
with economically advanced
countries, is facing a growing
financial burden and shortage
of infrastructure in the healthcare
sector due to a number of
reasons. These include a
steadily growing population
(estimated to be around 2% a year, according to CIA World
Factbook); an ageing population
(the pensionable population
is expected to grow from
2.8% of the population in 2005
to 4% of the population in
2020 and to 6.5% of the population
in 2030, according to a
2009 Business Monitor
International [BMI] report); an
increasing awareness by its citizens
about quality healthcare;
and a changing pattern of
disease – largely as a result of
lifestyle changes emanating
from the modernisation of
Saudi society.
Starting in the 1970’s the
government has implemented
a series of five-year development
plans using its oil wealth
to transform the country from
a relatively undeveloped
country into a modern industrial
state. More recently there
has been an attempt to gradually
transform the economy to
one that is not so heavily
dependent on petroleum in an
effort to broaden the economic
base and increase the living
standards of all Saudis.
Although this has not as yet
been entirely successful there
has been some diversification
of the economy into industry
and agriculture. These development
plans have also
resulted in considerable growth
of the kingdom’s infrastructure,
which has seen the building of
roads and highways, a significant
increase in power generation,
the construction of ports
and the establishment of
modern communications
systems.
Another key aspect of these
five-year development plans
has been the development of
education, healthcare and
social services. To encourage
development in these areas the government invited the private
sector to establish public-private
partnerships and joint
enterprises supported by
generous government financing
and incentive programmes.
This took place in the later
1980s and early 1990s and the
healthcare sector, in particular,
saw the construction of a
number of large private and
public hospitals in major cities
in the kingdom.
Development of the healthcare sector has been ongoing, although currently the public
sector still dominates healthcare
provision, with state
healthcare expenditure representing
75% of total spending
and about 80% of bed capacity
provided by the Ministry of
Health, the Ministry of
Defence and state owned
companies.
The Ministry of Health
The Ministry of Health (MoH)
is the major government
agency responsible for the
management, planning,
financing and regulation of the
healthcare sector. It provides
preventive, curative and rehabilitative
healthcare services as
well as primary healthcare
(PHC) services through a
network of 1,925 healthcare
centres throughout the
kingdom (according to 2006
MoH Department of Statistics
health indicators).
The MoH has adopted the
referral system whereby general
practitioners at health centres
refer patients to specialists at
some 220 general and specialist
hospitals (according to 2006
MoH Department of Statistics
health indicators).
There are three other healthcare
service providers in the
kingdom which are responsible
for providing healthcare to their
sectors of the population. They
are: the Ministry of Defense and
Aviation (MODA), the
Ministry of Interior (MOI) and
the Saudi Arabian National
Guard (SANG).
In addition, the Ministry of
Education provides primary
health care to students and the
Ministry of Labor and Social
Affairs operates institutions for
the mentally retarded and
custodial homes for orphans.
The Government also funds
certain key tertiary hospitals
such as the King Faisal
Specialist Hospital and
Research Center in Riyadh, a
state-of-the-art facility offering
healthcare on a par with some of
the leading facilities in economically
advanced countries.
Infrastructure
As an example of the ongoing
healthcare infrastructure
development, late last year,
Prince Naif Bin Abdul Aziz,
the Interior Minister,
announced plans for seven new
hospitals and nine health
centres to be built in various
places across the kingdom.
One of these projects is the
King Abdullah Medical City in
Makkah, the first phase of
which is already complete.
When the final phase is
complete it will consist of
three hospitals with a total of
1,500 beds – a 500-bed
specialist hospital, a 500-bed
maternity and children’s
hospital and Makkah’s 500-bed
Al Nur Specialist Hospital will
be incorporated into the
medical city.
Dr Fatih Mehmet Gul,
Business Development Manager
of Acibadem Healthcare
Group and Chief Editor of
Healthcare Business Middle
East, based in Jeddah, told
Middle East Health that there
are other key healthcare projects
being developed in
Riyadh, Jeddah, Qassim,
Madinah and Dammam with
several small scale projects in
other cities.
“King Abdullah Economic
City project outside Jeddah
will have a healthcare city, Qassim will have another
medical city and there will be
one other medical city in
Madinah,” he said.
According to the BMI
report, the MoH has embarked
on an initiative to build 2,000
Primary Healthcare Centres
across the kingdom in an effort
to provide greater access to
primary care and to facilitate
healthcare awareness campaigns.
The report notes that in
2005 a research paper by the
International Journal of Quality
Health Care assessed the
quality of primary healthcare
in Saudi Arabia. Along with a
number of other findings the
paper identified weaknesses in
chronic disease management programmes. To remedy the
situation the government has
placed more emphasis on
developing disease-specific
treatment centres, such as the establishment of country’s
largest diabetes centre at
Prince Salman Hospital in
Riyadh in 2007. Diabetes is a
major issue in KSA. In 2007 it
had the third highest diabetes
prevalence in the world –
16.7% according to the
International Diabetes
Federation.
According to a Research and
Markets report, government
capital health spending for
2009 was to be spent on establishing
86 new hospitals with a
capacity of 11,750 beds, several
new health centres and further
development of the Saudi Red
Crescent. According to the
report, 2009 health infrastructure
development was second
only to education and
manpower in terms of budget
allocation for capital expenditure.
Manpower
These are positive developments,
however the development
of these new facilities
will trigger an increased
demand for foreign medical
workers, which creates a new
set of challenges.
In 2008 KSA recruited 8,000
nurses – 25% of them from the
Philippines. However, the
kingdom still faces a shortage of
nurses and this is expected to be
exacerbated with these new
developments. To counter this,
the government and private
sector are establishing a number
of nurse training facilities to
increase the number of Saudi
nurses. The Soliman Fakeeh
College of Nursing & Medical
Science and the Batterjee
Medical College, both in
Jeddah, are two examples.
Most of the kingdom’s
healthcare workers are
recruited from abroad. And in
an effort to meet demand, the MoH is in the process of
recruiting a further 5,000
doctors from India, Pakistan,
Bangladesh and other Middle
Eastern countries to staff these
new facilities, according an
Arab News report in February.
Dr Khalid Al-Mirghlani,
spokesman for the Ministry of
Health, was quoted as saying
general physicians, consultants,
specialists and surgeons
were required. The BMI report
says the recruitment drive aims
to bring the doctor-patient
ratio down from 1:4,000 to
1:400, making it more in line
with that in economically
advanced countries.
In May the MoH announced
that the Government would
inject a further SR15 million
(about US$4 million) into the
Saudi Council for Health
Specialties (SCHS) over the
next three years with the aim
of increasing the number of
Saudi healthcare professionals.
Also, in May some 407 Saudi
physicians were awarded the
Saudi Board Fellowship
Certificate (SBFC) by SCHS.
The graduates, of whom 165
are women, received their
certificates in 34 specialties. It
is expected they will ease the
shortage of senior physicians in
the Saudi healthcare system.
It was also reported in May
that HH King Abdullah had
approved a new grading system
for Saudi healthcare professionals
which aimed to remove
disparities among Saudi physicians
working at different
healthcare centres in the
kingdom “by extending the
principles of justice and
equality to all of them”. This
has resulted in a standardised
salary scale for doctors and
other staff working in government
and specialised hospitals,
which applies to hospitals of
the National Guard, Defense
and Aviation Ministry, Interior
Ministry, Health Ministry and
King Faisal Specialist Hospital
and Research Center.
The growth in new medical
facilities across the kingdom is
also likely to please medical
device manufacturers as these
new facilities will boost
demand for medical supplies,
devices and equipment.
However, in an effort to regulate
and reduce the costs of
imported medical equipment,
the Saudi Government established
in 2007 the National
Company for Unified Purchase
of Medicines and Medical
Appliances to act as the sole
supplier of medicines and
medical appliances to government
health institutions. The organisation has been tasked
with developing and enforcing
a regulatory system for medical
devices. This will include
establishing licensing procedures
for manufacturers and
suppliers. In what is a first step
in developing a regulatory
framework for medical devices,
the organisation in 2007
started the Medical Devices
National Registry, which is a
voluntary web-based project
involving the registration of
manufacturers, agents and
suppliers in the country.
Minister of Health
In February this year Dr
Abdullah bin Abdul Aziz Al-
Rabeeah was appointed
Minister for Health. Following
his appointment he said he
would give priority to
addressing the shortage of beds
and medical facilities at public
hospitals.
Speaking in April during the
inauguration of a new wing of
the King Saud Medical
Complex in Riyadh he said
there was a growing demand
for more medical facilities
throughout the kingdom. He
added that the ministry had
embarked on a several new
projects such as family health
and home health care
programmes.
More recently Dr Abdullah
Al-Rabeeah has ordered the
restructuring of all existing
boards of administration of
medical cities and specialised
hospitals that are under the jurisdiction of the Ministry of
Health. All existing boards for
these facilities will be abolished
and replaced with a
single board to be known as
the Medical Cities and
Specialized Hospitals Board. It
will act as the supreme
directing body for these establishments,
which includes
King Abdullah Medical City in
Makkah, King Fahd Medical
City in Riyadh, King Khaled
Eye Specialist Hospital in
Riyadh and King Fahd
Specialist Hospital in
Dammam.
Insurance
To alleviate the increasing
financial burden on government
of funding a national
health system, the state has
enacted a health insurance law
which makes it mandatory for
employers to buy private
health insurance for their
expatriate workers. The
gradual rollout of this initiative
is being overseen by a specially
established council of the MoH, which among several
responsibilities, regulates the
private medical insurance
industry. In January this year,
the government introduced
new regulations that expand
the insurance scheme to Saudi
nationals working in small and
medium enterprises in the
private sector. Large private
sector companies already
provide health insurance for all
their employees.
The Government is aware of
the problems it faces in
ensuring an equitable provision
of quality healthcare to all
its citizens. If it can meet the
targets its sets itself in the five-year
development plans; if it
can constructively engage the
private sector to take over the
running of certain healthcare
facilities as well as play a
greater role in investment in
manufacturing of medicines,
pharmaceuticals and medical
equipment, through the
privatisation of several stateowned
operations; and if it can
keep a lid on the burgeoning
growth of modern lifestyle
diseases, then the Kingdom of
Saudi Arabia will in all likelihood
stay on track with its
aspiration to provide a standard
of healthcare that rivals
the best in the world.
Sepco Environment uses latest technology for medical waste management
In 1997, Saudi Gulf
Environmental Protection
Company (SEPCO
Environment), a company
specialising in the field of environmental
protection, was
established. The company,
which has a mission to
preserve, develop and protect
the environment, initially
specialised in biological waste
management and is still the
leader in the GCC/North
Africa region in this field.
SEPCO Environment has 10
major waste treatment facilities
spread across Saudi Arabia
and three other treatment
plants in Lebanon, Sudan and
Tunisia. SEPCO Environment
services 4,884 healthcare facilities,
including polyclinics,
hospitals, research facilities
and many others.
As the leader in advanced
medical waste management, SEPCO Environment uses the
latest technology and offers
excellent treatment and
management programmes for
the medical waste problems in
the Kingdom of Saudi Arabia.
SEPCO Environment
utilises state-of-the-art technology
– the Microwave
Disinfection System, the
Autoclave Disinfection System
and the Thermal Oxidation
Unit – for treating not only
medical waste, but other waste
as well.
In accordance to the conditions
set by the Presidency of
Meteorology and Environment
(PME) and Ministry of Health
(MoH), SEPCO Environment
has its own fleet of trucks,
which are well equipped for
safe collection, handling and
transportation of biological
waste, from the source to the
company’s treatment stations.
The company is certified by
PME for the development of
Environmental Impact
Assessment (EIA) projects in
various sectors of industry and
provides chemical waste
management, pharmaceutical
waste management and municipal
solid waste management.
Furthermore, SEPCO
Environment has developed its
own autoclave machine the
‘SepcoClave’, a locally engineered
autoclave that is
utilised by SEPCO
Environment for treating
infectious biological waste.
The technology is not only
certified by PME in Saudi
Arabia, but also certified in
Qatar, United Arab Emirates,
Egypt, Tunisia and Sudan.
SEPCO Environment uses
its extensive resources to
research and acquire the best
available technology for the
treatment of different wastes.
The company continues to
develop relationships with
international companies
specialising in waste management.
As well as providing new
technologies to combat
different waste streams, SEPCO Environment also
provides technical assistance
to the community, local agencies
and private companies.
The company helps raise
public awareness by providing
booklets, magazines, seminars,
training and workshops.
Raising public awareness and
developing skills in this field
helps preserve and protect the
environment. As a company
committed to environmental
protection SEPCO Environment
is accredited with ISO 14001
and ISO 9001:2000.
● For more details visit:
www.SepcoEnvironment.com or
info@sepcoenvironment.com 
Date
of upload: 30th Sep 2009
