Health care system in Saudi Arabia: an overview Article Analysis

Health care system in Saudi Arabia: an overview Article Analysis Health care system in Saudi Arabia: an overview Article Analysis annotate the attached article and write the good things in the article and bad things as well mohammed_aleissa_dmm651_2ndjournal_club__1_.pdf e0c031adcfaf538f4dd460a88e268c95180.pdf mine.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS EMHJ • Vol. 17 No. 10 • 2011 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale Review Health care system in Saudi Arabia: an overview M. Almalki,1,2 G. Fitzgerald??2 and M. Clark 2 ? ????????:????? ??????? ?????? ?? ??????? ??????? ????????? ? ????? ???????? ???? ???? ????????????? ???????? ?? ???????????? ????????:??? ??? ????? ??????? ??????? ???????? ?? ??? ???????? ?????? ????? ??????? ?????? ??? ???? ??????? ???????? ? :????????? ? ??? ?? ???? ??? ?? ?? ??????? ???? ??? ?????? ???? ???? ????????.?????? ????? ????? ??? ????????? ?? ?????? ???????? ?? ? ????? ?? ?????.??????????? ? ????????? ??????? ?? ????? ?????????? ???????? ??????? ??????????? ???????? ???????? ?????? ???????? ??? ??? ???????? ??????? ??????????????????? ?? ???? ?????? ??? ?????? ??? ??? ????? ??????? ????????? ???? ???? ????? ????? ?????? ????????????????? ?????? ?? ??????? ????????? ? ??????? ??? ?????? ???????.? ???? ????????? ?? ???????? ??????????? ????? ?????????????????? ???? ???? ????????? ?????? ???????? ? ?????? ????????? ???? ???????????????? ??????? ??????? ????? ??????? ?????? ?? ??????? ??????? ???????? ?? ??????? ??? ???? ????? ????????? .????? ??????? ?????? ???????? ABSTRACT The government of Saudi Arabia has given high priority to the development of health care services at all levels: primary, secondary and tertiary. As a consequence, the health of the Saudi population has greatly improved in recent decades. However, a number of issues pose challenges to the health care system, such a shortage of Saudi health ?professionals, the health ministry’s multiple roles, limited financial resources, changing patterns of disease, high demand resulting from free services, an absence of ?a national ?crisis management policy, poor accessibility to some health care facilities, lack of a national health information ?system, ?and the underutilization of the potential of electronic health strategies. This paper reviews the historical development and current structure of the health care system in Saudi Arabia with particular emphasis on the public health sector and the opportunities and challenges confronting the Saudi health care system. Aperçu du système de santé en Arabie saoudite RÉSUMÉ Le gouvernement d’Arabie saoudite a accordé une priorité élevée au développement des services de soins de santé à tous les niveaux : primaire, secondaire et tertiaire. En conséquence, la santé de la population saoudienne s’est grandement améliorée au cours des dernières décennies. Toutefois, le système de santé est confronté à de multiples défis tels que la pénurie de professionnels de santé saoudiens, les rôles multiples du ministère de la Santé, des ressources financières limitées, l’évolution des tableaux de morbidité, la forte demande générée par la gratuité des services, l’absence de politique nationale de gestion des crises, l’accès médiocre à certains établissements de soins, l’absence de système national d’information sanitaire et la sous-utilisation du potentiel des stratégies de cybersanté. Le présent article passe en revue l’histoire du système de santé saoudien et sa structure actuelle et met l’accent sur le secteur de la santé publique, les opportunités qui s’offrent à ce système et les obstacles auxquels il est confronté. College of Health Sciences, University of Jazan, Jazan, Saudi Arabia (Correspondence to M. Almalki: [email protected]). Faculty of Health, School of Public Health, Queensland University of Technology, Brisbane, Australia. 1 2 Received: 28/12/08; accepted: 05/01/10 784 ??????? ?????? ???? ?????? ??????? Introduction Health care services in Saudi Arabia have been given a high priority by the government. During the past few decades, health and health services have improved greatly in terms of quantity and quality. Gallagher has stated that: “Although many nations have seen sizable growth in their health care systems, probably no other nation (other than Saudi Arabia] of large geographic expanse and population has, in comparable time, achieved so much on a broad national scale, with a relatively high level of care made available to virtually all segments of the population (p. 182).” Health care system in Saudi Arabia: an overview Article Analysis [1] According to the World Health Organization (WHO) [2], the Saudi health care system is ranked 26th among 190 of the world’s health systems. It comes before many other international health care systems such as Canada (ranked 30), Australia (32), New Zealand (41), and other systems in the region such as the United Arab Emirates (27), Qatar (44) and Kuwait (45). Despite these achievements, the Saudi health care system faces many challenges which require new strategies and policies by the Saudi Ministry of Health (MOH) as well as effective cooperation with other sectors. This review outlines the historical development and current structure of the Saudi health care system. A particular emphasis has been given to the public health sector that is operated by the MOH, including the key opportunities and challenges it faces. In addition, this review highlights demographic changes and the economic context of Saudi Arabia in relation to the Saudi health care system. Demographic and economic patterns of Saudi Arabia The last official census in 2010 placed the population of Saudi Arabia at 27.1 million, compared with 22.6 million ??????? ?????? ???? ???????? in 2004 [3]. The annual population growth rate for 2004 to 2010 was 3.2% per annum [3], and the total fertility rate was 3.04 [4]. Saudi citizens comprise around 68.9% of the total population; 50.2% are males and 49.8% females [3]; 67.1% of the population are under the age of 30 years and about 37.2% are under 15 years; the population over the age of 60 years is estimated at 5.2% [5]. According to United Nation projections, it is estimated that the population of Saudi Arabia will reach 39.8 million by 2025 and 54.7 million by 2050 [6]. This is a natural outcome of the high birth rate (23.7 per 1000 population), increased life expectancy (72.5 years for men, 74.7 years for women) [4] and declining mortality rate among infants and children [1]. The under 5 years of age mortality rate fell 250 per 1000 live births in 1960 [7] to 20.0 per 1000 in 2009 [4]. Apart from advancements in health care and social services, these improved statistics can mostly be attributed to the compulsory childhood vaccination programme implemented by the government since 1980 [7]. This unprecedented growth will increase the demand for essential services and facilities including health care, while at the same time creating economic opportunities. Saudi Arabia is one of the richest and fastest growing countries in the Middle East. It is the world’s largest producer and exporter of oil, which constitutes the major portion of the country’s revenues [8,9]. In recent decades, however, Saudi Arabia has diversified its economy, and today produces and exports a variety of industrial goods all over the world. The sound economy and well-established industry base affects the Saudi community by increasing their income, leading to a per capita income of US$ 24 726 in 2008 [10] compared with US$ 22 935 in 2007, US$ 14 724 in 2006, US$ 13 639 in 2005 [11,12] and US$ 8140 in 2000 [13]. Based on 2010 information, Saudi Arabia is ranked at a high level in the Human Development Index (0.75), which gives the country a rank of 55 out of 194 countries [10]. The improvement in the national income is expected to impact positively on its various services including the health care services. Brief overview of health services development Health services in Saudi Arabia have increased and improved significantly during recent decades [14]. Health care system in Saudi Arabia: an overview Article Analysis The first public health department was established in Mecca in 1925 based on a royal decree from King Abdulaziz [15]. This department was responsible for sponsoring and monitoring free health care for the population and pilgrims through establishing a number of hospitals and dispensaries. While it was an important first step in providing curative health services, the national income was not sufficient to achieve major advances in health care, the majority of people continued to depend on traditional medicine and the incidence of epidemic diseases remained high among the population and pilgrims [15]. The next crucial advance was the establishment of the MOH in 1950 under another royal decree [15]. Twenty years later, the 5-year development plans were introduced by the government to improve all sectors of the nation, including the Saudi health care system [16]. Since then, substantial improvements in health care have been achieved in Saudi Arabia. Current structure of health services Currently the MOH is the major government provider and financer of health care services in Saudi Arabia, with a total of 244 hospitals (33 277 beds) and 2037 primary health care (PHC) 785 EMHJ • Vol. 17 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale No. 10 • 2011 centres [4]. These services comprise 60% of the total health services in Saudi Arabia [4]. The other government bodies include referral hospitals (e.g. King Faisal Specialist Hospital and Research Centre), security forces medical services, army forces medical services, National Guard health affairs, Ministry of Higher Education hospitals (teaching hospitals), ARAMCO hospitals, Royal Commission for Jubail and Yanbu health services, school health units of the Ministry of Education and the Red Crescent Society. With the exception of referral hospitals, Red Crescent Society and the teaching hospitals, each of these agencies provides services to a defined population, usually employees and their dependants. Additionally, all of them provide health services to all residents during crises and emergencies [16]. Jointly, the government bodies operate 39 hospitals with a capacity of 10 822 beds [4]. The private sector also contributes to the delivery of health care services, especially in cities and large towns, with a total of 125 hospitals (11 833 beds) and 2218 dispensaries and clinics (Figure 1) [4]. The advancement in health services, combined with other factors such as improved and more accessible public education, increased health awareness among the community and better life conditions, have contributed to the significant improvements in health indicators mentioned earlier. It has been noted, however, that despite the multiplicity of health service providers there is no coordination or clear communication channels among them, resulting in a waste of resources and duplication of effort [17]. For example, there are considerable opportunities to take advantage of equipment, laboratories, training aids and well-trained personnel from different countries. However, as a result of poor coordination, the benefit of these opportunities is limited within each sector. In order to overcome this and to provide the population with up-to-date, equitable, affordable, organized and comprehensive health care, a royal decree in 2002 led to the establishment of the Council of Health Services, headed by the Minster of Health and including representatives of other government and private health sectors [18]. Although the aim of the Council was to develop a policy for coordination and integration among all health care services authorities in Saudi Arabia [19], significant progress has yet to be achieved in this area [20]. Saudi health care system Private sector (fee) Govt. sector (free) MOH (public) Other agencies. Health care system in Saudi Arabia: an overview Article Analysis All levels of health care All levels of health care All levels of health care Referral hospitals % of hospital services provide by various health care sectors in Saudi Arabia Teaching hospitals School health units 19.3% ARAMCO health services Armed forces medical services Employees & Security forces medical services their families National guard health affairs 59.5% + 21.2% Emergencies Health services in the R oyal Commission for Jubail & Yanbua MOH Red Crescent Other Govt. Private Emergencies Figure 1 Current structure of the health care sectors in Saudi Arabia (MOH = Ministry of Health)?. Source of data: [4] 786 ??????? ?????? ???? ?????? ??????? Public health care system (Ministry of Health) In accordance with the Saudi constitution, the government provides all citizens and expatriates working within the public sector with full and free access to all public health care services [7,21]. Government expenditure on the MOH increased from 2.8% in 1970 [18] to 6% in 2005 and 6.2% in 2009 (Table 1) [4]. According to WHO the total expenditure on public health during 2009 was 5% of gross domestic product [22]. The MOH is responsible for managing, planning and formulating health policies and supervising health programmes, as well as monitoring health services in the private sector [23]. It is also responsible for advising other government agencies and the private sector on ways to achieve the government’s health objectives [16]. The MOH supervises 20 regional directorates-general of health affairs in various parts of the country [18]. Each regional health directorate has a number of hospitals and health sectors and every health sector supervises a number of PHC centres. The role of these 20 directorates includes implementing the policies, plans and programmes of the MOH; managing and supporting MOH health services; supervising and organizing private sector services; coordinating with other government agencies; and coordinating with other relevant bodies [23]. Figure 2 illustrates the organizational structure and the relationship of departments within the Saudi health care system from the community to MOH level. “Health friends” is a selective committee consisting of useful and influential community members, including representatives from PHC centres, who are knowledgeable about common social norms and the potential of the community. The essential role of this committee is to liaise between PHC centres and the communities they serve [24,25]. ??????? ?????? ???? ???????? Table 1 Budget appropriations for the Ministry of Health (MOH) in Saudi Arabia in relation to the ?government budget, 2005–09 Year Government budget (SRa) MOH budget (SR) %b 2005 280 000 000 16 870 750 6.0 2006 335 000 000 19 683 700 5.9 2007 380 000 000 22 808 200 6.0 2008 450 000 000 25 220 200 5.6 2009 475 000 000 29 518 700 6.2 Source: [4]. a US$ 1 = 3.75 SR; bAs a % of the total government budget.? SR = Saudi riyals Levels of health care services The MOH provides health services at 3 levels: primary, secondary and tertiary [4]. PHC centres supply primary care services, both preventive and curative, referring cases that require more advanced care to public hospitals (the secondary level of care), while cases that need more complex levels of care are transferred to central or specialized hospitals (the tertiary level of health care). Transition to PHC services Until the 1980s, in line with the expectations of population, health services in Saudi Arabia were largely curative, emphasizing the provision of treatment for existing health problems [18,23]. The curative care model, however, can be costly to health providers, when many diseases can be prevented or minimized through developing a preventive strategy. A variety of preventive measures were run by the MOH through former health offices and to some extent through maternal and child health care centres. A number of disease control activities were performed by vertical programmes, e.g. malaria, tuberculosis and leishmaniasis control [18,23]. In accordance with the Alma-Ata declaration at the WHO General Assembly in 1978 [26], the Saudi MOH decided to activate and develop the preventive health services by adopting the PHC approach as one of its key health strategies. Health care system in Saudi Arabia: an overview Article Analysis Consequently, in 1980, a ministerial decree was issued to establish PHC centres. The first step was to establish suitable premises throughout the country. Existing facilities located in adjacent areas were integrated into single units. These included former health offices, maternal and child health centres and dispensaries. The health posts in small and rural districts were upgraded to PHC centres [18,23]. The health centres aimed to focus on the 8 elements of the PHC approach: educating the population concerning prevailing health problems and the methods of preventing and controlling them; provision of adequate supply of safe water and basic sanitation; promotion of food supply and proper nutrition; provision of comprehensive maternal and child health care; immunization of children against major communicable diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs [24,25]. Focusing on a PHC strategy and applying a logical referral system has helped to reduce the number of visits to outpatient clinics [23]. About 82% of client visits to MOH facilities during 2009 were to PHC centres comprising more than 54 million PHC clients [4]. The creation of individual and family health records inside each PHC centre has reduced duplication of consultations. The use of the essential drugs list and documentation of prescriptions in patient health files has not only reduced the costs of medications, but also improved prescribing practices. 787 EMHJ • Vol. 17 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale No. 10 • 2011 Figure 2 Organizational structure of the Ministry of Health (public) health care system in Saudi Arabia. Source: [23] Health services in the pilgrimage (hajj) season Saudi Arabia has a unique position in the Islamic world, as it embraces the 2 holiest cities of Islam, Mecca and Medina. About 2 million pilgrims from all over the world perform the hajj annually. During the 2009 season, there were 2.3 million pilgrims, 69.8% of whom came from foreign countries [4]. Hosting such an event annually is a major challenge that requires a planned and organized effort across numerous agencies and departments to ensure adequate essential services, such as housing, transport, safety and health care [21]. 788 Health care services in the hajj season provide preventive and curative care for all pilgrims, irrespective of their nationality. Preventive care includes health education programmes, vaccination and chemoprophylaxis for all pilgrims via quarantine services at airports and land ports. The provision of emergency and curative services takes place through a network of health care facilities. For example, in 2009, there were 21 hospitals, of which 7 were seasonal, with a total of 3408 beds and 176 beds for emergency admissions. There were also 157 PHC centres, of which 119 were seasonal. 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