HEALTHCARE: Finding a cure

Formulating a single healthcare policy for a region as diverse as the Middle East is no easy task. 'Health priorities are different in each country,' says a senior World Health Organisation (WHO) representative based in Cairo. 'In the more middle-income countries of the region - Egypt, Jordan and Syria - the main concern is the risk posed by non-communicable diseases such as cardiovascular disease, cancer or diabetes. But in low-income countries such as Yemen and Sudan communicable diseases such as malaria, tuberculosis and HIV are the main concern.'

Regional health authorities do have one thing in common, however. From Morocco to Iran, rapid population growth is forcing governments to think hard about long-term provision of medical services. A recent World Bank report highlighted the problems facing one country in particular: 'Between 2000 and 2020, the population of Saudi Arabia will increase at an average annual rate of 2.8 per cent, resulting in a 75 per cent larger population,' says the report. 'The population will begin to age, and those over 60 years will increase from 4 per cent of the total population in 2000 to 7 per cent by 2020. Thus, over the next 20 years the kingdom will be confronted by the dual disease burdens of communicable [and] non-communicable diseases. The ability of the kingdom to support the population will depend on the efficiency and effectiveness of the Saudi health system in providing necessary services.'

One of the strengths of the Saudi system may eventually prove its undoing. There is currently universal healthcare cover across the kingdom. All Saudi citizens and expatriates are catered for through several mini-national health services, and employers are required to cover expatriate workers' medical costs. But by 2020, the state - which accounts for 80 per cent of all health spending - will no longer be able to afford free lifetime cover for the entire population.

Money aside, one of the World Bank report's key criticisms is the organisation of healthcare throughout the region: 'There is a lack of data for decision-making, and policy-making is not co-ordinated among the multiple public agencies which finance and deliver care,' it says.

The WHO official echoes this concern: 'The five key factors for any government when setting out a healthcare policy are: how it will be financed; how it will be governed; what human resources are at hand; what is needed; and finally, service delivery - looking at the cost and of course the quality of care.'

As in other key sectors, from power generation to construction, many governments are turning to the private sector for help.

'In such a huge country as Saudi Arabia there is potential to develop an increased role for the private sector,' says Isam Moursy of GE Healthcare. 'Abu Dhabi, Dubai and Qatar are all working with the private sector in various ways, but the most important thing for all governments across the region, whether they go fully private or not, is to try to build a system around the priorities.'

For GE, the priority is to get regional governments to update their approach to healthcare. 'We are working with governments across the region to adapt their policies to make them more efficient, saving both time and money - to rethink healthcare away from the treatment of disease to early diagnosis,' says Moursy. 'The response has been receptive, with a lot of policies being rethought. In the Gulf, such a discussion can be raised due to the availability of funds. This is the right time for regional governments to investigate diseases such as diabetes, cardiac issues and breast cancer.'

Attitudes towards reform, and towards private healthcare in particular, still vary wildly across the region. 'Some governments have made attempts at reforming their health sectors by tackling such issues as quality and accreditation, which is progressing but at various paces in differen