HEALTHCARE: Staffing up

Only 2 per cent of the physicians practising in Qassim province, north of Riyadh, are Saudi nationals. The rest are expatriates. Although the situation is not as drastic elsewhere, over-reliance on foreign workers is a broad characteristic of the Gulf's healthcare sector.

'Until 20 or so years ago, the region lacked locally trained doctors or nurses,' says John Freeman, president of online recruitment agency Arabian Careers. Medical and allied healthcare staff were recruited mainly from the West and the premium salaries on offer were sufficient to attract them. Later, budgetary cutbacks meant the local healthcare sector could no longer afford to entice European or US staff, and the recruitment effort shifted focus instead to the Indian subcontinent and the Philippines.

At the same time, Gulf governments began to introduce medical education and training programmes for nationals. Despite concerted efforts to nationalise healthcare, however, the workforce remains disproportionately expatriate. According to a report on GCC healthcare by McKinsey & Company, 75 per cent of physicians and 79 per cent of nurses working in the region come from abroad.

Naturally, the figures vary across the region. Of the GCC states, Bahrain employs a comparatively high proportion of nationals in healthcare. 'Bahrain has a longer history of medical training,' says Mona Mourshed, a principal in McKinsey's Dubai office. 'It sent physicians to study abroad, for example to Cairo University, before building its own medical infrastructure.'

Countries with a high population such as Saudi Arabia are also beginning to see a positive shift. 'Saudi physicians are short on experience, but with time they will achieve the necessary level of quality,' says Monthir Kuzayli, director of the American University of Beirut medical centre. 'In the rest of the Gulf, the problem is exaggerated because of insufficient numbers, meaning there is no base from which to generate professionals.'

But for states such as the UAE, heavy reliance on foreign healthcare workers raises a number of problems. First, continuity of care cannot be guaranteed. 'If I go to see a physician from the UK and he tells me to come for a follow-up appointment in three months, he may no longer be there when I come back,' says Kuzayli. This is closely linked to the questions of staff retention and turnover rates. Its dependence on foreign labour makes the Gulf particularly susceptible to the exodus of healthcare staff.

Global shortages in healthcare workers create a great deal of competition for trained professionals. 'While the Gulf continues to be financially competitive, the global shortage is so great that everyone is competing,' says Mourshed. Nurses, for example, will come to the Gulf for two or three years before moving to the US or the UK. 'The West is attractive because of greater professional development opportunities,' says Mourshed. 'The Gulf needs to work harder to retain staff - both expatriates and nationals.'

A great deal of investment has gone into developing local education and training facilities in recent years and more is yet to come. Qatar will build a new $900 million medical care and research centre - the training hospital for Weill Cornell Medical College. Many other facilities are being built across the region.

But some feel the stream of funding aimed at developing human resources in healthcare is driven by flawed policies. 'The offshore institutes which have sprouted are looking for profit first,' says Ghanim al-Shaikh, regional adviser on human resources development at the World Health Organisation. 'Because of this, students are mostly foreign.'

Deliberate nationalisation policies have had mixed success. The introduction of local physicians and pharmacologists has proved easier than training local nurses. 'It is easier to recruit nationals into professions which are considered more glamorous,' says Ku