A revolution is under way in the Gulf’s healthcare sector. After years of patients admitting themselves to hospital for relatively minor ailments, governments across the region are turning their attention to primary healthcare clinics where consumers can access care through a single point of contact.

The recent focus on primary healthcare has been driven by population growth averaging
4 per cent a year in recent years, increased life expectancy and increasingly common and costly diseases.

Throughout the Gulf there has been a sharp increase in non-communicable diseases including diabetes, cancer, cardiovascular diseases and other obesity-related illnesses.

The World Health Organisation estimates these ‘lifestyle diseases’ are now responsible for nearly half of all deaths in the Gulf region.

Much of the problem stems from a large proportion of the population being overweight. The proportion of UAE nationals who are overweight exceeds 60 per cent, with women accounting for the majority of this. In Saudi Arabia, 66 per cent of Saudi women are deemed overweight, with more than a third of the total population considered obese. The rate of diabetes in the kingdom has risen from 17 per cent to 25 per cent over the past decade.

The region’s existing facilities will therefore struggle to cope with the number of patients seeking treatments in the future. As a result, governments across the region are looking to make changes.

USmanagement consultant McKinsey & Company says in its GCC Healthcare 2025 report that while single-point access to a family doctor is widespread in many parts of the developed world, this is not the case in the GCC primary healthcare system. Instead, patients tend to choose any one of a number of points of access, ranging from a local doctor to a specialist hospital.

McKinsey argues that this approach breeds inefficiency. Valuable administrative and specialist time is taken up unnecessarily if the patient has not chosen the right point of access, increasing delays and waiting times for seriously ill patients.

But the consultancy’s report says making the switch to single-point access will not be easy, with “substantial investment” required to make a successful transition.

Despite recognition of the need for investment, development of the primary healthcare sector has been slow in the Gulf region.

Although state spending on healthcare has increased in absolute terms, Saudi investment bank NCB Capital says the share of healthcare as a proportion of total government expenditure has declined over the past few years. The region’s largest economy, Saudi Arabia, faces one of the greatest logistical challenges in providing primary healthcare services.

This is partly attributable to its size and
wide geographic spread, but also to the kingdom’s demographics: nearly 40 per cent of the population are under 14 years of age, almost double the proportion in the US and UK, and significantly increasing the need for immun-isation programmes.

Saudi Arabia is alert to the problem, with the Health Ministry and the state-run Saudi Arabian General Investment Authority (Sagia) working together on a health strategy.

Manar al-Moneef, general director of healthcare and life sciences at Sagia, says the primary healthcare sector is so important to the kingdom that it has decided to delay a plan to outsource hospital management in favour of focusing on community healthcare systems.

Under a plan approved by the government in 2002, all 220 Health Ministry hospitals were to be transferred to a new entity, the General Organisation for Hospitals.

Private partners

Although separate from the ministry, the organisation was to be fully owned by the government. The new body would then enter into partnerships with private companies to manage or own the hospitals.

By eventually bringing in the private sector, Riyadh hopes to improve standards and introduce an additional source of funding to pay for the expansion of the system.

“We have put the plan [to outsource management of public hospitals] on hold while we work on a different set of priorities,” says Al‑Moneef.

In February 2009, Saudi Arabia’s King Abdullah bin Abdulaziz al-Saud selected Abdullah al-Rabeeah as the new health
minister. His appointment came at a time when swine flu was rapidly spreading throughout the kingdom.

Al-Rabeeah responded with a series of awareness programmes and pledged to improve services by having one doctor for every 400 patients, compared with the current situation of one doctor for every 4,000 patients.

Al-Moneef says Al-Rabeeah has set out a new strategy whereby primary healthcare will be at the heart of the changes, along with development of an e-health system in the kingdom.

“The reason we have delayed the [outsourcing] plan is because of the importance of primary care,” says Al-Moneef. “If you look globally, 90 per cent of health problems are treated at the primary level. So to improve the platform of healthcare services in Saudi Arabia and try to manage disease prevalence, there is a major need to first create family services.”

In 2006, there were 1,925 healthcare centres in the kingdom, and the ministry plans to set up 2,000 new clinics.

“The healthcare centres will be treating the majority of diseases in Saudi Arabia then controlling them and trying to reduce the prevalence of diabetes and cardiovascular hypertension in particular,” says Al-Moneef.

Although the expansion of the primary healthcare sector represents a potential investment opportunity for the private sector, Al-Moneef argues that it may be limited given the smaller profit margins on offer.

Historically, primary centres have been of only minor commercial interest, with governments collecting little data on the value of the sector. “Primary care globally has not been proven to be successful for the private sector,” says Al-Moneef.

Given the lack of expected private sector interest, Sagia expects the government to take the lead in developing the new clinics.

“The Health Ministry would like to lead this effort and leave the secondary and tertiary, which are the revenue generators, to be done by the private sector,” says Al-Moneef. “We hope this focus on primary care will transform services [because] you do not need as many [hospital] beds if you have a proper primary healthcare service.”

The lead taken by Saudi Arabia’s government in developing primary healthcare clinics is being replicated throughout much of the Gulf, according to Dinah Rowe-Roberts, director of healthcare advisory at consultant PricewaterhouseCoopers (PwC).

“We are certainly seeing an emerging interest in primary care, and I think there is a growing recognition of governments operating in the primary care health system, which most of the population reach on a regular basis,” says Rowe-Roberts.

While she agrees that private sector groups have traditionally steered clear of investment in primary healthcare, PwC sees growing
interest in the sector. “We are seeing more private sector groups looking at primary healthcare clinics,” says Rowe-Roberts. “That is a growing trend in the region [and] whether they use international operations to run them will depend on the nature of the organisation that is setting up the clinics.”

In January, Netherlands-headquartered Philips announced a partnership with the
University Medical Centre Hamburg-Eppendorf and the UK’s Pragma Group to build a series of health check centres across the Middle East. Targeted for busy professionals, the centres will offer a comprehensive check-up including a full body magnetic resonance imaging scan.

Rowe-Roberts says there is more outpatient care affiliated to hospitals in the Gulf than is typical of developed countries, a position she expects will change as healthcare authorities try to meet consumer expectations.

“It is all about convenience,” she says.
“People do not want to have to drive to a hospital and park in a big car park just to see a
doctor for a runny nose. I think that if con-sumers have confidence in the ability of the physicians then it is very likely to be a successful business proposition.”

In the UAE, Mubadala Healthcare, a division of government-owned investment vehicle Mubadala Development Company, is key to the expansion of healthcare provision. Mubadala is setting up a health system for Abu Dhabi comprising family clinics, speciality treatment centres, general and multi-speciality tertiary care hospitals, and ancillary services such as testing laboratories.

Dubai developments

Neighbouring Dubai is also switching its attention to primary clinics. The American Hospital Dubai announced plans in mid 2008 to open five primary healthcare clinics, at the same time as expanding the hospital to accommodate 60 new beds. The hospital will also move from being a secondary-care hospital to a tertiary, or specialist care facility. Secondary (consultant-led treatment) and primary care options will also be available.

The largest healthcare project is being developed by Tatweer, a subsidiary of state-owned Dubai Holding, based on affiliations with international institutions. Tatweer is setting up a medical free zone, Dubai Healthcare City (DHCC), which comprises two distinct phases: the medical community, focusing on acute care; and the wellness community, with out-patient clinics and health resorts.

Qatar’s primary healthcare sector remains dominated by the public sector. Hamad Medical Corporation runs the state’s network of 23 primary clinics, with two health centres opening in Doha central market and Al-Karaana on the outskirts of the city.

While the building blocks for a strong healthcare centre appear to be in place, more must be done if the GCC is to catch up with global standards. “You do still find people are travelling overseas for their healthcare, so there is some way to go to get everyone confident in a national healthcare system,” says Rowe‑Roberts.

Al-Moneef stresses the importance of developing primary clinics suitable for a local population. “While I think we can learn from the lessons of other countries [in the Gulf], each country has a different system that applies to it, and you cannot just cut and paste a system from another country,” says Al-Moneef. “You need to take the benchmark and then see what the best system is for your own people.”

By adapting the developed world’s model for a primary care sector to local requirements, GCC governments are well placed to address the need to invest in primary healthcare for their growing populations.