Facing up to a healthcare staffing crisis in the Gulf

10 August 2010

The Gulf states are making significant strides in improving healthcare provision in the region, but progress could be derailed by a shortage of medical professionals

Key fact

More than $10bn-worth of new hospital projects are planned or under way in the GCC

Source: MEED

When Saudi Arabia’s health minister Abdullah al-Rabeeah attended the separation surgery of conjoined Iraqi twins at the National Guard hospital in King Abdul Aziz Medical City in Riyadh in June, it was not the surgeons or the doctors that were singled out for praise at the success of the operation.

“Saudi nurses participated amazingly in a complicated surgery,” said Al-Rabeeah. “This participation should be considered an invitation for national staff to join nursing, especially females.”

The nurses in turn expressed their delight at being given the opportunity to take part in a complex and high-profile procedure.

The health minister’s decision to single out Saudi nurses and praise their contribution was the latest step in the ministry’s efforts to boost the number of home-grown medical professionals. Although hospitals report that they are hiring more Saudi national staff in medical, technical and management roles, most nursing posts are filled by expatriates from developing countries.

Importing nurses

Few Saudi nationals choose to study nursing at university. The main reason for this is that nursing has historically not been considered a prestigious profession in the Gulf states.

“Nursing is not as popular as being a medical board member, medical technologist or a doctor,” says Helen Ziegler, founder of recruitment specialist Helen Ziegler Associates, which has been supplying medical professionals into GCC states for 27 years. “They need to import most of the nurses. Although they are training their own nurses, most of them take management positions.”

Nursing is not as popular as being a medical board member, medical technologist or a doctor

Helen Ziegler, Helen Ziegler Associates

This trend is repeated across the GCC, although countries tend to rely on different markets for their staff. Kuwait has historically used Indian and Pakistani medical professionals, whereas Saudi Arabia and the UAE favour the Philippines. The huge demand for Filipino nurses in the Middle East has even led to a staffing crisis in the home nation, with the government in Manila asking where all its medical staff have gone.

In 2009, Saudi Arabia was the top destination for workers from the Philippines with more than a quarter of all workers – equivalent to 291,419 people – moving to the kingdom.  Nurses alone accounted for 9,623 of the recruits. This was an increase of 9 per cent on the 8,848 nurses that entered in 2008.

In the GCC as a whole, the number of nurses increased by an average of 7 per cent between 2008-09. Only the UAE saw numbers fall, which experts say was due to the general downturn in growth.

The region already struggles to attract sufficient medical professionals, but with more than $10bn-worth of new hospital projects planned or under way competition will intensify. Kuwait alone expects to require an additional 4,000 doctors and 10,000 nurses by 2016, if its nine planned new hospital projects all go ahead.

Cutting costs

At the same time, hospitals are coming under increasing pressure to cut costs, amid the growth of medical insurance and private healthcare provision. This is leading to a greater reliance on professionals coming from developing countries. “There are more and more hires from emerging nations,” says Ziegler. “Private hospitals are in the business of making money, but you don’t make money if you have to pay the high salaries required for staff from the US, Britain or Australia. If you hire maybe a few key people [on high salaries] and then the rest will be from the Philippines.”

At King Faisal Specialist Hospital in Riyadh a nurse from the UK earns $60,000 to $65,000 depending on their speciality. A Filipino nurse’s salary is significantly lower at around $10,000. Local nurses again expect higher salaries, but these can be justified if local nurses are given senior roles.

One of the other main barriers to entering the nursing profession in the GCC is the lack of good quality education and training opportunities. Instead of investing locally, governments have historically paid for nationals to train as nurses overseas. This is also the case for doctors – there are currently 450 Saudi residents training in Canadian medical schools, for example.  But recently there has been a drive to invest in new training facilities and improve existing courses to meet international levels as advised by the World Health Organisation (WHO). The Nursing Board of the Saudi Council for Health Professionals is currently developing an Advanced Nursing Diploma programme that will build on the technical nursing course currently available in the kingdom.

International partnerships

Independent educational facilities are also partnering with international experts. In Al-Khobar, the Saad College of Nursing and Allied Health Sciences is working with the School of Nursing at Northern Ireland’s Ulster University on its nursing programmes. Other partnerships at research level are resulting in improved training opportunities for locals.

Leading the way of such development is Dubai Healthcare City, where renowned educational institutions such as the US Harvard Medical School and the American University in Beirut, sit alongside specialist medical centres like the US Mayo Clinic, France’s Isis paediatric centre, the UK’s Great Ormond Street children’s hospital and Germany’s University Medical Center Hamburg-Eppendorf.

Despite huge investments … interest among GCC nationals in pursuing a career in healthcare is limited

Similar arrangements are in place in Saudi Arabia, at Jeddah International Medical Centre, and in Qatar at Education City. Qatar’s need for healthcare professionals is set to soar with the construction of the new 550-bed Sidra Medical Care and Research Centre, which will open with an initial capacity of 420 beds. Billed as an ‘academic medical centre’, it will specialise in care for women and children when it opens in 2012. “The Qatar market is developing with the new Sidra hospital, which is looking for senior people to get it up and running,” says Ziegler. The centre management say that the recruitment process for day-to-day operational staff will begin in 2012.

The centre’s research work, however, is already under way. Its biomedical research will focus on the causes of diabetes, cancer and childhood diseases. This will be done in partnership with fellow Education City resident the Weill Cornell Medical College and Hamad Medical Corporation, creating more opportunities to develop local expertise.

Despite the huge investments the Gulf states and the private sector are making in medical training facilities, interest among GCC nationals in pursuing a career in healthcare sector remains limited. Of the 17 students who graduated from Weill Cornell Medical College in the last year, just two were Qatari nationals.

As a result, some hospitals around the GCC are still in desperate need for paediatric oncology doctors, cardiac intensive care unit nurses and anaesthetists. Recruiters say that Saudi Arabia seems to be achieving the most success of using local staff, particularly in senior medical roles. This is reinforced by the Foreign Affairs Ministry, which carefully monitors the disciplines entering the kingdom. “In certain occupations it is becoming more difficult for expatriates to work, particularly in areas such as medical technology, IT, and X-ray departments,” says Ziegler.

Saudi Arabia still lags the rest of the region in terms of per capita medical staff. With 6 nurses per 1,000 people, Qatar leads the GCC in the availability of nursing staff, while Bahrain has 5.29 and Saudi Arabia has just at 3.5. For physicians, Bahrain has the most per capita, while Saudi Arabia ranks among the lowest.

Capacity building

This is likely to change in the future. Saudi Arabia is in the middle of a capacity building programme that will see it have an additional 2,000 primary healthcare centres and 100 hospitals by 2015. It is therefore seeking more staff. At the same time, the kingdom has tightened its entry criteria to improve the standards of its recruits. The Saudi Commission for Health Specialities introduced a two-hour, 70 multiple choice question licensing exam in December 2009. It must be taken by all non-Western trained medical professionals from laboratory technicians to doctors and pharmacists.

Across the GCC, universities are expanding and modernising their medical programmes. States are bringing in international universities and medical centres to improve training and local students are being encouraged to enter the medical profession.

Despite the best efforts of regional governments, gaps remain in areas such as nursing, which remains an unpopular career choice, and medical specialisms from anaesthetists to childhood cancer doctors.

With demand for medical services set to soar in the GCC amid a surge in chronic diseases, a looming staffing crisis threatens to derail the progress made so far in improving healthcare provision in the region. Addressing the shortage will be a key focus in the years ahead.

Despite huge investments … interest among GCC nationals in pursuing a career in healthcare is limited

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