Oman has been singled out for praise by the World Health Organisation in the past for the rapid and cost-effective development of its healthcare system. Now it risks falling behind as it struggles to adapt to a new paradigm and escalating costs.

The sultanate is facing the challenge of transitioning from a focus on treating infectious diseases to managing lifestyle problems such as diabetes and obesity, which typically require a higher per capita spend and lifelong treatment.

Despite ambitious plans, Oman’s flagship health projects have stalled in the design or tendering stages. Instead, a more modest programme to build or replace ageing regional public hospitals is slowly going ahead.

High spending

The 2015 budget committed to a high level of spending in the health sector; the allocation is RO1.6bn ($4.2bn), or 11.3 per cent of total outlay. This suggests delayed healthcare projects should be revisited in 2015. Plans include opening and operating 11 new hospitals and healthcare centres around the country.

Slower spend on hospital schemes over the past few years may have been due to an oversupply of beds after intensive building in the 1990s. Bed occupancy rates in public hospitals were running at only 60.5 per cent in 2013.

Progress in developing the healthcare sector has been slow. For 2012-15, the Health Ministry proposed 45 hospital projects. Regional projects tracker MEED Projects shows only three health centre schemes and two new hospitals currently under execution for the ministry, not counting hospital extensions.

Medical city

The Sultan Qaboos Medical City complex was proposed in 2012, but little progress has been made. A masterplan is now under discussion by a higher committee, according to the Health Ministry. It expects to appoint a consultant soon and move forward with the scheme.

The $1.5bn complex will involve 2,000 beds spread across five hospitals: general, paediatric, trauma, head and neck, and organ transplant. Associated facilities such as laboratories, research and teaching centres, and accommodation will cover the rest of the 5-million-square-metre plot.

The private International Medical City in Salalah, owned by a joint venture of Apex Medical Group (which is owned by Saudi Arabia’s Al-Joaib Group) and the US’ GE will cover 866,000 sq m, about 22 kilometres from Salalah International airport.

The first phase of the $1bn project will comprise a 250-bed multi-speciality tertiary care hospital, an organ transplant centre, a rehabilitation centre and a diagnostic centre.

Later phases will involve an extension of the main hospital to 530 beds, a wellness centre, accommodation for staff and patients’ families, and research, teaching and convention centres.

The project has reached an advanced design stage, but has been inactive for about two years. Neither Apex nor GE has responded to requests for comment.

Improving services

However, more modest projects are going ahead, albeit behind schedule. They are part of a strategy to improve and restructure health services in all areas of the country.

A RO214m ($556m) contract was awarded to the local Galfar Engineering for package one of the new Royal Oman Police Hospital in Seeb in December 2014. The hospital will cover 90,000 sq m and have 460 beds. It is scheduled for completion at the end of 2017.

The Health Ministry has received technical bids for the 54-bed Mayzuna Hospital and an award is expected in late 2015. The planned budget is RO16m-RO20m.

The New Sultan Qaboos Hospital in Salalah will have 700 beds and a built-up area of 200,000 sq m. The project also includes adult and paediatric emergency services, physiotherapy, nuclear medicine, dietary services, warehouses, a pharmacy and a laboratory. A tender was issued to the 16 prequalified contractors on 25 March, with a submission deadline of 1 June.

Regional facilities

The Health Ministry is working on detailed designs for five new regional hospitals, which should be tendered in the second half of 2015. The Suwaiq Hospital will have a capacity of more than 300 beds. Najat Hospital will have a capacity of slightly fewer than 200 beds. The Sumail, Al-Falah and Khasab hospitals will also have fewer than 200 beds each, and are being built to replace ageing existing facilities.

“The budgets depend on different components and the distribution of beds across departments, as determined by local needs, and the detailed designs for the sites,” says a ministry spokesperson. “And there are plenty more important hospital projects in the pipeline.”

Private sector

Government spending still accounts for 81.1 per cent of total health expenditure. In 2012, the private sector owned only 11 of the 65 hospitals in Oman, containing 448 of the country’s 5,977 beds. The country’s Health Vision 2050 strategy, published in May 2014, envisages a 50-50 spending split by 2050, with the private sector taking over costly inpatient services.

Although health spending may come under pressure if oil prices remain near $50 a barrel, the Health Ministry expects the upward trend to continue, with 8-10 per cent of GDP spent on health in 2020, compared with 2.7 per cent in 2012. The factors driving this increase include demographic changes, rising expectations from Omani citizens, escalating costs of healthcare supplies and technology, and the increased prevalence of lifestyle health problems.

Thanks in part to Oman’s success in reducing child mortality, malnutrition and incidence of communicable diseases, the population grew at a rate of 6.4 per cent in 2013, according to the National Centre for Statistics and Information. The number of Omanis rose by 3.8 per cent, and the rest of the increase came from expatriates.

Life expectancy

Improved standards of living have brought a new set of challenges related to lifestyle. Afflictions such as obesity and diabetes are on the rise and people are living longer.

Life expectancy has risen from 49.3 years in 1970 to 76.6 in 2013. In 2013, 6 per cent of the Omani population was aged 60 or over, but Health Vision 2050 projects this proportion will increase to 13.1 per cent by 2050. Expensive geriatric support will expand the costs of providing almost free healthcare to citizens.

The Health Vision 2050 is primarily concerned with the transition from preventing and treating communicable diseases and malnutrition to managing long-term conditions, often caused by lifestyle. These include diabetes, obesity, hypertension, heart problems and diseases caused by smoking. Treatment for communicable diseases reduced from 43.2 per cent of services in 1996 to 33.5 per cent in 2012.

In an October 2014 presentation, Bassim al-Bahrani, director of the National Oncology Centre at Oman’s Royal Hospital, predicted that by 2030, cancer will become the leading cause of death in the sultanate, ahead of ischemic heart disease and stroke. Citing a report by the France-based International Agency for Research on Cancer, he said that because of increasing life expectancy, the number of new cancer cases in the sultanate will rise from 1,289 in 2011 to 2,451 in 2020 and 3,792 in 2030.

Medical tourism

There is also a strong focus on genetic disorders, geriatric care and treatment of injuries caused by road traffic accidents, the leading cause of mortality in 2010. So the Health Ministry is investing in education programmes, preventative primary care and specialised tertiary services such as organ transplant, dialysis and oncology centres. The planned medical cities, with their specialised units, are intended to meet this need. Currently, many patients travel abroad for specialised treatment, but Oman hopes to reverse this trend and become a centre for medical tourism.

However, not only is the transition to the new paradigm costly, but long-term conditions are more expensive to treat and manage. The 2016-21 five-year plan, due to be published soon, will contain a more project-specific strategy for investment. Costs will be mitigated by encouraging the development of local training centres and health equipment supply chains.

Building programme

The current and future health projects programme seeks to address geographical disparity in access to treatment, as there is an oversupply of secondary care in certain areas.

Outside the Greater Muscat area, Oman has a population dispersed over extremely difficult terrain, making access to healthcare, especially specialised tertiary care, difficult and expensive. According to the 2010 census, 15.2 per cent of the population lives in remote areas.

The Health Vision 2050 recommends the completion of the Sultan Qaboos Medical City complex in Barka by 2020, and two further medical cities – one in the northern part of the North Al-Batinah governorate by 2035, and another in the Al-Wusta governorate by 2045 – to provide tertiary care services across the country. The ministry will demolish 26 of 31 local hospitals that were built before 1987 and are not suitable for inpatient care.

Primary care

Healthcare facilities are being reclassified with a focus on primary care, and by 2050, Oman will boast 437 new and replacement health centres and 112 hospitals. The Health Ministry has long-term plans for 41 50-bed hospitals to service populations of 50,000, 47 150-bed hospitals for populations of between 50,000 and 100,000, and 24 300-bed hospitals for populations of more than 100,000.

They will be built in expandable 50-bed blocks and include emergency care and dialysis units, as well as private rooms, depending on local needs. The 300-bed hospitals will include specialised units and accommodation for patients’ families.

The execution of this programme will depend on levels of government revenues and the institutional capacity to tender and staff the facilities.