Through good planning, heavy investment and solid service delivery, Oman has tackled over the past few decades many of the basic fundamentals of public healthcare, including both health services themselves and wider issues that have an essential impact such as sanitation, nutrition, education and the collecting of reliable data to aid planning and provision.

Infant mortality has dropped by nine tenths over the past 43 years, while average life expectancy has soared from 49 years to 72.6.

The number of cases of malaria fell from 32,720 in 1990 to just 2,051 in 2012.

Change has been rapid, and often recent: it was only in May 2004 that the authorities imposed a mandatory requirement to report births and deaths.

Challenge evolving

But Oman’s government and health specialists recognise that the challenge is now set to evolve in several ways.

The make-up of the population is expected to shift, while the type of health problems that the people face is already changing.

So the sultanate’s healthcare system has to adapt – and this reality is recognised in a long-term strategic analysis produced by the government last year, after extensive consultation with a range of local and international experts.

Health Vision 2050 looks ahead by three and a half decades, exploring likely future needs and the ways in which they could be met.

It is not an overly prescriptive document; Health Minister Ahmad bin Mohammad al-Saidi has said better approaches may be developed over time.

However, some of the key challenges are already evident.

Oman’s population is on course to double by 2050.

Moreover, its structure will evolve: the proportion of the population aged 60 or over is set to rise from 4.4 per cent in 2014 to about 24.5 per cent, according to the Global Age Watch Index.

Elderly patients

The health problems of older age, such as cancer, dementia and general infirmity, will become much more prevalent, and the number of patients affected by these afflictions is set to rise massively.

Research in Nizwa governorate has revealed that poor nutrition is a serious problem among elderly people, and more generally, non-communicable diseases that are largely affected by lifestyle – such as cancer, diabetes and heart disease – are becoming much more common as the sultanate becomes more prosperous.

Other lifestyle-based problems are also becoming more frequent.

The rate of road traffic accidents is one of the highest in the world, with a consequent toll in deaths and injuries.

Government figures show that the incidence of sexually transmitted disease trebled between 2000 and 2012.

The Health Vision study suggests this may be partly explained by younger Omanis travelling much more, while progress in educating them on how to stay safe has been limited.

The document notes that a 2008 survey of students at universities, colleges and higher educational institutions found that only 3.9 per cent knew how to prevent HIV transmission.

Some of the big communicable diseases that used to be such a threat in the past are no longer a major worry

Oman has seen a big decline in issues associated with poverty and low development levels – such as deaths in childbirth, infant mortality and problems linked with poor sanitation.

Some of the big communicable diseases that used to be such a threat in the past are no longer a major worry.

On the other hand, problems such as inherited genetic disorders and congenital blood disorders persist, just as they do in other relatively affluent, developed countries.

Lifestyle changes

Oman is moving on from the era where it was possible to achieve quick wins in improving health standards by providing, for example, clean water or proper ante-natal and post-natal care.

Current and future challenges are much less amenable to obvious interventions, as Western countries have found.

Many of the health problems of prosperity are particularly difficult to tackle, because progress largely depends on convincing members of the public to change the way they live, including what they eat and how much they exercise.

Some 24.1 per cent of Omanis are obese, and this may partly explain the rise in the incidence of diabetes mellitus from 8.4 per cent of the adult national population in 1991 to 13.2 per cent in 2008, and potentially higher now.

When it comes to cancer the picture is more complex.

Incidence of the disease remained almost constant for most of the period from 1991, and then a sudden drop was reported in 2010; but this may be explained by reporting anomalies rather than a dramatic shift in the health of Omanis.

The regional pattern is striking: the disease was more than twice as common in Dhofar and Muscat as in the rural Musandam peninsula.

The picture is further complicated by the fact that, like other GCC states, Oman has a large population of expatriates – 44 per cent of its 4.3 million inhabitants, according to the National Centre for Statistics and Information.

Overall, population density, make-up and healthcare needs vary widely from one region of Oman to another. In 1991, the government set up a decentralised health structure based on 10 regions (wilayats – now 11 in number), which allows officials at the local level to organise care in ways that are suited to local circumstances.

Most healthcare is funded by the government and provided in state-owned and operated facilities; the public sector accounts for 92.5 per cent of the 5,977 hospital beds in the country.

Because of the rapid growth of the health system to cover the entire country, and the need to provide facilities accessible even to small and remote communities, Oman has faced particular challenges in ensuring the most cost-effective use of hospitals.

The rate of bed occupancy was 69 per cent back in 1995, but had fallen to 59 per cent by 2012.

Medical training

The sultanate remains heavily dependent on foreign health service personnel.

But there has been significant progress in training and recruiting nationals for some skilled medical roles, particularly nursing.

While 29 per cent of physicians, 27 per cent of pharmacists and 20 per cent of dentists are Omani, that percentage rises to 54 per cent of all nurses.

Muscat believes strong primary healthcare coverage must remain the backbone of the health system

Muscat believes that strong primary healthcare coverage must remain the backbone of the sultanate’s health system.

There are 168 standard local health centres, complemented by 24 extended centres and 30 local hospitals. In geographical terms, relative to population, coverage is fairly even across the country.

Yet actual human health varies between regions. Dhofar, Ad Dakhiliyah and North Ash Sharqiyah governorates have higher levels of morbidity for both communicable and non-communicable diseases, and both North and South Ash Sharquiyah have high levels of childhood malnutrition.

To tackle these disparities, the government wants to see greater community involvement.

It also wants the primary healthcare system to give more emphasis to preventative measures and to helping individuals stay healthy, rather than just viewing its remit as the treatment of sick patients.

There are also plans to provide more specialist services at the primary level, and foster a culture in which local doctors develop specialist interests.

Geriatric care is to be given greater priority at the grassroots level, because by 2050 it is likely that people aged 80 or over will account for 7 per cent of the population.

Medical cities

At the other end of the scale, the government envisions the creation of ‘medical cities’, where highly specialised facilities can be concentrated, easing the current pressure on hospitals that are already congested.

Overall, as many as 2,000 beds could be provided for the specialised treatment of a range of ailments.

The first medical city, in the Muscat area, should be completed in 2020.

But others are set to follow: in 2035 in northern Al-Batinah, to cater for the north of Oman; and in Al-Wusta in 2045, to cater for the south.

And there is recognition that in order to ensure patients reach hospital in as good a condition as possible, a top-class ambulance and emergency medical service is required.

To help finance these improvements, the government envisions that between 20 and 50 per cent of hospital beds should be in private rooms.

Larger hospitals would also provide accommodation for patients’ companions.

Rapid recruitment

Staffing will have to grow to ensure this expanded system can operate properly.

The government forecasts that Oman will need to recruit about 5,740 physicians by 2020, if care standards are to match those in high-income countries.

The authorities have tried to educate more Omani doctors, nurses and other medical personnel.

But if the health service is to be expanded at the pace that the sultanate plans, the scale of rapid recruitment required may force the country to increase its reliance on expatriate staff, at least for a transitional period.