Private sector to play larger role in Oman healthcare

10 August 2010

Oman has built an enviable health system in just four decades. But population growth and rising chronic diseases mean it must build more hospitals and clinics to keep ahead of demand

Key fact

Oman’s 2010 budget allocates OR294m ($764m) for healthcare spending

Source: Health Ministry

In the 40 years since the 1970s oil boom, Oman has transformed its healthcare sector from an operation that struggled to offer minimum medical care to one that the World Health Organisation (WHO) deems “excellent”.

The ministry will build more primary healthcare centres, the first [point of] entry into the system

Saif al-Nabhani, Health Ministry

When Oman first set up its health ministry in August 1970, the country had just two hospitals and 13 medics. Since 1976, seven successive five-year health plans have transformed healthcare provision and medical training in the sultanate. Today, the country employs 4,579 doctors and offers near-universal free healthcare for nationals.

Health centres in Oman
Source: Health Ministry

WHO studies show Oman has reduced the rate of deaths among under-fives faster than any other country in the world, achieving a 14-fold drop since the early 1970s. Infant mortality rates have also fallen to a tenth of their level.

Comprehensive coverage

Healthcare programmes have achieved 98 per cent coverage for all vaccine-preventable diseases. Treatment programmes have brought measles, malaria, mumps and tuberculosis  under control and reduced blindness from cataracts and trachoma. Polio was eradicated in 1993 and tetanus in 1995. Improved sanitation has reduced cases of cholera and typhoid.

The government has pledged to open up the market further to private healthcare providers

The health ministry runs 172 institutions, including 48 of the country’s 59 hospitals, and integrates healthcare provision across the country. Nationwide, the country has 5,497 hospital beds and a network of medical centres, dispensaries and clinics that report to the ministry. In addition to the health ministry, private hospitals, several major state departments and companies provide healthcare for employees.

Oman now has 1.9 doctors and 1.97 hospital beds for every 1,000 people. But the country’s rapid economic development has brought a new set of health challenges. Diseases of the affluent West such as obesity, diabetes, cancer, high-blood pressure, as well as road accidents rates are all increasing steadily.

A 2006 study carried out by the health ministry in partnership with London School of Economics reported that 11.6 per cent of Omanis had diabetes and 21.5 per cent suffered from hypertension. More than half the population – 50.6 per cent – had high cholesterol and 19.1 per cent were obese, with a body-mass index of 30 or more.

The study found that a third of all adult deaths in Oman’s hospitals were due to diseases of the circulatory system. The WHO attributes the spread of cardiovascular disease to sedentary lifestyles, lack of exercise and unhealthy eating habits. These, along with smoking, will increase the incidence of cancer as the population ages.

Cancer is the third most common cause of adult deaths in Oman, where the number of smokers continues to rise.

The sultanate also has high accident rates: the WHO says that deaths from road traffic accidents are among the highest in the world. Injuries from work-related accidents and falls are also above average.

All of these factors place an immense burden on the country’s healthcare system.

Health spending

This year marks the end of Oman’s current five-year plan for healthcare development. The 2006-10 plan approved 58 healthcare projects and focused on improving mother and baby health and on public awareness programmes to reverse the spread of lifestyle-based illnesses.

The sixth plan, which ended in 2006, focused on expanding primary healthcare into rural communities and on reducing the need for specialist care overseas. However, the plan failed to increase provision to one health centre for every 10,000 people, so the target was carried over to the seventh plan.

Healthcare remains a priority for government spending. Oman’s 2010 budget allocates OR294m ($764m) to healthcare, representing 12 per cent of all funds allocated to civil ministry spend. This represents an 8 per cent increase in annual funding for the sector. The government plans to spend OR247m on new facilities, including a new heart disease unit at the Royal Hospital.

The health ministry is currently drawing up the aims and objectives for the eighth five-year-plan. “The ministry will build more primary healthcare centres, the first [point of] entry into the healthcare system,” says Saif al-Nabhani, the ministry’s director-general of planning.

“Services in the regional referral hospitals will be enhanced to provide specialist services and reduce referrals to health institutions in the capital Muscat.”

The plan will also confirm Oman’s commitment to private healthcare and the need to address costs through measures such as expanding health insurance coverage.

New hospitals

In January, the National Economy and Finance Minister Ahmad Mekki said the government planned to invest $2.4bn in projects, including new hospitals.

In February, Health Minister Ali bin Mohammad bin Musa announced a new hospital-building programme to include a new Royal Hospital in 2012. With some 3,000 patients seeking treatment every day, the minister acknowledged that Oman needs more health centres, hospitals and clinics to cope.

Yet the health ministry has still to confirm reports that the next five-year plan will include the construction of six new hospitals.

Despite Oman’s many successes in improving its healthcare system, it faces several challenges in future, not least keeping pace with population growth of 2.2 per cent a year. It also needs its healthcare infrastructure to reach scattered rural communities, while meeting the demand from the half a million expatriates estimated to be working in the country.

Public hospitals and clinics handled 11 million outpatient visits in 2008, and this will increase as the population grows. State spending on healthcare is expected to rise from $800m in 2009 to nearly $1.4bn by 2014.

Although the public sector still accounts for more than 98 per cent of the country’s hospital beds – and the health ministry for 83 per cent of those beds – the past decade has also seen private healthcare providers arrive in Oman. The sultanate now has three private hospitals, and more than 700 privately-run health centres and polyclinics.

Muscat Private Hospital opened in 2000. Run by Allied Medical, part of the international hospital management company, UMG Group, the 72-bed hospital in Bausher offers in-patient and out-patient care, ranging from diagnostic imaging tests to cardiac surgery.

The government has pledged to open up the market further to private healthcare providers and to devolve decision-making to regional hospitals’ management boards, so private healthcare is expected to play a far greater role the future. 

The GCC represents a lucrative market for private healthcare companies, pharmaceutical giants and medical manufacturing firms. Regional spend on healthcare is still comparatively low, at no more than 4 per cent of gross domestic product (GDP) – half the European average of 8 per cent of GDP.

GCC nations collectively spend $12bn on healthcare today, according to estimates from the Washington-headquartered World Bank, but this is set to reach $60bn by 2025. Sales of pharmaceutical products are also expected to increase to $7.6bn by 2014 and to $9.6bn by 2019.

In Oman, the state is responsible for some 82 per cent of healthcare spending – among the highest levels in the GCC. But expansion will open primary, secondary and tertiary care, education, training and the pharmaceuticals sector to private players in future.

Although the country provides free healthcare for all Omanis and for expatriates working for the government, the law requires employers to provide medical cover for foreign nationals working in the private sector and their dependents. The health ministry controls the licensing for private medical companies, setting and monitoring standards of care.

Private providers

With Oman finalising plans for a comprehensive health insurance scheme, private healthcare companies see new opportunities for growth. Dubai-based DM Healthcare has pledged to invest nearly $26m in new hospitals and medical centres in Oman during 2010-15.

Having entered the market in 2009, DM Healthcare now manages a hospital, four medical centres and four pharmacies in Oman. It plans to add two hospitals in the sultanate, and to operate 15 medical centres and 15 pharmacies in major cities across the country.

In June, it inaugurated the Aster Hospital, Sohar, a private hospital serving the region of Batinah.

The 50,000-square-foot hospital has 60 beds and 18 outpatient clinics, three operating theatres and specialist provision for high-risk pregnancies. It employs doctors from Iraq, Egypt and India and operates a network of primary clinics in Liwa, Sohar, Saham and Shinas. DM Healthcare plans to offer package discounts to the hospital’s corporate clients.

In June, the health ministry landed critical funding for new equipment from Oman LNG’s social investment programme, totalling OR667,000. The money will be used to pay for a CT scanner at Sur General Hospital; a communication network linking Royal Hospital Muscat to regional hospitals; a simulator for the Omani Nursing Institute; and a video conferencing system at Sur Hospital.

Official sources in the health ministry see such deals as a blueprint for future funding and expect the private sector to play a central role in meeting the country’s future healthcare needs.

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