Having not built a hospital for 20 years, Kuwait is trying to make up for lost time, with plans to build nine in the next seven years.

The largest is the $1.3bn Jaber al-Ahmed al-Sabah Hospital, which the Health Ministry plans to open by 2013. The facility, which will house 1,010 general practice beds and 158 specialist trauma beds, is the largest public hospital project in the region.

The eight others, including a paediatrics hospital and a maternity unit, should all be ready by 2016, and in total will cost a further $4.5bn to develop. They will provide 5,350 new beds, more than doubling the number of general and specialist hospital beds in the country from 4,712 today.

This drive to expand healthcare facilities is not unique to Kuwait. Improving the quality of public healthcare delivery is a critical policy challenge for all six GCC governments.

Faced with unprecedented population growth, due to a combination of mass immigration, a substantial decline in mortality rates and high fertility rates, the region’s existing facilities have been struggling to cope with the numbers of patients seeking treatment in recent years.

Meeting challenges

At the same time, a shift to a more sedentary lifestyle in the local population, brought about by increased affluence, has led to a sharp increase in non-communicable diseases, such as diabetes, cancer, cardiovascular disease and other obesity-related illnesses. Such chronic illnesses, which require long-term treatment, are proving to be a huge burden on the health systems in the Gulf, and many of the region’s hospitals lack the specialist equipment and facilities to deal with them.

Traditionally, health authorities have preferred to send hundreds of patients overseas each year for treatment rather than invest in specialist hospitals. But with the population increasing rapidly, this is unsustainable over the long term.

At the current growth rate of about 5 per cent a year, the GCC’s 39 million population is on track to double over the next two decades. US management consultant McKinsey & Company predicts the cost of healthcare in the GCC will increase by 240 per cent over the period.

Furthermore, with GCC governments striving to transform their countries into developed economies, the ability to care for the sick and injured in their own modern, world-class facilities will be a key measure of success.

Governments are responding to these challenges with massive hospital building programmes and heavy investment in setting up primary care clinics to increase screening and early diagnosis. Including Kuwait’s plans, more than $10bn worth of healthcare projects are under way in the Gulf, according to MEED Projects-CMI, which tracks project activity across the Middle East.

Dubai Health Authority has AED5bn ($1.4bn) worth of hospital projects planned or under way. One of the largest will be the construction of a new accident and emergency hospital, the 300-bed Al-Maktoum Hospital, on Emirates Road, behind the Ibn Battuta shopping mall. US architect Perkins Eastman is expected to tender the AED1.6bn construction contract by the end of September. The hospital will have a total built-up area of 87,793 square metres and will take three years to build.

The facility is intended to relieve some of the pressure on Rashid Hospital Trauma Centre, which is currently the only public accident and emergency facility in the emirate. Its catchment area has grown relentlessly since the turn of the century, as vast swathes of what was once desert have been transformed into densely populated residential developments amid the boom in real estate construction.

“This hospital is important as it will serve the highways and the new [suburbs of] Dubai,” says Qadhi al-Murooshid, director general of the Dubai Health Authority. “It will also cover the new airport, Jebel Ali Port and free zone, and Palm Jumeirah.”

In October, a 93-bed general hospital is due to open in Hatta, in the Dubai enclave bordering Oman. This will be the first hospital dedicated to serving the remote areas of the emirate. The total cost of the facility, including medical equipment and accommodation for 500 staff, is almost AED300m.

The authority is also investing to expand the range of specialist services on offer in Dubai. Piling work on an AED1bn 200-bed paediatrics hospital within the grounds of Al-Wasl Hospital began in June, and the consultancy contract for a 240-bed cancer centre is due to be awarded in the near future. The tender for a AED30m construction contract for a stand-alone pathology department within the Dubai Hospital compound will also be issued in the next few months, and the construction award for a centre for preventative medicine in Jebel Ali is due to be made by the end of the year.

In addition to these projects, the Dubai Health Authority has commissioned the construction of three new daycare centres in Rashidiya, Deira and Al-Barsha, at a cost of AED65m each. The units will be completed by 2010 and will complement the authority’s 20 existing primary care health centres. Two further centres will follow next year, in Al-Warqa and the Jumeirah/Umm Seqeem areas. Also in October, a AED70m rehabilitation centre for the elderly is set to come into service, providing rooms for 35 inpatients.

According to Dubai Health Authority, the emirate will require 6,000 hospital beds by 2010, almost double the current number. It already provides 2,000 beds, while the private sector offers 1,500 beds. The health authority is committed to adding a further 600 beds, and 1,000 more will come by the end of 2010 at Dubai Healthcare City, a multi-billion-dollar healthcare project being developed by Tatweer, a subsidiary of state-owned conglomerate Dubai Holding. Al-Murooshid expects the private sector to supply the remainder.

Dubai Healthcare City will include a 450-bed university hospital, which will function as the city’s main tertiary care facility when it opens in 2011.

Elsewhere in the UAE, Abu Dhabi is focusing on improving the quality of care at its existing facilities, with plans to expand the emergency ward at the public Al-Mafraq Hospital this year at a cost of more than $500m. However, the largest project due to be launched in the emirate is the $1.9bn construction of the Cleveland Clinic, a project backed by state-run investment vehicle Mubadala Development Company.

Bahrain is also building a new public hospital. The 312-bed, $130m King Hamad General Hospital is scheduled to open in 2010 in the Muharraq area, to take some of the pressure off the 900-bed Salmaniya Medical Complex, which currently lacks the capacity to deal with a major incident involving multiple casualties.

At a site close to King Hamad General Hospital, the $1.6bn Bahrain Health Oasis is being developed by Ithmaar Development Company in partnership with the Royal College of Surgeons in Ireland (RCSI). It will host health centres covering diagnostics, nutrition and diabetes, cosmetic surgery, aesthetic medicine, and sports medicine (see page 32).

In Qatar, meanwhile, three public hospitals are being built at the QR3.2bn Hamad Medical City, which in total will provide 1,100 additional beds. The facilities will provide paediatric, trauma and orthopaedic care, as well as a nursing home for the elderly and a renal dialysis unit. A 300-bed community hospital is also under construction in Al-Wakrah.

Regional investment

The largest healthcare project under way in Qatar is the $2.4bn Sidra Medical & Research Centre at Education City. Due to open in 2012, Sidra has been designed as a ‘five-star’ hospital. It is being set up with a $7.9bn endowment from non-profit organisation the Qatar Foundation for Education, Science & Community Development.

The hospital will initially house 412 beds, but will have the infrastructure to expand this to 550. The clinical focus will be on obstetrics, gynaecology and paediatrics, although Sidra will also offer selected surgical services for adults, including transplants. The long-term vision is for Sidra to become a referral centre for patients from across the region.

These facilities will significantly expand Qatar’s healthcare system. As of 2007, the country had nine hospitals and 23 health centres employing 9,524 medical staff, 1,775 of whom were doctors.

Given the wider geographic spread of its population in comparison with other GCC countries, Saudi Arabia is building a series of smaller hospitals to improve the coverage of its public health system, rather than concentrating on one or two megaprojects. Demand for hospital beds in the kingdom is predicted to rise from 50,000 to 70,000 by 2016, driven by an ageing and increasingly wealthy population seeking more specialist healthcare treatments.

In its 2009 budget, Saudi Arabia allocated SR52.3bn ($14bn) to its healthcare and social welfare services sector, including the cost of building 86 hospitals with a combined total of 11,750 beds. This represented an 18 per cent increase on the SR44.4bn allocated in 2008 to set up 250 primary healthcare centres throughout the kingdom, as well as eight hospitals.

Oman is the least active market in the region, with just one major public healthcare project under construction: the $60m cardiac centre at Sultan Qaboos Hospital in Salalah. As of December 2007, Oman had 50 public hospitals and 160 clinics, along with five private hospitals and 787 clinics.

The construction of so many hospitals across the Gulf at the same time throws up a further challenge for the Gulf’s health auth-orities: recruitment. “A good quality health service comprises three components: facilities, equipment and well-trained staff,” says Al-Murooshid.

The region’s healthcare sector is already heavily reliant on imported manpower. Saudi Arabia and the UAE have the highest proportion of expatriate physicians, at 80 per cent, according to Saudi investment bank NCB Capital. More than 90 per cent of nurses in Kuwait and the UAE are foreign nationals.

In Qatar, while 30 per cent of the medical workforce is Qatari, only 7 per cent of nurses are locals. Bahrain has the smallest contingent of overseas health workers, with expatriates comprising 20 per cent of doctors and 48 per cent of nurses.

The Gulf has struggled to attract health professionals to work in its hospitals, with high turnover also a problem. The oil boom in recent years has meant countries have been able to offer significant salary increases to alleviate the issue, but with so many projects set for completion in the next few years, competition for talent will intensify once more. Kuwait alone expects to require an additional 4,000 doctors and 10,000 nurses by 2016, if its nine new hospitals all go ahead.

“Few health services in the world have the luxury of having all the professionals they need,” says Christopher Austin, principal consultant at the UK’s PA Consulting Group. “Healthcare demand is growing in all corners of the world and there are many countries that have challenges in recruiting and retaining a clinical workforce, so the Gulf region is not unusual in that sense.”

Recruiting locals

Mindful of the recruitment issue, all of the Gulf states are trying to boost the number of locals employed in the health sector. Oman’s national health policy, for example, calls for the training of Omanis in all areas of healthcare so the country can become self-sufficient. Crucially, this is meant to happen without the quality of service being compromised.

To boost the recruitment of nationals in the sector, there has been a wave of investment in medical teaching facilities across the GCC. The US’ Weill Cornell Medical College in Qatar opened in 2002. Harvard Medical School, also of the US, has set up at Dubai Healthcare City, and Abu Dhabi signed an agreement in February this year with two German universities - Munich Technical University and the University of Bonn - to establish a college for medicine and health sciences in the emirate.

Kuwait is also planning to open a medical faculty and 600-bed teaching hospital at Shadiyah, and there are similar schemes in Saudi Arabia, such as the development of a 400-bed hospital and a medical and pharmaceutical college at Umm al-Qura University in Mecca.

Meanwhile, in June 2010, the first students will graduate from the RCSI Medical University of Bahrain. Qatar is also establishing a robotic surgery centre in partnership with Imperial College London. The centre, which is due to open by the end of 2009, will include a simulation operating theatre and will be used to train 80 students and 50 surgeons from the region each year.

But despite all these investments in modern teaching facilities, there is still limited interest among GCC nationals in pursuing a career in healthcare. Out of the 17 students that graduated from Weill Cornell Medical College in May this year, for example, just two were Qatari.

“Governments need to ensure that medicine and clinical work is perceived as a noble profession to pursue,” says Austin. “Culturally there can be some challenges too, especially for females who, once they get married, find it difficult to balance family life with the hours a clinician has to maintain. Those issues will need to be addressed if they are to attract a stronger national workforce.”

Failure to address this human resources challenge will severely undermine the efforts the region’s governments are making to expand and modernise their public health services. While hospitals can be designed and built in as little as four years, it takes seven years to train a doctor.