Saudi Healthcare System Research Articles

A Master of Public Health with a Concentration in Mass Gatherings Health.

IntroductionThe Kingdom of Saudi Arabia (KSA) is in a unique position and different from other nations that periodically host an event, such as the World Cup or the Olympics. The KSA is faced annually with millions of pilgrims coming from around the world to participate in the Hajj, Umrah, and Ziarah rituals. Continuously hosting such huge mass gatherings poses overwhelming challenges to the Saudi healthcare system. Consequently, an additional specialized cadre of qualified public health personnel is needed. The purpose of this article is to describe the establishment of an academic public health program that addresses this need.Materials & MethodsIn response to the dire need for public health specialists, a landmark project was launched in 2013 at Alfaisal University (AU). The project aimed to establish a Master of Public Health (MPH) program with a concentration in the health aspects of mass gatherings. The MPH program was created in collaboration with the United States-based Partners HealthCare International (PHI), the Saudi Global Center for Mass Gatherings Medicine (GCMGM) at the Ministry of Health (MOH), the Ministry of Education (MOE), and the Ministry of Hajj and Umrah (MOHU). A needs assessment was conducted to help in the program development. The needs assessment drew on the unpublished findings of an institutional review board (IRB)-approved anonymous market survey that was administered to prospective students of the MPH program.ResultsThe needs assessment study revealed the need for an MPH program with concentrations in mass gatherings health, health policy and management, and biostatistics and epidemiology. Consequently, we designed an MPH program to include these three concentrations. In particular, the mass gatherings health concentration aimed at preparing qualified public health specialists to help manage risks to the Saudi public health system, to analyze health data, and to recommend policies associated with the continuous mass gatherings events. Challenges to program development included working with multiple governmental agencies, absence of a frame of reference to develop a program curriculum, a lack of qualified faculty, lengthy and tedious government approval procedures, and inadequate funding. After obtaining the required approvals, the MPH program with a concentration in mass gatherings health was inaugurated in the fall of 2016. This program is accredited by the Saudi government to prepare public health specialists trained and locally certified in mass gatherings health issues.ConclusionsThe public health experts of the AU have established what may be the first MPH program with a concentration in mass gatherings health. The main challenges to program development were identified, and appropriate actions to meet these challenges were taken. This innovative MPH produces certified specialists equipped with the analytical and policy-making tools necessary to continuously monitor and improve the public health aspects of mass gatherings. Besides, the program provides a frame of reference for the development of unique public health programs, not only in the KSA but worldwide.

A Basic Course in Humanitarian Health Emergency and Relief: A Pilot Study from Saudi Arabia.

Political unrest in the Middle East heightens the possibility of catastrophe due to violent conflict and/or terrorist attacks. However, the disaster risk reduction strategy in the Saudi health care system appears to be a reactive approach focused more on flood hazards than other threats. Given the current unstable political situation in its neighboring countries and Saudi Arabia's key role in providing humanitarian assistance and disaster relief to those affected by internal conflicts and wars, it is essential to develop a framework for training standards related to complex humanitarian disasters to provide the requisite skills and knowledge in a gradual manner, according to local context and international standards. This framework could also support the World Health Organization's (WHO; Geneva, Switzerland) initiative for establishing a national disaster assistance team in Saudi Arabia. The main aim of this study is to provide Saudi health care providers with a competencies-based course in Basic Principles of Complex Humanitarian Emergency. The interactive, competencies-based course in Basic Principles of Complex Humanitarian Emergency was designed by five experts in disaster medicine and humanitarian relief in three stages, accordance to international standards and the local context. The course was piloted over five days at the Officers Club of the Ministry of Interior (MOI; Riyadh, Saudi Arabia). The 33 participants were from different health disciplines of the government sectors in-country. The participants completed the pre- and post-tests and attended three pilot workshops for disaster community awareness. The overall knowledge scores were significantly higher in the post-test (62.9%) than the pre-test (44.2%). There were no significant differences in the pre- and post-knowledge scores for health care providers from the different government health disciplines. A 10-month, post-event survey demonstrated that participants were satisfied with their knowledge retention. Importantly, three of them (16.6%) had the opportunity to put this knowledge into practice in relation to humanitarian aid response. Delivering a competencies-based course in Basic Principles of Complex Humanitarian Emergency for health care providers can help improve their knowledge and skills for humanitarian assistance and disaster relief, which is crucial for disaster preparedness augmentation in Saudi Arabia.

Cost-Effectiveness of More Intensive Blood Pressure Treatment in Patients with High Risk of Cardiovascular Disease in Saudi Arabia: A Modelling Study of Meta-Analysis.

Objective The current literature suggests that more intensive blood pressure (BP) treatment is clinically more effective than less intensive treatment in patients at high risk for cardiovascular disease (CVD). In this analysis, we evaluated the potential clinical benefit and cost-effectiveness of more intensive BP treatment in patients at high risk of developing CVD over their lifetimes. Methods A Markov state-transition model was developed for the BP strategies to estimate the lifetime incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) using evidence published from a meta-analysis. The other model inputs were retrieved from previous studies. Estimated costs were collected from five hospitals in Riyadh. The model used a lifetime framework adopting Saudi payer perspective and applied a 3% annual discount rate. Sensitivity analysis was conducted using one-way and probabilistic sensitivity analysis (PSA) to evaluate the robustness and uncertainty of the estimates. Results Treating 10,000 patients with high CVD risk with more intensive BP therapy would avert a total of 873 CV events over their remaining lifetimes as compared with a less intensive strategy. The projections showed that more intensive BP therapy would be cost-effective compared to the less intensive strategy with incremental costs per QALY of $20,358. Probabilistic sensitivity analysis suggested more intensive control would be cost-effective compared with the less intensive control of BP 87.25 % of the time. Conclusion The result of this study showed that more intensive BP treatment appears to be a cost-effective choice for patients with a high risk of CVD in Saudi Arabia when compared with a less intensive BP strategy. Thus, this finding provides strong evidence for the adoption of this strategy within the Saudi healthcare system.

An Analysis of Public-Private Partnerships and Sustainable Health Care Provision in the Kingdom of Saudi Arabia.

This study considers the issue of health care provision in Saudi Arabia, looking in particular at the challenges for health care providers and ministry officials. Although the study concentrates on factors specific to Saudi Arabia, it also examines the problem from a broadly international perspective. In particular, the study explores the experience of health care modernisation in the United Kingdom to conceptualise the practicality of fusing public services with market ideals. There is a pressing need to modernise the Saudi health care system with the economic burden on the state-funded Ministry of Health being an unsustainable means of providing health care in future. The solution resides partially in opening the public health care system to alternative sources of management and revenue. In particular, public-private partnerships will be considered as a viable means of funding health care in Saudi Arabia and for improving standards and the quality of care. This study concludes that, whereas the move towards a public-private partnership approach to health care provision has been touted as a precondition for modernisation and development, the precise fusion between government and non-government forces remains a source of conjecture. As a result, the study advocates caution when evaluating the benefits and pitfalls of partnerships between public and private actors.

What drove the health system reforms in the Kingdom of Saudi Arabia? An analysis.

The primary objective of this article is to present the key directions taken by the Saudi health care system, following the announcement of the Saudi Vision 2030. The changing international scenario, together with reduced oil revenues, high population growth, emerging lifestyle diseases, and demands for better quality of care, has impacted the development of the Saudi health system. The government is now ardently pursuing private sector development and has initiated privatization and marketization as a core strategy of reforms in its health system. This article posits that the current economic conditions of the KSA and local and global market dynamics are the primary drivers for these reforms. This study is based on a scoping literature review. The intended reforms will have very limited contribution to improving the population's health, and the study remains inconclusive. The Kingdom took a protective approach in reforming its health sector. The social values that undergird the government actions, especially, how much priority it gives to maintain status quo in the social and economic fabric vis-à-vis economic growth and development, have exerted a significant influence on whether the KSA chooses a pro-government or a pro-market approach; however, this could lead to a hybrid model of health care system.

Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach.

BackgroundThe Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is ‘free at the point of delivery’ (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households’ willingness to pay (WTP) for a contributory national health insurance scheme.MethodsUsing the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period. Multi-stage sampling was employed to select the study sample. Using a double-bounded dichotomous choice with the follow-up elicitation method, respondents were asked to state their WTP for a hypothetical contributory national health insurance scheme. Tobit regression analysis was used to examine the factors associated with WTP and assess the construct validity of elicited WTP.ResultsOver two-thirds (69.6%) indicated that they were willing to participate in and pay for a contributory national health insurance scheme. The mean WTP was 50 Saudi Riyal (US$13.33) per household member per month. Tobit regression analysis showed that household size, satisfaction with the quality of public healthcare services, perceptions about financing healthcare, education and income were the main determinants of WTP.ConclusionsThis study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source of healthcare financing.Electronic supplementary materialThe online version of this article (10.1007/s40258-017-0366-2) contains supplementary material, which is available to authorized users.

An investigation of the saudi healthcare system's readiness for change in the light of vision 2030: The role of transformational leadership style

Objectives: Organisational change is among the major challenges that face healthcare organisations, and many factors affect their ability to be ready to adopt the change desired. Among these important factors are the significant role of the attitude of the leadership that is responsible for the change. This empirical study was conducted to examine the role and contribution of the transformational leadership style to the readiness for change in healthcare organisations in Saudi Arabia. Materials and Methods: Primary data were collected from a sample of 83 middle managers in the hospitals in the Al-Qassim region in the Kingdom of Saudi Arabia. The study used a self-administered questionnaire to examine the role of transformational leadership in the readiness for change in healthcare organisations. Cross-sectional data were analysed using SPSS. Results: A positive and significant relation was found between transformational leadership and the readiness for change with 30% variation in the dependent variable (R2 = 0.30). Conclusions: This study is valuable for healthcare policymakers and providers, as it offers information about the leadership behaviours desired in readiness for change that have the potential to influence the intentions, attitudes and beliefs of members of healthcare organisations that help them accept and understand a change initiative.

Exploring shared risks through public-private partnerships in public health programs: a mixed method

BackgroundThe natural assimilation of the process through which health partners sustain long-term relationships is a key issue in maintaining social well-being, reducing health risk factors, and sustaining public health programs. One global initiative in building effective healthcare systems is public-private partnerships (PPPs). This study elucidates the proposed key performance indicators initiated by the Ministry of Health of Saudi Arabia based on the projections of the government, known as Vision 2030, from the perspective of health risk factors.MethodsThrough an inductive content analysis, this study assessed primary and secondary data in relation to the Saudi National Transformation Program (NTP). To identify the institutions that played a role in formulating the new Saudi Healthcare System, health policies, regulations, and reports published between 1996 and 2016 were categorized. After ranking the risk factors, the investigator selected 13 healthcare professionals in four focus group interviews to insightfully explore the challenges that the NTP faces from a health risk perspective. Thus, the study employed qualitative data gathered through focus group interviews with key figures as well as data extracted from written sources to identify distinct but interrelated partnerships practiced within risk management.ResultsA methodological overview of NTP priority and implementation offered practical guidance in the healthcare context. The five critical factors in maintaining successful and sustainable PPPs were (1) trustworthiness, (2) technological capability, (3) patient-centeredness, (4) competence, and (5) flexibility. Concession on primary and secondary healthcare services might be a good option based on the literature review and considering its popularity in other countries. A high outcome-based risk of PPPs was found as the most commonly shared perspective in risk management.ConclusionsAlthough the impact of the NTP rise has yet to be explored, its potential for challenging health consequences requires consideration and substantial regulatory action. This study contributes to the emerging critical analysis on local health initiatives by highlighting how integration may only be possible with a more radical conceptualization of national health governance.

Prospects and challenges for free-of-charge health care system: A way forward to health insurance in Saudi Arabia

This article discusses the evolution and development of the effective health care system and the government strategy in reducing its financial burden that are associated with the health care through privatising the public health services and demonstrating the importance of the social health insurance (SHI) cooperative scheme in Saudi Arabia. In recent past, Saudi Arabia’s health care services have been regarded well internationally, as reflected in by high average life expectancy and low rate of infant mortality. The literature suggests that the Saudi health care system has become competitive in the international health care systems such as those available in Canada, Australia, New Zealand as well as United Arab Emirates, Qatar, and Kuwait in the Middle East. Three levels of health care services-primary, secondary and tertiary-greatly contributed for the advancement of Saudi Arabia’s health sector. However this paper argues that the Saudi Government will confront major challenges in the funding and delivery of health care as the current pattern of the health funding system has stretched by an ageing population, growing number of labour immigrants, the growing burden of chronic illness, and the ineffective health services. It contends that the inequalities in health services that exist between urban and remote regions’ citizens persist; therefore, it points to the need for reforming Saudi health care system. This paper also discusses that the private sector is playing effective role in assisting the government to reduce its medical expenditure. Despite these improvements, extending equity health services is a serious challenge for the government. This paper further suggests that this challenge can be mitigated through an effective and efficient operation of SHI services in all geographical regions encompassing rural friendly healthcare services and easy and affordable access to health services delivered by the public and the private sector.

Privatization of Saudi health-care system and its significant effect: A review

This is a review paper focusing on privatization of health-care delivery system in the Kingdom of Saudi Arabia and its potential impact. 30 suitable literature were identified from a database out of which only 20 were relevant after reading the abstract, and finally, only nine relevant papers from literature search and seven more papers from the references were included in the review. Although privatizing the Saudi health-care system has some benefits and challenges, there is no strong scientific evidence to support the privatization of health-care system in Saudi Arabia. It is recommended that prior starting the privatization, the Saudi Government should make suitable policies and plans to overcome the challenges.

ISQUA16-3009UNDERGRADUATE STUDENTS PERCEPTIONS AND SATISFACTION WITH THE QUALITY OF THE INTEGRATED MEDICAL CURRICULUM

The College of Medicine in the University of Dammam has implemented an innovative integrated undergraduate medical curriculum since 2014 in order to reform the quality of undergraduate medical education, to achieve Saudi-NCAAA accreditation for the college of medicine and to support quality improvement in Saudi Healthcare system. Like any innovative curriculum it needs to be evaluated for proper implementation. The main objective of this study is to evaluate student perceptions and satisfaction with the quality of the integrated medical curriculum. A cross-sectional survey was conducted during December 2015 among the two cohorts of medical students studying the integrated medical curriculum in the college of medicine. A sample of …

The obstacles facing scientific and medical publishing in Saudi Arabia.

BACKGROUND AND OBJECTIVESMedical and scientific publishing in Saudi Arabia has flourished in the last ten years. Such a form of publishing faces its own obstacles and the experience of the Annals of Saudi Medicine if analyzed can delineate such obstacles. The aim of this study is to identify the workflow obstacles facing the Annals of Saudi Medicine.METHODSRoot-cause analysis of the workflow process and output from submission till publication for the period January 2012–December 2013. Key performance indicators were developed and analyzed after being extracted from the online submission system.RESULTSFor the period of the study, 1058 manuscripts were received annually. These manuscripts originated in descending order from: Saudi Arabia 34%, Turkey 16%, India 12%, China 8% and Western Countries 3%. Categories of the submissions were: original articles 53%, case reports 31% and others 16%. Only 103 of the submissions were accepted annually for publication. Out of 7,709 requests to review a manuscript, only 1,579 (20%) resulted in a review. Out of a sample of 744 rated reviews, only 10% were poor in quality. The average turnaround time for review was 79 days. The main reason for the delay was the low response of the reviewers.CONCLUSIONThe Annals of Saudi Medicine is a regional or continental journal with substantial submissions as case reports. This affected its Impact Factor and Hirsch Index. Moreover, the review process is delayed due to the poor response of the reviewers.

Economic costs of diabetes in Saudi Arabia.

Background:Diabetes imposes a large economic burden on the individual, national healthcare systems, and countries.Objective:To determine the economic impact of diabetes mellitus on Saudi healthcare system, both now and in the future.Materials and Methods:This research study uses a prevalence-based approach that combines the demographics of the population (classified by nationality, sex and age group) with and without diagnosed diabetes in 1992 and 2010. The economic impact of diabetes is estimated in this study, using secondary sources of information provided by Ministry of Health, Ministry of Finance and Central Department of Statistics and Information databases.Results:People diagnosed with diabetes, on average, have medical healthcare expenditures that are ten times higher ($3,686 vs. $380) than what expenditures would be in the absence of diabetes. Over 96% of all medical healthcare expenditures attributed to diabetes are incurred by persons of Saudi nationality, with the remaining 4% incurred by persons of non-Saudi nationality. The population age 45-60 incurs 45% of diabetes-attributed costs, with the remaining population under age 15 incurs 3.8%, age 15-44 incurs 27.5%, and age 60 and above incurs 23.8%.Conclusion:The actual national healthcare burden because of diabetes is likely to exceed the $0.87 billion estimated in this study, because it omits the indirect costs associated with diabetes, such as absenteeism, lost productivity from disease-related absenteeism, unemployment from disease-related disability, lost productivity due to early mortality by disease. The social cost of intangibles such as pain and suffering and care provided by non-paid caregivers as well as healthcare system administrative costs, cost of medications, clinician training programs, and research and infrastructure development is also omitted from this research study. Further studies are needed to confirm the present findings and to improve our understanding of economic costs of diabetes and its related complications.

Attitudes of Emergency Department Staff towards the Role of Clinical Pharmacists in a Region of Saudi Arabia - A Pilot Study

Purpose: To evaluate the attitudes and perceptions of medical doctors and nurses in the Emergency Department ED towards the role of clinical pharmacists.Methods: A pilot study was conducted among the medical and paramedical staff of the ED of Public Hospital, Eastern Region, Saudi Arabia, Al-Ahsa, using a 24-item questionnaire on Doctor of Pharmacy (Pharm-D) program as well as clinical pharmacist and medical staff attitudes toward the availability and possible role of clinical pharmacist in EDs. The data analysed statistically.Results: Sixteen of the 20 respondents expressed a willingness to participate in the study. Six (37.5 %) of the respondents were doctors while the rest were nursing staff. Ten (62.5 %) of the ED staff were aware of the professional degree held by clinical pharmacists (i.e., Pharm-D), and a majority, 12 (75.0 %) had heard of a health care professional called a clinical pharmacist. While exploring medical staff attitude toward the availability of a full-time pharmacist in EDs, 13 (81.3 %) of the respondents viewed this favorably while that regarding the role of pharmacists in drug adherence and patient care was viewed less favorably. Fourteen (87.5%) disagreed with giving prescription rights to clinical pharmacists for minor ailments.Conclusion: These findings highlight the need to enhance the interaction between the medical and paramedical staff on the one hand, and the clinical pharmacist on the other. Clinical pharmacists need to be given an opportunity to prove their capabilities in direct patient care in order to facilitate the full participation of future Pharm-D graduates in direct patient care in the Saudi health care system.

The Saudi Healthcare System: A View from the Minaret

This review article provides information about the origins, history, evolution and current status of the Saudi healthcare system, which is currently being transformed from a publicly financed and managed welfare system to a market-oriented, employment-based, insurance-driven system. Since its inception in the 1920s, the system has provided free healthcare to all Saudi nationals at publicly owned facilities run by government-employed administrators and healthcare providers. For millions of foreign workers in the country, healthcare at privately owned for-profit facilities has been paid for either by the employer or by the individual. At the completion of the three-stage transition, everyone in the country, whether employed in the public or private sector, is expected to have insurance coverage provided by the employer. All Ministry of Health-owned hospitals will be divested to the private sector, whereas primary health centres are likely to be retained by the government. Many of the operational details of the transition are unclear at this stage and will be worked out in the coming years. This paper provides a context for these changes and highlights some of the existing issues and weaknesses. The article also points to some of the future challenges and cautions against pitfalls involved in the complete transformation of the system.

"The Saudi Healthcare System: A View from the Minaret": More Similarities than Differences

"The Saudi Healthcare System: A View from the Minaret": More Similarities than Differences

Assessing knowledge of the patient bill of rights in central Saudi Arabia: a survey of primary health care providers and recipients

BACKGROUND AND OBJECTIVESLittle is known about the implementation of the patient bill of rights (PBR) in Saudi Arabia. Therefore, this study was conducted to explore to what extent health care recipients and providers know about the bill and its implementation.DESIGN AND SETTINGA cross-sectional survey conducted on health care professionals and patients at Primary Health Care Centers in Riyadh, Saudi Arabia, during July 2010.PATIENTS AND METHODSThe study employed a self-administered questionnaire to collect data from 500 patients (aged 18 years or older) and 500 health care providers (physicians and nurses) in primary health care (PHC) centers in Riyadh. Data was collected on the respondents’ knowledge of the existence and contents of the bill, the extent to which the bill is implemented, and the obstacles that may hinder bill implementation. The data was analyzed and presented in a descriptive fashion.RESULTSMore than three quarters of patients and one third of PHC providers did not know about the existence of the bill. Among those who knew about its existence, about three quarters of patients and almost half of PHC providers had little (or very little) knowledge about the bill contents. In general, patients scored lower means of perception than PHC staff about the implementation of the bill’s aspects. PHC staff reported several obstacles that may hinder the implementation of the PBR in Saudi Arabia.CONCLUSIONSPatients and health care providers lack necessary knowledge about the PBR. More dissemination of information about the bill, taking into account the particularities of the Saudi population is needed. Future research is required to establish measures that are effective in ensuring that patients rights are ensured.

Health care system in Saudi Arabia: an overview

The government of Saudi Arabia has given high priority to the development of health care services at all levels: primary, secondary and tertiary. As a consequence, the health of the Saudi population has greatly improved in recent decades. However, a number of issues pose challenges to the health care system, such a shortage of Saudi health professionals, the health ministry's multiple roles, limited financial resources, changing patterns of disease, high demand resulting from free services, an absence of a national crisis management policy, poor accessibility to some health care facilities, lack of a national health information system, and the underutilization of the potential of electronic health strategies. This paper reviews the historical development and current structure of the health care system in Saudi Arabia with particular emphasis on the public health sector and the opportunities and challenges confronting the Saudi health care system.

Infection control in Saudi Arabia: Meeting the challenge

Hospital-acquired infection poses significant clinical and economic burden worldwide. In the Kingdom of Saudi Arabia, infection control is a young, rapidly growing specialty. An infrastructure to expedite the growth of this important discipline is fast being established. The kingdom faces unique challenges when addressing infection control, which are the subject of this review. Much of the policy-making in domestic infection control is driven by the preventive medicine concerns of the annual pilgrimage (Hajj) to Mecca, which are unparalleled. The Saudi Ministry of Health acts to contain and control public health risks at this gathering of 2 million. Infectious hazards at the Hajj include meningococcal meningitis, respiratory tract infections, bloodborne diseases, and zoonotic diseases, all of which have international ramifications as pilgrimaging Muslims return home. In the wake of the extraordinary pace of modernization in Saudi Arabia, deficiencies in infection control remain, which are slowly being redressed. This review examines the anatomy of infection control and its evolution in the kingdom. Future goals and infection control policy-making are given particular emphasis. Saudi Arabia seeks increasing international partnership in the area of infection control and preventive medicine. The Saudi health care system was formed on the basis of Western models to resounding success. Saudi Arabia is now in a position to provide experience and knowledge in return. International dialogue in the infection control arena is of mutual value. Important public health progress is afoot in this young kingdom, and these advances translate both regionally and on the international platform. (Am J Infect Control 2002;30:57-65.)