Saudi Health Research Articles

Does prolonged television viewing affect Body Mass Index? A case of the Kingdom of Saudi Arabia.

BackgroundThe rising prevalence of overweight and obesity and their health implications is a major public health concern worldwide. This study set out to understand the relationship between the number of hours spent watching television and Body Mass Index (BMI) in the Kingdom of Saudi Arabia using data from the Saudi Health Interview Survey.MethodsThe study employed both ordinary least squares and quantile regressions to estimate the mean and distributional association of prolonged television watching and BMI.ResultsThe findings showed that prolonged television viewing is associated with larger BMI values. Additionally, the relationship was found to be greater towards the lower and upper tails of the BMI range and insignificant in the middle of the BMI distribution. Furthermore, the findings also showed that there is a gender gap in BMI levels, where females are likely to have higher BMI values than males.ConclusionsThe creation of more proactive recreational programs that can act as substitutes to television watching is recommended in order to reduce the amount of time that individuals spend watching television. It is also recommended that such interventions are tailored towards improving females’ levels of physical activity. The inclusion of television programs aimed at encouraging physical exercise and healthy diets is also imperative.

Use of electronic health records among Saudi and Non - Saudi health providers - a comparative study at a secondary hospital, Saudi Arabia.

Electronic Health Record (EHR) system is now considered the backbone of effective storage and retrieval of patient records in a healthcare setup. This study is an attempt to assess the knowledge, attitude and practice of healthcare professionals in the use of Electronic Health Record system in patient care. It was a comparative cross-sectional study, conducted among the clinicians working in King Khaled Hospital, Almajmaah, Saudi Arabia. The data was collected from 260 clinicians using systematic random sampling technique. A pre-validated questionnaire was used to gather the data. Nineteen items were graded based on the adaptability, usability and knowledge of the participants. The total duration of the study from conception to completion was 6 months. There were 146 (56.2%) Saudis and 114 (43.8%) non - Saudi participants. Knowledge of computer was slightly more among Saudis 134 (51.5%) than non - Saudis 104 (40.0%) (p>0.05). Saudis had an overall positive attitude toward using the EHR as compared to non-Saudis (p<0.001).Frequency of accessing computers daily was more among Non-Saudi practitioners 93 (35.8%) as compared to the Saudis 85 (32.7%) which was statistically significant (p<0.001). This study has attempted to correlate that clinician's adaptability with an electronic record system that requires prior expertise in the use of computers. It recommends further foray into researching barriers associated with slow uptake and positive attitudinal change among clinicians using the electronic health records system in healthcare facilities across Saudi Arabia.

Interprofessional Education: Saudi Health Students' Attitudes Toward Shared Learning [Letter

Introduction Interprofessional learning occurs through healthcare professionals' learning processes, increase collaboration, and improve the quality of patient care. This study aimed to demonstrate the attitudes of students in respiratory care (RC) as well as nursing and clinical laboratory sciences (CLS) during their last semester prior to graduating and then beginning their interprofessional education (IPE) with the help of the Readiness for Interprofessional Learning Scale (RIPLS) questionnaire. Methods Sixty-seven students (25 RC, 14 nursing, 28 CLS) were recruited for this study. All participating students had never been exposed to IPE or any other professional experience. All students were instructed to answer the RIPLS questionnaire, which comprised 3 subscales and a total of 19 items, to assess their readiness to interactively engage with other students as well as shared learning. The 3 subscales included teamwork and collaboration, professional identity, and roles and responsibilities. The total RIPLS scores ranged from 19 to 95, and all respondents had been instructed on the RIPLS-measured concepts beforehand. Results Sixty-seven students participated in this study (49% male, 51% female), for which the response rate was 100% (25 [37%] RC students; 14 [21%] nursing; 28 [42%] CLS). The overall RIPLS scores were considered high, ranging from 66.86 to 74.6 (Table 3). CLS scored the highest among all disciplines 74.6 (79%), while RC scored the second highest with 71.4 (75%) and nursing the lowest with 66.9 (70%). A one-way ANOVA revealed a highly significant difference among the three groups' mean scores for overall attitudes (ANOVA p = 0.001). A post hoc Bonferroni comparison indicated that the overall RIPLS scores for CLS were statistically higher than those of nursing (ANOVA p = 0.009). Conclusion Healthcare students appear to be ready for the implementation of IPE. However, the findings reveal the need to enhance nursing students' awareness of their professional roles and attitudes as well as the advantages of IPE.

Interprofessional Education: Saudi Health Students' Attitudes Toward Shared Learning.

IntroductionInterprofessional learning occurs through healthcare professionals’ learning processes, increase collaboration, and improve the quality of patient care. This study aimed to demonstrate the attitudes of students in respiratory care (RC) as well as nursing and clinical laboratory sciences (CLS) during their last semester prior to graduating and then beginning their interprofessional education (IPE) with the help of the Readiness for Interprofessional Learning Scale (RIPLS) questionnaire.MethodsSixty-seven students (25 RC, 14 nursing, 28 CLS) were recruited for this study. All participating students had never been exposed to IPE or any other professional experience. All students were instructed to answer the RIPLS questionnaire, which comprised 3 subscales and a total of 19 items, to assess their readiness to interactively engage with other students as well as shared learning. The 3 subscales included teamwork and collaboration, professional identity, and roles and responsibilities. The total RIPLS scores ranged from 19 to 95, and all respondents had been instructed on the RIPLS-measured concepts beforehand.ResultsSixty-seven students participated in this study (49% male, 51% female), for which the response rate was 100% (25 [37%] RC students; 14 [21%] nursing; 28 [42%] CLS). The overall RIPLS scores were considered high, ranging from 66.86 to 74.6 (Table 3). CLS scored the highest among all disciplines 74.6 (79%), while RC scored the second highest with 71.4 (75%) and nursing the lowest with 66.9 (70%). A one-way ANOVA revealed a highly significant difference among the three groups’ mean scores for overall attitudes (ANOVA p = 0.001). A post hoc Bonferroni comparison indicated that the overall RIPLS scores for CLS were statistically higher than those of nursing (ANOVA p = 0.009).ConclusionHealthcare students appear to be ready for the implementation of IPE. However, the findings reveal the need to enhance nursing students’ awareness of their professional roles and attitudes as well as the advantages of IPE.

Estimation Of Direct Medical Costs Of Middle East Respiratory Syndrome Coronavirus Infection: A Single-Center Retrospective Chart Review Study.

BackgroundAmong the countries affected by Middle East respiratory syndrome (MERS), Saudi Arabia was impacted the most, with 2,058 cases reported as of June 2019. However, the impact of the MERS epidemic on the Saudi economy is unknown.PurposeThe present study aimed to evaluate the direct medical costs associated with the management of MERS cases at a tertiary referral hospital in Riyadh, Saudi Arabia.MethodsThe study involved a retrospective chart review of confirmed cases of MERS coronavirus (MERS-CoV) infections in a tertiary care referral center in Riyadh, Saudi Arabia, from January 2015 to October 2018. The collected data included sociodemographic characteristics, medical information, and the cost of hospitalization of each patient as estimated by micro-costing.ResultsA complete set of relevant information was available only for 24 of 44 identified MERS-CoV cases. Patients were mostly females, and the mean age was 52 years. Diabetes, hypertension, and chronic kidney disease were the most frequent comorbidities. The length of hospital stay varied from 1 to 31 days, averaging 4.96 ± 7.29 days. Two of the 24 patients died. The total cost of managing a MERS case at the hospital ranged from $1278.41 to $75,987.95 with a mean cost of $12,947.03 ± $19,923.14.ConclusionThe findings of this study highlight the enormous expenses incurred by the Saudi health care system due to the MERS-CoV outbreak and the importance of developing an enforceable nationwide policy to control MERS-CoV transmission and infection.

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.

Learning styles and satisfaction with educational activities of Saudi Health Science University Students.

ObjectivesMedical knowledge is constantly changing; this puts pressure on educators to adapt instructional strategies to their students' learning styles (LSs). Therefore, identifying the LSs of medical students could help teachers to develop teaching strategies to achieve better outcomes. The purpose of this study was to determine the LSs of health science university students, and to assess the relationship between LSs and student satisfaction with educational activities.MethodsThis cross-sectional descriptive study was conducted in the Colleges of Medicine and Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) Jeddah. We used Kolb's LS and a modified Student Satisfaction Survey from Mott Community College, Michigan. All participants received self-administered questionnaires; LS and demographic data were used as predictor variables. Students' satisfaction levels were considered the outcome variable.ResultsA total of 359 students were recruited (mean age 19.0 ± 1.4 years; 53.5% males). The most popular LS was Accommodator (29.2%), followed by Assimilator (27.9%) and Diverger (25.6%), while the Converger style (17.3%) was the least preferred LS. The satisfaction scores of the students showed that they were generally satisfied with a mean score of 64.4%. Males were found to have higher satisfaction across all variables than females (p = 0.002).ConclusionsThis study could not find a predominant LS or satisfaction difference across LSs among health science students. Thus, the current educational programmes in KSAU-HS meet students' LSs and satisfaction. Educators need to broaden their strategies for instruction, so as to build an effective learning environment.

Acceptance of Tele-Dental Health Education Among Head and Neck Cancer Patients in Saudi Arabia.

Based on the latest published cancer report by the Saudi Health Council, Saudi Cancer Registry (SCR) in 2014, the percentage of cancer incidence got higher than the previous report in 2012 by 10.2% [1]. Increasing the incidences of head and neck cancer (HNC) remains a local public health burden that provoke us to consider technology innovations to manage its serious health consequences. We aimed to evaluate patients' preception toward technology usage in reciving health care.

A Narrative Review of the Prevalence of Periodontitis in Saudi Arabia: A Proposal for a National Oral Health Research Agenda for Vision 2030

Objective:The objective of this narrative review is to summarize the current knowledge on the prevalence of periodontitis in the Kingdom of Saudi Arabia (KSA) and to make recommendations for monitoring and improving oral health in the KSA population.Background:Periodontitis is a significant health issue in the general population, so conducting routine public health surveillance for this condition is important in every country. KSA is currently implementing a strategic plan called Vision 2030 which aims to improve many of the country’s infrastructures, including healthcare.Methods:To conduct this narrative review, Google Scholar (GS) was used to search for peer-reviewed articles on the prevalence of periodontitis in KSA. No limits were placed on the year of publication, but only articles translated into English were considered. Search terms used included “Saudi Arabia”, “periodontitis”, “surveillance”, “prevalence”, “rates”, “oral health” and “dental”.Results:The earliest estimate identified was from 1992, in which the rate of lack of periodontal health was estimated to be 90% in KSA residents aged 25 and over. A more recent estimate reported rates around 50%, but used a different case definition. Studies on tobacco use, periodontal health and KSA established that how tobacco is used strongly influences periodontal status. Other dental studies in KSA focus on other topics. The Saudi Health Information Survey (SHIS) conducted in 2013 asked oral health questions, but did not seek to estimate the rates of periodontitis in KSA.Conclusion:The World Health Organization’s (WHO) recommendations suggest that KSA should conduct research to develop surveillance case definitions of periodontitis that will have specific utility in KSA, and can be standardized to compare KSA rates with the rates worldwide. The existing surveillance definitions and efforts in other countries have been considered less than optimal, so research is needed to inform KSA’s effort. Recommendations are made for a national oral health research agenda in KSA under Vision 2030.

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.

Zika Virus: Knowledge, Attitudes, and its Prevention Approach Among Students of the Health Colleges at Qassim University, Saudi Arabia

Background: Zika virus (ZIKV), a flavivirus transmitted by Aedes species mosquitoes, was first identified in the Zika Forest in Uganda in 1947. There is a Saudi concern about Zika, and the Saudi health authority is trying to do their best to prevent any outbreak considering that people’ precautions that are taken based always on their knowledge toward infectious diseases. Aim: To assess the level of knowledge and attitudes towards Zika virus (ZIKV) and its prevention among Health Colleges’ students at Qassim University (QU), Saudi Arabia. In addition, to identify factors associated with level of knowledge regarding ZIKV. Methods: A stratified random sample of 343 students (male and female) participated in a cross-sectional study. The questionnaire consisted of 46 questions assessing the knowledge, attitudes, and prevention practices regarding ZIKV. Results: Mean age of participants was 22 years old (SD ± 1.6) and the internet was the commonest source of information. Overall, most participants had poor knowledge regarding ZIKV (n = 274, 79.9%) and positive attitude (n= 294, 85.7%) regarding learning more about ZIKV. In terms of prevention practices, more than half of participants (n=191, 54.7%) confirmed using mosquito nets to prevent mosquito bites. Statistically significant differences were detected between participants’ level of knowledge and their age (p < 0.037), colleges (p < 0.039), academic level (p < 0.001), and residence area (p < 0.001). Conclusion: Findings revealed the lacuna of knowledge of participants regarding ZIKV. This finding arises the need for implementing ZIKA Virus health education program for university students.

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.

Knowledge and Awareness of Osteoporosis among Saudi Physicians and Nurses: A Cross-Sectional Study.

AIM:We aimed to evaluate the awareness and knowledge of osteoporosis in a sample of 141 health professionals.MATERIALS AND METHODS:A group of 141 health professionals (medical, surgical, primary health care and nursing departments) were enrolled in this cross-sectional study in the period from August 2017 to November 2017. The participants completed a questionnaire composed of 19 questions about osteoporosis which covering the main domains of knowledge on osteoporosis. Each correct answer carried 1 point whereas incorrect or ‘don’t know’ carried 0 points. This gave a total score range of 0-19. A cut-off level of < 10 points was considered as poor knowledge while ≥ 10 was regarded as good knowledge.RESULTS:Out of 141 respondents, 78 were females, 63 males, mean age of the participants was 38.17 ± 9.6 years, less than 40 years (n = 89), more than 40 years (n = 52). Nurses (n = 54), medical (n = 29), surgical (n = 35), primary health care (n = 23). Most of the study group with experience of fewer than 10 years (n = 66), 127 (90.1%) had good knowledge and 14 (9.9%) had poor knowledge p-value < 0.01.CONCLUSION:Our study revealed that Saudi health professionals have a good of knowledge about osteoporosis and no significant difference in osteoporosis knowledge between the health professional subgroups.

Proceedings of the Saudi Health Simulation Conference 2018

Proceedings of the Saudi Health Simulation Conference 2018

Hospital-supplier integration and hospital performance: evidence from Saudi Arabia

PurposeThe purpose of this paper is to develop a comprehensive conceptual model for the impact of hospital-supplier integration on the overall performance of healthcare organisations. It also investigates the moderating role of lean practices between hospital-supplier integration and hospital performance.Design/methodology/approachData were collected from 498 public and private hospitals in Saudi Arabia using a survey. Structural equation modelling was used for data analysis.FindingsThe results indicate that hospital-supplier integration has a positive impact on the hospital performance. These effects are even more notable when adopting lean practices in the hospitals.Research limitations/implicationsThe data were collected from one developing country, namely Saudi Arabia. Thus, the findings may be relevant to the Saudi context but not those of other developing countries. Second, the data were collected from the hospitals’ end but not from the suppliers, so the latter’s perspectives on the themes covered here are not known. Future research may investigate the validity of the model in various developing countries whose healthcare systems have different characteristics, and the relationships between hospitals and their suppliers may follow different governance models.Practical implicationsThe developed model and results will help hospitals in the Saudi health system to make better decisions on managing their logistics and supply partners.Originality/valueThis study extends the current research by developing a model that highlights the impact of hospital-supplier integration on the overall performance of healthcare organisations and tests this model to confirm its validity. To the authors’ knowledge, this study would be one of the first that uses both lean thinking and relational view of competitive advantage theory combined to examine the moderating role of lean practices on the inter-organisational relationships in Saudi Arabia.

Advancing pharmaceuticals and patient safety in Saudi Arabia: A 2030 vision initiative

Low-quality medicines deliver sub-optimal clinical outcomes and waste precious health resources. It is important to ensure that public funds are spent on healthcare technologies that meet national regulatory bodies such as the Saudi Food and Drug Authority (SFDA), quality standards for safety, efficacy, and quality. Medicines quality is a complicated combination of pre-market regulatory specifications, appropriate sourcing of ingredients (active pharmaceutical ingredient (API), excipients, etc.), manufacturing processes, healthcare ecosystem communications, and regular and robust pharmacovigilance practices. A recent conference in Riyadh, sponsored by King Saud University, sought to discuss these issues and develop specific policy recommendations for the Saudi 2030 Vision plan. This and other efforts will require more and more creative educational programs for physicians, pharmacists, hospitals, and patients, and, most importantly evolving regulations on quality standards and oversight by Saudi health authorities.

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.

Evolution of emergency medical services in Saudi Arabia

Aim: The purpose of this study was to provide an overview of the evolution of emergency medical services (EMS) in Saudi Arabia to describe its history, organisational service providers, governance, EMS statistics and the educational development of the field with the disparity of educational approaches. Background: The EMS is an important part of the healthcare system as it is often the first point of contact for medical emergencies. The EMS in Saudi Arabia has seen a number of positive changes over the past decade, some of which include the development of several university and college programs dedicated to teaching EMS, the evaluation of the profession from a post-employment first aid model into a pre-employment bachelor's degree model, the generous governmental scholarship grants overseas and the official accreditation of EMS as a profession. It has been approximately nine years since the first EMS bachelor's degree programs were developed in Saudi Arabia, some of which were directly adopted from universities in developed countries such as Australia. Despite these positive changes, the current EMS system in Saudi is faced with many challenges, both organisational and educational, including the lack of research, community involvement, the educational status of practitioners and the inconsistencies of statistics relating to response time and rate of transfer. This paper describes the history of EMS in Saudi Arabia with a specific focus on identifying the disparity in the educational outcomes and approaches adopted by colleges and universities in the Kingdom. Methods: The data utilised for the research of the EMS profession in Saudi Arabia were obtained from the literature using search tools such as MEDLINE, Google Scholar, Saudi health journals, Saudi university websites, government reports and statistics. Conclusion: The EMS profession in Saudi Arabia has advanced greatly in the past 12 years. Yet there is still scope for considerable improvement, especially with regards to developing empirically identified core competencies for EMS bachelor's degree graduates. There is also the need for providing more outreach to the public to improve awareness of current services and available training, building more collaboration between the industry employers and academic institutions and investing further in EMS research through the development of Saudi-based postgraduate master's and PhD EMS degrees. This paper is the first to provide an overview of the EMS service in Saudi Arabia, for institutions and researchers to gain a better understanding of the history and current standing of the service from an educational and operational perspective.

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.

The Referral System between Primary and Secondary Health Care in Saudi Arabia for Patients with Type 2 Diabetes: A Systematic Review.

Background In Saudi Arabia, the mortality of diabetes is currently reported at 6%. A well-administered referral system is crucial in aiding the management of this disease. Method A single reviewer employed a systematic approach to searching the literature databases with regard to the question: what are the attributes of referral systems in Saudi Arabia for patients with type 2 diabetes (T2D)? The results were analysed in order to provide recommendations to improve the Saudi health system. Results Twelve primary studies were identified from a systematic search. Overall, the 12 studies did not clearly mention any of the factors of a good referral system. The referral problems identified by this study included patients' unnecessary requests for referral, unstructured referral letters, and unclear dissemination guidelines for referral. Conclusions This research attempted to identify the efficiency of the referral processes that were implemented for patients with T2D. The majority of the included studies were completely silent on the main referral factors for patients. If this review is representative of the referral system in Saudi Arabia, then, in the context of T2D, current referrals are unsafe. Further research on the quality of the referral system, taking into account at least some of the WHO referral guidelines, is required.