Kuwait Healthcare:
Responding Pro-Actively
To Visible Stress Symptoms

WITH the world’s seventh largest reserves of oil, Kuwait is able to fund a relatively generous healthcare system for all its citizens. Historically, Kuwait spends just over three per cent of its $106 billion annual GDP on healthcare. Just over 14% of this sum was spent in the private healthcare sector but medical provision for Kuwaiti nationals is provided free whereas expatriates must pay an annual health insurance fee.

As elsewhere across the world, private healthcare facilities generally offer a higher quality of healthcare with shorter waiting times. Although the government regulates the fees charged by private hospitals, they can still be substantial [1]. Private healthcare is forecast to account for 15-20% of total healthcare expenditure in the coming years.[2]

 

The central government oversees the provision of healthcare and the Ministry of Health is responsible for its administration. Kuwait, which covers 17,818 square kilometres — slightly smaller than Slovenia — is divided into six health regions: Kuwait City, Hawali, Ahmadi, Jahra, Farwania and Al Suabah. Each region has considerable autonomy in financial and administrative affairs, and in the training of the health workforce, and the management of health services. Following the Covid-19 pandemic, they were all forced to respond in a more targeted manner.

 

According to the latest International Monetary Fund (IMF) mission statement, issued on 5 June 2023, Kuwait’s GDP growth in 2022 reached 8.2% — a significant rise on the 1.3% recorded in 2022 following the most acute phase of the Covid-19 pandemic and which reflects the surge in oil revenues.[3] On the back of these improved oil revenues, Kuwait is now planning a major fiscal expansion with higher spending on public sector wages and a range of subsidies and social benefits, particularly in the healthcare sector.

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Demographics

 

Kuwait’s population is modest. In 2016, the total number of citizens amounted to 1.3 million, with an additional 3 million non-nationals living in the country. Nearly a fifth of Kuwaitis are aged between 15 to 24, while a mere 3.4 % are aged over 60 – demonstrating a younger population distribution.
On average, Kuwaiti males have a life expectancy of 79 years, while women’s expectancy is of 83. In 2015, the under-five mortality rate per 1000 births was 3.2 (latest data available[4]), lower than Bahrain’s infant mortality rate of 9.98 per thousand.

The number of physicians per 10,000 population was relatively low at 17.9. By way of regional comparison in Bahrain, which has about half the population of Kuwait, that number is 22.6, although these figures are more recent.[5] Nevertheless, the urgent need to recruit more doctors is evident.

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The Impact of the Covid-19 Pandemic
 

Kuwait experienced 665,982 cases of Covid-19 which resulted in a total of 2,570 deaths.[6] These figures are the most recent available and reported by the World Health Organisation (WHO). The Sheik Jaber Al-Ahmed Al-Sabah Hospital, established in 2020, has been dedicated to treat patients suffering from Covid-19 symptoms.

Kuwait imposed one of the strictest sustained lockdowns globally as a result of the Covid-19 pandemic. This had a damaging impact on business activity, particularly across the small and medium sized enterprise (SME) sector. Kuwait was also obliged to restructure its aviation and energy sectors, cancelling several multi-million-dollar contracts and culling many jobs performed by foreign workers. [7]

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The lockdown was especially severe for low-skilled foreign workers. The International Labour Organisation (ILO) estimated this segment of the population lost a total of around 260,000 jobs across all sectors between December 2019 and December 2021, equivalent to 18% of their total employment before the pandemic. In the recovery phase following the pandemic the electricity and gas sector stood out as the sector keenest to recruit labour while construction, arts and entertainment, and public administration, were also quick to rehire people.

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Kuwait’s Evolving Health System

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Healthcare financing is based on what the WHO refers to as “a single-payer system”.[8]  In July 2016, a new financing model — the Afiya programme — was introduced to provide an alternative financing method for the country’s most vulnerable citizens. This programme mainly focuses on more than 110,000 retirees, facilitating their ability to access treatments from public and private healthcare facilities.

Non-nationals, meanwhile, have access to an alternative plan run by the non-governmental organisation Patient Support Fund. It is mandatory for all foreign nationals to have health insurance through the private or public sector. In recent years, this has sparked controversy as some locals claim to suffer delays in treatments at public facilities due to high demand from expatriates. This led to citizens being prioritised at public health facilities, for example, through being assigned specific times for treatment.

 

As in other Gulf Cooperation Council (GCC) countries, Kuwait faces an increased demand for healthcare services. The pressure on medical professionals is clearly evident, resulting in longer waiting lists and visible signs of stress in the system. A “Kuwaitisation” policy is seeking to redress a reliance on overseas health professionals but, inevitably, this process takes time, especially considering the years of training required for doctors, dentists and pharmacists. In the case of nurses, Kuwait is facing serious challenges in recruiting young locals, so the country is likely to remain heavily reliant on qualified overseas professionals from countries such as the Philippines[9]. It is estimated that the public sector alone will need to recruit around 15,000 medical professionals in the coming years.[10]

 

Kuwait boasts a modern healthcare infrastructure, focused on 6 principal general hospitals and several national specialised clinics. In aggregate, the government runs 28 general and specialised hospitals. Currently, Kuwait is busy building additional hospitals. Two recent projects were the Sheikh Jaber Al-Ahmed. Al-Sabah Hospital, inaugurated in 2020 and initially devoted to treating Covid-19 patients, and the New Jahra Hospital, which was built at a cost of $1.1 billion (USD). These hospitals provide an additional 2402 beds. Currently, only two hospital beds are available for every 1000 people, a situation exacerbated by rapid population growth and problems associated with diseases, such as diabetes and coronary complaints, which require professional care.

 

As part of its $104 billion (USD) National Development Plan Kuwait is investing in over 3,300 new hospital beds. This strategy aims to deter citizens from seeking specialist treatment aboard, including services such as remedial cancer treatment, for which many citizens have traditionally visited London’s Harley Street cluster of clinics. In the past, Kuwait has been unable to offer some of these specialist medical treatments, notably in the field of cancer care, but this issue is now being addressed.[11]  

Primary health care centres in Kuwait have switched to computerised registration systems and efforts are underway to improve the database linking services provided at the primary, secondary and tertiary levels. The Ministry of Health established a new position, the Assistant Under Secretary of Digital Health Affairs, who is responsible for promoting the digitalisation of the heath care service and workflows. Overseas companies with considerable experience in this area are contributing to the transformation of Kuwait’s health system in respect of digitalisation.

The section above explains the addition of hospital capacity – in the form of new beds – as well as the digitalisation of the health service.

 

Future Challenges

 

Anyone who has visited Kuwait in summer appreciates the intensity of the heat. This extreme heat, sometimes soaring to over 50 degrees centigrade, coupled with high humidity and dust and particulates generated by the desert and ongoing construction work can seriously affect people, especially those with respiratory conditions. These climate-related issues put a lot of pressure on Kuwait’s health system.

As in other Gulf states, diabetes and health conditions linked to lifestyle have led to a great deal of concern and triggered pro-active moves to encourage people to adopt healthier lifestyles and diets. Today, emphasis is being placed on health promotion and voluntary initiatives, with a focus on home-based interventions. Furthermore, the IMF has recently urged Kuwait to implement a 5% value added tax on tobacco and sugary drinks as a key element in promoting healthier lifestyles.[12]

Kuwait is actively working to reduce waiting times and tackle the high patient load on medical staff. Other challenges include establishing a systematic assessment of the quality of healthcare and improving the referral and follow-up system, which should be facilitated by the newly implemented computerised linkages between primary, secondary and tertiary care levels.

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Kuwait needs to prioritise its health goals and reorganise its approach to health provision. In a recently published doctoral paper[13] focusing on “How will current health spending in Kuwait meet the demands of a changing epidemiological and demographic landscape?” Abdullah Meshal Mubarak Abdullah Alsabah of University College London’s (UCL) Institute for Global Health points out that “Since current health spending is financed almost exclusively from oil revenues, the state’s ability to meet growing demand will be dependent on either growing oil revenues at the same rate, reducing spending in other sectors, rationing health service provision or improving the efficiency of health spending”.

While oil revenues in the last couple of years have climbed significantly, it remains the case that Kuwait needs to prioritise its spending on healthcare and direct it more efficiently.

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The UCL research indicates that there is scope to improve health promotion and health services for the elderly. Dr Abdullah Meshal Mubarak Abdullah A Alsabah recommends more attention should be focused on “public education about the value of preventative medicine, and the trade-offs involved when dividing a finite resource to where it can help the most people”[14]

The UCL research further highlights the case in favour of separating the roles of health regulation, financing and provision. Currently, the Ministry of Health (MoH) is responsible for all these functions and this approach risks conflicts of interest.[15] It may therefore be sensible to explore alternatives which mitigate any conflicts of interest and improves healthcare for Kuwait’s expanding and ageing population.

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(21/07/2023)

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Notes

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[1] ‘An Expat Guide to Healthcare in Kuwait,’ page 4.  https://www.expatfocus.com/kuwait/health/an-expat-guide-to-healthcare-in-kuwait-4523 

[2] https://www.trade.gov/country-commercial-guides/kuwait-healthcare, 13 September 2022.

[3] https://www.imf.org/en/News/Articles/2023/06/05/mcs060523-kuwait-staff-concluding-statement-2023-article-iv-mission, 5 June 2023.

[4] Source: Country Cooperation Strategy at a Glance, Kuwait, World Health Organisation (WHO).

[5] Kuwait figure for physicians relates to 2009, source: ibid., WHO.

[6] Source: https://coronavirus.jhu.edu/region/kuwait, (The WHO in its Country Cooperation Strategy at a glance brief specifically highlights the problem associated with training nurses who are Kuwaiti citizens. This is a point confirmed by the heart surgeon working in the Gulf who I had dinner with recently).

[7] Source: ‘Skills Needs in Kuwait following the Covid-19 pandemic’, International Labour Organisation, July 2022, https://www.ilo.org/wcmsp5/groups/public/---arabstates/---ro-beirut/documents/publication/wcms_853305.pdf

[8] Source: Country Cooperation Strategy at a Glance, Kuwait, World Health Organisation (WHO).

[9] Source: Country Cooperation Strategy at a Glance, Kuwait, World Health Organisation (WHO).

[10] https://www.trade.gov/country-commercial-guides/kuwait-healthcare, 13 September 2022.

[11] Source: https://www.trade.gov/country-commercial-guides/kuwait-healthcare, 13 September 2022, page 4.

[12] https://www.imf.org/en/News/Articles/2023/06/05/mcs060523-kuwait-staff-concluding-statement-2023-article-iv-mission, 5 June 2023

[13] ‘How will current health spending in Kuwait meet the demands of a changing epidemiological and demographic landscape? A study exploring ways to improve the efficiency of health spending in Kuwait’, Abdullah Meshal Mubarak Abdullah A Alsabah, Ph.D awarded in 2020 by University College London (UCL)  Institute for Global Health, https://discovery.ucl.ac.uk/id/eprint/10124644/1/Alsabah_10124644_Thesis_sigs_removed.pdf

[14] Ibid, page 119.

[15] Ibid., page 124.