Saudi Arabia’s Healthcare System: Striving For New Quality Standards

THE Kingdom of Saudi Arabia (KSA) has gained an impressive reputation in recent years for its cutting edge medical services and expertise. It has built an enviable record for preventative medicine and predictive and personalised care. Continual improvements and fresh healthcare initiatives are a corner stone of the country’s 2030 Vision Reform Agenda.

 

The KSA accounts for 60% of the GCC countries’ healthcare expenditure. In contrast to its neighbours, it boasts a relatively large population, estimated by the IMF at 33.48 million.[i] Significantly, the majority of the country’s population is under 30 years of age as the 2022 census revealed that 63% of Saudi citizens are less than 30 years old, with the median age being 29.[ii]

 

A striking feature of contemporary Saudi society is the increasing participation of women in the labour force, which has now reached 36% of the total number of employed individuals. This has already exceeded the 30% target outlined in the 2030 Vision Reform Agenda.[iii] Additionally, more than half of university graduates are women. Consequently, the country can leverage this rich talent pool as a crucial resource in training doctors, nurses, pharmacists and other medical professionals. 

 

Saudi Arabia has prospered in recent years due to higher oil and gas prices. Yet it would be misleading to perceive its national wealth as entirely dependent on hydrocarbon resources. The country’s authorities have pursued economic diversification, a strategy that has proven to be highly successful. For instance, one-fifth of the country’s exports in terms of revenue are now non-oil.[iv]

 

The robust economy has allowed Riyadh to make strategic investments through its sovereign wealth fund (the Public Investment Fund, PIF), both domestically and internationally. A focal point for this investment — channelled through the PIF — is the ambitious creation of a new digital city at NEOM. And a key area for investment in NEOM is a range of cutting edge medical services, grounded on the latest digital and DNA techniques pioneered by the global healthcare industry. Dr Mahmoud Alyamani, with 20 years of experience in neurosurgery and healthcare administration, spearheads this initiative.

 

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Heathcare in Saudi Arabia

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Total expenditure on healthcare and social development reached $50.4 billion (USD) in 2023, constituting 16.96 % of the Government’s 2023 annual budget. The Saudi government has increased its investments in healthcare significantly over the past few years. In 2020, the government allocated SAR 147 billion ($39.2 billion USD) to the healthcare sector.[v] This was linked to the adoption of universal free healthcare services for Saudi citizens in 2019.

 

The substantial progress achieved by the country in healthcare is evident in the significantly improved healthcare quality indicators. According to data from the World Health Organisation (WHO), life expectancy at birth has increased from 68 years in 1990 to 74 years in 2019[vi], and infant mortality rates have plummeted from 32.5 per 1000 live births in 1990 to 5.3 per thousand in 2019.

 

 

Healthcare Delivery

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The Saudi government is responsible for providing healthcare services and serves as the primary funder of the healthcare system, which comprises three tiers: primary, secondary, and tertiary services. Primary healthcare services are provided through primary healthcare centres (PHCs), which offer essential healthcare services, including preventive care, health education, and screening services. Secondary healthcare services are administered via hospitals and specialist centres, which introduce more advanced healthcare services, including diagnostic services, surgical procedures, and emergency care. Tertiary healthcare services are delivered through specialised hospitals, offering advanced treatment for such health issues as severe heart complaints and a wide range of cancers.

A notable feature of healthcare planning in Saudi Arabia is the way in which the government has invested in the development of healthcare facilities across the country. This investment is structured through 20 health directorates, based on 13 regions across the country. As of 2021, there were over 460 hospitals and 2,000 primary healthcare centres.[vii]

 

The Ministry of Health (MoH) is the regulator for all healthcare related activities and services within the country. Looking ahead, the MoH has opted to privatise healthcare services wherever feasible. This pivotal development will encourage many opportunities for providers based in the country as well as internationally. The Ministry aims to increase the private sector’s contribution from 40% to 65% by 2030, a major change of gear. As part of this overall strategy, the MoH plans to privatise 290 hospitals as well as many primary healthcare centres.

 

Saudi Arabia recently established a Health Holding Company (HHC) to be responsible for day-to-day administration. Part of its important remit is to introduce private sector participation. To date, it has identified nine priority areas for public-private partnerships (PPP), namely: primary care, hospitals, medical cities, laboratories, radiology, pharmacies, rehabilitation, long-term care, and home care. The MoH expects that over the next five years there will be more than 100 PPP projects in health services leading to $12.8 billion (USD) in private sector investment. Currently, nineteen PPP projects are underway, mobilising total investment of $2.9 billion (USD).

 

Covid Lockdown: A Catalyst for a Fast Growing Digital Health Sector

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KSA was severely disrupted by the Covid-19 pandemic. Since most of the population lives in urban centres, the infection spread quickly. Following a comprehensive risk assessment, the authorities promptly initiated measures to suspend religious, recreational, sports, and commercial gatherings. Public transport was affected, and curfews were imposed to mitigate the impact of the virus. In total, the nation reported 841,469 cases of Covid-19, resulting in 9,646 deaths.[viii] However, Saudi Arabia was efficient in implementing an ambitious vaccination programme, beginning in December 2020.

By 19 January 2021, both the Astra Zeneca and Moderna vaccines had been approved and a rapid programme of vaccination ensued. This produced a positive outcome as a detailed review article by academics (Asharaf Abdul Salam et al) at the Centre for Population Studies, King Saud University, Riyadh, observes:

The country statistics show remarkable control, credit goes to the committed efforts of the Ministry of Health, Saudi Arabia, and disciplined adaptations by the public. Overall, the percentage of population affected is low.[ix]

Significantly, the Covid-19 pandemic catalysed healthcare in the country, and induced a greater emphasis on remote and digitally based healthcare services. In turn, Saudi Arabia has emerged as one of the fastest-growing digital health markets in the Gulf region. In this context, the government has allocated $1.5 billion (USD) for healthcare IT and digital transformation programmes.

 

 

Future Initiatives

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Under Vision 2030, Saudi Arabia’s Government plans to invest more than $65 billion (USD) to develop the country’s healthcare infrastructure, reorganise and privatise health services and insurance, launch 21 health clusters across the country, and expand the provision of e-health services.[x] 

 

The Private Health Institutions Law passed in 2019 allows foreign investors to own, operate, and manage hospitals and health centres in Saudi Arabia through PPP and build-operate-transfer (BOT) models. This legislation is likely to exert a profound influence on future healthcare facilities and treatment in the country. Certainly, there has been considerable interest among global healthcare providers in the opportunities emerging in the country. One area of medical care that has peaked a lot of interest is in the creation of Telemedicine Centres. These foster collaboration between medical institutions — inside and outside Saudi Arabia — to facilitate the exchange of knowledge and experience to enhance diagnostic accuracy. The key benefit that telemedicine offers is its ability to encourage access to and assistance from expertise outside the Kingdom, thereby benefiting patients.

 

Challenges

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Like many other advanced economies, Saudi Arabia wrestles with an array of medical issues essentially triggered by lifestyle patterns. These are influenced by an over-reliance on motor vehicles, a lack of exercise and ill-informed dietary choices. Almost 18% of the adult population has diabetes, with more than 40% classified as medically obese. Cardiovascular disease manifests a decade earlier than in many countries, triggered by high cholesterol levels, hypertension and excessive smoking.[xi]

Such medical challenges call for greater education and information on lifestyle choices. In a nutshell, many Saudi citizens would benefit from integrating more exercise into their daily routine. Recognising this worrying trend, the Saudi authorities plan to increase spending to prevent and treat diabetes and lifestyle-related ailments. This is a prudent strategy, especially considering that in 2021, the country spent 25% to 35% of its total healthcare budget on diabetes, obesity, and cardiovascular diseases. To bolster preventive and integrated care on such issues as diabetes, along with improving access to health services, the MoH is actively launching health clusters across Saudi Arabia. Each cluster will constitute an integrated network of healthcare providers serving approximately one million people. So far, the MoH has launched two clusters; the Riyadh First Health Cluster and the Riyadh Second Health Cluster.

 

 

Overall Assessment and Conclusion

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Saudi Arabia has made impressive improvements to the quality and reach of healthcare services over the last decade. The adoption of digital technology, telemedicine and a series of initiatives aimed at preventative healthcare and education promise to address many of the country’s most urgent needs. Despite these advancements, there remains certain aspects of healthcare that require a more sustained effort. For example, mental health is something of a ‘Cinderella’ service characterised by limited access to professional advice. There are only 2.2 psychiatrists per 100,000 citizens in the country, far lower than the global average of nine psychiatrists per 100,000 and the problem is particularly acute in rural areas.

Indeed, rural areas fare significantly less well than urban centres of the country. A report[xii] issued in 2020 by Saudi Arabia’s General Investment Authority (SAGIA) suggests that the country suffers from a shortage of approximately 15,000 doctors and 20,000 nurses.[xiii] To improve access to first class healthcare across the country, the government must invest in training and educating healthcare professionals. Fortunately, this is a priority that has been taken on board by the authorities. As Dr Emmanuel Ako, a consultant cardiologist at Dr Sulaiman Al Habib Hospital in Riyadh, notes:

Saudi Arabia is actively addressing this need through various initiatives including increasing investment in medical education and training programmes, recruiting healthcare professional from abroad and fostering partnerships with international medical institutions like John Hopkins, Baltimore, and King’s College, London. Crucially, it is incentivising local talent to pursue careers in healthcare through scholarships and career development opportunities for sustainability of its workforce.[xiv]

The introduction of increased private capital and the privatisation of various healthcare services are poised to transform medical services in Saudi Arabia. The changes over the next five years are expected to be deep. Yet, in contrast with many other countries across the Middle East and North Africa, KSA is in the enviable position of being able to channel substantial resources to fund this ambitious programme of healthcare initiatives.

 

(22/03/2024)

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Endnotes:

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[i] Article IV Staff Report, IMF, published September 2023.

[ii] Saudi population at 32.2 million. 63% of Saudis under 30 years old, census shows, Reuters, 31 May 2023. Note the total population in 2022 is slightly lower than the IMF estimate made in its latest country report published in 2023.

[iii] Article IV Staff Report, IMF, published September 2023.

[iv] Article IV Staff Report, IMF, published September 2023.

[v] Saudi Arabia – Country Commercial Guide, US Government International Trade Administration, published 1 March 2024, see www.trade.gov/country-commerical-guides/saudi-arabia-healthcare.

[vi] Source:  World Health Organization. Saudi Arabia: WHO statistical profile. [ Apr; 2023 ]. 2021. https://www.who.int/data/gho/data/countries/country-details/GHO/saudi-arabia?countryProfileId=05e416f4-8a29-404f-835c-d2352e3bf803

[vii] Healthcare system in the Kingdom of Saudi Arabia: An Expat Doctor’s Perspective,  by Swathi Gurajala,  see www.ncbi.nim.nih.gov/pmc/articles/ PMC 10250784, published 9 May 2023.

[viii] https://www.worldometers.info/coronavirus/country/saudi-arabia/#google_vignette

[ix] https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.736942/full

[x] Source: Saudi Arabia – Country Commercial Guide, US Government International Trade Administration, published 1 March 2024, see www.trade.gov/country-commerical-guides/saudi-arabia-healthcare

[xi] Author’s correspondence with Dr Emmanuel Ako, Intervenionist Cardiologist at Dr Sulaiman Al Habib Hospital, Riyadh, Saudi Arabia.

[xii] Healthcare system in the Kingdom of Saudi Arabia: An Expat Doctor’s Perspective,  by Swathi Gurajala,  see www.ncbi.nim.nih.gov/pmc/articles/ PMC 10250784, published 9 May 2023.

[xiii] Saudi Arabian General Investment Authority. [ April 2023 ]. 2020. https://sagia.gov.sa/en/why-saudi-arabia/sectors/healthcare/

[xiv] Author’s correspondence with Dr Emmanuel Ako, Intervenionist Cardiologist at Dr Sulaiman Al Habib Hospital, Riyadh, Saudi Arabia.