Healthcare Policy and Politics in the Gulf States Working Group I

On April 27-28, 2014, CIRS convened the first working group under the research initiative Healthcare Policy and Politics in the Gulf States. Healthcare practitioners, strategists and social scientists from various disciplinary backgrounds gathered over two days to discuss the rapidly changing health profile of the region, the existing conditions of health systems, and the challenges posed to healthcare management across the six countries of the GCC.

In recent decades, Gulf Cooperation Council (GCC) governments have heavily invested in socioeconomic development and have increasingly played an instrumental role in the development of healthcare systems. Rapid transformation of health systems took place between the mid-1970s and the early 1990s across the six GCC States. Commonalities between GCC states, such as geographic location, political order, the presence of hydrocarbon reserves, and the large influx of foreigners into the region, have created common threads across the healthcare industries of Bahrain, Saudi Arabia, Oman, Kuwait, Qatar, and the UAE. The evolution of healthcare systems, however, has not been uniform across the region, with Oman (ranked 8th in the 2000 World Health Report on health systems) and Bahrain experiencing more successful models of development as compared to their Gulf counterparts. The participants attributed this development to two salient features in healthcare planning: local healthcare leadership and progressive planning that focused on comprehensive health services. The healthcare leadership involved in the organization and planning of Oman’s healthcare system in the early 1970s was predominantly comprised of local expertise allowing for models of development that were based on local needs and that were conducive to the local environment catering towards long-term development of the sector. This stands in comparison to the “mercenary mentality” that was characteristic of foreign healthcare leadership in other GCC States. Bahrain was amongst the first in the GCC to set up primary healthcare centers enabling a significant proportion of the population to easily access health services—a sector that continues to be under-developed in other GCC states as they disproportionately give emphasis to secondary and tertiary care.  Despite disparate levels of healthcare services development across the GCC, the GCC secretariat has adopted some common plans and models that provide a regional approach to the sector. One example is the GCC-wide common purchasing in the pharmaceutical industry, which started in the mid-1970s and has, accordingly, had a major impact on the market. More recently, GCC ministers of health have agreed to create a unified mental health improvement plan to develop a sector that has long been neglected in the region and that is in need of transformation.

While GCC healthcare expenditure continues to be on the rise, there remains a significant gap between investments in healthcare and health outcomes of Gulf citizenry. Rapid urbanization rates and changes in lifestyle have resulted in populations that exhibit a high prevalence of diabetes and obesity (in Qatar, for instance, 70% of nationals are overweight and 40% are obese). Chronic non-communicable disease is on the rise in the Gulf and, as such, preventive medicine and lifestyle health are of growing importance, emphasizing a necessary shift from the current focus on secondary curative care.  Moreover, primary care – considered to be the “gate-keeper” of healthcare models in developed countries around the world – plays a key role in preventive medicine, emphasizing the need to provide incentives to patients for its utilization. In addition to the type of care, participants emphasized the need for multidisciplinary teams—incorporating nutrition experts and diabetes educators, for instance—to effectively prevent a rise in the prevalence of chronic disease.

While Gulf nationals predominantly suffer from these lifestyle diseases, the expatriate and migrant populations of the GCC have health profiles that are distinct from nationals.  The three tiered population of the region—comprised of locals, long-term residents, and more transient migrant workers—requires Gulf governments to plan accordingly for the health needs of each population. One segment of the population, short-term migrants, is largely employed in the construction sectors of the GCC and, as such, incorporation of occupational health and safety in the healthcare model is another component that the Gulf is increasingly focusing on. Much like the need for preventive care in the case of lifestyle diseases, primary needs for occupational health—such as safety assessments and hazard identification—are not healthcare related but are related to prevention. To have an effective systems approach to occupational health however, a feedback system needs to be incorporated that includes frontline workers and allows for open communication with higher management. Achieving this form of participatory health planning and management, however, is very challenging in hierarchical settings that lack labor unions and labor management.

In addition to satisfying the health needs of foreign migrant residents—who comprise the bulk of GCC populations—GCC states have to cope with their reliance on foreign skills to supply their healthcare workforce. This poses broad risks to the region as the excessive reliance on foreign human resources may leave GCC states vulnerable in times of regional sociopolitical instability should there be an exodus of the foreign workforce. In the absence of political crises, however, challenges remain. In the hospital setting or workplace where nurses, physicians, and staff come from a variety of different cultures, speak a multitude of languages, and have been trained under different schools and standards, the effectiveness of providing care is challenged. Additionally, the hierarchical social organization that was outlined in the context of the construction industry is also prevalent in hospital settings—much of it due to many of the GCC states’ sponsorship system (kefala) where tenuousness exists in the work-status of foreign staff. This tenuousness affects relationship dynamics between local and foreign staff and between patients and hospital staff.

While participants of the working group tackled a multitude of topics—ranging from substance abuse in the Gulf to social organization of nursing practices—a common challenge facing scholars studying healthcare in the region is the lack of both available and published data. Thus, while the industry is rapidly evolving, scholarship on the topic remains limited and is constrained by the limited availability of information, underscoring the need for additional research on the area.

Participants and Discussants:

  • Mohamad Alameddine, American University of Beirut
  • Samir Al-Adawi, Sultan Qaboos University
  • Zahra Babar, CIRS - Georgetown University School of Foreign Service in Qatar
  • Matt Buehler, CIRS – Georgetown University School of Foreign Service in Qatar
  • Nerida Child Dimasi, CIRS - Georgetown University School of Foreign Service in Qatar
  • Suhaila Ghuloum, Weill Cornell Medical College in Qatar; Hamad Medical Center
  • Barb Gillis, CIRS - Georgetown University School of Foreign Service in Qatar
  • Cother Hajat, United Arab Emirates University
  • Mehran Kamrava, CIRS - Georgetown University School of Foreign Service in Qatar
  • Nadir Kheir, Qatar University
  • Nabil Kronfol, Lebanese Healthcare Management Association; Center for Studies on Ageing
  • Ravinder Mamtani, Weill Cornell Medical College in Qatar
  • Tatjana Martinoska, Enertech Qatar
  • Suzi Mirgani, CIRS - Georgetown University School of Foreign Service in Qatar
  • Dwaa Osman, CIRS - Georgetown University School of Foreign Service in Qatar
  • Janet Rankin, University of Calgary Qatar
  • Salman Rawaf, Imperial College London; WHO Collaborating Center for Public Health Education and Training
  • Ganesh Seshan, Georgetown University School of Foreign Service in Qatar
  • Rosemary Sokas, Georgetown University
  • Elizabeth Wanucha, CIRS - Georgetown University School of Foreign Service in Qatar

Article by Dwaa Osman, Research Analyst at CIRS