Toward Efficient Primary Healthcare in the UAE: Needs Assessment - Coursework Example

Toward Efficient Primary Healthcare in the UAE: Needs assessment Introduction The UAE has undergone rapid developments in the last 40 years thereby comparing to the United States and Western Europe in terms of health and the economy (Hamidi, Shaban, Mahate & Younis, 2014). The number of government healthcare facilities has risen by nearly 450%; in 1970, there were only 7 hospitals in the UAE, but the number shot to 20 in 1980, and 29 in 1990 (Yeboah, 2007). The number of private hospitals in UAE has also increased over the years by about 25%, from just about 24 facilities in 2000 to about 30 in 2003; with the increase in the number of both public and private hospitals, the number of nurses has also gone up by about 1,368%. In the year 1970, the UAE had only about 1000 nurses but the recent developments over the past few years have seen that number soar rapidly to about 14,680 nurses in 2003. The increase in the number of health centres is parallel to the increase in the number of physicians and the population; in the years 1990 and 2000, the number of health centres increased radically to 5,222 and 6,946 respectively (Yeboah, 2007). This paper presents a plan for a needs assessment on the primary healthcare service in the UAE in general and particularly in the Dubai emirate sub-population; this investigative paper focuses on the process of the needs assessment in the target population and the rationale for the methods used. Needs Analysis Following the sharp increase in the population, there has also been a steady increase of about 20% in the attendants of primary healthcare centres in the UAE, from 3,765, 171 in 1992 to 4,519,385 in 2000. For instance, during a 20 year period from 1979 to 1999, there has been an upsurge in the number of laboratory tests conducted in the UAE, from 2,760, 414 to 11,787,937, which is nearly a 327% increase; apart from that, blood bank units have also grown significantly from 9,005 in 1984 to 29,690 in 2000. From this statistics, the implications of an ever rising population size on the health services provision is clear; an increase in the population size creates a greater demand and subsequently greater provision of health services (Alrubaiee & Alkaaida, 2011). Health services in the UAE are distributed according to the spatial distribution of the population (Margolis, Al-Marzouq, Revel, & Reed, 2003); population distribution across the seven Emirates is uneven, with the largest Emirates, Abu Dhabi and Dubai, having the highest population concentrations. The increase in the number of school health projects and manpower involved in the provision of these services indicates the high demand for health provision in schools due to a huge concentration of attendees in the school age population. In the year 1970, only about 129 schools were participating in the School Health Program but the number rose steadily by about 377% to 615 in 1996 (Yeboah, 2007); similarly, the number of students attended to rose by 638% in the same timeline. The number of healthcare professionals in the School Health Programs also increased tremendously in the same period, doctors by about 2,075%, dentists by 1,000% and nurses by 1,117%; the health of children in the UAE has improved significantly, following these interventions. Capacity requirements and projections for PHC in Dubai In many advanced countries around the world, healthcare systems are designed to give prominence to primary healthcare services and to promote utilization of these services as the first point of care within the populations (DHA Policy & Strategy Department, 2011). The WHO recommends the orientation of health systems towards primary healthcare since it is known to result to high quality health outcomes, greater user satisfaction as well as efficient utilization of resources (Hamidi, Shaban, Mahate & Younis, 2014). Availability and even distribution of primary healthcare services inevitably enhances the overall health of the population thereby reducing mortality and enhancing indicators for child and maternal health. Improving continuity of care would ultimately enhance patient satisfaction as well as the overall primary healthcare service provision (Fan, Burman, McDonell & Fihn, 2005). Like many advanced countries, the Dubai Emirate has given greater priority to Primary healthcare over the years; however, numerous gaps still exist in the primary healthcare because many UAE nationals and expatriate elites prefer the care of specialists and over the counter purchase of prescription drugs to the primary healthcare services (Yeboah & Yeboah, 2014). According to Fan, Reiber, Diehr, Burman et al (2005), education level determines patient satisfaction and consequently their confidence in primary healthcare facilities. Similarly, a vast majority of the low-income expatriates do not utilize the primary healthcare services, mostly due to financial constraints and the lack of health insurance; this group often waits until their conditions have deteriorated to benefit from the free services of the emergency departments. The number of primary healthcare physicians per capita is significantly lower in Dubai than it should be; Dubai’s ratio of PHC physician to people of nearly 1:2438 does not compare favourably to the ratios in advanced PHC systems of the world such as Denmark (1:1,600), Norway (1:1,200) and the UK (1:1,400). Internationally, the recommended ratio of PHC physicians to population is set at 1:2,000; when this ratio is compared to Dubai’s official growth rate or projection, a large gap between the actual number of PHC physicians and the expected number is revealed. Theoretically, Dubai has only about 746 PHC physicians when actually it requires about 957 PHC physicians; however, the international standard does not apply to Dubai. Taking various factors such as Dubai’s distinctive demographical structure as well as the population’s inclination to specialized services into consideration, the country requires only 395 PHC physicians to meet its PHC demand (DHA Policy & Strategy Department, 2011). The implication of this statistic is that there is sharp mismatch between the number of PHC physicians and the demand for PHC services in Dubai; the marked oversupply of PHC physicians undermines the quality of medical care. Furthermore, utilization of PHC services in Dubai is acutely lower than in most countries; its current visit rate of 0.7 visits per year staggers behind Denmark’s 6.2, Norway’s 4.6 and UK’s 4.0. In terms of national versus private facility utilization, UAE nationals largely prefer national PHC facilities to private ones even after the introduction of the private insurance for all government employees. In addition to that, there exists some geographical gaps in coverage of PHC services due to the disproportionate clustering of services in central regions of Dubai at the expense of peripheral areas of the Emirate (DHA Policy & Strategy Department, 2011). Most of the newly-populated areas of Dubai are highly deficient of PHC services since they are consolidated in central areas; the lack of adequate coverage of PHC services creates inequality in service access. The WHO recommends that PHC services need to be as close as possible to where people live and work, not more than 15-30 minutes away, to facilitate easy access (AL-Ahmadi & Roland, 2005). The UAE is presently committed to expanding access to primary health services. Objectives The objectives of this needs assessment is to identify the causes of the gaps or the discrepancy between current and expected performance levels within the UAE healthcare system, as well as solutions to the challenges inhibiting the desired performance levels. Patient satisfaction will be one of the leading indicators of the quality of primary healthcare services across the target area population (Harrison, 1996). Target Audience The target audience for this needs assessment is the UAE population; participants will be citizens, experts, leaders as well as decision makers within the UAE target area, both nationals and expatriates included. Sampling Procedure Representative subsets of the UAE population from which generalizations concerning the UAE primary healthcare system will be drawn through probability sampling; this sampling method will allow generalizations to be made regarding the UAE primary healthcare system. Data Collection Methods Multiple data collection methods will be utilized in this needs assessment including the existing data review approach, attitude survey approach, the key informant approach, community forum, as well as the focus group interview (Watkins, Meiers & Visser, 2012). The existing statistical data will be explored to yield insights into the primary healthcare service provision, coverage, as well as utilization; the type of data that will be utilized will include descriptive statistics in the form of census data, primary healthcare surveys, as well as hospital records. The document or data review method will be effective in studying different existing sources of information such as reports, data files, among other written artefacts for the sole purpose of collecting information that can be verified independently. The attitude survey approach will be used to retrieve information from a representative sample of the UAE population, particularly on issues relating to primary healthcare services, demand and provision. The key informant approach would be effective in highlighting priority primary healthcare areas within the UAE population; key UAE leaders and decision makers who possess information about the primary healthcare needs and concerns will provide vital information for the needs assessment. Public forums or meetings will be held to facilitate discussions on the primary healthcare needs, priority areas, as well as probable solutions to these problems; the public will be free to attend to contribute their views regarding the primary healthcare in UAE. Focus groups comprising of people of specific skills, experience, or views will used to gather detailed information regarding primary healthcare in the UAE. Instruments and Techniques The measuring instruments and techniques that will be used in this needs assessment include personal interviews, telephone surveys, as well as questionnaires (can either be hand-delivered or delivered by mail). Key informants or individuals in the population sample may be interviewed or be issued with questionnaires to yield valuable information regarding the primary healthcare needs in the UAE. The SWOT analysis technique would be conducted to identify, organize as well as to prioritize the strengths, weaknesses, opportunities and threats underpinning primary healthcare in the UAE target area. The Delphi technique is yet another powerful tool that can be effective in gathering expert opinions regarding primary performance challenges with regards to primary healthcare; this technique can lead to a group decision regarding the way forward. Data Analysis The needs assessment information will be analysed using different methods of data analysis, depending on the type of data, including charts, diagrams, tables, as well as graphs. For instance, fishbone diagrams (cause-effect diagrams) will be highly effective in identifying the probable or actual causes of performance problems with regards to the UAE primary healthcare. A root cause analysis will be used to highlight the causal factors contributing to the performance gaps within the UAE target area primary healthcare; this technique will be useful in identifying factors preventing the desired level of performance from being actualized. Analysis of qualitative data will yield trends or patterns inherent in primary healthcare in the UAE target population. Quantitative data will be analysed to yield averages or percentages across the responses of independent respondents in the needs assessment process; for instance, valuable information such as satisfaction with the current primary healthcare services (Di Palo, 1997). Decision-making tools & Techniques Numerous tools and techniques will be used to analyse and highlight priority areas in the needs assessment process as well as to arrive at decisions regarding the way forward; generally, these tools and techniques ensure that issues relating to the primary healthcare service are given due consideration in an inclusive decision-making process. The nominal group technique will be effective to engage in consensus planning leading to prioritization of issues as well as decision-making. A multi-criteria analysis technique will be used to facilitate the systematic comparison of qualitative data across multiple variables; this method is a valuable tool that facilitates decision-making on the basis of the information collected in the needs assessment process. The table-top analysis technique will also be used to identify the gaps, performance deficiencies as well as communication challenges in primary healthcare in the UAE target population. The pair-wise comparison technique will be utilized to narrow down the multiple options derived from the needs assessment based on a set of agreed-upon criteria to specific priority areas. Conclusion The needs analysis of the primary healthcare service and provision in the target area of UAE reveals that several discrepancies between the current and the expected performance levels exist. Many UAE nationals and expatriate elites prefer the care of specialists and over the counter purchase of prescription drugs to the primary healthcare services; a sharp mismatch between the number of PHC physicians and the demand for PHC services in Dubai still exist. Furthermore, utilization of PHC services in Dubai is acutely lower than in most countries and the coverage of PHC services is uneven due to the disproportionate clustering of PHC services. Availability and distribution of PHC services inevitably enhances the overall health of the population thereby reducing mortality and enhancing indicators for child and maternal health. The numerous gaps that still exist in the UAE PHC system need to be filled; the needs assessment plan highlighted above will be effective in highlighting the causes and solutions to these gaps thereby contributing to effective PHC services in the UAE. References AL-Ahmadi, H., & Roland, M. (2005). Patient satisfaction with primary health care services in the United Arab Emirates. Int J Qual Health Care, 17 (4): 331-346. Alrubaiee, L., & Alkaaida, F. (2011). The mediating effect of patient satisfaction in the patients perceptions of healthcare quality - patient trust relationship. International Journal of Marketing Studies, 3(1), 103-127. DHA Policy & Strategy Department. (2011). Primary healthcare in Dubai capacity requirements and projections. Retrieved from: https://www.dha.gov.ae/EN/SectorsDirectorates/Sectors/HealthPolicy/Documents/PHC%20Need%20Assessment%20in%20Dubai.pdf Di Palo, M.T. (1997). Rating satisfaction research: is it poor, fair, good, very good, or excellent? Arthritis Care Res. 10(6):422-30. Fan V.S., Reiber G.E., Diehr P., Burman M., et al. (2005). Functional status and patient satisfaction: a comparison of ischemic heart disease, obstructive lung disease, and diabetes mellitus. J Gen Intern Med. 20(5):452-9. Fan, V.S., Burman, M., McDonell, M.B., & Fihn, S.D. (2005). Continuity of care and other determinants of patient satisfaction with primary care. J Gen Intern Med 20(3):226-33. Hamidi, S., Shaban, S., Mahate, A. A., & Younis, M. Z. (2014). Health insurance reform and the development of health insurance plans: The case of the emirate of abu dhabi, UAE. Journal of Health Care Finance, 40(3), 47-66. Harrison, A. (1996). Patients evaluations of their consultations with primary health clinic doctors in the United Arab Emirates. Fam Pract. 13(1):59-66. Margolis S.A., Al-Marzouq S., Revel T., Reed R.L. (2003). Patient satisfaction with primary health care services in the United Arab Emirates. International Journal Quality Health Care. 15(3):241-9. Watkins, R., Meiers M.W., & Visser Y.L. (2012). A Guide to Assessing Needs: Essential Tools for Collecting Information, Making Decisions, and Achieving Development Results. Washington DC: International Development Association Yeboah, D.A. & Yeboah, T. M. (2014). Over the counter sale of prescription only medication in abu dhabi, UAE: Law enforcement or health ethics? British Journal of Applied Science & Technology, 4(7), 1128-1137. Yeboah, D.A. (2007). Impact of population variables on health services demand and provision. Arab Studies Quarterly, 29(1): 61-70. Read More