Health System In Saudi Arabia - Report Example

Health System in Saudi Arabia Name of Student Student Number Institution Course Code Instructor’s Name Date Report about Health System in Saudi Arabia. World Health Organisation (WHO) has shifted its main focus to the health systems around countries. In its 2000 report, World Health Organisation (WHO) conducted a study in 191 countries (WHO, 2000). The performance of health systems poses a major concern to the policy makers for considerable time (Tandon et al. n.d). Country policymakers pay intense attention towards enhancing the outcome of their health system. Most nations have of late been introducing reforms in the health sector with the explicit aim of enhancing performance. The WHO report of 2000 defines health system as inclusive of all individuals, groups and organisations with the fundamental aim of improving health (Muray and Frenk, 2000). The 2000 World Health Organisation report was published with the main purpose of providing countries with ways and methods that in turn help in the judgement and improvement of their health system performance (WHO, 2000). The main purpose of this part of the report is to discuss and explains the WHO report 2000 models. According to WHO (2000), goodness and fairness are the objectives of good health system. In regard to this, goodness can be defined to as the highest achievable level of health system excellence, with available recourses and fairness means that the more equitable level among individuals and groups I terms of access to health system (WHO, 2000). The 2000 WHO report indicated three issues to be given intense consideration, which include; performance, responsiveness and fairness in financial contribution (Muray and Frenk, 2000). With regard to quality of health system, the average of health and responsiveness, as well as equity of health system can be recognised by inequalities in health, responsiveness and financial contribution (Muray and Frenk, 2000). In order to evaluate the health system achievement, World health Organisation report 2000 places a five criteria: 1) Overall level of population health, 2) Distribution of health in population, 3) Overall level of responsiveness, 4) Distribution of responsiveness, and 5) Distribution of financial contribution (WHO, 2000). 1. Overall Level of Population Health. WHO has used disability adjusted life expectancy (DALE) so as to judge overall level of population health and as a result of to take a broad picture of how to well the objective of good health is being achieved (WHO, 2000). 2. Fairness Irrespective of socioeconomic status, people ought to get equal access to health system services; this is in respect to fairness and distribution of health in the population WHO, 2000). On the same note, people should be treated without any discrimination or difference (WHO, 2000). In addition, it is certainly factual that the health system without equal access will not achieve a high level of better health to its population (WHO, 2000). It has been clearly indicated that enhanced utilisation of health system will improve health status of the population (WHO, 2000). 3&4 Responsiveness: Responsiveness and the manner of its distribution in the population are other components of the measures concerning how the system achieve comparative to non-health aspects and whether or not it meets the expectation of people (WHO, 2000). Goodness and fairness differ in the sense that goodness means with respect to non-health system respect to how well the system responds to what people anticipate and fairness means that the health system responds and treats people equally without favouritism and disparity (WHO, 2000). Responsiveness constitutes two components:- Elements for respect to persons that can be evaluated by patients and they include respect for dignity of the person, (waiting for diagnosis, respect for people time value) confidentiality, and autonomy (WHO, 2000). The elements considering the patients and their relatives as clients of health system and they include prompt attention, facilities of acceptable quality, and choice of the provider (WHO, 2000). 5. Distribution of financial Contribution: The concept of fair financing is that when individuals contribute towards the health system according to the ability to pay rather than the magnitude of the illness (WHO, 2000). Fair distribution of financing among people play a significant role of health system, and people obtain better health (WHO, 2000). The reason behind this is that fair financing reduces the risk of inaccessibility to health system (WHO, 2000). World Health organisation (2000) has enhanced the component so as to evaluate the performance: level of health 25%, distribution of health 25%, level of responsiveness 12.5%, distribution and fairness of financial contribution 25% (WHO, 2000). In the final point, the consideration that WHO report 2000 ranked countries in the annex tables in regards to the performance, responsiveness and fairness (WHO, 2000). Health System in Saudi Arabia and WHO Report 2000: The Ministry of Health portal of Saudi Arabia plays an important role in the provision of health care service. With a free health care in the Kingdom of Saudi Arabia, there have been many challenges and achievements in the quest for effective health system in the Kingdom. Saudi Arabia has experienced considerable development within the health system in recent past, and it is clear that healthcare is one of the priority sectors within the government’s current development plan (Al-yousuf, Akele, Al-mazrou, 2002). Components of Health System in Saudi Arabia: Saudi Arabia is a welfare state with a right to health to all Saudi citizens being provided through the development of specific socioeconomic and health policies (Al-yousuf et al. 2002). There are three tier health care systems which incorporate; primary, secondary and tertiary. These correspond respectively to health centres, general hospitals, and specialist hospitals. Al-yousuf et al. (2002) indicate that major components of health system in Saudi Arabia incorporate: 1. Personal health services incorporating: a) Ministry of health (MOH) (Stewardship) b) Military hospitals c) Ministry of interior hospitals d) Referral hospitals e) Private health sector that constitute Private hospitals, clinics, and pharmacies. 2. Health in population distribution. Examples of these include the smoking cessation clinics which are distributed in most nations and free vaccination against influenza and other disease during the hajj season (Al-yousuf et al., 2002). Further, Al-yousuf et al. Highlights the duplication of health services among the different components of health systems. This called for effective coordination and increase for number of health care centres to cover the entire nation, as well as rationalise their location and allocation of human resources. The recent inclusion of a five year term for ICT enhancement in the health care system will see the enhancement of healthcare service delivery in Saudi Arabia and greatly improve health care awareness which will culminate to improved health status of the people. World Health Organisation Report 2000 and Saudi Arabia: With respect overall performance, Saudi Arabia is ranked at 26th among 191 countries. The ranking was considered very effective in comparison to other gulf countries after Oman. The reasons behind this are: (1) Saudi Arabia is a wealthy nation and the health care is financed form the government kitty of the revenue accounting for 80% of all health spending (Al-yousuf et al. 2003). (2) The statistics estimation from the ministry of health indicates that total expenditure on the health care accounts for 3.4% of the GDP (Health Indicators, 2006). (3) The reason behind overall performance being on the top 30 countries is that the stewardship of health systems in Saudi Arabia is the ministry of health (MOH) which is the main provider for health services in Saudi Arabia (Al-yousuf et al. 2003). Further, it works well and acts as supervision for all health system activities (Al-yousuf et al. 2003). 1- Overall Level of population Health: Saudi Arabia is ranked at position 58 in terms of DALE (WHO, 2000). The Kingdom of Saudi Arabia has experienced drastic changes in the lifestyle and its living standards, as a result to the improvement in socio economic status. Consequently, free public health services are provided to all Saudi citizens in the Kingdom of Saudi Arabia (Al-yousuf et al. 2003). This has resulted to decreasing mortality rate, increasing life expectancy and changing morbidity (Al-yousuf et al. 2003). WHO report (2000) illustrates that the life expectancy at birth for males and females are 65.1 and 64 years respectively. This probably brings out the impression that people in Saudi Arabia possess a low life expectancy in comparison to the developed nations. 2- Distribution of Health in Population: World Health Organisation estimates that Saudi Arabia was ranked at 70th position among all countries with 0.847 (1 is a perfect equitable, and Zero is the lowest equitable) (WHO, 2000). With the aim, “health for all”; it makes the health system appear more available, as well as giving all citizens (in urban and rural areas) the rights to access and enjoy free health services. However, the situation does not appear to have major effects on the Data and distribution of health population in Saudi Arabia. Further, research has been conducted in South Western Saudi Arabia to examine patients’ utilisation and satisfaction with emergency care services. The study shows that people from rural areas in South-western are receiving good care in the emergency room equal to others (Mahfouz et al., 2007). Nevertheless, the study cannot be generalised to the whole Saudi population. In 2002, Saudi health system passed a new law on ensuring optimal utilisation of health facilities and available resources, as well as ensures balance regarding health services among all areas (urban and rural areas) in the kingdom. Conversely, there is limited evidence on it effect on the data. Consequently, the Saudi government have embraced the technology for e-health care system to enhance health care service delivery in all health sectors and enhance patient records management. According to Altuwaijri (2010), the introduction of ICT in healthcare has provided avenues for the transformation of health care delivery by making it more accessible, affordable and effective across contemporary world. 3& 4 Responsiveness and its Distribution: With respect to WHO report, 2000 level of responsiveness in Saudi Arabia is 67. The reason behind this could be due to cultural differences between patients and expatriate heath workers (Brown and Busman, 2003). Cultural and Religion Barriers: Cultural and religion barriers play an important role in the establishment of the framework of healthcare in some cities within Saudi Arabia. These are barriers considered autonomous for patients. A good example is that the majority of women refused to be examined by male health workers owing to their spiritual believe. Further, one of the problems which may affect the responsiveness of health system is that expatriate health care workers are more than 60% of the allied health care (physiotherapy, occupational therapy and laboratory) which consequently acts a hindrance in the health sector due to communication barriers among patients and health workers orchestrated by culture and language differences (Brown and Busman, 2003). 5- Distribution of Financial Contribution Concerning the distribution of financial contribution, Saudi Arabia is ranked at position 37 (WHO, 2000). The WHO has been involved in the support for national health priorities. Intense and constructive consultation has been employed by World Health Organisation in conjunction with the Ministry of Health leadership, as well as stake holders to come up with strategic future joint plans for effective health systems. This has been through the following strategic directions: 1) Supporting the strengthening of national health systems, 2) developing national capacities for analysis, interpretation and response to health information, 3) Prevention and control of infectious diseases and non-communicable diseases, and 4) Promoting the development of coherent and effective health care delivery (WHO, 2011). Critical Appraisal of models Component of WHO Report 2000: World Health Organisation Report 2000 has raised various concerns and questions. Extensive debates have been focused on the report, and many people have criticized the way in which the assessment component of the health system was conducted. Much criticism has been levelled against the concept obtained, and methodology followed by the WHO report 2000 (Navaro, 2002). This section of the report illustrates some criticism of WHO report 2000. 1- Conceptual Concerns : According to WHO (2000), health system has the significant impact on decreasing mortality and morbidity in countries, and they ought to focus on investing more in the provision of health system so as to achieve enhanced health. Nevertheless, the WHO 2000 report have neglected crucial factors that could play a vital role in changing the morbidity and mortality, such as, political and socioeconomic factors (Navaro, 2002). The factors highlighted are highly crucial in the improvement of health status and decreasing mortality. For instance, in countries like Iran having resources distributed by political forces enjoy improved health (Navaro, 2002). The privatisation of health system leads to rise in the challenge and eventually leads to improved efficiency (Navaro, 2002). This means that, improving efficiency will help the responsiveness of health system. On the contrary, this is not applied case. A clear example is with the U.S. that is ranked at the top of the countries with respect to responsiveness, whereas majority of people in the U.S. are not contented with their health system (Navaro, 2002). 2- Methodology Concern: Wide criticism has been levelled towards the methodology used in the health assessment by World Health Organisation report 2000. (a) Inadequacy of information: According to Braveman et al. (2000), WHO report 2000, failed to provide information regarding methods relating to the manner of allocating resources. Although key information regarding the WHO report 2000 came from 35 countries, 191 countries had been ranked on health system, responsiveness overall and on equality in responsiveness (Almeida et al. 2000). This shows that there was the lack of information from some countries. Thus, some information is not applicable as a guide by policy makers in devising new policies (Braveman et al. 2000). Further, extra concerns were raised concerning the reliability and accurate measures of population health in WHO report 2000, and as a result of that, the estimation of DALE for a number of countries have been carried out with the absence of information regarding life expectancy and diseases in the country (Almeida et al. 2000). (b) Concerns of Using Methods: In the process of the country ranking, the use of methods of different weight for each component of the single performance indicator changes leading to conflicts (Navaro, 2002). A clear example is the conflict between political and government sides in Spain as a result of changing the ranking of Spain from 7th to 21st in terms of quality of life. On critical analysis, there is a small relation between WHO Report 2000 measures and performance. According to Jamison and Sandbu (2001), in spite of only 20% of people in Italy being satisfied with their health system, it is ranked in 2 overall of performance which proves that measurements keys are not useful. With respect to the dependence of DALE as a measurement of level of population health, it can yield misleading ranking of countries (Coyne and Hilsenrath, 2002). Consequently, there are many factors affecting DALE besides health status such as cultural and social factors. For example, AIDS in South Africa which led to, the declining of DALE was driven by cultural and social factors (Coyne and Hilsenrath, 2002). Saudi Arabia Approaches to Health System Functions The WHO report 2000 clearly outlines the four key functions of the health system, these include: Stewardship also referred to as governance or oversight. Financing Human and physical resources or the creation of resources Service delivery and its management and organisation. Stewardship Stewardship function reflects the fact that the Saudi people entrust both their lives and their resources to the health system. The Saudi government enhances the role of a steward by utilising its revenues paid by people through taxes and social health insurance, as well as coming up with regulations fostering and governing the operation of health services. This is in line with the description of the role of a steward in the healthcare system as explained by (WHO 2004). Through the current development, enforcing and implementation of policies affecting the health system like the introduction of e-health, the KSA government is playing a crucial role of a steward. According to WHO (2000), the primary roles of the Ministry of Health is to develop a health sector policy aimed at improving health system performance and promoting the health of the citizens. The Saudi authorities are ensuring sustainability of the health outcomes to be realised in the health sector (Almariki et al., 2011). This is being enhanced by encouraging the health personnel to undertake enhanced training and the employment of expatriates from outside the country. With the five year strategic health policy in KSA, projections for heightened service care delivery are crucial. Creating Resources The creation of resource encompasses the function of health system to recruit, train, deploy and the retention of human resources. Further, the procurement, allocation and distribution of healthcare deliverables and essential medicine and supplies, as well as the development of the health infrastructure like facilities and equipments. With regard to WHO report (2000), the human resources are the most crucial part of a functional health system. The Saudi government has encouraged the expatriates to improve its human resource and improve health sector service delivery (Saudi Healthcare Forum, 2011). Consequently, the inclusion of ICT in the healthcare provision will greatly enhance the resource development. The human resource will be enhanced with relation to use of ICT as the service delivery will be enhanced. Delivering Services Service delivery at the Saudi health facilities is critical. The government facilities offer close to 80% of the health services in the country with the remainder being provided by the private sector. The functioning of the health system compose an array of health sector components incorporating the roles of the private sector, government contracting of services, the decentralization, quality assurance, and sustainability. The health care services in Saudi Arabia are provided at primary, secondary and tertiary levels in governmental and private sector. Decentralisation is critical in the improvement of administrative and service delivery effectiveness, enhance local participation and reduce ethnic and regional tensions. With respect to Saudi Arabia, the private sector is a key source of health services and its coverage is on the increase. Services provided are mainly promotional, preventive, curative and rehabilitative. They incorporate maternal and child health, immunization, management of chronic diseases, dental health, food hygiene, essential drugs provision, environmental health, health education and disease control. WHO (2003), indicates that use of government health services contribute low effects towards the indicators like child mortality without the contributions of private sector health services as well as the non-governmental organisations. On the same note, it is clear to note that massive improvement in socioeconomic improvement has been realised in the past 30 years with profound progress in respect to health (WHO, 2011) Saudi government provides health care services via various government agencies. The public and private hospitals exist and account for 80% and 20% respectively to health care system (Muray and Frenk, 2000). This section of the report sets out to apply WHO models to health system in the Kingdom of Saudi Arabia. It will give an overview of the health system in KSA and e valuate how good, fair and responsive is it. The report will discuss a number of issues and other concerns related to the health system in Saudi Arabia. Financing Health financing is very critic al in the sense that it is the key determinant health systems performance in terms of equity, efficiency, and quality. The Saudi government has enhanced the financing of the health sector and the health care is free in the government sponsored facilities. The fact behind understanding the financing of government health systems and resources enhances the strategic complementation of health financing already in place, advocate for more funding in areas requiring intense financing, and the aiding of populations to access available resources. The Saudi government introduced the Insurance scheme to ease the burden of financing the growing population. According to Barrage et al. (2007), though the health care in Saudi is government sponsored, it is difficult for the government to meet the demands of the growing population, thereby, the inclusion of partners from private sector to offer world c lass services is crucial. The citizens of Saudi have access to free public healthcare (Al-yousuf et al., 2002). Thus, they are not entitled to pay for health insurance and the expatriates have been forced to have health insurance. The rapid expanding population raises the attention to policy makers to start to initiate new ways of prepayment insurance for citizens (Al-yousuf et al., 2002). This indicates that new health insurance system is imperative for processing and privatisation of public hospitals is the future plan to enhance efficiency (Al-yousuf et al., 2002). The Saudi government caters for the healthcare provision accounting for 80% of the total health care services. In 2009, the Saudi’s total health expenditure totalled $US16.7 billion which was a 26.5% increment from 2008. (Almariki et al. 2011). Conclusion In conclusion, it is clear that this report has three parts. The first part explains the models of WHO report 2000 which have been used to assess the performance of the healthcare system. The definition of goodness, fairness and responsiveness and its distribution has been done here. The second part of this report discusses the health system in Saudi Arabia the manner in which WHO report 2000 models are applicable to Saudi Arabia. Saudi Arabia has been ranked 26th overall in the health performance. It has also been evidenced that the health system in Saudi Arabia fairly good with respect to the overall level of population health, responsiveness and fairness. Nevertheless, there exist a number of cultural and religion barriers that affect the level of responsiveness of health system in Saudi Arabia. The third part of this report looks into various criticism with respect to WHO reports 2000 concepts and methodology. Consequently, in the recent past, the World Health Organisation in conjunction with the Ministry of Health Portal of Saudi Arabia had been in collaborative strategic directions towards the enhancement of the health systems. The report also has highlighted some of these strategic directions in the course of discussing part two of the report. This has been in the improvement of health systems in Saudi Arabia and improving its health ranking at the global context. References Almariki, M., Fitsgerald, G. and Clark, M., 2011. Health Care System in Saudi Arabia: An Overview. Eastern Mediterranean Health Journal, Vol. 17(10), p. 784-793. Almeida, C., Braveman, P., Gold, M., Szwacwald, C., Ribiero, J., Miglionico, A, Millar, J., Portal, S., Costa, N., Rubio, V., Segall, M., Starfield, B., Travessos, C., Uga, A., Valete, J., Viaca, F., 2001. World Health Report 2003. Methodological Concerns and recommendations on Policy Consequences of the World health Report 2000. The Lancet. 1692-1697. Altuwaijiri, M., 2010. Supporting the Saudi e-Health Initiative: The Master of Health Informatics Programme at KSAU-HS. Eastern Mediterranean Health Journal, Vol. 16(1), p. 116-124. Al-yousuf, M., Akele, T., Al-mazrou, Y., 2002. 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