Dubai rolls out health expansion plan

Dubai Health Authority (DHA) has announced a 10-year plan to generate tens of thousands of health care jobs, the construction of dozens of new facilities and the opening of eight new medical education institutions by 2025. DHA’s former director-general, Essa Al Maidoor, told local media the introduction of mandatory health insurance had created a great opportunity for investment in the sector to meet the demand for specialist services and primary care generated by a growing population.

SIGNIFICANT GROWTH: The scale of the challenge being undertaken in the Dubai Clinical Services Capacity Plan (DCSCP) is apparent when DHA’s projected increases in personnel and facilities are compared to its most recent published data for 2014. Under the 10-year plan’s targets, 8000 new beds would be added to the 4169 available in 2014, a 196% increase; 7101 doctors would join the 6781 physicians registered in 2014, up 112%; and 8510 new nurses would be hired, taking the total to over 20,000, a rise of 75%. While these increases are significant, they are not entirely unprecedented in Dubai’s recent history. DHA figures for staff in its own hospitals comparing 2003 and 2013 show the number of dentists increased by 130%, the number of doctors by 90% and the number of pharmacists by 80%. The rise in nurses was more modest at 43%, and the new health care plan acknowledges that nursing recruitment is a significant issue in the emirate, as well as internationally. The DCSCP was developed following extensive consultation with various health care providers in state hospitals and the private sector, including their views on human resources.

The growth is in large part due to efforts to see the private sector take a leading role in the provision of care, with the Dubai Healthcare Strategy 2016-21 seeking to have 70% of health care provided privately by 2021. The new push toward privatisation has been driving much of expansion of the sector. “Anything that has been privatised in Dubai has proven to be efficient,” David Hadley, CEO of Mediclinic Middle East, told OBG. “The focus should be on ethics and quality first and price second.”

NURSING NUMBERS: When hospital nurse numbers in 2014 are compared, the private sector comes close to the 70% target of health care provided privately in the emirate, employing about 66% of the total. However, private sector hospitals say recruitment and retention of nurses is a challenge. “The issue is growing every year as there is more demand for professional nurses,” Mohaymen Abdelghany, CEO of Al Zahra Hospital, told OBG.

A number of solutions have been suggested to address the shortage of nurses in Dubai. The first is to improve training facilities by building five new nursing schools. DHA intends to work with private hospitals to train nursing students and nursing assistants with a two-year diploma course. DHA said salaries for nurses could be increased to make them more competitive compared to other GCC countries and that more flexible shift patterns could be introduced. It would also like to make nursing a more attractive profession for Emiratis, noting that very few of Dubai’s nurses are citizens. DHA is pursuing a number of strategies to recruit, retain and promote nurses in the emirate. DHA organises two overseas recruitment drives annually and in recent years has recruited 500-800 nursing staff each time. In March 2016 there were 4874 nurses working in five hospitals and 15 clinics in Dubai, and representing 20 different nationalities. However, DHA has recognised that it must provide career, training and development opportunities for its new nursing recruits. “In 2015 the DHA promoted 1000 nurses and have provided a fast-track growth path to exceptional nursing staff,” Fouad Chehab, director of nursing at Dubai Hospital and chairperson of the Nursing Forum at DHA, told local media. “This is one of the reasons our turnover rate is much lower than international standards; ours is 5-6% while the international rate is 10-18%.”

NEW MEDICAL SCHOOLS: Dubai Healthcare City Authority (DHCA) has also identified a need to build three new medical colleges to train doctors and other health service professionals, in addition to the Mohammed bin Rashid University of Medicine and Health Sciences in Dubai Healthcare City, which will accept its first undergraduate medical students in September 2016. The authority wants to improve residency programmes and encourage more coordination between hospitals and universities to ensure the professional development of clinical specialities such as anaesthesia. In addition to these facilities, a Dh1bn ($272.2m) university hospital is being built at Dubai’s Silicon Oasis by Saudi Arabia’s Dr Sulaiman Al Habib Hospital. The project is being completed in two phases, with the hospital expected to open in 2017, followed by the medical college in 2019.

MEETING NEEDS: At the same time, DHA will pay close attention to proposals for new hospitals and health care facilities, and will only grant a “certificate of need” for proposed institutions that are in the right location and that will not duplicate existing service provision. These certificates help incentivise development in underserved locations, and help investors achieve greater returns by limiting competition in a geographic area. Private hospitals are also working to differentiate their offering in an increasingly crowded market. Peter Makowski, CEO of the 184-bed American Hospital, explained to OBG how his hospital focuses on specific local needs: “This hospital is committing itself to a programme of preventive health measures, something that will benefit the citizens of Dubai, given the high incidence of non-communicable conditions such as diabetes.”

DHA also identified a need for additional primary and tertiary facilities to serve newer areas of Dubai, such as Jebel Ali, Jumeirah Lakes Towers and the Dubai South area near the new Al Maktoum International Airport. There had been a tendency for hospitals to cluster together, with a report published by Colliers in 2014 suggesting that 71% of existing hospitals are in what is referred to as “old Dubai”. DHA said the plan will be reviewed every two years to ensure the development of facilities and staffing remains relevant to changes in Dubai’s health care landscape.

HEALTH SURVEY: In May 2016 the results of a 2014 health survey of 3298 Emiratis and expatriates were published, allowing DHA and private health care providers to reappraise and refine their plans to increase the supply of staff and facilities to meet the evolving demands of the population. The survey found significant differences in the incidence of some non-communicable diseases and symptoms when the Emirati and expatriate populations were compared. The overall incidence of hypertension was 5.1% in women and 3.2% among men, but among Emiratis 18% of women and 20% of men suffered from the condition. Those same Emirati men were also more likely to suffer from high cholesterol (19.8%) than female Emiratis (18.5%), while the gender disparity was reversed among the wider population with just 3.9% of non-Emirati men suffering from high cholesterol, a condition that affected 6.6% of non-Emirati women. Overall, 36.1% of those surveyed were borderline obese and 11.9% were obese, although no breakdown was given for nationals and foreign workers. These survey results are particularly important when it comes to directing preventative-medicine campaigns. The demographic structure also means that there is a greater need for geriatric medical services among national citizens than in the expatriate community. Among the elderly, 14.7% of people surveyed suffered from high cholesterol, while 27.4% had hypertension. The data also suggested there is a demand for long-term care for some elderly Emiratis. Among those surveyed, 35% required additional help for some daily activities, 16.4% for bathing, 14% for changing clothes and 8.1% for eating. The survey was the second to be conducted in Dubai and the first since 2009. “Compiling such information is important as it is will guide the authority in creating its future strategies and plan effective initiatives, that aim to find solutions and raise awareness about relevant health issues in Dubai,” Humaid Al Qatami, chairman of the board and director-general of DHA, said at a press conference.

HOSPITAL SCHEMES: In addition to new projects, there is a Dh3bn ($816.6m) scheme to improve and expand facilities at Rashid Hospital, the emirate’s main trauma centre. Other projects include Sheikh Mohammed bin Rashid Hospital, Al Maktoum Hospital and Al Khawaneej Hospital. Mark Adams, CEO and founder of Anglo Arabian Healthcare, which owns a number of hospitals and clinics in Dubai and other parts of the UAE, is pleased DHA is planning ahead. He predicts that Dubai’s population will double to 5.4m by 2025. “There is unprecedented growth in new health care facilities across the region, with 18 new private hospitals under construction in Dubai alone,” Adams told OBG. He also believes provision is segmenting, with some companies focusing on workers living in labour camps, representing 30% of the market, with another 35% devoted to low-cost provision, while 25% will cater to mid-market customers and 10% will offer a premium brand. “Enlightened operators are building ‘feeder clinics’ to secure their referral base into secondary care,” he added.

LONG-TERM CARE: The DHA’s health care strategy has also focused on making the most appropriate use of existing public facilities by developing solutions with the private sector. One of the key areas they are focusing on is further development of rehabilitation services and long-term care. DCSCP found that almost 150 acute beds at Rashid Hospital were being occupied by patients requiring long-term care. In addition, many private patients seeking longer-term care solutions resorted to treatment overseas. In January 2016 the UAE’s first private in-patient rehabilitation centre was inaugurated in Dubai. The Dh35m ($9.5m) centre stems from a partnership between JCI-accredited Canadian Specialist Hospital and Wagner Health and Care-Austria and will provide 48 private beds or patients requiring medium- and long-term care near their families. Mohammad Rashid Al Falasi, chairman of Canadian Specialist Hospital, told local media, “Our rehabilitation centre will address the needs of such patients and help them solve these challenges within UAE itself and ensure that they get the best treatment here”

NATIONAL PRIORITIES: Al Baraha in Dubai is one of two hospitals operated by the federal Ministry of Health. Ahmed Obaid Al Khadeim, the hospital’s director-general, believes that as the UAE grows the different emirates should co-ordinate their health care strategies. “There are internal differentiations within the UAE, and differences among GCC countries themselves,” Al Khadeim told OBG. “All the authorities are overlapping and it’s costly.” Al Khadeim also believes there should be greater differentiation between the roles of hospitals, saying that only trauma or emergency cases should be referred to Rashid Hospital, which is functioning at full capacity. “The mentality of the patients is to go to private hospitals, but the government will have to do more to encourage people to seek treatment in primary care clinics first, and develop a greater focus on preventive medicine for non-communicable diseases,” he told OBG.

DHA introduced the concept of urgent care across its 13 primary health care centres in Dubai, of which two work round-the-clock and the remaining are open until 10pm. They offer several health specialisations in addition to primary health care so that people can use facilities close to their homes.

MARKET SIZE: According to Colliers’ report, the value of Dubai’s private hospitals climbed from $430m in 2005 to $887m in 2013, and it projected that by 2020 this will reach $1.62bn. It estimated the value of private hospital businesses, including property, grew from $860m in 2005 to $1.75bn in 2013, and predicted they will be worth $3.23bn by 2020. The Colliers predictions are based on 1500 new private sector beds being added to the supply by 2020. The DCSCP anticipates that 8000 new beds will be needed across both public and private hospitals by 2025, which would suggest an even more valuable private sector. The potential for growth in health care provision in Dubai, and across other parts of the GCC, has made the sector attractive to private equity firms. Dubai-based Al Masah Capital has announced it will invest Dh1.1bn ($299.4m) in its Avivo Group, ahead of a planned initial public offering on the London Stock Exchange by the end of 2017. Avivo operates 32 health care facilities in the UAE and Kuwait, employing 200 doctors and 1000 health care professionals.

Alpen Capital, a local investment bank, has predicted the GCC health care market will grow at a compound annual growth rate of 12%, and that it will be worth almost $70bn by 2018. “Private equity groups see health care as a growing, profitable and defensive area to invest in, and they will help to continue market growth and consolidation,” Adams told OBG.