Growth in the health care work force demonstrates the impact of years of Saudi Arabia's labour policies

One of the most significant challenges facing Saudi Arabia’s health care sector moving forward will be finding the necessary qualified health care professionals to meet the rising demands of the Kingdom’s quickly expanding population. A McKinsey report published in December 2015 estimates that Saudi Arabia’s population of nationals will reach 27m by 2030. The government and private sector players have historically relied on large numbers of health care staff from overseas. Currently, around three-fifths of health care workers are non-nationals, with 76% of the Kingdom’s physicians, including dentists, and 63% of its nurses coming from abroad.

Skilling Up

Efforts to boost the number of nationals in the workforce have gathered momentum in recent years, with the development of educational capacity at the heart of government strategy. “We recognise that there are gaps in the health care workforce and are actively working with our colleagues in the Ministry of Health (MoH) and other government entities to address skills deficits,” Dr Basmah Al Buhairan, managing director of health care and life sciences at Saudi Arabia General Investment Authority, told OBG. “One concrete example of options being discussed is a strategy to attract more internationally renowned medical colleges to set up operations in the Kingdom.”

Public information campaigns in recent years outlining the employment opportunities in the sector, coupled with a focus on improving the quality of schooling on offer, have boosted the number of nationals joining the sector, significantly narrowing the gap between national and non-national staff.

Labour Growth

Saudi Arabia’s health care workforce has experienced rapid growth in recent years. In 2014 the sector employed 81,532 physicians, 165,324 nurses, 22,241 pharmacists and 94,960 allied health professionals. This represented a sizeable increase across all categories since 2010, with the number of physicians, nurses, pharmacists and allied heath personnel increasing by 24%, 27%, 49% and 38%, respectively. The MoH continued to be the main driver of growth in this regard, with its workforce rising by 25% between 2010 and 2014, from 149,395 to 186,303 employees. In 2014 other governmental sectors employed a total of 71,498 health care professionals, while private sector health care staff numbered 106,256.

Foreign Workers

Foreign workers comprised 61.6% of the Kingdom’s health care labour force in 2014. Although Saudiisation progress has been made in recent years, foreign worker participation in the sector looks set to continue. McKinsey projects that 6000-7000 nursing positions will need to be filled between now and 2030 to keep up with growing demand. To cope with this, efforts have focused on attracting and training local talent in a bid to boost nationals’ skills and reduce the reliance on foreign labour. Under the National Transformation Programme – a set of economic reforms announced as part of Vision 2030 – the MoH is aiming to have 150 Saudi nurses and support staff per 100,000 people by 2020, up from 70.2.

Meanwhile, authorities are working with recruitment agencies to maintain and develop links with foreign institutions to ensure the supply of health care workers does not dip. In January 2016, for example, the MoH announced that it was in the process of finalising plans for the employment of Egyptian, Sudanese and Pakistani female nurses in public health institutions across the Kingdom.

However, such an approach is increasingly unfeasible for many private players. “Health care providers worldwide, not just in Saudi Arabia, are recruiting from the same pool of nurses, whether these be Filipino or Indian,” Farah Halwani, director of operations and business development at Kingdom Hospital in Riyadh, told OBG. “This puts pressure on budgets, as the high demand relative to supply drives up the wages.”

Revolving Door

Another challenge is the high turnover of nurses and physicians. “Saudi Arabia is essentially the world’s biggest training centre for health care workers,” Dr Mushabbab Al Asiri, executive medical affairs director at King Fahad Medical City, told OBG. “Many will come here for two or three years before moving to Western markets. For others, it is a question of coming here to alleviate short-term financial problems for their families before returning home.” The challenge therefore lies in putting the right incentives in place.

Attracting medical professionals to rural areas is a challenge faced by all countries, not just Saudi Arabia. “The key is to give health care workers a complete package,” Dr Haitham Alfalah, CEO of King Saud Medical City, told OBG. “This doesn’t just relate to salaries, but also to the career opportunities and the provision of top-notch facilities.”

Education

The number of people enrolled in medical courses in the Kingdom has seen a significant increase in recent years, and this looks likely to continue given ambitious government plans to train 100,000 nurses in the Kingdom by 2025.

The Kingdom’s oldest university, King Saud University (KSU) in Riyadh, was founded in 1957, and its first college of medicine was established in 1969. The College of Applied Medical Sciences was added to the Riyadh campus in 1976, and other colleges of medicine were established at the Abha and Qassim campuses in 1980 and 2000, respectively. In addition, the university has colleges of nursing, pharmacy, dentistry and emergency medical services at campuses across the Kingdom.

According to MoH figures, KSU led the way in terms of students enrolled on courses of medicine in the 2014/15 academic year, with 2162 students out of a Kingdom-wide total of 17,187 across 23 colleges. King Khalid University in Abha had the highest number of students enrolled in applied medical sciences and pharmacist courses, with 3100 and 1193, respectively. This was out of a total of 21,739 students undertaking applied medical science courses and 8588 enrolled at pharmacy colleges in Saudi Arabia. The number of students at the Kingdom’s 13 nursing colleges stood at 6797, of whom 1069, or 15%, were enrolled at King Saud bin Abdulaziz University for Health Sciences.

The total number of students enrolled at university colleges of medicine and health for the 2014/15 academic year stood at 61,421, representing an increase of 118% on the 28,229 enrolled during the 2009/10 academic year and indicating the significant progress that has been made as a result of government efforts to attract greater numbers of Saudi nationals to the sector.

Saudiisation

The rising number of enrolled students has translated into higher Saudiisation in recent years. Although reliance on foreign health care workers will likely continue in the near term, the MoH has been successfully working to close the gap. In 2010 Saudis accounted for 54% of the MoH labour force of 149,395, with 6818 physicians, 37,009 nurses, 1406 pharmacists and 35,023 allied health professionals. By 2014 this had risen to 63%, or 118,206 out of a total of 186,303. Particularly impressive was the jump in the number of Saudi nurses, from 37,009 in 2010 to 54,785 in 2014, or from 49% to 60% as a proportion of all MoH nurses.

These figures show that the ministry’s efforts to reduce reliance on foreign health care workers, while at the same time boosting the number of nationals working in the sector, are paying significant dividends. The share of Saudi nationals in the MoH labour force grew by 47% between 2010 and 2014, while the proportion of non-Saudis fell by 2% over the same period. Medical staff working in other, non-MoH governmental facilities saw more modest growth, with the total number of employees rising by more than 20% from 59,356 to 71,498 over the period, of which 48% were Saudi nationals.