OBG talks to Dr Awni Al Bashir, President, Private Hospitals Association (PHA)

Interview: Dr Awni Al Bashir

What role is the private sector playing in health care provision in Jordan?

DR AWNI AL BASHIR: At the turn of the 20th century, all hospitals in Jordan were foreign missionary and Baptist clinics. The first government hospital was established in the 1950s. The private sector became more involved in the 1980s, and in 1984 several private hospitals joined forces and created the PHA.

The PHA was designed to help private clinics advance shared interests (as is still true today). At first the association was mostly a lobbying group, but now it also markets Jordanian hospitals overseas. Today, 61 of the 102 hospitals in Jordan are private institutions and the private sector has been making huge contributions to the Jordanian health care system. There is currently a new medical liability law working its way through parliament that would offer greater protection to hospitals from lawsuits, a measure that would undoubtedly support more business growth in the sector.

The prevalence of private facilities is relieving pressure on the public sector. Although the quality and technology in public and private hospitals are similar, private providers can offer more amenities to patients.

What can Jordan do in order to solidify its status as a medical tourism destination?

AL BASHIR: The World Bank recently ranked Jordan the fifth-strongest medical tourism destination in the world, reflecting the country’s advanced medical equipment, short waiting times in appointments, political stability, sound banking system and quality customer service. In 2011 Jordan received about 240,000 medical tourists from 89 countries, 90% of whom came from the MENA region. Foreigners accounted for 23% of all patients treated in Jordan and generated $1.3bn in revenue. The most common procedures for medical tourists are cosmetic operations, kidney and liver transplants, orthopaedic surgeries, neurology and heart surgeries.

Jordan now has 61 private hospitals holding 4200 beds. Seven Jordanian hospitals recently received Joint Commission International accreditation, a testament to our strong health care system. Moreover, most Jordanian physicians are trained in the US or Europe and are fluent in both English and Arabic.

How can Jordan attract medical tourists while still maintaining the quality and integrity of the health care system for local citizens?

AL BASHIR: While promoting medical care for foreigners is important, we must first consider the needs of Jordanians. The recent influx of Libyans has put a strain on our medical infrastructure. Many hospitals have seen significant overcrowding and there is concern among Jordanians that Libyan patients will receive priority. While medical tourism can put a strain on resources, overall it has a positive effect because international demand encourages local health systems to improve their quality and their medical infrastructure. Still, it is important that the wealth and advancements generated from medical tourism be distributed to rural areas that might normally be neglected.

What are the challenges the Kingdom faces in terms of addressing health care staffing needs?

AL BASHIR: In the past five years, the average growth rate of medical services employment reached 13%. Moving forward, we expect the ratio of physicians to patients to reach 28:10,000 (up from the current 26:10,000), nearly the same ratio as in the US.

But brain drain is a significant problem in the sector, especially in regards to nursing. In particular, Jordan is suffering from a severe shortage of female nurses. Last year over 1000 nurses left Jordan for higher paying jobs in the UK (about 300) and the Gulf (about 900).

Overall, there are about 30,000 Jordanian doctors working around the world. One-third of these are in Jordan, one-third are in the West and one-third are in the MENA region. Although private sector salaries are higher than public ones, they are still no match for the remuneration packages offered to doctors overseas.