Healthy expansion: Addressing a growing demand for services

A rising population and changing lifestyle patterns are creating new challenges for Ras Al Khaimah’s health care industry. Increasing health care concerns are of great consequence to the government at both the federal and emirate level, and the situation requires greater participation from the private sector as well. New opportunities for the private sector alongside the government lie in the direct provision of health care services and in the rapidly developing health insurance segment.

ORGANISATION: The federally run Ministry of Health (MoH) is responsible for both regulating the health care sector and operating public medical care facilities. Since the majority of health care centres in RAK are public institutions, the MoH oversees a significant portion of the emirate’s medical system.

However, similar to many forms of policymaking in the emirates, health care policy in the UAE is largely determined at the local level. Furthermore, the MoH receives significant input from the RAK government on health policies, since many local MoH employees are from the emirate.

The MoH’s system comprises general hospitals, specialty hospitals, primary health centres (PHCs), maternity and paediatric care centres, and school health centres, as well as supporting institutions such as pharmacies. All of the clinics and hospitals operating in RAK are required to be MoH-certified, whether they are private or public.

PRIVATE OPTIONS: For much of RAK’s history, public health institutions were the only source of medical treatment. This is changing, however, and in recent years, private medical centres began entering the market and changing the industry. The growing private health care industry and the MoH have shown high levels of collaboration for the most part.

While private health care continues to expand in the UAE, public health facilities have also been on the rise. To facilitate the accreditation process of new public hospitals, the president of the UAE, Sheikh Khalifa bin Zayed Al Nahyan, issued a decree in late 2009 calling for the establishment of a Federal Health Authority (FHA). However, Sheikh Khalifa later reversed this decision with a law in early February 2012 that scrapped the 2009 FHA measure.

The decision came after the MoH board advised that funds and administrative resources would be better directed towards improving public hospital services, supplying medicines, and upgrading medical and technical staff qualifications, rather than the development of a new organisational framework. Reports from early 2011 explain that the FHA would have relieved the MoH of the responsibility of operating a substantial number of public sector clinics and hospitals throughout the UAE.

BY THE NUMBERS: According to the World Health Organisation (WHO), the UAE’s health care system ranks as the 27th best in the world. As of early 2012, the MoH was responsible for 64 public health centres and 15 public hospitals, employing over 1000 Emirati nurses and 400 doctors (in addition to medical professionals from abroad), according to data published in February 2012 in the Khaleej Times.

Health care spending for the country is indicative of the rising costs and demands being placed on the system. Expenditures were estimated to be Dh37.4bn ($10.2bn) in 2011 and are projected to reach Dh61.8bn ($16.8bn) by 2015. Health care expenses as a percentage of GDP were forecast to reach 2.9% in 2011, while the GCC average for the same year was 3.1%. At the same time, health care spending per head in the UAE was forecast at $1451 in 2011, compared with the GCC average of $709, according to information provided by RAK Hospital, a private facility in the emirate, and the Economist Intelligence Unit. Average life expectancy in 2011 was projected to be 76.5 years.

As of 2010, the latest figures available at the time of press, there were four government hospitals in the emirate with a total of 535 beds, according to figures from RAK Hospital. Saqr Hospital is the largest, with 231 beds, the greatest share of which, 46, are devoted to postnatal care. The next-largest divisions are paediatric care, surgery and orthopaedics with 30, 27 and 27 beds, respectively. Saqr Hospital employed 57 doctors and 262 nurses in 2010.

Next, Ebrahim bin Hamad Hospital (previously known as Saif bin Ghobash Hospital) has 151 beds, with 69 devoted to standard medical hospitalisation, 34 for psychiatry purposes and 20 dedicated to the treatment of infectious diseases. The hospital had 32 doctors and 182 nurses on staff in 2010. The third-largest public hospital, Obaidallah Hospital, holds 86 beds and had three doctors and 27 nurses in 2010. Shaam Hospital, the smallest of the four government hospitals, has separate male and female wards with a total of 67 beds, and in 2010 the facility employed 14 doctors and 40 nurses.

In addition to hospitals, RAK has 18 primary medical centres, 16 of which were located in rural areas. In 2010, there were 90 health centres supplementing the emirate’s schools, comprising 89 individual school units and one central clinic.

RAK Hospital figures show that a total of 106 doctors and 511 nurses worked in the four local government hospitals in 2010. The data also shows that government hospitals admitted 24,674 patients in 2010, nearly the same number of patients admitted to public hospitals in 2009. Surgical operations totalled 9600 in 2010, representing an 18.3% decrease from the 11,757 operations performed in government hospitals in 2009.

Private health facilities are growing in RAK, and there are currently two private hospitals: RAK Hospital and Al Zahrawi Hospital. In 2010 RAK Hospital had 65 beds and employed 66 doctors. Al Zahrawi Hospital had 20 beds and 15 doctors in the same year. With 85 beds between the two institutions, this figure represents a 21.4% increase compared to 2009, when there were 70 private hospital beds in the emirate. The number of patients admitted to private hospitals rose by 43% between 2009 and 2010, increasing from 4424 to 6325. Private pharmacies in the emirate numbered 74 in 2010, according to the most recent data provided by RAK Hospital.

PUBLIC UPGRADES: Health care is a high priority for the UAE’s government, and commitment to the sector is evident in the 2012 budget. The federal government increased the budget for the MoH by nearly a third, from Dh2.3bn ($626.1m) in 2011 to more than Dh3bn ($816.6m) in 2012, according to recent data published in the Khaleej Times. Furthermore, the MoH and the Ministry of Public Works (MoPW) have been working together to redirect some funding towards the maintenance and improvement of government hospitals in RAK.

Of the planned upgrades for Saqr Hospital, roughly 40% had been completed by January 2012. This includes scheduled maintenance work such as updating x-ray and ultrasound machines. The construction of a parking area for visitors and patients was also completed in order to reduce congestion around the facility. Saqr Hospital’s ultrasound units were expanded, and work is under way to improve the medical records section, laboratories and food court. There are also working plans to build a separate centre for outpatient clinics.

The emirate’s three largest hospitals – Saqr, Ebrahim bin Hamad and Obaidallah Hospital – provide care for RAK’s urban population, which live in and nearby RAK City. While Saqr and Ebrahim bin Hamad hospitals serve a wide range of medical needs, Obaidallah Hospital concentrates solely on geriatric care and is the only such facility in the region. The MoH’s Dh24m ($6.5m) investment into the facility demonstrates the ministry’s dedication towards advancing medical care in RAK as well as the Northern Emirates. RAK’s only rural hospital, Shaam, was built to the north of the city near the border with Oman. Though still in the planning stages, the MoH is looking to eventually build a new hospital nearby to replace the Shaam facility.

ADDED CAPACITY: Public care in RAK will significantly expand with the addition of two new hospitals. Abdullah bin Omran Hospital is scheduled to open in 2012 and will supply the emirate with 82 beds. In addition to providing general care, the institution will include four operating theatres and an outpatient clinic, as well as facilities for paediatrics, internal medicine, and obstetrics and gynaecology. Rashid Abdullah Omran, a local businessman, is donating Dh80m ($21.8m) towards the construction of the hospital, which will be named after him.

A second public hospital in the works is Sheikh Khalifa Specialist Hospital. Planning for the new facility began in 2009, and the Dh1bn ($272.2m) project covers 57,000 sq metres and should be finished by September 2012. The facility will house some 248 hospital beds and will treat heart diseases, cancer and medical emergencies.

PRIVATE CARE: RAK Hospital is the main private medical facility in the emirate and was built at the behest of RAK’s ruler, Sheikh Saud bin Saqr Al Qasimi. The institution was established as a joint venture between ETA Star Health care, a division of ETA Ascon Group in Dubai, and the RAK government.

The facility is managed by Sonnenhof Swiss Health and is the only hospital in the world to be certified by the Swiss Leading Hospitals system and accredited by the US Joint Commission International. By meeting both of these international standards of quality, the institution is considered the best hospital in the UAE’s Northern Emirates.

With 13,000 sq metres, RAK Hospitals has three levels and includes 26 outpatient clinics, four operating theatres, one cardiac catheter lab, an in-house pharmacy and emergency services. From the initial 60 beds, the facility has added five more and hopes to eventually expand to 150 beds. The intensive care unit currently has eight beds, the nursery holds four and the neonatal intensive care unit has one bed. RAK Hospital recently announced plans to open a neurosurgery department and aims to establish a dedicated eye centre next to the institution, as well as a facility for treating diabetes. In August 2011 the hospital registered its 60,000th patient since its opening in November 2007.

RAK’s other private hospital, Al Zahrawi, has a longer history in the emirate. The facility first opened its doors in 1987 and, like RAK Hospital, is located in RAK City. The institution contains one labour room, and its operating theatre is capable of treating routine as well as emergency surgeries. Other treatments that are available at the hospital include dentistry, dermatology, neurology, ophthalmology, psychiatry, radiology and paediatrics.

MEDICAL INSURANCE: Although the quality of health care continues to improve in RAK, covering the growing costs of medical procedures poses a significant challenge for the emirate and the country as a whole. According to UAE Medical Insurance, a large health insurance advisory in the GCC region, health care costs in the UAE have nearly tripled in the past decade. Since RAK citizens have free access to medical care at public institutions, the government is bearing the brunt of these rising costs.

To address the growing financial burden, the federal government plans to establish a mandatory health insurance programme for all UAE citizens. Abu Dhabi has already implemented a required insurance scheme, and as of mid-November 2011, more than 90% of those living in the emirate were insured by some form of medical coverage.

Mandatory health insurance will eventually take effect in RAK, though a date has yet to be determined. Details on the programme are sparse, but it is likely to resemble Abu Dhabi’s current system to some extent. Managed by Health Authority – Abu Dhabi, the scheme requires all employers and individual sponsors to supply health coverage for employees and their families. Beneficiaries can make a choice between private insurance firms and Daman, an insurance company that is majority-owned by the local government. In addition to a range of insurances plans, Daman offers the Thiqa programme, which grants UAE citizens access to free health care at a number of public medical facilities.

Although expatriates working in RAK are currently not required to have health insurance, many employers nonetheless offer some form of coverage. Not all insurance plans offered provide sufficient coverage, however, and many expatriates therefore choose to purchase their own coverage from private international insurance firms.

LABOUR CHALLENGES: A labour shortage of health care providers is one of the most significant challenges facing RAK’s health sector. As the emirate’s population rises, so does the number of patients requiring care, but the supply of nurses has not maintained the same rate of growth, and this is causing serious constraints for the industry.

The problem is two-fold: there is an insufficient number of Emirati students entering the medical profession, and attracting health professionals from abroad has proven difficult, largely due to the burdensome licensing procedure and inadequate incentives. Additionally, low English-language test scores have slowed the career paths of some local students aspiring to enter the medical field.

PREVENTIVE MEASURES: Several measures are being taken to address the issue. For example, the government is working to educate students on the value of the medical field by emphasising the current demand for medical professionals in the UAE and highlighting the rewards of the occupation. This effort appears to already be having a positive effect.

The RAK Medical and Health Sciences University (RAK MHSU), located nearby Saqr Hospital and directly next to RAK Hospital, is also taking steps to address the emirate’s labour shortage. A total of 644 students have graduated or are currently studying at the university since the hospital opened its doors in 2006. Enrolment in 2011 reached 166 students, up from 121 students in 2010, according to recent figures provided by RAK MHSU.

The school offers bachelor’s programmes in medicine and surgery, dental surgery, pharmacy and nursing. Master’s programmes in pharmacy practice, pharmaceutical chemistry, and nursing – as well as a registered nurse-bachelor’s of science in nursing (RN-BSN) bridge programme – are also offered. RAK MHSU’s programmes are enhanced by an agreement between the university and the MoH that allows students to do their clinical training in government hospitals. This arrangement benefits both parties: public hospitals can utilise the university’s resources and RAK MHSU students are able to use public hospital equipment during their clinical training.

Although the majority of the school’s students are non-Emirati, UAE citizens made up the third-largest segment of bachelor’s students in 2011, at almost 12%. Of the 126 undergraduates, 15 represented the UAE. At 33%, RAK MHSU’s postgraduate student body is more heavily local.

Several measures are being taken to encourage greater enrolment of UAE students in the medical university. The Sheikh Saud bin Saqr Al Qasimi Foundation for Policy Research, a local think tank focused on issues of social and economic development, is offering three to four full scholarships to RAK MHSU students. The foundation has a similar offering for students in RAK MHSU’s nursing programme.

IMPROVING HEALTH: There are a number of specific health problems that are particularly prevalent in the local population, with diabetes being the most common of these at present. Indeed, according to 2011 RAK Hospital statistics, one out of every two people aged 40-70 years in the UAE is diabetic, although not all are aware of having the condition.

There is strong reason to believe that the substantial shift towards a more sedentary lifestyle is perpetuating many of the common chronic health complications in RAK today. Cars are the usual mode of transportation throughout the emirate, resulting in limited physical exercise. The frequent occurrence of vitamin D deficiency, which often results from lack of exposure to sunlight, highlights how sedentary many have become.

To help combat these trends, RAK MHSU has been raising discussion of local health concerns in its classrooms and undertaking a number of public awareness campaigns that aim to encourage healthy habits. One of these, RAK Hospital’s Defeat Diabetes initiative, ran for three days in mid-November 2011. The programme provided free consultations with cardiologists, along with a number of similar services. Another campaign, organised by the RAK Parents Council, encouraged youth to adopt healthy eating habits by way of competitions, lectures and a range of school events that promoted healthy food. The campaign lasted for one year, and concluded in February 2011, with future plans for the RAK Parents Council to establish several model school cafeterias that provide students with nutritious food.

RAK Medical Zone, the emirate’s primary health services complex, is also playing an important role in the local diabetes education effort. The centre is taking steps to better understand the public’s awareness of the syndromes, complications and types of diabetes by carrying out an expansive survey. Collected survey data will not only be used to create more effective awareness campaigns in future, but also to increase knowledge of treatment needs.

PRIVATE CONTRIBUTION: The education and awareness efforts of local health facilities are being complemented by investment from private industry. Among other activities, Gulf Pharmaceutical Industries (Julphar), a RAK-based company, is working to meet the medicinal requirements of those who already suffer from diabetes. The firm recently finished construction of a $136m biotechnology plant in RAK, where it will produce the raw material used in insulin – a medical necessity for some diabetics.

With commercial production expected to begin in the summer of 2012, Julphar started trial production early in the same year. According to Julphar’s chairman, Sheikh Faisal bin Sager Al Qasimi, the plant is the first facility of its kind to be built in the region, and it should meet all of the country’s insulin needs, with ample capacity to spare.

CRYSTAL CLEAR: It is expected that as much as 80% of the facility’s output will be exported, once Julphar gains authorisation from several foreign regulatory agencies, including the EU. The company aims to produce 1500 kg of insulin crystals per year – enough to produce more than 40m vials of insulin, according to a company press statement released in February 2012. Assuming Julphar hits its production targets, the new plant will be the fifth-largest insulin producer in the world.

One of the consequences of the project will be that insulin produced in RAK will cost less to transport to local customers, thereby reducing dependence on more expensive imports. As up to 8% of the country’s health budget is allocated to the treatment of diabetes, locally produced insulin could result in significant savings. Funds previously dedicated to insulin could be used to compensate for the rising costs of other drug and medical procedures. Yet, as beneficial as it is to find a less expensive source of insulin, a focus on preventive care should do more over the long run to contain costs and, ultimately, to improve the health of Emiratis.

“Significant health advancements in RAK cannot be made without adequately addressing preventive health care issues,” explained S Gurumadhva Rao, vice-chancellor at RAK MHSU. “The MoH has shown leadership in this area, and further participation at all levels will be required in order to increase awareness and, more importantly, adjust individual behaviour,” he told OBG in early 2012.

OUTLOOK: The demands placed on the health sector in RAK have become increasingly complex. The emirate’s population is rising steadily, resulting in a greater number of patients requiring care. Medical costs are increasing and a large portion of the population is either suffering from diabetes or is susceptible to developing the condition.

All of these factors require adjustments in both public and private health care, and for the most part, the sector appears to be effectively adapting. New hospitals and medical facilities are being built to accommodate the rising demand. A nationwide mandatory insurance programme is expected to take effect, redistributing health-related costs between the government and citizens. Steps are being taken to increase the number of Emirati students studying medicine and nursing to reduce the labour shortage, and awareness campaigns are promoting the long-term benefits of a healthy lifestyle.