Infrastructure build out through 2022 to boost capacity and access

Qatar is investing significantly in health care infrastructure in the next decade, as it looks to build one of the world’s best health systems. In the 2014/15 budget, allocations to the sector increased by 12% year-on-year to QR15.7bn ($4.3bn). The number of health care facilities will more than double by 2022, with a focus on primary care centres and specialist hospitals. These capital-intensive investments are among the biggest projects being executed in the state.

PLANNING AHEAD: In 2013 the Supreme Council of Health (SCH) completed Qatar’s first health facility master plan, outlining health care infrastructure requirements and implementation needs for the coming 20 years. The capital cost of the proposed build out will total some QR56.83bn ($15.58bn) through 2033.

As of the end of 2013, Qatar had a total of 38 health care facilities in the government-run segment, which dominates the sector. This included 25 health centres, eight hospitals, three specialised units and two Medical Commission (MC) centres, with a total of 2100 hospital beds, according to the SCH’s 2013 annual report. By end-2015 there are expected to be 2223 hospital beds, with three new health centres, one hospital and a specialised centre set to open that year.

The SCH’s long-term projections see Qatar more than doubling the number of health care facilities to 92 by 2022. By that year, the organisation forecasts there will be seven MC centres, 43 health centres, 15 hospitals, 18 other specialised units, nine support facilities and 5581 hospital beds in the government-run segment.

The expansion is intended to ensure that by the time Qatar hosts the 2022 FIFA World Cup, it surpasses OECD best practices on bed density. This large-scale build out should provide relief to existing facilities, which have become increasingly overextended on the back of rapid population growth, with the state’s population doubling between 2006 and 2011.

While demographic growth may not continue at its current rate of 10% per year, demand for health services will be sustained by factors like the prevalence of chronic illnesses, a growing number of seniors, and more access to care thanks to greater insurance penetration through the National Health Insurance Scheme, known as Seha. Faleh Mohamed Hussain Ali, acting CEO of the National Health Insurance Company (NHIC), told OBG he was confident the increases in clinic and hospital capacity would help the state manage rising demand on a system that is already under pressure.

NEW FACILITIES: In 2013 the SCH began construction on three hospitals and eight collocated or adjacent to health centres and MC units – all due to open in 2016. Planning for the Trauma Mass Casualty Hospital in Doha entered the next phase, expected to open in 2021. The hospital will include an American College of Surgeons-accredited Level I trauma centre of excellence, and a full range of surgical specialties and subspecialties. The hospital will also be equipped for a variety of emergency scenarios, including mass casualty events and infectious disease outbreaks, and will operate an internationally accredited academic health system.

The year 2013 also saw the start of construction on Naufar, the Qatar Healthcare & Rehabilitation Centre, due to open in 2015. Naufar will focus on the treatment and rehabilitation of patients with substance abuse and behavioural disorders.

Primary Health Care Corporation (PHCC), one of the three primary public health care networks, began construction on six health centres in 2013, while planning continued on an additional 13. These centres, due to open by 2017, are largely being built in busy suburban areas and will focus on primary care. “The new Al Karaana and Lghuwairya health centres provide significant increases in capacity, access and the range of services provided to patients, with a focus on preventive care for non-communicable diseases. Their floor size will be 2500 sq metres each, which represents a five-fold increase of the current footprint,” Dr Mariam Ali Abdulmalik, managing director of PHCC, told OBG.

HMC EXPANSION: Hamad Medical Corporation (HMC), another public health care network, is also developing capacity. In recent years, HMC has opened three new hospitals – Al Wakra Hospital, the Cuban Hospital and Heart Hospital – hiring more than 3000 staff in the process, including management and clinical experts.

In 2014 HMC adopted a facilities master plan for the development of the Hamad Bin Khalifa Medical City (HBKMC), which will include three new specialist hospitals and a new research institute that HMC plans to make a centre for medical research, drawing in experts from around the world and developing Qatar’s capacity for in-country innovation in treatment and care. Together, the three facilities form a QR2.4bn ($657.8m) complex, with a targeted completion date of mid-2015.

The ambulatory and minimally invasive surgery hospital will have 130 short-stay beds and 14 operating theatres, with a planned capacity of over 28,000 surgeries per year. It will feature clinics specialising in podiatry, gastroenterology and urology, among others.

The physical medicine and rehabilitation hospital will have 200 beds, divided equally between orthopaedics and fractures; cardiovascular diseases; spinal cord injuries; fractures and brain injuries; and paediatrics. It will also have one of the largest hydrotherapy suites in the region, as well as gyms and outpatient clinics for occupational therapy and organ transplants.

The women’s hospital will have one of the largest neonatal units in the region and planned capacity of 8000 births per year, with new nursing and medical staff being actively recruited. The hospital includes 190 beds for women, 53 in a paediatric intensive care unit and 48 incubators for babies, as well as a gynaecology centre with two rooms for Caesarean operations.

PRIVATE SECTOR ROLE: While the government has taken the lead in capital investment to develop health care facilities, the SCH is also keen to engage the private sector. The SCH is currently drawing up plans to engage a private sector provider to partner with PHCC to run four new primary care centres, and is also in the process of drafting a policy on operating such facilities, weighing the benefits of different models of public-private partnership, including concessions to the voluntary sector. Regardless, the authorities will likely be seeking top-tier international partners.

The private sector is poised to play a more central role in capacity expansion, thanks to concerted efforts on the part of the SCH, which has stepped up its approval process for new private facilities. In 2013 it processed 44% more facility preliminary approvals and 10% more licences than in 2012, and developed a private sector policy to identify specific challenges in facility expansion and tools to facilitate private health sector growth.

The SCH anticipates that around half of Qatar’s health infrastructure needs will be met by the private sector, including acting as the developer, with opportunities stemming from the on-going expansion of the HBKMC, workers clinics and research centres. Other opportunities include niches in which the government still has less reach than it would like, including long-term beds outside a hospital setting, such as hospices; mental health; respite care; and intermediate care, or care outside hospitals, often in the home. Many of these are culturally sensitive areas, and Qatar will need to choose well-accredited partners. Beyond care itself, the SCH is seeking greater private sector participation for services ranging from education to catering.

WORKER HEALTH: Some of the new health facilities being established by the SCH are on-site facilities for single male labourers working on projects like construction sites. The UN International Labour Organisation has recommended on-site care as an appropriate, cost-effective way of delivering high-quality care to workers, especially for larger employers.

This is particularly the case in Qatar and other Gulf countries, where companies have a limited responsibility for expatriate workforce health and many projects are hazardous. In addition, labour accommodation tends to be communal and removed from the main population centres, making access to traditional facilities more difficult. From these new on-site clinics, workers will be able to obtain basic treatment and be referred to the traditional health care system on an as-needed basis. The SCH has provided temporary facilities while these worker-oriented clinics are in the process of being rolled out, which were outsourced to the Qatar Red Crescent Society.

For their part, the permanent facilities will be built with a flexible design, given the medium-term nature of many labour-intensive projects – and the fact that some will likely be scaled up in the coming years. A competitive process with output-based requirements is being used to outsource the permanent facilities.

The investments that Qatar is making in health care infrastructure are already bearing fruit, as the range of new primary care centres in particular demonstrates. In 2015 the three new HMC hospitals should open their doors, breaking new ground for specialist care in the state. Given the roadmap for investments to 2022 and beyond, opportunities for the private sector and foreign companies to support development, management and supply are likely to increase, particularly as the SCH sets out new models for public-private partnerships.