Medical education and training investment to aid workforce Saudiisation

The rapid expansion of the health care system in Saudi Arabia has increased demand for health workers, from doctors and nurses to hospital administrators and pharmacists. As part of the Kingdom’s ongoing transformation into a knowledge-based economy, and with a view towards the sector’s long-term sustainability, the government is investing heavily in medical education and training for nationals. These efforts are already yielding results in terms of raising the proportion of Saudis working in the health sector, though there are parts of the system – particularly in the private sector – where Saudiisation rates remain stubbornly low.

Growing Labour Force

In 2013, the latest year for which complete data are available, the Kingdom’s health sector labour force was made up of 80,475 physicians (including dentists), 154,568 nurses, 91,781 allied health professionals and 21,766 pharmacists – significant increases in the first four categories, which rose by 45.6%, 39.4% and 53.9%, respectively, since 2009. In the same span, growth in the workforce at the Ministry of Health (MoH) amounted to 42%, or 51,738 new personnel – outpacing that of the health sector as a whole – with the ranks of its physicians, nurses, pharmacists and allied health professionals swelling by 46.7%, 32.5%, 44.0% and 56.8%, respectively. Nurses continued to represent the largest part of the MoH workforce in 2013, numbering 29,969, followed by allied health professionals (22,641), physicians (13,577) and pharmacists (1860). Staff in the rest of the state health sector have also expanded in the 2009-13 period, albeit more modestly than at the MoH – these non-MoH organisations saw their numbers of physicians, nurses, pharmacists and allied health professionals rise by 10.3%, 23.6%, 23.1% and 21.4%, respectively.

Saudiisation

Besides expanding the overall health labour force, the Saudi government has managed to increase the participation of Saudi workers within the sector. Out of all health workers in the Kingdom, Saudis accounted for 22.4% of physicians, 35% of nurses, 17.7% of pharmacists and 69.6% of allied health professionals in 2013. The policy of Saudiisation has been particularly successful at the MoH, where Saudi staff numbers increased by 59.4% (from 66,745 to 106,387) between 2009 and 2013, compared to a 21.4% increase in non-Saudi staff numbers (from 56,398 to 68,494) during the same period. As a result, the Saudi proportion of the MoH workforce rose from 54.2% in 2009 to 60.8% in 2013. This success is reflected in the above-average rates of Saudi representation across all staff categories at the MoH. In 2013 the MoH employed 10,549 Saudi physicians (27.84% of physicians at the MoH), 48,495 Saudi nurses (57.8% of the MoH total), 2149 Saudi pharmacists (90.3%) and 45,194 allied health professionals (89.1%). The increase in the proportion of MoH nurses who are Saudi has been particularly striking, going from 48.7% in 2010 to 57.8% in 2013. The proportion of Saudis employed in the rest of the government health sector has increased more gradually, rising from 34.5% in 2008 to 38.9% in 2013. In the non-MoH government health sector Saudis accounted for 6813 physicians (50.1% of the total) 3959 nurses (13.2%), 1134 pharmacists (61.0%) and 14,571 allied health professionals (64.4%) as of 2013.

Private Sector

The private health sector, for its part, has seen the largest relative increase in Saudi workforce participation in recent years, boosting the numbers of Saudis employed in private health facilities by 59.5% between 2009 and 2013. Despite these advances, Saudi participation in the private health sector labour force in 2013 accounted for 6860 workers out of 98,802, or 6.9% of the total. “Saudiisation is proceeding in the health care sector, but the need for health care workers is so great that foreign workers will still be needed for some time to come,” Essam Bokhari, head of planning and development at the Saudi Commission for Health Specialties (SCFHS), told OBG.

Indeed, overall employee numbers have grown continuously from 57,221 in 2009 to reach their current level, reflecting an expansion in private health services. In 2013 the private health sector employed 29,003 physicians (including dentists), 40,737 nurses, 17,525 pharmacists and 18,397 allied health professionals.

Training

To meet the demand for health professionals in the Kingdom and continue increasing Saudi participation in the sector, the government has invested heavily in medical training for its citizens. The SCFHS, which supervises health training programmes and sets standards for the profession, is responsible for evaluating health institutions for the purposes of training, approving the results of specialised exams and issuing professional certificates. It also funds health-related scientific research, organises seminars to discuss domestic health problems, monitors the implementation of reforms and collaborates with international partners to further medical training in the Kingdom. For instance, it is currently developing new training programmes in cooperation with Canada and Jordan.

Education

Meanwhile, the number of future Saudi health professionals has continued to grow in recent years. As of 2013, the number of students in health-related majors at the Kingdom’s universities reached 16,230 in medicine, 4152 in dentistry, 7394 in pharmacy, 20,292 in applied sciences and 4815 in nursing.

Women accounted for 50% of all students, and 30% of those at the fellowship and postgraduate levels. These figures suggest that the proportion of female Saudi health workers will continue to grow in the coming years – in 2013, men still accounted for 73.9% of physicians, 62.4% of pharmacists, 70.5% of allied health professionals and 19.7% of nurses. At the undergraduate level, 98% of the students enrolled in medical courses at universities in the Kingdom are Saudi nationals. Among postgraduate students the proportion is significantly lower, ranging from 47.2% in endocrinology to 11.9% in anaesthesia, perhaps reflecting the increasing popularity of Saudi universities for foreign students.

While the health sector continues to suffer from a lack of local knowledge and expertise, the King Abdullah Scholarship Programme has helped to address this, particularly since it started to focus more on scientific subjects in recent years, as Faisal Bindail, deputy general manager business development at AJA Pharma, told OBG. The health sector should benefit from the government’s broader investment in education, too. As Bokhari pointed out to OBG, “The health care sector also has a great need for support workers in non-medical fields, such as human resources.”

Incentives

Besides investing in medical training and education, the government expects a number of other measures to attract greater numbers of Saudis to the medical profession. For example, the Shura Council passed a law in 2014 to reduce working hours for private sector employees from 45 to 40 hours per week, including a mandatory two-day weekend. In parallel, the Ministry of Labour raised nationalisation quotas for the health care sector from 25% to 30%.

To compensate for the extra costs of these policies, health care providers anticipate having to raise their prices by up to 30%. However, price hikes of this kind may also have a knock-on effect on other parts of the health system. “Insurance companies are still hurting from ad hoc price increases from health care providers. The MoH and Council of Cooperative Health Insurance need to do more to control hospital fees,” Mohammed Al Badr, general manager of AJA Pharma, told OBG. To mitigate the effect on patients, in 2014 the government began restricting private institutions from charging patients for opening a medical file on their behalf.

There are also costs associated with relying on foreigners to staff medical facilities. Bokhari told OBG that one of the difficulties with relying on staff from countries like the Philippines is that they tend to come to work in Saudi Arabia for only a relatively brief period before moving on to work in Western countries.

Skills Transfer

The structure of the health care market also plays a role in fostering local skills development. “In contrast to places like Dubai, localisation in the Saudi health care sector has generally taken the shape of foreign companies forming joint ventures with local partners, as Philips and GE have done. This has proved a successful policy for ensuring skills transfer to the Saudi market,” Atif Choudhary, marketing development manager at Arabian Health Care Supply, told OBG. For example, Philips announced a joint venture with Al Faisaliah Medical Systems in September 2012 to sell the Dutch firm’s health care products in Saudi Arabia, including medical imaging systems, patient monitoring devices and clinical information solutions. Similarly, GE is represented in the sector by GE El Seif Healthcare Arabia, a joint venture between GE and El Seif Development in which GE holds a 51% stake.