Bahrain readies for the future in education and health care

Education and health care are important policy priorities in Bahrain’s wider drive to develop a knowledge-led economy. As the first country in the GCC region to introduce government-sponsored education in 1919, Bahrain has a long track record of public instruction, as well as a robust private education ecosystem that has developed in the subsequent years. Fostering the next generation of local talent and innovation is a key government objective that will continue to shape the sector in the coming years, from primary through to the higher and vocational levels.

In the health care space, the Covid-19 pandemic has taken up much of the sector’s attention since 2020. Looking ahead, however, the kingdom is working to build on successive decades of gains in terms of health care outcomes, while at the same time evolving its services in response to the shifting burden of care towards lifestyle-related diseases.

Education Oversight

The Ministry of Education (MoE) is the sector’s primary oversight body, and is charged with maintaining the quality and effectiveness of educational programmes. Under the umbrella of the ministry, there are directorates for each level and type of education, ranging from kindergarten and primary, to vocational and continuing education. Basic education is both compulsory and free for students who are aged six to 14 years, and is segregated by gender.

At the tertiary level, the Higher Education Council (HEC) – which operates under the auspices of the MoE – regulates the tertiary segment. Higher education institutions usually offer mixed-gender learning environments. Both public and private licensed institutions are subject to inspection by the Education and Training Quality Authority.

Education Policy & Budget

Sector policy is guided by the overarching Bahrain Economic Vision 2030, the country’s long-term development agenda. Among the roadmap’s education-related priorities are upskilling young Bahrainis to meet labour market demands, improving teacher training, establishing minimum quality standards, and investing in research and development.

In addition, a new 10-year education policy came into effect in 2022, which seeks to expand the sector. Under the plan, 18 new schools will be constructed at an estimated cost of BD118.3m ($313.8m), while another 56 facilities will be remodelled. The sector is also the target of a Bahrainisation drive – announced in late 2021 by Majid Al Nuaimi, the minister of education – which seeks to fill vacancies for teachers with qualified Bahraini nationals.

Education spending earmarked for 2022 in the two-year 2021-22 national budget increased by around 1% to BD331.7m ($879.8m), including both recurrent and project expenditure. As a share of total spending, this represented 9.3%, making it one of the largest recipients by sector, after defence, public order and safety, and social protection. As part of the initiative to increase the number of local teachers in schools, the Bahrain Teachers College saw a sizeable increase in funding, up nearly 40% at BD6.4m ($17m) for the year.

Student Body

According to the most recent MoE figures, in the 2018/19 academic year there were 115,125 students enrolled in schools at the primary level – 72,074 in government schools and 43,051 in private schools, of which 49.1% were female and 50.9% were male. At the intermediate level, the breakdown was 37,048 in government schools and 15,263 in private schools for a total of 52,311, with female students comprising 49.4% and male students the remaining 50.6%.

Of the 39,076 students at general secondary schools, 27,697 were enrolled at government schools and 11,379 at private schools, with a 56:44 femaleto-male ratio. Technical and vocational secondary students numbered 6814, all in the public sector, and skewed roughly 90:10 male to female.

Performance

Bahrain has a high literacy rate, at around 97.5% of those aged 15 and above as of 2018, according to World Bank data. This is a substantial improvement from 70% at the start of the 1980s and above the global average of 86%.

Bahrain ranks highly in the GCC in terms of international testing benchmarks. On the latest Trends in International Mathematics and Science Study (TIMSS) test, which are administered every four years, Bahrain ranked a close second in the GCC for fourth-grade mathematics in 2019, with a score of 480, which was above the regional average of 437 that year. In fourth-grade science, meanwhile, Bahrain led the GCC with a score of 493, compared to a regional average of 441.

At the eighth-grade level, Bahrain placed first in the GCC for both mathematics and science, with scores of 481 and 486, respectively. The regional averages, by contrast, were 434 for mathematics and 461 for science. Overall, these scores put Bahrain on a relatively similar footing to countries such as France or New Zealand, and edging closer to the TIMSS centre point of 500.

Public

The public K-12 system spans nine years of basic instruction, beginning with primary and intermediate education, followed by three years of secondary education on either a general or vocational track. Upon graduation, students either enter the labour market, pursue tertiary education, or undertake further vocational or technical training.

In terms of institutions, the latest breakdown from the MoE showed a total of 210 government schools in the 2018/19 academic year – 111 at the primary level, 22 elementary or middle schools, 38 preparatory schools, 30 high schools or other tracks, six vocational and technical training institutions, and three religious institutes. That year there was a total of 14,103 teachers and administrative staff across all government schools.

The breakdown of institutions by gender was relatively even, with 107 catering to boys and 103 to girls, though the religious institutions only serve male students, preparing them for work in Islamic religious affairs. The public sector also includes a gifted student centre, which provides additional support for advanced students.

Private

Private schools in Bahrain fall into three groups: those catering to Bahraini nationals, those aimed at expatriate students in general and schools targeting a particular foreign community. In expat schools there are a variety of languages of instruction and curricula offered, including the national curricula of the UK, the US, India and Australia, as well as the International Baccalaureate (IB). Of the private institutions operating in the 2018/19 academic year, there were 71 nurseries, 130 kindergartens and 70 private schools, according to the latest MoE data. That year there were 8283 teachers and administrative staff employed at private institutions.

St Christopher’s School, established in 1961, is one of the most well-known institutions offering the UK curriculum in Bahrain, along with the British School of Bahrain, which was acquired by the London-headquartered Inspire Education Group in January 2018. The IB, for its part, is taught at Ibn Khuldoon National School and Modern Knowledge Schools, among others. The Multinational School Bahrain uses the Australian curriculum, while the AMA International School and the Bahrain Bayan School both apply the US curriculum. The Indian national curriculum is taught in English at the Bahrain Indian School and The Asian School.

Higher Education & Vocational

Bahrain’s tertiary education segment is projected to grow at a compound annual growth rate of around 5.1% from 2018 to 2023, according to a 2020 report on the education sector in the GCC by Islamic investment bank GFH Financial Group. This is being driven by an expanding network of foreign universities, as well as increasing government support for higher education, which is considered to be critical to economic diversification, the development of a knowledge-led economy and the Bahrainisation of the workforce.

Bahrain is home to three public higher education institutions: the University of Bahrain, Bahrain Polytechnic and the Bahrain Training Institute. Founded in 1986, the University of Bahrain is the largest of the three, with a student body of approximately 25,000 across its nine colleges and 120 academic programmes as of the 2018/19 academic year, while Bahrain Polytechnic, established in 2008, had a student body of some 2738 as of 2019.

The Bahrain Training Institute, formally inaugurated in 1992, plays a key role in offering training in technical and vocational skills, which is another important plank in the government’s programme to prepare the next generation of Bahraini talent. The Nasser Vocational Training Centre is another significant provider of technical and vocational education in the kingdom.

In the private segment, there were some 14 universities active as of early 2022, according to the HEC, including the American University of Bahrain, the British University of Bahrain and Applied Science University, among other institutions.

Technology

Bahrain had an early-mover advantage when it came to shifting learning online in response to the pandemic. The country has a well-established foundation in ICT (see ICT chapter), and had been working with the International Society for Technology in Education (ITSE) to train teaching staff in ICT prior to the pandemic, in addition to serving as the host of ITSE’s official standards training centre for the GCC. On the individual level, internet penetration stood at 99% and mobile penetration at 131% as of the start of 2020, which put students in a strong position to adapt to the sudden shift online. Notably, Bahrain had launched an e-learning programme as early as 2004 – the King Hamad Schools for the Future project – which sought to incorporate ICT into teaching at the primary and secondary levels, with an view to connecting all schools to the internet and deploying e-learning.

The kingdom’s digitally enabled approach to learning promises to pay dividends well beyond the lockdown periods necessitated by Covid-19. “Studying online helps students develop other skills, such as independent learning and proper time management. They also become more technologically aware and advanced in their thinking,” Ghassan Aouad, president of Applied Science University, told OBG.

Health Oversight

The health sector is overseen by the Supreme Council of Health (SCH), which was inaugurated in 2013 to steer health care strategy at a national level. The Ministry of Health (MoH), for its part, is responsible for public health regulation, monitoring and evaluation. The ministry’s mission is to enhance service delivery. Government hospitals and primary care centres are managed independently under a board of trustees. The National Health Regulatory Authority (NHRA), established in 2009, serves as the regulator for both the private and public health care segments, the latter of which is smaller and tends to offer more specialised care.

Health Policy & Budget

Health sector policy is guided by several medium- and long-term government strategies, as well as the overarching Bahrain Economic Vision 2030 and the Bahrain Economic Recovery Plan, the latter of which was launched in response to the pandemic. Health projects are included among the $30bn in investment earmarked across 22 strategic projects under the plan (see Economy chapter). “This transformative investment will raise education and lifestyle opportunities for young people, and provide quality health care, homes and career paths for them as they progress into adulthood,” Sheikh Salman bin Khalifa Al Khalifa, minister of finance and national economy, said when announcing the programme.

The National Health Plan 2016-25 is the guiding document for the sector, and is aligned with both the UN Sustainable Development Goal of achieving universal health coverage and Bahrain Economic Vision 2030’s goal of access to quality health care for all nationals and residents. The latest NHRA Strategy, spanning 2021-25, pertains to the regulation of the sector to ensure the safety and efficacy of both public and private health services.

The National Health Insurance Law (NHIL), which came into force at the end of 2018, is another important policy for the sector. Among its many provisions, the NHIL established a dedicated insurance fund to collect contributions and finance the health system, and established the Health Information and Knowledge Management Centre to gather, process and evaluate medical data in the national scheme.

The health sector is projected to receive some BD297.9m ($790.2m) in recurrent expenditure for 2022 in the two-year 2021-22 budget, down marginally from BD298.3m ($791.2m) in 2021. The MoH saw the bulk of the allocation (BD216.9m, $575.3m), followed by King Hamad University Hospital (BD34.5m, $91.5m), Bahrain Oncology Centre (BD23.9m, $63.4m) and Mohamed bin Khalifa Al Khalifa Cardiac Centre (BD18.6m, $49.3m).

The NHRA, for its part, received BD2.5m ($6.6m) in funding, while the SCH was allocated BD1.2m ($3.2m) and the remaining BD200,000 ($531,000) was earmarked for expenditure to cover emergency cases and treatment for Bahrainis abroad. In terms of project-specific expenditure, the sector is slated to receive BD5.8m ($15.4m) in 2022 – BD1.8m ($4.8m) for the SCH and BD4m ($10.6m) for the MoH.

These allocations represent a continuation of Bahrain’s elevated health care expenditure as a percentage of GDP, relative to the GCC. In terms of economic output, health care accounted for 3.5% of GDP as of the third quarter of 2021.

Indicators

Bahrain has a relatively high life expectancy at birth, estimated at 77.3 years in 2019, according to data from the UN Population Division. The MoH expects this to increase to 77.9 years over the 2020-25 period. These figures compare favourably to the global average of 72.6 years in 2019 and are in line with the GCC average of 77.3 years.

According to the most recent MoH data, there were 1020 physicians, 2957 nurses, 110 dentists, and 226 pharmacists and technicians working in public health in 2019. The public primary and preventive health care workforce stood at 2268 that year, with another 4404 in secondary health care and 34 in the school health programme. Including the private sector, the NHRA reported a 17,043 licensed health care professionals nationwide as of 2020.

As of 2017, the most recent year for which World Bank data was available, there were 1.74 hospital beds per 1000 people in the kingdom, down from 2.08 in 2012. The distribution of beds that year was 82.9% in public hospitals and 17.1% in private hospitals, roughly consistent with the prior four years of data and reflecting the relative weight of the public sector in the provision of secondary care.

Disease Burden

Diseases of the circulatory system – which include hypertension as well as other cardiovascular conditions – were the leading cause of death in Bahrain in 2019, comprising approximately 46.6% of the total, according to the most recent statistics from the MoH.

Neoplasms, a term that refers to both benign and malignant tumours, were the second-largest cause of death, at 15.7%, followed by external causes (7%) and diseases of the respiratory system (6.1%). Infectious and parasitic diseases, in contrast, accounted for 2.1% of the total. This is supported, in part, by the country’s high rate of childhood vaccination, which ranges from 96% to 100%, depending on the vaccine.

These figures reflect the growing burden of care for non-communicable diseases in the kingdom – a trend frequently seen in increasingly affluent societies, where sedentary living, stress, and other environmental and lifestyle factors contribute to their incidence. In particular, the incidence of obesity has continued to rise since 2000. Non-communicable diseases account for around 83% of deaths in Bahrain, compared to a global average of 71%.

This disease profile has important implications for the evolution of health care in the country, as preventive medicine, nutrition and public awareness have a fundamental role to play in both the treatment and prevention of such lifestyle-related diseases. With Manama becoming the first Middle Eastern capital to earn the World Health Organisation’s Health City designation in 2021, stakeholders will be looking to transform wellness-conscious urban planning into tangible improvements in health outcomes in the years ahead.

Public & Private Care

As in the education sector, Bahrain’s health care industry has a well-established track record: the kingdom’s first hospital opened in the 1890s. In the intervening years, the kingdom has exhibited a strong commitment to improving health outcomes among the population, with a focus on data-led policy-making.

There were seven government hospitals in operation in early 2022, along with two maternity hospitals and 27 government health care centres. The public primary health care network is divided into five geographic areas. Health Region 3 was the busiest in 2019, with 872,898 general visits, or 27.6% of the total. Of this figure, 347,369 visits were recorded at the Yusuf Abdul Rahman Engineer Health Centre that year, nearly 40% of the region’s total.

Meanwhile, in the private sector, there were 20 private hospitals with a total of 518 beds, 90 private clinics, 280 private medical centres and 133 dental facilities licensed by the NHRA as of 2020. Services in the private sector tend to be more specialised than in the public sector, which is reflected in the large number of private care centres with particular focus areas, ranging from dermatology and ophthalmology, to psychiatry and paediatrics.

Insurance

The 2018 NHIL made health insurance mandatory for all nationals, residents and visitors, beginning at the start of 2019. Under the Social Health Insurance Programme envisioned by the NHL, better known as Sehati, employers will be required to pay contributions on behalf of foreign employees and, in some cases, their dependants.

Bahraini nationals, meanwhile, will continue to access care free of charge at public facilities, with the cost of services covered by government contributions. Nationals who wish to receive treatment at private health care facilities are responsible for covering a maximum of 40% of the cost, with the government subsidising the balance.

“Expanded coverage will help to foster healthy competition in the sector, which will boost access to health care. This, in turn, will improve overall the welfare in the kingdom and reduce the burden of disease on the government and society as a whole,” Kasim Ardati, managing director of Bahrain Specialist Hospital, told OBG. The first phase of Sehati is reportedly due to launch in the second half of 2022, beginning with the smaller cohort of expatriates in the kingdom, before opening up enrolment to Bahraini nationals in early 2023.

Health Tech

Technology played a central role in Bahrain’s pandemic response. The national task force – the National Taskforce for Combatting the Coronavirus – was established to coordinate response and mitigation efforts, and issued advice and updates via the special Health Alert website that is operated by the MoH. In tandem, the BeAware Bahrain smartphone app was quickly developed by the Information & eGovernment Authority and the taskforce, in order to facilitate contact tracing and related quarantine procedures.

Even prior to the specific telemedicine and public health monitoring advances necessitated by the pandemic, Bahrain’s health sector was in the midst of a digitalisation drive. Catalysed by the early e-government ambitions of Bahrain Economic Vision 2030, major stakeholders in the sector have been pursuing digital innovations as part of wider efforts to streamline operations. For example, in 2021 the NHRA launched Munshaat, an online platform accessible via mobile phone for NHRA inspectors and officials, designed to facilitate electronic record-keeping and reduce the manual entry of data. The Mehan system was rolled out around the same time, offering licence-related services to around 18,000 medical professionals. “Services will include applying for a professional licence, renewal[s], good standing certificate[s], reference letters and other add-ons,” Dr Mariam Al Jalahma, CEO of the NHRA, told media at the time of the launch.

Outlook

With the world in early 2022 more optimistic that it can look beyond the emergency measures required to navigate the pandemic, many countries hope to leverage their recent advances in education and health care to develop a more flexible, hybrid approach. As a regional leader in the ICT space and with an established track record in both learning and medicine, Bahrain is well positioned to fortify both sectors in the post-pandemic era, through a mix of continuity and innovation. In the years ahead, the country will continue its efforts to prepare the next generation of Bahraini talent to work in an increasingly tech-based and knowledge-led economy. Integrating digital tools into the classroom from an early age will ensure a tech-savvy workforce that can keep pace with innovation.

Meanwhile, in the health sphere, as the Sehati insurance scheme begins its formal rollout in 2022 and 2023, it will offer the kingdom an opportunity to evaluate and adjust its health services in real time, using actionable data collected from providers and facilities and analysed at the national level. Robust regulation and oversight, in cooperation with the private sector, will be key ingredients for success.