Development of Sharjah's health sector aided by legal changes, expansion of provision and cutting-edge research

These are times of rapid expansion in Sharjah’s health care sector, as the emirate seeks to meet the needs of both an expanding population and heightened demand for top-of-the-range medical services, changes that are highlighted by the opening of hospitals, clinics and pharmacies, as well as the development of the new Sharjah Healthcare City (SHCC).

The sector’s value will rise from some $2bn in 2016 to reach $2.4bn by 2019, according to the Sharjah Investment and Development Authority. Meanwhile, in March 2017 Abdulla Ali Al Mahyan, chairman of Sharjah Health Authority (SHA) and the SHCC, told local media predictions average annual sector growth across the UAE was expected to be 12.7% leading up to 2020, with the overall market reaching a value of Dh71.6bn ($19.5bn) in that year.

Developing Landscape

Campaigns to improve public health are ongoing. At the same time, the emirate is bracing for change in its administrative and financing structures, as the years ahead are likely to see the adoption of the same local health authority system as in neighbouring Dubai and Abu Dhabi, moving local services out from under the federal remit. Mandatory health insurance for both private and public sector employees is also on the way, with implications for demand and supply in the sector.

At the same time, investment and support for medical research and development is increasing with the local university medical schools accumulating a growing number of patents (see Education chapter). Furthermore, medical tourism is also becoming an area of focus, as the emirate tries to gain a share of this lucrative international market. In all of these ventures, the private sector has a key role, with the emirate keen to see local and global companies boost their presence in the years ahead.

Structure & Services

As one of the UAE’s seven emirates, Sharjah’s health care sector is largely under the remit of the federal-level Ministry of Health and Prevention (MoHP), headquartered in Abu Dhabi. The current minister of health and prevention for the UAE is Abdul Rahman bin Mohammed Al Owais, who has been in the post since 2013. The MoHP regulates both public and private providers in the sector, with state primary care and hospital services under its control. However, facilities in Abu Dhabi and Dubai, which now have their own health authorities, are exceptions. In the former, the Department of Health (HAAD) regulates the sector, while in the latter the Dubai Health Authority (DHA) is the lead agency.

The federal ministry maintains executive offices in the other five emirates, with the Sharjah Medical District (SMD) acting as the representative in Sharjah. The body oversees all public and private services, with a partial exception of University Hospital Sharjah (UHS), an area of special interest of Sharjah’s ruler, Sheikh Sultan bin Muhammad Al Qasimi, which functions as a semi-governmental institution, with its operations overseen by a specially appointed board of trustees. Though the SMD issues the licence for UHS and oversees the staff, the SHA is in charge overall. The SHA was established in 2010, with the aim of eventually undertaking a role similar to the HAAD and DHA, as the emirate’s own, independent sector authority. Currently, SHA looks at health care strategy and development for the emirate, which includes planning and managing SHCC.

With the independence of the HAAD and DHA, the emirate has become the largest area within the MoHP’s jurisdiction. Sharjah is also unique in that it has coverage on both the Gulf and Indian Ocean, with a range of towns and villages in between. This geography, which includes rugged mountain areas and the exclave of Nahwa, poses logistical challenges for health care providers, although these difficulties have been easing as the road network improves.

Demographics

The emirate has a population of just over 1.4m, with approximately 85% of the population living in Sharjah City, according to the last census conducted in 2015. The bulk of the total, 1.2m, was made up of expatriates, while some 770,000, or 55%, were between 20 to 39 years of age. This is largely an effect of the expatriate employment profile, with most of this demographic being young, semi-skilled and skilled manual and service sector workers. Among foreigners the population is significantly more male than female, with men making up 68% of this group and women accounting for 32%. Among nationals, the gender split is much more even, with females having a slight majority at 50.1%.

Since 2015 the population has undoubtedly grown further. The average annual growth rate between 2010 and 2014 stood at 6.59% with SHA estimates placing the population around 2.7m by 2025.

Prevalent Concerns

The emirate has many of the medical issues familiar elsewhere in the UAE and indeed across the Gulf countries. Increasing wealth and the prevalence of sedentary work and lifestyles among nationals has led to the rise of a number of non-communicable diseases (NCDs) including diabetes, cancer, obesity, smoking-related diseases and cardiovascular diseases (CVDs).

The UAE has made NCDs a focus in its national agenda, Vision 2021, with half of the 10 specific goals listed for the health care sector aimed at combating them. This includes targets of lowering the number of CVD deaths per 100,000 people, decreasing the number of smokers, reducing the prevalence of diabetes and child obesity, and cutting the number of deaths from cancer per 100,000 people. The MoHP has also developed an NCD multi-sector action plan, running from 2017 to 2021, and has set up a national Committee for NCD Prevention.

Regional Leader

Sharjah has often been at the forefront in the UAE in combating these common issues. In 2003 the emirate was the pioneer in launching a clearly defined, the MoHP strategy for home and primary health care for the elderly, which was extended elsewhere in the UAE in 2008.

In 2012 Sharjah City joined the World Health Organisation’s (WHO’s) Healthy Cities Programme, which stresses the importance of inter-sectoral partnerships in improving the overall health environment of an urban area, bringing a wide number of stakeholders, such as local communities, businesses, health bodies, and waste management facilities, into the planning and development of sustainable local programmes. After three years of running the scheme, it became the first city in the MENA region to be awarded Healthy City status by the WHO and is now a regional training centre for policymakers from other municipalities wishing to reach the same level. Maintaining the standards associated with the designation is one of the SHA’s responsibilities.

One of the main aspects of the programme is its emphasis on health education. The SMD and the MoHP run frequent campaigns on issues such as diabetes and CVDs, encouraging sports and regular exercise, as well as other healthy practices. A recent example was the “Let’s Walk” campaign, run in conjunction with the Sharjah Commerce and Tourism Development Authority and aimed at encouraging exercise during the hot summer months. A range of local groups also participated, showing another key aspect of the emirate’s health care sector: the active non-governmental wing. Friends for Diabetes, Friends of Kidney Patients and the Friends of Cancer Patients took part in the campaign, along with the emirate’s health education department. In 2015 Sharjah was also awarded the title of “Baby-Friendly City”, after a three-year campaign based on the WHO and UNICEF International Baby-Friendly Hospital Initiative, which has the aim of encouraging mothers to breastfeed for the first two years, with a range of regulations supporting them in the workplace and at home. Sharjah was the first city in the region to achieve this.

Hospitals & Clinics

As of early 2018 Sharjah was home to 17 private hospitals, along with more than 1600 additional medical facilities, such as clinics and health centres, according to the SMD.

In Sharjah City alone there were around 850 pharmacies, a number which has increased in number recently, after a regulation stating that pharmacies must be at least 200 metres apart was lifted. There are also two major public hospitals, Al Qasimi and Al Kuwaiti. The former includes a specialist gynaecology, obstetrics and paediatrics facility on its campus, which was the first in the region to offer keyhole surgery for children when it opened in 2014.

In addition to its targets for NCDs, Vision 2021 aims to improve health care provision across the emirates. This includes plans to increase the percentage of accredited health facilities, while raising the UAE as a whole in comparative measures, such as the Legatum Prosperity Indicator and indices drawn up by the WHO. This latter point requires an improvement in basic health outcomes, health infrastructure and preventive care, and “physical and mental health satisfaction”. The average number of physicians and nurses per 1000 people is also to be boosted.

Accreditation in Sharjah is the responsibility of the MoHP and the SMD, which has the additional goal of ensuring all local health facilities have such certification by 2021. In 2016 the figure for the entire UAE was just under 68%. Standards are thus being continuously elevated, a factor which is sometimes a challenge for private institutions in particular, as this can impact bottom lines. However, the SMD is aware of this issue and is currently working with institutions to help them achieve their targets.

“At the SMD office we run random medical and pharmaceutical facility inspections in the emirate to check the compliance of the MoHP laws and regulations,” Dr Dalia Abdul Moety Murad, head of the SMD’s Inspection and Control Department, told OBG. “We ensure the quality and safety of the services provided to the public, while implementing the ‘friendly inspection’ initiative, which was started by Dr Amin Al Amiri, assistant undersecretary for Public Policies and Licensing Sector. This is a strategic partnership with all private owners and investors and the MoHP to ensure medical facilities can easily and properly follow the practices provided.”

Staffing

In terms of its workforce, Sharjah does face challenges with nursing staff, although had no shortage of doctors in early 2018, according to the SMD. Cultural reasons are often cited as a cause for the shortfall in nurses, the profession is not traditionally one taken up by Emiratis and globally nursing staff are highly sought after in a wide range of markets, creating strong competition for staff.

The emirate has been working to ease recruitment by making use of IT solutions. Prospective medical staff can register their details online with the MoHP and apply from abroad for a range of positions. Doctors, meanwhile, are facing stricter controls on licensing, as the emirate moves to strengthen its professional medical workforce. Previously, regulations had been more relaxed, particularly in the free zones, but now any doctor operating in Sharjah must be licensed by the MoHP. Facilities failing to comply can face fines or even closure.

Healthcare City

The SHCC, initiated in 2012 by the ruler of Sharjah, is perhaps the largest, recent development in the sector. The project offers a dedicated free zone for all companies involved in health care provision, with numerous benefits: including 100% ownership rights, zero taxes and duties, the possibility to repatriate 100% of profits, easy licensing and consolidation of administrative matters, as well as internationally competitive IT, utilities and transport infrastructure. The site is also located conveniently close to Sharjah International Airport and a number of major highways, which will help in meeting the objectives of establishing itself as a regional centre, as well as a destination for medical tourism. Upon completion the SHCC is planned to cover approximately 4.8m sq metres, with room for hospitals, clinics, biotech research centres, laboratories, rehabilitation facilities, wellness centres, hotels and apartments, complementary and alternative medicine centres, offices, retail facilities, and logistics and light industrial units.

The first private health group to sign up for the city was the UAE’s own Ahalia, which announced in March 2017 plans for a 100-bed general hospital at the site. The firm, accredited by the US non-profit Joint Commission International, will be joined soon by the Dh12.5m ($3.4m) Sheikh Khalifa Accident and Trauma Hospital. While not part of the SHCC the facility will be based in the free zone and forms part of a larger programme to establish specialist clinics and centres across the country, with other hospitals bearing the Sheikh’s name now completed in Ajman, Umm Al Quwain and Ras Al Khaimah. The facility in Sharjah will have 175 beds and inpatient facilities that include a 30-bed intensive care unit (ICU). Eight operating theatres will also be on site, along with a range of state-of-the-art accident and emergency departments. The new unit will help ease the load at Al Qasimi and Ajman’s Sheikh Khalifa hospital, which currently take the majority of accident cases in the two emirates. In August 2017 the SHA continued its promotion of the SHCC overseas, with the signing of a memorandum of understanding with the Arab-German Chamber of Commerce and Industry in Berlin. The agreement is part of its effort to develop a strong network of knowledge, practice and technologies.

Expanding Services

Elsewhere in the emirate, other developments include plans by the locally based Zulekha Healthcare Group to construct a 150-bed facility, that will be modelled on the entity’s Alexis Hospital, located in Nagpur, India. According to the January 2018 announcement, the facility will provide both primary and secondary care, along with day care and outpatient departments. Zulekha, which is also expanding its facilities in Dubai, was one of the first private health care operators in Sharjah, with the 30-bed Zulekha Hospital opened in 1992, which has expanded to become a 150-bed facility.

Additionally, in April 2017 the 120-bed MedCare Hospital opened in the emirate. The facility is part of the chain operated by Aster DM Healthcare and brings over 20 specialities together under one roof, including physiotherapy, nephrology and an emergency department. The hospital also offers a unique service in the emirate – online consultations as follow-up appointments. Another 2017 opening was the Thumbay Hospital Day Care Facility in Sharjah’s Rolla district, offering a range of day care options, as alternatives to more expensive hospital stays.

The emirate also offers a leading medical teaching and research facility with the UHS. Located on the campus of the University of Sharjah (UoS), this is now a 325-bed facility, with 22 ICU beds, seven operating theatres and 46 outpatient clinics, among other services. As a regional centre of excellence, it is able to leverage its relationship with UoS to ensure junior doctors are kept up to speed with new methods and procedures. Standardisation is important both for insurers and patients covering their own costs.

Getting Better

At UHS, for example, 70-75% of patients are covered with the remainder paying out of pocket for treatment. Systems are being improved to ensure that hospitals in Sharjah, and the UAE in general, have a standard rate for particular procedures and treatments. In recent years, a common, base price has been established in some areas, which is then subjected to a multiplier, calculated according to the quality of hospital services provided and other relevant factors. A diagnosis-based revenue group system is also under way, which will set a price for the total treatment package of a particular condition.

This will help to eliminate cost variance caused by differences in add-on fees, which can occur in areas such as longer inpatient stays or medication. Much work remains to be done, however, with prices for the same treatment still sometimes diverging considerably between facilities. One related area for improvement is in unification of patient databases across the country. Health facilities often lack any record of previous patient treatment and risk, making them difficult to assess medically and in terms of insurance premiums. The tendency has been for insurers and hospitals to charge for a worst-case scenario, driving up prices. Meanwhile, the regulatory framework continues to strengthen. New rules on professional negligence and indemnity have now been implemented, making it mandatory for hospitals and their doctors to be insured against such issues. This has reduced risk greatly, with previous penalties often threatening to close uninsured facilities.

Going forward, the emirate’s health insurance system is also likely to change considerably. The mandatory health coverage currently in place for state employees and their families is likely to be expanded to the private sector in the years ahead, following the lead of neighbouring emirates. This move would bring many uninsured into the system, creating a boost in volume that could potentially drive down costs. However, many details remain to be determined regarding implementation. A rise in the of number of patients will have to be met with an expansion of facilities, particularly of a basic kind, with some grading of hospitals also likely to allow top-end facilities to maintain their level of care. The year ahead will likely see further debate on this issue.

Outlook

The sector is undoubtedly facing major expansion, as a growing population, the potential introduction of mandatory insurance coverage and the support of the sector by the government and its ruler take effect. New hospitals, clinics, facilities for training and ancillary industries are all set to be further boosted by these developments. However, Sharjah is not alone in trying to enhance its health care industry and finding the right combination to distinguish itself from neighbours will continue to exercise minds in the coming years, with specialisation and greater service quality to be likely pathways.