1. 1 The Experience of Private Hospitals In the Republic of Yemen Success and Problems Dr. Ali K. Abbas Yemen International Health & Education Consultants

2. 2 Introduction: Yemen just like many other developing countries has provided health care services free of charge for a long period of time In early 1990s: –Continuous increase in the magnitude and variety of health problems. –Unprecedented rates of population. –Increasing demand for quality and quantity of health services. – Shortage of financial resources.

3. 3 Decision: MOPH&P has approved the ownership of health facilities by non-health staff INVESTORs

4. 4 Main positive aspects: Increase access to basic services. Better access to modern health facilities for more people. Provide services which are not cost effective for the public hospitals. Reduce excessive demand for public services (more funds available for under-served areas and preventive services).

5. 5 Limitations: Private providers will locate in the most profitable area and concentrate in urban centers. Prices in the private hospitals are usually higher than public hospitals making access to the poor difficult. Private providers will not provide sufficient preventive care and unpopular health advices. Little interest in training and updating knowledge and skills of their staff, if there are costs involved.

6. 6 Adverse effects: Reinforce existing inequalities in access to health services between regions (urban/rural). Reinforce inequalities within household income levels. Drain the public hospitals of qualified staff. May enhance medical mal practice.

7. 7 The Mandate of the MOPH&P: It is the responsibility of MOPH&P to actively influence the development of the private sector: Influencing the regional distribution of health care providers (incentives and restrictions). Controlling quality and efficiency and enforcing norms and standards.

8. 8 The first and most important step… To influence and strengthen The private sector … is the presence of: Laws and Regulations …Norms and Standards ….

9. 9 Legalization: At the beginning: The MOPH used an article in the Law of Medical Practice for licensing private facilities. At the same time, the Public Investment Corporation was able to license private health facilities with 15 day notice to the MOPH. Because of lack of clear and comprehensive regulations and problems in licensing, monitoring and quality of health services

10. 10 On the 29 th of December 1999: The President of the republic of Yemen has signed the Law No. (60) Private Medical and Health Establishments

11. 11 Law No. (60) for 1999: Private Medical and Health Establishment is: any place made for examining and/or treating and/or nursing and/or dispensing pharmaceutical products to patients and those places contributing to the provision of primary health care services This include: Hospitals, polyclinics, medical centers, radiological centers, medical laboratories, athletic medical centers, audio and visual medical centers, rehabilitation and physiotherapy centers, tooth laboratories, private clinics, pharmacies …etc

12. 12 Main objectives of the Law: Organize the services of the private medical and health establishments according to: modern scientific and technical regulations and standards Strengthen the process of monitoring and check up. Distribute private health and medical services in the rural and urban areas. Participate in promoting health education and the provision of PHCS.

13. 13 There two important articles in this Law: A37: The law gives the existing medical and health establishments one year to follow the technical regulations and three years to follow the physical regulations. A41: Determines that the cabinet should issue an executive bylaw that includes the technical and physical standards for all private medical and health establishments

14. 14 Facts for life: In many cases, there is lack of confidence and poor communication between the private and public sectors … It is very important to understand that strengthening the public sectors capacity to regulate the private sector can well be in the best interest of both sides. Responsible private health service providers will benefit from standards when this keeps unqualified competition out of the business

15. 15 In Yemen just like many other countries… * The executive BYLAWS has not been fully identified issued neither been implemented. * Neither Technical nor Physical norms and standards has been developed * The (3) years has passed with no real changes in the situation of the private sector.

16. 16 Dr. Khalid Al-Kuhlani Unfortunately, a vulnerable law, failed to meet the purpose of its issuance, was enacted. ?????? There was no control and following up on these establishments neither by the MOPH&P nor by the related authorities. The existed private medical establishments neither have met the needs nor supplemented the existing shortage These establishments have changed into mere profitable institutions seeking only quick and fast profits without paying any attention to the quality and efficiency of the medical services.

17. 17 Conclusion: The private sector is presently largely unregulated There is enough anecdotal evidence available to conclude that quality and safety standards in the private sector are LOW

18. 18 Opportunities: * Private (fee-taking) for profit hospitals and other health facilities in 1998 estimated to be around 9500 establishment in the country, 550 out of which were hospitals (with uncertain number of beds). * During the last few years, many hospitals has been closed and new bigger and better hospitals has been opened and there are still few more to be established.

19. 19 Hopefully: * The good and efficient services will force the worse to either get better or step a side for the best interest of the customer… * The main opportunity available to improve the quality of health services is in wider competition rather than laws and regulation enforcement.