1. Health System in Saudi Arabia CHP300: Community Health Program-l Mohamed M. B. Alnoor

2. Health System in Saudi Arabia To know why should a medical student understand the health system To understand what is a health system To know the components of a health system To Know the strengths and weaknesses of the current health system To Know the Cooperative Health Insurance in KSA To know the challenges facing the current Saudi health system To know the future changes in the Saudi Health System Strategy Lecture Objectives

3. Health System in Saudi Arabia Lecture Objectives Why should a medical student understand the health system You belong to it (you are part of the system) To participate in the system’s improvement process To understand the medico-legal aspects of patient care

4. Health System in Saudi Arabia What is Health: Definitions Health System (WHO) 1948 “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”

5. Health System in Saudi Arabia Definitions What is a Health System ? A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. Health System What is a System ? A SET OF INTERRELATED AND INDEPENDENT PARTS DESIGNED TO ACHIEVE A SET OF GOALS.

6. Health System in Saudi Arabia A health system needs to provide services that are:  Responsive,  Financially fair,  Treating people decently. (WHO) Health System Needs

7. Health System in Saudi Arabia  information,  staff,  funds,  communication,  supplies,  transport, and  overall guidance and direction. Health System Needs A health system needs

8. Health System in Saudi Arabia  Financing Resources  Legislative Authorities  Health Regulators  Health Care Providers  Human Resources  Medical supplies providers  Pharmaceutical producers  Judiciary Services Health System: Components

9. Health System in Saudi Arabia Financing Resources:  Governmental 5.9% of GNP in 2006.  Out of pocket.  Charity.  Donation. Health System: Components

10. Health System in Saudi Arabia Legislative Authorities: The Royal Cabinet:  Al Shora Council  The Bureau of Experts Health System: Components

11. Health System in Saudi Arabia Health Regulators: The National Organizations:  The National Health Council  Ministry of health  The Saudi Commission for Health Specialties  Council of Co-operative Health Insurance  The Saudi Food and Drug Authority Health System: Components

12. Health System in Saudi Arabia Health Care Providers: Ministry of Health Ministry of Defense and Aviation National Guards Ministry of Interior Specialized Hospitals (KFSH, KKESH) Universities (Ministry of Higher Education) Health System: Components

13. Health System in Saudi Arabia Health Care Providers: Ministry of Social welfare The Private Health Providers The big Companies: Saudi Aramco, SABIC, Saudi Electric Company, Saudi Airlines Charity Health Providers The Saudi Red Crescent Health System: Components

14. Health System in Saudi Arabia Health Care Providers: MOH 58.5% Private Sector 23 % Other Governmental Sectors 18.7% Hospital Beds distribution according to sectors Source: MOH Annual report 2007 Health System: Components

15. Health System in Saudi Arabia 14271409 SECTOR # OF BEDS # OF HOSPI TALS # OF BEDS # OF HOSPI TALS 31 87722025 918162MINISTRY of HEALTH 10 257396 59230OTHER GOVERNM. 12 5901276 44561PRIVATE SECTOR 5472438638 955253TOTAL Health Care Providers: Health System: Components

16. Health System in Saudi Arabia Health Care Providers: PRIMARY HEALTH CARE SECONDARY HEALTH CARE TERIEARY HEALTH CARE Level of Care >2000 Around 400 Health System: Components

17. Health System in Saudi Arabia Human Resources:  Professionals  Nationalities  Gender  Cultural Backgrounds Health System: Components

18. Health System in Saudi Arabia Medical supplies providers: Medical supplies (consumables) Medical Equipment Medical Instruments Medical Devices Around 30 Medical Supplies Factories in KSA Health System: Components

19. Health System in Saudi Arabia Pharmaceutical Producers: Medications Medical Solutions Immunizations Health System: Components

20. Judiciary Services  Committee for Private sector violations  Medico-legal committee.  Health Insurance Violation Committee Health System in Saudi Arabia Health System: Components

21. Health System in Saudi Arabia Ministry of Health Organizational Chart

22. Health System in Saudi Arabia Ministry of Health Organizational Chart الوزير وكيل الوزارة للشئون التنفيذية وكيل الوزارة للتخطيط و التطوير وكيل الوزارة المساعد للطب الوقائى وكيل الوزارة المساعد للطب العلاجى وكيل الوزارة المساعد لاعداد و تطوير القوى العاملة وكيل الوزارة المساعد للتخطيط و البحوث

23. Health System in Saudi Arabia Distribution of Provinces (13)

24. Health System in Saudi Arabia Province Organizational Chart

25. Health System in Saudi Arabia Province Organizational Chart للشئون الصحية المدير العام ادارة الاعلام و التوعية الصحية اللجنة الطبية الشرعية ادارة المتابعة الفنية المستشارين الادارى و الفنى لجنة المخلفات الطبية ادارة ضمان الجودة المساعد للتخطيط و التطوير المساعد للمستشفيات المساعد للتموين الطبى المساعد المالى والادارى المساعد للرعاية الصحية الأولية المساعد للتخطيط و التطوير

26. Health System in Saudi Arabia Role of Provincial Health Director Manage Patient Care Supervise the private sector Supervise reporting of infectious diseases among all health providers Co-operate with health related agencies Participate in the health development planning

27. Health System in Saudi Arabia STRENGTHS AND WEAKNESSES OF THE CURRENT HEALTH SYSTEM Strengths: Universal (covers everybody) (NHS) Accessible Comprehensive ( primary, secondary and tertiary) Safe Equitable

28. Health System in Saudi Arabia Weaknesses:  Single source financing dependent  Multi - sectoral: o Duplication of services among Providers o Difficult to Co-ordinate o Waste of resources STRENGTHS AND WEAKNESSES OF THE CURRENT HEALTH SYSTEM

29. Health System in Saudi Arabia CHALLENGES FACING THE CURRENT HEALTH SYSTEM  Financial 1956: 39.549.458 SR 1958: 68.480.000 SR 1960: 116.395.000 SR 2009: 40.43 billion SR 2010: 61.20 billion SR 2011: 68.70 billion SR Budget allocated to the health sector by the Ministry of Health :

30. Health System in Saudi Arabia CHALLENGES FACING THE CURRENT HEALTH SYSTEM  Financial  Data for decision-making/policy-making.  Manpower  Population:  Growth  Aging  Demanding  Changes in Disease patterns (NCD)  New medical technologies and new medications

31. Health System in Saudi Arabia  The overall development boom  Population growth of 3.1% per annum  Expatriate workers ( seven millions)  Increased demand on health services  Rise in the cost of health care HIGH COST OF HAELTH CARE

32. Health System in Saudi Arabia A delivery system that prevents abuse and excessive use a managed health care model, under the Cooperative Health Insurance HIGH COST OF HAELTH CARE

33. Health System in Saudi Arabia Islamic Cooperative Insurance (Takaful) Sudan in 1979 and Malaysia in 1984 Followed by : Indonesia Brunei Saudi Arabia Bahrain Qatar. Health Insurance The Cooperative Health Insurance in KSA Recently, UAE, Kuwait, Egypt and Bangladesh

34. Health System in Saudi Arabia Act and Laws 1985 : Royal Decree No (M/5) 1999, Cooperative Health Insurance Act. Based on Islamic ‘Takaful’ Aimed at covering ultimately the whole Saudi and non Saudi population. Health Insurance The Cooperative Health Insurance in KSA(Takaful) 2003: control law of cooperative insurance companies. 2005: compulsory for all non-Saudis(private sector) 2008: included Saudis (private sector ) May 2009: bylaws were declared

35. Health System in Saudi Arabia Pros and Cons Pros H.I. became the largest insurance business: By 2011: 8.3 million health insured individuals, 2,147 Health Care Providers accredited 26 Health Ins. Co. certified Future : 2011-2020: up to 40,000 job opportunities. 2016: will be worth US$18 Billion. Health Insurance The Cooperative Health Insurance in KSA(Takaful) Cons Continuous increase of health care cost Lack of compliance with the Shariaa laws

36. Health System in Saudi Arabia

37. Proposed Health Reforms 1] Sectoral coordination: (National Health Services Council ) 2] Health manpower (Labor Force Council in Saudi Arabia) 3] Financing health care Future changes in the Saudi Health System Strategy

38. Health System in Saudi Arabia Proposed Health Reforms 4] The function of the Ministry of Health 5] Relevant Data and Statistics 6] Improve the Pharmaceutical Sector Future changes in the Saudi Health System Strategy

39. Health System in Saudi Arabia The function of the Ministry of Health Future changes in the Saudi Health System Strategy Develop and supervise enforcement of regulations and control rules Continue to provide public health services and primary health care services Ensure that the disadvantaged categories have continued access to adequate health care Establish and supervise the implementation of strategies and general plans.

40. Health System in Saudi Arabia 1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Ensure competent public and personal health care workforces. 9. Evaluate effectiveness, accessibility, and quality of personal and population- based health services. 10. Research for new insights and innovative solutions to health problems. The 10 Essential Public Health Services: