Background and Scope of the Project

Over the course of the past decades, robust earnings for the Gulf Cooperation Council states have led to increasing state-led development in many different socioeconomic sectors. Along with investing in their productive sectors, the GCC states have also been investing substantially in strengthening the social sectors of education, human capital development, and healthcare. Each of the six countries has undertaken robust efforts to build infrastructure, to expand and modernize educational and healthcare systems, and to provide social and health services which are commensurate with national needs and with citizens’ expectations. While estimates vary greatly between different sources, currently health-care related spending in the GCC is estimated at approximately $25 billion, with projected growth in demand indicating that by 2015 this will need to increase to $44 billion and by 2025 to $60 billion.

While the Gulf states have devoted considerable efforts to boosting the healthcare sector, the region still does not match other developed nations in terms of infrastructure and capacity. This is at a time when the GCC states face a number of healthcare challenges, and across all six states policymaking reflects the rising concern over the escalating demand for quality healthcare and the mounting economic burden to the state. Despite these improvements in healthcare outcomes, rapid population growth, higher rates of life expectancy and an aging population, along with increases in certain health conditions prevalent in the region have brought to the fore the need for more focused state intervention. Additionally, citizens in the GCC have heightened expectations of the quality and standard of national healthcare provision. While the approaches, plans, long-term visions, and strategies for improving national healthcare vary amongst the six GCC countries, in each case the role of the state has been instrumental.

Rapid changes to the environment and lifestyle of the Gulf over the course of mere decades have completely changed the health profile of the region. While major successes in combating infectious diseases and improving standards of primary healthcare have been reflected in key health indicators—such as the decreasing levels of infant and maternal mortality rates and dramatic increases to life expectancy—new patterns and trends in healthcare have emerged which pose different and yet significant challenges. Increasingly in the Gulf we see the appearance of “lifestyle” or “wealthy country” diseases such as the chronic conditions of diabetes, heart disease and cancer, usually associated with highly developed nations. These new challenges require highly trained and skilled healthcare workers, and an environment that supports local training, state of the art diagnostic laboratories, research production and dissemination, and knowledge acquisition to meet emerging healthcare needs.

The demographics of the region also impact on the needs and conditions of the healthcare system. Bifurcation of the population into the categories of nationals and highly skilled expatriates with greater disposable incomes, and the large numbers of low income migrant workers creates different health profiles and needs for different segments of the populace. In the Gulf states the healthcare field is currently dominated by expatriate expertise. Public health professionals have drawn attention to the critical need for the GCC to develop national and regional expertise in healthcare management. Many regional states have recently established state-of-the-art medical teaching and training programs, specifically designed to build a national cadre of health professionals. It is also essential to build national expertise in management of healthcare. Medical technology remains a key determinant of strong healthcare systems, so additional areas such as research and development are pivotal to new strategies developed by the states.

Healthcare costs for GCC national to date have been primarily borne by their governments, and this has become a major challenge for the state. Particularly in the wealthier states of Qatar and the UAE, most nationals prefer to receive medical treatment abroad instead of relying on the national healthcare system, an undertaking that in most cases is funded by the state. This has substantially increased the burden of healthcare costs for the state. With the increasing costs associated with healthcare provision, we see a shift across the region, as governments move from the traditional approach of publically-run healthcare to alternate models. Some of the Gulf states have been trying to make the healthcare sector more attractive for private actors. It is assumed that if the governments, by providing infrastructure and a strengthened regulatory environment, create a more enabling environment for the private sector, they can play a more active role in managing regional healthcare needs. However, it is unclear whether the governments envision a complete departure from the current state-led healthcare system. It may be that the governments would like to support a role for the private sector, while still retaining the core responsibility for healthcare provision.

While recent scholarship has drawn attention to educational developments in the Gulf states, social scientists have so far paid scant attention to the ways in which the region is developing policies and practices in the area of healthcare management. In order to promote rigorous, academic exploration of this subject, CIRS is launching a new research project on the topic of “Healthcare Policy and Politics in the Gulf States”. The purpose of the CIRS research initiative is to determine the economic, political, and social implications of healthcare management in the region. A focused examination of healthcare in the Gulf needs to devote attention to three primary areas of consideration; the healthcare environment, healthcare delivery, and healthcare economics. Employing a multi-disciplinary perspective this project will examine existing conditions of healthcare systems in the GCC, identify the existing challenges and pressures on the countries and societies, and assess how through their policymaking apparatus states are attempting to meet these challenges.

Some of the thematic topics and areas of inquiry we will address through this research endeavor include:

The Gulf states have undertaken a range of initiatives to reform national healthcare systems. What are the implications of these changes to health access and quality for divergent groups of the population?
The burden of managing the economics of regional healthcare has been to date upon the public sector. However, recently each of the Gulf states has initiated programs to invigorate private sector actors. How will privatization and health insurance help meet the challenges of the looming epidemic of diabetes, heart disease and cancer?
Issues of workforce quantity and quality are of concern for countries in the region, as are those of creating regulatory standards that govern entry into practice and continued competence. But is regulatory standard setting the only ingredient required to create a strong healthcare workforce? Or do other steps need to be taken?
Does the GCC have a false sense of security when it comes to infectious disease? Given the recent spate of global epidemics and the strain on countries caught off guard, is the GCC making adequate efforts to prepare for these sorts of health emergencies?
What are the diverging patterns of availability and access to healthcare in the GCC states? Little information is available on migrant workers health needs, and how they access health care system.
There is also a need to address the social and medical implications of other areas of healthcare, in particular affecting vulnerable groups, such as those suffering from mental illness, substance abuse and addiction, and early childhood development issues.
Reform is also needed to expand emergency medical care in the Gulf. How are emergency medical services being reformed, and what are particular challenges to the region? Motor vehicle injuries and emergency care is a critical issue.

Article by Zahra Babar, Assistant Director of Research at CIRS