Healthcare providers and governments in the GCC region have partnered with U.S. health systems to design and implement a variety of initiatives aimed at ensuring access to high-quality speciality care locally, decreasing the number of patients with complex care needs who need to travel abroad.
Women’s health has been an issue for a long time, but the products and services have not evolved more than menstruation care, fertility, and mother and child wellness. However, women’s health today has to revolve around factors such as mental health (women have five times more mental health issues than men), cardiac care (women have three times more heart attacks compared to men) or focus on care for autoimmune disease (women are seven times more vulnerable to it than men). This is where Femtech (Female Technology) comes in. It refers to diagnostics, therapeutics, drugs, apps, and wearables that empower women to control their own body.
Based in the U.S., Reenita Das, Partner and Senior Vice President, Transformational Health, Frost & Sullivan, was recently named in the Top 100 Women in Wearable and Consumer Tech by Women of Wearables. She has two big passions. One is to change the healthcare system so that it pays attention to wellness; the second is to focus on women in STEM (Science, Technology, Engineering and Math).
In an interview with Arab Health Magazine, Das shared that she has been in the healthcare business for the past 25 years and always wanted to work in areas that would have an impact and where she could make a difference. “I was always a curious person by nature and loved to ask questions, to study and find answers. As I started working in many industries, I felt that healthcare had the biggest reward because it dealt with human beings and talks about changing behaviour, wellness and is just an inspiring area to work in,” she said.
Das started working in the area of Femtech because she felt that women had no voice in terms of healthcare products and services. “Most products, devices or drugs are not tested on women and always have large audiences of men, whereas 50 per cent of the economy is women,” she said. “Secondly, we are reaching a world where we are going to be dominated by SHEconomy. It means that women will generate an economic value close to US$24 billion by the next two to three years, which is more than the GDP of China and the U.S.!”
Today, almost 30 per cent to 40 per cent of women own businesses, 20 per cent of the global wealth is in the hands of women, and yet, as a group, they are not advancing in terms of healthcare. Because of this, Das emphasised, she is doing a lot of work in building awareness around Femtech and is trying to help in efficiently navigating the system so women can have access to better products.
“The difference between women’s health and Femtech is that it puts the power back to women. It is going to be a huge sector,” Das said. “We have done a lot of research within it. It is going to be about US$50 billion according to our projections, and a large part of the sector is going to be apps and wearables. There are also a lot of women-driven companies. Whether it is an island in Europe, Australia, or the U.S., women are coming together much stronger and it is becoming a global movement. I am very excited about Femtech, as it is a big area driving much-needed change.”
"We are reaching a world where we are going to be dominated by SHEconomy. It means that women will generate an economic value close to US$24 billion by the next two to three years."
Das is also the founder of GLOW (Growth, Innovation and Leadership of Women) at Frost & Sullivan. She started the initiative after becoming the first woman partner in the company. That was when she realised that her work had just begun and that it was the first step towards having a female voice at the table.
“Gender diversity is a big issue today. I realised that I had to do something for the billions of women who have not been heard yet,” she said. “I felt that women need a different approach when it comes to mentoring and networking. Women don’t network as much as men; we don’t have a girl’s club and usually end up competing with other women instead of supporting them. We don’t know what girl power is! That’s why I started GLOW. We are doing a lot of work in training and mentoring within Frost & Sullivan and have globalised it across the world. My goal is to eventually create a non-profit and take it outside the company.”
Das also stressed that the number of girls opting for STEM fields is quite low in the U.S. She is a board member of an organisation called High-Tech, High Heels (HTHH) that helps to get young girls interested in STEM.
“We are working in middle schools in Silicon Valley and are running programmes to help young girls think positively and get them to build apps, go out and pitch, and work on projects that are close to their heart, but it is all computer-, engineering-, or math-based. We are trying to change the perception that STEM is nerdy, only for boys, or uncool,” she concluded.
Das highlights several developments that are set to transform the healthcare industry.
AI in medical imaging: The industry will see some applications that will go a long way in reducing radiologists’ time.
Value-based care: This will involve looking at outcomes and value to the consumer and the environment, rather than volume. Instead of just selling a product and saying this is the price of the product, the sale of the product is going to be tied to the outcome. Almost 15 per cent of the healthcare expenditure globally is going towards value-based healthcare.
R&D: Asia is becoming a Research and Development (R&D) hub overall for manufacturing. Twenty per cent of R&D is going to come out of Asia rather than the Western countries.
Voice: It is becoming a big area in healthcare. With Alexa becoming Health Insurance Portability and Accountability Act (HIPAA)-compliant, it will be a great tool not only for physicians but also for patients.
Home care: Home is soon going to become the new clinic around the world, and this is an area that the UAE is starting to focus on.
Blockchain: The technology can be useful for clinical trials because it provides visible and transparent information about what trials are running, what results are being achieved, what types of patients are enrolling, and if there is any gender bias. Eventually, in the coming years, blockchain is all set to move to a stage where everyone will own their medical records, instead of a doctor or insurance company owning the information.
Recently, RAK Hospital’s diabetes care team introduced a pocket-sized diabetes passport that illustrates important checkpoints for a patient, such as, blood pressure, body weight, feet examination, glycated haemoglobin, lipid profile, kidney, liver function, uric acid, as well as annual eye, peripheral nerves and cardiac examination.
The goals of these indicators are defined in the diabetes passport as well as how often the patient should perform these tests. These individual goals are determined for the patient personally by their physician. The passport contains a list of all current medications, possible allergies, and the name and telephone number of the physician. A reminder of the annual flu-vaccination is also included.
As a result the patient is well informed, can track the progress of their blood glucose, kidney status, cholesterol levels, performance of the annual peripheral nerve studies for both small fibres of the nerves utilising a non-invasive tool such as Sudoscan and large nerve fibres, cardiac and eye exam, and is therefore well informed about the standard of the diabetes care given and confident that they will be taken care of.
Diabetes mellitus is a chronic disease characterised by chronic elevation of blood glucose level. According to the recent International Diabetes Federation, the prevalence of diabetes, especially type 2, is progressively reaching epidemic proportions. At present, nearly 425 million people live with diabetes; this number is projected to rise by 48 per cent to 629 million by the year 2045.
Low- and middle-income countries carry almost 80 per cent of the diabetes burden. In the Middle East and North Africa (MENA) region, the prevalence of diabetes is projected to rise by 110 per cent by the year 2045. Studies have revealed that 17.3 per cent of the UAE population between the ages of 20 and 79 have been diagnosed with type 2 diabetes. Rapid urbanisation, unhealthy diets and increasingly sedentary lifestyles have resulted in previously unheard higher rates of obesity and diabetes.
What makes the situation more frightening is the fact that undiagnosed and poorly managed diabetes is associated with long-term specific complications to the small blood vessels that lead to eye, kidney, and peripheral nerve diseases, which are the leading causes of blindness, end-stage renal failure and lower limbs amputations. In comparison with people without diabetes, patients with diabetes have a fourfold increase in the occurrence of cardiovascular disorders manifested as heart attacks, stroke, and peripheral gangrene. Being a chronic disease, diabetes causes devastating personal suffering, huge economic burden both to the families and healthcare systems.
The passport contains a list of all current medications, possible allergies, and the name and telephone number of the physician. A reminder of the annual flu-vaccination is also included.
However, prospective studies have confirmed that comprehensive care for patients with diabetes where control of blood glucose is implemented together with screening for microvascular complications to the eyes, kidney, peripheral nerves for early detection of abnormalities, and early treatment, resulted in a considerable reduction in the rates of these diabetes-specific complications. Additionally, screening for cardiovascular risk factors in patients with diabetes such as hyperlipidaemia, hypertension, advocating a healthy lifestyle and smoking cessation resulted in prevention of major cardiovascular events.
As such, diabetes management requires continuous comprehensive medical care with multifactorial risk-reduction strategies beyond glycaemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications.
Optimal diabetes management requires an organised, systematic approach and the involvement of a coordinated team of dedicated healthcare professionals such as an endocrinologist, diabetologist, nutritionist, diabetes educator, podiatrist, ophthalmologist, cardiologist, and neurologist, working together in an environment where patient-centred high-quality care is a priority.
And this is precisely our goal at the RAK Hospital Diabetes centre. We define patient-centred care as care that is respectful and responsive to individual patient preferences, needs, and values and that ensures that patient values guide all clinical decisions. Part of the Arabian Healthcare Group, RAK Hospital’s diabetes care programme for patients with diabetes aims at excellence in holistic diabetes care guided by the most recent and continuously updated international guidelines for the care of diabetes. Through this programme, all attendees with diabetes mellitus are addressed and are reminded of their regular health check-ups and annual comprehensive physical and biochemical examinations.
“RAK Diabetes Centre has invested millions in this initiative with the sole purpose of creating a diabetes-controlled UAE, and in effect a healthier environment for both adults and children. We aim to help control a disease that is not only the root of several other ailments but eventually a severe burden on the health budget of any country,” says Raza Siddiqui, CEO, Arabian Healthcare Group.
Introduction of computation in the healthcare field has opened the gate for continuous amazing discoveries in modern medicine and improved diagnostic and therapeutic approaches. Predictive computational modelling is used in different fields, such as marketing, weather forecasting, and resource management. While there is a great need for accurate and prompt intervention to treat many diseases, healthcare providers are reluctant in using computational models in their daily work to manage their patients. That is, however, understandable because they are worried about the accuracy of such models, especially if the prediction may suggest shifting the patient’s therapeutic regime one way or another. In this article, I aim to explore the types of computational models, and how a clinician can build a successful model, which they may use as an irreplaceable tool in their daily patient care routine.
A model is built to simulate how a system works, like building a model airplane or a car. So, using the computer to build a model that simulates the functions of a system (how it works) is generally what a computational model is. The model’s concept is built on a scientific basis, which may include mathematical equations, statistical analysis, or biomedical rules obtained from scientific literature or a combination of different scientific disciplines. A model does not have to be an exact replica of the system it aims to simulate, it just needs to simulate simply how it works and produce the outcomes in a manner like the original system or close enough to provide a useful understanding for the user about the process in order to take a proactive approach in anticipation to the outcome of the simulation. A model aircraft or a model car does not have to have an AC or a top of the line sound system to simulate the damage of a car crash or how air turbulence affects the stability of an aircraft.
Computational models have many appealing benefits for healthcare providers and health researchers. Computational models can be used to perform In-silico experiments. When a model is valid and well-designed, it can perform thousands of simulations in a short time and at negligible cost. For example, a model simulating the response of cancer cells to treatment can run many simulations in minutes costing only the hardware, compared to performing actual wet-labs experiments that require funding and hundreds of hours to perform the same experiments. Computational simulations can help in testing medications in the safe – virtual – environment; it can also bring different understandings into the causative factors of different physiological processes or triggering factors in disease conditions.
As healthcare professionals, we have a common preconception that this computational model is beyond our understanding or capability. That notion is inaccurate because many of the successful health-related computational models are built by teams that involve health professionals who do not have any programming skills or technical expertise.
There are different methods to design computational models. Conventional methods are mathematical, statistical, or agent-based models. It is essential to choose the proper approach carefully to simulate the system or the condition of interest.
Mathematical models are designed based on complex mathematical equations. The equations are used to estimate and calculate the parameters of the factors involved in the simulation. Those models require a professional mathematician in the team to create the appropriate equations.
Statistical models use statistical methods such as regression analysis or ordinary differential equation to determine the most relevant factors involved in the system to include them in the model. Statistically based models require a large sample size during the factors’ analysis and later during the training of the model. Statistical-based methods can be used to create models that analyse x-rays, or radiological images, to diagnose bone fractures or brain tumours.
Agent-based models (ABM) treat the active components in a system as agents. Each agent has a life-span, rules of interactions with other agents, and specific attributes. ABM’s require to have the system or the process to be simulated well-understood in the literature. It is better to build the model using the most accurate parameter values from the literature and have a professional on the subject who works closely with the team – or a part of it – in order to have the proper model’s design. ABM has been used to simulate many systems that range from cellular interactions and wound healing to the simulation of disease spread in a community.
Like any research project, a thorough literature review is required to understand the process or the system in interest. The process must be generally explained well enough to build a sound model. Not all the details are required nor are expected to be available in the literature. If we want to simulate the digestion of a material in the stomach, for example, we will find some missing values such as the amount of enzymes or acidic secretions required to digest a gram of the material. This is when we need to go and start building the equations to estimate that number. If the process is not well-explained in the literature, the design step is going to be difficult, and the model will be criticised for being a technical experiment rather than a health directed solution.
After having the process mapped with all the steps and values, select the proper design method according to the resources available. A healthcare professional who is an expert on the system or process being simulated is an important member of the team. Such an individual can advise the team and provide the much-required feedback to ensure the model’s design credibility.
A healthcare professional who is an expert on the system or process being simulated is an important member of the team.
The computational model, like any other software tool, requires much testing to ensure that the model is appropriately running. It may be a good idea to perform usability tests to make it more acceptable for healthcare providers.
The most important step comes next: validation. The team must carefully determine the proper approach to validating the model. In many cases, where the model is simulating a disease condition or a response to treatment, there must be a proper sample of actual cases available. For example, if we aim to simulate the effect of a drug on reducing the inflammation, we must have recorded cases of individuals who received that drug (control) and compare the outcome to the virtual case where the virtual patient is matching the criteria of the control. By comparing the outcome values of the simulation, e.g., inflammatory cells, body temperature to the reported values from the case, and statistically comparing the results using the proper tests, the team can decide whether the model is valid or not. The validation process must be performed and well documented. The model must also go through the other steps for any tool, meaning: reliability, sensitivity, and specificity.
Finally, like any software, the model must be updated and tested regularly. Adding or removing factors in simulations, testing new drugs, or other required changes due to new information available in the literature helps to keep the model trust-worthy by the clinicians and users alike.
Computational models and simulations are being used in all industries but are not well utilised in healthcare. We should move in and take this solution and create our models instead of waiting for companies to sell us packaged solutions that will need many customisations. In this article, we simply reviewed the general concepts and requirements for health professionals to build their model. Health professionals – it is time about time to build our own computational models, and its that simple.
References available on request.
Despite the advances and improvement in promoting patient safety and quality of care around the world, these issues remain an important public health challenge. Research and policy development have shown that tackling this is much more complex than previously thought. In addition, the pressure on healthcare organisations to have greater accountability and deliver better outcomes, for less cost has created a new paradigm in the process of transforming healthcare around the world. This is compounded by a global shift in health focus with ageing populations and the rise of chronic diseases, which are shifting the focus of the healthcare industry away from curing diseases in the short term and moving towards the long-term improvement of outcomes.
This type of evolution will require a shift in the way governments, providers, payers and others interact, therefore moving to integrated healthcare delivery systems to coordinate care and services for all patients, including the most vulnerable. There are four major elements that are fundamental for the transformation of healthcare – Quality, Safety, Value-Based Healthcare and Outcomes.
There has been a steady rise in the cost of care without a parallel, measurable increase in the quality of the healthcare delivered to patients. This has led to a situation of low-value care and for a demand to change into an evidence and value-based healthcare system.
The drive for providers delivering healthcare based on facts and disease-specific, sound research has grown dramatically and is expected to continue on a global basis. This is essentially founded on the demands of a much more educated patient, payors and government agencies asking healthcare organisations to be more accountable for their outcomes.
For healthcare organisations wanting to improve quality with value-based delivery of care, there needs to be an environment of collaboration and team mentality. This means that providers must work together as a team, involve patients in order to provide ‘patient-centred” care, and create a situation that is appropriate to each individual’s overall needs. This strategic change has been shown to provide higher quality in the delivery of care; founded on a care experience for patients that is more focused, coordinated and ultimately more efficient.
One of the foundational elements of success with this strategy is for healthcare providers to “think outside” of their disconnected, “siloed” approach and encourage them to work within a community of providers utilising “best practices” in order to offer the most appropriate and cost-efficient care for patients.
Historically, change in healthcare has happened in a reactive, fragmented manner with each crisis that arises, as the primary driver for that change. A way of responding to the current changes occurring in healthcare is to consider every change an opportunity to influence the path an organisation desires to be on throughout their transformational journey.
Healthcare leaders are responsible to establish the path that their organisations will take, to that effect, one of the primary directives is to envision how patient safety will be in the future and how it will impact their respective organisation. In addition, they must foresee the changes needed between the present and the future in order for their vision to become reality.
With a macro-level view of where organisations need to strive to be, there are a number of initiatives that have to be undertaken in order for patient safety to not just be a priority, but to be a part of every moment that healthcare is delivered to a patient. These initiatives include:
A well-designed environment of healthcare delivery – needs to be safe, efficient, and designed to provide patients with healing aspects within the facility with advanced technologies that will support clinical care delivery. The environment will be safer by greater compliance with hand-hygiene guidelines, reduced patient falls and improved medication management. Construction materials need to be free of toxic materials and more effective in reducing contamination with infectious organisms. It is paramount that the development of this environment be throughout the organisation including the ambulatory setting.
The best way to ensure that the investments necessary for the development of these healthcare environments are commonplace, is the implementation of evidence-based design and the right investments for the organisational transformation. Likewise, there needs to be a revision of the usual accounting practices of separating operating and capital expenses, which make it difficult to implement strategies that optimise the life-cycle cost of a building.
Health Information Technology – provides a platform for healthcare organisations to establish solutions that will influence the speed and character of the technologic implementations. A direct interface between health information technology (HIT) and patient safety has been long established. This has evolved in the form of electronic medical records (EMRs), computerised physician order entry (CPOE), an electronic medication administration system (e-MAR) and electronic prescribing (eRx).
Four decades ago, the promise that HIT would make the delivery of healthcare safer, faster, better and more clinician friendly was a viable vision, yet, since that time our enthusiasm has stalled. In spite of the opportunities that HIT holds, we also have to be realistic of the difficulties in its interoperability, data standards and storage safety and how to best apply it for improving patient safety. Because we want HIT to provide us the long awaited and promised patient safety solutions, we often overlook the difficulties that technology amplifies or complicates. The IT industry needs to develop a digital infrastructure that provides healthcare organisations with data liquidity. This would allow for a common format that would support medical research, boost efficiency and improve patient safety.
A new collaborative relationship needs to develop between the companies that develop HIT systems and the global clinical community. Therefore, this new technology environment would keep patients safer and would ultimately promote the purchase of safer HIT systems that would be truly valuable to the transformation of healthcare organisations.
Patient-centred care – although many organisations around the world believe that they embody the definition of “patient-centred care” by delivering what patients say they want; it doesn’t completely represent safer care or the much broader concepts that “patient-centred care” embodies.
A model of co-creation and true partnership with patients is necessary to strengthen a culture of safety in a healthcare organisation. This relationship is based on mutual respect, trust, transparency, accountability and shared decision-making. This re-design of healthcare delivery will not just involve the patient and the healthcare team, but also take into account the patient’s perspective, thoughts, behaviour and of course participation. This new model can drive guidelines’ development, funding, solutions, ethical initiatives, research and policy development. All of these qualities of the healthcare delivery model will assure that the healthcare system is safe, compassionate, just and efficient.
A more comprehensive “patient-centred” programme needs to have a complete understanding of the dynamics of the communication of risk and the impact on patient engagement. In addition, a robust patient reporting system for medical errors, reengineering of safety solutions and best practices, with an unwavering support from executive leaders, will significantly contribute to patient safety.
Complex systems for the delivery of care – healthcare organisations must recognise that the delivery of clinical care is comprised of complex systems and, in order for an organisation to be able to transform itself, there needs to be a deep understanding of complex systems.
To be able to do this, clinicians, administrators and legislators have to consider the delivery of healthcare as a conglomerate of complex systems. These leaders must learn to have a “systems thinking” approach. This management style and thought process is necessary when designing and implementing evidence-based changes that are targeted toward reducing harm and improving safety for patients. This requires more than just adding new processes to an unchanged existing system. Often, it requires a system redesign to incorporate new functions in order to be efficient, reliable, effective and have sustainable changes.
There must be a prospective evaluation methodology based on a continuous vigilance, measuring processes and outcomes to identify early indicators of change. Once systems thinking has been implemented, clinical practice can become dramatically safer.
"A model of co-creation and true partnership with patients is necessary to strengthen a culture of safety in a healthcare organisation. This relationship is based on mutual respect, trust, transparency, accountability and shared decision-making." Dr. David Jaimovich
In order to change national health policies, improve the operational performance of healthcare organisations and further improve outcomes, there needs to be advances and alignment in policy reform, improving the health system and applying health management education to organisational practice.
Globally, there is a recognised movement towards an incentive-based performance structure for healthcare providers. This is the shaping of the framework for a Value-Based Payment (VPB) system for healthcare organisations and a Reward for Performance programme for clinicians.
Although health systems around the world have different organisational, ownership and payment structures, they are all facing significant macro-level drivers of change, including rapid dissemination of HIT systems, ageing populations, cutting-edge medical treatments, escalating healthcare costs and an increasing demand for improving performance and better outcomes.
One of the first interventions that are necessary for the change to begin, is for administrative healthcare leaders to receive management training in order to be effective systems leaders; gaining specific skills and competencies to assure effective organisational and system level performance. These new, learned competencies will provide these management leaders with the ability to have a value-based approach to a budgeting and payment framework.
These competencies usually fall within two domains: the health environment and the business of healthcare. Within the health environment competency domain, there are certain health systems and organisational competencies that are most important:
In addition, multiple business competencies are required. Special attention must be given to the financial management competencies, especially as follows:
A very important lesson that administrators must learn is the need to adapt to the important changes in healthcare financing. There must be greater emphasis in learning about healthcare performance improvement and the measurement and metrics that will determine whether the initiatives implemented have been successful.
In the U.S., the Centers for Medicare and Medicaid Services has introduced and implemented a new VBP programme. To be successful under this new programme, hospitals have to report and present on 12 separate metrics across four domains: Safety, Clinical Care, Person and Family Engagement and Efficiency and Cost Reduction. Although this VBP programme reflects the needs of the U.S. health system, the reasons driving these policies are globally applicable. There is worldwide concern about improving quality of care, patient safety, and cost reduction. Management leaders need to be prepared to understand the metrics implemented, the impact their goals will have on their health system and how consumerism will affect their long-term aspirations as a health system. These target metrics can be exploited to negotiate with payors, health insurance systems and Ministries of Health.
Excellent outcomes are essential to the survival and growth of all hospitals and healthcare systems around the world. To have excellent outcomes, organisations must continuously improve their delivery of care, which is increasingly more expensive, but failure to do so can be so much more expensive.
Healthcare administrators are universally facing the challenge to improve clinical outcomes in a cost-efficient manner. Improving outcomes means improving the health of the population, the patient experience of care, reducing the per capita cost of healthcare and improving the work life of healthcare providers.
This framework for improving healthcare delivery outcomes must consider all four of these dimensions, which, require a significant level of system change. To accomplish long-term, sustainable change and better outcomes, the appropriate balance amongst the four dimensions must be achieved.
Although, each improvement initiative may not embody all of these dimensions, creating a framework that shows meaningful context that each of these are essential for success. The improvement that is achieved needs to be visible and be relevant to the objectives and goals of the organisation. The information that is collected and the results that are attained must be disseminated throughout the organisation in order to align all associates and stakeholders with the institution’s priorities.
It is important that an organisation develop the capability to relate every outcome to these dimensions, although not all may be included in the proposed processes for success. The organisational ability to have data-driven solutions for improving outcomes is a key indicator of readiness for sustainable outcomes improvement. To be able to have solutions based on data, an organisation must define and establish clear measures of improvement before any initiatives are implemented. The organisation should focus on the most common categories of measures – process, structure and outcomes. An acronym that is helpful in explaining the goals and objectives of how success will be measured is SMART – Specific, Measurable, Actionable, Relevant, and Time-based. The SMART acronym first appeared in the November 1981 issue of Management Review published by George Doran and collaborators.
All of the above-mentioned initiatives – new payments based on outcomes, better care and reliable data that can be used by clinicians and the community, are transforming healthcare throughout the world. The changes occurring in healthcare today requires administrative and clinical leaders to be ready to take well-thought out risks in order to provide the healthcare consumer with excellent, evidence-based, outcomes driven personalised care.
The organisational ability to have data-driven solutions for improving outcomes is a key indicator of readiness for sustainable outcomes improvement.
The Kingdom of Saudi Arabia (KSA) with a current estimated population of approximately 32.6 million is the largest country in the GCC. Under Vision 2030, the country is going through fundamental structural changes in all the sectors including healthcare.
The healthcare sector in KSA is undergoing evolution on the back of rapid advancements in technology, research and development (R&D) in line with the global and regional trends. However, healthcare providers and professionals are grappling with several challenges concurrently, such as patients becoming customers and the patient care transitioning from “fee for quality” rather than “fee for service”. This coupled with new compliance requirements that aim at wellness and prevention plus ensuring better coordination and efficiencies, add depth and complexity to an increasingly competitive marketplace.
Recent trends and industry dynamics require operators in the healthcare sector to make challenging decisions. Whilst the healthcare system has improved across the region including Saudi Arabia, the sector offers opportunities for investors/operators. KSA’s healthcare sector is structured to provide a basic platform of healthcare services to all, with specialised treatment facilities offered at some private and public hospitals.
Colliers International’s KSA Healthcare Overview 2018 (the 8th in The Pulse series) provides an in-depth analysis of key factors impacting the Saudi healthcare sector and its future outlook and identifies opportunities and challenges to operators and investors.
Key factors that make KSA’s healthcare market attractive are:
KSA had an estimated population of 32.6 million in 2018, which is expected to double, reaching 77.2 million by 2050, growing at 2.65 per cent per annum. Assuming a more conservative 1.02 per cent average annual growth, as suggested by World Bank, KSA’s population would still reach 45.1 million by 2050.
This increase in population is expected to fuel the demand for healthcare services in the Kingdom. Concurrently, the healthcare system needs to treat emerging lifestyle diseases and illnesses associated with modern and urban lifestyle, partially due to the growing middle-income population.
The population pyramid in KSA has significantly changed between 1980 and 2015, and it will further change by 2050. This will have a significant impact on healthcare demand in terms of quality, quantity and type of healthcare facilities.
The changing population will have the following impact on demand for healthcare in KSA:
Analysing the demographic trends, it is estimated that KSA’s population will change from Baby Boomers to Generation X, Y & Z. This shift would impact disease patterns and in turn the type of healthcare services required. Lifestyle diseases (also sometimes called diseases of longevity or diseases of civilisation) are diseases that appear to increase in frequency as countries become more industrialised and life expectancy increases due to urbanisation and rising disposable income. A more sedentary, consumption of processed food often leads to increased chronic diseases (diabetes, coronary problems and obesity-related illnesses).
Diabetes: The rate of diabetes related illnesses has witnessed an unprecedented increase across the MENA Region. Based on figures available for 2014, there were over 422 million people diagnosed with diabetes in the world and MENA’s contribution was 38.7 million diabetic patients in 2017, which is expected to increase to over 70 million by 2024. In KSA during 2017, the diabetes prevalence rate was 17.75 per cent for age group 20-79 years, totalling to over 3.8 million cases.
Obesity: In 2016, KSA’s obesity prevalence rate among adults was 35.4 per cent, also one of the highest in the MENA region.
Hypertension: The prevalence of hypertension among adults in 2015 in KSA stood at 23.3 per cent, also one of highest in the GCC region.
In KSA during 2017, the diabetes prevalence rate was 17.75 per cent for age group 20-79 years, totalling to over 3.8 million cases.
In 2016, KSA had 2.23 beds per 1,000 population, which was quite low compared to world average of 2.7 beds per 1,000 population. Number of doctors per 1,000 population ratios of 2.83 is quite impressive, however, the Kingdom has high dependence on foreign physicians.
Colliers has projected the demand for total number of beds based on the following scenarios:
The government is encouraging private sector participation in the healthcare sector as the public sector’s role is gradually transitioned to becoming more of a regulator rather than as a provider of healthcare facilities, as highlighted in the National Transformation Programme (NTP) and the privatisation plan. In 2017, Saudi Arabian General Investment Authority (SAGIA) announced that foreign investors can have 100 per cent ownership in health and education sectors. Once implemented this is expected to boost private sector investment in healthcare in KSA.
Government commitment to healthcare is evident as it continues its efforts in developing various medical cities, however, many of these facilities are expected to be operated in conjunction with private sector investment using various Public Private Partnership (PPP) models.
The PPP draft bill released in July 2018 for public debate and comments, is expected to boost private investment in the Kingdom with the concurrent impact on the Saudi economy. The PPP draft bill is the beginnings of the legal framework on which the Saudi government can begin to outsource healthcare provision. The outsourcing is expected to be done through typical PPP projects for a fixed duration and/or selected disposal of government assets. The Saudi government stated its aim is to raise US$200 billion by 2030 through privatisation.
Based on demand/supply analysis and characteristics of the healthcare sector in KSA, Colliers has identified the following opportunities for investors and operators:
Daycare surgical centres: Due to advancements in healthcare technology (for example laparoscopy) a number of daycare surgeries (treatments/procedures) have significantly increased, resulting in higher demand for daycare surgery centres. The demand for daycare surgical centres has also increased regionally and in KSA, due to increase in prevalence of number of lifestyle diseases such as diabetes, obesity, depression, strokes, cardiovascular diseases, blood pressure, etc., which does not require treatment in traditional hospital set-ups. Dedicated purpose built daycare surgery centres and Centres of Excellence can be part of a large office complex and retail centres; requiring space between 3,000 to 5,000 sqm.
Demand for maternity and paediatrics: Number of private health facilities, especially in Riyadh and Jeddah are focusing on maternity and paediatrics owing to high demand for these specialties. Hospitals such as Dallah Hospital, Specialist Medical Centre and Dr. Sulaiman Al Habib have separate buildings dedicated for mother and child services. As per Colliers research, throughout KSA and especially Riyadh and Jeddah, there is a high demand for maternity and paediatric services supporting a business case for developing stand-alone hospitals or as part of a hospital complex.
Laboratory and diagnostic centre: Standalone laboratory and diagnostic centres are required in KSA to support the increasing volume of outpatient facilities. Long term care (LTC)/rehabilitation: With the changing age profile, KSA requires a large number of LTC facilities. The government is seeking private sector facilities specialised in LTC to refer their patients requiring rehabilitation and/ or long-term care.
Increased demand for specialised services: Centres of excellence focusing on certain specialties such as ophthalmology, cosmetic surgery, IVF and orthopaedics are expected to grow further, especially in Riyadh and Jeddah. Many General Hospitals have also established dedicated wings to provide highly specialised services in a single specialty and this has often been a key factor for their success.
Primary care: Owing to the large population in KSA and high occupancy rates of hospitals, the country requires more primary care clinics and medical centres to meet the demand of the rising population.
NEOM City, which will cost US$500 billion and was announced in October 2017, will be located on the Red Sea Coast promising a new lifestyle that does not currently exist in Saudi Arabia. The new city is planned to span over a total area of 10,000 square miles (25,900 square kilometres) linking KSA to Egypt and Jordan, creating new markets for many sectors, including healthcare and biotech.
The biotech sector will focus on next-generation gene therapy, genomics, stem cell research, nanobiology, bioengineering plus attracting the talent to research, develop and apply the new knowledge; NEOM will be a new nexus for this vital activity.
In the last few decades alongside the demand for primary accommodation, a second-tier demand for second homes within the residential market has emerged, especially in the Eastern Province. With the development of NEOM city, Colliers expects that the second homes market will flourish in the Red Sea area, not only as secondary homes but also as an investment product supported and driven by leisure, healthcare and wellness. Sustaining high occupancy levels all year round in second home destinations can be challenging. Colliers has witnessed and advised on these challenges in a number of countries.
Often, they can be addressed through introducing healthcare and wellness driven resorts, long-term care and rehabilitation facilities. These facilities can have a positive impact on occupancy levels by attracting not only vacationers but also retired households and those seeking longer holidays within proximity to healthcare facilities. While seasonality is part of the story, it can also be due to the lack of destination pull factors. Complex destination components, alongside leisure and environment include proximity of hospitals, clinics, long-term rehabilitation centres, wellness retreats, fitness/skill retreats and retirement homes.
There is an opportunity within the holiday home market for developers to create destinations by providing essential community infrastructure.
One of the key challenges faced while establishing quality hospitals in KSA is the high funding requirement. Despite the fact that banks and other financial institutions actively seek investments within KSA’s healthcare sector, they often limit their exposure by only servicing known market participants with proven track records. International or regional operators contemplating entry into KSA’s market often struggle to secure project finance unless there is a recourse to alternative cash flows.
Further, difficulties arise with the terms offered. Healthcare investments are typically long-term investments contradicting a bank’s risk appetite, which typically extends to a tenure that ranges between five to seven years.
The various options available to operators based on availability of funds are:
However, each of these options have financial, operational and legal advantages and disadvantages and operators should seek professional advice before entering into any such arrangement.
The Kingdom is moving towards encouraging more private sector participation in the healthcare sector, however; the extent of investment required is significant.
In Colliers opinion, one way of bridging the required investment is by way of creating more Real Estate Investment Trust (REIT) funds. Based on Colliers estimate, REIT funds in the Kingdom can unlock around US$7.5 billion to US$8.5 billion property value from the private sector, thereby playing a key role in augmenting growth in the healthcare sector.
Colliers is currently working with several market participants through traditional and emerging funding options to assist them in their expansion plans.
In summary, the healthcare sector in KSA, especially the private healthcare sector, offers several lucrative opportunities for developers, investors and operators. However, it also possesses a number of challenges, such as high capital cost, difficulties in attracting quality doctors (and especially, nurses) and funding constraints for the new entrants.
Colliers International works with a number of market players to assist them in their expansion plans either by expansion of existing brand or attracting international brands to the region. It also assists number of market participants through traditional funding options, such as debt and equity, or emerging funding options, such as OpCo/PropCo, or a Joint Venture (JV) with an investor and REITs.
Global Health Exhibition and Congress, held under the patronage of the Saudi Ministry of Health, brings together 15,000+ key healthcare professionals from KSA and across the globe to meet, learn and do business in the Kingdom of Saudi Arabia. Learn more about the comprehensive range of healthcare products and services being showcased by the world’s most innovative and prevailing companies.
In today’s national landscape, healthcare organisations are being pressured by consumers and purchasers to compete on value. This means providing high quality health outcomes, excellent experiences and lower costs. To accomplish this, integrated delivery systems must be able to manage pluralistic care and payment models, simultaneously ensuring the highest value to customers in both risk-based and traditional fee-for-service contracts. This “both/and” environment requires new ways of managing healthcare at multiple levels – the organisation, its multiple populations and individual patients.
The past 30 years have shown dramatic changes in how healthcare in the United States is financed. In the 1980s, health plans (led by the U.S. federal government through the Centers for Medicare and Medicaid Services [CMS]) transitioned from pay-for-volume approaches with discounted fee schedules to Diagnosis Related Group (DRG)-based payments for inpatient services regardless of lengths-of-stay. Almost two decades later, large commercial payers such as Blue Cross Blue Shield of Michigan created quality bonus programmes, tying earned incentives to relative performance on collaborative quality improvement programmes. In 2012, CMS introduced Value-Based Payment programmes, which use outcome-based quality, satisfaction and utilisation measures as the basis for earn-back incentives (for certain quality and service measures) or straight penalties (such as for readmissions and Hospital Acquired Condition penalties).
Value-based care was expanded to physician services when CMS launched an alternative care deliver/payment model for Medicare beneficiaries called an Accountable Care Organization (ACO) as part of the Affordable Care Act (ACA). An ACO is a network of doctors and hospitals that shares responsibility for providing care for “attributed” patients. Under an ACO risk-based arrangement, providers share in savings or losses with the payer, based on the negotiated risk contract. Healthcare costs, described as per-member, per-month or PMPM – along with pre-defined quality and service metrics – are tracked against baseline or target performance, and the difference between actual and targeted performance represents the potential shared savings pool.
CMS’s value-based payment programmes continue to expand the earnings potential for high-performing organisations. The most sophisticated, with highest potential for both upside and downside risk, include the Next Generation Accountable Care Organization (NGACO) model, in which Henry Ford Health System (HFHS) has participated since 2016. Increasingly, non-government payers and even large employers are also entering into contracts with healthcare organisations using similar value-based parameters. These can be referred to as direct-to-employer contracts, such as HFHS’s General Motors ConnectedCare contract, which began in 2019.
“Henry Ford recognised more than a decade ago that we could not continue to work in the fee-for-service model and still provide our patients with the best and most appropriate care possible,” said Bruce Muma, MD, Medical Director of Henry Ford’s Population Health Management team. “Additionally, we recognised our Health System’s ability to survive and thrive in a strictly fee-for-service world was coming to an end, as the healthcare industry made a definitive shift to value-based care. We embraced this new path and began putting people and programmes in place to become a leader in value-based care in the industry.”
“Value-based care” and “population health” approaches are widely used to create favourable health outcomes for patients. HFHS has an extensive Population Health Management team, which is responsible for designing, delivering and coordinating high-quality healthcare services to manage health outcomes, experiences and costs for a population using the best available resources within the healthcare system. Examples include patient-centred team models, electronic patient registries, and virtual care alternatives for patients with multiple chronic conditions.
HFHS, including its provider-owned health plan Health Alliance Plan (HAP), has a long history of care delivery innovations, now referred to as population health management. Examples include chronic disease programmes developed collaboratively by HFHS providers, care coordination activities to assist patients with transitions between sites of care, and an electronic medical record (EMR) implemented system-wide in 2013. The EMR is also offered to private practice physicians who are part of the Henry Ford Physician Network (HFPN), Henry Ford’s Clinically Integrated Network of employed and private practice physicians.
The System’s Population Health Strategic Framework supports the system’s vision to be the trusted partner in health, leading the nation in superior care and value.
Under this framework, HFHS identifies targeted populations, implements care delivery models or programmes that address value gaps in those populations, and responds to existing or new value-based contracts based on success with these population health management capabilities. This ongoing process is enabled by robust analytics to measure performance, engaged clinicians implementing best practices, EMR tools and alerts, and integrated process improvement and contracting expertise.
“We recognised our Health System’s ability to survive and thrive in a strictly fee-for service world was coming to an end, as the healthcare industry made a definitive shift to value-based care. We embraced this new path and began putting people and programmes in place.”
Over the past three years, HFHS has introduced dozens of population health management programmes to leverage people, processes and technologies in new ways. Still, broad success in value-based care requires a holistic, organisation-wide transformation. As healthcare organisations aim to transition from volume-based care to value-based healthcare delivery and financing, the following infrastructural elements have emerged as critical for long-term success:
Culture and leadership: Leadership teams and incentive structures must reinforce shared accountability for simultaneous growth in population health management and strategic tertiary/quaternary care programmes.
Physician strategy: Ongoing development of a high-performing network of physicians providing primary care, specialty and geographic coverage for value-based populations.
Operations, technologies, and partnerships: Innovative care models and tools to enhance coordination across the care continuum, both inside and outside the health system. Examples include new access approaches, such as telehealth and walk-in clinics; community partnerships and information networks to capture data, such as social determinants of health and connect patients with needed resources; and, finally, analytics tools that give physicians and care teams the data they need to close gaps in care.
Risk-based contracting expertise: Speed and agility in launching new risk-based arrangements as part of a growing portfolio of successful value-based contracts.
In the long run, effective population health strategies that can make value-based care a success demands new partnerships among providers and payers, new care management models, integrated data support, redesigned IT structures and a potentially seismic shift in thinking by health system leaders on the definition of healthcare success.
“Henry Ford Health System has fully supported the shift to bring in more value-based contracts,” said Susan Hawkins, Henry Ford’s Senior Vice President of Population Health. “To achieve high performance on these contracts, we have needed resources, creativity and commitment, which we continue to receive from the system and from our team members. We are constantly exploring, creating and implementing new interventions to improve health outcomes, improve the care experience and reduce the cost of care – the cornerstones of value-based care.”
Hospitals are arguably some of the most demanding and challenging buildings to design. They house a diverse range of specialist clinical services each with their own critical design, function and process requirements. With continuous advancements in research, technology, expectations, needs and policy, healthcare planning demands expertise to optimise performance and efficiency, in a challenging competitive market.
At the inception of each development project, the aspirations and vision are outlined. These initial objectives may be driven by service demand or infrastructure deficiency, but all healthcare projects have the one common goal of improving healthcare delivery.
The overall success of a project can be traced back to the time and effort invested at the early stages, when the strategic plan and brief is defined. Changes later on become progressively more expensive as the project develops and can lessen the integrated nature of the design. There is a tendency to rush this stage as it seems unproductive, but it is imperative that a strategic assessment of all influencing factors is carried out to ensure that the project vision is achieved in the most effective manner to optimise health and investment outcomes.
Emerging and strategic issues that influence a hospital’s service and infrastructure requirements range from: demographics and epidemiology; healthcare statistics; site conditions; regulatory criteria; technological opportunity; and financial feasibility. The healthcare planner is adept at gathering, organising and assessing available data in order to predict the current and future service demand and prioritise needs. For long lasting success, healthcare facilities need to be able to adapt to accommodate future changes in demand, expectations, care and technology.
Each healthcare project deserves a unique solution, developed to address the particular needs of the client and region. It takes knowledge and understanding of best practice in healthcare design across the globe to effectively adapt to diversity in socio-economic profile, resource or time constraints. While health inequality exists, experience and insight offer strategic opportunities for sensitive yet successful results in any market.
Before putting pen to paper on designs, the briefing process offers the greatest opportunity for the client and users to influence the design. The brief typically describes the scope, function, quality, timescale and cost of the project, but on a healthcare project, the briefing process additionally involves the definition of clinical design standards such as: operational capacity targets; operational principles; patient flow charts; configuration guidelines; and notable medical equipment. The brief is the highest level of control document throughout a construction project, therefore its completeness at the outset is fundamental to the efficient progress of the development.
Healthcare projects involve a multitude of stakeholders, often with disparate and conflicting views. Clinical professionals’ input, together with strong client leadership, is highly valuable in defining the service needs and functional requirements of each department, such as the workload and operational procedures. The healthcare planner acts as the nucleus of this process of knowledge sharing amongst stakeholders to reach the best solution for patient care delivery. This involves discussion of new models of care; evidence-based design; new technology and regulatory constraints. These aspects can have a significant impact on the sizing of departments, with for example, a shift from healing to prevention leading to larger diagnostic and treatment facilities and a reduction in bed numbers.
Before putting pen to paper on designs, the briefing process offers the greatest opportunity for the client and users to influence the design.
It is important to consider that clinical professionals may not have experience of construction projects and this drawn out process has significant demands on time for regular meetings, to initially inform the brief and latterly the designs. There tends to be a common difficulty in identifying the exact requirements and recording them in writing.
To progress on the basis of incomplete instructions leads to provisional decisions being made, that may have major implications later. The healthcare planner holds the experience to ask the right questions; the objectivity to identify real needs; the skills to overcome challenges; and the tools to establish an effective communication system, to manage the complex and dynamic web of information and requirements. This systematic approach eases pressure on the clinical, client and design teams and ensures that informed decisions are made on-time.
Beyond the briefing stage, the healthcare planner remains a valuable member of the design team, acting as a single point of contact for clinical queries from the architects, engineers and project managers involved in developing the project. The healthcare planner can assert the needs of the patient and clinicians, throughout design, coordination and construction process.
Embarking on the design of a hospital project should not be underestimated, as indicated by the extensive and specialised preparation works involved. The need to provide ever increasing quality, value-based healthcare in a competitive market demands healthcare planning expertise. The healthcare planner’s knowledge and understanding of service objectives; clinical processes and technical implications, drives the team towards opportunities to improve efficiency and advance the model of care. Through innovation, optimisation and flexibility in strategic planning, the healthcare planner can add value, reduce risk and maximise the lifespan of the development. Investing time in the pre-design stage pays dividends, not only in time and money, but furthermore in the fundamental objective of improving health outcomes.
Through innovation, optimisation and flexibility in strategic planning, the healthcare planner can add value, reduce risk and maximise the lifespan of the development.
In today’s modern setting of transformative technologies, the tremendous surge in information and data is revolutionising healthcare globally and in the UAE. The country's healthcare system has evolved significantly in the last decade under the governance of a federal regulator – Ministry of Health (MoH) – and two Emirate-level regulators – the Abu Dhabi Department of Health (DOH) and Dubai Health Authority (DHA). Despite this, the country’s healthcare sector still faces significant challenges, some of which are driven by the multiplicity of stakeholders and interest groups. Adding weight to these organisational complexities, the country faces a heavy challenge when it comes to non-communicable diseases such as diabetes and obesity.
Furthermore, the unsustainable costs of care, paired with higher inflation rates, does not bode well for the future of the sector or for patient welfare. As healthcare costs skyrocket, patients are struggling to cope with the fiscal strains of treatment amidst other socioeconomic impacts of non-communicable diseases. This is creating an air of uncertainty for those under care, especially given the fact that chronic diseases are often long in duration.
The exorbitant costs of non-communicable diseases, including lengthy and expensive treatments for diseases such as obesity, are weighing down the healthcare sector’s ability to successfully combat premature deaths. According to the World Health Organization (WHO), 30 per cent of the world’s population is obese or overweight, with figures being more alarming in the Middle East. To date, more than 36 per cent of children in the UAE are obese, which is double the global average. Additionally, a study by the University of Washington’s Institute for Health Metrics and Evaluation revealed that 66 per cent of men and 60 per cent of women in the UAE are obese.
Examples like this reiterate the importance of the healthcare industry to the UAE’s future development. Moreover, the country aims to achieve a high-quality healthcare system, both regionally and globally (e.g. Dubai Plan 2021), in which effective industry governance will be essential, especially in line with the UAE’s National Agenda. However, the fragility of the healthcare system and the strain of costs on patients’ need to be overcome in order for a healthier outlook to prevail.
As such, the UAE has a tremendous opportunity to take a fresh look at its health sector governance; to not only achieve set goals and position the UAE healthcare system as regional (and global) leader, but also to guide the transformation of the sector in a way that all stakeholders can contribute. Our research has demonstrated that although specific governance challenges differ depending on contextual factors, nearly all health systems confront a common set of problems – which includes:
1. The healthcare environment is changing so rapidly that even best-in class systems present gaps in governance.
2. The evolution of governance systems has created overlapping responsibilities that lead to unclear accountability and conflicting directives from competing regulatory entities.
3. The relevant regulatory agencies often lack the expertise and capabilities required to cope effectively with today’s challenges.
Redesigning the UAE’s healthcare system should focus on driving the existing governance system to operate more effectively in a way that is comprehensive, clear and simplified.
Let’s not forget that the UAE has been on the forefront of healthcare transformation in the region when it separated operational institutions from supervisory and regulatory bodies. Such efforts reinforce the overarching role of the MoH as a regulatory and monitoring authority.
The Emirate of Abu Dhabi has led by example in distinguishing healthcare management from healthcare regulation. It has done this by carving out the General Authority of Health Services into three entities: the Abu Dhabi Health Services Company (SEHA), an independent public joint stock company that owns and operates all public hospitals and clinics across Abu Dhabi; Daman, an insurance company; as well as the Department of Health, which regulates the public and private healthcare sectors.
Dubai has taken tangible steps, with Law No. 6 and Decrees No. 17 and 18 of 2018 leading to restructuring the internal management of the DHA on par with global standards, specifically in terms of organisational units and their roles and specialties.
As such, the UAE has a tremendous opportunity to take a fresh look at its health sector governance; to not only achieve set goals and position the UAE healthcare system as regional (and global) leader, but also to guide the transformation of the sector in a way that all stakeholders can contribute. Our research has demonstrated that although specific governance challenges differ depending on contextual factors, nearly all health systems confront a common set of problems.
Seven principles of effective governance design
An effective healthcare governance system will define the rules and regulations to drive “appropriate” behaviours for actors in the system and will monitor performance in order to optimise the health value for the entire population. To bring this system to life, there are seven design principles that should inform any effort to redesign health sector governance:
While some of these principles may sound obvious, the logic underlying them and the way they work together to create a coherent governance-operating model is essential. What’s more, these high-level principles will serve as a constant reference point in efforts to design the details of the governance system.
The UAE’s roadmap to transforming its healthcare sector will require a specific and clear roadmap communicated to all stakeholders to ensure alignment and minimise disruption. The roadmap should hinge on four basic steps:
1. Assess healthcare system performance in terms of global benchmarks: Benchmarking other health system best practices for governance, as well as how these practices can be adapted to the UAE’s national context.
2. Define goals: The UAE needs to establish a baseline for current system performance and the existing governance model. For example, there is an urgent need for a sustainable, effective and trusted healthcare delivery model, while managing costs by reducing “leakages” in the system.
3. Redesign the governance model: Ensuring complementarity between federal and emirate regulators where a clear division of roles among the seven design principles will have multiple benefits, including improved steering of the system, lower overall costs, and increased cooperation.
4. Plan for implementation: As well as separating operational and regulatory functions, policy decisions in the UAE should also focus on strengthening prevention and wellness. The curative aspect of the system has improved significantly in the last decade. It’s time to integrate health prevention and maintenance in the governance of the system. Moreover, the further separation of operations and governance, if done effectively, can reap benefits to the population and the economy. Restructuring efforts have proven vital not just in increasing efficiency, but also towards reducing costs, size, units, departments and levels in the restructured institution, and improving overall competitiveness.
Globally, even the best-governed health systems can benefit from a renewed focus towards addressing critical gaps in the healthcare environment. In the UAE, this approach will be particularly beneficial. The result will be a more efficient, more responsive system that provides high-quality services to industry stakeholders, to the nation’s citizens, and to the transformative visions outlining the nation’s future progress.
References available on request.
The UAE’s roadmap to transforming its healthcare sector will require a specific and clear roadmap communicated to all stakeholders to ensure alignment and minimise disruption.
