Technology and investment are driving forces in healthcare and play a role in shaping its future. Since inception, Hayat National Hospitals Group has been dedicated to delivering the best healthcare services through unwavering motivation and initiated the expansion of new health projects to meet the growing needs of the health sector in the Kingdom of Saudi Arabia. 

In our exclusive interview with Dr. Hussain Saad Hasosah Al Qahtani, the Assistant CEO of Al Inma Medical Services and Hayat National Hospitals Group, we learn more about how the group is investing in state-of-the-art tools to deliver patient satisfaction.

Globally, new hybrid models of care delivery involving face-to-face and remote care are emerging post-pandemic, ensuring constant patient-physician communication and patient experience are not compromised. This is propelled by the increased uptake of digital health solutions such as telehealth.

The Kingdom of Saudi Arabia (KSA) is moving in the same direction, and this is evident from the strong growth forecasted for telehealth, which includes virtual visits, mHealth, and remote patient monitoring (RPM) in the region. This is estimated to reach US$415.4 million by 2025, according to a Frost & Sullivan analysis. While virtual visits/ consultations have an emerging adoption rate, remote patient monitoring technologies currently have a low adoption rate in Saudi Arabia.

The evolving telehealth landscape

The adoption of digital health solutions such as telehealth is rising in the Middle East, especially in markets with high digital/smartphone penetration among the population, like in the KSA.

The market is ripe for investment and the launching of new products as consumer awareness and acceptance of digital health solutions continue to increase. In late 2021, KSA-based telehealth startup Cura closed a Series A investment of US$4 million from ELM and Wa’ed (the entrepreneurship arm of Saudi Aramco).

Other national and international vendors include healthcare-focused companies such as Altibbi, Babylon, and Tabiby, and others such as Saudi Telecom Company. Vendors see strong opportunities in this market and are experimenting with B2C and B2B business models.

As health insurance becomes compulsory, over 90 per cent of healthcare spending in the next decade will be driven by private insurance; therefore, the need for management and preventive care will intensify the competition among private participants. These vendors position themselves as partners in the patient’s journey toward preventive care, chronic disease management and post-acute care monitoring services. These will also be the three core areas for providing telehealth services in the future as countries look at reducing costs of care and increasing efficiency and quality of care. This will further drive the telehealth market in this region.

Surge in telehealth due to COVID-19

A strong boost to the uptake came from the COVID-19 pandemic when the only method for care delivery was virtual. In addition to the SEHA app, which was introduced in 2018 to manage virtual care, several other apps were introduced during the pandemic to manage patient populations.

Digital health applications — Seha, Mawid, Tawakklna, Tabaud and Tetamann — effectively facilitated healthcare delivery to COVID-19 patients in the region.

Initially part of the Vision 2030 strategy, efforts were focused on workflow digitization of public and private healthcare providers with electronic health records (EHRs) and clinical workflow management systems. More recently, the pandemic forced Saudi Arabia to adopt other digital solutions that are more consumer-centric and allow for virtual care.

While globally as well as in the KSA, the adoption of telehealth has dipped slightly since the start of the pandemic, there is no going back to pre-pandemic levels. Healthcare provider bodies and patients will continue to demand virtual care services.

The government impetus — a key driver

The Ministry of Health (MoH) of Saudi Arabia has recognised the importance of care digitisation and continuously updates its regulations regarding its application in a positive direction. It is mandated that telehealth be included in healthcare insurance coverage by public and private bodies (MoH).

This is a major driver for the continued adoption of telehealth — almost making it a standard of care in the country. Further, access is assured via the Seha, the free Saudi mobile app issued by the MoH. The app provides visual medical consultations and allows all citizens anywhere to have face-to-face medical consultations with their doctors across the KSA.

Several other apps support virtual care delivery. In addition, the National Health Information Center launched the Saudi Telehealth Network initiative to connect health care facilities with primary health care centres and hospitals in remote locations using telehealth solutions. Further, the Saudi Commission for Health Specialties (SCFHS) recently launched a telemedicine training programme for remote patient contact. The programme is open to all health practitioners, who will receive three hours of training in the tools for treating patients remotely using digital technology (Arab News). Government support is among the most essential aspect of healthcare digitisation, and KSA is leading the charge.

Telehealth is here to stay

While there are several noteworthy developments for telehealth in Saudi Arabia, scalability and ensuring continuity of uptake will be most important in the long run. A continuous increase in the incidence of chronic conditions and an increase in the millennial population that demands on-demand and quick access to care are the key reasons for strong telehealth demand in the country. Despite a dip in the growth rates of virtual consults across the globe, there is no reason for the adoption to return to pre-pandemic levels in 2022.

Further, as care-at-home models emerge, remote patient monitoring will see strong uptake. Saudi Arabia has only seen some RPM pilots, and no scalable deployment has been achieved. With the growth in the aging population and focus on reducing healthcare costs, RPM has a strong potential to manage patients at home. So far, the advantages of these tools for managing patients remotely are clear, and patients and physicians are convinced of the benefits.

As time passes and more evidence of the use of telehealth for effective virtual management of diseases emerge, healthcare providers and patients will demand a single-point virtual health solution. Virtual care platforms will be in great demand, and vendors will need to focus on creating an all-in-one solution to support provider organisations.

It will also be important for vendors to innovate pricing models and B2B2C go-to-market strategies and integrate patient engagement solutions to create the true “digital front door” experience for KSA residents. However, vendor developments, healthcare providers and public sentiment, and favourable government initiatives support the country’s healthcare objectives of Vision 2030, which are well on their way to being achieved on target.

[References]
Ministry of Health KSA
Arab News 
 

— Chandni Mathur is the Senior Consultant, Healthcare and Lifesciences Practice at Frost & Sullivan.

As one of the most important sectors contributing to Saudi Arabia’s future-forward economy, the Kingdom has made significant strides in improving its healthcare infrastructure and developing the sector to achieve privatisation of services provision and public-private partnerships (PPPs), an elevation in the quality of care, the application of virtual healthcare platforms and the enhancement of the health service through essential supply chain reform.

The demand for healthcare in KSA has continued to rise, and this has been witnessed by the increasing healthcare budget and healthcare investment made over the past 10 years. KSA accounts for 60 per cent of the Gulf Cooperation Council (GCC) countries’ healthcare expenditure, and the sector remains a top priority for the KSA Government, according to Trade.gov. In 2022, it will spend US$36.8 billion on healthcare and social development – 14.4 per cent of its 2022 budget.

According to a report published by Mashreq and Frost & Sullivan, KSA plans to invest US$66.67 billion in healthcare infrastructure and boost private sector participation from the current 40 per cent to 65 per cent by 2030, targeting the privatisation of 290 hospitals and 2,300 primary health centres.

With life expectancy in KSA projected to increase from 76.4 to 81.8 years by 2050, and the Kingdom’s population expected to grow from 34.3 million in 2019 to 39.4 million by 2030, increased investment in infrastructure and innovation is expected to drive strong growth in the Kingdom’s healthcare sector.

Building resilience through healthcare investments

Priority investment areas for the KSA Ministry of Health (MOH) include:

• Launching Health Clusters across the Kingdom
• Increasing the number of internationally accredited hospitals
• Doubling the number of primary healthcare visits per capita from two to four
• Decreasing the rates of smoking and obesity
• Improving the quality of preventive and therapeutic healthcare services
• Expanding digital healthcare innovation
   

Leading healthcare sub-sectors in Saudi Arabia

According to Trade.gov, the following sub-sectors of the KSA healthcare market present the best opportunities for investment:

Dental services: The dental care service sector is anticipated to grow thanks to increased dental care spending, growing penetration by insurance coverage, and an increase in the per capita income.

Digital health: KSA is expected to be one of the fastest-growing digital health markets in the GCC, with the government allocating US$1.5 billion for healthcare IT and digital transformation programmes.

Health insurance: This sector’s key growth drivers include an increase in the insured population, medical insurance requirement to renew residency for expats, for all Saudis working in the private sector, and for tourists’ visa applications.

Medical devices: Medical equipment has an estimated value of US$2 billion and is growing at a CAGR of 10 per cent. KSA seeks to transition from a manufacturer of low-value commodities to a manufacturer of high-value medical products offering financial incentives to encourage local manufacturing.

Pharma and biosciences: The transition to an increasingly privatised and comprehensive healthcare system will drive demand for patented and generic medicine.

Under Vision 2030, the Kingdom is prioritising local production, technology transfer, conducting clinical trials locally, and training the local labour force.

Speciality clinics and ambulatory care centres: It is also expected that the government will use public-private partnership (PPP) models to build capacity in speciality areas. The government’s focus on wellness and preventive care will drive investment toward non-hospital settings.

Saudi Vision 2030 and the health sector transformation programme

Launched in 2022, the newly established Health Sector Transformation Programme, part of the Kingdom’s Vision 2030, aims to ensure the continued development of healthcare services in the Kingdom by restructuring the health sector to be a comprehensive, effective and integrated health system that is based on the health of the individual and society.

The programme depends on the principle of value-based care, which ensures transparency and financial sustainability by promoting public health and preventing diseases and applying the new model of care related to disease prevention.

It also aims to improve access to health services through optimal coverage and a comprehensive and equitable geographical distribution, expanding the provision of e-health services and digital solutions, and improving the quality of health services.

The programme has made commitments that by 2025, 88 per cent of the population will be covered by inclusive health services, and the unified digital medical records system will cover 100 per cent of the population.

Better outcomes in today’s digitalised healthcare environment

IoT and 5G are transforming the healthcare sector in KSA, enabling monitoring of patients in remote areas and critical early interventions, therefore serving healthcare providers to improve their efficiency and reduce costs.

There are several other trends to watch out for in the medical environment, including virtual hospitals, wearables and telehealth. At the same time, 5G will enable new and improved use cases, such as augmented reality surgery, robotic-assisted surgery, connected ambulances, after-surgery care and remote patient monitoring.

The virtual hospital SEHA is linked to more than 130 hospitals around the Kingdom, using the latest treatment technologies, expanding the employment and investment of medical robots to save time and effort and relieving the hardships of travel and transportation and for critical cases that require specialised, accurate and quick consultations while facilitating the provision of health services at home.

Plan a resilient health workforce in Saudi Arabia

With a health system in transition and prepared for changing priorities, the KSA government plans to build a more resilient workforce with less reliance on foreign health workers. According to Lin, T.K., Bruckner, T.A., Alghaith, T. et al., it is estimated that KSA will require between 1.64 and 3.05 physicians and nurses per 1,000 population to provide health services in 2030.

Overall, the total supply of physicians and nurses (including both Saudi and foreign) will grow from 270,198 in 2020 to 399,354 in 2030 (for physicians: from 92,642 to 138,635, respectively; for nurses: from 177,556 to 260,719, respectively).

Increase hospital capacity to meet changing demands

Meanwhile, research from Knight Frank indicates that to keep pace with population growth, KSA will require an additional 20,000 beds by 2035, based on the current density of beds. Based on the global average of bed density, the Kingdom faced a gap of 14,000 beds in 2016, and this gap is expected to widen to 40,000 beds by 2035.

With the life expectancy of both males and females on the increase, Colliers International expects this to create demand for long-term care (LTC) facilities, focusing on geriatric-related care, rehabilitation and home healthcare services.

Based on current international benchmarks of four to six beds per 1,000 population above 65 years, Colliers estimates that KSA needs between 6,400 to 9,600 beds dedicated for LTC. This is expected to reach 41,200 to 61,800 LTC beds by 2050.

As Saudi embarks on Vision 2030, the country’s healthcare system is set to be a radically different landscape over the coming years as digital transformation and a major revision of goals and policies takes the country into the future. The ambitious plans for the nation’s health and well-being are already underway with a complex roadmap of reform on the agenda to ensure that Saudi Arabia is among the world’s leading healthcare nations by the time Vision 2030 takes fruition.

The population of the country continues to grow. It is expected to increase to 39.5 million in mid-2030, rising from 33.5 million in mid-2018, but the government has been faced with a rising number of challenges in its healthcare system.

In 2015, residents from overseas amounted to 30 per cent of the population of the Kingdom and as the country continues to attract international businesses, foreign direct investment and international tourism, this will continue to rise.

The Healthcare Transformation Strategy, managed by the Ministry of Health’s Vision Realisation Office (VRO), draws a roadmap towards overcoming these challenges in line with international standards, and has become a major pillar of the Saudi Vision 2030 plan, supported by institutions including the Ministry of Health, Saudi Health Council, King Faisal Specialist Hospital and Research Center, Saudi Food and Drug Authority, The Saudi Red Crescent Authority, and the Ministry of Education. The VRO has laid out key themes to direct policy such as financial reforms, workforce development, digital transformation and provider reform.

The Health Sector Transformation Programme was launched during 2022 to ensure continued development of healthcare services in the country and focus efforts in this vital sector. The coronavirus pandemic was one of the first major focuses of the Health Sector Transformation Programme, feeding into the response to the health, economic and social impacts of the pandemic as well as overcoming the crisis and its challenges.

Some of the major challenges the programme aims to address are the rates of avoidable injury and non-communicable disease that remain high by regional and international standards. There are also goals to reduce preventable mortality and avoidable morbidity in both the working and elderly populations, aiming to raise life expectancy from 75 to 80 years by 2030. Specific areas of concern include heart disease, stroke, diabetes mellitus, respiratory disease, mental health, road traffic accidents, and congenital diseases.

The health sector has already achieved many accomplishments such as improving the quality and efficiency of health services and facilitating access with a focus on digital transformation. It also launched a package of applications such as Sehhaty and Mawid, while increasing service coverage across all regions of Saudi Arabia.

Technology is a major driver as Saudi moves into this new era of technology-driven solutions making healthcare more accessible to all. In 2020, more than 67 million appointments were booked through the Mawid app while 8.6 million medical consultations were provided through the Sehatty app and the 937-call centre.

Saudi Arabia also ranked first in the Arab world in the 2021 World Happiness Report, produced by the UN’s Sustainable Development Solutions Network, and 21st globally. The annual report, which scores countries globally on the health and happiness of their populations, is seen as a barometer for prosperity and a key indicator of a nation.

The Health Transformation Programme will work on enabling comprehensive transformation in the sector and restructuring it into a comprehensive, effective and integrated system that can address key challenges such as lack of access to medications, inconsistent delivery of care and lack of consistent clinical guidelines.

A fundamental focus of the programme is boosting public health and disease prevention, in addition to improving access to health services through optimal coverage, comprehensive and equitable geographical distribution, and expanding the provision of e-health services.

Rates of avoidable injury and non-communicable disease remain high by regional and international standards. While Saudi Arabia has made notable progress in improving the health of its population over recent decades, particularly in areas of child and maternal mortality and the reduction of communicable disease, areas of concern now include heart disease, stroke, diabetes, respiratory disease, mental health, road traffic accidents and congenital diseases, all of which are manageable.

One of the factors to address is the outbreak of communicable diseases, with a focus on sub-areas such as managing contagious diseases at Hajj or following man-made and natural disasters.

The Ministry of Health notes that primary care is a key focus moving forward with investments being carried out across the Kingdom to enhance the distribution of secondary and tertiary hospitals and associated resources.

Steps will be taken forward to augment the capacity in extended care services such as rehabilitation, long-term care and home care. Greater distribution of services will be made available across the Kingdom to ensure those in remote areas get wider access to care options.

Financially, the health system will also support the containment of public expenditure and the diversification of the Saudi economy, as per the Vision 2030 plan. This is needed to address the risk of long-term reductions in the price of crude oil and the impact that will have on public revenues. Attracting investment into the sector will be a key goal moving into the next phase to align with wide-ranging reforms.

As the system moves forward, it will be a key priority to have more staff to match the population size and recruit a larger number of Saudis that can take healthcare into the future as it moves into a new era of digitisation, offering hope for the betterment of the country’s people, alongside the implementation of more unified and digital systems.

However, the number of Saudi healthcare professionals has risen by 65 per cent since the launch of the program, marking a new wave of talent to take the vision forward. Saudi Arabia’s new holding company appointed by the government to take over healthcare services, the Health Holding Company (HHC), has a broad-ranging brief as it embarks on the task of digitising and advancing the Kingdom’s healthcare system.

Taking over from tasks once done by the Ministry of Health, the HHC will focus on providing medical services and care via upcoming health clusters, a set of independent companies that focus on specialist services.

On the ground, there are many achievements among the population that speak volumes about the successes of the programme. With the top-down encouragement of sport from access to sport in local areas to bringing international sporting championships to the Kingdom, there is a fresh push to get the country into a new, more active generation.

New data shows that weekly sports participation rates have risen by 37 per cent between 2015 and 2019 with a 149 per cent increase in female participation. More than 130,000 people take part in sports regularly now, reflecting a new push towards a healthy, active nation.

New health insurance for pilgrims has also been a major part of the country’s developments across not only health but the tourism sector, helping streamline and enhance the pilgrim experience, along with the lessons learnt from the pandemic. With new procedures, Saudi Arabia hopes to welcome 30 million Umrah pilgrims each year by 2030.

Further achievements have seen the patients receiving emergency medical care within four hours of arrival increase from 26 per cent in 2016 to 87 per cent in 2020, a huge point of pride for the system as it evolves and advances.

This has all not gone unnoticed, with satisfaction in hospital services increasing from 81.5 per cent in 2019 to 84.06 per cent in 2020. Satisfaction in primary care services also increased from 73 per cent in 2018 to 80.52 per cent in 2020 while life expectancy increased from 72.6 years in 2000 to 75 years in 2018, all reflective of the wider systemic changes across the board.

Moving forward, primary healthcare continues to be a key focus to ensure greater provision and consistency across the country, along with greater supplies of rehabilitation, long-term, and home care services. A great focus is placed on raising the quality of patient care, with standardisation plans afoot, which will be aided by greater digitalisation methodology that will in turn support the quantification and management of resources, activity levels, product quality, and performance.

These changes are already being noted internationally, as a recent report by the European Center for Digital Competitiveness ranked the country second in the world to have continually invested in digital infrastructure.

Consultants PWC also highlighted that since the establishment of a National Digital Transformation Unit, the Kingdom of Saudi Arabia’s public and private sectors have invested almost US$15 billion into information and communications technology infrastructure.

Experts are praising developments. Samer AbuGhazaleh, Chairman of the healthcare council at Jeddah Chamber of Commerce, told MEED: “Through Vision 2030, the Saudi Health Ministry has taken the bold step to shift from being both the regulator and the operator to being just a regulator and gradually assigning the operations to the private sector.”

Overall, these positive developments show the country is primed for foreign investment with privatisation targets and demand drivers prompting new market opportunities in the Kingdom for private players and healthcare investors alike, major private healthcare players such as Saudi German Health, Dr. Sulaiman Al-Habib Medical Group and King’s College Hospital already announcing plans to open or expand services in the Kingdom, forecasting growth in demand over time.

[References]
Ministry of Health KSA
 

 

Health screening needs to change according to advancements in technology such as in the use of artificial intelligence (AI) in process of mammography, but new methods should not affect vigilance, according to an article published in the Climacteric journal in April 2022.

Besides talking about the use of AI in mammography, the article titled ‘Changes to health screening — we need to remain vigilant’ comments on the limitations of studies to date and the characteristics of future studies that could provide the information needed to properly assess the impact of the introduction of AI into screening mammography.

The article argues that there are well-established criteria for the use of a new health screening programme described more than 50 years ago and these criteria are still appropriate. However, it should not be assumed that once a form of health screening is in place, it should be continued forever since there is always room for improvements, it adds.

Dr. Mahira Yunus, Interventional Breast Radiologist, at Fakeeh University Hospital in Dubai referring to the article says that advancements in the techniques of mammographic screening have already happened. “There is the shift from screen-film to digital mammography and the use of breast tomosynthesis as an alternative to two-view digital mammography for breast cancer screening. Another modification to screening mammography on the horizon is the incorporation of AI into the interpretation of mammographic images,” she explains.

According to the article, “Why is the introduction of AI into screening mammography being contemplated? Even the best performing screening mammography programme (with a low rate of interval cancers coupled with a low recall rate) will miss some cancers which subsequently present as interval cancers prior to the next scheduled screening round.”

The article also adds: “Early publications about the value of AI in the analysis of radiology images were optimistic and there were even predictions that AI would threaten the future of the specialty of radiology. It might sound like a simple exercise to establish whether the incorporation of AI into mammographic screening improves the performance of a screening programme. However, the reality is that, despite hundreds of publications on the subject in recent years, a systematic review by Freeman et al. has shown that the picture is still not clear.”

Explaining, Dr. Yunus adds that when incorporating AI with mammography, it is possible that AI will improve sensitivity and reduce the rate of interval cancers. “As we already know that even the best performing screening mammography programme will miss some cancers, which subsequently present as interval cancers,” she says.

Furthermore, screening programmes tend to use two independent readers and so are relatively expensive to run and the use of AI could help to reduce these costs, she adds.

According to Dr. Yunus, the article argues that although it might sound like a simple exercise to establish whether the incorporation of AI into mammographic screening improves the performance of a screening programme especially when the AI system was more likely to detect micro-calcifications that are associated with ductal carcinoma in situ, it has been argued that AI programme was detecting very slow-growing tumors (leading to overtreatment). 

The ideal approach to evaluation of AI in a mammographic screening programme would be a randomised controlled trial where the performance of a trained AI programme is evaluated prospectively in a screening setting, where the comparator was standard practice, according to the article.

The article also adds that more prospective studies need to be done while establishing the accuracy of the results need to be reported as real numbers (true positives, false positives, true negatives, and false negatives), which allows for the calculation of sensitivity and specificity in both the AI system and the comparator (and the difference between them).

However, the introduction of technology in the use of health screening should not affect vigilance. “All the above-listed reasoning does not rule out the need to be vigilant while using technology for health screening,” says Dr. Yunus.

“Healthcare providers should stay cautious when new technology is introduced into a screening programme. It should not be assumed that what seems like a simple modification, leaves the balance of benefits and harms unchanged,” she adds.

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Asma Ali Zain is an independent journalist and a regular contributor at Omnia Health.