Health Ministry needs overhaul

The change in leadership at the Ministry of Health that sees Dr. Abdullah Al-Rabeeah succeeded by Labor Minister Adel Fakeih puts the Health Ministry at a crossroads. The monumental challenges of getting the upper hand over the coronavirus notwithstanding, the Health Ministry is faced with internal issues that might affect its work in eradicating MERS as well as boosting the low morale of government health care workers.
Al-Rabeeah is a humble and down to earth person and exhibits professionalism at every level. He took Saudi Arabia to the international level in health care with its conjoined twins separation program. His implementation of a system at the National Guard’s hospitals remains in place and is unrivaled by any other Saudi health care program.
But the greatest enemy of any organization, particularly one as large as the Health Ministry, is a mid-level management structure unwilling or ill-equipped to carry out administrative policies and decisions. Unique, forward-thinking policies that led to contract signings with Saudi or foreign consultants had the promise of offering first-class services to patients. The problem was that somewhere along the line of conception to completion, many projects were never carried out or established at the minimum level, thus creating a gap between the providers and the patients.
Saudis soon began to distrust government hospitals. Those who could afford it, traveled abroad for medical care while others opted for care in private hospitals. Saudis and expats not financially capable of such care entered a health care system they had little confidence in and paid a high price with subpar service. Saudi Arabia often provided third-world care to sick people who could not find beds in hospitals or dealt with questionable care in emergency rooms.
This doesn’t mean that all care was substandard. Quite the contrary, Saudi Arabia boasts a sizeable number of skilled surgeons, internists and consultants. Nurses and technicians are well trained.
The problem is neither resources nor available facilities, but the use of those resources and the distribution of expertise — expertise that is found in big cities but absent in the rural areas.
A hierarchy developed in which some consultants looked at the bottom of the personnel pyramid of technicians and nurses and viewed them more in a master-and-slave relationship. Further, high-level administrators cut across-the-board financial incentives for nurses and technicians who worked with infectious diseases or other dangerous work and left it to middle managers to determine on an individual basis who was deserving of the financial rewards. Often the incentives did not go to the best deserving, but to those who had wasta. For the most part consultants are treated well and receive financial incentives for their hard work. But nurses and lower level technicians have been deprived of financial incentives to carry out their jobs, leading to poor morale and the public airing of the Health Ministry’s dirty laundry on television news shows and newspapers.
Saudi Arabia does have good models of exceptional medical practices in specialized hospitals, such as King Faisal Specialist Hospital, the National Guard Specialist Hospitals and Armed Forces Hospitals. Why the high standards applied at these facilities are not implemented at every government hospital is a mystery.
Another mystery is the use of foreign companies to bring modern medical care to the Kingdom. For example, recently, a trustworthy friend wrote about the Health Ministry signing a SR12 billion contract with three international companies to run dialysis centers throughout the country. As a result dialysis sessions more than doubled from SR450 to SR1,400 per session. The agreement is only for five years and there is no integration of foreign expertise into our own health care workforce and system. Rather, we are left with a large question mark of what happens when these foreign companies go home.
Every Saudi is entitled to have access to a hospital bed. They are entitled access to a consultant and not have to wait until they are terminally ill. They are entitled to medical prescriptions at Health Ministry pharmacies without undue financial burdens. And each Saudi is entitled to a clean hospital to minimize hospital-borne viruses that are just as dangerous as any virus contracted outside the facility.
It takes time to reach this level of professionalism, but as we are quickly learning from the spread of MERS, the clock is ticking and time is not really a luxury.