PHC Reform in Saudi Arabia

PHC Reform in Saudi Arabia

As outlined in Saudi Vision, 2030, agenda requiring a transformation in all Government departments, the Ministry of Health is also taking necessary steps to reform the health sector. According to Zweife l& Breyer (1997 p. 52), three pillars- an ambitious nations, a vibrant society, and a thriving economy form the basis of Saudi’s Vision.  To begin with, a vibrant society pillar concerns a healthy living, which ensures that citizens live healthy, cutting across all the ages. Furthermore, the pillar targets caring for people’s health, which is attained by the public sector reducing infections by facilitating preventive measures as well as advocating for the use of primary health care. Contrary to the other two pillars, which indirectly contributes, in facilitating health care services.

According to the report of (UNESCO 2000, p. 63), the health sector’s Vision was to bring separation among provision, regulation and payment. The implementation of this could result to separation of responsibilities in that the ministry to retain the role of regulation whereas services to be provided by corporatized public bodies. Under governance, there will be creation of regulations and improvement functions vital for sustaining strong health care standards. Also, governance creates leadership and delegates it in the health care system.

However, the corporatized public bodies are entitled to delivering quality services in the health care organizations via integrated networks and but not limited to, incorporation with private sector. Also, the bodies will provide their services in a patient centric manner. Their duties involve allocating resources, paying salaries and employing the staff in the health sector as well as closely monitoring the managers’ performance, (United Nations, Department of Economic and Social Affairs 2007, p. 19). Public expenditure is reduced by incorporation of private sector by supplying and providing services. Private sector benchmarks for performance of managers, and establish meaningful partnership purporting to boost quality of service delivered.

Standalone financing entity will fund the system based on outcomes that in turn leads to value payment model. There will be involvement of insurance to aid all citizens and visitors to access healthcare services. Furthermore, digital information systems and workforce will be developed and strengthened.  The strengthening will involve increasing the capability of workforce, re distribution and diversification. Also, the digital information will trigger the value based health care approach, (Starfield 2020, p. 12).

Furthermore, the new model is patient centric aiding individuals and their families to manage their Health via self-care. The model facilitates delivery of vital services through coherent interventions through the six systems. MOC can best be implemented by incorporation of essential payment approaches including private sector. The figure below shows workforce, governance and e-Health development, (Tarimo et al. 1994, p. 96).

The key role of Enhanced Primary Care (EPC) is to improve the role of primary care in all the systems of care. Furthermore, the intervention magnifies the responsibility of PHC in service delivery through mobile and minute clinics. Basing on the new model principles, the  EPC aims at integrating services in the whole system and deliver services through population need- based and  the approach of multidisciplinary, (UNICEF 2020 p. 139). In regard to the guidelines of the nation, EPC intends to create a primary health care which will be first and last point of contact systems in the healthcare.

The Map Road to Primary Health Care Reform, 2016-2010

According to the Indian Council of Medical Research, (1981, p. 44), PCH was recognized by the National Transformation Program 2020 to have significantly prioritized the nation’s vision 2030. The road map of Saudi Arabia’s Vision invested much in making greater achievements in public, private and nonprofit sectors. Alignments were witnessed in government ministries, institutions and entities to fit in the first phase. Information removed from review of health care in KSA shows that

1. PHC did not fully integrate the preventive programs and care of NCD and that in only streamline its efforts to curative care.
2. Dental and mental health services are limited.
3. Patients with chronic infections seek services from a separate team as PHC lacks the services.
4. PHC have limited role in public Health and promotion
5. Approaches like people centered and continuity of PHC lack in PHC practice leading to ill-defined and lack of community engagement, lack of multidisciplinary and high staff turnover, insufficient qualified staff in chronic infections, lack of necessary communication and interpersonal skills, and wrong and weak follow-up and referrals.

The table below shows seven strategies for reforming PHC in Saudi Arabia as proposed;

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The ministry of Health implemented using the seven initiatives to achieve PHC reforms in its Kingdom. The initiative is;

1. Strengthening family medicine approach initiative. This initiative aims at strengthening delivery system of (PHC) through implementation of family practices. Also, it includes the integration of mental Health and NCDs in PHC in an attempt of reducing wastage of resources and provision of services like those related to chronic diseases.
2. PHC Centers Quality Improvement Initiatives. The initiative focuses in implementations of internal processes and procedures at PHCC that regards national requirements from health care association called central board for accreditation. It also builds capacity to workforce leading to provision of quality services.
3. Strengthening of the electronic health information system. This is where conversion of electronic recording and reporting system from paper was transitioned. Furthermore, incorporation of numerous electronic application to initiate smooth running of services, (UNICEF 2020, p 31). Mawid and Wasfaty are the two mobile application used in necessitating the operation in patients’ services.
4. Specialized policlinics initiative. Transferring of magnitude PHC centers to policlinics is done here. This is where health services requiring specialization are provided in a densely population by the consultants, family physicians and other specialists.
5. Mobile clinic initiative. The services are provided through mobile clinics. It is essential in nomadic population. The services rendered include, maternity care, vaccination, curative services and administering of vital medicines.
6. Extended after- hour services initiative. It key role is improving accessibility of patients to high quality and urgent health care services which aid in rapid respond thus reducing mobility complications associated to traffic accidents and referrals. Furthermore, pre referral measures for life saving (Advanced Life Support ALS) like Medical Tele Consultations with call number 937 for calling, (UNESCO 2020, p. 117).
7. Initiative of school based obesity reduction. According to Starfield (2020 p. 75), high rate of overweight and obesity, 23% and 9.3%, respectively among school children of Saudi. The initiative aimed at reducing the rate of obesity by 5% in schools and adolescents of the age between 6-18 years.
8. Initiative of national dental Health for primary schools. It targeted in reducing cases of tooth decay among school children. It attained the aim by providing preventive and curative services at the nearest PHCC.
9. Primary mental health care initiative. Improved services related to mental thus reducing cases like those of depression and anxiety.
10. Health coach initiative which is concerned with assigning PHC staff to communicate with, gain education to promote services of chronic disease patients.
11. Clinical health awareness that increases the level of creating health awareness to the public. It achieves its goals through provision of health education sessions. Furthermore, it also trains educators.
12. Lastly there is a community empowerment initiative that employs the concept of participation. It involves the empowerment teams from PHCC, the educators and helps in identifying the needs to address.

Scaling up of Family Physicians Post-Graduate Training Program. It is used to fill PHC physician gaps are done as well as capacity building. It also increases post graduate posts in Family Medicine.  There is also provision of training to the family medicine members.

Refresher training for family physicians. The training gives general knowledge to practitioners working at PHC centers.

Leadership training program for public health leaders.  The ministry of health work together with administration for training and academies. The key role is to give managerial skills to PHCC managers, and other public heath leaders, (United Nations 2015, p. 56).

Some of the efforts to engage community to identify their health needs.

The efforts are displayed through community empowerment initiative where the PHCC teamwork in collaboration with communities in discovering their health problems and addressing them. Besides, there is patients support group where volunteer patients meet in guidance of a medical practitioner to share experiences, (World Health Organization 2008, p. 53).

A Team-Based Care Approach (Empanelment)

A team-based approach introduced in 2020 is being piloted in two health regions. The core objective was to hold health care providers accountable. Each healthcare is expected to know its population and follow health care management. Also, it aims at improving the quality of services by interpreting data, tracking performance hence positive outcomes.  PHC establishes sub administrative units and attach it with a limited number of health care practitioners.

This approach will involve six main components.

1. Network health care teams. It will be a small group of 5-10 members representing a small region, and headed by a public health officer. The officer will be aided by two to three administrative staffs, (UNICEF 2020, p. 87).
2. Panel health care team. This will be based on the population size. It will have GP/FP, a nurse and one supportive staff. The group is entitled to deliver patient centered services.
3. Population empanelment. It is a continuous process of assigning people to health care personnel responsible for offering them healthcare services. An average of 1000 to 1500 of the population will be roistered to each team of health care in relation to the location, (World Health Organization 2008, p. 43).

The suggested method for empanelling includes; selecting of individuals from information system and in those who attended PHC centers

4. Segmentation of empanelled population which includes person with specific proactive services.
5. Proactive population outreach that facilitates provision of services at homes and communities like schools providing services like vaccination.
6. Proactive health care that is responsible for screening chronic diseases and others related to maternal and child care.

Benefits of Empanelment

Empanelment constitutes a lot of benefits to all stakeholders. To patients, they enjoy boosted communication between the patient and the service provider. It also helps in identification of health problems and patient satisfaction as well as building trust. The patient has sufficient time to interact with the professional practitioner

To the provider of health service, he or she is in a position of comparing subpopulation of patients. Furthermore, empanelment balances workforce since each provider has a distinct panel helping to reduce overload, (United Nations 2007, p. 96).

Lastly to the practice, it has a fair distribution of responsibilities and promotes analysis of data essential for decision making. Besides, it reduces general costs of the health facilities.