It’s patients first, health minister spells out policy

The Ministry of Health has achieved tremendously during the past three years, counting its pioneering Home Health Care Program as one of its key successful initiatives, the Kingdom’s health minister told Arab News in an exclusive interview. Dr. Abdullah Al-Rabeeah said his ministry is moving forward with a comprehensive health care plan to better meet the Kingdom’s needs and improve health standards for the next decade. He said the Home Health Care Program, which provides care in the home for needy patients, was a key part of this strategy. The minister was keen to increase the number of health services available in villages and rural regions. “Some regions are not attractive for doctors to work in because of the difficulties in offering medical services in the Kingdom’s remote and rural regions and major residential townships as well,” he said. “Therefore, the ministry launched the Visiting Doctor Program nearly three years ago. We have exerted a lot of efforts to improve the scheme and now it has become a well-known initiative…We continue attracting a number of doctors from North Africa, Europe and Australia as well as from several Arab and Muslim countries to work in hospitals in remote regions.” Al-Rabeeah also expressed a desire to ensure future Haj experiences are even more smooth and disease-free for pilgrims, particularly with regard to the running of the ministry hospitals in the holy sites. He also had a vision to establish the Kingdom’s public health sector as one of the leading ones in the world, as demonstrated by the opening of the Middle East’s first proton-therapy center for cancer treatment in Riyadh recently. Full text of the interview: Arab News: Could you describe the recent achievements of the Ministry of Health? Abdullah Al-Rabeeah: The Ministry of Health (MoH) is moving forward with a well-defined strategy. We have drawn up the strategy, which is based on a nationwide comprehensive health care plan for the next 10 years. This strategy aims to realize the fundamentals of justice, comprehensiveness, integration, and the best possible service with a focus on top quality and utilization of the highly advanced means of technology. The national health care plan was finalized after top officials of MoH as well as Saudi and international experts carried out detailed and in-depth studies at various levels. However, the ministry will not stop at this point. It is imperative to have immediate achievements as well as medium- and long-term achievements. The health care sector is also required to achieve goals at various levels. Needless to say, the MoH has achieved tremendously during the past three years and is proud to highlight the Home Health Care Program as among its achievements. We started the program from scratch, but now there are more than 11,000 patients who are taking advantage of this initiative. I believe this is the most remarkable achievement that we have made within a short span of time. Similar is the case with Hospital Bed Management Program. I believe that it is essential for the MoH to employ the best means to utilize every hospital bed. I admit that there was a shortage of beds. Hence, the ministry worked out a program to best utilize hospital beds based on a rota. Earlier, each bed had four rotations in a month. But now, each bed is having six rotations, instead. This means that there has been an improvement in the utilization of hospital beds. The ministry is also implementing another program that is likewise related to beds, namely One-day Treatment or Surgery. At present, there has been a tremendous progress in this field worldwide. Several in-patients receive treatment or undergo surgery in a day and return home the same day. Apart from providing them a great deal of mental relief, this also means a speedy recovery for patients having the presence of their family members, in addition to the low cost of treatment. Though we started the program from scratch, we managed to score excellent performance results — 35 percent of the total surgeries carried out in a day. Regarding the quality of health care, we have made significant achievements. Under the MoH, there were no hospitals that won any certificates for quality of service. We started subjecting MoH hospitals to the quality programs. Hence, we relied on two methodologies. First was securing internal accreditation from the National Center for Health Care Quality and Accreditation under a program called the Morning Program, so far, about 30 MoH hospitals have benefited from this program, which follows the American and Canadian criteria and standards. In order to maintain these quality criteria at the ministry, we have referred 10 hospitals for review and accreditation to the Joint Commission International (JCI), the US-based global leader in accrediting health care organizations. At this point, three of them received accreditation from JCI, including King Khaled Eye Specialist Hospital in Riyadh, King Fahd Medical City in Riyadh and King Fahd Specialist Hospital, Dammam. The accreditation process for the remaining seven hospitals is under way. Similarly, we introduced the Bed Referral Program. Medical errors are one of the most talked about topics. The MoH believes that the best way to mitigate medical errors is to introduce necessary regulations. Therefore, we introduced the Bed Referral Program, which consists of more than 18 criteria aimed at protecting patients against such errors. By this, we have started recording all major medical errors. The ministry’s online control centers have access to information about any grave medical errors taking place at any one of its hospitals. It even allows me to find out about such errors within 48 hours. It is a qualitative leap in the history of the ministry. Among the ministry’s other accomplishments, the most important one is, its concern for patients. Being a ministry for service, the MoH’s focus is on the patient. The ministry has even introduced a slogan: “The patient is first.” Therefore, all our programs are aimed at ensuring the patient’s satisfaction. A central department was formed to achieve the ministry’s objective which is linked to the highest authority at the MoH. Earlier, the department was meant only for establishing relations with patients, and this year the ministry added ensuring the rights of the patients. In this way, we are exploring the prospects of establishing a good rapport with patients and then guaranteeing their rights as well as the rights of the institution taking advantage of the program. Correspondingly, the ministry is showing interest in the affairs of employees. There is a higher department at the ministry that is dealing with rights of MoH employees and guaranteeing justice and fairness to all employees. The ministry has also made remarkable achievements in the opening and operation of more hospitals across the Kingdom. During the last three years, we opened 30 new hospitals, in addition to more than 400 primary health care centers. Apart from these, the MoH has made numerous other achievements. One of which I would like to shed light on the remarkable progress made by the ministry is in the field of IT, where it has received awards and recognition for its excellent performance. At present, we have more than 18 projects aimed at upgrading IT standards while rendering medical services to patients. Least to mention is the Visiting Doctor/Professorship Program which is another milestone achievement of the ministry. Now, the MoH can compete with any other country in the world with regard to attracting medical staff from various countries and deploy them in the Kingdom’s remote and rural regions. Under the program, the ministry takes advantage of the service of specialist doctors from many advanced countries for a period of two or three months. They return after completing the specific period and then other doctors come to replace them. The ministry was able to attract as many as 1,200 specialist doctors to work under this program during 2011.  AN: It was announced that last year’s Haj was free from any diseases. This was a remarkable accomplishment. What about the ministry’s health plan in the wake of a growing number of pilgrims every year? Could you please shed light on some of the salient features of the ministry’s Haj plan for this year? Al-Rabeeah: Well, as I mentioned earlier, the ministry is going ahead with a well-thought out working plan and methodology. We have also drawn up plans and programs on the basis of our past experience in Haj. I think that the Kingdom’s MoH is one of the few health ministries in the world that have obtained expertise in mass gatherings medicine. This expertise has enabled the ministry to plan how to handle the growing number of pilgrims every year. As part of taking advantage of this expertise, the MoH organized a Lancet conference on mass gatherings medicine two years ago. Senior officials of international organizations who attended the conference lauded the ministry’s efforts. The organizations had also approved Saudi Arabia as the global pioneer in mass gatherings medicine. During the last year, the ministry focused on curative and preventive medicines as well as laying down sound health regulations and conditions after reviewing the global situation of infectious diseases. This was in coordination with international organizations such as the World Health Organization (WHO) and the US Centers for Disease Control. All these helped us to frame health regulations and requirements to prevent entry of any infectious diseases into the Kingdom. The second factor is the great efforts of authorities at all land, sea and air entry points to the Kingdom. Teams of experts and specialists from the ministry were there to carry out medical tests on pilgrims as well as to give them vaccinations. The third important factor is the presence of a large number of MoH hospitals and medical centers all over the Kingdom, especially at the two holy cities and the holy sites. Moreover, there has been coordination with various Haj missions in a scientific and professional way to ensure the sound health of their respective pilgrims. All these contributed to make the ministry’s Haj operation plan a resounding success. Regarding the question about the plans for the next Haj season, I would like to point out that we would follow the same pattern. We would closely monitor trends of infectious diseases across the world. After going through these and collecting necessary information, we develop the health conditions and requirements to be met by pilgrims from various countries. We always focus on preventive medicine as our first priority. Then our concentration is on the Kingdom’s entry points to prevent the entry of any pilgrim carrying infectious diseases. Moreover, we learn from errors that happen every year and are keen not to repeat them again, and thus make the operation of the pilgrimage much better than the previous year, God willing. AN: The MoH is to undertake the difficult task of making available health services in villages and rural regions. Qualified doctors and medical staff are reluctant to work in the extremely difficult conditions associated with those regions. How would you tackle this situation? Al-Rabeeah: I believe this is a challenge facing the entire world. There is a scarcity of specialized doctors in the world as a whole and therefore Saudi Arabia is not a special case. However, some regions are not attractive for doctors to work in because of the difficulties in offering medical services in the Kingdom’s remote and rural regions and major residential townships as well. Therefore, the ministry launched the Visiting Doctor Program nearly three years ago. We have exerted a lot of efforts to improve the scheme and now it has become a well-known initiative with the MoH, similar to a number of programs existing in several other countries. We continue attracting a number of doctors from North Africa, Europe and Australia as well as from several Arab and Muslim countries to work in hospitals in remote regions. I think this is the temporary solution to the problem. Regarding future solutions, we hope the King’s Scholarship Program as well as the ministry’s places for scholarships have been potential in attracting several young men and women from these remote regions to join the Visiting Doctor Program, and they can return to work in their regions after completing specializations in all branches of health science. The MoH hospitals and health centers would make available the best possible work environment as well as top class technology to them. AN: Most often, local daily newspapers carry reports about doctors working in the health sector with fake certificates. What are the measures taken by the ministry to tackle this problem? Is there a viable policy to encourage qualified doctors to enter the health sector? Al-Rabeeah: I believe the detection of several cases of forgery is a positive thing for the ministry’s monitoring wing. In the event of unearthing such certificates, the Saudi Commission for Health Specialties (SCHS), MoH and other concerned agencies start scrutinizing these certificates and track down their original source and the bogus institution that issued them. We are also interacting with some specialized companies in finding out who is behind these fake certificates. After having great experience in this field, we are able to detect a large number of such forgery cases and subsequently managed to prevent the holders of such certificates from working in the Kingdom’s health sector. Therefore, I see detection of forgery as a positive element for the Kingdom and there is nothing negative in it. AN: How can the ministry tackle the problem of several doctors leaving MoH hospitals to join the private health care sector? Does this happen because of a disparity in salary between the two sectors? Al-Rabeeah: We have the perception that both the public and private sectors are part of one sector to serve citizens. As for the MoH, it is responsible for taking care of not only the public health sector but the private health sector as well. I personally believe that there is no problem with the government sector. At the same time, I reiterate that the percentage of those leaving the government sector is very low. People tend to look only at the number of doctors leaving the sector and do not consider the number of new professionals joining in. At a time when nearly 7,000 new doctors have joined MoH service, the number of those leaving is merely 20 to 30. There could be individual cases of doctors leaving the government sector but the main reason for this is not financial gain. Some doctors prefer working in the private sector due to the number of working hours, as the government sector’s working hours are fixed and longer. Anyhow, a doctor in the government sector can be more proud of serving the nation and its people. A large number of Saudi doctors are coming forward to take up jobs in the government sector after an order issued by Custodian of the Two Holy Mosques King Abdullah ensuring salary parity for MoH employees compared to other government sectors. AN: Several nurses are complaining about long duty hours at private hospitals, saying this has had an adverse impact on their social and family life. Can the ministry do anything to regulate their working hours? Al-Rabeeah: Working hours should be compliant with the provisions of the Labor Law. So far, we did not receive any written complaints with regard to violations of the Labor Law. If the ministry received any complaints, we will handle them in accordance with the provisions of the law. We won’t allow anyone in the government or private sectors to violate the law in a way that infringes the rights of employees. AN: King Fahd Medical City (KFMC) is an exemplary model for providing health care. Are there any plans to establish similar medical faculties in various regions? Al-Rabeeah: KFMC is a specialized medical city. Custodian of the Two Holy Mosques King Abdullah has ordered the setting up of another five medical cities to serve people in various regions of the Kingdom. They include King Khalid Medical City in the Eastern Province, King Faisal Medical City in Abha to serve the people in the southern region, Prince Muhammad Medical City to serve people in the northern region, King Abdullah Medical City for people in the western region and King Fahd Medical City to serve people in the central region. Apart from offering excellent treatment facilities, these medical cities would also serve as the best education centers, both for higher medical specialties and educational faculties. However, the MoH believes that medical faculties should be an integral part of universities. It is difficult for a faculty to stand by itself without being affiliated to a university. Hence, there was a decision to affiliate the medical faculty at KFMC with King Saud University for Health Sciences. Of course, the ministry also has plans to tie the remaining medical cities with universities. If any university wants to take advantage of these medical cities, we will extend cooperation to them. At present, there are 24 universities in the Kingdom and they are fulfilling the educational requirements of various regions. AN: What about the progress of the Comprehensive National Health Care Program that covers five medical cities? Al-Rabeeah: On the very second day of King Abdullah’s order to establish five medical cities, a higher committee headed by myself was set up. The committee with the participation of senior MoH officials and concerned departments has worked out a vision for these cities. Subsequently, branch committees have been formed to draw up the actual requirements of these cities to enable them to extend the best possible health care services. The ministry has taken advantage of these specialized committees. Engineering firms have been invited to draw up plans for these cities. We will race against time to implement these projects. For instance, we have completed the design work phase with regard to KFMC, and are expected to award the project next week. AN: Is there any comprehensive national strategy to combat AIDS? What are the steps taken by the ministry to tackle this deadly disease? What are the procedures being taken when any citizens or foreigners are found to be HIV positive? Al-Rabeeah: The Ministry is giving top priority to preventive medicine. The MoH has always promoted the concept of prevention as better than a purely curative approach with regard to general health. We have worked further on developing this concept to a greater level by giving priority to environmental health. The ,inistry’s priorities included a specialized program for those infected with AIDS. There is a specialized department at the ministry to tackle this disease wherein this was launched in line with the criteria of WHO. It is inevitable that we should take care of those affected by AIDS like other patients. We give prominence to their rights: both as individuals as well as their rights in society. Therefore, the ministry has made every effort to introduce regulations aimed at protecting these patients in a way enabling them to fully integrate in society. The ministry also looks at it as imperative to instill confidence in the patients and that society should not be afraid of them. In order to achieve this objective, the MoH started setting up counseling clinics and now there are several such clinics across the Kingdom. We also started clinics to facilitate interactions with AIDS patients with transparency and candidness. As a result of this, these patients came forward and responded positively. We also started working on a statistical program with these patients. Our main focus should be to make the younger generation aware of the dangers of AIDS with an objective of reducing the number of such cases in the future. AN: There are reports about the increasing number of cases involving psychiatric disorders in the Kingdom. Is there any national strategy for the treatment of mental patients and taking care of their families? Al-Rabeeah: Of course, the ministry is keen on ensuring the physical and psychological well-being of citizens. The MoH has a well-defined strategic plan to deal with mental illness and problems of addiction. Accordingly, the mental health department at the ministry had drawn up a strategic plan that was presented to the concerned authorities for approval. The MoH has more than 14 strategic programs for various regions of the Kingdom. We have also given approval to new projects to establish mental health hospitals. The ministry is also going to undertake a national survey on mental patients and in cooperation with the Prince Salman Center for Disability Research and various Saudi and foreign universities. The MoH also studies the implication of mental health cases as we know there are several problems for citizens, including mental disorders, and addiction problems normally associated with youths. God willing, we will work together to solve or at least mitigate these problems. AN: A large number of Saudis from the Northern Border Region is going to Jordan for medical treatment. What is your message to these people? Al-Rabeeah: I was briefed on some media reports about citizens receiving treatment in Jordan. I have also gone through statistical figures about the patients visiting various Saudi hospitals and health centers in these regions. It is irrelevant to compare these figures. As for those receiving treatment at these health centers, they are very huge in number compared to those going to Jordan. The citizens have a greater level of confidence in these centers, especially after introducing the Visiting Doctor Program and opening of some excellent health projects in the northern regions. We know well that these regions need more health facilities. We have several mega projects for the four northern regions. With the completion of Prince Muhammad Medical City, these regions will have sufficient health service facilities. There are also certain other factors that prompt some citizens to go abroad for treatment, and these include family relations there, vacations, or taking advantage of some specialized treatment facilities available at nearby major cities in Jordan. However, the ministry has great concern for the health affairs of citizens. The message from the ministry to citizens is that the MoH is keen on making available the best possible health services to the citizens in these regions in a much easier way and by guaranteeing justice and fairness. AN: Saudi Arabia boasts of having the Middle East’s first proton therapy center at Riyadh’s King Fahd Medical City. How is this therapy, which is the most advanced form of cancer treatment available today, going to benefit citizens and foreigners? Is there any Saudi doctor who has acquired proficiency in this medical specialization? Al-Rabeeah: Absolutely. The MoH is giving priority to both treatment and research as well as health technology transfer. Transfer of highly advanced technology is one of the programs of the ministry. Regarding proton therapy, the MoH is a forerunner. Everybody knows that proton therapy is a rare form of treatment available at limited centers worldwide. MoH viewed the ideal way to obtain this technology is to establish investment partnerships with global expert houses in this field. After getting approval from the Council of Ministers, the ministry clinched a partnership agreement with a Saudi investor and a foreign investor to establish the first proton therapy center in the region. As you mentioned, the center will provide treatment to both citizens and foreigners not only in the Kingdom but also in the neighboring states, because such a center caters to the needs of the entire Gulf region. Therefore, we carried out an economic feasibility study prior to establishing the center. There is no doubt that there are specialized doctors at KFMC who have now obtained specialization in proton therapy. After completion of the project, there will be dozens of Saudis who will be specialized in various fields of proton therapy. AN: The Saudi Red Crescent Authority is an exemplary example on how to render voluntary medical services, especially with regard to air ambulance services. Does the MoH have any plans to enter the field of operating air ambulance services between various hospitals? Al-Rabeeah: We see the health sector, including the MoH and other branch health sectors, whether it is the National Guard or the Ministry of Defense or the Ministry of Interior or various universities, as a single system. The Saudi Red Crescent Authority (SRCA) is also part of this. As per the Kingdom’s health system, ambulance services along the highways, including roads and air routes, is the mission entrusted to the SRCA. The ministry is currently undertaking the transportation of patients from one hospital to another. In view of the existing coordination between the MoH and the SRCA, air ambulance services should be solely within the jurisdiction of the SRCA, instead of duplicating the services by the ministry and the authority. The MoH should remain as an ally, supporting the SRCA to improve this service, due to the fact the ministry is a major beneficiary and we laud the services rendered by the SRCA. AN: How is it possible for you, the minister, to maintain a balance in your dual role as a minister and a doctor? Al-Rabeeah: Had this question been from my wife, it would have been even more relevant (laughing). Of course, there is no doubt that I was brought up like any other Saudi citizen. I have chosen the job of a surgeon as my profession. I preferred to be a pediatric surgeon purely out of my love of children. Throughout my life, I worked in this field. I offered a portion of my duty to the nation through my service in this profession. But when I was asked to shoulder a much higher responsibility, I was honored to serve the nation in any role that was found suitable for me by Custodian of the Two Holy Mosques King Abdullah and Crown Prince Naif, deputy premier and minister of interior. Being a doctor who loves his profession, I deemed it necessary to continue with this line of work. However, I could not neglect my duty as a minister because the requirements at the ministry are much greater. Therefore, I continue being engaged in my favorite profession as a surgeon only on Thursdays and Fridays. Therefore, I extend many thanks to my wife and children for their proper understanding about my love for this chosen career. They are pleased with my situation and sacrificed for me for the sake of the nation and the patients as well.