The Gulf is battling the highest per capita incidence of lifestyle diseases in the world. What emphasis is being placed on preventative medicine in Oman today?
AL-SAIDI: Unfortunately, this part of the world is considered to be the capital of non-communicable diseases. The leader of those diseases is diabetes. Oman is similar to the other GCC countries and the prevalent percentage of diabetics in our population is 12.5%. These are the diagnosed diabetics. But let me emphasize that there are many people, whether in Oman or elsewhere, that are diabetic and they do not know it. In order to tackle diabetes and the non-communicable diseases, we set up a very strong primary healthcare infrastructure in Oman, which is the entry point for the healthcare system. That is the firs step for patients to start their journey into healthcare. Over the last 4 years we have introduced screening programs, designed not only to prevent diabetes, but to tackle all major non-communicable diseases, such as hypertension, high level of cholesterol in the blood, hyperlipidemia, and renal impairment. Diabetes is of course the predominant cause of cardiovascular diseases. We have very scary numbers of patients who, unfortunately, carry these diseases. The portion of diabetic adults is more than 12.5%, and in certain countries in the region it reaches 25% of the population. Hypertension in Oman is at an average of 40% of the adult population, whereas for lipid dysfunction, or a high level of lipid in the blood, the percentage is more than 44%. Prior to the 1970s, infectious diseases were the common cause of death and morbidity in Oman and the rest of the GCC countries. Now, the story has reversed. We have managed, with all the development in the Sultanate, to control most of the infectious diseases. However, with the changes of lifestyle in the region, the non-communicable diseases, which used to be more prevalent in the West, are now present in Oman and in the region too. The difference between the non-communicable diseases and the communicable diseases is that most of the communicable diseases are short clusters and usually curable; whereas, the non-communicable diseases are, unfortunately, chronic and progressive, which in turn make them very expensive to manage. The budgets of the Ministries of Health in the region, and in Oman in particular, will be burdened by the non-communicable diseases. Of course the Ministry of Health is one part of the whole system. We cannot tackle it alone as a Ministry of Health. It needs the cooperation of everybody, from homes, to schools, industries, and other ministries. Everybody should be thinking about healthy lifestyles. Health promotion is one of the major objectives on which the ministry is embarking on, as well as the screening programs. The national committee, chaired by the Undersecretary of Planning for the Minister of Health and other representatives from all government agencies and the private sector, is one of the major initiatives implemented by the Ministry to tackle non-communicable diseases. The committee is working very hard to implement all of the Ministry’s strategies, including prevention and early detection, as well as the implementation of standard management for specific conditions, which aims at minimizing the complications. Unfortunately, I must repeat, unhealthy lifestyles are the major contributors to non-communicable diseases, whether it is cancer, heart disease, diabetes, kidney disease, or hypertension. We can only advise and promote healthy lifestyles, but it all depends on the people. Exercise in our part of the world, unfortunately, is very limited. We have the excuse of the hot weather. However, there are indoor exercise places. We have 6 months of beautiful, nice weather for walking and for other activities in Oman. Our aim is to alert the public about the danger of these diseases and provide them with facilities, such as early screening, and provide the appropriate treatment by working together with the other government agencies and the private sector. There is no point for us to talk about healthy lifestyle, when non-healthy food is available for a much cheaper price than healthy food. We need to work together to tackle this issue. When His Majesty Sultan Qaboos took over in 1970, we only had 2 missionary hospitals, less than 12 doctors, and about 30 nurses. The life expectancy for Omanis in the early 1970s was less than 50 years. The death rate of infants and children below 5 was very high. In fact, 181 0f 1,000 infants would die before reaching the age of 5, and 118 of 1,000 infants would die before reaching the age of 1. Within less than 30 years of the new era, our life expectancy jumped to 74 years, instead of 50, which is probably one of the fastest phenomena worldwide. The mortality rate of infants dropped to be comparable to that of advanced countries, that is, 10.5 and 9.5, respectively, from 181 and 118. The number of hospitals we have now is 65, instead of 2 missionary hospitals. Out of 65 hospitals, 50 are governmental, that is, under the government and the Ministry of Health supervision, 5 are under other governmental agencies and 10 are private. We have more than 186 primary healthcare institutions in Oman under the Ministry of Health alone.
What are the main challenges that the Ministry of Health is currently facing?
AL-SAIDI: One of the main challenges is finance. No matter how much you spend on healthcare, it will never be enough. In Oman, we spend an average of 2.4% of the GDP on healthcare. If you take it as an absolute number, this percentage amounts to about 500 USD per person, whereas the international average is about 900 USD. The second most pressing challenge is human resources. There is a severe shortage, worldwide, for healthcare providers, such as doctors, nurses, and healthcare professionals. We are very lucky in a way, as in the nursing institution in Oman, we have more than 65% Omanization. These are healthcare professionals such as nurses, physiotherapists, and technicians. Thus, our shortage is not as severe as that of the doctors. These are our major challenges. We have met some of our major successes, but we still have major challenges.
How does Oman compare to regional neighbours with regard to the provision of specialty care?
AL-SAIDI: If we do go back to the 1970s, we did not have any specialized healthcare. In Oman, we started by strengthening primary healthcare, which is an absolute must for any type of successful, reasonably priced healthcare. Then, of course, primary healthcare became strong and the public, with the development of communicable diseases, started requiring specialist care. There is great progress there, but it is not as successful as in primary healthcare. In the Sultanate, we do have a hospital in each of the 10 provinces, providing secondary and partially tertiary healthcare. However, the tertiary healthcare, or the specialized healthcare, is mainly concentrated in the capital area of Muscat at the moment. We have certain specialist care, of which we are very proud of, such as for cardiovascular diseases, or cardiologist, or cardiothoracic surgery, that is, bypass and adult cardiac surgery. These are advanced and we are doing very well. However, we need more. For this reason, we have just completed the building of a cardiac centre in Salalah, which is 1,200km away from Muscat. Also, in progress, there is the building of the largest cardiac centre in Muscat. This will be ready within a year. Our waiting list for cardiac surgery and cardiology intervention is comparable to many countries, which are spending more money than us. We are managing the numbers, but we still aim at making it better. Other advanced or specialized care is oncology, that is, cancer care. We have an excellent oncology centre in Muscat. But this is not enough and we definitely need more. The latest equipment is provided, as well as the latest medications. Our oncologists follow international protocols. Most of them have been trained in Western countries and are doing an excellent job. However, we are not aiming at making the specialty services exclusively concentrated in Muscat; we want to spread them all over the country. For the viewers who have never heard about Oman, who have not heard any news, we are planning to build the Medical City, which will be the ultimate, specialized healthcare in the country. The plot of land for that is already there and we invite our international friends and colleagues to participate, not only in the planning and structure of the City, but to start working hand in hand to make this a centre of excellence for the region and for Oman. So, there is some progress in specialized healthcare, but our ambition is to go higher and higher. We are looking for the day in which not only no Omanis will go abroad to receive medical treatment, but for people from abroad to come to Oman to be treated in Oman. This is an ambition that, with the help of our international friends and colleagues, and with the dedication and workforce of our team here, we can realize. Muscat is a beautiful city, but there are limitations on land because we are limited by the mountains behind us and the sea in front of us. In fact, one of the obstacles we had was to find a proper location. This is a Medical City for the country. Thus, we need to be accessible to the population, as well as to the international patients, visitors, and staff. Therefore, the struggle was to find a location that we are happy with. I am glad to say that we found a location which is less than 50km away from Muscat International Airport. It is a prime location and now we are working on the details. There will be an announcement for a managing company to manage the complex. If it was up to me, I would love to see the first phase of the Medical City to be completed by 2016, but this is my and my team’s wish and ambition. Whether we can accomplish it or not, it all depends on many factors, but we are working around the clock. We will invite the private sector to contribute and participate and there will be place for everybody. The plot of land we acquired is 5,000 square kilometers, which is a huge plot. Parts of it are dedicated to the private sector to have its projects. In addition to the Medical City, which is highly specialized, we also have in the pipeline the construction of 10 hospitals to take care of all the regions of Oman. We are planning to finalize these in the coming 4 to 6 years. We aim to increase the number of hospitals together with the whole status of the Sultanate, improve the quality of care provided in our primary healthcare institutions, and make them accessible to the public. I need to stress that healthcare in Oman is provided free of charge by the government. This is one of the challenges that we are facing for 2 reasons. One is the expenses of healthcare itself. Secondly, if you ask me as a person, and not as a minister now, people look at things that are free with no appreciation. It is not appreciated because it is free. That is probably one of the reasons why many of our people go abroad for treatment. Of course, this is a commitment from His Majesty, that is, to make health and education accessible and free to everyone. That is why it is free of charge. People abroad pay a huge amount of taxes.
Which healthcare indicators are showing positive trends and which remain challenges?
AL-SAIDI: The Millennium Developments Goals health indicators, set by the UN, and whose target is 2015, have all been achieved by Oman much before its deadline. This does not mean that we do not have challenges, because we do. As a healthcare provider, the most difficult challenge is human resources, as well as changing people’s lifestyle to adopt healthier habits. Whether we like it or not, non-communicable diseases are increasing. One other issue that we are faced with is our congenital or hereditary diseases. This is due to the social structure of the region and Oman. Up to 7% of Omani babies will have one form or another of congenital diseases. We do offer and provide pre-marriage screening for people to avoid getting married if they are carrying genes which can lead to congenital diseases, but of course you cannot force a couple who is in love not to get married because of this. But, we do offer this service free of charge. We have antenatal screenings for diseases too. Nevertheless, congenital diseases remain one of the major challenges, as 7% of the population is affected by it and this is a huge number for congenital or hereditary diseases.
What are the elements that should attract investors to come into Oman?
AL-SAIDI: Unfortunately, I think, we are not well marketed as a country. In fact, there are many factors that shall attract investors to come and establish their operations here, mainly the high standard of the institutions, the political stability, the excellent security, a stable economy, and the variation of geographical landscapes and weather, which characterize Oman. In fact, when temperatures in the summer reach 45° and above in Oman and in the region, and humidity is at 80-90%, we have the southern part of Oman with the monsoon season where temperatures oscillate between 25-28°. There is no sun, and it is beautiful and green. So, the variation of geography and weather in Oman, in addition to other major factors, such as security, stability and the economic progress, are all very attractive features for investors to come and invest in Oman. The other thing, as a government body, we are encouraging and providing facilities for the private sector. I have just mentioned the Medical City, that is a 5km lot, where I welcome any serious investors to come and say, “I want this percentage of your plot, and I’ll build a diagnostic centre”, or “I will build an oncology centre”, etc. Thus, the scope for growth in Oman is huge. Rehabilitation is another point for the private investors to look into. At the moment, up to this very minute, we do not have a good rehabilitation centre in Oman. If a serious investor comes tomorrow and says “I want to build a rehabilitation centre as part of your Medical City”, I would say “Please do! Thank you very much. We will send you the patients”. We are working to encourage the private sector locally and internationally to come and participate. Oman is still an undiscovered and unspoilt heaven, from whichever angle you look at it. I’ll remind you, I am the Minister of Health, but tourism in Oman is very promising and we have all the right potentials for making Oman an excellent destination for healthcare.
We are planning to build the Medical City...The plot of land we acquired is 5,000 square kilometers, which is a huge plot. Parts of it are dedicated to the private sector to have its projects. In addition to the Medical City, which is highly specialized, we also have in the pipeline the construction of 10 hospitals to take care of all the regions of Oman. We are planning to finalize these in the coming 4 to 6 years.
How is Oman’s healthcare sector collaborating with the international community?
AL-SAIDI: Our collaborations with international centres of excellence are links which we are proud of and which we encourage. We are seeing more and more links between Oman and many European centres. We have had doctors from Sweden operating at the Royal Hospital in Oman, carrying out cardiac surgery for children. We have had doctors from Germany working on our hospitals, and doctors coming to do operations from Britain. We are contracting many doctors from other parts of the globe, as they have the know-how. I would prefer for them to come and operate on my patients here, as it is more convenient for our patients. Training of Omanis is also an important element. We take Omanization very, very seriously. At the moment, only 30% of the doctors are Omanis. So, what we are looking for in our international friends, as well as the partnerships with our institutions, is for training positions to be filled and for further healthcare providers to come into the country. We do send doctors to North America, to Europe, to Australia, and to New Zealand for training, but we aim for more slots of training to be held in Oman for our Omani doctors.
What are the best investment opportunities in Oman’s healthcare sector?
AL-SAIDI: The University of Oman and its Faculty of Health Sciences will be a great project that will attract people to come and work here. At the moment we are working with many universities, but this is an invitation for everybody who wants to have a good academic lifestyle in our institutions. Our Medical City, with which we need help and partnerships with international organizations, is another great project. We will need international companies to help us in designing and structuring our new hospitals. Considering that only 30% of the doctors are Omani and 70% are expatriates, we will need more expatriates to come and work in Oman. Since the 1st of July last year, His Majesty has approved a salary increase for doctors, which is very competitive and attractive. I can assure you that the pay for the doctors in Oman is now not only comparable, but competitive with, many European countries. We invite all our colleagues and those who are viewing this interview to visit our website for more information.