Changing dynamics

hospital

Oman’s healthcare landscape is riding the crest of a qualitative change driven by a plethora of initiatives both in the public and private sectors. The government is focusing on improving tertiary healthcare facilities by developing specialised hospitals and medical cities while private operators are upgrading their services by foraying into super specialty and tertiary services across the country.

The reminiscences of two hospitals in the capital area with a total of one dozen beds and staffed by a handful of physicians and nurses, and ten tiny ill-equipped clinics scattered across the interiors, serving the healthcare requirements of the entire population of the Sultanate in 1970 are still vivid in the living memory of many Omanis. Some elderly people could dig out from their old documents a handwritten prescription by the legendary Dr Wells Thoms who served at the erstwhile American Mission Hospital in Muttrah which was later rechristened as Al Rahma, or a medical report prepared by his immediate successor, Dr Donald Taeke Bosch who later helped to incorporate those hospitals into the new Ministry of Health (MoH) hospital programme.

Now, forty odd years since the country’s tryst with Renaissance which also marked the beginning of Oman’s massive public health infrastructure development, the Sultanate is home to 65 hospitals with a total number of 5,859 beds and 1,143 health centres both in the public and private sectors (See box: Healthcare at a glance). The rising lifespan is a telling indicator of how far Oman’s healthcare sector has come of age. The average life expectancy at birth stands now at more than 72 years, a long way up from only 49 years in 1970. Another tangible result of this incredible development story has been the total eradication of communicable diseases such as measles, malaria and typhoid. As the Minster of Health HE Dr Ahmed Bin Mohammed Al Saéedi recently pointed out, under-five mortality rate has dropped from 35 per 1,000 live births in 1990 to 11.9 in 2011. Infant mortality rate has also dropped from 29 to 9.5 deaths for every 1,000 live births. With 19 doctors per 10,000 people, as against the global average of 14 doctors, and spending on healthcare 4.9 per cent of the total government expenditure (the budgetary allocation for healthcare sector in 2013 was RO547mn), Oman is expected to meet the Millennium Development Goals by 2015. Furthermore, the country’s healthcare market is projected to be worth over $2bn by 2015 and the total expenditure of the healthcare sector in 2013 is approximately 5 per cent of the total public expenditure, rising to $1.4bn from $1.3bn in 2012.

Getting a face lift

Even though all these indicators which present a rosy picture of the overall growth of the sector over a period, there has been a constant mismatch between the increasing healthcare demands of a growing population and the capacity of the existing facilities to provide quality services, especially when it comes to advanced secondary and tertiary care. Despite having achieved much, the country’s healthcare facilities, counted in 2000 among the top ten of the world’s most effective healthcare systems by World Health Organisation (WHO), are now faced with a set of new challenges. Presently, 38 per cent of Oman’s population is under 15 years, which will undergo a drastic demographic change in the coming decades. In addition, several non-communicable diseases triggered by the sedentary lifestyle and higher calorie intake have posed a new threat to public health. According to MoH, roughly 15 per cent of the population suffers from diabetes while 25 per cent is clinically obese. Although primary and extended healthcare centres and dispensaries distributed throughout the country are capable of providing primary health services, and numerous regional and sub-regional hospitals offer a wide array of secondary services (both ambulatory and in-patient) in fields as diverse as general medicine and general surgery, cardiology, and obstetrics and gynaecology, they are not sufficient enough to accommodate the healthcare requirements of all the citizens. In addition, the number of hospitals that can offer quality tertiary care services is abysmally low. Only four national referral hospitals – Royal Hospital, Khoula Hospital, IbnSina Hospital and Al Nadha Hospital – and Sultan Qaboos Hospital, to a limited extent, can offer such advanced services. The waiting time for an appointment can extend to months, resulting in patients not getting treatment on time and being at times forced to go abroad. While returning from one of the interviews for this report, this correspondent met with a road accident and, having sustained some minor injuries on head which bled profusely, was rushed to a nearby hospital in an ambulance. But at the overly busy emergency ward of the hospital, he had to wait for more than one hour unattended by any doctor, until he eventually pleaded to a passing-by doctor to get his wounds dressed. Fortunately enough, he had received some first aids by the exemplary medical staff of the Royal Oman Police at the ambulance. It was a firsthand experience of how the existing healthcare facilities are hard-pressed to meet the increasing demand.

It all points to the fact that Oman’s healthcare sector is in the dire need of quantitative expansion and qualitative development and upgradation. In order to cope with the changing dynamics, the government has devised several short term strategies and a long-term master plan called Health Vision 2050, which aims at radically improving the healthcare facilities in the country. Increased government spending is poised to usher in substantial improvement in government facilities by developing specialised hospitals and large medical cities. As part of a short term strategy, the government aims to have 346 government healthcare facilities including 70 hospitals and a medical city by the end of 2015. The 723-bed, five-storey Sultan Qaboos Hospital in Salalah, which is under construction from 2012, will include facilities for paediatric emergency services, general medicine and surgery, orthopaedics, psychiatry, neurosurgery and radiology. Another major public hospital which is currently at the planning stage is the proposed Muscat General Hospital to be set up near Muscat International Airport. Fiscal provision for this project has been made in the current eighth five-year plan. Some of the recent government initiatives to set up tertiary facilities include the National Diabetes and Endocrine Centre which serves as a one-stop clinic for diabetic patients and the National Genetics Centre at Muscat’s Bausher Polyclinic complex, designed to provide a host of genetic services, including genetic medicine, genetic counselling and genetic health education. MoH’s massive upcoming projects include the $1.8bn Medical City coming up in Barka, which is currently at the design stage. The Ministry has already started a field study for the 500-hectare project in the Wilayat of Barka. The complex will have more than 2,000 beds combined, integrating five specialist tertiary hospitals.

Private sector advantage

Till recently Oman’s healthcare industry has been characterised by low private sector penetration. For example, in 1995 the country had only one private hospital with a total of six beds. But during the last few years, the private health landscape has undergone a tremendous metamorphosis with a lot of players coming in, and the sector is continuing to expand as a result of strong government incentives. During the last five years there has been a surge in the number of private players, intensifying competition in the market and forcing the operators to improve quality and upgrade services.

Opening a new chapter in Oman’s healthcare development will be the upcoming International Medical City project in Salalah which is expected to open in 2016. Spearheaded by the Saudi-based Apex Medical Group (AMG), the $1bn facility will house a multispecialty tertiary care hospital and three medical centres of excellence for organ transplant, rehabilitation and diagnostics. AMG has concluded the final stages of design for the project with the recent completion of infrastructure planning. The first phase of the project – planned to be finished in 2016 – will see the completion of a healthcare complex comprising a 250-bed multi-speciality tertiary care hospital. The second phase includes a healthcare resort combined with a four-star medical hotel, residential quarters for faculty and staff, serviced apartments for clients, and commercial components. The third phase will focus on the development of a medical education complex and an R&D centre. Testifying to the strong government backing for the project are the allocation of the 870,000 sqmetre plot by the Ministry of Tourism and the support of MoH as a strategic partner.
Anyone watching the latest trends in the industry can understand that a lot of newcomers are scrambling for a bigger slice of Oman’s private healthcare pie and the sector is, ipso facto, undergoing a qualitative shift. As observed by K Jayan, director of UK-based Starcare Health Systems which runs Starcare hospital in Oman, there has been a shift from volume based business to quality based operation. “The healthcare sector in the Sultanate is in a phase of transformation with increasing participation from the private sector and unprecedented demand for quality healthcare,” says Jayan who has the rich experience of commissioning three hospitals and six medical centres in Oman in a short span of time. “Although there is an increase in the number of private hospitals and polyclinics, people are looking for more quality operators who can provide advanced secondary and tertiary care services. There is still a huge gap and a lot of potential to tap in that area. When we studied the market before Starcare started operation in 2011, we identified a huge opportunity in quality healthcare services. That is why we positioned ourselves as a premium level but affordable hospital.” Starcare is a 50-bed multispecialty hospital offering over 35 specialty services. The hospital has completed the project in lesser than a year and got the accreditation of US-based Joint Commission International in a short span of 342 days of its operation. Jayan also discloses that Starcare is planning to come up with a 250-bed tertiary care facility – Starcare National Hospital at an estimated investment of RO25mn which will be commissioned by 2015. This is in addition to various other projects in pipeline including a budget/economy brand called Safecare targeting middle class families, modelling on its recent venture in the Indian state of Rajastan.
Jayan avers that some years ago, the demand for private care was so high that those who were coming to do business in Oman were more preoccupied with bottom line than other criteria. “But they have contributed too. But now things have changed considerably because for the last four years there is a perception that quality healthcare matters. Now people have more choices and everyone is quality-conscious. When we got JCI accreditation, the support and appreciation including from MoH was significant. In this regard, we fondly recollect the visit by the Minister of Health to our facility apart from other esteemed guests like ambassadors, high-ranking officials and top businessmen. The initiatives of the MoH in ensuring the quality of private healthcare providers in the recent years have been commendable.”
Another private hospital which got JCI accreditation in the Sultanate is Muscat Private Hospital (MPH), a 72-bed facility launched in 2000 which is so far arguably the single largest facility in the private sector.
Dr Benny Panakkal, medical director, Badr Al Sama Group of Hospitals, thinks that Oman’s private sector healthcare is going through a transitional stage wherein competition has not only enhanced the quality of services but also helped increase people’s awareness about healthcare and make them more health conscious. He says Badr Al Sama which started operation in Ruwi in October 2002 as a clinic was the first private clinic in the country to offer round-the-clock services. Later evolved into a full-fledged hospital, Badr Al Sama offers various specialty and super specialty services such as cardiology, nephrology, gastroenterology, intensive coronary unit and dialysis etc. The latest introduction is a state-of-the-art Cardiac Catheterisation Laboratory (CATH LAB) which offers coronary angiogram and angioplasty services. Referring to the increasing demand in Oman for such treatments, DrPanakkal, himself a cardiologist who started the cardiology department in the hospital way back in 2003, says within two weeks of installing the services, the hospital has done six angioplasties and more than 10 coronary angiograms. “I think we are the first hospital in the private sector to start several advanced services such as dialysis, three dimensional echocardiography, stress echocardiography and transesophageal echocardiogram,” he adds. Now with hospitals and polyclinics distributed in eight localities across the length and breadth of the country, Badr Al Sama Group is the largest provider of healthcare services in the private sector in Oman.
Another interesting development in the private sector was the recent launch of Sugar Clinic, a state-of-the-art super specialty facility for diabetes treatment by Apollo Hospital Group. Talking about the rising burden of chronic lifestyle diseases in Oman, V T Saileswaran, managing director of Apollo Medical Centre in Oman, states that the prevalence of diabetes amongst adults is 12.5 per cent while hypertension is as high as 40 per cent. He added that the group is committed to strengthen the Sugar Clinic initiative in Oman as it plans to add more such clinics over the next 12 to 18 months. India-based Apollo Group forayed into Omani market six years ago by setting up Apollo Medical Centre. The centre was largely aimed at providing primary care services while acting as a follow-up facility for patients availing care at the various Apollo facilities abroad.
Sharing about the future plans, Apollo Group’s representative and head of operations in Oman, AbhilashPillai mentioned about the long association the group shares with the people of Oman. He added the group is currently in the process of assessing and evaluating the various healthcare opportunities in the geography. “Sugar Clinic is a complete integrated solution to manage diabetes and offers customised solution to individuals availing diabetes care,” adds Pillai. “The centre offers a wide array of services such as specialist consultation, end-to-end diagnostics, general podiatry and diabetes wound care center, footwear store, exercise advice/ prescription by a trained physiotherapist, pre- diabetes screening and management programme, diabetes education, diabetes foot clinic- screening, risk assessment and treatment, diabetes eye clinic equipped with state-of- the- art non-Mydriatic fundus camera, insulin pump clinic, diet and nutrition clinic and pharmacy.”
Pillai exudes confidence that due to a host of reforms and initiatives undertaken by MoH, private and public sector health establishments in Oman will be capable of catering to most of the country’s healthcare needs in about three to five years’ time.
Al Raffah Hospital from DrMoopen’s Group started operation in Oman with medical centres at various locations in the Al Batinah region. Currently the group has two hospitals and one medical centre, in addition to a clinic at Omantel headquarters in Seeb. Furthermore, a new medical centre in Amerat is all set for operation and another one in Al Khoud is expected to open by November, while a hospital project in Nizwa is in the pipeline.
“In Oman there are both premium level hospitals and low-end facilities; therefore we are positioning ourselves somewhere in the middle targeting the middle-income to low-income people who can avail our facilities,” says its chief operating officer SeeniyaBiju. “We started with specialist doctors and seeing the requirements of the public, we moved on into a super specialty hospital. Right now, we have most of the super specialties like gastroenterology, laparoscopic surgery, urology, cardiology etc. As we see people consider us as a critical care centre, we are in the process of adding more super specialties such as neurology and nephrology.”

In another major development, India-based NOVA Medical Centres, which in partnership with Omzest group of companies started its first Middle East operation in March 2012 by opening a polyclinic in Al Khuwair, is all set to launch a unique short-stay surgical centre. “It will be called a short-stay surgical centre where people will come for surgery, get operated and stay minimally in the hospital,” says Dr (Col) KM Harikrishnan, general manager of operations and senior consultant. “It will be a state-of-the-art surgical facility where we will provide all advanced services. It is being set up as a joint venture between NOVA and OMZEST Group of companies. Through this unique facility, we are looking to reduce the cost of surgical treatment. We believe that the longer the patient stays in the hospital, the higher will be the cost both for the patient and for the organisation. We have already got the preliminary approval from the Ministry of Health and the Ministry of Housing and the construction is going to start very soon. And we expect that we will be up and running in 18 months. We plan to bring all the top-class tertiary level medical health available to us on a regular basis. We will also be inviting local Omani and expatriate doctors in senior positions to come and utilise our facilities so that they can offer tertiary care services which they are currently providing in the government services.”
The existing facility of NOVA offers a lot of super specialty services such as general surgery, laparoscopic surgery, internal medicine, paediatrics, gynecology, ENT, cardiology, radiology, dermatology, family physicians, general practice etc. Recently NOVA has tied up with Eurosleep, a Europe-based sleep disorder management set-up. “In addition, we have put in place a new concept called ‘sleep clinic’ which will be a unique set-up for assessing people at home without disturbing them. We will evaluate them at the comfort zone of their bed with equipment attached to them; and the next day the analysis will tell us what their sleep disorder is,” says DrHarikrishnan.
DrHoussam Ahmed Akoum, who recently took charge as the chief operating officer of KIMS Oman Hospital, feels that Oman has a long way to go towards improving the quality and enhancing the efficiency of services on a par with other countries in the GCC region. “There is no denying the fact that government has done a brilliant job in laying the foundation of a solid healthcare sector by investing heavily on setting up infrastructure”, he says. “But the level of health consciousness among the public is very limited. We need to inculcate a health culture in the society. People need to be constantly alerted about serious health issues in order to make them health conscious.” DrAkoum thinks that compared to Saudi Arabia, where he worked for a long time as a senior consultant, Oman’s private sector industry is still in a bourgeoning stage and the market is very small. “Therefore there is still a huge potential to tap, for the private operators if they are ready to meet the challenges head on.” KIMS Oman, an initiative by Kerala Institute of Medical Sciences (KIMS), is a multi-specialty hospital with state-of-the art facilities. Located in Darsait, this 56-bed facility offers services in almost all specialties such as cardiology, orthopaedics, neurology, general medicine, urology, paediatrics, general surgery, dermatology, endocrinology, ENT, gastroenterology, ophthalmology, anesthesiology, family medicine, plastic and cosmetic surgery, dentistry etc. DrAkoum informs that KIMS is planning to expand the existing facility to 75 to 80-bed hospital.

Hurdles galore

One of the bigger challenges facing private healthcare operators is the non-availability of qualified professionals such as doctors and paramedical staff. “Although the increase of population creates a lot of opportunities for the sector, getting qualified and competent professionals has always been a big challenge,” says Biju. “In India where we get majority of our staff from, people are very well paid.The people are not very keen to leave the country and come here until and unless you give them something really attractive.”

Pillai corroborates this view saying one of the major challenges of health care sector in Oman and around the world today is attraction, retention and development of quali?ed healthcare professionals. Jayan substantiates it further stating, “Noted healthcare professionals are in huge demand everywhere in the world. A talented and successful medical specialist now earns in India or the country of his or her origin more than what we can offer here. If you want to have quality people here you need to pay more and it directly affects your cost of operation.” He feels that in Oman, compared to other countries in the GCC region, revenues are not commensurate with the operational cost. “The revenue is not as high as the operational cost in Oman due to various factors such as lower insurance premium as compared to other GCC countries. The proposed mandatory insurance for all can further improve the situation and magically change the healthcare industry.”

DrAkoum calls for a comprehensive upgradation of the medical education in the country in order to produce more talented professionals to meet the increasing demand not only in the public sector but in the private sector also. “Private sector has an acute shortage of quality health professionals. As long as the country depends on foreign professionals to meet its demand, the mismatch between the demand and supply will continue.”

DrHarikrishnan highlights the necessity of making it easier for the expertise to be brought in from other countries, especially India. According to him, a uniform policy on health insurance would be greatly helpful. “I feel everybody should have health insurance so that people can avoid waiting for the government sector alone. A lot of expatriates who do not have access to health insurance cannot afford treatment in the private sector. Therefore health insurance needs to be made compulsory for all and sundry and insurance companies need to be instructed by the government to make sure that they offer health insurance to everybody unconditionally. It is compulsory for the insurance companies in all European and many of the south Asian countries to accept anybody who walks in.”

Many insurance companies consider obesity surgery as a cosmetic surgery, which DrHarikrishnan describes as being farthest from truth. “Obesity is the forerunner to so many diseases including the overall reduction in life expectancy. Insurance companies should realise that the cost of obesity surgery borne by them will actually save a lot of money for themselves, the patients and the healthcare sector in general, by preventing conditions like diabetes and arthritis requiring treatment for 20 to 30 years. The number of people reporting for such surgeries and medication will drastically reduce if they spend money upfront on obesity surgeries.”

DrPanakkal says the overall healthcare cost in Oman is relatively high. People who are not covered by insurance expect more economical treatment. “One welcome change I have observed during the last few years has been the shift of many people from cash payment to insurance coverage. That really helps the private sector to thrive better,” he says. “Earlier buying medicines and getting treatment and investigations were very costly for most of the people, so they waited to go home and brought most of the medicines from there. The cost of medicine in Oman is also higher compared to their home country, because medicines available here are mostly from branded and reputed companies. Once insurance came, this scenario changed. We also find some brands suddenly go out of stock. For instance, Lasix, a very essential medicine for the treatment of heart failure, went out of stock a few months ago panicking many patients.”

“Definitely healthcare is not that cheap in Oman,” adds Biju. “If you want to do a knee surgery the implant itself costs you a thousand riyals. You need to pay the consultant a bigger amount. So you cannot do a surgery at a cheaper cost. But it is not much higher than going abroad.”

Purchase and procurement is another challenge, as noted by Jayan. The hospitals need to make booking much in advance. Most of the suppliers are nodal points and do not deal directly with the manufacturers, thereby increasing cost and delaying delivery. Once there is a substantial increase in volumes, the manufacturers will set up direct outlets. However, the options are much better compared to earlier days. DrHarikrishnan also calls for making the import of equipment easier and less cumbersome. “We go through the process of getting approval from the Ministry for everything and it takes from weeks to months. If there could be a clear-cut policy and certain companies are pre-approved by the government on the basis of their performance, we can approach those companies and cut both time and cost. Ultimately reducing the cost for the private sector companies means that that much cost has been reduced to the patients because whatever cost is incurred by the private sector is passed onto the patients.”

Easing procedures

In order to ensure the quality of health services in the country, MoH closely monitors the private operations during the planning, construction and the actual running, in the form of technical protocol and the selection of doctors, nurses and paramedical staff. The ministry has made it mandatory for all health professionals from abroad to pass its examination to get recruited anywhere in the country. All the applicants have to travel to Oman to take the test. As per the current regulations, a doctor, say, can come only once in a month to write the exam and, if failed in that attempt, has to wait till the next month to clear the test. Some private operators say the whole process kind of delays the recruitment process in the private hospital.

Biju thinks introducing online exam will be a good option so that the professionals need not come all the way to Oman only to write the exams. “In Dubai they do online exams which reduces the difficulty for the applicants. Here we lose a lot of good people because they find it very difficult to travel for the test and again for the interview. In addition, interviews should be more frequent rather than once in a month. However Oman is one of the better places to set up health care facilities. Here people are very humble and getting clearance is very easy. It normally takes only three weeks to get a visa for a doctor in Oman whereas in Qatar it will take three months. If you look at Saudi it takes nearly six months. Our group is established in different parts of the world and we find Oman to be one of the best places to operate from. Initially we had to wait for months for an inspection, but right now they have increased their efficiency.”

The Ministry of Manpower’s regulations are also creating a lot of operational problems for the private operators. “As per the Ministry of Manpower regulation we are forced to give a holiday on Friday and Saturday whereas a sector like ours cannot have a holiday,” says Biju. “On Friday evening, you find the hospital almost empty without staff. Some of these rules make it difficult to function as a hospital which has to function round the clock. Rules like having two-day compulsory holidays will be very difficult for a service sector like ours which deals with life and death of people and therefore has to operate everyday.” According to Jayan, although the Oman Labour Law has incorporated many changes considering the international standards and general wellbeing of employees across the industries, there should be scope for certain customisation when it comes to doctors and paramedical staff.

Going abroad

Another major challenge is to enable the sector to meet up its various new problems thereby reducing the number of people pursuing advanced care abroad. As DrHarikrishnan explains lifestyle related problems are on the rise in Oman. Most important of these are diabetics, visual impairment and communicable disease. Obesity is an alarmingly growing problem. Sports injuries and traffic accidents cause a lot of orthopedic disabilities these days. “We are trying to discourage people from going abroad because we bring expertise to their door in bariatric surgery and orthopedics. We bring experts here for the surgery and our in-house doctors will look after the postoperative care.” Jayan says the number of people flying outside the country for advanced treatment has come down considerably after they have realised that they can get the same treatment in Oman. “People are flying abroad either because they don’t get the expertise they are seeking or they do not have the trust in the private sector. It is slowly changing now. We need successful organisations that are proving their mettle,” he adds.

DrPanakkalsays as the private sector is getting stronger with upgraded services and advanced facilities, they can change the perception of people. Equipped with more doctors, infrastructure and expertise, they can attract more people who are going abroad. However he admits that tertiary facilities such as open heart surgery organ transplantation programmes etc. require huge investment; but people who go abroad for such facilities constitute a small percentage of the total population. Citizens get most of such facilities from the MoH hospitals like Royal Hospital and Sultan Qaboos University Hospital free of cost and expatriates would like to do it in their home country; therefore such facilities are not easily sustainable in the private sector.

Saileswaran opines that every business opportunity has a life cycle and the same holds true for the medical tourism business. “At the early stage of this lifecycle you would see almost all acute care needs referred to aboard for treatment. However, as the healthcare infrastructure of the geography improves one will slowly see changes in this very mix which is already underway in Oman. Yet, some complex procedures would continue to be referred to select international centres of excellence.”

According to Biju, some people club healthcare with their foreign trips. “And for some tertiary care facilities people opt for foreign facilities,” she says. “A heart attack patient may prefer India for advanced cardiac treatment because we don’t have the full setup here in the private sector. But there are still people who go abroad for, say, orthopedics or laparoscopic surgeries because of a lack of awareness. However their number is declining to a great extent. I can surely say that at least every month about 20 per cent of our patients who had planned to go abroad for surgery change the decision and get it done here. With more hospitals coming up, their number would decrease further.

Lack of planning

Many people who start operation in the private healthcare sector do not do a proper study or plan before starting hospitals, thereby causing a lot of troubles. Jayan feels that it is important to understand the dynamics of the industry before starting operations like any other venture. The health sector demands high-level technical expertise and critical management abilities considering the multifarious challenges varying from recruitment to medical protocols and clinical scrutiny. He opines that it brings a new opportunity for the likes of Starcare Health Systems who proved their expertise in turning loss making healthcare facilities into profit making units. “Now we are getting a lot of proposals from various polyclinics and other facilities in Oman to provide management expertise. We carefully study all the proposals and when we are confident we actually take them up.”

“Setting up a hospital is a big challenge,” adds Biju. “Right now we see some people who have no prior experience in the industry coming and venturing into a hospital or a clinic. I think this is not a good trend. When those people come to the field, they create a lot of problems in terms of quality. We should identify people who have good background and expertise in the field. It is good if you can actually look at the credibility of the people who come to start.” She also avers that new operators have to take into account the geographical distribution of facilities. “Some people don’t take into account the geographical importance of the location before opening a hospital. If you have too many facilities in a single location, then eventually everybody will suffer. In pharmacy, they have a very good rule that there should be a minimum distance of 300 metres between the outlets so they do not allow you to set up a pharmacy next to another. A similar thing must come up for hospitals too.”

Sharing the burden

As long as there is a discrepancy between the demand for health services and the provision of the government, the latter cannot ignore the private sector’s contribution. It needs to be given more opportunities to expand in order to provide tertiary level services which will reduce the burden of government hospitals. DrHarikrishnan feels that although private sector is very well regulated by the Ministry in Oman, there has to be some room for it to flex its muscles and expand its services. “Overly regulating the entire private sector will prevent them from offering the services which are in demand and which the government sector is not in a position to address.

A lot of government-private sector interaction is going on these days. The government is very keen to have good partnership with the private sector for providing services together. As DrHarikrishnan explains, there is a huge waiting list for endoscopies and major surgeries, especially orthopedics, in the government sector. The government can partner private facilities capable of providing excellent services to take care of these treatments. “I think there are some talks going on but I don’t know what level of understanding has been reached. What we can do is to have a tight leash on the quality of the doctors, nurses and paramedical staff we employ in order to give the highest standard of care. I recently attended a meeting organised by the Ministry of Health which addressed the important topic of professional development of doctors in the private sector. We recommended that we should have a panel of government and private institutional representatives who can decide on how government and the private sector can collaborate to help one another. For instance, at the moment the private sector depends on the government sector for certain acute emergencies and ICU facilities while the government can pass on some of its load in terms of common surgeries.”

Biju opines that the public sector is encouraging the private sector by sending patients to private facilities for gastroenterology and laparoscopic surgeries. She says discussion is going on with regards to referring a number of their patients to private hospitals. For example, form next month onwards, Sohar government hospital is sending some of their delivery cases to Al Raffah hospital in Sohar.

Jayan calls for a continuous dialogue and exchange of views between MoH officials and the private sector to ensure participation and progress. “Coordination committees and other government mechanisms should be utilised to establish a financially viable and practically effective healthcare model. For instance there is scope for improving the licensing procedure in the private sector and this would help to attract good talent from other countries,” he adds.

This all testifies to the fact that strategic partnership is the way ahead. Fostering healthy partnership and cooperation between public and private sector can go a long way and do wonders in addressing most of the healthcare problems facing the country today.


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