A digital transformation

Rémy Levastre, managing partner for healthcare at Entermarkets Management Consultants, examines Saudi Arabia’s Vision 2030, its focus on the healthcare sector, transformation and privatisation

As highlighted in the National Transformation Plan (NTP) and the privatisation plan, Saudi
Arabia healthcare sector’s key priorities revolve around privatising government healthcare services, increasing public-private participation (PPP) healthcare delivery models, scaling up medical education, training its local workforce, and boosting the adoption of digital information systems.

The kingdom’s Vision 2030 aims to drive the digital transformation of health systems and inspire new collaborations between public and private sectors for improved clinical and financial outcomes. For this, the ministry of health in Saudi Arabia is undergoing a profound change from being a provider/regulator to a regulator. The institutional transformation process will separate service provider functions from the regulatory functions making the ministry’s role as a regulator rather than as a provider of healthcare facilities so it can supervise, monitor and design health policies.

Government’s push for
healthcare privatisation

The need to embark on healthcare transformation stems from a number of factors like rapid increase in healthcare expenditure as healthcare services are free for all Saudis. In a rapidly growing and ageing population, this tends to be a costly and unsustainable model.

There is a need to undergo a transformational shift from its status as a cost centre to a revenue centre in alignment with Vision 2030.

Attracting participation of the private healthcare providers will increase the effectiveness of accessibility and reduce the cost while ensuring the quality of healthcare delivery. The ministry of health currently has 20 clusters providing healthcare services across the country and it is crucial that they are running in the most cost-effective way to provide the best quality safety and efficiency.

The government intends to transfer responsibility for healthcare provision to a network of new companies that compete both against each other and against private sector operators. Under this structure, hospitals and health centres will be detached from the ministry and
made either into standalone companies or clusters that compete with each other as regards quality, competence, and productivity

According to Frost & Sullivan, the main priority of Saudi Arabia’s healthcare sector is to enhance the role of the private sector from the current 25% to 35% for economic diversification. The increasing number of private hospitals will bridge the gap of quality and accessibility of healthcare services in public hospitals which currently is a major issue in a
geographically scattered population. Privatisation will bring a lot of opportunities for investors, pharmaceuticals, in-vitro diagnostics (IVD) and medtech manufacturers, healthcare IT vendors, and support services.

To facilitate private sector participation, Saudi Arabia is taking effective regulatory frameworks like @Saudi Arabian General Investment Authority (SAGIA) announced in 2017 that foreign investors can have 100% ownership in the health and education sectors.

Once implemented, this is expected to boost private sector investment in health care. The Private Public Partnership (PPP) draft bill, released in July 2018 for public scrutiny, is also expected to boost private investment with a concurrent impact on the Saudi economy. It is the beginnings of the legal framework through which the Saudi government can begin to outsource healthcare provision. The National Centre for Privatisation (NCP) was established to regulate privatisation in KSA. The NCP is tasked with establishing the frameworks under which privatisations occur.

The Saudi government has stated that its aim is to raise US$200bn by 2030 through privatisation. New developments being constructed under Vision 2030 will also spell out further investment and opportunities in the healthcare sector. NEOM, a US$500bn megacity and a key part of the country’s strategic vision to diversify the economy and attract tourists
from all over the world, will create new markets for many sectors, including healthcare and biotech that will bring investment into hospitals, clinics, long-term rehabilitation centres, wellness retreats and fitness retreats.

Some major private investments from foreign companies in the KSA healthcare sector include:

• Amanat’s acquisition of a 33.2%
stake in the Saudi long-term care
provider Sukoon International
Holding for US$47.8m in 2015

• Abu Dhabi’s NMC Health also
announced in August 2016 that
the firm had bought a 70% stake
in As Salama Hospital in Al Khobar
for US$28m

• NMC Health also invested US$4m
in a 120-bed long-term care facility
in Jeddah that has the potential to
expand to 220 beds

• In 2016, Aster DM Healthcare
Group from Dubai planned to build
or acquire four healthcare facilities
in Saudi Arabia within four years

• In January 2017, Dubai-listed
Amanat Holdings acquired a
13.2% stake in Saudi-based International Medical Company (IMC)
for US$97m. Amanat said it will
assist IMC, which operates a 300-
bed multi-disciplinary hospital in
Jeddah, with expertise and capital
as the Saudi hospital expands
operations both within the existing
facility and the Western Region
over the next five years

• Pfizer opened a US$50m manufacturing facility in January 2017 in
King Abdullah Economic City

2020 Hajj – the toughest challenge for Saudi
Arabia’s healthcare system

Hajj is a major public health management exercise for the ministry of health. Around 5 million pilgrims visit Saudi Arabia every year, which provides a major challenge in providing health services and containing infectious diseases arising from such a large mass gathering. Emphasis on digital health in Saudi Arabia has played a fundamental role in supporting health emergency management by strengthening existing response mechanisms, in its efforts to tackle the Covid-19 pandemic and also recently in Hajj without any coronavirus cases.

Pilgrims were electronically tagged with bracelets designed to monitor and record their health status and track individuals quarantined upon their return home. The Saudi health minister, Tawfiq Al-Rabiah in a Global Digital Health Summit in Riyadh said: ‘Digital tools, along with the implementation of exceptional health and safety measures, have assisted us
successfully navigating one of the largest gatherings in the world under extraordinary circumstances.’

It needs to be noted that Saudi Arabia has prior experience of tackling MERS virus in 2012 which is why unlike other countries, its healthcare system was well stocked with inventories of PPE with a clear roadmap of the pandemic response strategy.

Saudi Arabia’s Covid-19
response at a glance

The ministry of health has been pursuing a digital-first strategy, pre, during and post-Covid. Investments in digital health made in 2019 have given the ministry a head start in its pandemic response. These include:

• The central appointment system
(Mawid), which is an app that
enables patients to book, cancel
or reschedule their appointments
at primary healthcare centres,
as well as managing their referral
appointments. 51 million appointments have been made using the
application, serving over 12 million

• A virtual medical consultation app
(Sehha) with an AI component that
offers face-to-face interactions
with medical professionals and can
be used abroad by Saudi citizens
and residents free of cost

• A dedicated app (Tatamman) for
individuals in isolation facilities,
which provides direct and continuous contact with the patients
to provide them with up-to-date
health care information as well
and ensuring their compliance with
health regulations

• @The University of Oxford and @
King Abdul Aziz University (KAU) to
establish an Artificial Intelligence
(AI) centre for healthcare in Saudi
Arabia. It will bring together senior
AI research specialists to provide
creative solutions and treatments
for rare, metabolic, and cardiac diseases and supported by
specialists from areas including
biochemistry, medicine, pharmacology, epidemiology, IT, bioinformatics, and data science.

According to PWC’s AI impact report for the Middle East, the region will benefit from 2% of the total global benefits of AI in 2030 which is equivalent to US$320bn and 11% of total GDP. The public sector, including health and education, contributes US$59bn and its AI contribution is 18.6% to the Middle East GDP by industry.

• There are dedicated apps for
healthcare practitioners to share
medical information, and to
prescribe medications to patients
remotely with no physical interaction, thus minimising the possibility
of infection

• Virtual clinics and tele-ICUs to provide healthcare practitioners with
direct access to patients remotely.
This has allowed for seamless
communications with residents
and nurses to consult virtually

• Tele-rounds and remote consultations through robotics, which safeguards healthcare professionals by
minimising physicians to Covid-19
patients contact

• Teleradiology to cover Covid-19
designated hospitals. These initiatives prove that digital health has
and will continue to be the most
effective tool in which we can ensure rapid response and delivery
of efficient, safe and effective care

MADE IN 2019

Riyadh Declaration G20
Summit Healthcare Saudi Arabia

Saudi Arabia’s @Riyadh Global Digital Health Summit has been at the forefront of laying out the framework to deal with future global pandemics. The seven key priorities included adopting health intelligence, interoperable digital technology, AI, effective communication, data governance, data quality and innovation in the healthcare sector.

The recommendations of the summit underscore the importance of data-driven protocols, effective communications, confront misinformation, global data reporting standards, prioritising digital health policies, capacity building of people on digital health, ethics and privacy, comprehensive health programs and health surveillance systems.