One evening in late June 2015, a suicide bombing at a mosque in Kuwait’s capital, Kuwait City, claimed the lives of 27 people and injured 227. The ensuing chaos at hospitals served to highlight to Kuwait’s Ministry of Health that the nation was not fully prepared to mount an efficient medical response to a large-scale domestic disaster, man-made or natural. In response, the Ministry supported an immediate nationwide initiative to recruit and train more doctors in emergency medicine and sponsor more training for doctors and nurses in disaster management. The effort has paid off. “We are now at the frontlines in terms of disaster management,” says Dr. Lujain Al-Qodmani, assistant registrar at the Ministry of Health and international relations officer for the Kuwait Medical Association, as well as an emergency care physician at Amiri Hospital.
Ambitious strides towards improvement have become a central priority of Kuwait's healthcare system. The advances center around an extensive multi-year plan, announced by the Kuwait Ministry of Health in 2010, to invest heavily in the widespread expansion of medical infrastructure and services, and increase the country’s internal medical capacity. Since the Ministry’s plan took effect in 2012, the country has been adding to its roster of medical staffers in a wide variety of fields, as well as building new facilities and adding onto existing ones while reducing the need to send patients outside its borders for care. And there’s much more to come. “The Ministry of Health is evolving new strategies,” says Al-Qodmani.
Much of the urgency for improvement has come from the Kuwait government’s enormous spending on care outside the country. An estimated US$2–2.5 billion of the government’s US$10 billion annual budget goes to sending some 2,000 patients abroad each year to North America or the European Union to receive extended or specialized care.
Part of this need to send patients elsewhere stems from the Kuwait healthcare system’s inability to cope with epidemic rates of chronic disease. According to the World Health Organization, 20 percent of Kuwait’s population is diabetic, ranking it in the top ten countries in the world for prevalence of the disease. Within the country’s hospital patient population, 40.6 percent are diabetic. This high incidence of diabetes overlaps with a 52 percent obesity rate among adult females and 37 percent among males. “We have a predominantly unhealthy population here in Kuwait, including one of the most obese populations in the world,” says Dr. Mussaad Al-Razouki, chief business development officer of Kuwait Life Sciences Company. Cardiovascular disease is also prevalent in Kuwait, accounting for 46 percent of deaths. These high rates contribute to a large demand for preventative and extended care that the country can’t always meet. To make things worse, the number of patients sent out of the country for care is likely inflated because the process is vulnerable to exploitation. “Unfortunately, there have been official reports of a lot of abuse of the program,” says Al-Razouki. “Some individuals are sent along for non-medical purposes.”
The Ministry of Health has set out to lower the number of out-of-country patients by building on the capacity of the country’s healthcare system, which currently comprises 20 public hospitals, 21 private hospitals, and 92 primary healthcare centers. To that end, the Ministry plans to add approximately 4,600 beds, 150 operating rooms and 500 outpatient clinics via 8 different hospital projects in Kuwait that will be underway over the next decade. One of these key projects will be a maternity and pediatrics hospital build by the Ministry of Public Works that will have a total capacity of 1,500 beds.
Government spending accounts for 83 percent of total healthcare spending in the nation. Even so, that accounts for only 5.6 percent of the government’s total annual expenditure, a relatively low rate compared to countries with more advanced healthcare systems, including an 18 percent rate in the U.S. and 11 percent in Canada.
Some of that slack in the Kuwait government’s spending is being taken up by the private sector. The country’s 21 private hospitals currently require private payment, and for the most part have focused on higher-end, high-comfort care for affluent patients. The Royale Hayat Hospital, for example, is the first hospital in Kuwait to combine healthcare and hotel services, offering patients the option of staying in private apartments. Originally established as a maternity hospital in 2006, it has expanded over the years to offer wide range of medical services including pediatric, internal medicine and pain management. “People who can afford private care often choose us,” says Dr. Abubakr Ameen Elmardi, head of obstetrics & gynecology at the Royale Hayat. Like other high-end private sector hospitals, Royale Hayat is also able to offer higher wages than what public sector facilities can provide, leading to higher retention rates of medical staff.
But private healthcare may become increasingly involved with government-paid care, thanks to a wide-ranging US$110 billion development plan put forth by the government that emphasizes the establishment of public-private partnerships, or PPPs. One of these PPPs has included the establishment of the Kuwait Health Assurance Company (KHAC), which aims to manage the healthcare needs of the large number of expatriates living in Kuwait. Expatriates account for roughly 70 percent of Kuwait’s population, but most are ineligible for many services provided to nationals, including free health services. All expatriates have been required to purchase health insurance from KHAC, allowing them to seek medical attention at one of the state-owned medical facilities. However, the Kuwait government’s deal with KHAC was canceled suddenly in January 2017, leaving 3.1 million expats in the country in medical-care limbo.
Newly emerging telemedicine protocols may prove to be a promising way to bridge some of the gaps in the system, including the fact that Kuwait’s healthcare system continues to rely on non-national health professionals. Kuwaitis represent only about 6 percent of nurses in the country, and about a third of its resident doctors. Dr. Ali Buabbas, a post-doctoral fellow in medicine at Kuwait University, has researched the potential for the use of telemedicine in Kuwait. He believes the government would have to up its investment substantially in this technology if it is to help supplant face-to-face services in the nation on a meaningful level. “Kuwaiti patients are willing to go for telemedicine, but it needs proper implementation,” says Buabbas, adding that even with a strong telemedicine system, some patients will still need to seek treatment abroad.
Aside from telemedicine, Kuwait hospitals are undertaking a number of other digital medicine initiatives. The Ministry of Health’s Emergency Medical Services division partnered with the U.S.-based Intergraph to set up a computer-aided dispatch (CAD) system that coordinates the dispatches for all emergency and non-emergency operations. The system is fielding an average of more than 700 calls per day. The EMS also worked with Intergraph to enable web-based communications between dispatchers and ambulances working in the field.
Kuwait hospitals are also trying to improve their currently limited and fragmented electronic medical records (EMR) systems. The Dasman Institute for Diabetes, a leading Kuwait facility, has been implementing a more extensive EMR system, including a patient portal where patients can view their files and communicate with their providers. “We are always looking to improve and add to it,” says Faisal Al-Refaei, the chief operating officer at Dasman Diabetes Institute. The institute has also undertaken an extensive eHealth program in partnership with the University of Dundee in the U.K. The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is an informatics system that includes a disease registry of thousands of children and adults with diabetes, providing an overview of clinical and operational data. The Dundee partnership also provides a mobile application Kuwaitis can use to help self-manage their diabetes through diet and other lifestyle modifications.
Mairi Scott, a professor of General Practice and Medical Education and associate dean at the School of Medicine at University of Dundee, believes these kinds of preventative and managerial approaches to health are becoming more vital to Kuwait. “Primary care clinics there are exceptionally busy,” she says. “Doctors don’t have physical space or capacity to get stuff done.” Other mobile applications should help ease the burden. For example, AbiDoc — the Middle East’s first cloud-based scheduling system to help patients book appointments from their phone — is one of the apps streamlining the process for patients seeking and attaining treatment.
In spite of the challenges, the progress has instilled confidence in many that Kuwait is on its way to a substantially higher-quality and higher-capacity hospital system. Ultimately, though, the biggest improvements may come through helping the population stay healthy enough to avoid needing to go to the hospital as often. “The global healthcare system is looking more toward preventative care,” says Al-Razouki. “We hope to be a part of that focus.”
— Laura Kiesel
Laura Kiesel is a freelance writer based in Arlington, Massachusetts.