Abstract
Comparative studies aim at bringing about better understanding of issues at hand (Dickson & Alakeson 2010; Kluge & Henner 2007). In this paper we look at the various health system issues in two countries namely Saudi Arabia and Romania.
The selection of both countries is informed by their close population demographics with Saudi Arabia having a projected estimate of 29 million people compared to Romania’s 21.8 million. It is also informed by the availability of crucial health data and statistics. The research finds that both these health systems are streamlined to face similar needs yet the challenges faced by both are quite different. The paper shall provide a comprehensive but brief summary of the health policies, achievements, structures, objectives and challenges in both countries.
Background
Brief profile of Saudi Arabia
The Kingdom of Saudi Arabia is the largest country in the Middle East with an approximate territorial size of 2,149,690 square kilometres. Its population is estimated to be 25,731,776 as of July 2010. About 5.75 million of the population is composed of non-Saudis. The country’s first public heath department was established by King Abdel-Aziz Al-Saud in 1925 with its base at Makka AlMukrma. Saudi Arabia’s Ministry of Health was created in 1952 and it took over as the chief health policy provider (Ministry of Health 2010).
Between 1970 and 1980, Saudi health services were mainly curative since most of the health personnel had only undergone formal training in patient-oriented fields in hospital-based medical schools. The curative services were provided through a network of dispensaries and hospitals. Preventive care was relegated to health offices though some maternal and child healthcare centres provided some form of preventive service. Episodic outbreaks and other disease control measures were undertaken through vertical programs and health offices respectively.
In the 80’s, primary health care (PHC) was popularized with organizations such as the World Health Organization (WHO) calling for health for all. This led to the issuance of a ministerial decree that sought to establish health care centres that integrated all these services. The PHC approach led to the delivery of all-inclusive medical care in Saudi Arabia.
In 2002, a Royal decree established Saudi’s current health system. The decree aimed at promoting comprehensive and integrated health care to all Saudis cheaply and equitably. The Council of Health Services was established in the Ministry of Health to oversee healthcare reforms as well as to include stakeholders in the private health sector in the formulation of health policy. As of 2010, Saudi Arabia had 200 hospitals and1848 PHC centres (WHO 2011). The budget allocation for the Ministry has also grown substantially from 2.8% of the budget in 1970 to 11.3% in 2010.
Brief Profile of Romania
Romania is a country located in the south-eastern part of central Europe. The country has a geographical area of approximately 237,500 square kilometres. The 2006 population estimates showed that the country has about 21.58 million inhabitants which is a considerable drop from earlier estimates e.g. it is 5.4% lower than in 1992. The country has made tremendous health reforms since the revolution of 1989 that saw it cease to be a communist country to become a democratic republic. However, the health system in the country is still among the poorest in Europe (WHO 2011).
The Romanian government is the sole authority running the health care system. The Ministry of Public Health formulates policy and allocates funds to various health causes. The country’s National Health Insurance Fund (NHIF) is the chief financier of healthcare. There is also a College of Physicians (CoPh) that regulates those in the medical profession. Every year, a framework contract is signed between the Ministry, the CoPh, the NHIF and both private and public health providers that seeks to deliver heath services to the people of Romania.
In 2006, the Romanian government began to implement comprehensive health reforms. A new law was passed which attempted to streamline the country’s health care system. Other associations that inform health policy in the country are the Federative Chamber of Physicians (FCP), the Romanian Medical Association and the Society of General Practitioners. The new health law seeks to address the various issues facing the Romanian health system and prescribes measures that would put Romania at par with most European countries in terms of quality healthcare (Ministry of Public Health 2006).
Comparisons between Saudi and Romanian Health Systems
Structure
The differences in structure between the Saudi and Romanian health structures are informed by the different political and social settings in the two countries. Saudi Arabia’s monarch has complete authority over the health care system which it delegates through ministries and councils. In actual sense, the Ministry of Health (MoH) in Saudi Arabia is responsible for the formulation of health policy. It receives budget allocations and determines how to allocate them with regard to equity, urgency and necessity.
The Saudi system has 13 health regions led by a Regional Director General who answers to the Deputy Minister for Health for Executive Affairs and the Deputy Minister for Planning and development. The regional directorates are responsible for supervising the health services provided in health provinces. Provincial health directors supervise general hospitals, health centres and the private sector. This is the structure that oversees health policy in Saudi. The MOH is responsible for provision of over 60% of all health services in the country while the rest is shared between other governmental bodies and the private sector.
The Romanian public health care system is on the other hand shaped by democratic processes. Its parliament formulates laws that guide the application of resources in the provision of healthcare. The Ministry of Public Health (MPH) has a relatively bigger duty to ensure that public health is available to all. The Romanian system is almost similar in terms of structure. The MPH is responsible for public healthcare and it delegates its duties to the district health authorities which are responsible for the supervision of public hospitals and health care. Unlike in Saudi Arabia where the government provides 60% of the health care, the Romanian private health sector plays a huge role. Due to mandatory insurance, most Romanians opt for private healthcare since the cost is met by the insurance companies.
Components of the Health System
As earlier stated, the MoH in Saudi Arabia is responsible for overseeing the roll out of the country’s health policy. However, there are major components in the system that also shape the health system. These are associations, councils and research and support centres. The private sector also plays a major role in the country’s health system contributing 23% of the total health expenditure. Major private health facilities include; Saudi German Hospital, Saudi ARAMCO, SAAD Medical Centre, Social Insurance Hospital and Royal Commission Hospital among many others. The major referral centres include; King Faisal Specialist & Research centre located in Riyadh and Jeddah, King Khalid Eye Specialist Hospital in Riyadh and Sultan bin Abdul-Aziz Humanitarian City in Riyadh.
There are also other specialized hospitals run by the Ministries of Defence, Interior, Education, Labour and the National Guard that provide treatment for special categories of persons such as the military. Medical institutes such as King Abdul Aziz University Hospital provide specialized training for medical personnel thus contributing to the health care system. Other non-profit organizations and associations offering support to Saudi health care include; Saudi Council for Health Specialists, Saudi Red Crescent Society, Saudi Centre for Organ Transplant, Saudi Paediatric Association and Saudi Ophthalmological Society among others.
In Romania, private health care plays a bigger role due to the challenges in the public health system. However, the insurance system in the country has helped to ensure that people access health services from both private and public providers. The Ministries of Interior, Labour and Defence run a separate insurance system catering for specialized groups. Medical associations and organizations such as the Romanian Medical Association offer support to the health system by licensing medical personnel. There are also charities and non-profit organizations such as the Romanian Red Cross, Heart of a Child Foundation and Humanitas that promote health among poor communities in Romania.
Vital Statistics
The population structure of Saudi Arabia is quite evenly distributed with 38% of the population being young persons below the age of 14 years, 59.5% are middle-aged and fall between 15 to 64 years and finally 2.5% is above 65 years. The median age is thus 24.9 years for males and 23.4 for females as at July 2010. The Saudi population was growing at a rate of 1.548% in 2010 with a birth rate of 19.43 births for every 1,000 people. The death rate was at 3.34 for every 1,000 people. The rate of infant mortality was placed at 16.73 deaths for 1,000 live births of males and 14.14 deaths for 1,000 live births of females. Life expectancy was 73.87 years for males and 71.93 for females coming to an average of 2.35 children born per woman (WHO 2011).
In Romania, the population demographics show a nation in steady decline (Government of Romania 2008). 2006 estimates reveal that annual population growth rate is at -2.8 for every 1,000 people. The female population at the time formed 51.3% of the population while only 15.4% of the population was below 14 years. Meanwhile, 14.7% of the total population comprised of people above 65 years. The rate of birth was 10.2 births for every 1,000 people while that of death was at 12.0 deaths for every 1,000. Fertility rate was below 1.3 live births per woman (Government of Romania 2008).
Key Strategies
Saudi Arabia and Romanian systems differ when it comes to the strategies they have adopted in their health systems. In Saudi Arabia, the main strategy has been to curb preventable diseases while also ensuring that curative services are available cheaply and equitably across the population. The nomadic population has also been included in the official 2010 health plan due to the issue of inequity in health provision. Other issues that have been considered in the strategy are ways to curb the negative effects of smoking (Ministry of Health 2010).
Unlike Saudi Arabia, Romania has had to implement serious strategic reforms in its health policy especially due to the fact that its death rate surpasses its birth rate (Graham, 2010). Additionally, it is one of the few European countries that have reported deaths out of preventable diseases. Chief among its 2009 strategies has been national hospital reform. Another key reform has been the drug policy strategy. Family health especially maternal and child health have formed the bulk of its health strategies (Schoen, 2005).
Health Problems
Saudi Arabia has some serious health challenges facing its population. WHO (2011) finds the major issues as; genetic diseases, non-communicable diseases, cancer, injuries, smoking, road accidents, nutrition and mental health problems. Genetic diseases are mainly attributed to the high rates of consanguineous marriages in the country (Walker, 2009) and they include blood disorders such as thallassaemia and sickle cell disease (WHO 2011) and metabolic disorders.
Smoking is a major health issue with 20% of the adult population engaging in it (38% males and 2% female). It has led to higher incidences of cancer with more cases of leukemia, breast cancer and lung cancer being reported. The main non communicable diseases reported are increasing cases of diabetes mellitus, hypertension and renal failure. Cases of diabetes mellitus are especially a rising concern with over 1.5 million cases being reported. Road accidents have also been a serious issue accounting for 80% of deaths.
In Romania, the main health problems according to the Ministry of Public Health (2006) have been cardiovascular diseases, mental disorders, malignant neoplasm, accidents and injuries and other non-communicable diseases. Cardiovascular diseases were established as the lead cause of death in 2006. The problem has been linked to the large number of smokers which is 48% of all males above 15 years and 13% of women and also nutrition since Romanians eat foods with high calories and sugar content.
Alcohol consumption has also been a major issue with 56.2% of the population above 15 years being reported as consuming alcohol with 3.3% highly dependent. Other health problems include high incidence of tuberculosis which is the highest in Europe (153 cases for every 100,000 people), HIV/AIDS, syphilis, measles, high maternal mortality rates and poor child health (Ministry of Public Health 2006).
Other Key Challenges
Saudi Arabia’s health system has faced several challenges. Key among the challenges is the inequity in health provision. Due to the sparse population, it has been difficult to provide health services to all especially the nomadic communities. Lack of health information is also another factor leading to unresolved health problems (WHO 2011). The Kingdom of Saudi Arabia has also been accused of having a poor human rights record which hinders reporting of health problems and also other issues such as the health of women.
Romania has relatively bigger challenges compared to Saudi Arabia. The country has a poor responsiveness to health needs which are quite many. The number of health facilities is not enough for the population and providing affordable health care has also proven to be an arduous task due to financing issues. Other challenges have been lack of proper awareness programs for several diseases, a declining population growth rate and lack of enough resources directed towards health care.
Future outlook
Saudi Arabia seems to have all its health challenges within its stride. This is due to the fact that it has a good financial foothold being the world’s largest oil producer. With time the health system in Saudi Arabia shall be well designed to meet all the needs of its growing population. However, the smoking problem might pose a huge risk of poor health if something urgent is not done to curb it in future. WHO (2011) also states that the increase in population and complex ailments will likely threaten the ability of the government to provide free healthcare with the absence of a tax system and health insurance. The issue of observation of human rights is also being addressed which means that the country’s maternal health is likely to improve (Walker, 2009).
Romania on the other hand seems to be struggling amid its various health challenges. However, there is a good political climate which will help in bringing the much needed health reforms to ensure that the country catches up with the high health standards in Europe (Case & Vladescu 2004). The problems they are facing are not insurmountable and as long as they are properly addressed, the future still looks bright for the country.
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