Breaking the transitory workforce cycle
By World Healthcare Journal-
While countries across the globe are grappling with shortages of healthcare staff, the countries of the Gulf Cooperation Council – Saudi Arabia, United Arab Emirates, Bahrain, Kuwait, Oman and Qatar – face unique challenges.
The GCC’s demand for staff is driven by growing commitments to providing high quality and accessible care, expanding populations, longer lifespans and an increasing burden from long-term illnesses. The GCC population is projected to reach 53m this year, a 30 per cent increase since 2000, while GCC countries have some of the highest adult obesity and type 2 diabetes rates in the world.
Against this background, medical services – particularly hospitals – are expanding rapidly, but fast primary care remains more challenged.
The UAE expanded its hospitals from 107 to 137 in the four years to 2017, while Saudi Arabia opened around 10 hospitals a year. Qatar is establishing itself as a major international player in medical research.
There are too few GCC health workers, while too many of them come from overseas. It has around 5.5 nurses per thousand population, compared with 11.3 in the United States and 13.3 in Germany. According to Mark Britnell’s landmark study of the challenges facing the global health workforce, 85 per cent of healthcare workers in the UAE and 78 per cent in Saudi Arabia come from overseas. Only 3 per cent of the nurses in the UAE are Emirati.
The Gulf countries are attractive to Western workers, with high salaries, low taxes and the opportunity to work in a well-resourced hospital. The pay rates are even more attractive to clinicians from countries such as India, Pakistan and the Philippines.
Overseas staff typically return home after a few years, locking the Arab states into a cycle of high-volume recruitment. The rapid turnover makes it difficult to build stable teams and retain expertise, while local staff are under pressure to provide continuity.
In Saudi Arabia, expanding the role of Saudis in the healthcare system is a major part of the Vision 2030 plan to diversify the economy, which includes creating more high-value jobs. The aim is to add around 100,000 Saudis to the health sector by 2030, with an emphasis on primary care as the best way to tackle lifestyle diseases. Similarly, there is a demand for more public health staff. This compares with a need to increase the total nursing workforce by more than 33,000 posts.
Expanding the local workforce is made harder by the large number that leave nursing relatively soon after qualifying compared with European countries. While some of this is driven by women leaving for family reasons, working hours and a desire for more flexible conditions are also factors.
Alongside international migration, there are staff movements within the GCC – between countries and from the public to private sector in pursuit of better pay and conditions – as well as doctors moving from rural areas to the cities, a pattern seen in many countries. Gulf medical talent is also moving to Europe, North America and Australia.
The rapidly expanding clinical training in the GCC is a mix of local institutions and partnerships with international organisations, such as Cornell University from the US training doctors in Qatar, and the Fatima College of Health Sciences in the UAE training nurses in collaboration with UK universities.
The need for more local staff highlights the crucial role of women. In the decade up to 2014 countries such as Qatar and the UAE had a health workforce which was around 50 per cent female, considerably higher than the rest of the economy but still lower than European countries. In Saudi Arabia, the proportion of women was under 30 per cent. In the UAE female applicants for medical training have been outnumbering men by around 3 to 1.
It will take the Gulf states years to tackle their workforce challenges, but tremendous ambition, major public and private sector investment, growing international collaboration and committed political leadership are maximising the chances of success.
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