According to the recent Alpen Capital GCC Healthcare Industry Report, the region’s population size is estimated to increase by 6.6 million individuals to 61.6 million by 2022, of which nearly 17 per cent will be people aged above 50. Plus, the region’s propensity for non-communicable diseases, the expanding size of the population and the ageing factor, are all set to exert pressure on the existing healthcare system.
In order to tackle the high expenditure, the GCC reportedly has over 700 healthcare projects worth US$ 60.9 billion under various stages of development, of which more than 85 per cent of the projects, by value, are hospital projects and rest are clinics and research centres. The report highlighted that of the total, 264 projects worth US$ 24.7 billion are under the construction stage.
In this regard, the Ministry of Health in Saudi Arabia reportedly aims to increase private sector contribution in total healthcare spending to 35 per cent by 2020. In the UAE, the Dubai Health Authority (DHA) expects Public-Private Partnerships (PPPs) to increase in ambulatory care, home care, long-term stay, and day-surgery centres. While in Kuwait, the Kuwait Authority for Partnership Projects will be implementing PPP projects in the country. The other GCC countries are also participating in such developments and creating opportunities for the private healthcare providers.
One of the notable trends witnessed in the region is that of local providers tying up with international healthcare brands or leading hospitals opening up branches locally and even working with distinguished doctors, in order to share their trusted expertise locally. The spectrum of collaborative endeavours is diverse in healthcare and involves international hospitals coming together to improve the culture of health in the local communities. There is enough evidence that suggests such collaborative partnerships can indeed have a beneficial collective impact.
For instance, the U.S.-based Johns Hopkins works with affiliates in the UAE, Lebanon, and Saudi Arabia to set new standards for healthcare in those countries and to train and inspire local clinicians, researchers, and administrators.
Pamela Paulk, President, Johns Hopkins Medicine International told Arab Health Magazine: “Our goal is not to develop a one-time set of solutions to immediate challenges before we move on to the next opportunity. Instead, we develop close, sustainable relationships with our colleagues, so they can take full responsibility — for maximum benefit to their communities —long after our collaboration ends.
“We collaborate on research that has the potential to change medicine for generations. We also share with our affiliates the latest research advances achieved here in Baltimore, so our affiliates can quickly apply them at the local bedside.”
One other notable case of such cooperation was the opening of Moorfields Eye Hospital NHS Foundation Trust’s first overseas branch, after more than 200 years of its foundation, in Dubai. It is one of the oldest centres for ophthalmic treatment, teaching, and research. The outpost has now become one of the GCC’s leading eye care institutions and has led to further expansion in the UAE with the opening of Moorfields Eye Centre Abu Dhabi.
Elhadi Hassan, CFO, Moorfields Eye Hospital Dubai said: “The Moorfields international business model incorporates teaching and research as well as clinical care and has proved to be very successful over more than 10 years in the UAE. It may even provide a blueprint for other leading UK and international healthcare institutions looking to expand internationally.”
Hassan shared that many of the consultants in Dubai undertook their training at Moorfields London and all of them are based in the Middle East full time, to ensure the quality and consistency of patient care and follow up.
Another example is the model adopted by RAK Hospital, which has close ties with a number of Indian hospitals that are instrumental in sharing their know-how. It is also managed in co-operation with Sonnenhof Swiss Health (SSH) of Switzerland.
Dr Raza Siddiqui, CEO at Arabian Healthcare Group and executive director at RAK Hospital shared: “The concept of international cooperation is very dear to my heart because I started this 20 years ago. At RAK Hospital, we get the best from outside and bring them here when we need to. For example, we have tied up with India’s Apollo Hospitals as well as Fortis Escorts that offers the best in cardiology services and they have deputed a team of eight full-time staff. Here doctors have the option of going for temporary posting overseas and can go back to their home institution when they want.”
Plus, RAK Hospital’s association with SSH was strategically planned, as Dr Siddiqui’s aim was to promote RAK Hospital for medical tourism. “After basic research, we realised that Switzerland was a pioneer in medical tourism and many people were heading there for medical treatments. Therefore, we tied up with SSH to offer the best of both hospitality and healthcare to the local community.”
Blueprint for Success
When such collaborations are forged, institutions have to respect the local culture and vision of international colleagues. The strategies must be adapted to each affiliate’s specific needs, resources and cultures — all as part of the collaboration between experts of both the parties.
Individuals around the world have different ideas about what constitutes quality healthcare and how it should be delivered. Paulk commented: “Even though Johns Hopkins has a global reputation for excellence in healthcare, research and education, it would be wrongheaded to think that what we do in Baltimore can be applied directly in other places in the world.”
Moorfields, for example, has established itself as an integral part of the healthcare community in the UAE and works with public and private hospitals, referring primary physicians, and the insurance sector, as well as working directly with the staff and families of some of the major public and private sector organisations.
“As one of the first healthcare organisations in Dubai Healthcare City, we have actively supported the Dubai Healthcare City Authority (DHCA) in shaping the direction of Dubai’s healthcare sector and regularly meet DHCA visitors or potential investors from an educational, research or treatment, and clinical side, to share our experience and expertise at our location in Dubai Healthcare City,” Hassan said. “This includes other NHS providers who may be considering opening here. We help shape the growth and development of the healthcare market in Dubai, not only from a private standpoint but also in working with the government on PPPs to raise the standard of care.”
The collaboration among hospitals also extends to other areas such as research and training. In fact, Moorfields Dubai has engaged in a unique collaboration with Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU) and also works together with the Dubai Medical College.
Recently, RAK Hospital entered into a partnership with Dr William Hodge who is mentoring a team of doctors at the hospital. Dr Hodge is a celebrated orthopaedic surgeon, who developed the patented ‘Arabic Knee’ treatment and specialises in hip and knee joint replacement.
Dr Siddiqui explained that the resident team has to fully understand the technology and concept, to make the partnership successful, otherwise the element of competition creeps in, which needs to be avoided. Also, working in isolation would not be beneficial to either the patients or the organisation.
He emphasised: “With any personal or professional relationship in life, I follow the principle of safeguarding the interests of your partner and never being selfish. Once you enter into a relationship you have to ensure that the partner’s interest is met. We have done the same, and our partnerships have been very fruitful and beneficial for us.”
On the other hand, Hassan stressed that once Moorfields had identified the Middle East and GCC region as the preferred location for its first international site, there were several challenges such as, where to base the hospital for optimum impact and the creation of world-class facilities; how to attract and recruit the professional staff required to support the Moorfields team of consultants; and how to ensure equivalent high standards of quality and safety through a robust governance framework.
Therefore, the best solutions often come from finding the right balance between two opposing approaches — providing the aspects of healthcare that make sense to everyone and honouring those aspects that might vary from region to region.
Paulk said: “Much of our international collaborative healthcare work — including opening access to quality care, promoting the importance of nursing and creating stronger clinical programmes that address the most pressing medical needs of the community —have proven applicable and even necessary in every country where we’ve worked.
“Our goal is not homogenising healthcare but creating comprehensive local programmes that will thrive long after we finish our collaborative work. By respecting the richness and diversity of how medicine is practiced and received in local communities, we can have much more success in opening access to quality healthcare around the world — a core tenet of our mission.”
As the healthcare industry struggles with rising cost burdens, inefficiencies, and patient dissatisfaction, there is a need to reward physicians for implementing prevention strategies — such as cancer screenings and smoking cessation — and for providing treatments that achieve good outcomes for patients.
“More advanced systems are starting to shift from a volume-based model to one that’s value based—focused on prevention and population health,” said Paulk. “We need to continue to move care from hospitals to outpatient settings, as well as into the community to address population health needs, determine social issues that impact health and emphasise prevention.”
She highlighted that for example, in the Middle East — a region of over 400 million people — nearly 65 per cent of the population is younger than age 30. This can be seen as a great opportunity to begin early education about preventive care to shift the focus from sickness and cure to wellness and prevention.
“In terms of health propensities, cancer accounts for almost one in five deaths in the UAE. We are working closely with Tawam Hospital to establish a centre of excellence to enhance and expand oncology services,” she highlighted.
Additionally, in order to bring efficient techniques at affordable costs to the local community, Dr Siddiqui shared that collaboration is a great exercise as it allows individuals and organisations to learn from the best and pass on the benefit to the people. “The whole idea behind the collaboration is to bring the best policies, procedures, protocols, techniques and pass on to the patient for his benefit,” he added.
Furthermore, Hassan highlighted that Moorfields Dubai meets the need for a specialist eye hospital serving the local, regional and wider international populations, in a subspecialist area which private or public sector investors may find attractive.
The experience of these institutes demonstrates that international healthcare brands can successfully establish their own operations and build partnerships to provide access to more local care for communities across the GCC and maybe even beyond.
Partnering for Health
King’s College Hospital London (KCH) first entered the UAE market in 2014 with the opening of its flagship clinic in Abu Dhabi. KCH in the UAE is a joint venture with Al Tayer Group, Dubai Investments and UK-based Ashmore Group. The joint venture aims to merge KCH’s international expertise, with local market know-how and access and brings KCH’s 175 years’ experience as a world-renowned British teaching hospital to the emirates.
Christian Schuhmacher, CEO of KCH in the UAE shared: “One of the deciding factors for KCH to bring its world-class care to the UAE was to give back to this impressive and generous nation. In 1979, the late Sheikh Zayed bin Sultan Al Nahyan, the founding father of the UAE, provided a sizable donation that helped establish KCH’s liver research centre in London, which is now amongst the top three liver specialist centres in the world. Our commitment to the UAE is unwavering and we are proud to play a role in helping it become a leading international healthcare hub. We are fully aligned with the UAE government’s healthcare vision and delivering on our promise of giving back to the UAE.”
In line with this vision, KCH’s Dubai-based hospital is set to open in Q1 2019, and will provide advanced tertiary medical care, including cutting-edge treatment and procedures.
“Our biggest focus has been to marry the best practices from the UK with the gaps in the local healthcare landscape and our inherently connected, always-on relationship with London and commitment of sharing expertise has meant we are able to do just that on a local level,” he concluded.
A look at some other examples of effective international cooperation in hospitals:
American Hospital Dubai: The hospital is the first healthcare organisation in the Middle East to join the Mayo Clinic Care Network. The agreement gives it access to the latest Mayo Clinic knowledge and promotes collaboration among physicians to benefit patients.
Mediclinic Middle East: It is part of Mediclinic International, a private hospital group with three operating platforms in Southern Africa (South Africa and Namibia), Switzerland and UAE, and a 29.9 per cent shareholding in Spire Healthcare, a UK-based healthcare group with 38 hospitals. In February 2016, Mediclinic International combined with Al Noor Hospitals Group, with operations mainly in Abu Dhabi. Currently, Mediclinic Middle East operates six hospitals and 24 clinics in the UAE, with more than 700 inpatient beds.
Cleveland Clinic Abu Dhabi: The hospital was established as the result of an agreement signed in 2006 between Mubadala Development Company, and U.S.-based Cleveland Clinic in support of the Abu Dhabi government’s Economic Vision 2030 to develop a world-class healthcare sector in the emirate. The hospital is a 364 bed facility and is a physician-led medical facility served by North American board certified or equivalent physicians.