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The Middle East is characterized my many health problems for instance lack of enough qualified doctors and prevalent of communicable diseases such malaria (Pierre-Lewis & Akala, 2004). Iraq in 2006 had 2006 doctor for every 10,000 people compared to UK with 216.6 per 10,000 people (World Bank, 2008). Studies indicates that the region is characterized by various challenges that will require adjustments of health systems, these challenges are high mortality rates, prevalence of communicable and non-communicable diseases and high population growth rates(Arab Human Development Report,2002). Despite facing some challenges, studies indicate that Middle East countries have achieved a significant improvement in overall health status of their citizens over the last decades (World Bank, 2008). This has been attributed to reduction in both mortality and morbidity rates and through and improvement in access of basic health services (Pierre-Lewis &Akala 2004).
Most countries in the region have their health systems operating under a curative model (Pierre-Lewis &Akala 2004). Studies indicate that this model is characterized by high expense and is ineffective in dealing with rising health problems (World Bank, 2008). Studies have suggested that health systems in the region need a radical reconfiguration so that they incorporate promotional and preventive services (Pierre-Lewis &Akala 2004). Studies further indicate that most countries in the region have many problems in their health systems; these problems include: inadequate participation of the private sector, lack of enough commitment to the systems, poor disease surveillance systems, lack of adequate human resource and lack of transparency (World Health Organization Statistical report, 2004). This suggests radical overhaul of national health systems in Most Middle East countries in inevitable.
United Arab Emirates which is one of the major economies in the Middle East is characterized by modern health care systems that are well equipped with facilities and professionals (Arab Human Development Report, 2002). Despite the fact that most health care systems are concentrated in major cities; overall, majority of the population in remote areas have access to basic health facilities (Pierre-Lewis &Akala, 2004). Studies indicate expenditure on national health systems has tremendously increased from 274 million pound to over 500million pounds in the recent years (Library of Congress Federal Division, 2007).
UAE has experienced tremendous social economic developments over the last four decades; this has led increase and wide distribution of population (UAEinteract.com, 2011) ). This has prompted the government to adopt a decentralized National health system (World Bank, 2008). In this system each district is equipped with 9 medical districts with medical and administrative capacity to organize, plan, supervise and develop their own health care services (World Bank, 2008). Administration that is set at district level includes all represents all the departments of the ministry of health (Pierre-Lewis &Akala, 2004). Also the government operates its own Department Of Health and Medical Service (DOHMS) which is an independent from UAE ministry of health that is administered by the federal government, that is; Federal Ministry of Health (FMH). FMH operates health care system across UAE and hospitals in northern emirates. DOHMS operates 18 medical centers and three hospitals (Pierre-Lewis &Akala, 2004). National health systems in UAE are also characterized by national performance standards and facilities with modern equipments. The ministry of health (MOH) has a well established network of health centers and hospital thus making the health services more accessible (Pierre-Lewis &Akala, 2004). MOH's curative services are managed by departments in headquarters that respond to needs of all departments at district level. Some of the departments in the MOH include: Department of Primary Health Care, Department of Planning and Computers, Department of Dentistry, department of nursing (Library of Congress Federal Division, 2007). Health care in UAE was free but in 2001 the government introduced some charges with the aim of reducing the draw of healthcare on public fund and increasing the cost of expatriates (where health insurance is a requirement). This has led to a decline in number of individual visiting public hospitals. To improve National health care system the government is currently expanding and upgrading its health care facilities (Margolis &Carter 2005).
Like UAE, Qatar operates a national health system where most medical services are free for nationals and subsidized for expatriates residents and visitors (Hilborne et al, 2004). The country has already started implementing a health insurance scheme for expatriates. The national health care system of Qatar in modeled to emphasize on community-based local health services that are vital in provision of primary health care (Annual Health Report, 2008). ). Just like UAE, Qatar in increasingly decentralizing its secondary health care facilities to remote or rural areas (Annual Health Report (2008). Studies indicates that Qatar national health care system lacks clarity among stakeholders in executing strategic health planning, health policy analysis, priority setting, monitoring and evaluating performance of hath systems and coordination among different health stakeholders(Hilborne et al, 2004).
The main regulatory instrument of national health care system in Qatar is the National Health Authority (NHA). Established in 2005, NHA is mandated to offer both treatment and preventive service to the public. NHA also carries out supervision roles in the provision of medical services at home including treatment of Qatar citizens living abroad (Meili et al, 2007). Moreover NHA has a mandate of regulating manufacturing of drugs to ensure that they comply with the required quality standards. NHA plays a role in organizing medical private sector and together with health insurance systems; NHA enhances provision of health services and dissemination of health awareness and education (Pierre-Lewis & Akala, 2004). NHA has the following departments: Health Research, Public Health, Quality Management, planning and evaluation, legal affairs, administrative and financial affairs, health care financing and foreign health relation (Meili et al., 2007). Although Qatar is increasing decentralizing its secondary health care facilities, it operates a less decentralized national health system as compared to UAE. Also the Qatar system is characterized by a less efficient system of monitoring effectiveness of health services. Another weakness is lack of effective communication between sector providing health services (Meili, R.C et al, 2007).
The Qatar system lacks national health information system and accessibility to information is characterized by high costs (Hilborne et al, 2004). This leads to poor assessment and impact and evaluation, poor planning, duplicated effort, poor and uniformed decisions and waste of time and resources. To improve the Qatar health systems the following proposals have been suggested: putting in place a well coordinated health research systems, establishing well coordinated and effective information systems and putting in place efficient accountability procedures (Hilborne, et al,2004).
The Saudi Arabia health care system is characterized by social economic and health facilities. The health systems are administered by the ministry of health (MOH) (Khoja, 2005). Although it has a well defined administrative and organizational structure, this is system is less decentralized than both UAE and Qatar (Pierre-Lewis & Akala, 2004). The ministry of health is responsible for strategic planning and iniating health policies that provide health care to more than 60% of the population (Ministry of Health, 2010). MOH also supervises delivery of health service and other related activities. Health Services council which is under the MOH, is responsible for preparation and coordination of different health care strategies in the kingdom. The health system is Saudi Arabia is characterized by autonomous public hospitals. Private Service providers are also engaged through contracts. Unlike in Qatar, health services are effectively integrated. Although currently various improvements are being carried out, this health system is characterized by easy accessibility and availability of health information and data (Memish, 2002). Although there is a health system research, it is characterized by various problems such as administrative regulations and logistics (Pierre-Lewis & Akala, 2004). The benefits of this system are: high flexibility and performance (Mansour & al-Osimy, 2005). Accountability in the Saudi Arabia system is better as compared to Qatar. This system is characterized by a number of problems such as: financial problems, administrative problems and procedural issues (Scientific Committee for Quality Assurance, 2009)
Health systems in the Middle East are characterized by various problems that need be overcome. They need to develop more encompassing models that takes into account curative and preventive strategies. Nevertheless, countries like UAE are operating an effective national health system that is appropriately decentralized to provide easy accessibility primary health care even in remote areas. Despite being effective, this system needs further improvement. Although Qatar operates a decentralized health care system a major overhaul is needed to enhance accessibility of health services and information, promote accountability and enhance provision of health services. Also the Saudi Arabia needs further decentralization to enhance accessibility of health care service.