ACCESSIBLE TO ALL
In October 1936, the monthly American magazine Contemporary Review wrote: “The sanitation of Makkah and Madinah was as defective as it possibly could be. Water was scarce and there were no hospitals or good qualified doctors to be found … and so mortality was very high among the pilgrims and citizens alike.”
The magazine was describing conditions in the days before King Abdulaziz bin Abdulrahman Al-Saud unified the peoples of a large part of the Arabian Peninsula into the modern Kingdom of Saudi Arabia. In that article, entitled “A Decade of Progress in the Hijaz,” published on the tenth anniversary of the extension of King Abdulaziz’s rule to the region in western Saudi Arabia in 1926, the magazine noted that while health and medical conditions were this bad in the largest urban centers in the peninsula, they were even worse in the smaller villages and the countryside, resulting in high infant mortality and low life expectancy. It then observed that in the decade of Saudi rule to date, “a great deal has been done” for the health, comfort and safety of citizens and pilgrims to the holy sites alike.
The “great deal” that the magazine referred to was just the beginning of a major national effort to make quality health care available to all Saudi citizens and pilgrims, wherever in the Kingdom they may be. Moreover, from the outset of this effort, King Abdulaziz decided that medical treatment would be provided at the government’s expense.
Within four decades of the establishment of the modern Kingdom, the government had built a network of modern hospitals and clinics. Each of the provinces had set up its own medical facilities and within a relatively short time, once-endemic diseases such as malaria, smallpox and cholera were virtually eradicated, the infant mortality rate was drastically reduced and life expectancy rose sharply. By 1970, a total of 74 hospitals and 591 clinics had been established in the Kingdom.
That year, Saudi Arabia launched the first of its five-year plans that would greatly accelerate the pace of development in all areas, including in agriculture, commerce, industry, transportation, communication and education, as well as in health care.
During the first four development plans, between 1970 and 1989, the Saudi health care system underwent a dramatic change. In the early years of this period, the emphasis was more on establishing the necessary health care infrastructure of hospitals, clinics, pharmacies, laboratories and research facilities. Gradually, as these facilities were put into place, the emphasis shifted to the qualitative improvement of medical care and service by encouraging more Saudis to pursue careers in this field and attracting larger numbers of qualified medical personnel from abroad, while at the same time continually updating technology to incorporate the latest medical advances, as well as establishing working relationships with the most famous specialized hospitals in the United States and Europe.
The government’s achievements in the health sector during the 1970-89 period were truly astounding. The number of hospitals increased from 74 with 9,039 beds to 262 with 40,675 beds, while the number of clinics rose from 591 to 3,070.
The Ministry of Health and other government agencies have been responsible for establishing most of the hospitals and clinics that have been established throughout the country, even in the smallest of villages. However, the government has also sought to encourage greater private sector involvement in the field by offering long-term, interest-free loans for the establishment of hospitals, clinics and pharmacies. By 1990, the private sector accounted for 27 percent of the health care services offered in the Kingdom.
To meet all the health needs of Saudi citizens from preventive care through advanced surgery, the Kingdom has implemented a two-tier health service plan. The first tier is a network of primary health care centers and clinics established throughout the country. The number of such facilities, which provide preventive, prenatal, emergency and basic health services, stood at more than 4,000 in 2001. These centers are supplemented by a fleet of mobile clinics that routinely visit the more remote villages, dispensing vaccines and performing basic medical services. By reaching people throughout the country, these centers and clinics have contributed greatly to the improvement of health standards in the general public, with special emphasis on preventive and prenatal care. They have been instrumental in reducing the infant mortality rate in the Kingdom from 68 per 1,000 births in 1980 to less than 30 per 1,000 in 2000. Almost 99 percent of Saudi children are now immunized against common diseases.
The second tier of Saudi health care is a network of advanced hospitals and specialized treatment facilities that are strategically placed in major urban areas throughout the country to be accessible to all. Today, there are 318 such hospitals with 46,400 beds.
The Kingdom’s commitment to raising the quality of the health care and services provided to its citizens is reflected in the fact that while the number of hospitals and primary health care clinics and centers have increased five-fold over the past 30 years, the number of physicians employed at these facilities rose 27-fold, from 1,172 to more than 32,000, twenty percent of whom are Saudi. There has been a similar increase in the nursing staff, from 3,260 to 68,000, and in the technical staff from 1,740 to 39,960, with females accounting for more than half.
With a population of 22.1 million, Saudi Arabia's ratios of one hospital bed per 476 people and one doctor per 690 people are among the lowest in the world.
Saudi Arabian citizens who in the old days were forced to travel abroad for sophisticated medical treatment are no longer obliged to do so and can receive the same quality medical service at home. By the late 1980s, sophisticated surgical procedures such as open heart surgery and organ transplants were beginning to be performed in various Saudi hospitals to the highest international standards.
Hospitals have been established in all cities and towns in the Kingdom. One example is the King Fahd Medical City, one of the largest such medical facilities in the Middle East, which encompasses five hospitals — including for pediatrics, general medicine and psychiatric care — and various health centers, as well as outpatient facilities.
The King Faisal Specialist Hospital and Research Center headquartered in Riyadh is another example of Saudi Arabia ’s modern hospital system. In the past quarter century, the facility has built a reputation as a leading hospital and a premier research center in the Middle East.
Consisting of a complex of hospitals and extensive outpatient facilities, it has departments for cardiovascular diseases, obstetrics/gynecology, oncology, pediatrics, pediatric hematology/oncology, radiology, neurosciences, dentistry, urology and orthopedics. Its Department of Surgery performs general, pediatric, plastic, renal, ophthalmology, thoracic and vascular procedures.
Its research center conducts studies in biological and medical research, biomedical physics, epidemiology and scientific computing, genetics, radiopharmaceuticals and comparative medicine. Recently, this and other research facilities in the Kingdom have been conducting pioneering research, including in stem cell transplants.
In addition to general hospitals, the Kingdom has some of the finest specialized hospitals. Two decades ago, most hospitals only offered general services. There are now hospitals specializing in almost all fields of medicine, as well as a large number of research facilities conducting cutting-edge studies and experiments.
One such facility is the King Khalid Eye Specialist Hospital, which is one of the world's largest and best-equipped eye hospitals. Established in 1983, the hospital performed a total of 84,000 surgical operations, including cornea transplants and laser procedures, during its first decade.
An integrated medical city occupying a square mile of land in northwest Riyadh, the facility employs more than 1,500 physicians, nurses, medical technicians and support staff. In 1988, the hospital established a program to train ophthalmologists and has turned out hundreds of specialists since then.
While organ transplant procedures were once a novelty in the Kingdom, with the first heart transplant successfully completed in a Riyadh military hospital in 1986, such operations are now routine in Saudi Arabia. For example, the King Faisal Specialist Hospital and Research Center specializes in kidney and liver transplants, performing hundreds of these operations annually, and marked its one thousandth bone marrow transplant in May 2002.
Saudi hospitals have also been pace setters in organ transplants. For example, the first uterus transplant in the world was performed at the Soliman Fakeeh Hospital, a private facility in Jeddah, in 2001.
Similarly sophisticated surgical procedures are undertaken by most Saudi hospitals. In the field of cardiology, for instance, the first open-heart surgery in the Kingdom was completed in the mid-1970s in a small hospital in Jeddah. Teams of Saudi and expatriate specialists in world-class cardiology centers in the Kingdom’s top hospitals now perform open heart surgery routinely. More than 10,000 open heart surgeries have been successfully undertaken since the techniques were introduced in the Kingdom two decades ago. Today, many medical centers located throughout the Kingdom offer specialized cardiac care, and the nation's cardiac units are experiencing a 70 percent success rate, according to a recent Ministry of Health report.
The most famous of the hospitals specializing in cardiology is the King Fahd National Guard Hospital in Riyadh, which performs more than 750 cardiac procedures annually. Other cardiology hospitals have been established in Jeddah, Makkah, Madinah and Dammam. The recent opening of two new cardiology centers in Riyadh and Jeddah, devoted exclusively to the treatment and research of heart diseases, will further research and treatment in this field.
In addition to major hospitals, medical colleges and universities also conduct basic health research. Many institutes have made striking advances with potential benefits that reach well beyond Saudi Arabia. The research center at King Saud University's School of Pharmacology, for example, has developed new drugs, notably one for diabetes. King Abdulaziz University is also a center for advanced medical research, and King Saud University's College of Science is using radioactive biotopes to determine the effect of antibiotics on bodily functions. At King Khalid University Hospital, scientists are testing whether indigenous medicinal plants could help in treating cancer.
The government subsidizes medications, which are readily available to patients and cost less than in most countries. It also encourages Saudi companies to manufacture pharmaceuticals through long-term interest-free loans and support services.
An important role in health care is played by the Saudi Red Crescent Society, which is a member of the International Federation of Red Cross and Red Crescent Societies. It provides first aid and emergency medical services, operating about 150 medical centers and branches throughout the country, in addition to four mobile clinics and more than 500 ambulances and medical evacuation helicopters. It also plays a special part in caring for the millions of Muslim pilgrims during the annual Hajj or pilgrimage to the holy sites in Makkah and Madinah. Each year, the society sets up for the pilgrims hundreds of health care stations staffed by thousands of doctors, nurses, medical technicians and support personnel.
The Saudi Red Crescent Society also responds to natural and man-made disasters abroad, with personnel and volunteers sent to various parts of the world. Early in the 1990s, the society operated field hospitals and food distribution centers in Somalia where famine victims received medical care and food donated by Saudi Arabia. Since then, its staff have been involved in relief operations in Bosnia-Herzegovina, in Kosovo, Chechnya and Palestine, supplying tents and clothing as well as medicine and foodstuffs. In addition to these services, the society has helped teams of surgeons from the King Fahd Hospital Heart Center perform sophisticated medical procedures in less developed nations, and set up cardiology centers in such countries.
Saudi Arabia has also established an efficient network of facilities to treat and rehabilitate the mentally and physically handicapped. The Ministry of Health and the Ministry of Labor and Social Affairs have established a network of rehabilitation centers for the handicapped. These facilities fall into two categories. The first offers services for medical, physical and mental treatment and rehabilitation of patients and is operated or supervised by the Ministry of Health. There are currently 18 such centers. The second group of centers focuses on the social rehabilitation of the handicapped and is run by the Ministry of Labor and Social Affairs. There are presently 14 centers throughout the country that teach the mentally and physically impaired social, educational and vocational skills designed to help them enter society as independent, productive individuals. There are also 24 special education institutes for the blind and the deaf in Saudi Arabia and three centers for handicapped children.
The government also provides financial and technical support for a large number of charitable and benevolent societies. The centers run by the Saudi Benevolent Association for Handicapped Children and the Prince Salman Center for Senior Citizens are but two of the many such institutions throughout the country.
Over the past two decades, the government has also worked to enhance the capability of universities and hospitals to train the large numbers of doctors, nurses and medical technicians the country will need in the future. The Ministry of Health currently operates 24 health institutes and 13 medical colleges, including six exclusively for females.
The government’s plans to build more general and specialized hospitals and to encourage greater participation by the private sector will ensure that quality medical care will continue to be available to all Saudi citizens.