Click image to view larger version

H E Dr Ali Jaffar Mohamed, Advisor Health Affairs, supervising the Directorate General of Health Affairs, Ministry of Health, talks to Srinivasan Iyer about the efforts being made to improve the healthcare infrastructure and tackle emerging problems

WHO has ranked Oman's healthcare system as the second best in Asia and the eighth best in the world. Where do we go from here?

We are proud of our past progress and achievements duly acknowledged in the World Health Organisation 2000 report. The Ministry of Health (MoH) is committed to sustain these achievements and strive for an even better placement in the global and regional healthcare systems ranking. MoH shall continue to focus on three basic aspects that have played a pivotal role in the ministry's success story – human resource development, expansion of healthcare facilities and improved quality of healthcare
services. MoH is aware of the fact that in the end, it is the quality of healthcare services which matters the most, irrespective of the numbers and variety of facilities and equipment available in our healthcare facilities. Structured quality assurance programmes under the supervision of trained quality services experts have therefore already been introduced at the primary healthcare level, followed closely by steps to expand its scope to secondary and tertiary healthcare facilities. Screening programmes for those over 40 for diabetes, lipid profile, BMI, occult blood in stools (for early detection of colon cancer) and breast cancer screening are some of the services coming up in the near future.

Despite the best efforts of the government, there seems to be a long waiting list for surgeries. Why is that?

Contrary to the prevalent perception, the average waiting time for routine surgeries, as per available records, is well within the acceptable international norms. According to data from Royal Hospital and Khoula Hospital, the waiting time is two to three weeks for any normal elective surgery. For very few selective highly specialised surgical modalities like open heart surgeries, it is around six to eight weeks with a maximum waiting period of 12 weeks. The waiting time for surgeries is dependent upon several internal and external factors. The ongoing expansion projects (phase VIII) at Khoula Hospital and the global short supply of doctors who have specialised in anaesthesia, pathology, as well as obstetrics and gynaecology some of the prominent factors forcing long waiting period. The waiting period for highly advanced surgeries like hip replacement is two to three months and for knee replacement it is six months, based on the MoH appointment system. The MoH is in a continual process of identifying, addressing and resolving the causative factors to ensure that the waiting period for routine surgeries does not exceed six to eight weeks.

Are the complaints by the people about the healthcare system justified?

Every individual is entitled to file his/her complaint at any level within MoH. We have an effectively established system of complaint management through a network of regional clinical audit committees and mortality & morbidity committees. At the headquarters level, the complaints are effectively managed through the Primary Medical & Technical Committee (PMTC) and the Higher Medical Committee (HMC).

There are two primary medical and technical committees comprising members and chairpersons from within the senior clinical staff of MoH. Each committee meets once a week, and has an average case disposal rate of five cases per month.

The highest committee at the ministerial level is the Higher Medical Committee (HMC), which has multi-sectoral representation, with the chairperson from the Sultan Qaboos University Hospital. Other than the senior clinicians from MoH, HMC has members from the medical services of the Royal Army, Royal Oman Police (ROP), and private sector. This committee meets once in two weeks, and has an average case disposal rate of one per month.
|
Objective data from PMTC and HMC shows that approximately 46 per cent of the complaints managed at the MoH headquarters in 2005 and 60 per cent in 2006 had no grounds to suspect any clinical mismanagement. We believe the public needs to be
educated further regarding the difference between clinical mismanagement and acceptable complications associated with any medical and/or surgical treatment modality. Complaints provide valuable information and an opportunity to weed out lapsing systems and unsafe medical practices.

Are there any plans to expand Khoula and Royal hospitals? Is the government planning to set up new hospitals and health centres?

The expansion of Khoula Hospital, which was built in the 1960s, has been an ongoing process for the last four to five years. It is currently in phase VIII of the expansion plan. At the end of this expansion, it will have an accident and emergency unit, a burns unit and an ICU, as well an increase in the number of inpatient orthopaedic beds.

The facilities and services at Royal Hospital had been extended in the recent past by the creation of new departments of Radiotherapy and Oncology. Further expansion of services is planned with the creation of a new cardiac centre in the near future. Expansion of the facilities and services at the grassroots level can be seen by projects for new regional health centres in Muscat (4), Dhofar (3), Al Wusta (3), North Sharqiyah (3), Dakhliyah (2), Buraimi (2), South Sharqiyah (5), Dahirah (3), North Batinah (2), and South Batinah (3). New extended health centres are under construction in Sohar and Nizwa. Construction is also due to begin shortly on a hospital in Seeb wilayat for mental health, psychiatry and drug abuse.

What is the reason for so many private sector clinics and hospitals setting up operations in the last few years?

We believe that every individual should have choice regarding his or her healthcare needs within the public and private sectors. To make this choice fair, it is vital that the private as well as public sector have treatment facilities that are at par with competitive quality services. The government looks at the private sector as its partner since it complements the healthcare services provided by the ministry.

What are the steps the government taking to combat HIV?

Oman has a very low incidence of HIV/AIDS. Among its efforts to combat HIV/AIDS, Oman adopted in the early 1990s a National Programme for Prevention of HIV/AIDS that focused on epidemiological surveillance, community prevention, blood safety and case management, including treatment, support and counselling. The programme was recently revised to include develop-ments with long-term strategic significance for minimising transmission and caring for people living with HIV/AIDS. Oman also participates in different regional and international meetings to find out the latest strategies being adopted in the AIDS prevention programmes globally, parti-cularly in relation to the surveillance and what is applicable in Oman.

Lifestyle diseases like diabetes pose a serious threat. So is rising obesity among the youth. What is being done to curb these?

Lifestyle diseases are indeed the dominant ones in Oman at present. However, we have to remember that they are related to individual behaviour and choices and are not easy to change. They are also not easy to treat. MoH is now formulating a strategy on diet, physical activity and health. It will encourage a healthy diet and for more people to take up physical activity. The sultanate has also joined the international treaty to curb tobacco use and is currently formulating legislations to combat tobacco use in public places. Further, MoH is also conducting a nationwide screening programme for diabetes, obesity and chronic renal disease. This will be conducted at the primary healthcare level. People above 40 who have these conditions will be identified and treated early to reduce the rate of complications arising out of such conditions.

What are the criteria for sending patients abroad to get treatment? Can you please elaborate on the process?

During the ’70s and ’80s, the number of patients sent for MoH sponsored treatment aboard was very large. This number has come down from 418 patients in 1990 to 237 in 2006. So on an average it is about 15-20 patients per month now. This drastic reduction of treatment abroad cases is because of the phenomenal expansion of the healthcare services with provision for most of the modern treatment modalities within the country. There is an established process for availing government-sponsored treatment abroad. Recommendations are forwarded only for those cases requiring treatment modalities not available within Oman and where such treatment is expected to have a beneficial effect on the health of the patients. There is a national committee comprising senior clinicians and managers looking at each and every case and determining both the aspects stated above. The recommendations of the committee are implemented after due approval by the Office of the Undersecretary for Health Affairs.

Are there any plans to set up pharmaceutical companies to manufacture generic drugs?

There already are four pharmaceutical companies manufacturing drugs in Oman. The government would certainly encourage anyone interested in setting up a new pharmaceutical company. Prospective investors must take into account that such companies can only be set up in dedicated industrial locations and all the relevant regulations and quality criteria and the good manufacturing practices established by the government have to be meticulously adhered to. Oman is also interested in going in for generic versions of drugs, provided they meet the required standards for safety and quality and adhere to good manufacturing practice.

How are the vaccination programmes implemented? Has Oman managed to eradicate polio?

The vaccination programme is carried out under the expanded programme of immunisation initiated in 1981. Ten antigens are covered under this programme and a high routine coverage, more than 95 per cent, has been maintained for more than a decade. As a result of the Communicable Disease Surveillance and Control System established in 1991, not a single case of polio or diphtheria has been recorded since 1993 and 1992 respectively. To maintain the polio-free status, high alert on imports to Oman is being continued until its global eradication. Only a single case of tetanus neo-naterum (1995) has been recorded since 1991. Oman has achieved the WHO regional target of measles elimination with an incidence rate less than one per 100,000 population for the past eight years.

The last recorded case of polio was in 1993. Though polio eradication has been achieved in Oman, the fear of import remains as long as cases occur in countries like India, Pakistan, Nigeria and Afghanistan. The end goal is to have no wild virus circulation by the end of 2007 or latest by mid-2008 as per WHO targets.

The Ministry of Health is evaluating the feasibility of using needle-free jet injectors for immunisation. What is the progress so far and how soon will it replace needles and syringes?

The BioJector B2000 needle-free injector delivers the vaccine intra-dermally by pressure, and is being used in a study conducted in Oman. The success of this study would also help in the introduction of this technique for other vaccines. This instrument has been in use in the routine immunisation of infants, toddlers and older children in a number of county health department clinics in the US. As the jet injector is needle-free, its use is very safe in view of absent margins of improper reuse without sterilisation as seen with ordinary needles and syringes.

In this study, started in March this year, participants were enrolled from birth until the age of seven months. This study will go on till December. The total number of newborns enrolled is 400 from the four regions, South and North Batinah, Dhofar and South Sharqiyah. After finishing the study, all the matters would be discussed with the providers and users of the service, and further course of action will be decided.

What is your opinion on the mergers and acquisitions in the private sector?

Consolidation, mergers and de-mergers in the private healthcare sector are not under MoH. People visit the private clinics to get good services and treatment. If the services are good, the healthcare institutions do well, if not they are bound to close down. MoH, however, ensures that all healthcare facilities and services in the private sector comply with the regulations governing their structural set-up, furnishing and equipment and minimum standards of safe clinical practice. Any violation of the standards of safe clinical practice would certainly result in mismanagement and would result in an investigation and subsequent imposition of penalties by the government for these violations.

Will more resources be committed as healthcare costs rise?

Yes, the healthcare costs will rise in the coming years. The government is committed to taking care of the healthcare needs of the population and shall continue to commit additional resources, as close as possible to the amount that is required to meet the increasing demands.