Future of FM in SA

The Future of Primary Care in Saudi Arabia

• Presenter: Dr. Khalid I. AlQumaizi
• Date: 24/09/2024

Historical Background

• SALUT AUX PARTICIPANTS
• DE LA CONFERENCE INTERNATIONALE
• SUR LES SOINS DE SANTE PRIMAIRE!

Alma’ Ata Declaration

1. The Conference strongly reaffirms that health is a fundamental human right.
2. The existing gross inequality in the health status of the people is politically, socially, and economically unacceptable.
3. The people have a right and duty to participate individually and collectively in the planning and implementation of their health care.
4. Primary health care is essential health care based on practical, scientifically sound, and socially acceptable methods and technology.
5. An acceptable level of health for all the people of the world by the year 2000 can be attained through a better use of the world’s resources.

The Beginning of the Newly Structured Primary Care Services

1. In accordance with the Alma-Ata declaration, Saudi Arabia has committed to develop its primary health care services.
2. The Ministry of Health integrated both preventive and basic curative health care services in 1984.
3. These services targeted individuals, families, and the community, and provided a range of health care services including maternal and child health, immunization for communicable diseases, follow-up for patients with chronic diseases, dental care services, health education, and essential drugs.

Whole-Person Care

• Whole-person care is the hallmark of good Primary Care. The patient-centered consultation not only takes into account the diagnosed disease and its management but also adds another dimension—that of the psychosocial hallmarks of the patient, including details about:
  1. The patient as a person
  2. Emotional reactions to the illness
  3. The family
  4. The effect on relationships
  5. Work and leisure
  6. Lifestyle
  7. The environment

The Main Elements of Primary Care

There are eight essential components of Primary Health Care (PHC):

1. Health education on prevailing health problems and the methods of preventing and controlling them.
2. Nutritional promotion including food supply.
3. Supply of adequate safe water and sanitation.
4. Maternal and child health care.
5. Immunization against major infectious diseases.
6. Prevention and control of locally endemic diseases.
7. Appropriate treatment of common diseases and injuries.
8. Provisions for essential drugs.

All these basic requirements are incorporated in the SDGs for 2030 from goal 2 to goal 4.

The Degrees of Care

• Self-care (75%)
• General practice care (25%)
• Hospital (2.5%)

The future of primary care in Saudi Arabia

Enhancement of Primary Care Project

The Saudi Healthcare Transformation

• Healthcare Financing
  • Establish a value-based payment system
• Workforce
  • Enhance quality and quantity of workforce
  • National Healthcare Workforce Planning Unit
• eHealth
  • Provide digital tools (apps) for patients and workforce
  • Accelerate IT infrastructure build-up at MoH
• Private Sector Participation
  • Privatization of healthcare services
  • Support localization of pharmaceutical and medical devices.
• Corporatization
  • Corporatize health services delivery.
  • Create local clusters that ultimately form accountable care organizations.
• Governance
  • Strengthen MoH to lead sector reform and transform it to be more strategic.
  • Create a range of regulatory bodies.

Model of Care

Shifting the Mindset

Treating Sickness	Promoting Wellness
Hospital-based/specialized care	Community-based/primary care
Facility-based (silos)	Cluster-based (integrated)
Paying for infrastructure	Paying for services
Focusing on inputs	Focusing on outputs/outcomes
Delivering care	Delivering value
Bringing patients to doctors	Bringing doctors to patients

The future of primary care in Saudi Arabia

Enhancement of Primary Care Framework

1. Services
2. Engagement
3. Capabilities
4. Population Health
5. Governance
6. Funding
7. Regulations

The future of primary care in Saudi Arabia

Services

• Defining the scope of services
• Essential and essential plus
• Mega centers
• Urban vs rural
• Extended working hours
• Urgent Care Centers

Engagement

• Defining catchment population
• Population registration
• Empanelment
• Improving access
• Patients satisfaction

Capabilities

• Capabilities profiling
• Assessment methodology
• Leadership training
• Family medicine residency
• Case coordinator , health coach
• Repurposing of the staff
• Building teams capabilities
• Change management
• Physical and IT capabilities

Population Health

• Defining population health KPIs
• Population health need
  • assessment
• Defining the contractual
  • requirements with payer
• Training the PHM teams

Governance

• Designing the governance of Primary care
• The authority matrix within the ecosystem and within the clusters
• Interaction with other stakeholders
• Culture of accountability
• Reporting requirments

Funding

• Defining funding strategy
• Incentivize mobilization of services to primary care
• Funding the Capex by PPP
• Measuring the ROI

Regulations

• Revising the policies that hinder the empowerment
• Regulating the private sector to adopt family medicine based approach
• Revising the privileges of the PHC staff
• Clinical guidelines
• Professional licenses
• Infrastructure standards
• Non clinical standards