Chronic disease has increased alarmingly in Middle East populations, with heart disease up by 44%, strokes up 35% and diabetes up 87% in the period from 1990 to 2010.1 As in other developing regions, the Gulf Cooperation Council (GCC) area is burdened by the rising prevalence of these non-communicable diseases (NCDs) and increasing health care costs and expenditures. Urbanization, Western food, the climate and increasingly sedentary lifestyles are all pushing diabetes to epidemic levels in some areas (e.g., 20% in Saudi Arabia). 2
As the number of people seeking care (and associated costs) rise, resources have dwindled. Middle Eastern countries are rebalancing their economies in the face of falling oil prices, which are likely to remain low for the foreseeable future. This leaves health care with little or no support from other sectors (excluding the United Arab Emirates, which has rolled out extensive mandatory health insurance). The uncertain economic environment in countries such as Saudi Arabia and Egypt has also led to shifting priorities and a wavering of governmental commitment to investment in the health care sector. In this climate, opportunity seems ripe to partner with private finance to support NCD management programs.
Last year, the Government of Saudi Arabia announced Vision 2030 — its plan to reduce dependence on oil revenues and develop an alternative economy around service sectors such as health, education, infrastructure and tourism. Despite robust growth in the health care sector, provider systems in the region continue to lag behind international standards, while in some countries infrastructure issues also exist with bed-to-population and medical personnel-to-population ratios still considerably below global averages.3
How PPPs can help
In addition to funding infrastructure projects, public-private partnerships (PPPs) have the ability to rapidly introduce new technologies and innovative approaches to services that can improve care delivery models, delivering operational efficiencies that reduce costs. With PPPs, health systems may gain program experience and tooling they cannot afford or develop on their own. For example, a PPP may offer experienced resources to train personnel in analytics-driven decision-making processes, with a focus on achieving better outcomes and lowering costs.
Some governments are taking a more balanced approach to risk management when it comes to PPPs, recognizing this creates incentives that are a win for all players. “Previously, PPP contracts in Saudi Arabia had been very one-sided — for example, the private sector took all the risk,” says Dr. Jalal al Geilani, Director, EY Health and Life Sciences in the country. “But modernizers within the government realize this needs to change and are attempting to make PPPs more attractive to private finance and gain the confidence of the industry.”
For investors, shared risk models present an attractive opportunity to enter into PPPs in the GCC region, using their experience to deliver services in an efficient and cost-effective manner, generating faster returns than a new entrant or traditional operator.
Nurse practitioners: addressing the need
Using PPP-funded intermediary roles, such as nurse practitioners (NPs) or nurse educators (NEs), for follow-up visits to treat and manage diabetes and other NCDs can help tackle some of the GCC’s health care challenges. Nurses are cheaper and faster to train than doctors and can focus on “personal touch” care, which improves patient satisfaction, while delivering cost efficiencies. According to the American Association of Nurse Practitioners (AANP), patients treated by NPs have higher satisfaction, fewer unnecessary ER visits, fewer hospital readmissions and fewer preventable hospitalizations compared to patients under doctors.4, 5 The result is an overall cut in costs.
“Effective NPs also spend more time liaising with patients, their families and health care professionals, leading to better patient satisfaction and outcomes,” says Dr. Madiha Qazi, Senior Consultant, EY Health, MENA. PPPs such as this could benefit providers in forming tighter relationships with other stakeholders within a country’s health care ecosystem and a stronger presence within communities, driving solutions for NCD management at a regional level.
Capable of providing primary, acute and specialty health care services to diverse populations, NPs can diagnose patients and develop individualized treatment plans, follow up on courses of treatment, collaborate with other health care professionals and maintain detailed records.
“In short, NEs take on the burden of patient visits, while running education programs and managing cases as effectively as consultants themselves would,” says Qazi. “Patients complained of being attended by ‘distracted’ or ‘automated’ physicians under the old system, which saw physicians take the lead for diagnosis, treatment and follow-ups, with a nurse only assisting at the minimal possible level.”
Looking at the bigger picture, as Qazi explains, there are opportunities for rapid growth in the use of PPP-funded NEs or NPs to tackle other NCDs in the GCC region: “In addition to diabetes, cardiology, women’s health, nephrology, neurology and pediatric oncology are all areas that can benefit from their use, and there will be opportunities for more PPPs to tackle these chronic diseases in 2017 and beyond.”
With their ability to facilitate the sharing of resources — including funds, knowledge, experience and information — running successful partnerships with GCC governments to manage treatment programs for chronic diseases offers the first step into the Middle East for private funding organizations. In health care, decision-making support through the use of data mining and analytics and the provision of medical devices are two areas worth exploring for potential future investments in PPPs.