Health Care Systems Management as Dissertation

Excerpt from Dissertation :

The infant mortality rate is of 8.97 deaths per 1,000 live births. This rate places Kuwait on the 160th position on the chart of the CIA. The adult prevalence rate of HIV / AIDS is of 0.1 per cent.

In terms of economy, Kuwait is a relatively open, small and wealthy economy. It relies extensively on oil exports -- petroleum exports for instance account for 95 per cent of the total export revenues as well as for 95 per cent of the federal income. The Kuwaiti representatives have recently set the goal of increasing the oil production per day. Currently, Kuwait is facing the pressures of the internationalized economic crisis -- which however, due to recent economic surpluses in Kuwait, affects the economy to a lower extent.

Simultaneously with the increase in oil production, the Kuwaiti authorities are also focusing on diversifying the economic activities in the sense of supporting non-oil related operations. "Kuwait has done little to diversify its economy, in part, because of this positive fiscal situation, and, in part, due to the poor business climate and the acrimonious relationship between the National Assembly and the executive branch, which has stymied most movement on economic reforms. Nonetheless, the government in 2009 passed an economic development plan that pledges to spend up to $140 billion in five years to diversify the economy away from oil, attract more investment, and boost private sector participation in the economy. Increasing government expenditures by so large an amount during the planned time frame may be difficult to accomplish" (Central Intelligence Agency, 2010).

In a more numeric format, the following economic variables are noteworthy:

Kuwait registers a gross domestic product of $142.1 billion, being as such the 59th largest economy of the globe

The GDP growth rate has been a negative one of 1.7 per cent

In a context in which the global income per capital is of $10,500, the Kuwaiti income per capita is of $52,800, making Kuwaitis the seventh wealthiest population on the globe

51.5 per cent of the GDP is generated by the services sector, 48.2 per cent is generated by the industry sector and only 0.3 per cent is generated by agricultural activities

The labor force is of 2.04 million individuals and the unemployment rate is of 2.2 per cent

The inflation rate is of 4 per cent

Exports account for $50.25 billion and imports account for $17.09 billion

The telecommunications industry in Kuwait is rather underdeveloped, with as few as 541,000 main telephone lines in use and less than 3 million mobile telephones in use. In terms of internet users, these do not exceed one million. There are seven airports and 4 heliports in Kuwait as well as 5,740 kilometers of roadways. From this standpoint, the country's infrastructure is rather underdeveloped.

Relative to the status of crime in the society, Kuwait is currently facing severe problems of human trafficking. The country is a desirable destination for South Asian immigrants looking for a better life, but these are often abused upon arrival and employment. The Kuwaiti authorities have yet to efficiently address the problem. "Kuwait is a destination country for men and women who migrate legally from South and Southeast Asia for domestic or low-skilled labor, but are subjected to conditions of involuntary servitude by employers in Kuwait including conditions of physical and sexual abuse, non-payment of wages, confinement to the home, and withholding of passports to restrict their freedom of movement; Kuwait is reportedly a transit point for South and East Asian workers recruited for low-skilled work in Iraq; some of these workers are deceived as to the true location and nature of this work, and others are subjected to conditions of involuntary servitude in Iraq. […] Kuwaiti government has shown an inability to define trafficking and has demonstrated insufficient political will to address human trafficking adequately; much of the human trafficking found in Kuwait involves domestic workers in private residences and the government is reluctant to prosecute Kuwaiti citizens; the government has not enacted legislation targeting human trafficking nor established a permanent shelter for victims of trafficking" (Central Intelligence Agency, 2010).

3.2. The health care system in Kuwait

a) Brief history

Medical services in Kuwait are as old as the country itself, but the evolution of the medical system was only commenced starting in the early twentieth century. During the 1910s decade, the country was abundant in American missionaries, who offered medical services to the population. These missionaries represented the first and foremost medical trainers and they set the basis for the development of Kuwaiti health care. The involvement of the American missionaries was due to the fact that Shaykh Mubarak Al Sabah the Great -- the ruler of Kuwait -- had "invited doctors from the Arabian Mission of the Dutch Reformed Church in the United States to establish a clinic. By 1911 the group had organized a hospital for men and in 1919 a small hospital for women. In 1934 the thirty-four-bed Olcott Memorial Hospital opened. Between 1909 and 1946, Kuwait experienced gradual, albeit limited, improvement in health conditions. General mortality stood between twenty and twenty-five per 1,000 population and infant mortality between 100 and 125 per 1,000 live births" (Regional Health Systems Observatory EMRO).

By the 1940s decade, the country was beginning to register the first significant revenues from oil exports. The state officials used the money to invest in the health care system and by 1949 they had opened the Amiri Hospital. The Kuwait Oil Company had also launched investments in health care and had primarily opened several smaller size medical care clinics. By 1950, the mortality rate had fallen to be somewhere between 17 and 23 per 1,000 individuals and the infant mortality rate had also decreased to 80 -- 100 deaths per 1,000 live births.

During the 1950s decade, the Kuwaiti authorities developed and implemented a comprehensive plan to develop the medical system. The main scope was that of ensuring medical assistance for free to the entire Kuwaiti population. The free access to medical services was so increased that it even included veterinary services. The developments were possible with the aid of foreign medical staffs -- especially Egyptian medical doctors -- and the endeavor came to cost Kuwait one third of its entire national budget. The main critique brought to the reform was that it focused on treating the illnesses, rather than preventing them. Nevertheless, the reform did materialize in a series of positive outcomes. "The number of doctors grew from 362 in 1962 to 2,641 in 1988. The doctor-to-patient ratio improved from one to 1,200 to one to 600. Infant and child mortality rates dropped dramatically; in 1990 the infant mortality rate was fifteen per 1,000 live births. Life expectancy increased ten years in the postindependence years, putting Kuwait at a level comparable to most industrialized countries" (Regional Health Systems Observatory EMRO).

b) Organization

At the most generic level, the Kuwaiti heath care system is divided into two categories -- the public health care system and the private health care system.

Figure 1: Kuwait national health system

Source: Regional Health Systems Observatory EMRO

The public health care system is organized into two tiers -- the central Ministry of Health (MOH) and the regional health offices. The Ministry of Health is located in the City of Kuwait and it has seven specific functions, as follows: planning, resource allocation, financing and budgeting, regulation, monitoring, evaluation and delivery of health care services. The MOH is the third largest public employer, after the ministries of education and interior.

One of the most notable ministerial decrees was the one dividing the country's public health care sector into six divisions -- the City of Kuwait, Hawali, Ahmadi, Jahra, Farwania and Al Suabah. Each of the six regions is requested to complete the following four functions:

The implementation of medical action plans in accordance with the ministerial specifications in order to ensure the provision of medical services to the people in the respective region

The offering of various types and levels of medical care

The implementation of training programs for medical, technical and administrative staffs

The construction and implementation of a "comprehensive computerized system of health information in the area" (Regional Health Systems Observatory EMRO).

There are three categories of health care facilities -- primary health centers, secondary health centers and specialized health centers. In terms of primary health centers, there are 782 of them and they offer "general practitioner services and childcare, family medicine, maternity care, diabetes patient care, dentistry, preventive medical care, nursing care and pharmaceuticals" (Regional Health Systems Observatory EMRO). The secondary health centers are formed from a general hospital, a health center and specialized clinics and dispensaries. The scope of the secondary care facilities is to provide the best possible care for the patients. Finally, in terms of specialized medical facilities, these are organized into the following ten categories: maternity care, pulmonary ailments, mental disorders, neurosurgery, burns treatment, allergies, cancer…

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