Lack of accountability, transparency and integrity, ineffectiveness, inefficiency and unresponsiveness to human development remain problematic (UNDP).
Poverty remains endemic in most Gulf States with health care and opportunities for quality education poor or unavailable, degraded habitats including urban pollution and poor soil conditions from inappropriate farming practices. Social safety nets are also entirely inadequate and all form part of the nexus of poverty that is widely prevalent in Gulf countries. While economic growth is not a sufficient condition for eliminating income poverty, it is certainly necessary in the overall scheme of things. Knowledge remains a cornerstone of development and knowledge absorption involves providing the capacity to use knowledge through education. One significant question remains relative to human development issues in Gulf States because the region has significantly outperformed all developmental regions with the exception of Latin America and the Caribbean. Taken as a group, Gulf countries spend a higher percentage of Gross Domestic Product on education that any other developing region, which is important because global estimates indicate that a one percentage point increase in the share of the labor force with secondary education translates to a six to fifteen percentage point increase in the share of income received by the poorest 40%. Knowledge acquisition entails not only building on a country's own knowledge base but generating new knowledge through research and development, but also promoting openness that includes the free flow of information and ideas, establishing constructive engagement in world markets, and attracting foreign investment. The commitment to openness is particularly important because the majority of Gulf countries lag behind other regions in terms of technological development. One issue that is relevant for the region is "brain drain" because many of the university-educated Arabs find little opportunities in their home countries and often remain abroad after completing their education rather than bringing that knowledge home (Ayubi, 1996).
Culture and values are critical in terms of development and this is where the Gulf States face significant challenges because of how globalization is viewed by many Arabs as a threat to their way of life. Those activities that will promote economic development are not necessarily considered desirable and significantly hamper the efforts of Gulf governments in providing greater advantages for their populations. Political participation in Gulf countries remains weak, primarily because of a lack of representative democracy and restriction on liberties. The weakening position of the state relative to citizens illustrates the philosophical differences between the royal families and average citizens. The position of the state as patron is diminishing while the power position of citizens is increasing as states depend on them for tax revenues, private sector investment and other necessities. The middle class, however, is experiencing greater power as a new range of resources have put them in a better position to contest policies and bargain with the state. Saudi Arabia is better suited to international trade because of its ties with the United States but it remains unclear whether the majority of its citizens benefit from this relationship. One significant issue is job creation that has not matched workforce growth. Special employment generating projects, programs and funds have a place in Gulf countries but broad-based growth is the major determinant of job creation and remains unable to meet demand (Metz, 1993; Oxford Business Group, 2007, 2008).
1.3 Saudi Arabia in comparison - Saudi Arabia is considered to be "medium" in terms of the Human Development Index although it is sixth in line behind Kuwait, Bahrain, Qatar, UAE, and Libya. SA's current population growth is more than 3%, which compounds problems like unemployment and job creation. Saudi Arabia has a significant urban population, more than 80%, which both provides opportunities in terms of economic growth as well as the problems experienced by countries from an historical standpoint in terms of industrialization and the dependency on government and the economy rather than the land for support. Conversely, education is high in Saudi Arabia, as there are 1915 active research scientists as compared with Kuwait at 884. Telecommunications are fairly good in Saudi Arabia as compared to other Gulf States but PC penetration remains insignificant. Saudi Arabia has ratified four of the principal international human rights treaties but has failed to ratify the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights. Life expectancy in SA for males is 68.4 and females 71.4, falling mid-range as compared to other Gulf nations with a total population of slightly over twenty million. The country's infant mortality rate is 18.3 per thousand, on the lower end of the spectrum as compared to its neighbors and the percent of children fully immunized at one year is 92%, one of the highest in the region. Total health expenditure, as a percentage of GDP is 3.5%, fairly average, while the responsiveness in terms of health as ranked among Arab countries is seventh. Energy production in SA remains high, 19.64 with consumption at 4.34. The number of adult illiterates is 2.7 million, with two thirds of that number being women. Saudi Arabia moved from 61% of the population in primary school in 1980 to 78% in 1995, a figure that has likely continued to increase. Secondary education rose from 29 to 58% during the same period while tertiary education rose from 7.1 to 15.3%. The unemployment rate remains relatively high at 15%, political participation nonexistent, while there are 125 civil societies as of 1992. Saudi Arabia's openness in terms of the economy is 77% and the country's inflation was reduced from 7% in 1960-1984 to 1% from 1985-1998 (Ibid; Bradley, 2006).
What becomes clear when one evaluates the various statistics available for Saudi Arabia is that its educational and other potential has not necessarily translated into an improved way of life for the majority of the country's citizens. This is in terms of potential vs. reality although the country is considered medium in terms of human development. The challenge for Saudi Arabia in the future is finding a way for greater political and economic participation among its citizens, something that is likely to be difficult considering the problems that exist relative to the adversity between the government and the people. The government should continue to promote education and focus on technology and greater openness in trade with other countries throughout the region ("Saudi Arabia," Al-Bab, 2009).
1.4 the Current Healthcare System in Saudi Arabia -- the current healthcare system in Saudi Arabia is nationalized care. The government provides heal services through state controlled agencies, from the national to the local level. However, in recent years there seems to be a growing role and larger participation from the private sector and foreign companies.
The Saudi Ministry of Health (MOH) is the primary governmental agency responsible for preventative, curative, and rehabilitative healthcare for the country. The Ministry currently provides primary health care (PHC) services through a large network (about 2,000) of care centers situated throughout the country, typically based on population and demographic analysis (Saudi Ministry of Health Review, 2007).
The MOH is also the central referral system that provides services focused on curative care through 220 hospitals and clinics ranging from primary general practitioners to advanced technological and laboratory services. Within the Kingdom, the MOH leads all management, planing, financing, and regulating of the entire health care sector, while also supervising and ensuring that appropriate levels of care are provided at various levels of society. In general, then, most scholars view the MOH as a National Health Service for the entire population (NHS).
Additional healthcare services are ancillary parts of the Saudi government: primary, secondary, and tertiary care for specific demographic and pscyhographic parts of the population; security, armed forces, border and port control, etc. These ancillary services are provided by the Ministry of Defense and Aviation (MODA), the Ministry of the Interior (MOI) and the Saudi Arabian National Guard (SANG). Other governmental and bureaucratic organizations that operate under the MOH, for healthcare related issues, are:
Ministry of Education -- Healthcare for students of all ages.
Ministry of Labor and Social Affairs -- Healthcare for special needs (mentally or physically handicapped), and orphans.
General Organization for Social Insurance/General Presidency of Youth Welfare -- Healthcare for certain populations in connection with sporting facilities and events.
Royal Commission for Jubail and Yanbu -- Healthcare for employees and residents for those two cities and their specific populations.
Saudi Arabian Airlines -- Healthcare for employees and their families.
Saudi Arabian Higher Education Program -- Healthcare, through medical colleges and hospitals, specialist curative services and educational training programs; health research in conjunction with other agencies.
Saudi Red Crescent Society -- Emergency services, accident rescue, transportation of patients to hospitals; and an important management of healthcare for pilgrims during Hajj and Umrah in Mecca and Medina (Oxford; "New Saudi," 2007;…