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| INVITED ARTICLE |
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| Year : 2014 | Volume
: 2
| Issue : 2 | Page : 77-80 |
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Public health in the saudi health system: A search for new guardian
Waleed A Milaat
Department of Family and Community Medicine, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| Date of Web Publication | 18-Jul-2014 |
Correspondence Address:
Waleed A Milaat
Department of Family and Community Medicine, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-631X.136973
Saudi Arabia has witnessed a significant improvement in its health indicators. The kingdom has spent generously on the curative health services and established hundreds of hospitals and primary health care centers. However, we believe that this huge health expenditures and the presence of curative services is not the only reason for this improvement. Public health services have also had a significant impact on people's health and that this improvement is due to a combination of public health programs such as immunization, environmental sanitation and health education with good formulation of sound health policies and health delivery systems. It is noted that health plans and expenditure in the health system are concentrating on the curative aspects and there is a significant weaknesses in public health services. Additionally, most jobs are allocated for curative care and there is scarcity of job titles related to public health in the health structure, such as public health officers, public health inspectors and public health specialists. A suggested body namely, Ministry of public health, will work to confirm that all issues related to health of the public in every aspect of daily life in the kingdom are within the genuine interest of all policy makers. الملخص:
شهدت المملكة العربية السعودية تحسنا كبيرا في المؤشرات الصحية وأنفقت الدولة بسخاء على الجانب العلاجي وتم إنشاء مئات المستشفيات ومراكز الرعاية الصحية الأولية. ولكننا نرى أن النفقات الصحية الكبيرة والخدمات العلاجية ليست هي السبب الوحيد للتحسن في المستوى الصحي حيث أن برامج الصحة العامة كان لها أيضا تأثير كبير على صحة الناس وأن هذا التحسن هو نتيجة لمزيج من برامج الصحة العامة كالتطعيم وتحسين المرافق الصحية البيئية وتحسن الثقافة الصحية مع صياغة السياسات الصحية السليمة وتطوير طرق تقديم الخدمات العلاجية.
والملاحظ أن خطط النظام الصحي ومجالات الإنفاق لا زالت مرتكزة على الدور العلاجي وبروز الضعف في الخطط الصحية الوقائية وبرامج الصحة العامة فإننا نعتقد أنه قد حان الوقت لإيجاد هيئة مستقلة لرقابة الصحة العامة في النظام السعودي تسمى وزارة الصحة العامة بعيدا عن وزارة الصحة من أجل العمل كضمان للصحة العامة للناس وتأكيدا بأن القضايا ذات الصلة بالصحة العامة في كل جوانب الحياة اليومية في المملكة هي محل اهتمام حقيقي لدي صناع السياسة والقرار ات Keywords: Public health, guardian, Saudi health system
How to cite this article:
Milaat WA. Public health in the saudi health system: A search for new guardian. Saudi J Med Med Sci 2014;2:77-80 |
| Prelude | |  |
No one can question the impact of Public health interventions in the improvement of health status and health indicators for every country in the world. Historical evidence of John snow work in controlling the London cholera Epidemic of 1854 is followed by many public health interventions in the city water system that proved to be of great impact on people's health and quality of life. [1] Scotland, for example, after the Reform Act of 1832, worked to improve its sewage treatment, organize its water supplies from fresh Lochs, build clean water reservoirs in Edinburgh and by the 1860s Medical Officers of Health were appointed for Scottish cities. [2] This all led to a dramatic improvement of Scottish life expectancy and quality of life even before the era of medical and surgical innovations.
Recent public health programs all over the world have led to a well appreciated decrease of human suffering and pains and reduction of high morbidity and mortality rates figures. Japan, for example has achieved a relatively rapid improvement in life expectancy through the 1960s until now, [3] passing other countries like England and Wales in the process through organized programs of public health nature mainly in the environmental issues. Finland has achieved a relatively rapid reduction in the lives lost to heart disease in the late 1980s after application of preventive measures related to life style changes. [4] The Initiative of "healthy cities" which started in developed countries such as Canada, USA and Australia has led to major positive health outcomes. These initial successes, were copied in many areas in the developing world such as Korea , Philippine and China which used the same implementation strategies to begin their own programs by involving many community members, various stakeholders, and commitments of municipal officials to achieve widespread mobilization and efficiency. Today, thousands of cities worldwide are part of the "Healthy Cities network" and exist in all WHO regions. Vaccination programs are well recognized interventions that led to improvement of human health status. Although they have both medical and public health faces, these programs cannot work without real health planning, health management and public sectors partnership in a public health mood.
| Saudi health situation | | |
Historically, preventive services started in the early 1950s when the ARAMCO oil company, in collaboration with the WHO, helped the MOH to control malaria in the eastern region of Saudi Arabia. [5] Programs to control bilharziasis, leshmaniasis, trachoma, tuberculosis and other endemic diseases followed suit in the various regions of the country on both vertical and horizontal levels. [6],[7],[8] The country also adopted the new concept of Primary Health Care (PHC) developed in 1978 and in 1983 began to promote it as the basis of its health care delivery system. This strategic step has been most fruitful with the immunization of over 90% of the children in Saudi Arabia against infectious childhood diseases in the EPI program. [9]
The basic law of the Saudi citizen rights, article 31 states that the government is responsible for public health in the Kingdom and should provide healthcare services to every citizen. Saudi Arabia had experienced huge improvements in the health indicators which speaks of a good achievement in the health of the population. The kingdom has spent a lot on health mainly on the curative aspects as hundreds of hospitals and primary care centers were established all over the kingdom [Table 1]. [10] This was associated with major contract with medical and paramedical staff from all over the globe for service delivery [Table 2]. [11]  | Table 1: Budget appropriations for the Ministry of Health (MOH) in Saudi Arabia in relation to the government budget, 2005-2009
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 | Table 2: MOH manpower, health centers and bed expansion over the years in Saudi Arabia
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Big health expenditures and curative services are not the only reason for these major improvements in health. Clearly, the country is not an exception from the rest of the world and public health programs had also great impact on health of population. It is the combination of many public health programs that worked on all determinants of health, being social, economical, environmental, health delivery and health policies which made the change. A critical analysis of infant mortality rates over the last 50 years in the kingdom [Table 3] [12] when tied to the economic boom in the country and the social changes that took place in the living situations all over the country speaks of a real effect of public health programs such as vaccination programs, better environmental sanitation and female education.
Life expectancy has increased dramatically, and the birth rate remains one of the highest in the region. The continuous presence of hereditary and infectious health problems in certain areas in the country (malaria in the south, Dengue fever in the west and hereditary blood diseases in the east and south), has been compounded by the emergence of new acute and chronic infections (such as avian influenza, rift valley fever and resistant types of tuberculosis). Additionally, such morbidities as diabetes mellitus (type II), hypertension, cardiovascular diseases, road traffic accidents and various types of cancers resulting from sedentary unhealthy life-styles are reaching alarming rates. Furthermore, Saudi Arabia is expected to face new challenges with the continuing demand for health care for special groups such as the handicapped, geriatric population and the increasing number of pilgrims visiting the Islamic holy places in the country. To cope with all these challenges simultaneously a reform of the health system is necessary. [13]
The Saudi health system was built on a curative orientation and this was noted literally in the Saudi MOH 10 years health strategy. [11] The strategy recognized the concentration on curative services and the lack of preventive application as one of the deficiencies and weakness in health plans. In fact the strategic plan was titled with a curative slogan (patient comes first). Curative services dominated expenditure in the Saudi health budgets and most jobs in this system were reserved for curative purpose. Jobs like district public health officers, public health inspectors, health educators, environmental sanitary workers and similar in the public health arena are rarely mentioned in the Saudi health cadre for a long time. The carrier path for public health and public health work force is not well formulated in the MOH job hierarchy.
It is until recently when the ministry decided to change the look towards public health by creating a separate "Ministerial Agency of public health" headed by a vice minister under which two sub-agencies are included, namely, primary health care and preventive health. Although it is a good start to mention the word "public health" for the first time in the system and consider its existence as an important component of health maintenance in the country, but no clear objectives were provided in the this change. Clearly from this move, the specialty was recognized under the preventive and curative moods only.
| The dream | | |
The old look towards public health as group of horizontal and vertical preventive programs connected to the curative and preventive work in the primary health care delivery system is far beyond its ideology and concerns. Other domains of health planning, health legislation, healthy life maintenance, safe health delivery and quality of care evaluation from the public point of view are not included in this move.
Health of the public is affected by decisions made by people outside the health domain in other ministries. We think it is time that this specialty be well recognized and served in order to make the great impact on the people in the kingdom. Saudi system should consider an independent body for public health specialty away from the domination of the ministry of health in order to work as a guardian for the health of the public. The American model of Surgeon General who safeguards the health of the Americans and being accountable to the congress or the British medical council who is directly reporting to the parliament are some of the ways in which the health of the public is well guarded. Let us dream of a next move in which the health of the public in Saudi Arabia and their related issues in every aspects of life become the real concerns of each policy maker in the system. We are dreaming of a day in which all policies decided in every ministry in the kingdom be under the veracious scrutiny of the guardian of a public health body. Let us dream of healthy public policies in all areas of our daily life. It is nice to dream and act towards this dream. it is definitely better late than never.
| References | | |
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[Table 1], [Table 2], [Table 3]
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