Qatar's healthcare system under strain

Rapid population increase has meant billions of riyals spent on hospitals and qualified medical staff.

Patients await medical attention in the male waiting area of the accident and emergency unit of Hamad Medical Centre in Doha.

DOHA // Feeling ill? You might not want to be in Qatar. The country has about 1.4 hospital beds for every 1,000 people - the lowest total in the GCC, one-fifth as many as Turkmenistan and Slovakia and fewer than poor countries such as the Democratic Republic of Congo.

"It's not a good situation," said Moza al Malki, a writer and family therapist. "Sometimes people go to be hospitalised and they can't find an open bed." Despite a spike in government spending and the hiring of thousands of health-care workers, Qatar's few hospitals and clinics are under severe strain because of a tripling of the population in the past dozen years. "This huge increase in the population has put a huge load on our public health facilities," said Jamal Khanji, head of the government's medical licensing department. "There is a definite need for expansion, and that expansion is happening."

Qatar has four public and five private hospitals, but the lynchpin is Hamad Medical Centre. The country's primary health facility, it receives more than 80 per cent of public health-care spending. Since 1999, that spending has risen from QR850 million (Dh858m) to QR4.3 billion, and the number of both nurses and doctors has tripled. Yet no major new health facilities have opened since 2004, and relative to population, the numbers of doctors, dentists, nurses and pharmacists fell anywhere from 15 per cent to 40 per cent during the past five years.

On a recent afternoon in Hamad's emergency room, dozens of workers sat waiting for medical attention. Several limped, two held their stomachs and one held a bandage to his bleeding face. Hamad's bed occupancy rate, in the low 70s a decade ago, has hovered around 90 per cent for two years. A March study from the University of Michigan Health System found that occupancy rates above 80 per cent increase the risk of in-patient death by nearly six per cent.

Qatar's foetal death rate, at 4.8 per 1,000 births in 2005, is now near eight per thousand, its highest in a decade. This is similar to rates in the UAE and Saudi Arabia. Many residents have turned to pricey private providers or travel outside Qatar for health care, abandoning essentially free services at government-run facilities. Zakia Ali Malallah, a Qatari poet and commentator, recently wrote a column in the local Arabic language daily Al Watan about her three-hour wait to see a doctor at Hamad, vowing to never return.

And when Ms al Malki's son was seriously injured in a motorcycle accident, her family sent him to Germany for treatment despite the high costs. "Nobody trusts Hamad now," she said. "Even if I had to sell my house I would've sent him." The government is spending billions to alter that mindset. Set to come online in the next few years are paediatric and orthopaedic hospitals, a cardiac surgery centre and, at a cost of US$3 billion (Dh11bn), the Sidra Medical Centre. Construction is to begin this year on three hospitals exclusively for male labourers.

Qatar's 2.25 doctors per 1,000 people is higher than Germany (2) and the UK (1.8) and just below the United States (2.43), according to the Organisation for Economic Development's annual health data report. Yet specialists are rare. Qatar has one specialist in tropical medicine, for instance, despite the presence of hundreds of thousands of people who hail from and regularly return to the Philippines, India, Bangladesh and Sri Lanka.

The Supreme Council of Health recently gave all primary health centre employees a five-per-cent salary rise, in an effort to increase retention, and began a recruitment drive for doctors and other health staff from across Arab countries. "If you look at the need for nurses in this country, I would like to tell you we are talking about thousands," Mohammad Fathy Saoud, the president of Qatar Foundation, said at a recent event.

A new policy allows the wives and adult children of resident healthcare professionals (except physicians) to work as trainees until the fulfillment of the experience required for licensing. Last month, the government created the Qatar Health Practitioners' Council to monitor medical licensing. The new body appeared shortly after the licences of 32 general practitioners were revoked because they were found to be practising without medical doctorates. All were given three years to earn a post-graduate degree, failing which their clinics would be closed permanently.

Health-care staffers could also use certification training. As a western expatriate was being rushed to the hospital in an ambulance this week, an emergency medical technician tried to take his blood pressure but failed to use the electronic machine properly. The machine constricted the patient's arm until his fingers turned blue. "The nurses and some other staff, we have to admit it, are mostly unqualified," said Ms al Malki. "They don't know what to do."

That may be starting to change. Last month, the University of Calgary-Qatar graduated the country's first university-trained nurses, the result of a programme nurtured by Qatari First Lady Sheikha Mozah bint Nasser Al Missned. "There is a huge move to improve health services here," said Mr Khanji. "The leadership of this country wants Qatar to be a hub for medical services in the region and you cannot achieve that without competent staff, a high level of safety, and recognised accreditation systems."

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