Dr. Zohair Sebai On the State of Healthcare In KSA

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Dr. Zohair Sebai On the State of Healthcare In KSA

Posted 07 Jan 2018


Alexander Woodman

Dr. Zohair Sebai On the State of Healthcare In KSA

In the 1950s there were a couple of hospitals in Saudi Arabia with only 10 Saudi physicians which did not even represent 10 % of the total number of physicians in the country. During the past five decades, the Public Healthcare sector has experienced rapid growth. Today there are 462 hospitals and 21,000 Saudi doctors.

Saudi Arabia is experiencing demographic and epidemiological transition, represented by a growing burden of chronic non-communicable diseases, while population expectation of quality care services is expending. According to the World Health Organization, the number of primary health care centers has increased by 8.9% since 2004. The number of hospitals, physicians and nursing staff also increased. In addition, improvements in health care indicators have been realized in the areas of maternal and child health. This has helped reduce mortality rates and lowered vaccine-preventable diseases as well as eradicating poliomyelitis at the national level.

AW. Please tell us what made you become interested in Public Health?

ZS. When I was in my secondary school I read a book by A.J. Cronin titled the Citadel. It was the story of a doctor who devoted his life for the health of the public, and the prevention of diseases. I think this book shaped my interests in public health.

AW. As the founding father and an expert in Public Health, please tell us a brief history of Public Health in Saudi Arabia.

ZS. In 1950, the Health Services emerged in Saudi Arabia. At that time, we had a couple of hospitals with no more than 1000 beds in the whole Kingdom. The total number of physicians was 111 of which less than 10 were Saudi physicians. At present after only 64 years we have in the country 462 hospitals, 69,000 beds, 2,200 health centers, 82,000 doctors of which 21,000 are Saudi doctors. It is quite an achievement.  

Public Health activities started slowly with the help of Aramco Co, which helped us to control Trachoma, Malaria and Schistosomiasis. The Eastern Province of the country saw for the first time a health education and maternal and child health programs among Aramco Employees. Soon the Ministry of Health took over.

Healthcare KSAAW. Since your first book (Health in Saudi Arabia Vol.1 published in 1985). What changes have occurred?

ZS. We have more hospitals, beds, primary health care centers and colleges of medicine. The budget for health has soared to unprecedented level. However, the orientation of health services has remained curative as it was before. There are many efforts to apply preventive and promotive medicine activities, and we are looking for more.

AW. As a leader, the Prophet Muhammad was an exemplary figure. I learned that he stopped eating when he was 80% full. Incidentally, this is also the ancient tradition of the Okinawans (a Blue Zone area in Japan). In what others ways did the Prophet Muhammad promote Public Health?

ZS. From the Quranic prospective Allah Says: “Eat and Drink but not to excess. Prophet Mohammad (peace be upon him) advised his companions to eat moderately but if one must add more to his stomach, then let it be one third for food, one third for water, and one third for air."

AW. What is the role of Islam in promoting Public Health in Saudi Arabia?

ZS. Islam calls for many acts which all lead to a healthy life style. Islam calls for moderation in life. It prohibits alcohol, drugs, adultery and gambling. It emphasizes cleanliness as a part of our faith.

AW. Do Saudis currently follow the Prophet’s tradition?

ZS. Yes and no. when I say yes, I mean people believe in the guidance of Islam. However, practice could be something different.

AW. What are the major Public Health differences that you have observed between Saudi Arabia, other GCC nations, and the rest of the Arab World? 

ZS. We all share a common culture, history and faith. The differences I would say are not between nations but rather between individuals. Those who are better educated and have a better standard of living usually lead a healthier life no matter what nationality they belong to.

AW. Is there a difference in the health status within the different ethnic groups in Saudi Arabia and the Arab world?

ZS. Both genes and environment share their influences on the health status of people. I would say the role played by the environment (education, standard of living, social status) is bigger than the role played by genes. This is why the differences between individuals in the same ethnic group are more than the differences between ethnic groups.

AW.  Please tell us what kind of Public Health milestone has Saudi Arabia achieved in the past 30 years. What are the declines, if any? 

ZS. Several mile stones have been achieved over the last three decades. One is the legislation that immunization should be completed before admission into school. This raised the level of immunization to a very high level. The second is the influence of high income. In the last 30 years, we started to observe a high prevalence of health problems such as diabetes, hypertension and psychosomatic diseases. All of these are the result of adverse changes to our diet, less exercise, sedentary lifestyle and stress.

On the upside, we have seen an improvement in the prevalence of infectious diseases, infant and maternal mortality rates. The third factor could be the tremendous increase in the number of medical schools. However, we have to revise our medical education system in order to be more relevant to the needs of the Saudi people.

AW. The current trend in the U.S. is the biopsychosocial approach.

ZS. This is a natural development. I am personally a believer in this model since it became popular in the mid-seventies. It simply goes along with the World Health Organization’s definition of health “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

AW. Do doctors in KSA consider the biopsychosocial theory as a holistic approach when addressing Public Health issues?

ZS. Doctors all over the world study this concept in their medical schools. Unfortunately, in practice they become busy with treating patients after they become sick. They don’t have time to apply what is logic. I repeat, this is the general attitude of practicing physicians almost everywhere.

AW. What changes do you think are necessary, in terms of diet, way of life, and governmental involvement in order to bring positive change in Saudi Arabia?

ZS. We need to adapt balanced diet, more exercise and healthy life style in general. We need to reorient our medical education towards comprehensive health care. We need to produce members of the health time, who believe in and practice health care in terms of prevention, treatment and promotion as an integrated entity. We need to reorient our primary health care to play a bigger role in promoting health in the society. Our hospitals should be health promoting hospitals. Finally, we need to involve people to play an active role in planning, implementing, following up and evaluating health services provided to them.  Let me remind you that this is the stereotype of health care, which needs to be improved in almost every corner in the world.

AW. Does the current geo-political situation hinder or advance the Public Health programs in the region?

ZS. Definitely the current geo-political situation hinders Public Health programs. I can see that Saudi Arabia still enjoys better health services compared to many other countries around us. This goes without saying to the stability which we enjoy.

AW. War causes displacement, and it affects a population’s physical and psychological wellbeing. In what way does the geo-political situation affect life expectancy, infant mortality, and longevity?

ZS. Wars carry with them disasters for innocent people. More civilians are usually affected than military. Look at what is happening in Syria and Iraq. Thousands of infants are dying because of lack of nutrients, medicine and shelter. I pray to Allah to give us all peace and stability.

AW. Are there differences in these variables in an area that is politically stable?

ZS. During political instabilities, one expects higher infant, pre-school and maternity mortality rates. You would expect a higher morbidity and mortality rates of almost all sectors of the population. It is not only the shortage of medical care but insufficient nutrition, bad environment and stress. 

AW. The influx of foreigners into the gulf has been tremendous: What is their impact on Public Health in Saudi Arabia?

ZS. Foreigners bring with them different cultures, habits and ways of life. No doubt that some of these by time will infiltrate into the Saudi health attitudes and practices. The issue deserves an applied research which is badly needed.

AW. Does Saudi Arabia have to constantly change its health regulations in order to meet the demands and challenges foreign workers bring into the region?

ZS. Let me remind you that the first steps taken in applying the health insurance system was directed towards foreigners. Many labor regulations have been issued to suit the needs and demands of our guests.

AW. In your book, you remarked that the Saudi Arabia health service is a curative-centered approach. What model do you think is suitable for KSA?

ZS. The comprehensive approach (preventive, curative and promotive) model is what we need. This is applied not only to Saudi Arabia, but rather to the Middle East Region. Most of our health problems, acute and chronic as well, are preventable. So why should we wait until people become sick to treat them. Lately we have taken good measure towards implementing the comprehensive health care through the 2,200 primary health care centers we have, but we need more.

AW. Will this model promote preventive measures and also focus on future Public Health issues and their solutions?

ZS. I believe if you spend 10% of your health budget on health promotion (health education, better environmental, occupational health, safety measures, maternal and child health etc.) you would gain alot by minimizing the cost of health care as well as improving the health of the people.

AW. Research and the availability of data are the foundation components to framing policies to promote public health. Where does Saudi Arabia stand on Public Health research? Is it in its embryonic stage?

ZS. Lot of medical research is going on. Hundreds of papers are being published every year in local and international journals. However, we need to emphasize also the type of research which would answer the question how, not only the questions of what and why. This type of research (operational research) would help us to solve our current and future health problems.


Dr. Zohair Ahmed Sebai has nearly four decades of active community medical service. He graduated from Ain Shams Faculty of Medicine, Cairo, in 1962, studied tropical medicine at the Bernard Nocht Institute, West Germany and obtained his master and doctor degrees in public health from Johns Hopkins School of Hygiene and Public Health, USA, in 1969. The author carried out the field work for his doctorate degree in public health in a nomadic community in Saudi Arabia, studying the health of the Bedouins and their family medical care program. During his work in the Ministry of Health (1969-1973) as a director of planning and in King Saud University (1974-1982) as a professor of community medicine and founding dean of the Faculty of Medicine at Abha, he has been occupied with various aspects of public health. This has been expressed in his research and teaching in health planning, health manpower development, and medical education. His main objective is to interrelate medical education with community health problems and needs.

Alexander Woodman is an award-winning writer from Los Angeles, California and University of California (UCLA) honors graduate. Currently based in the Middle East, his academic research interests are in global health, international health policy development, transnational and trans-cultural health politics, medical ethics and visual culture.

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charles_333 says:

11 months 1 week ago
Interesting read and insights into the KSA health industry. Apart from the numbers around physicians and healthcare professionals, I'm wondering what percentage of health-related services are delivered by government vs. private sector businesses? And how are these companies such as hospitals and medical clinics promoting their services to try and win a larger share of the domestic market? Charles

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