Improving Service Outcomes and Public Value in Saudi Arabia

Improving Service Outcomes and Public Value in Saudi Arabia

Background Information

Saudi Arabia is the richest and fastest-growing economy in the Middle East, and is the world’s largest oil producer, which has contributed substantially to making the country one of the leading global economies. Saudi Arabia has undergone economic diversification, and industrialization is slowly catching up, with the country now exporting products to various regions worldwide. The strong economy has led to an increase in income levels, which stood at USD 24,726 per capita in 2008 (Almalki & Clark 2011), and is likely to make a positive impact on service provision in various public sectors, including health and education.

A 2010 census found that Saudi Arabia had a population of 27.1 million, compared to 22.6 million in 2004, representing an annual growth of 3.2 %. According to UN estimations, this is likely to increase to 39.8 million by 2025 and to 54.7 million by 2050 (Almalki & Clark 2011), as a result of a high birth-rate, high life-expectancy (72.6 years for men and 74.45 years for women) and a low child mortality rate, which have been attributed to improvements in healthcare and other social services. The compulsory childhood vaccination programme, in force since 1980, has also played a part in population growth, which has led to an increased demand for fundamental services, such as healthcare and education.

Saudi Arabia has made commendable progress in upgrading its public institutions; in 2010, it was ranked 28^th in the world, with regard to the development of public facilities, such as schools and hospitals (Ramady 2010). However, despite these developments, some of the challenges regarding the quality of service delivery have not been addressed appropriately, which has affected service outcomes in health and education in particular.

Healthcare Services

Healthcare services have significantly improved in recent times, beginning in early 1952, when the first public health department was set up in Mecca, following a decree from King Abdulaziz. Its aim was to provide free healthcare for the citizens of the city, as well as for visiting pilgrims, and several hospitals and dispensaries were established to effectively deliver health services. However, the services from the government health care centers were not enough to serve all those people.. Therefore, many people continued to rely on traditional medicine, and outbreaks of communicable diseases were prevalent.

Another significant move towards effective services was the founding of the Ministry of Health (MOH) in 1950, following a royal decree, then, in 1970, the government began a 5-year development plan, with the aim of improving all public sectors (Jeffreys 2011). Subsequent substantial improvements in healthcare have contributed to a relative improvement in service delivery.

The MOH  is currently the main provider of healthcare services, via 244 hospitals (with 33,277 beds) and 2037 primary healthcare centres, nationwide (Almalki & Clark 2011). The contribution of these services has been vital to the improvement of service delivery in the healthcare sector.

In addition, the government has also provided funds to establish referral hospitals, such as the King Faisal Specialist Hospital, armed forces medical services, security forces medical services, Ministry of Higher Education hospitals (for teaching), Royal Commission for Jubail health services, Red Crescent Society, and the National Guard health services (Almalki & Clark 2011). The Ministry of Education (MOE) has also established health units in all major schools. Although some of these health facilities serve specific populations, they all provide services to any citizens during emergencies.

The private sector is instrumental in the delivery of healthcare services in urban areas, and operates 125 hospitals, with a bed capacity of 11,833, and 2218 clinics and dispensaries. These facilities are owned by wealthy individuals and private companies, and are located nationwide (Jeffreys 2011). Since the 1970s, the government has been using incentives to encourage private investment in the health sector; however, healthcare remains primarily public sector-dominated.

Despite government contributions to run public health facilities, surveys have shown that the quality of services provided in private healthcare is superior, with the majority of patients reporting improved service outcomes, compared to public hospitals (Al-Hawary 2012). Private hospitals hire foreign medical professionals, who are more focused on the delivery of quality services to protect their jobs and to meet set benchmarks in profit realisation. In addition, these hospitals set specific standards that their employees must reach in order to attract more customers. Therefore, the service provided is customer-oriented and is continually improved to satisfy patients through positive outcomes.

Patients treated in public health facilities complained of poor services that were associated with the laxity of the medical personnel. The majority of the facilities report long waits for patients, not because of lack of equipment, but because the medical staff are less committed to improving service delivery (Al-Hawary 2012), which is also attributed to the government’s lack of follow-up to ensure such improvement. Furthermore, medical personnel are not keen to attract more customers or patients because of the low fees that are charged. They also lack motivation to deliver quality services, as the government does not have adequate measures for their assessment.

The Education Sector

Education, from primary school to high school, is free and open to all residents. Children enroll in kindergartens at the wishes of their parents, but primary schools (all day schools) admit children from the age of 6 years. They are categorised as non-coeducational, and, according to UNESCO statistics, the enrollment rate is 99% for boys and 96.4% for girls (Ramady 2010). Children then progress to pursue 3 years of intermediate education.

For their final 3 years of education, students may choose to continue at free secondary school or to receive specialised education at technical secondary institutes, where they obtain training in various fields, such as agriculture, industry and commerce. The overall enrollment rate at secondary schools drops to 90% (Schwab et al. 2010).

The government is currently in the process of creating over 150 vocational training institutes. These are expected to create more than 3 million jobs within 10 years of establishment, thereby reducing the overreliance on oil income (Ramady 2010), and the primary areas targeted to benefit include automobile components manufacture and metals processing.

Tertiary education is provided through 24 government universities. Degrees in medicine, engineering and pharmacy take 6 years to complete, while humanities and social sciences take 4 years. In addition, the government annually awards over 5,000 bursaries to enable students to study abroad (Schwab et al. 2010). Kind Saudi University is the largest public university in Saudi Arabia, with a population of 40,000 students.

In 2010, Saudi Arabia was ranked 7^th in the world in terms of public expenditure on education, which contrasted hugely with its world ranking of 74^th with regard to the quality of education provided in public institutions (Schwab et al. 2010). These data were interpreted as showing that education quality was not matching education investment. The government allocates over 20% of its total budget to the education sector, so infrastructure development has also been a priority, as witnessed in the number of public schools constructed. Consequently, the development of  sector is attributed to the high economic growth resulting from oil revenue.

The government is unhappy with the quality of education offered in its public schools (Ramady 2010), which has significantly affected primary and secondary education. Many scholars associate this lack of quality with the free education, which often leads to high enrollment rates. Boys’ schools are often of higher quality than girls’ schools, which therefore has an effect on the outcome of their studies.

Suggested Solutions/Recommendations

Economic stability has enabled the government to expand the health sector by increasing the number of facilities and by attracting investors. Although there is no doubt that the government has attempted to improve the healthcare and education infrastructure, little has been done to promote total quality management (TQM), which is necessary in service delivery.

TQM is a continuous process, so the government should allocate specific funds to the MOH and MOE, funds which should then be channeled to the quality departments in healthcare centres and public schools throughout the country (Jeffreys 2011). Correct utilisation of these funds will ensure that qualified personnel can be hired for quality control management. This may also involve the purchase of sufficient medical equipment in all public hospitals, so the MOH should establish quality training programmes to ensure its effective use. This is likely to result in the improvement of service delivery in all public healthcare facilities and residents of Saudi Arabia will directly benefit.

The MOH and the MOE should encourage all quality management professionals to remain in their area of specialisation to ensure a continuous delivery of quality service to their clients and to reduce the rate of turnover of medical personnel and teachers. It is paramount that these professionals have a clear job description and career titles to avoid duplication of services, (Ramady 2010) and that they are also motivated through appropriate remuneration packages. Special consideration should be given to individuals working in remote parts of the country, in the form of hardship benefits. This will prevent future situations whereby medical personnel avoid working in health facilities that are located in such areas. Public servants in the MOE may also be hesitant to work in remote schools, due to long travel distances or other unfavourable conditions.

Since Saudi Arabia lacks efficient national information systems, the MOH and MOE should endeavour to facilitate the establishment of regional quality health and education information systems, respectively, with these systems being located in every region in the Kingdom (Courtney & Shabestari 2013). These will provide the education and health policy- and decision-makers with valuable data for measuring the implementation of quality management programmes in all regions. In addition, all the challenges affecting the improvement of service delivery will be identified, which will help the MOH and MOE to formulate solutions for improving service outcomes in the public sector and thereby increase public confidence in those institutions.

Conclusion

The government is committed to providing affordable healthcare and free education up to secondary level, and infrastructure development is primarily conducted using funding from the government, which uses oil as its main source of income. As the government focuses on infrastructure improvement to support education and health services for an ever increasing population, it is vital to focus on improving service delivery in public institutions. This can be accomplished by establishing TQM and information systems in all public facilities. Quality service will lead to an improvement in service outcomes and in the value of public facilities. Customer satisfaction will consequently increase, making the government proud of the services offered.

References

 

Al-Hawary, S 2012, ‘Health care services quality at private hospitals, from patient’s          perspective: A comparative study between Jordan and Saudi Arabia’, African Journal of   Business Management, vol. 6, no. 22, pp. 6516-6529.

Almalki, F & Clark, M 2011, ‘Health System in Saudi Arabia: An Overview’, EMHU, vol. 17,     no.10, pp. 784-793.

Courtney, K & Shabestari, O 2013, Enabling Health and Healthcare Through ICT:           Available, Tailored and Closer, IOS Press, New York, NY.

Jeffreys, A 2011, The Report: Saudi Arabia 2010, Oxford Business Group, Oxford, UK.

Ramady, M 2010, The Saudi Arabian Economy: Policies, Achievements, and Challenges, Springer, New York, NY.

Schwab, K, Blanke, X, Ianouz, M, Mia, I, & Geiger, T 2010, The Global Competitiveness Report             2009-2010, World Economic Forum, London, UK.

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