March 29th 2011
£595 / $1040 / €745
At a time of political upheaval in many countries, this new report presents hard-to-find facts, figures and statistics on the economic, demographic and health structure of 18 Middle Eastern countries.
Why Middle East, and why now?
Tunisia, Egypt, Libya, Jordan, Bahrain, Algeria, Saudi Arabia and Syria – hardly a state in North Africa and the Persian Gulf has been untouched by popular demands for political reform. It may be through revolution or political concession, but a wind of change is sweeping through the region. What is less certain is how it will pan out and what the new realities will bring. For exporters of medical equipment and supplies, the region has always presented opportunity and challenge: the wealthy oil-rich states taking social healthcare to the highest of levels in contrast with their non oil-rich neighbours who can be counted amongst the most poorly provided. As the political tide ebbs and flows, it is appropriate to benchmark the state of healthcare provision in each country.
Health expenditure: wide variations
Health expenditure provision varies widely. The less well-off countries tend to have a limited public sector augmented by whatever people can afford out-of-pocket. There is, however, a trend towards boosting expenditure through health insurance schemes, such as that recently introduced in Morocco. There is little external aid funding for health expenditure in the region, although some funding is occasionally available on an ad-hoc basis for the purposes of reconstruction in places like Iraq or Lebanon. The wealthier Gulf States used to operate a policy of free government-funded healthcare for all, but increasing costs have led to changes over the past decade. Most states now require expatriate workers to have insurance arrangements, and the contributory insurance concept has also been extended to locals in places like Kuwait over the past decade.
Imports of medical equipment and supplies topped US$5.1 billion in 2009
The first thing to note is a near total reliance on imported products. Only a handful of countries have any noticeable capacity to manufacture even the most basic items. These largely comprise Israel and the more developed states of northern Africa, although some basic capacity also exists elsewhere. Even the bigger producers are reliant on imports for upwards of 90% of their requirements. Elsewhere, in Iraq or Yemen for example, the figure rises to 100%. Imports tend to be sourced from the USA and Europe, principally Germany, France, the UK and Italy. Japan has been a major supplier of diagnostic apparatus in recent years, and China has begun to emerge in a number of countries as a leading supplier of consumables and other items at the lower end of the technology scale. Israel is a major exporter of medical equipment, but does virtually no trade with its neighbours.
A distinction can be drawn between the North African/Eastern Mediterranean region and the Persian Gulf. The former largely comprises states with a large but old healthcare infrastructure, often dating to colonial times. Numbers of beds and facilities are generally good, but conceal the fact that many will be outdated, and much equipment is in need of modernisation. Expenditure on such upgrades is taking place and is growing, although there is still major scope for growth. Access to primary care outside the cities is often lacking, even in oil rich countries, as many are hampered by poor infrastructure and political instability. Provision of trained medical staff is a problem in rural areas for these reasons, and also due to poor wages and working conditions. The exception is the Gulf, where states have little trouble attracting well-trained doctors and nurses from all over the world.