2.0 QUALITY AND ACCESS IMPROVEMENT

Transcription

1 2. QUALITY AND ACCESS IMPROVEMENT SCH ANNUAL REPORT 22

2 SCH ANNUAL REPORT 22 2 February 23 3

3 CONTENTS FOREWORD P6 ACRONYMS P7 EXECUTIVE SUMMARY P8. INTRODUCTION P. REFORM P2.2 SCH, HMC AND PHCC P3 2. SYSTEM EXPANSION P4 2. INCREASING FACILITIES P5 2.2 INCREASING WORKFORCE P INCREASING SERVICES P INCREASING FINANCING P27 3. SYSTEM ADAPTATION P29 3. ENHANCING HEALTH PROMOTION AND PREVENTION P STRENGTHENING PRIMARY HEALTH P REMODELING HOSPITAL P39 4. QUALITY AND ACCESS IMPROVEMENT P44 4. IMPROVING SERVICES P IMPROVING FACILITIES P IMPROVING PROFESSIONALS P59 5. CONCLUSION P6 REFERENCES P62 ENDNOTES P63 23 General Secretariat, Supreme Council of Health Published, February 23 Supreme Council of Health, Qatar P.O. Box 42 Doha, Qatar Printed in Qatar,

4 FOREWORD ACRONYMS This Report summarizes the 22 progress and 23 plans of the Supreme Council of Health, Hamad Medical Corporation, and Primary Health Care Corporation. The Report reveals 22 as one of our busiest years. Two new hospitals, and a cancer diagnosis and research center, were opened. Planning continued for a further nine hospitals, two diagnostic, research and treatment facilities, eighteen primary health care centers, and two Medical Commission units. Implementation of the 39 Projects of the National Health Strategy 2-26 was accelerated. This progress reflects the Leadership s greatest commitment yet toward better health care; it extended a record budget, and unceasing, timely guidance. Throughout 23, we would like to deliver more impact for our people. This document outlines how our future plans are taking shape. Together, we are improving our future. His Excellency Mr. Abdulla bin Khalid Al Qahtani Minister of Health, and Secretary General Supreme Council of Health CD Communicable Disease DRG Diagnosis-Related Groups ED Emergency Department GCC Gulf Cooperation Council GS SCH General Secretariat HGH Hamad General Hospital HMC Hamad Medical Corporation IACR International Agency for Cancer Research ICD International Classification of Diseases ICT Information and Communication Technology IHR International Health Regulations MC Medical Commission MDG Millennium Development Goals MENA Middle East and North Africa MOE Ministry of Environment NCD Non-Communicable Disease NHA National Health Accounts NHIC National Health Insurance Company NHS National Health Strategy 2-26 OPD Outpatient Department PET-CT Positron Emission Tomography - Computed Tomography PHC Primary Health Care PHCC Primary Health Care Corporation PMS Premarital Screening QHR Qatar Health Report QR Qatari Riyal QNRF Qatar National Research Fund QSA Qatar Statistics Authority SCH Supreme Council of Health SHI Social Health Insurance SML Single Male Laborers TPA Third Party Administrator TRI Translational Research Institute WHA World Health Assembly WHO World Health Organization

5 EXECUTIVE SUMMARY CHAPTER. INTRODUCTION CHAPTER 2. SYSTEM EXPANSION CHAPTER 3. SYSTEM ADAPTATION CHAPTER 4. QUALITY AND ACCESS IMPROVEMENT The State of Qatar had the world s fastest growing population over the last decade. The fastest growth took place only since 25. In response, in 2, the Supreme Council of Health formulated the National Health Strategy In 22, its implementation accelerated in all areas system expansion, system adaptation, and quality and access improvement. 2. Facilities 2 New hospitals New cancer diagnosis, research and treatment facility 6% Annual increase in hospital beds (297 beds) Planned 9 New hospitals 2 New diagnostic, treatment and research facilities 38% Increase in hospital beds (836 beds) 8 New primary health care centers 2 New Medical Commission units/centers 2.2 Workforce 6% Annual increase in clinical workforce National Health Workforce Plan development began New Human Resources Law developed 2.3 Provider Activity 2% Annual increase in SCH center visits % Annual increase in HMC activity 5% Annual increase in PHCC center visits 2.4 Financing 47% Budget increase Among first public organizations with program-based budgeting GCC s first SHI implementation under way World s first NHA with a new classification system First unified system of coding defined First minimum data set mandated 3. Enhancing Health Promotion and Prevention National Screening Committee established Communicable disease early case detection improved International Health Regulations drafted National Emergency Preparedness Road Map developed Nutrition surveillance plans developed Physical activity programs into core school curricula Qatar diabetes briefing book published Global Adult Tobacco Survey pilot conducted,62 Tobacco visits and 927 tobacco violations First breast and bowel cancer clinical guidelines First breast and bowel cancer screening specifications Mental Health Law drafted Oral health survey and situational analysis conducted National food safety situational analysis completed Food Safety Authority Ministerial approval received Food Safety Law drafted New air quality station acquired Environmental carcinogens study commenced Occupational health guidelines developed 3.2 Strengthening Primary Health Care PHCC established as autonomous organization National Primary Health Care Strategy developed 3.3 Remodeling Hospital Care First Clinical Services Framework First national Healthcare Infrastructure Master Plan commenced First pediatric kidney transplant First transcatheter aortic valve implantation system Double organ donation registrations 59% Fall in overseas transplants since Improving Services Patients report Qatar health care improvement in last 2 months 9% of Qatari nationals satisfied with service quality and availability Qatar reached most health MDGs Qatar reached complete/near complete reproductive health coverage Public hospitals most commonly visited healthcare providers Regional Excellence in [Trauma] Surgery Services Award for HMC 8% Fall in urgent operation cancellations on day of admission 48% Fall in HMC OPD in-clinic waiting times 72% Fall in no-show HMC OPD rates PHCC center visitors extremely satisfied Laboratory Integration and Standardization Strategy developed Health service performance agreements developed 22 WHA Patient Safety Technical Session hosted iphone/ipad healthcare location application developed 65% of Cerner Millennium implementation design complete First statistical Qatar Health Reports Human Subject Law developed Research data and biological samples use policy developed Use of Embryonic Stem Cells in Research Strategy developed Qatar National Cancer Research Strategy launched Neurosciences Institute initiated

6 . QUALITY AND ACCESS IMPROVEMENT INTRODUCTION 4.2 Improving Facilities 2% Increase in private sector facility approvals since 2 National Accreditation Body plans developed All HMC facilities meet Joint Commission International standards Several HMC services successfully re-accredited PHCC assessment by Accreditation Canada International commenced PHCC centers under renovation 4.3 Improving Professionals 25% Annual increase in clinician licensing applications processed Qatar Council for Health Practitioners foundation established 2+ Training sessions for clinical and non-clinical staff 4,+ Staff trained The State of Qatar (Qatar) had the world s fastest growing population over the last decade []. Qatar also had the world s second fastest growing population between 95 and 2 [2]. Expatriates now comprise 86 percent of Qatar s population [3]. Almost half of the population consists of non-qatari males employed in construction, fuel extraction, machinery operation, or similar trades i [4]. Half of the population is under 3 years of age, and there are three males for every female [3]. Rank 2-2 Growth Qatar.9 2 United Arab Emirates Turks and Caicos Bahrain Western Sahara 5.2 Changing lifestyles and a unique demographic profile have led to a high burden of non-communicable diseases (NCDs), a high risk of communicable diseases (CDs), and a high rate of preventable injuries. The impact of NCDs is similar ii to that in ageing, or aged, populations [3, 5]. The rate of reported CDs has risen iii between 25 and 2 [3, 6]. In 22, Qatar registered two of the world s nine laboratory-confirmed cases of infection with the novel human corona virus [7]. A third of classified deaths are due to external factors iv, such as accidents and injury [3]. Rank 95-2 Growth United Arab Emirates Qatar Western Sahara Kuwait Djibouti 4.75 Table. World s Fastest Growing Populations 2-2 Source: UNESA, 2 Table 2. World s Fastest Growing Populations 95-2 Source: UNESA, 24

7 . REFORM.2 SCH, HMC AND PHCC Rapid population growth and changing lifestyles have imposed unparalleled strains on health care provision. They have also provided momentum for full health system reform; supported by all-encompassing socio-economic development. In 2, the Supreme Council of Health (SCH), Qatar s highest health authority, launched the country s first comprehensive health reform. This built on the country s long-term development strategy, Qatar National Vision 23. The reforms focus on three pillars: system expansion, system adaptation, and overall quality and access improvement. Enhanced health promotion and prevention, and strengthened primary care, will co-exist with additional and specialized secondary and tertiary capacity; as an integrated system of care, guided by a robust national policy. The reforms are being delivered through the National Health Strategy 2-26 (NHS), a rigorous implementation methodology. In 22: SCH established a dedicated NHS Program Management Office; overall NHS implementation was accelerated; and NHS vision was restated, to include a total of 39 Projects. This Report outlines the 22 achievements and 23 plans of SCH, Hamad Medical Corporation (HMC), and Primary Health Care Corporation (PHCC). It reports progress against each of the three reform pillars: system expansion; system adaptation; and quality and access improvement. The SCH is responsible for the regulation, oversight and funding of HMC and PHCC. In 22, it also had one primary health care (PHC) center and one Medical Commission (MC) center. دولة قطر State Of Qatar The HMC provides secondary and tertiary care, including a national ambulance service and home healthcare services. In 22, it had 83 percent of Qatar s hospital beds. The PHCC provides comprehensive primary health care, including health promotion. In 22, it had 9 percent of Qatar s primary health care clinics vi, but provided the majority of Qatar s primary health care. Current Model of Care Future Model of Care المجلس ا على للصحة Supreme Council Of Health TREATMENT ABROAD TERTIARY TREATMENT ABROAD CONTINUING Hamad Medical Corporation Regulation, Oversight and Funding Primary Health Care Corporation SCH, HMC, PHCC Governance, 22 ACUTE ACUTE 83% 9% HEALTH PROMOTION & PREVENTION PRIMARY HEALTH PROMOTION & PREVENTION PRIMARY 7% 9% Current and Future Model of Care v, Qatar 83% HMC 7% Other Figure. Hospital Beds, Qatar, 22 9% PHCC 9% Other Figure 2. PHC Clinics, Qatar,

8 2. SYSTEM EXPANSION The planned model of care entails considerable infrastructure expansion, at all levels of care. Expansion is required in the number of facilities, size of the workforce, number of services and the amount of funding. Current Model of Care This Section outlines SCH, HMC and PHCC 22 progress and 23 plans in: 2. Increasing Facilities 2.2 Increasing Workforce 2.3 Increasing Services 2.4 Increasing Financing Future Model of Care 2. INCREASING FACILITIES In 22, the SCH, HMC and PHCC: opened 3 new facilities; and planned for 3 further facilities between 23 and 22. To ensure that demand is met, and to guide future policy and investment: SCH, HMC and PHCC Hospitals Other vii Facilities 3 3 PHC Centers MC Centers 3 viii 3 Total Table 3. SCH, HMC and PHCC Facilities (by category), TREATMENT ABROAD ACUTE TERTIARY TREATMENT ABROAD CONTINUING ACUTE SCH began the development of a national Healthcare Infrastructure Master Plan, which will map current and future facilities, and major equipments in 23; and is developing a 23 Capital Expenditure Committee, and a certificate-of-needs process, to evaluate new projects. New Secondary and Tertiary Care Facilities Total Diagnostic/ Treatment/ Research MC Centers PHC Centers Hospitals Current and Future Model of Care, Qatar HEALTH PROMOTION & PREVENTION PRIMARY HEALTH PROMOTION & PREVENTION PRIMARY In 22, the SCH and HMC opened: 2 new hospitals; new research/diagnosis facility; and 297 hospital beds. In January, the SCH and HMC opened the Cuban Hospital, in Dukhan. This has 87 beds, employs over 3 Cuban Government clinical staff, and includes specialty areas such as general medicine and surgery. In April, the HMC opened a positron emission tomography computed tomography (PET-CT) facility, in Doha. This is Qatar s sole integrated cancer diagnosis and treatment facility. Figure 3. Growth in SCH, HMC and PHCC Facilities (by category), 2-25 HMC Category (%) Hospitals Research/Diagnosis Facility -- HMC Hospital Beds,9 2, Table 4. HMC Secondary/Tertiary Care Facilities (by category) and Hospital Beds, ,5 2,,5,,9 2,28 In December, the HMC opened Al Wakra Hospital, in Al Wakra. This has 2 beds, and provides a full range of specialties, such as general medicine and surgery Figure 4. Growth in HMC Hospital Beds,

9 Entrance to the HMC Cuban Hospital, Dukhan, Qatar, 22 HMC Al Wakra Hospital, Al Wakra, Qatar, 22 Opening of HMC Al Wakra Hospital by His Highness Sheikh Hamad bin Khalifa Al-Thani, Emir of Qatar,

10 Planned Secondary and Tertiary Care Facilities In 22, the SCH and HMC planned: 9 new hospitals; 2 new diagnostic, treatment and research facilities; and 836 new beds by 25. Category (%) Hospitals HMC SCH HMC Other Facilities PET-CT Facility. TRI -- Neurosciences Institute -- Hospital Beds 2,28 3, N/A HMC 2,28 2, N/A SCH 36 ix Table 5. SCH and HMC Secondary/Tertiary Facilities and Hospital Beds (by category and provider), Figure 5. Growth in SCH and HMC Hospitals (by provider), ,5 3, 2,5 2,,5, 5,9,9 2 2,28 2,28 22 Total SCH HMC 3, , Figure 6. Growth in SCH and HMC Hospital Beds (by provider), 2-25 HMC continued the construction of the New Women s Hospital, Ambulatory and Minimally Invasive Surgery Hospital, and a Physical Medicine and Rehabilitation Hospital. Opening is scheduled in 24. HMC began the construction of the new Communicable Diseases Hospital. This is scheduled to open in Doha, in 25. HMC completed the design phase of the Translational Research Institute (TRI), its core translational research facilities. Construction will commence in 23. It is scheduled for completion in 25. SCH completed the design phase for three hospitals in the Doha Industrial Area, Messaied, and the Ras Laffan Industrial Area. Construction will begin in 23. Opening is scheduled for 25. Initially, these will meet the specific needs of single male labourers (SML), an important and considerable population segment. Dedicated services include trauma and injury, occupational health, and physiotherapy. A flexible design model was developed, to allow their layout and services to be adjusted as the population changes. To ensure high-quality services, these hospitals will be operated by the private sector, through a competitive procurement process, and output-based contractual requirements. HMC began the design and planning stage for a New Cancer Hospital. This is scheduled to open in 28. SCH and HMC developed proposals for a new Mass Casualty Trauma Hospital. The outline design phase will commence in 23. It is expected to open before the Qatar 222 Fédération Internationale de Football Association World Cup. It will provide a trauma level I centre, complete trauma care system, and a coherent trauma service continuum. HMC began the development of the Neurosciences Institute, to help improve mental health and neurological outcomes, through research, training and clinical activities. Facility Expected Opening Area HMC New Women s Hospital construction construction 24 Doha 2 HMC Ambulatory and Minimally Invasive Surgery Hospital construction construction 24 Doha 3 HMC Physical Medicine and Rehabilitation Hospital construction construction 24 Doha 4 HMC Communicable Disease Hospital construction construction 25 Doha 5 HMC Translational Research Institute design construction 25 Doha 6 SCH Hospital design construction 25 Doha 7 SCH Hospital design construction 25 Messaied 8 SCH Hospital design construction 25 Ras Laffan 9 Neurosciences Institute development development 25 Doha HMC New Cancer Hospital proposals outline design 28 Doha HMC Mass Casualty Trauma Hospital proposals outline design 22 Doha Concept Design General View, of 3 Planned SCH Hospitals, 25 Concept Design Perspective Aerial View, of 3 Planned SCH Hospitals, 25 Table 6. Construction Plans for SCH and HMC Secondary/Tertiary Care Facilities,

11 Planned Primary Health Care Facilities In 22, the SCH and PHCC planned: 8 new primary health care centers; and 2 new MC units/centers. SCH continued the planning, design and construction of three PHC centers, in Doha and Zekreet. Construction will complete in 23; when operations will be handed over to the private sector. SCH continued the design phase of two MC units/ centers, to be integrated within the new PHC centers. PHCC developed an Enhancement Plan for ten new PHC centers, expected to open between 24 and 25. Prototypes were developed for health centers, community health centers, and health and wellness centers. Health and wellness centers will be the largest, at around 25, square meters each. Aside from traditional services, they will also offer poidiatry, diatry and gymnasium services. SCH is conducting a study for a new PHCC primary health care and pediatric urgent care center, in Doha s Al Sadd area. The design phase for the, square meter land plot will be conducted in 23. Facility Expected Opening Area SCH PHC Center re-construction construction 23 Umm Saimir, Doha 2 SCH PHC Center re-construction construction 23 New Industrial Area, Doha 3 SCH PHC Center planning construction 23 Zekreet 4 SCH MC Unit/Center design construction 23 Doha 5 SCH MC Unit/Center design construction 23 Doha 6 PHCC Al Karaana Center design construction 24 Al Karaana 7 PHCC Al Ghuwairiya Center design construction 24 Al Ghuwairiya 8 PHCC Al Roda Center design construction 24 Al Roda 9 PHCC Al Jama a Center design construction 24 Doha PHCC Al Waab Center design construction 24 Doha PHCC Al Nuaim Center design construction 24 Al Nuaim 2 PHCC Rowdat Al Khail Center design construction 24 Doha SCH completed the design phase of four centers, collocated and/or adjacent to the three planned SCH hospitals. Construction will begin in PHCC Umm Salal Center design construction 24 Umm Salal 4 PHCC Al Wajbah Center design construction 25 Al Wajbah 5 PHCC Muaither Center design construction 25 Muaither 6 SCH PHC Center design construction 25 Doha 7 SCH PHC Center design construction 25 Doha 8 SCH PHC Center design construction 25 Messaied 9 SCH PHC Center design construction 25 Ras Laffan PHCC PHC Center land study design N/A Al Sadd, Doha Category Growth (%) 25 2 Table 8. Construction Plans for SCH and PHCC PHC Facilities, PHC Centers SCH 8 7. PHCC Total SCH MC Units 3 2. SCH PHCC Total Table 7. SCH and PHCC PHC Facilities (by category and provider), 2-25 Figure 7. Growth in SCH and PHCC PHC Facilities (by provider), 2-25 Concept Design Perspective Aerial View, of 3 Planned SCH Collocated Health Centers, 25 Designs for New Wellness Centers, PHCC,

12 New Design for Al Nuaim Center, PHCC, 24 Swimming Pool Design for New PHC and Wellness Centers, PHCC, Waiting Area Design for New PHC and Wellness Centers, PHCC, Dental Clinic Reception Design for New PHC and Wellness Centers, PHCC,

13 2.2 INCREASING WORKFORCE Between 2 and 22, SCH, HMC and PHCC recruited: 6 new physicians; 894 nurses; and 866 allied health professionals. x By 23, PHCC projects that PHC clinical staff will grow by 82 percent. The HMC is recruiting,7 more nurses. SCH xi, HMC and PHCC 2 22 Growth (%) Physicians 2,27 2, Nurses 6,739 7, Allied Health Professionals 3,594 4, Total 2,36 4, To ensure that demand is met, in 22: SCH began the development of a National Health Workforce Plan, which, in 23, will map and project workforce numbers; enhanced internal recruitment processes; and reduced recruitment timeframes. SCH, HMC and PHCC developed a new Human Resources Law, to unify remuneration across them, and administrative and medical staff. 6, 4, 2,, 8, 6, 4, 2, 2,36 3,594 2,27 6, ,28 4,46 2,87 7, Total Allied Health Professionals Physicians Nurses The SCH had the fastest increase, and the smallest in absolute numbers. This was due to the opening of its PHC centre half way through 2. Category 2 22 Growth Growth (%) SCH Physicians Nurses Allied Health Professionals HMC,36 2,59 xii, Physicians,488, Nurses 5,99 6, Allied Health Professionals 2,899 3, PHCC,84, Physicians Nurses Allied Health Professionals Total 2,36 4,28, Table. SCH, HMC, PHCC Medical Workforce (by category and provider), 2-22 The percent increase observed in HMC was the largest in absolute numbers, due to the opening of its two new hospitals. The PHCC had the slowest increase, demonstrating its steady facility numbers between 2 and 22. 6, 4, 2,, 8, 6, 4, 2, 2,36,84, ,28,99 2, Total SCH PHCC HMC Figure 9. Growth in SCH, HMC, PHCC Medical Workforce (by provider), 2-22 Table 9. SCH, HMC and PHCC Medical Workforce (by category), 2-22 Figure 8. Growth in SCH, HMC and PHCC Medical Workforce (by category),

14 2.3 INCREASING SERVICES 2.4 INCREASING FINANCING Between 2 and 22, the growth in SCH, HMC and PHCC activity was in direct proportion to the growth in their facility and workforce numbers. In order to meet demand, and guide future growth and investment: SCH completed Qatar s Clinical Health Services Framework; and is expanding this to specialty and subspecialty level, through the 23 Healthcare Infrastructure Master Plan. Qatar s public healthcare budget witnessed a rapid increase during 22. The approved budget for financial year 22/23 was 47 percent higher than that of the previous year. This reflects the Leadership s unquestionable commitment towards the future model of care. The SCH made equally determined efforts during 22. By 3 December 22, the SCH General Secretariat (GS) had utilized 98.6 percent of the approved budget for financial year 22/23 on realizing plans for the future model of care. Activity by Category 2 22 Growth (%) SCH 82,468 29, PHC Visits 79,8 25, MC Examinations 2,657 xiii 3, HMC 2,68,339 2,288, Inpatient Admissions 64,722 7, Outpatient Visits 793, , ED Visits 675, , Day Case Surgeries 2,67 2,84.3 Home Healthcare Visits 7,56 9, ,, 6,, 5,, 4,, 3,, 5,892,43 82,468 3,64,336 6,325,447 29,55 3,87,356 5,782, 596 4,86 5,586, ,59 3,84 7,97, ,9 5,356, ,784 7, ,47 7,92, ,47 9,49,22,6 7,2 Total GS PHCC HMC Births 7,624 8, PEC Activity 486, , Ambulance Calls 69, 23, xiv PHCC 3,64,336 3,87, Visits 3,64,336 3,87, Total 5,892,43 6,325, Table. SCH, HMC and PHCC Activity (by category and provider), ,, Total 2,288,586,, 2,68,339 SCH PHCC HMC 2 22 Figure. Growth in SCH, HMC and PHCC Activity (by provider), 2-22 Approved Budget Actual Expenditure Approved Budget Actual Expenditure Approved Budget FY 29/2 FY 2/2 FY 2/22 FY 22/23 Figure 4. Growth in Approved Budget and Actual Expenditure (in million QR, by provider), FY xv Improving Budgeting Actual Expenditure Approved Budget Improving National Health Accounts Program-based and multi-year budgeting are important tools for planning future healthcare initiatives and monitoring costs. The SCH improved the way in which total health expenditure is estimated and described. This will enable it to monitor, assess and improve expenditure.,2,,, 8, 6, 793, ,39 675, ,467 2,, 8, 6, 7,444 64,722 69,23,645 25, 2, 5, 2,84 2,67 9,767 7,56 7,624 8,84 SCH was one of the first Government organizations to implement program-based budgeting for 22-23; and produced its first multi-year budget for SCH published the world s first National Health Accounts (NHA) with the new classification system; and remained the only Gulf Cooperation Council (GCC) country to produce NHAs. 4, 4,, 2, 2, 5, Outpatients Visits ED Visits Inpatient Admissions Ambulance Calls Day Care Surgeries Home Healthcare Visits Births Figure. Growth in High Activity Visits, HMC, 2-22 Figure 2. Growth in Medium Activity, HMC, 2-22 Figure 3. Growth in Low Activity, HMC,

15 3. SYSTEM ADAPTATION Improving Financing The SCH finances HMC and PHCC through lumpsum budgets, based on historical expenditure. Users contribute nominal amounts to the revenue (user co-payments or predominantly employer-led private health insurance). Qatar s future model of care is based on enhanced health promotion and prevention, and strengthened primary care. These will co-exist with additional and specialized secondary and tertiary capacity; as an integrated system of care, guided by a robust national policy. This Section follows the intended continuity of the future model of care. It outlines SCH, HMC and PHCC 22 progress and 23 plans in: 3. Enhancing Health Promotion and Prevention 3.2 Strengthening Primary Health Care 3.3 Remodeling Hospital Care There is no link between provider payments, and performance or market forces. There is also no link between user contributions, and seeking the right level of care. NHA 2 Workshop, SCH, 22 Current Model of Care Future Model of Care The SCH is introducing social health insurance (SHI) in order to incentivize providers and users towards the aspired quality, accessibility, equity and model of care. It is thereby improving revenue collection, fund pooling, and provider reimbursement. SCH developed an SHI enabling law and supporting regulations; designed the National Health Insurance Company (NHIC); processed the selection of a third party administrator (TPA); developed a service fee schedule/costing standards; conducted coding training sessions for healthcare providers; defined a unified system of coding; and disseminated Qatar s first minimum data sets to ensure consistency. DRG Knowledge Transfer Session, SCH, 22 TREATMENT ABROAD HEALTH PROMOTION & PREVENTION ACUTE PRIMARY TERTIARY TREATMENT ABROAD ACUTE HEALTH PROMOTION & PREVENTION CONTINUING PRIMARY In 23, the SCH expects to: ICD--AM Train the Trainer Workshop, SCH, 22 Current and Future Model of Care, Qatar enact the draft enabling law; establish NHIC; award the TPA contract; finalize a communication strategy; and implement the SHI Scheme s first pilot phase. Outpatient Classification System Session, SCH,

16 2. QUALITY AND ACCESS IMPROVEMENT 3. ENHANCING HEALTH PROMOTION AND PREVENTION Public Health Governance Communicable Disease Surveillance Effective health promotion and prevention occurs at all levels of care, in order to prevent both new and recurring conditions. Current Model of Care TREATMENT ABROAD HEALTH PROMOTION & PREVENTION ACUTE PRIMARY This part of the Report details progress and plans for increased awareness, screening and early detection, for Qatar s main causes of morbidity and mortality. Future Model of Care TERTIARY TREATMENT ABROAD ACUTE HEALTH PROMOTION & PREVENTION CONTINUING PRIMARY The SCH is working towards a robust governance system for monitoring and evaluating the effectiveness of individual prevention initiatives. SCH built capacity and established individual projects; developed plans for a 23 National Public Health Committee; and developed plans for a 23 National Prevention Strategy. National Screening The SCH is developing an evidence-based and ethical National Screening Program, targeted at priority risk factors and diseases. SCH established a National Screening Committee for this work; developed plans for benchmarking national screening programs; and developed plans for 23 screening guidelines to providers. Chronic NCD Risk Factor Surveillance The World Health Organization (WHO) approach for chronic disease risk factor surveillance is through STEPwise Surveys. The SCH improved early communicable disease detection. It also identified ways to strengthen existing CD early warning surveillance systems, in collaboration with GCC countries. SCH conducted active surveillance visits; conducted lab-based case investigations for specific diseases; evaluated several disease control programs, such as for malaria; completed a draft revised Communicable Disease Control Law; and conducted hepatitis B virus status screening for MC Laboratory staff. Communicable Disease Prevention Respondents of a 22 PHCC Survey rated prevention through vaccinations among the most vital [8]. SCH implemented an electronic vaccine record program; updated vaccination schedules for children and adults; issued guidelines for vaccine management; and developed plans to target children -8 years for measles, mumps and rubella vaccinations, during 23. Current and Future Model of Care, Qatar SCH conducted Qatar s first STEPwise Survey (Qatari adults); published a preliminary report; and developed a comprehensive report for publication in early 23. Logo of Qatar s first STEPwise Survey, SCH, 22 Vaccination Clinic, Abu Bakr Al Siddik PHC Center, PHCC 3 3 3

17 Emergency Preparedness Diabetes Prevention Tobacco Cessation The SCH focus for emergency preparedness shifted from communicable diseases alone, to a wider remit of responsibility. SCH drafted an International Health Regulations (IHR) Law; established an IHR National Focal Point Committee; established five working groups to oversee the IHR 25 implementation; and developed a national health emergency preparedness road map. In 23, the SCH plans to conduct a Hazard Vulnerability Analysis of the health sector. The analysis will help develop a clear health disaster response framework, and support an emergency preparedness plan. Nutrition Surveillance and Promotion Bad nutrition is responsible for many physical and mental health problems. Qatari respondents to the 22 PHCC Study reported that greater emphasis needs to be given to tackling obesity. signed a Memorandum of Understanding on nutrition counseling student training, with Qatar University. HMC launched a patient publication focusing on health promotion; around 3, copies will be produced three times a year. Logo of We are Healthy Kids Program, SCH, 22 Physical Activity Promotion Inadequate nutrition and insufficient physical activity are two of the main risk factors for diabetes. Qatar s diabetes prevalence is three times higher than the estimated global prevalence [, 2]. SCH established a working group on diabetes prevention; published a Qatar diabetes briefing book; adopted a certified diabetes educator program; organized celebrations for Diabetes Day; developed plans for a 23 National Diabetes Strategy; and made preparations for a 23 National Diabetes Committee. HMC continued work on the establishment of a Diabetes One-Stop Clinic for 23. You can do it! We can help! Smoking Cessation Clinic at the Primary Health Care Corporation Smoking and exposure to second-hand smoke cause morbidity and mortality. The prevalence of smoking among Qatar s males is similar to xvi that worldwide; but almost 4 percent more adolescent males currently use tobacco in Qatar than the world average [5, 3]. SCH conducted a Global Adult Tobacco Survey pilot; conducted a Ramadan tobacco cessation media campaign; conduced a community awareness lecture campaign; and held outreach meetings and an education program, on the amended Tobacco Law, for shopping mall managers, hotel managers and other key stakeholders. Since the 2 launch of the program to establish smoking cessation clinics, the PHCC Gharafat Al Rayyan Community Health Center: assisted 578 clients with smoking cessation; conducted campaigns, such as World No Tobacco Day; and made plans to expand this service to two PHCC centers in 23. The 22 SCH STEPwise Survey found that over 9 percent of Qatari adults eat less than five servings of fruit and/or vegetables per day [9]. Almost a third of Qatar s population, and 4.4 percent of Qatari nationals, are reportedly obese [9, ]. SCH developed nutrition surveillance plans; published guidelines on healthy school snacks; published dietary guidelines for nurseries; rolled out the We are Healthy Kids Program to 36 schools; organized a Ramadan Health Awareness Campaign; introduced revised growth chart monitoring into PHCC; incorporated content on food labeling and marketing of sugar sweetened beverages for children into national food laws; and Physical inactivity is a global pandemic, with particularly high rates in the GCC. The 22 SCH STEPwise Survey found that over 7 percent of Qatari adults did not engage in vigorous activity. SCH organized celebrations for Sports Day; and introduced physical activity programs into core school curricula. Helping You Celebrate A Healthier Life Regardless of the health center you belong to you can utilize this service by making an appointment for consultation and smoking cessation medications. For appointment please call now: stopsmoking@phcc.gov.qa Tobacco Cessation Week Flyer, PHCC, 22 Also in 22, the SCH carried out the following inspections. Inspections carried out by SCH 22 Fines Visits,62 Violations 927 Table 2. Tobacco Inspections, SCH, ,5 QR 32 33

18 Cancer Awareness Cancer Screening and Diagnosis Women Screening Mental Health Awareness and Prevention The SCH National Cancer Strategy 2-26 identified inadequate nutrition, low physical activity and tobacco as some of Qatar s main cancer risk factors. Cancer accounts for percent of all deaths in Qatar [4]. As the population ages, this proportion could increase. SCH established the SCH NCS Program Team; developed a cancer awareness Communications Strategy; supported Breast Cancer Awareness Month, in October; supported Childhood Cancer Awareness Month, in December; developed plans for a 23 World Cancer Day campaign; made plans for ovarian, bladder and prostate cancer campaigns; and developed a cancer awareness survey. In 22, SCH work on cancer screening focused on breast and bowel cancer, Qatar s most reported cancers [3, 6]. SCH developed national clinical guidelines for breast cancer; developed draft guidelines for bowel cancer; developed National Breast Screening Program specifications; developed specifications for the Bowel Screening Program; completed a full report on basic epidemiology analysis; and completed a minimum data set. HMC opened a PET-CT facility which will enhance cancer prevention through state-of-the-art diagnosis and research. By 24, the SCH national Breast and Bowel Screening Programs will: cover approximately 53, women; provide one static breast screening site for the country; provide a One-Stop HMC Clinic for high-risk and symptomatic women; and provide a mobile unit with potential for eight sites across Qatar. As mothers and carers, women are instrumental to the well-being of future generations. Many current and potential PHCC visitors reported that well-woman and pregnancy care clinics would be useful [8]. SCH developed plans for establishing a National Committee for Women and Child Health; and in 23, it will prioritize screening for osteoporosis, nutritional deficiencies, cancer, pre-natal screening, and screening for postpartum depression. Premarital Screening Premarital screening services (PMS) have a proven role in decreasing the prevalence of inherited diseases arising from consanguineous marriages []. They also help control the transmission of sexually transmitted diseases by providing early diagnosis and treatment. PHCC continued to offer free premarital screening services; developed PMS guidelines; developed a PMS Policy; conducted a Process Mapping Workshop; and standardized processes in five health centers. Past inaction and future population ageing are likely to exacerbate mental health problems in Qatar. One third of females and one tenth of males reported suffering from depression, stress and anxiety, and/or insomnia [8]. Respondents called for greater emphasis on tackling stress and anxiety. In 22, the SCH: drafted a Mental Health Law, due for early 23; worked towards drafting a national Mental Health Strategy by 23; conducted two engagement events, in collaboration with HMC; and worked to identify a mental health minimum data set by 23. In 22, the HMC: began the development of the Neurosciences Institute, to help improve mental health and neurological outcomes, through research, training and clinical activities. In 22, the PHCC: drafted a mental health model of care for PHC centers; established referral criteria from PHC care to secondary care; and commissioned training of PHC clinical staff in mental health. In 23, the SCH plans to finalize the following: Communications Strategy; Research Strategy; work force review; profession-specific strategies; and a high-profile international conference. Cancer Awareness Measure Facilitator Training, SCH, 22 Opening of PET-CT Cancer Diagnosis and Research Facility, HMC, 22 Maternal and Child Health Workshop, PHCC 34 35

19 Oral and Eye Health Food Safety Preventable Road Injuries Respondents to the 22 PHCC Survey believe that greater emphasis needs to be given to dental/oral and vision/eye problems. They also consider dental services and clinics among the most vital and/or useful. SCH celebrated GCC Oral Health Week, Sight Day, Glaucoma Day; implemented an oral health survey; conducted an oral health services situational analysis; conducted eye health promotion in schools; and conducted nurse eye health training in schools. Dental Clinic in Al Rayyan PHC Center, PHCC SCH completed a situational analysis of food safety in Qatar; developed new policies for food safety across Government; received Ministerial approval for the new Food Safety Authority s project structure and governance; and developed the draft Food Safety Law, to be submitted for approval and enactment in 23. Environmental Health SCH drafted clauses on the use of environmental impact assessments, in collaboration with the Ministry of Environment (MOE); acquired a new air quality station; reconvened the National Air Quality Program for monitoring; made preparations to commence air quality monitoring in 23; developed plans for future air quality reports with MOE; and arranged a visit by the International Agency for Cancer Research (IACR) to carry out an assessment of the risk characterization of environmental factors and their related cancer burden factors. Qatar s rate of road traffic deaths is almost 25 percent higher than the global average xvii [5]. HMC launched Kulluna, a five-year campaign to raise awareness about road safety, safety in the work place and so on. SCH made plans to establish a medical committee to oversee the health elements of the National Road Safety Strategy; made preparations to introduce basic life support training for all emergency services, police and civil defense staff; and developed plans to establish a seatbelt and child restraint campaign. Preventable Occupational Injuries Due to a high proportion of Qatar s population being employed in construction and similar trades, the rate of work-related fatalities may be double the rate of the European Union []. SCH implemented an occupational health awareness program in the Doha and Al Khor industrial areas; finalized an industrial facilities field survey; developed guidelines on occupational health for temporary workers on construction sites, heat stress and work place risks; and incorporated occupational health promotion and prevention services in the design of three 25 SCH SML hospitals, six PHC centers, and two MC units/centers. SCH and HMC furthered planning for trauma prevention and support, through the Mass Casualty Trauma Hospital proposals. In 23, the SCH plans to carry out the following: finalize a Single Male Laborer Strategy; run education programs and activities for National Labor Week, in collaboration with the Ministry of Labor; and commence occupational health training for general practitioners. Kulluna Campaign, HMC, 22 Kulluna Campaign, HMC,

20 3.2 STRENGTHENING PRIMARY HEALTH 3.3 REMODELING HOSPITAL Qatar s future model of care is based on strengthened primary health care. During 22: SCH established PHCC as an autonomous organization; PHCC, SCH and HMC developed a National Primary Health Care Strategy 23-28; PHCC developed a PHCC communications plan; and SCH and PHCC continued planning and/or construction for eighteen PHC facilities. PHC Strategy goals for 23 include: PHC provider adoption of five key health promotion components; development of guidelines for Qatar s most common NCDs; establishment of PHC disease registers for those suffering from NCDs; mental health status checks as routine of PHC appointments; patient consultative councils; and patient records for -5 year-olds. The future model of care foresees a configuration of hospital services, in response to enhanced health promotion and prevention, and strengthened primary health care. Current Model of Care TREATMENT ABROAD This means redesigning hospital services, increasing specialized and tertiary care, designing continuing care, and reducing unnecessary treatment abroad. Future Model of Care TREATMENT ABROAD Current Model of Care Future Model of Care TERTIARY CONTINUING TREATMENT ABROAD TREATMENT ABROAD ACUTE ACUTE TERTIARY CONTINUING HEALTH PROMOTION & PREVENTION PRIMARY HEALTH PROMOTION & PREVENTION PRIMARY ACUTE ACUTE HEALTH PROMOTION & PREVENTION PRIMARY HEALTH PROMOTION & PREVENTION PRIMARY Current and Future Model of Care, Qatar Current and Future Model of Care, Qatar 38 39

21 Redesigning Hospital Services Increasing Specialized and Tertiary Care SCH and HMC work has focused on redesigning Qatar s priority areas, such as cancer, cardiovascular diseases, communicable diseases, trauma, emergency, and women s hospital services. In 22, the SCH: finalized Qatar s Clinical Services Framework, informing hospital service review and design that meet patient needs; began the development of a more detailed document, by specialty and sub-specialty level; and completed the design phase of three SML hospitals, focusing on occupational health and trauma services by 25. In 22, the SCH and HMC: opened the Cuban Hospital; and completed proposals for the Mass Casualty Trauma Hospital. In 22, the HMC: opened Al Wakra Hospital; opened the PET-CT facility; completed the design phase for the TRI facility; developed proposals for a New Cancer Hospital; continued the design phase for: new MRI and CT Suite in Outpatient Department (OPD) Annex; new Bone and Joint Institute; commenced and/or continued the construction of: New Women s Hospital; Ambulatory and Minimally Invasive Surgery Hospital; Physical Medicine and Rehabilitation Hospital; New Communicable Disease Hospital; and Diabetes One-Stop Clinic. HMC also completed the detailed design and full design documentation for the HGH Operating Theater Expansion Project, which will enhance specialized complex procedures, trauma surgical capability, and reduce waiting times: from 8 to 2 operating theaters, across 2,6 square meters; 4 specialist theaters equipped with specialist MRI, CT and angio imaging equipment (including Brain Lab capabilities); increase in the post anaesthesia recovery unit (from 2 to 34 beds); increase in pre-ops (from 6 to 6 beds) increase in the surgical intensive care unit (from 2 to 35 beds); and increase in the trauma intensive care unit post anaesthesia recovery unit (from 2 to 22 beds). In 23, the HMC will: commence the construction of Phase 2, new HGH Operating Theatre Suite; develop the outline design phase for: Phase 2, Al Khor Hospital; Phase 2, Heart Hospital; expansion of HGH s Emergency Department; and dermatology and dentistry services. In 22, the HMC: successfully carried out Qatar s first pediatric kidney transplant; started performing the transcatheter aortic valve implantation system, an innovative, life-changing procedure to improve the quality of life for high-risk patients; since a Ramadan campaign on the need for more organ donors in which Her Highness Sheikha Moza bint Nasser, Chair Person of the SCH Executive Committee, registered as a donor HMC s donation center has witnessed: double the number of people registering each day; and double the number of families consenting to deceased donation. The HMC s organ transplant plans for the near future include: perform the first pancreatic transplantation case in 23; perform the first partial liver transplant in 23/4; establish a bone and tissue bank; and establish an international program, for patients with living related donors overseas, to do their surgery in Doha. Designing Continuing Care Qatar lacks a system of continuing care. This comprises the areas of rehabilitation, sub-acute facilities, long-termcare facilities, nursing homes, and, of great importance, an empowered community-based support system. In 22 HMC furthered the construction of the new 2-bed Physical Medicine and Rehabilitation Hospital, which will significantly progress the capacity and expertise in the delivery of rehabilitation services for Qatar. HMC is developing a Continuing Care Design Strategy to identify, at a national level, service models for elderly, chronic and long-term care patients in the right settings. Pediatric Kidney Transplant Surgical Team, HMC, 22 Organ Donation Campaign, HMC, 22 Organ Donation Campaign, HMC,

22 Reducing Unnecessary Treatment Abroad Qatar s relatively small population does not always provide the necessary critical mass for certain secondary and tertiary services. As such, the SCH sends many patients for treatment overseas. Typical destinations include Germany, the United States, and the United Kingdom. Improvements are being made to reduce this where unnecessary, in order to enhance the quality and continuity of care, and optimize expenditures. Responsibility for clinical decision-making was transferred to HMC; SCH will retain administrative oversight; the new hospital services, and planned hospitals, will further negate the need for overseas services; and there was a 59 percent reduction in overseas transplants. In 23, the SCH and HMC will: identify a preferred list of overseas healthcare providers; establish quality criteria for preferred overseas healthcare providers; begin to determine clinical and administrative eligibility criteria; develop new by-laws on administrative issues for treatment abroad; and identify conditions for follow-up care in Qatar. Location of patients sent for Treatment Abroad Transplant Operations Growth (%) Qatar 8 +7 Overseas UK GERMANY 23% 35% Table 3. Transplant Operations (Qatar and overseas), HMC, Transplants in Qatar 28 USA 22 34% Figure 6. Growth in Qatar Transplant Operations, HMC, Figure 6. Growth in Qatar Transplant Operations, HMC, THAILAND 7% EGYPT 5 Overseas Transplants 28 % * Using Data from the month of April Figure 7. Reduction in Overseas Transplant Operations, HMC, Figure 5. Locations of Patients Sent for Treatment Abroad, April 22 Figure 7. Reduction in Overseas Transplant Operations, HMC,

23 4. QUALITY AND ACCESS IMPROVEMENT The SCH adopts the WHO view on universal health coverage. This refers to the ability to access and use quality promotive, preventative, curative and rehabilitative health services, while also not being exposed to financial hardship [6]. This Section outlines SCH, HMC and PHCC 22 progress and 23 plans in: 4. Improving Services 4.2 Improving Facilities 4.3 Improving Professionals 4. IMPROVING SERVICES Around 8 percent of visitors to PHCC centers rated the quality and range of available services as extremely important. Around 6 percent also rated cost as extremely important, while proximity to home/work was highly rated by 4 percent of respondents. Four 22 studies and reports found that both the quality of, and access to, Qatar s health care services have improved. This is testimony to the work of SCH, HMC and PHCC in providing and/or regulating health care. The 22 PHCC Study indicated that the overall quality of Qatar s healthcare services has improved over the past 2 months. How has the quality of healthcare changed in Qatar in the last 2 Months? An independent 22 poll found that 9 percent of Qatari nationals were satisfied xviii with the availability of quality health care [7]. Category Satisfied (%) Dissatisfied (%) Don t Know/Refused (%) GCC States Qatar 9 8 United Arab Emirates Oman 78 2 Bahrain Kuwait Kingdom of Saudi Arabia Other Middle East and North Africa States Jordan Iran Algeria 6 4 Palestine Turkey Lebanon Tunisia % 35% Egypt 38 6 Iraq Morocco Yemen % % Table 4. MENA Nationals Satisfaction and Dissatisfaction Rates, Gallup Poll, 22 35% It has become much better 32% It has become a little better 29% It has remained the same 3% It has become a little worse % It has become much worse 29% Figure 8. Reported Improvement in Qatar s Health Care, PHCC Study, 22 9% Satisfied 8% Dissatisfied 8% % 9% Qatar United Arab Emirates Oman Bahrain Jordan Iran Kuwaiit Algeria Kingdom of Saudi Arabia Palestine Turkey Lebanon Tunisia Egypt Iraq Morocco Yemen % Don t Know / Refused % 2% 3% 4% 5% 6% 7% 8% 9% % Figure 9. Qatari Nationals Satisfaction Rate, Gallup Poll, 22 Figure 2. Ranking of MENA Nationals Satisfaction Rates, Gallup Poll,

24 A 22 Survey reported very high or complete women care coverage [9]. A 22 Report reported that Qatar made considerable progress with the health-related United Nations Millennium Development Goals [8]. The Report found that Qatar has reached, or is close to reaching, many of the goals, before the 25 target date. Secondary and Tertiary Care Public Hospitals Public hospitals were the most commonly visited of all health care providers in Qatar, according to the 22 PHCC Study. Trauma and Critical Care % 9% 8% 7% 9% At least once by skilled personnel Figure 2. Antenatal Care Coverage, Qatar, 22 % 9% 8% 7% % 99% Skilled attendant at delivery Figure 23. Delivery Care, Qatar, 22 % 9% 8% 7% 96% At least once by skilled personnel Figure 22. Qatari Antenatal Care Coverage, Qatar, 22 Institutional deliveries HMC s Emergency Services a new multi-disciplinary team was tasked with transforming emergency services across HMC; 88 percent of patients arriving at the Emergency Department are now discharged in fewer than four hours (28,84 of 3,943 patients in March 22); 73 percent fall in number of overnight inpatient bed waits ( on December, from 4 on 2 February); 8 percent fall in number of operations cancelled on the day of admission, between January and June 22; 45% 4% 45% 4% 4% complete fall on most days in number of patients waiting for a bed in recovery rooms following surgery, between February and December 22 (from around eight patients per day); new medical intensive care unit beds were opened for cardiac patients in HGH and the Heart Hospital; first few of world-class emergency ambulances arrived; 28 experienced doctors and nurses were recruited in 22; and 72 new emergency nurses will be in post by 23. HMC s Trauma and Critical Care Fellowship Program was awarded the Excellence in Surgery Services Award; SCH completed the design phase of three new hospitals, with a focus on trauma, injuries and occupational health by 25; SCH and HMC completed proposals for a new Mass Casualty and Trauma Hospital, to offer a trauma level I centre, complete trauma care system and continuum by % 3% 25% 2% 5% % 5% 25% 2% 6% 3% Jan. Feb. Mar. Apr. % May 4% Jun. 35% 3% 25% 2% 5% % 5% Feb. % Dec Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Average -month Decline Figure 24. Percent of Urgent Operations Cancelled on the Day of Admission, HMC, 22 Figure 25. Percent of Overnight Inpatient Bed Waits, HMC, 22 Figure 26. Patients Waiting for Beds in Recovery Rooms Following Surgery, HMC, 22 HMC Excellence in Surgery Services Award, Arab Health,

25 2. QUALITY AND ACCESS IMPROVEMENT Women s Services HMC Outpatient Department Services HMC and SCH Hospitals outside Doha Impact on Overall Geographical Service Access new six-bed HMC Observation Unit; VIP rooms with exceptionally high standards and special menus were opened in HMC s Al Khor Obstetrics/Gynecology Unit; SCH prioritized women services in SHI implementation Phase ; and construction progressed on HMC s New Women s Hospital. fixed appointment system is under implementation in most HMC sites, between 2 and 23. HMC Dentistry Services fixed appointment system under implementation to reduce waiting times, avoid patients coming back to make appointments, reduce the no-show rate through reminders, improve patient care and privacy by reducing congestion; system due to go live in early 23. Hospitals Outside Doha 3 5 Doha 5 5 Total Table 6. HMC and SCH Hospitals (in and out of Doha), 2-25 Hospital Beds Growth (%) Outside Doha Doha,796,796 2, Total,9 2,28 3, percent of Qatar s population live outside Greater Doha [2]. This proportion is likely to remain stable or decrease (due to Doha s concentration of service and other sectors xix ). Only 5 percent of Qatar s hospital beds were located outside Doha in 2. This will more than triple by 25. Although slightly less than the proportion of population living outside Doha, Qatar has a uniquely low health-help seeking population (disproportionately young and male. Key Performance Indicators Pre-Go Live Post Implementation Improvement No Show Rate 43% 25% 72% fall In Clinic Waiting Time 67 minutes 35 minutes 48% fall Patient Satisfaction Level 68% 76% 2% increase Referrals Processed in Patient s Absence 89, Referrals Triaged 64, Table 5. Impact of Referral-based Outpatient Fixed Time Appointments, HMC 8% 6% 4% 2% % 43% Pre-Go Live 25% Post Implementation No Show Rate Minutes 67 Pre-Go Live 35 Post Implementation In Clinic Waiting Time 8% 6% 4% 2% % 68% Pre-Go Live 76% Post Implementation Patient Satisfaction Table 7. HMC and SCH Hospital Beds (in and out of Doha), Total SCH HMC Figure 3. Growth in HMC and SCH Hospital Beds Outside Doha (by provider), 2-25 Hospital Beds Share Outside Doha Doha 2,243 2,243 3, Total 2,358 2,655 4,94 Table 8. Qatar Hospital Beds (in and outside Doha), % 5% 5.5% 5.9% % 5% % 4.9% Figure 33. Growth in Proportion of Qatar s Hospital Beds Outside Doha, 2-25 Figure Percent Reduction in OPD No-Show Rates, HMC Figure Percent Reduction in OPD In-Clinic Waiting Times, HMC Figure Percent Increase in OPD Patient Satisfaction Rates, HMC

26 26% HMC Cuban Hospital 87 Beds, Dukhan 2 SCH SML Hospital 2 Beds, Ras Laffan 3 HMC Al Khor Hospital 5 Beds, Al Khor 2 Figure 3. Qatar s Population (in and out of Doha), 2 4.9% Outside Greater Doha Greater Doha 5.5% 74% 5.9% American Hospital 2 Beds, Doha 2 Sidra Medical and Research Center 4 Beds, Doha 3 Aspetar Qatar Orthopaedic and Sports Medicine Hospital 55 Beds, Doha 4 HMC Communicable Disease Hospital 5 Beds, Doha 5 HMC Ambulatory and Minimally Invasive Hospital 64 Beds, Doha 6 HMC Heart Hospital 5 Beds, Doha 7 HMC New Women s Hospital 62 Beds, Doha 8 HMC Women s Hospital 343 Beds, Doha 9 HMC Hamad General Hospital 63 Beds, Doha Al Emadi Hospital 225 Beds, Doha Al Ahli Hospital 2 Beds, Doha 2 HMC Rumailah Hospital 659 Beds, Doha 3 HMC National Center for Cancer Care & Research 76 Beds, Doha 4 HMC Physical Medicine and Rehabilitation Hospital 2 Beds, Doha 5 Doha Clinic Hospital 5 Beds, Doha 6 SCH SML Hospital 2 Beds, New Industrial Area, Doha % % % SCH SML Hospital 2 Beds, Messaied 2 HMC Al Wakra Hospital 2 Beds, Al Wakra Outside Greater Doha Greater Doha Figure 32. Qatar s Hospital Beds (in and out of Doha),

27 Primary Health Care PHCC Center Satisfaction In 22, PHCC center visitors were: extremely satisfied with the quality of services available ; satisfied with the range of medical specialties available ; three-quarters will re-visit PHCC centers in the future; three-quarters will recommend the visited PHCC clinic to others; General Practice Services General practice services were rated among the most popular by current and potential PHCC visitors. Dental Clinics Dental clinics were also rated among the most popular by current and potential PHCC visitors; PHCC enhanced standard dental referral protocols; communicated the new referral protocols to all dentists; modified dental record systems; and introduced dental appointments and allocation to patients time slots to complete treatment; Geographical Access Generally speaking, visitors were satisfied with the proximity of PHCC centers. The number of SCH and PHCC centers outside Doha will grow by 69 percent by 25. The proportion of SCH and PHCC centers outside Doha will be 52 percent by 25. Extremely likely 46 Somewhat likely Neither likely nor unlikely 33 Somewhat unlikely Extremely unlikely 7 3 Likelyhood to revisit Extremely likely 43 Somewhat likely Neither likely nor unlikely 33 Somewhat unlikely Extremely unlikely 8 4 Likelyhood to recommend Figure 34. Recommendation and Return Results, PHCC, 22 PHC Centers Growth (%) 23-5 Share Outside Doha Doha Total Table 9. SCH and PHCC PHC Centers (in and out of Doha), Total SCH 3 9 PHCC Figure 35. Growth in SCH and PHCC PHC Centers outside Doha (by provider), % PHCC Al Shamal Center Al Shamal 2 PHCC Al Ghuwairiya Center Al Ghuwairiya 3 PHCC Al Ghuwairiya Center Al Ghuwairiya 4 PHCC Al Daayen Center Al Daayen 5 SCH SML Center Ras Laffan 6 SCH SML Center Zekreet 7 PHCC Al Jumailiya Center Al Jumailiya 8 PHCC Umm Salal Center Umm Salal 9 PHCC Umm Salal Center Umm Salal PHCC Al Kaaban Center Al Kaaban PHCC Al Khour Center Al Khour PHCC Al Jama a Center Doha 2 PHCC West Bay Center West Bay 3 HCC Omar Bin Khattab Center Omar Bin Khattab 4 PHCC Rowdat Al Khail Center Doha 5 PHCC Center Al Sadd, Doha 6 PHCC Al Waab Center Doha 7 PHCC Madinat Khalifa Center Madinat Khalifa 8 SCH SML Center Doha 9 SCH SML Center Doha SCH SML Center Doha PHCC Mesaimeer Center Abu Hamour 2 PHCC Al Wafideen Center Al Wafideen 3 PHCC Al Wafideen Center New Mamoura 4 SCH SML Center Um Saimir, Doha 5 PHCC Al Shahania Center Al Shahania 6 PHCC Montazah Center Montazah 7 PHCC Umm Ghuwalina Center Umm Ghuwalina 8 PHCC Al Nuaim Center Al Nuaim 9 PHCC Abu Bakr Al-Sidiq Center Abu Bakr Al-Sidiq 2 PHCC Al Gharafa Center Al Gharafa 2 PHCC Airport Center Airport 22 PHCC Al Roda Center Al Roda 23 PHCC Muaither Center Muaither 24 SCH SML Center New Industrial Area, Doha PHCC Al Karaana Center Al Karaana 2 PHCC Al Karaana Center Al Karaana 3 PHCC Al Wajbah Center Al Wajbah 4 PHCC Abu Nakhla Center Abu Nakhla 5 PHCC Al Rayyan Center Al Rayyan 6 PHCC Al Wakrah Center Al Wakrah 7 SCH SML Center Messaied 47.6% Outside Greater Doha Greater Doha Figure 36. SCH and PHCC PHC Centers (in and out of Doha),

28 Laboratory Services Quality Governance Patient Feedback and Empowerment Up to 7 percent of medical decisions may be based on laboratory results [2]. Respondents to the 22 PHCC Study rated laboratory services among the most vital. SCH developed a Laboratory Integration and Standardization Strategy to prevent undesirable service duplication and gaps; and implementation will begin in 23, across clinical, nonclinical and biomedical research laboratories. Pharmaceutical Services The quality of, and access to, pharmaceutical services and products is essential for the quality of care, and patient safety. Respondents to the 22 PHCC Study rated pharmacy services among the most vital. In 22, the SCH: initiated the development of Qatar s Pharmaceutical Product Track and Trace System, for imported drugs, from manufacture to dispensing; identified pharmaceutical products currently in use, reporting that only 4, of 8, registered products are available in the market; published the revised national approved list of registered products; drafted legislation on pharmaceutical products pricing control; drafted legislation for the registration of medical devices, laboratory and diagnostic kits, and combating counterfeit medicines; worked to implement a GCC-wide electronic system for the submission of applications for drug registration; worked to establish a Qatar National Formulary; established a Community Pharmacy Steering Group to set the direction for community pharmacies in Qatar; and made plans for a Community Pharmacy Strategy to be produced in 23. This will identify ways to increase the public s choice of when, where and how to obtain medicines. In 22, the HMC: opened a third satellite pharmacy, a dispensary in an HGH OPD clinical area, to improve efficiency and patient experience; around 5 percent of around 32, monthly HGH OPD prescriptions are now dispensed from its three satellite pharmacies; and planned for the number of HGH OPD satellite pharmacies to double in 23. The SCH developed performance agreements mandating reporting and key performance indicators across all providers: work will be completed in 23; national clinical guidelines will be developed in 23; clinical care pathways will be developed in 23; and standards for referral and discharge procedures will be developed in 23. Quality and Patient Safety Promotion The SCH promoted concepts of quality and patient safety nationally (to providers and health educational establishments), and internationally. Providers SCH commissioned two publications on quality and safety; conducted meetings with educational institutions; developed a 23 online patient safety program to enhance provider knowledge and skills; and planned an international Healthcare Quality and Patient Safety Conference for April 23. Health Educational Establishments SCH conducted meetings with educational institutions; and developed plans to introduce WHO patient safety curriculum into existing curricula. International Arena SCH hosted the Patient Safety Technical Session of the 22 World Health Assembly (WHA); and received approval to its request to add Patient Safety into the 23 WHA Agenda. The SCH, HMC and PHCC enhanced patient feedback on quality: PHCC conducted 732 user interviews for its 22 PHCC Study; SCH developed Qatar s first National Healthcare Consumer Survey, to collect views from 6, users in 23; and HMC developed a Patient Experience Survey Questionnaire for roll-out in 23. SHI Impact on Quality and Access The 22 SHI progress will improve quality and access by: linking performance indicators to provider payments; introducing competition between public and private providers; providing information on patient activities; enhancing access to services to the entire population; providing access to all providers; and providing a generous benefit package. Optimal Private Sector Involvement The SCH, HMC and PHCC involved the private sector to gain from private sector efficiencies: Cuban Hospital being operated by the private sector; 3 SCH Hospitals for private sector operation by 25; 6 PHC centers for private sector operation by 25; 2 MC units/centers for private sector operation by 25; SCH commenced the development of a Private Sector Involvement Strategy, to identify areas for optimal private sector involvement; and will develop a Private Sector Engagement Strategy for effective public-private communications. Laboratory, West Bay Primary Health Center, PHCC Pharmacy, Madinat Khalifa Primary Health Center, PHCC 54 55

29 Medical Technology Research The availability of advanced medical technology was reported as the fourth most important by 22 PHCC Study respondents; 9% of Qatari nationals reported this as the single most important factor. Current PHCC visitors are satisfied with the availability of advanced medical technology at PHCC clinics. HMC opened a state-of-the-art cancer diagnosis and research PET-CT centre in 22. Information and Communication Technology (ICT) Effective ICT improves service quality by connecting all stakeholders: SCH developed an iphone/ipad application with a global positioning system feature, which will help the public to: locate health care facilities and practitioners; evaluate and give feedback on practitioners; enable practitioners to communicate with departments; host a complaint portal; and host a drug formulary. built its capacity for a national E-Health strategy by 23; and will introduce electronic health cards between 23 and 24, as part of SHI implementation. HMC and PHCC began the implementation of a new clinical information system, Cerner Millennium, to digitize and standardize HMC and PHCC processes: 65 percent of design stage complete (6 staff involved) full design due early 23 (98 percent international best practice fit); system build stage scheduled for completion in May 23; testing phase/go-live planned in HMC and PHCC for early 24; and full implementation scheduled for 26. HMC e-business Project s first two modules went live in September. Modules in human resources and payroll will be launched in 23. PHCC implemented an automated enterprise risk management system to anticipate future adverse events and take action. Healthcare Data Healthcare data and intelligence form the basis of evidence-based policy, and monitoring services. SCH published the first statistical Qatar Health Report (QHR); prepared the second QHR; will develop QHR 2 and 22, in 23; and developed proposals for an SCH National Health Observatory, a central source of healthcare data and intelligence. Research Governance Research improves the effectiveness and quality of health care. The SCH continued its work on governing the ethical conduct of research in Qatar. SCH ensured coordination of national research activities; encouraged research in underserved areas (e.g. public health and community-based research); 5 external and local institutional assurances were granted; developed a Human Subject Law; developed a policy on research data and biological samples use; developed a Use of Embryonic Stem Cells in Research Strategy; and commenced the development of a manual for the auditing and inspection of Qatari Institutional Review Committees. SCH launched Qatar National Cancer Research Strategy [22]; and commenced an environmental carcinogens study. HMC s QNRF research xx grants increased by 7.3 percent since 2 [23]; developed a Joint Appointments process, for its physicians and senior nurses to be appointed as faculty members at Weill Cornell Medical College or the University of Calgary Qatar; convened a Joint Institutional Review Board; opened a PET-CT facility for cancer research etc.; began the development of a Neurosciences Institute; and completed proposals for the Translational Research Institute. PHCC developed proposals for a PHC Research Plan for 23. 4, 2,, 8, 6, 4,,845,673,633,78 2, 2 22 Figure 37. Growth in QNRF Research Grants, HMC, 2-22 Launch of the SCH Qatar National Cancer Research Strategy,

30 4.2 IMPROVING FACILITIES 4.3 IMPROVING PROFESSIONALS Just over 6 percent of visitors to PHCC centers rated modern facilities as extremely important in ultimately deciding where to go. The work of SCH, HMC and PHCC for increasing the quality of healthcare facilities has focused on regulation, as well as renovation and construction of state-of the-art buildings. National Facility Regulation SCH processed 2 percent more preliminary approvals for private facilities, 2 22; made plans for a national and international accreditation system, for healthcare providers in Qatar by 24; developed plans for a national healthcare quality policy; and developed plans for an appropriate regulatory framework. International Facility Accreditation SCH supported private hospitals with international accreditation: 3 of the 4 private hospitals signed contracts with an international accreditation body; and The fourth hospital is selecting an international body. All HMC facilities currently meet the internationally recognized standards for quality of care, as set by the Joint Commission International. The following HMC services were successfully reaccredited in 22: National Center for Cancer Care and Research; Hamad General Hospital; Women s Hospital; Rumailah Hospital; Al Khor Hospital; and the Home Healthcare Service. PHCC is engaged in the preparatory process for assessment under the internationally recognized quality standard Accreditation Canada International: completed Boot Camps, involving 2 members of staff; and undertook a full program of workshops designed to embed the principles of quality into everyday practice. Facility Renovation SCH developed renovation plans for its Central Food Laboratories. HMC developed plans for a major refurbishment of the existing OPD Annex Building to create a fully functioning and improved facility, with improved waiting areas and a cafe. PHCC completed the design and procurement initiation phases for the renovation of eleven existing health centers. Renovation of four centers will be completed within Figure 38 Growth in Preliminary Approvals for Healthcare Facilities, SCH, 2-22 Appropriate regulation of the medical workforce, and the development of the medical and administration workforce is key in supporting the future model of care. Almost 9 percent of visitors to PHCC centers rated the quality/expertise of medical specialists as extremely important [8]. Around 8 percent placed the same significance on the quality of nursing/auxiliary staff, and doctors reputation/qualifications. Workforce Regulation SCH processed 25 percent more clinician applications, 2-22; recorded a total of 9,8 licensed health practitioners; processed 3 percent more applications for verifications; annual negative or failed verifications remained stable (8 percent); annual practitioner licensing examinations remained stable; Professional Registration 2 22 Growth (%) Registration Applications 2,638 3,288 25% Verification Applications 2,46 2,487 3% Licensing Exams per month Table 2. Registration and Verification Applications Processed, SCH, 2-22 Regulation Policies SCH enabled Qatar to be accepted for membership into the International Association of Medical Regulatory Authorities; developed plans for all practitioner retrospective verification; disseminated a new dental specialty qualifications policy; established the foundation of Qatar Council for Health Practitioners; and drafted the associated legislation and by-laws. HMC became the world s second and the region s first hospital system to achieve institutional accreditation from the Accreditation Council for Graduate Medical Education International. 3,5 3, 2,5 2,,5, 5 2,638 3,288 Registration Applications , 2,5 2,,5, 5 Figure 39. Growth in Registration and Verification Applications Processed, SCH, ,46 2,487 Verification Applications

31 5. CONCLUSION Clinical Workforce Training SCH commenced the development of a national Workforce Plan to meet needs through education, training and skill-mix optimization; and introduced resident sponsorship for healthcare professional training. HMC formed a Medical Performance Management Committee to focus on medical job planning and appraisal; conducted a Clinical Care Improvement Training Program; worked with the University of Calgary in Qatar to deliver accredited Diploma and Bachelor Degree courses in nursing; and HMC s Nursing Strategy includes training Qatari nurse leaders. PHCC organized two training sessions on early cancer signs and symptoms, to reach the 48-hour referrals target (35 physicians); organized 2 training sessions on continuing medical education (around,8 physicians and allied health professionals); conducted 7 continuous professional development sessions (almost,3 physicians); and offered 45 physicians attendance to overseas scientific conferences. Non-Clinical Workforce Training SCH organized 74 training sessions (total,759 participants); offered scholarship opportunities; and established a Committee to enhance educational sponsorship. PHCC requires all staff to engage in an annual training program; offered customer service training to 25 newly-hired appointment clerks; and offered other non-clinical skills training, such as basic life support, cardiopulmonary resuscitation, and fire warden training. Throughout 22, SCH, HMC and PHCC persevered towards the future model of care, in spite of some of the world s fastest increasing demand, increasing expectations and changing lifestyles. They fulfilled all plans on system expansion. They opened 3 new facilities, and planned a further 3 facilities for They successfully supported significant growth in clinical workforce numbers (6 percent) and patient activity (up to more than 2 percent). The SCH, HMC and PHCC stayed on track with adapting the system, at all levels of care. They developed and implemented numerous awareness campaigns, screening programs, laws, procedures and guidelines. For instance, 22 witnessed Qatar s first breast and bowel cancer screening specifications, clinical services framework, pediatric kidney transplant, and transcatheter aortic valve implantation system. Service quality and access indicators improved significantly. There was a marked improvement in women s care coverage, hospital waiting times, average lengths of stay, and operation cancellations. All facilities have achieved, or are engaged in, international accreditation and re-accreditation. Four new organizations were developed further. SCH received Ministerial approval for a Food Safety Authority. It designed the National Health Insurance Company, and established the foundation for the Qatar Council for Health Practitioners. Plans were developed for a National Accreditation Body. The SCH, HMC and PHCC achieved many regional and international firsts. In 22, Qatari nationals were the most satisfied among nationals of 7 Middle East and North African countries. The SCH is successfully implementing GCC s first SHI Scheme. The HMC was awarded a regional Excellence in [Trauma] Surgery Services Award. Furthermore, they achieved many international firsts. The SCH published the world s first National Health Accounts with a new classification system. The HMC s hospital system became the world s second, and the region s first, to achieve institutional accreditation from the Accreditation Council for Graduate Medical Education International. This progress reflects the Leadership s greatest commitment toward better health care, through a record budget and timely guidance. Throughout 23, SCH, HMC and PHCC will deliver more impact for Qatar s people. Training Sessions, HMC and PHCC,