H.H. Sheikh Khalifa Bin Zayed Al Nahyan President of the UAE and Ruler of Abu Dhabi

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2 H.H. Sheikh Khalifa Bin Zayed Al Nahyan President of the UAE and Ruler of Abu Dhabi

3 H.H. General Sheikh Mohammed Bin Zayed Al Nahyan Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces

4 Contents Vision, Mission, Values Chairman s Message CEO s Message About HAAD Health System at a Glance Health System Improvements Public Health Highlights Investor Highlights Patients Satisfaction Key Performance Indicators Strategic Plan Strategic Plan Priorities Delivering HAAD's Strategic Priorities: Our Achievements 2009 Organization Public Health & Policy Division Health Regulation Division Health System Compliance Division Emergency & Disaster Management Department Corporate Affairs Department Corporate Support Services Department Facing the Challenges of Emirati Health Breast Cancer Awareness H1N1 Pandemic Sustainability 7 Contents

5 Shared Vision For The Health System Everyone has access to healthcare World-class quality care and outcomes Vision Full spectrum services Quality regularly monitored and published Predominantly independent and private providers Mandatory health insurance Flexible and efficient financial system 'Everyone has access to healthcare' 9 Vision

6 Mission Values Ensure reliable excellence in healthcare for the community We believe in fostering the development of creative, leading edge solutions and implementing technologies that enhance services and improve productivity 3. Respect & Compassion We believe that all people have the right to be treated with dignity We care about the individuals and communities we serve 4. Integrity We believe in honest, ethical and professional behaviour We believe in being sincere, open and truthful, fostering trust in relationships 1. Commitment to the Community We Serve We recognize our responsibility to the community in which we reside and serve We are committed to promoting wellness, preventing illness and fostering development of programmes and services appropriate to the community we serve We make decisions based on sound, ethical principles We honour our obligations 5. Accountability We believe in regularly reporting our performance to our stakeholders Role of Regulator We are committed to providing the highest standard of care delivered in a learning environment 6. Collective Wisdom of Teamwork & Collaboration We believe that communication, teamwork and partnership is essential Regulatory Authority Ensure excellent quality healthcare for the community Define the strategy for the health system and set Public Private Partnership roadmap Monitor & analyze the health status of the population and performance of the system Shape regulatory framework for the health system Encourage adoption of world-class quality & performance targets Plan capacities and service levels Drive programmes to improve societal health Define minimum standards for health service providers and health professionals Regulate scope of services and premiums & reimbursement rates of providers and payors 2. Pursuit of Excellence and Continuous Improvement We believe that exemplary, effective and accessible services are developed and achieved through research, education and the application of best evidence-based practice We believe that collaboration with our partners will achieve positive results We work towards common goals through open communication, mutual support and win-win attitudes We respect our differences and build on our strengths Inspect against regulations and enforce standards Mission Values 10 11

7 The Health Authority Abu Dhabi continues to implement our Strategic Plan for the development of the Abu Dhabi Health System, in alignment with the Government of Abu Dhabi policy agenda. Based on the vision of the late Sheikh Zayed Bin Sultan Al Nahyan (God bless him) and greatly supported by His Highness the President Sheikh Khalifa Bin Zayed Al Nahyan, and His Highness General Sheikh Mohammed Bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, we continue to build on the foundation established over the past 3 years. Chairman s Message Our major accomplishments of 2008 were focused on defining HAAD s role as the regulator which included the launch of THIQA - our comprehensive health insurance plan for all Abu Dhabi nationals, as well as establishing quality standards for regulation of healthcare facilities and professionals. On reflection of our achievements in 2009, we have fully implemented these initiatives with >95% of nationals living/working in the Emirate of Abu Dhabi enrolled in THIQA and >95% of expatriates legally living/working in the Emirate enrolled in health insurance plans with licensed providers. Using the established standards for regulating the system has resulted in tangible benefits for patients as these requirements are applied through regular HAAD quality audits of all healthcare facilities, and examination and licensure of healthcare professionals with over 90% of health professionals practicing in the Emirate of Abu Dhabi registered in HAAD. Having our base firmly established in 2008, our focus in 2009 was on further improving medical outcomes and public health. Mammography screening rates increased from 16% in 2008 to 67% in 2009, nearing the international best practice rate of 72%. Key activities to improve the public health of the population included improvements in development of programs to address Metabolic Syndrome, Road Safety, Breast Cancer Awareness, Occupational Health and Infectious Diseases, with implementation of community plans for H1N1 prevention and containment. I would like to take this opportunity to thank our partners and staff who have worked collaboratively and diligently to bring our strategic vision closer to reality. We look forward to continuing our development of a strong, sustainable healthcare system for the population of Abu Dhabi. H.E. Dr. Ahmed Mubarak Al Mazrouei Chairman, Health Authority - Abu Dhabi Dr. Ahmed M. Al Mazrouei Chairman 'We look forward to continuing our development of a strong, sustainable healthcare system for the population of Abu Dhabi.' 13 Chairman s Message

8 Since its formation in 2007, the Health Authority Abu Dhabi (HAAD) has set ambitious priorities for executing health system reform within the Emirate of Abu Dhabi. These priorities are clearly defined in our five-year strategic plan and are fully aligned with the Abu Dhabi Government Strategy Map. They have also been reflected in our balanced scorecard, which further translates and operationalizes our vision and strategy into ambitious targets we hold ourselves accountable for to our stakeholders. The HAAD corporate balanced scorecard guides all of our external reporting and internal performance management and defines the outcomes (access, customer satisfaction and better health) and the internal processes needed to achieve those outcomes. Looking back at the year 2009, I am happy to tell you that we have made significant progress against those priorities and targets. CEO s Message The outcome which we want to achieve is a system in which everyone has full access to healthcare (access) resulting in a healthy population (better health) trusting the system (customer satisfaction). Providing Affordable Access: Together with our partner DAMAN, we have completed the enrolment of all Nationals into the Thiqa programme in The addition of special programmes for orphans, the handicapped and prisoners have completed our universal health insurance programme so without exception everyone in the Emirate has access to quality healthcare. Improving Health: In managing the first renewal for Thiqa, we have expanded the Weqaya programme to now include screening programmes for groups at high risk for breast cancer. The screening programme has not only been embraced by our people, the media and even the arts (a film documenting the tales of survivors of breast cancer prepared by HAAD was screened at the Middle Eastern Film Festival) but has already started to save lives by earlier detection and better treatment. It therefore contributed to improving people s health. This past year has also provided new and unexpected challenges for the Health Authority. The international H1N1 pandemic serves as a reminder that new health challenges will continue to emerge. Our swift response to this challenge, whilst continuing our broad range of activities, illustrates our increasing level of maturity as an Authority and our level of preparedness and flexibility. H.E. Zaid Al Siksek Chief Executive Officer, Health Authority-Abu Dhabi 'The H1N1 pandemic serves as a reminder that new health challenges will continue to emerge.' 15 CEO s Message

9 CEO's Message Scorecard Satisfying Residents: In the end, patients need to trust the care that they receive. To monitor patient satisfaction, we have administered two comprehensive surveys across public and private providers in the Emirate, including the largest health satisfaction survey to date in order to develop baseline and recommended actions. In order to deliver the desired improvements in outcomes, we need to start with ourselves and improve the service delivery of the Health Authority having, more customer friendly processes and developing and nurturing our people. We have a strong internal performance management system on all of our initiatives in the strategic plan. Processes: To improve our processes in 2009, we launched our completely redesigned new service area which creates a single customer interface for all of your dealings with the Health Authority. We have successfully automated some of the most important customer facing processes for faster and easier service and better data capture, examples of which are the new and electronic visa screening and death notification forms. Employees: Our employees at the Health Authority are our most valuable asset as they create these processes and deliver the services to our stakeholders. I am happy to say that our heavy investments in training such as the innovative leadership programme we started in collaboration with Johns Hopkins School of Public Health to properly plan for succession to the next generation of leaders in healthcare is already bearing fruit. We will continue to strive for recruiting the best and offering them attractive and long-term career prospects. Looking ahead, I am personally excited about continuing the journey towards building a truly world-class health system guided by our strategic plan together with the support of our employees, our dedicated partners to the government in insurance and healthcare provision, existing and new investors from the private sector, and last but not least all healthcare professionals who are delivering the care to the patient. In closing, I wish to express my gratitude to our customers, partners, and employees for their unwavering commitment; our accomplishments past, present, and future are only made possible through their collaborative efforts. Zaid Al Siksek Chief Executive Officer, Health Authority-Abu Dhabi The balanced scorecard is a strategic planning and management system used to align business activities with the vision, mission and strategy. Used extensively in business and government, it allows management to improve internal and external communications, and monitor performance against strategic goals. It is a performance measurement framework that adds strategic non-financial performance measures to traditional financial metrics to give managers and executives a more 'balanced' view of organizational performance. CEO s Message CEO s Message 16 17

10 About HAAD HAAD s Role as a Regulator & Policy Maker Define the strategy for the health system and set public private partnership roadmap Monitor & analyze the health status of the population and performance of the system Shape regulatory framework for the health system Inspect against regulations and enforce standards Encourage adoption of world-class quality & performance targets Plan capacities and service levels Drive programmes to improve societal health Define minimum standards for health service providers and health professionals Regulate scope of services and premiums & reimbursement rates of providers and payers The Health Authority-Abu Dhabi (HAAD) is the government regulatory authority for health services sector in the Emirate of Abu Dhabi. Established in February 2007, The Health Authority-Abu Dhabi develops the strategy for the health system of the Emirate based on the directives of the Chairman of the Health Authority and the Abu Dhabi Government. HAAD is responsible for the licensing and inspection of all health professionals and healthcare facilities (public and private) in the Emirate. It regulates all hospitals, clinics and primary healthcare facilities, as well as health insurance providers. HAAD also drives programmes to increase awareness and adoption of healthy living standards among the residents of the Emirate in addition to regulating the scope of services, premiums and reimbursement rates of the health system. 19 About HAAD

11 Our People Organizational Chart 'We are here to serve your health needs' About HAAD About HAAD 20 21

12 Health System Overview 2009 Health System at a Glance Source: WHO Statistical Information System/World Health Statistics 2009, Public Health Department, and Health Facility Database. Population 1.9m residents, 21% Nationals Median age 19 for Nationals and 30 for Expatriates births and deaths Life expectancy 74.4 for men, 74.8 for women Provider doctors, nurses and5 630 allied health professionals in licensed facilities: 39 hospitals (3 621 beds) 572 centers and clinics 467 pharmacies and stores Payer 33 licensed insurers compete for members Encounter 11.6 million encounters 2% inpatient ( ) 42% by Nationals 43% by hospitals Financing There are now more insurance contracts (2.2m) than residents Claim 9.1 Million claims processed 98.8% of claims for outpatients 23 Health System at a Glance

13 Public Health Highlights Investor Highlights Population Abu Dhabi has grown rapidly in previous years, with likely temporary consolidation in in 5 residents are Nationals of whom 2/3 are under 30 and half under 19. Most expatriates are aged between 20 and 40. Expatriates are overwhelmingly male and of Asian origin. A significant share are employed in construction and accommodated in labour camps. The introduction of mandatory health insurance in 2007 provided all residents in Abu Dhabi access to high quality care. Residence status is generally contingent on being employed, so there are very few retirement age or unemployed expatriates. Mortality rates have also declined steadily over the past years. Infant mortality is now comparable with most other developed countries and the WHO recently reported a decrease in the under 5 mortality rate from 15 to 8 per live births between 1990 and 2007 across the UAE. In 2009, the diseases of Circulatory System are the number one cause of death, accounting for 24% of all death cases registered in the Abu Dhabi Emirate. External Causes of morbidity and mortality and Neoplasms are the second and third highest cause of death. Injuries: Abu Dhabi has one of the world s highest rates of injuries due to road traffic collisions. They account for 14.4% of all deaths and are the leading cause of death amongst young males. Fines for speeding, mandated use of seat belts and traffic safety education programmes are some of the actions being taken by government agencies to counter this problem. Communicable diseases Rates of childhood communicable diseases are very low, due to immunization programs targeting children aged <5 years. Expatriates are screened for communicable diseases before acquiring residence status. Non-Communicable diseases The Emirate has very high rates of chronic diseases related to lifestyle including obesity, diabetes, and cardiovascular disease. WHO reports obesity rates of 25.6% for males and 39.9% for females for UAE residents over 15-years-of-age. Without major changes, these rates are set to increase further as the population ages. Cardiovascular diseases already accounted for a quarter of recorded deaths in 2009, our biggest killer. Adult Nationals were screened for cardiovascular risk factors in 2008 as a condition for enrolment in Thiqa insurance. Individuals thought to be at high risk of cardiovascular disease are now being followed up. Cancer caused 13% of all recorded deaths in the Emirate in Breast cancer is the dominant cancer in Abu Dhabi. Late detection of breast cancer has historically lead to significant increases in mortality. Female adult Nationals aged are being screened for breast cancer as part of their Thiqa insurance renewal. Education and awareness campaigns plus subsidized screening have increased screening rates for all nationalities. Respiratory infections are the most common nonlife threatening condition in the Emirate, accounting for over 18% of all encounters across all healthcare facilities. Respiratory infections impact workforce productivity and quality of life. Population The population is largely on or nearby Abu Dhabi island. Areas of growth in the short to medium term are expected to be just off the island (Khalifa City A, Mohammed Bin Zayed City, the islands adjacent to Abu Dhabi island) and the oldest city Al Ain. At the end of 2009 there were 0.4m National Thiqa members, 0.9m governmentsubsidised Basic members and 0.86m Enhanced members. Demand for health services in the Emirate stabilised in 2009 with the exception of ER encounters following significant increases in 2007 due to the introduction of mandatory health insurance for Expatriates and Thiqa for Nationals in Significant growth in demand for services relating to chronic diseases, e.g. diabetes, is expected, with larger volume increases in outpatient settings. It is, however, estimated that there will also be aggressive growth in inpatient services relating to both diabetes and cancer. Supply Despite growth in the number of doctors available to residents, it is estimated that up to 5,000 additional doctors and 6,500 nurses will be required by If churn rates remain at their 2009 level, this will require some 1,600 doctors and almost 1,800 nurses to be recruited annually. There are productivity reserves within existing facilities, with average physician productivity in most hospitals lower than the US average. Demand for inpatient services may require up to additional beds within ten years beyond the current 3,660 beds. 57 hospitals with temporary licenses suggests there is likely to be significant future development and investment in this area. Capacity gaps: Overall bed occupancy rates vary significantly by facility, but have not increased in aggregate. Bed occupancy in ICU, NICU and PICU was consistently above optimal level of 75% throughout Reimbursement HAAD sets prices for the Basic product uniformly, adapted from the US-Medicare structure. Providers negotiate prices with Payers for Enhanced plans, generally as a multiple of up to twice Basic product rates. Thiqa is reimbursed at the level of Daman s most generous Enhanced plan. Price levels are weighted towards outpatient care. In line with this, demand growth has been in ER and outpatient services whilst inpatient service levels have remained relatively stable from accounting for <2% of all encounters. DRGs, anticipated in 2010, will likely increase inpatient reimbursement. Provider market Government-subsidized SEHA facilities provided 89% of all critical care bed days, treated 58% of all inpatients and 36% of all outpatients. Payer market Mandatory eclaims for all from January 2010 ( created a market for eclaims software. Health System 24 at a Glance 25 Health System at a Glance

14 Patients Satisfaction Key Performance Indicators 2009 Overall Outpatient Department Satisfaction Indicators Overall outpatient satisfaction 83% Willingness to revisit the hospital Willingness to recommend the hospital Waiting Time (In Waiting Room/Area) 75.0% Time Spent (Physician) 80.0% 92% 94% Service Delivery Service Delivery Process & Technology Key Performance Indicators (KPI) Baseline Actual Target Success % of all Nationals living/working in the Emirate of Abu Dhabi enrolled in comprehensive health insurance plan % of all Expats legally living/working in the Emirate of Abu Dhabi enrolled in health insurance plan with licensed health insurer % mortality data collected by major diagnostic categories & adjusted for comparability % of all hospitals beds managed by internationally experienced hospital groups 50% >95% 90% 90% >95% 94% 25% 90% 60% >40% 70 >40% % Satisfied Customers (Outpatient) 64% 83% 70% % of Nationals in workforce 21% 34% 22% % of services/processes automated 10% 80% 70% Attention of Physician 81.9% % of total initiatives executed as planned N/A 86% 80% % of outsourced services with SLA 100% 100% 100% Clarity of Communication 81.9% People Development % Satisfied employees 70% 73% 73% # of high level managers in the leadership programme N/A 25% 15% Explanation of Medical Condition (Physician) 81.7% Explanation of Test / Treatment Provision of Translation / Interpreter Services 82.0% 84.0% 95% Nationals have Comprehensive Health Insurance 95% Expatriates have Health Insurance Privacy 82.3% Instructions Provided 82.2% Satisfied 83% Customers 80% (Outpatient) Internal Processes Automated Source: Survey of 3133 outpatients from 8 public hospitals within the Emirate of Abu Dhabi 100% Facilities Audited Health System 26 at a Glance 27 Health System at a Glance

15 Strategic Plan Priorities Strategic Plan Fill Critical Gaps in Capacity and Insurance Coverage Improve Medical Outcomes Inspect & Control for quality Improve Health Professional Education Increase Emiratisation of Health Sector Improve Public Health Create Customer Transparency Pay-for-Quality Increase in Private Sector Investment 10. Be Prepared for Emergencies 11. Automate Internal Processes 12. Develop Quality Workforce & Plan Succession 29 Strategic Plan

16 Delivering HAAD s Strategic Priorities Our Achievements 2009 Priority 3: Inspect & Control for quality 1,310 audits conducted by Health Audit, Hospital & Clinics Section 1,061 audits conducted by Health Audit, Pharmacy Section Successfully conducted audit visits to all of the facilities under the management of SEHA 70 ambulances and medical transport units were approved this year (This includes new applications and renewals) 'Following the introduction of Thiqa, more than 95% of Nationals living or working in the Emirate are enrolled in a comprehensive health insurance plan.' Priority 1: Fill Critical Gaps in Capacity and Insurance Coverage Following the introduction of Thiqa, more than 95% of Nationals living or working in the Emirate are enrolled in a comprehensive health insurance plan Equally, more than 95% of all Expatriates legally living/working in the Emirate are enrolled in a health insurance plan with a licensed health insurer Priority 2: Improve Medical Outcomes 9,327 Health professionals in the Emirate are registered with HAAD, approximately 90% of those practicing in the Emirate Established a follow up system for diabetics identified through Weqaya. A telephone invitation, call Center and appointment booking system has been established for those screening positive for diabetes, resulting in over 7,000 appointments and 3,000 visits for newly diagnosed diabetics 5 Memorandums of Understanding (MOU's) signed Priority 4: Improve Health Professional Education 265 continuing medical education (CME) activities; 10,655 attendees to HAAD sponsored CME events; 2, accredited CME hours 4,866 candidates sat for written and oral exams Introduction of online examination Center 1st Abu Dhabi International Nursing Conference Priority 5: Increase Emiratisation of Health Sector Critical gap still exists for clinical staff but increasing capacity for training should improve direction over coming years For non-clinical/management staff, start of healthcare leadership programme (Dr.Ph-MPH) for 25 Nationals with Johns Hopkins School of Public Health Ongoing promotion campaigns to recruit talented Nationals Priority 6: Improve Public Health Metabolic syndrome: Over 180,000 Adult Nationals from Abu Dhabi screened for cardiovascular (CVD) risk factors Link of Thiqa to mandatory screening showed over 70% of adults to have at least one CVD risk factor Strategic Plan Strategic Plan

17 Delivering HAAD s Strategic Priorities Our Achievements 2009 Development of school canteen guidelines (in collaboration with Abu Dhabi Food Control Authority & Abu Dhabi Education Council (ADFCA & ADEC) focusing on healthy eating Policy & Standards Completed a comprehensive review of all HAAD Policies & Standards and Definitions, in collaboration with a U.S. accreditation body, and national and international specialist law firms Minimum standards for healthcare facilities (policies, codes of practice, guideline, etc) developed in conjunction with a U.S. accreditation body Completed a review of the Terms of Reference for Medical Boards and produced a revised policy as part of HAAD Policy Manuals Priority 7: Create Customer Transparency Defined the data standards for all relevant quality data and created the processes and incentives, for a continuous, and reliable, data flow Regular mandatory patient satisfaction surveys by HAAD successfully introduced Priority 10: Be Prepared for Emergencies Formation of HAAD Incident Command system and Major Incident Plan. Incident Plan for external incidents Health Information System (HIS) link to Operations Center providing live patient information Geographic Information System (GIS) mapping link with Abu Dhabi Systems & Information Center (ADSIC) Priority 11: Automate Internal Processes Launch of Visa Screening System, setting standards for the Visa Screening process Public Health Notifications for Births, Deaths, Infectious Diseases, Injury & School Health Screening/Vaccinations developed and piloted with healthcare facilities Establishment of systems for electronic notification and certification of births, deaths and diseases Fully automated insurance product approval process via internet Automation of HAAD back office processes Priority 12: Develop Quality Workforce & Plan Succession Quality Workforce: Investing in and improving the training of all staff through a comprehensive training catalogue linked to employee personal development plans Succession Planning: Launched formal planning effort to identify critical business roles and development needs for both incumbents and potential successors in these roles Road Safety: Launched Emirate-wide road safety campaign including in-depth crash investigation of more than 200 fatal and severe road crashes in the Emirate Prospective patients are able to map the locations of our healthcare facilities around the Emirate through the Find a Doctor/Clinic tool located on the HAAD website Breast Cancer Awareness Improved Outcomes: 98 breast cancers detected earlier through screening during 2009 Occupational Environment: Launched Emirate-wide heat management campaign: 465 Companies, 4,460 work sites, 815,000 heat-exposed workers, more than 1,794 labour camps covered, more than 77,600 educational items distributed Priority 8: Pay-for-Quality Increase transparency on levels of pay through standardized new basic price list implemented in Q1, 2001 Planned introduction of Pay-for-Quality through Diagnosis Related Groups in August licensed insurers compete in an open market Infectious Disease: Launched GCC-leading H1N1 campaign for community and schools and managed roll out of H1N1 vaccine campaign for Hajj Pilgrims, pregnant woman and healthcare professionals Vaccination Programme: Introduction of new vaccine to the Expanded Programme on Immunization (EPI) schedule (Hexavalent vaccine) at age of two months Priority 9: Increase in Private Sector Investment Total increase of 88 new private facilities HAAD Winner of Best Healthcare Management Service Strategy Award at Hospital Build 2009 and Highly Recommended for Best Facilities Management Service Strategy Award at Hospital Build 2009 Strategic Plan Strategic Plan

18 7% Congenital malformations, deformations and chromosomal abnormalities 7% Endocrine, nutritional and metabolic diseases 2% Injury, poisoning and cetain other consquences of external causes 25% Other causes or unknown Public Health & Policy Division 13% Neoplasms Organization 22% External causes of morbidity and mortality 24% Disease of the circulatory system Leading causes of death 2009 Mission The mission of the Public Health and Policy Division (PHPD) is to improve public health increasing the length and quality of life of the population of Abu Dhabi. The Division does this by insuring effective regulation of the health system, by driving the health agenda in nonhealth sectors, and by driving the safe and rational use of drugs and medical devices. Responsibilities PHPD seeks to deliver measurable improvements in length and quality of life across the entire population of Abu Dhabi. This is done through health promotion and disease prevention programmes and a broad range of evidence based interventions. Continuous surveillance of vital statistics and regular screening provide HAAD with world class epidemiological data which is routinely analyzed to drive public health intervention and health system reform. Disease prevention programmes drive for measurable health impact through the targeted use of public health interventions such as vaccination and screening, and the consistent promotion of healthy lifestyle choices. All public health programmes are monitored against clear targets to drive for impact and continuous improvement. In collaboration with relevant stakeholders, PHPD formulates health policies to help ensure reliable excellence in healthcare. This includes ensuring the safety and effectiveness of drugs and medical products, and traditional, complementary and alternative medicine. 35 Organization

19 Public Health & Policy Division The scope of work includes: Identification and prioritization of public health needs through rigorous surveillance Implementation of evidence-based programmes to address these priorities Development, perpetuation and evaluation of best practices in disease control, occupational and environmental health, and family and school health Enhancement of knowledge in order to permanently change behaviour and attitude through effective health promotion Formalisation of the research regulatory framework in collaboration with other UAE regulators, and development of a funding process to promote and sponsor research into Abu Dhabi s disease priorities in a safe and sustainable research environment Coordination with external stakeholders in the planning and implementation of public health interventions Monitoring and evaluation of results to ensure continuous improvement The Public Health & Policy Division has four departments: Public Health and Research Pharma/Medicines Policy and Standards Zayed Complex for Herbal Research Public Health & Policy Division External causes of mortality % 12% 8% Road Traffic Injuries (RTI) Occupational Injury 8% Home 4% 3% 2% Other Suicide Drowning Occupational RTI Injury Category Road Traffic Injury (RTI) Occupational Injury Home Suicide Occupational RTI Drowning Other Total Leading causes of death Gender and age Changes vs By Nationality Changes vs Causes Diseases of the circulatory system (-1) (3) UAE 139 (20%) (1) External causes of morbidity and mortality Injury, poisoning, and certain other consequences of external causes Neoplasm (11) (14) (5) (15) Pakistan India Bangladesh 137 (20%) 118 (17%) 63 (9%) (50) (-26) (-7) Congenital malformations, deformations and chromosomal abnormalities Endocrine, nutritional and metabolic diseases (21) (-11) (3) Egypt Other 40 (6%) 183 (27%) (8) (31) Other causes or unknown (-2) Total Note: Changes in reporting procedures may account for some differences between years. Source: Preventive Medicine Department reports, Public Health & Policy; Health Statistics Analysis. Source: Public Health and Policies, Health Statistics Analysis Organization Organization 36 37

20 Public Health & Policy Division Public Health & Policy Division Public Health & Research Department Current Public Health priority areas ( ) Based on the leading causes of death, the Division devised 10 priority areas. Road Safety Safety In Heat 1- Achievable impact combines number of patients affected, how serious the condition is, gap between current UAE performance and international best practice, and availability of evidence based intervention. 2- Extended Programme for Immunization. HAAD addressed six of these priority areas with major health promotion campaigns, here are two examples Road Death: The HAAD Road Safety Programme is focusing on: Improving road traffic injury data by utilizing and improving health and surveillance data and conducting, or facilitating, targeted surveys and research to close knowledge gaps Increasing awareness and educating highrisk populations, and the community, about the dangers of risky driving behaviours and promoting safe driving practices Supporting, planning and implementing road safety initiatives with proven or likely effectiveness, e.g. child car seat initiatives and use of seat belts Working in partnerships with all concerned stakeholders to improve road safety in the Emirate The HAAD DRIVE SAFE SAVE LIVES road safety campaign in 2009 focused on speeding and the use of seatbelts, specifically targeting young male drivers. Instead of using the standard scare and fear tactics seen in many other injury prevention campaigns, the HAAD Road Safety message was positive and inspiring using World Rally car driver, Sheikh Khalid Al Qassimi, as the spokesperson. The message encouraged common sense rather than creating emotional pressure as a way of changing behaviour. HAAD recognized that changing driver behaviour is a long challenging process and can t be achieved by campaigns and education alone - proper law enforcement and good road engineering is necessary to improve road safety in a significantly shorter period of time. HAAD s efforts in changing driver behaviour were recognized at the Gulf Traffic Conference where it was awarded Gulf Traffic Award 2009 in the category Road Safety Changing Driver Behaviour Award (Campaigns) for the campaign. The award recognized that the campaign addressed the most pressing issues, speeding and seatbelt usage, and built a broader awareness of the importance of driving safely and the value of human lives. Road traffic injury was the second-leading cause of death in the Emirate in Up to November 2009 there were 401 road traffic fatalities, mostly young adults, with UAE Nationals accounting for one out of four of them (25%). Speed and failure to use a seat belt or child safety seat were identified as the leading causes for fatal and severe road traffic injuries. Occupational Accident: HAAD Heat Management Programme: Safety In Heat was divided at over 465 companies, employing more than 800,000 workers at over 4,500 worksites and 1,800 labour camp sites. The campaign, carried out in collaboration with the Ministry of Labour, aimed to increase employer and worker awareness of heat stress and the need to prevent heat illness. The programme included the free distribution of training packs, DVD videos, over 63,000 worker and supervisors pamphlets, over 13,000 posters in five different languages, and HAAD water coolers for smaller companies. An online Thermal Work Limit calculator and training workshops were also provided. All materials were made available to any company that registered at Organization Organization 38 39

21 Public Health & Policy Division An evaluation of the programme amongst company representatives and HSE personnel indicated a 79.6%, very good to excellent level of satisfaction. They rated the response to the programme in the good, very good or excellent categories at 93.9% for management and business owners, 95.5% for HSE personnel and 93.8% for workers. Statistics from two large companies indicated a significant decrease in heat related cases in 2009 compared with 2008: Company A had a 79.5% decrease in cases (from 15.3 to 1.16 cases/1000 workers) and Company B had a 50% reduction in serious cases (from 0.08 to 0.04 cases/100,000 work hours). The campaign will be repeated annually in the lead upto summer. Subsequent campaigns will repeat the core content, but evolve the materials to maintain interest. They will include graphics from additional sectors, and will be issued in additional languages. E-Notifications Systems for Birth, Death, Intrauterine Fetal Death (IUFD), Infectious Diseases: Using Online Tools to Improve Services As part of our effort to improve the quality of data and to enhance and streamline the data capture process, the Division developed web-based applications to capture Birth, Death, Intrauterine Fetal Death and Infectious Diseases Data. The system was developed to increase the speed of data collection, mitigate reporting errors, and improve communication between healthcare workers and HAAD. The system performed very efficiently during the H1N1 pandemic. Where the previous manual reporting mechanism had a considerable time lag, the E-Notification system enabled healthcare workers to log on from any location and upload data immediately. Increased validation resulting in improved quality control Enforced coding and standardization Improved customer services Real time data analysis Public Health & Policy Division Pharma/Medicines Department Poison and Drug Information Center The Poison and Drug Information Center (PDIC) improves pharmaceutical care by providing accurate and easily accessible, poison and drug information to the general public and the healthcare community. The number of enquiries in the general public increased in This can be attributed to the following reasons: The Center produced 13 brochures, in Arabic and English, addressing important health issues The Center launched a new website in June 2009 In co-operation with SEHA, the Center s toll free number was distributed to the public through a SEHA medication safety campaign One of the most important tasks of the division is to improve medication safety awareness among healthcare professionals in order to promote rational, and safe, use of medicines. In 2009, the number of safety issues communicated to healthcare professionals increased due to our continuous, daily, monitoring of international regulatory agencies, such as the Food and Drug Administration (FDA) and Center for Disease Control (CDC) in the USA, the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK and Therapeutic Goods Administration of Australia (TGA), amongst others. Safety information from these agencies is filtered according to relevance and then communicated to healthcare professionals in the following ways: for safety alerts Toxic Drug Info (quarterly newsletter) Web/fax for Health Advisories Medication Safety Issues Communicated to Healthcare Professionals Organization Organization 40 41

22 Public Health & Policy Division Public Health & Policy Division In an effort to improve patient safety and prevent harm from exposure to toxic agents, the Center conducted three surveys covering a wide variety of agents presenting potential risks for toxic exposure or abuse. These included: cough and cold household products herbal weight reduction products 110 locally available cough and cold products were screened for the appropriateness of the package (outer and inner), the correctness of the label information and the safety of ingredients. Two products were withdrawn from the UAE market. Key ingredients in the most commonly available household products were assessed. The Center is creating a referral database and developing guidelines for packaging. Quality Control Quality Control is the regulation section for pharmaceutical medicines and medical products. It is responsible for setting policy standards and guidelines for pharmaceuticals used in the Emirate and running a variety of related programmes and initiatives. Quality Control is involved in the listing of medical devices for all government subsidiary programmes in the insurance scheme. Section representatives sit on many committees, including vaccine committees and the Continuing Pharmacy Education committee. Pharmacovigilance programme The Pharmacovigilance programme (PV), launched in 2008, assesses the benefits, harm, effectiveness and risk of medical products and encourages their safe, rational and more effective use. PV safety monitoring covers Conventional medicines (prescription & nonprescription) Herbal and Traditional medicines Vitamins and Minerals Biotechnology products i.e. vaccines, serums and blood derived products Medical devices In 2009, the PV programme was extended to include all private hospitals in Abu Dhabi and Al Ain. Hospitals in PV Programme Private Public 2009 activities During 2009, work on the rational medicine use programme continued through outreach with various hospitals, medical Centers and clinics. A reporting mechanism covering adverse reactions and medication errors was launched and the PV programme collaborated with the Federal Ministry of Health on a unified, UAE-wide reporting system. Partnerships with international drug regulatory agencies were forged so that information on drug safety monitoring could be shared. HAAD Quality Control Laboratory HAAD is establishing a Quality Control Laboratory for drugs in Abu Dhabi. Construction has begun and the laboratory is expected to be operational by the middle of Policy & Standards Department A comprehensive review of all HAAD Policies and Standards was initiated, in partnership with a U.S. accreditation body, leading healthcare providers in the Emirate and national and international specialist law firms. This review aims to produce consolidated and integrated policy manuals that spell out the regulatory requirements across the full spectrum of health services. They will include the requirements for facilities, clinicians, health insurance provider and all other health services in the Emirate. A major part of this review was completed in 2009 with three policy manuals delivered. A fourth manual will be finalized in January Public and stakeholder consultations are planned for early 2010, with implementation workshops to be held from February to April The revised policies and standards in the manuals reflect global best practice, assuring that HAAD policies are transparent, evidence and risk based, able to be complied with and most importantly that they will remain relevant and effective over time. They will encourage the healthcare sector to deliver world-class care. Zayed Complex for Herbal Research The Research Center was conceived by the late Sheikh Zayed Bin Sultan Al Nahyan, the founder of the United Arab Emirates. His Highness felt that, in spite of all recent modern healthcare developments, there was a need for a Research Center to study herbal and traditional therapies. The Zayed Complex for Herbal Research and Traditional Medicine (ZCHRTM) was established in The Complex is unique in that, under one roof, it has traditional systems of medicine examined with modern scientific research tools and methodology. Using the work of the Complex, the Health Authority- Abu Dhabi is taking a leading role in the world wide investigation of herbal medicines. The Zayed Complex is actively involved in generating knowledge about new herbal treatments and verifying old traditions regarding the therapeutic properties of local medicinal herbs. These discoveries are made available for clinical use and further research for validation and documentation. Researchers from the Zayed Complex have been involved in many seminars on the advancement of the science of herbal and traditional medicine, and their cooperation has been sought by different international agencies. Organization Organization 42 43

23 Health Regulation Division Health Regulation Division Mission To ensure the provision of quality healthcare and protect and preserve the health, safety and welfare of the population of the Emirate. The Division implements health policies, laws, regulations and standards for healthcare facilities, professionals and health insurance companies, and also manages the treatment of UAE nationals abroad. Responsibilities The division promotes the provision of quality and safe healthcare by ensuring the highest standards as it manages all licensed activities of healthcare professionals, healthcare facilities and health insurance entities operating in the Emirate. The scope of work for this division includes: To provide fair, consistent and timely processes for those applying for a license or registration and maintain accurate records of licences and registrations issued To provide objective, efficient and timely processes for addressing allegations involving health professionals licensed by the Authority and develop proactive policies and procedures designed to address issues of concern To promote continuous development of health professionals to address current and emerging issues of the healthcare industry To provide the public with information and educational resources regarding the licensing, regulation and practice standards of health professions To collaborate with stakeholders to explore issues impacting the supply, training and employment of healthcare professionals To protect the public by promoting quality care through programmes, to license and certify healthcare professionals, facilities and providers To identify and promote professional standards for the highest quality healthcare To determine acceptable internationally recognized standards for the services of Health Insurance Providers and to implement these standards To set the general rules for reimbursement between providers and insurance companies, and the prices at which providers get reimbursed for the basic insurance product The Health Regulation Division (HRD) has four departments: Health Professionals Licensing Department International Patient Care (IPC) Health Insurance Regulation Department Health Facilities Licensing Department Health Professionals Licensing Department Professionals Licensed 2009 Total Alternative Medicine Clinical Support Services Professionals Licensed Nursing Pharmacy Physicians & Dentist Total Hospital Clinic Polyclinic Rehabilitation Center Center Diagnostic Center Provision of Health Service Office Pharmacy Store Total Hospitals Clinic Center Office Pharmacy Store Source: Public Health Department & Health Facility database Organization Organization 44 45

24 Health Regulation Division Continuous Medical Education and Professional Development: Total Accredited CME Hours Health Regulation Division Health Facilities Licensing Department To ensure the quality of healthcare professionals working in the Emirate is world class and to secure reliably high standards of healthcare services, HAAD requires, as a condition of their license renewal, all physicians, dentists, pharmacists and nurses to undertake continuous education. Similar conditions will in the near future, be applied to all other members of healthcare teams. ALL FACILITIES 1130 Hospital 40 Center 107 Polyclinic 187 Clinic All Facilities Licensed Provision of Health Service Rehabilitation Center 61Store 107 Center International Patient Care (IPC) IPC is responsible for ensuring appropriate international care is provided to UAE Nationals who are unable to find suitable care within the Emirate. It refers patients for treatment abroad or to private hospitals and medical centers in other Emirates. Applications for international treatment are considered by the Medical Committee which bases assessments on a thorough knowledge of the services available within the Emirate and abroad. Pharmacy 407 Provision of Health Service 11 Store 61 Office 5 Rehabilitation Center 98 Diagnostic Center Polyclinic 407 Pharmacy 201 Clinic Diagnostic Center Hospital Office When a patient is sent abroad IPC manages the arrangement of tickets, transportation and accommodation for the patient and a legal escort. If necessary an ambulance aircraft is provided to transport the patient to the country of treatment. Health Insurance Regulation Department: Insured Population Thiqa Basic Enhanced During 2009 Health Facilities Licensing began licensing new medical services including: Mobile Health Unit (single and multiple), Dialysis Center, Provision of Health Services (Health consulting services & hospital management, Employing/Transferring medical staff, Home Care Services, Medical Professional Development, Medical Transport service and Patient Escort services) Facilities Licensed Note: Source: Dec 2006 Dec 2007 Dec 2008 Dec 2009 Some numbers may be inflated, as cancellations during the year are not reflected. Payer submissions; some insurance data not available. 0 Total Center Clinic Hospitals Pharmacy Store Source: Public Health Department & Health Facility submissions Organization Organization 46 47

25 Health System Compliance Division Health System Compliance Division The Division s scope of work covers all public and private healthcare institutions and providers in the Emirate of Abu Dhabi. It monitors compliance with all applicable healthcare regulations and standards which includes but is not limited to: Clinics & Hospitals Audited 2009 Audit Type (Incl Adhoc & Pending Results) Number Ad Hoc (Private) 5% Ad Hoc (Public) 5% New Licensing 11% Maintaining effective auditing and monitoring systems and protocols to evaluate compliance with federal laws, HAAD rules and regulations, other international standards New Licensing 148 Licensing Renewal 534 Follow up Audit 499 Ad Hoc Audit 42% Facilitating and building patient satisfaction and trust in the healthcare system Ad Hoc (Private) 68 Ad Hoc (Public) 61 Mission Clinical reviews/investigations and complaints management to investigate, respond to and prevent identified compliance problems, including establishing appropriate and coordinated corrective action measures Total Audit Visits 1310 Follow up Audit 38% Licensing Renewal 41% The Health System Compliance Division safeguards the health and safety of the public by ensuring that legal requirements and professional standards of practice are maintained by healthcare providers. Responsibilities The Division enforces rules and regulations for healthcare providers (HCPs) and healthcare facilities (HCFs) to ensure that healthcare is provided in an ethical and professional manner, and in compliance with approved standards. HSCD audits healthcare facilities to monitor compliance with applicable rules and regulations and conformance to approved standards. Establishing and maintaining communication feedback process to disseminate findings Developing disciplinary guidance and appropriate criteria to respond to improper or illegal activities in healthcare facilities, and to carry out enforcement actions against facilities that have violated laws, regulations, and healthcare programme requirements and approved standards The Health System Compliance Division has two Areas: Health Quality Audit Department It also investigates complaints about health care providers compliance and violations. Clinical Reviews and Investigation Section Health Quality Audit Department Auditing public and private facilities During 2009 the Health Quality Audit Department focused on the public sector and conducted audit visits to all of the facilities under the management of SEHA. The Department conducted ten audits of Primary Healthcare facilities to ensure that Weqaya screenings were implemented and that they met all nominated criteria. In 2010 the focus will be on the private sector. Top 5 reasons for classifying healthcare facilities as disapproved : 1. Infection prevention standards and control practices guidelines were not met 2. No maintenance of the medical equipment or quality control and calibration materials 3. Improper medical records keeping 4. Clinical practice guidelines not met 5. Not performing facility regular and preventive maintenance, and not observing fire and safety standards in the facility Organization Organization 48 49

26 Health System Compliance Division Pharmaceutical Facilities Audited 2009 Audit Type (Incl Adhoc & Pending results) Number New facility 63 Licensing Renewal 417 Ad Hoc Audit 441 Follow up Licensing 140 Total Audit Visits 1061 Ad Hoc Audit 42% Follow up Licensing 13% New Facility 6% Licensing Renewal 39% Health System Compliance Division Special Projects Audit Visits to Assess H1N1 Preparedness The Division was heavily involved in the H1N1 assessment for all healthcare facilities and many unannounced visits were conducted to assess the situation. An intensive programme of visits to public schools was undertaken with 31 visits in just one month. These visits were made to ensure H1N1 preparedness in schools. Checklist Approval The Health Quality Department developed new checklists for healthcare facilities which are being tested. The Department is organizing a workshop with all healthcare facilities to discuss these new checklists. Standards The introduction of Hospital Standards, Continuum of Care Standards and Ambulatory Care Standards to the healthcare sector has driven enhanced compliance. HAAD standards and regulations are being widely implemented by HCFs. the auditing of visa screening Centers. All SEHA operated Centers were audited and detailed reports provided. Prescription Only Medicine Campaign The campaign aimed to educate the public about Prescription only Medicine (POM), warn of the dangers of self medication and convince people to see a physician before taking prescription only medicines. Follow-up auditing revealed a decrease in POM violations to 30%. Publishing an Awareness Raising Booklet In 2009 HSCD published a guide for parents on the rational use of antibiotics: The Do Bugs Need Drugs booklet combined: Visa Screening In addition to the regular Audits, on the request of the Public Health Division, the Health Audit team undertook 1. Material prepared by Do Bugs Need Drugs - Canada which is a community education programme to address the problem of antibiotic resistance in Canada. 2. Artwork painted by students in Abu Dhabi schools. The chosen pictures were all drawn by UAE nationals. Clinical Review and Investigations Section A proactive campaign to increase public awareness about the complaint system and why it is important to lodge complaints, was conducted using posters in healthcare facilities and pharmacies. To shorten the review time for complaints and to obtain unbiased decisions in clinical reviews, the Clinical Reviews and Investigation team signed two contracts with international consultancy companies. The maximum review time is now between 10 and 20 days. Calls Received Top 5 reasons for classifying pharmaceutical care facilities as disapproved : 1. Cleanliness and neatness 2. Inappropriate storage of medicines 3. Contravention of laws, regulations, or policies 4. Incorrect handling of controlled drugs 5. Damaged or expired items Local reviews, conducted with consultants, used to take between six and eight weeks. Now, due to the systematic approach learned from the international companies, typical reviews only take ten days. In line with our continuous efforts to ensure the quality of care in the Emirate of Abu Dhabi, cases of medical negligence are reviewed by an external committee, and there is an established system to refer these cases to the newly formed Disciplinary Committee for appropriate action. Organization Organization 50 51

27 Emergency & Disaster Management Department Corporate Affairs Department Build sufficient capacity to handle critical patients in emergencies Test personnel, plans and capabilities periodically; Establish clear emergency communication protocols and structures by which HAAD is directed, controlled and held to account. It defines the governance framework, specifying key governance bodies, reporting arrangements and an authority matrix. This structure determines how HAAD works, and is directed, day to day. One of HAAD s most important roles is to ensure that the Emirate s health sector is properly prepared for emergencies, disasters and other high risk events such as epidemics. To fulfil this role HAAD has an Incident Command structure modelled on similar systems in the U.S. and UK. To ensure preparedness HAAD maintains stockpiles of drugs and vaccines at strategic sites and maintains surveillance systems to detect and monitor emergencies. It monitors all healthcare resources to ensure sufficient capacity to cope with emergencies and maintains a communications network linking frontline services. These include emergency departments, ambulance services, search and rescue and hazmat teams, voluntary agencies and other relevant facilities including mortuaries. During an emergency, HAAD s Incident Command team, using the 24-hour Operations Center, mobilizes health resources, prioritizes patient management, and coordinates healthcare facilities, medical responses and public communications. Ensuring proper preparations When Emergencies occur In the event of an emergency, healthcare providers, blood banks, mortuaries must comply with all HAAD directives, provide treatment, prophylactic measures, provide assistance and advice as requested by HAAD. During 2009 HAAD coordinated the response for one major biological incident, the H1N1 flu pandemic, and 39 other incidents including serious road traffic accidents, airport incident standbys, fires and other emergencies. It also took part in nine multi-agency drills. During these incidents and drills the efforts of almost all major hospitals and health care centers in the Emirate were coordinated. Multi-agency coordination and cooperation included drills with the Ministry of Health (MOH), the Abu Dhabi National Oil Company (ADNOC), the Abu Dhabi Health Services Company (SEHA), the National Crisis and Emergency Management Authority (NCEMA), the Abu Dhabi Airports Company (ADAC), the Abu Dhabi Systems & Information Center (ADSIC), and the Environment Agency. During the year capabilities were added to the physical infrastructure: The Incident Management System was linked to Hospital Information Systems for live, real-time, information A Geo-spatial Information System, with the use of digital mapping for managing incidents and planning, was activated Training of medical disaster management administrators continued throughout The Corporate Affairs Department provides organizational development, manpower resource planning, and change management support. It also develops and maintains management tools and systems, including relevant manuals. In 2009 the Department delivered the Corporate Governance Manual which describes the processes The Department also delivered the Code of Conduct, which sets out the core standards of conduct expected of all HAAD staff whether at the corporate office or in the regions. It provides staff with a systematic guide on how they should approach their work and the decisions they have to make. A third major document, The Organization Function Manual describes the organizational relationships within HAAD and the principles underlying its structure. The objective is to establish clarity of purpose for each organizational unit, and provide guidance to each unit on how to undertake their roles and responsibilities. Each unit s role is clearly defined with activities and responsibilities detailed. The nature of relations between the different organizational units within HAAD are also described to ensure smooth and effective channels of communication. Healthcare facilities comply with HAAD s Standard for Emergency & Disaster Management and Business Continuity. They are required to: Be designed, constructed or retro-fitted to be disaster-resilient Conduct a Hazard Vulnerability Analysis (HVA) and plan to overcome vulnerabilities Develop a plan for managing critical operations and ensure operational continuity HAAD signed a service level agreement with the Abu Dhabi Systems and Information Center (ADSIC) to facilitate the sharing of geo-spatial data among government agencies and other stakeholders. The SLA fulfilled HAAD s commitment to the Abu Dhabi Spatial Data Infrastructure (AD-SDI), an initiative of the government of Abu Dhabi, administered within the Abu Dhabi Systems and Information Center (ADSIC) e-government programme. Organization Organization 52 53

28 Corporate Support Services Department Mission Corporate Support Services engages in a continuous cycle of action and analysis to deliver innovative support to the Health Authority with the goal of providing for all Human Capital needs from day-today job requirements (IT & Procurement/General Services) to attracting and developing competent highly productive employees (HR). Responsibilities Corporate Support Services supports operational excellence by developing performance measurement processes that drive continuous improvement and effective use of the potential of information technology. Its scope includes: Providing expertise on human resource issues and meaningful analysis and reporting for management decision-making Developing programs and services that empower employees and involve them in the business Developing and implementing best practice services in HR, IT, Procurement and General Service Ensuring equitable and competitive terms and conditions of employment, assisting in the effective management of resources and supporting institutional compliance and customer service Managing timely, efficient and cost effective provision of critical support services (procurement, inventory management, office services and housing services) Planning and coordinating the supply, commissioning, preparation and maintenance of information technology resources and services Providing services and technical support to manage shared data Ensuring the security of IT systems and data right people having the right access to the right programs and data The Corporate Support Services Department has three sections: Human Resources IT Services Procurement and General Services 2009 saw a number of HR initiatives and programs demonstrating HAAD s commitment to its employees. Events HAAD participated in the three-day NAJAH Exhibition, providing hundreds of potential employees with information about HAAD and the opportunities available. This event also allovwed HAAD to for share its messages on Breast Cancer Awareness, Road Safety and other public health programs. An employee recognition program, Mumtaz/Bravo, was launched, recognizing the contributions of two outstanding employees each month. Awards are given at bi-monthly staff meetings which also feature CEO briefings and presentations from Section Heads. Developement In pursuit of excellence and continuous improvement, Human Resources revised rating criteria in appraisal forms and processes and included a mid-year appraisal to supplement year-end evaluation. In addition to its programme of job specific training, HAAD offered two special training opportunities to all employees, Mind Mapping and Emotional Intelligence. Mind Mapping helps employees sort out complex issues and participate in brainstorming sessions. Emotional Intelligence helps facilitate better interactions between colleagues and customers. Human Resources completed a review and update of all job descriptions, changing remuneration including basic salaries, supplemental allowances and housing allowances. This was undertaken to ensure that HAAD remained competitive in the labor market. Corporate Support Services Department Employee Feedback In line with HAAD s commitment to creating an open and desirable working environment, CSS conducted a year end Satisfaction Survey and a mid-year PULSE survey. The improvement recorded across many key sections demonstrated HAAD s willingness to listen and take action. The Satisfaction Survey covered work questions and the 6 Core Values of HAAD. Overall satisfaction reached 81% with more than 85% safisfied with HAAD Values. In addition to the marked improvement in satisfaction ratings, there was a decrease in overall dissatisfaction from 11% to 7%. Pulse VS YE Survey Largest Improvements from PULSE Survey Demographics 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00% 60.00% 55.00% 50.00% % Overall Satisfaction Question Top 3 Scoring Questions from PULSE vs. YE Scores 94.00% 92.00% 90.00% 88.00% 86.00% 84.00% 82.00% 80.00% 78.00% +1.9% My immediate manager treats me with respect & dignity % I receive regular and timely feedback on my job performance I am comfortable raising and issue with my team if I feel strongly about it In 2009 HAAD s staff turnover remained below 10%. In line with HAAD s commitment to a diverse workplace, the number of male employees remained constant while the number of females increased. At the end of the year, HAAD employed 143 UAE Nationals, representing 35% of the total employees % I can see the relationship between what I do and the goals of where I work % % My supervisor recognizes when i do a good job +2.64% My immdiate manager listen to my concerns and suggestions YE Pulse YE Pulse Organization Organization 54 55

29 Facing the Challenges of Emirati Health Overview 1. The problem 2. The team 3. The initiatives 4. The achievements 5. The future Emirati Health: Breast Cancer Awareness 1. The problem Breast cancer is the leading cause of cancer death in much of the developed world. One in eight women will develop breast cancer during their lifetime. Every year in Abu Dhabi, over 130 women develop breast cancer and many do not seek treatment until it is too late. As a result 44% of cases in Abu Dhabi are fatal within 5 years of first diagnosis compared with 15-20% in best-practice countries. In order to reduce the number of fatal cases we are using the most effective means of detecting breast cancer, mammogram screening. In 2007 the mammogram screening rate for women over 40 was just 12% compared with around 70-80% in best practice countries. In 2007 HAAD set up a breast cancer programme to increase screening and reduce breast cancer mortality. The Global Initiative for Breast Cancer Awareness was launched in Abu Dhabi in November 2007 in partnership with Susan G. Komen for the Cure and the Institute of International Education, under the auspices of the National Higher Committee for Breast Cancer and the patronage of HH Sheikha Fatima Bint Mubarak. The Initiative brought Komen s proven Course for the Cure to Abu Dhabi. 57 Facing the Challenges

30 Emirati Health Breast Cancer Awareness Emirati Health Breast Cancer Awareness 2. The Team HAAD drove the programme, working with SEHA and other healthcare providers to provide facilities, equipment, staff and training. HAAD s approach, based on global best practice, is simple and practical, yet rigorous: a. Driving uptake: Women across the Emirate are encouraged to screen (including Breast Self Examination, Clinical Breast Examination and Mammograms). HAAD covered and or subsidized the cost of screening with health insurance and government revenues. b. Delivering world-class capacity: New screening facilities, providing world-class equipment, staff and training, were supplied. Enforcement included making screening a systematic part of the health checks undertaken for the National Health insurance program 'Thiqa'. The HAAD team worked intensively with healthcare providers, including them in the online appointment booking engine which increased usage of otherwise under-utilised facilities. Healthcare providers were given regular feedback with a newsletter. Training of healthcare professionals on all aspects of screening as well as treatment and post-surgical care was undertaken and monthly data from healthcare providers collated in the Breast Imaging Reporting and Data System (BIRADS). HAAD set up programme teams in each of the Emirate s three regions with the goal of raising awareness and training volunteers from local communities. 3. The Initiatives The teams began work in mid 2008, encouraging, enabling and enforcing women, communities and healthcare providers to take action. Encouragement included opportunistic screening. For example when mother took her child for a vaccination, she was invited to have a screening or given information on the benefits of screening, breast examination or book a mammogram. A documentary Healing & Hope was made using local survivors telling their own stories ( A television advertisement was also made and shown. Enabling included a website through which women could book screenings or for information. It also hosts videos for survivors and self examination stories. Nationals who had not been screened were also telephoned and invited to come in to be screened. A call center was also set up at the number A series of health promotion campaigns were also undertaken. Snapshot of HAAD breast cancer website and appointment booking system: found at Any trademarks featured remain the property of their respective owners Facing the Challenges Facing the Challenges

31 Emirati Health Breast Cancer Awareness Emirati Health Breast Cancer Awareness 4. The Achievements Mammogram Screening rate The mammogram screening rate was the key performance indicator used by the breast cancer team. We saw an increase in the screening rate from 12% in 2007 to 16% in 2008 and, to date, a screening rate of 67% in 2009, comparable with the rates seen in best practice countries. Number of Mammogram Screenings Education & Awareness Campaign The Breast Journal Award Breast Cancer Team Initiatives Website & Mini Campaign - April 2009 Healthcare provider regular communication - January 2009 Community Awareness - December 2008 Earlier discovery The number of late stage cancers discovered declined from 64% of total discoveries in 2007 to 56% in 2008, an indication that problems were being discovered earlier. With the significant increase in screening rates, it is expected that late stage detection will reduce significantly in coming years. As a result the proportion who can have breast conserving treatment is expected to increase. Mortality from breast cancer October Campaign 2007 October Campaign 2008 Changes in overall mortality rates take years to appear. We can predict that of the 88 lives predicted to be lost from breast cancer every year in Abu Dhabi, 40 lives (45% of the total) will be saved due to increased screening and early detection. These are 40 mothers, sisters and daughters who will be able to spend many more years with their families. Recognition The work of the HAAD breast cancer team has been presented at International Conferences including the American Public Health Association meeting in Philadelphia, and the 15th Multidisciplinary Symposium on Breast Cancer, where it received the prestigious Breast Journal Award. The team has been invited to present at future meetings of the Global Initiatives to tackle breast cancer. 5. The Future Over the next year, the breast cancer team will be working to: increase screening rates, ensure consistently excellent care and Centers of excellence in Abu Dhabi and developing standards and care pathways. In our campaign to raise screening rates we will focus on improving services in remote areas. This will be achieved through a mobile unit operating from Tawam Hospital in Al Ain and a new screening facility in Al Gharbiya Region. Facing the Challenges Facing the Challenges

32 H1N1 H1N1 Response 1. The Challenge Pandemics, the spread of infectious diseases throughout the world, have existed throughout history. Today due to easy international travel, they can spread quickly. Aware of the threat, HAAD has made preparations. An influenza outbreak in Veracruz, Mexico, was identified as a new strain of H1N1 influenza virus in April. It rapidly spread around the world and, in June, the World Health Organization (WHO) declared the outbreak to be a pandemic. H1N1 is typically contracted by person to person transmission through respiratory droplets. Those with more severe symptoms or those in an at risk group may benefit from antivirals. Overview 1. The challenge 2. Preparation undertaken 3. New virus identified 4. Pandemic phase 5. Achievements 6. The future 63 H1N1 Response

33 H1N1 Response H1N1 Response 2. Preparations Undertaken HAAD s preparations included a response network and a stock of antiviral drugs. In collaboration with international authorities, training sessions were held. Hospitals were instructed in pandemic flu preparedness. Receiving hospitals in all regions were identified, a management plan was put in place, and a stockpile of antiviral drugs was created. A network of stakeholders was established and a capacity building plan drawn up. 3. New Virus Identified When the new virus was identified in April, HAAD alerted all hospitals. A command team was established and the HAAD Operation Center was put on 24/7 high alert. Hospitals were instructed to implement their pandemic flu plans and a website provided H1N1 information for healthcare workers and the public. Educational materials were prepared and distributed. Increasing the level of surveillance, health care teams were deployed in ports of entry and thermal scanners were placed in airports. Passengers arriving from infected countries were screened and screening cards were distributed to airlines. The Sheikh Khalifa Medical City (SKMC) laboratory was designated as the diagnostic center, and health care personnel were given special training. All suspected cases were hospitalized, isolated and managed as inpatients. Front line personnel at ports of entry, those working in emergency medical services, airports and airlines were also trained and educational materials were produced and distributed. 4. Pandemic Phase On June 11, WHO declared H1N1 to be the first global pandemic of the 21st Century. HAAD immediately put all health care facilities on high alert, activated hospital plans, stepped up surveillance and increased laboratory capacity. Daily reporting on critical cases admitted to ICUs began and training for healthcare workers, school nurses and safety officers, was accelerated. On June 14 a public awareness campaign began with information in the media and campaigns in malls, government departments and mosques. A dedicated vaccination campaign for the Haj was conducted and HAAD, working with the Abu Dhabi Education Council (ADEC) launched an education programme for parents, students and teachers in the Emirate s schools. 5. Achievements The overall handling of the H1N1 pandemic was widely praised. There were no shortages of supplies, adequate facilities were available at all times, and there were no public panics. The effectiveness of HAAD s public information efforts were recognised by the Middle East Public Relations Association (MEPRA) which highly commended the effectiveness of the campaign. 6. The Future The process of handling the H1N1 pandemic has strengthened the capacities of the Emirate s health care system. HAAD has carefully documented this process and is in an excellent position to contribute to the control of any future pandemics. H1N1 Response H1N1 Response

34 Sustainability Environmental Sustainability HAAD began environmental conservation initiatives in 2008 taking a variety of measures to reduce the use of energy, fuel, water, and paper. The results of these activities are still being quantified, therefore 2009 data will be the baseline for measuring HAAD s environmental footprint in future reports. HAAD added 86 employees in 2009, taking the total number of staff to 285. Despite that increase significant improvements were made in consumption levels. HAAD s 2009 conservation achievements include: Successfully reduced electricity use by 34.5 %. Utility meters to measure water and electricity use installed Separate AC for computer server room installed. This reduced the need to cool the entire building Signs above all electricity switches to remind staff to turn lights off Conservation campaign displayed on LCDs throughout HAAD offices, encourages staff to reduce water, electricity, and paper consumption Carpooling in HAAD vehicles whenever possible. Drivers reminded to turn off engines while waiting Disconnect/lower the ACs, and all lights switched off, after business hours. 67 Sustainability

35 Sustainability Sustainability Environmental KPI Overall 2008 Consumption 2008 Consumption /Staff Overall 2009 Consumption 2009 Consumption /Staff Difference Difference /Staff Target Initial Achievements Initial Achievements /Staff Social KPI Performance % change 2009 Targets Electricity use (KW) Water use (Litres) 5,490,256 27,589 5,148,230 18, ,713-9,525-10% -7% -34.5% 19,468,350 97,830 22,306,281 78,255 28,377-19,575-10% +14.5% -16% UAE National employment 21 % 36.2 % % 22 % UAE Women employment 32 % % % 34 % Employee Satisfaction N/A 73 % N/A 75 % Printer/ Copier paper (Kg) Printer/ Copier Cartridges Note: 4.5 Litres equals 1 gallon % +10% -20% % +10% -24% Planned environmental initiatives: Green building standards for new buildings. HAAD plans to build four new buildings in the near future: a training Center, a data Center, a vaccine store, and a new mortuary Improved mileage tracking of HAAD's vehicles in order to measure and reduce vehicle emissions of greenhouse gases. HAAD's vehicle data will appear in the HAAD 2010 annual report Reduced paper consumption. Guidelines for circulating electronic copies only and limiting printouts HAAD began recycling paper in July Paper recycling is being tracked and will be compared with total paper use Social sustainability initiatives at HAAD: A training assessment programme to increase the skills and knowledge of all HAAD employees. This programme is designed to target specific needs of individual employees based on their current competencies and future objectives An annual employee satisfaction survey is conducted to identify opportunities to increase employee retention Provision of the 9 Essential Public Health Services to staff to reduce the burdens caused by chronic illness, infectious disease, or injuries Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate and empower people about health issues Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts. Enforce laws and regulations that protect and ensure safety. Assure a competent public health and personal healthcare workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems. Sustainability Sustainability 68 69