Health Care System in Kuwait

Health Care System in Kuwait
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Contents
F O R E W O R D ............................................................................................................... 3
1 E X E C U T I V E S U M M A R Y ........................................................................................ 5
2 S O C I O E C O N O M I C G E O P O L I T I C A L M A P P I N G ...................................................... 7
2.1 Socio-cultural Factors .................................................................................. 7
2.2 Economy .................................................................................................... 7
2.3 Geography and Climate ............................................................................... 9
2.4 Political/ Administrative Structure............................................................... 10
3 H E A L T H S T A T U S A N D D E M O G R A P H I C S ............................................................. 12
3.1 Health Status Indicators ............................................................................ 12
3.2 Demography............................................................................................. 14
4 H E A L T H S Y S T E M O R G A N I Z A T I O N .................................................................... 17
4.1 Brief History of the Health Care System ...................................................... 17
4.2 Public Health Care System ......................................................................... 17
4.3 Private Health Care System........................................................................ 21
4.4 Overall Health Care System ....................................................................... 22
5 G O V E R N A N C E /O V E R S I G H T ............................................................................... 25
5.1 Process of Policy, Planning and management.............................................. 25
5.2 Decentralization: Key characteristics of principal types ................................ 26
5.3 Health Information Systems....................................................................... 32
5.4
5.5 Health SystemsMechanisms
Accountability Research........................................................................... 35
........................................................................ 36
6 H E A L T H C A R E F I N A N C E A N D E X P E N D I T U R E ..................................................... 37
6.1 Health Expenditure Data and Trends .......................................................... 37
6.2 Tax-based Financing ................................................................................. 39
6.3 Insurance ................................................................................................. 39
6.4 Out-of-Pocket Payments ............................................................................ 40
6.5 External Sources of Finance ....................................................................... 41
6.6 Provider Payment Mechanisms................................................................... 41
7 H U M A N R E S O U R C E S ........................................................................................ 42
7.1 Human resources availability and creation .................................................. 42
7.2 Human resources policy and reforms over last 10 years............................... 44
7.3 Planned reforms........................................................................................ 45
8 HEALTH SERVICE DELIVERY.................................................................................... 48
8.1 Service Delivery Data for Health services .................................................... 48
8.2 Package of Services for Health Care ........................................................... 49
8.3 Primary Health Care .................................................................................. 50
8.4 Non personal Services: Preventive/Promotive Care...................................... 51
8.5 Secondary/Tertiary Care ............................................................................ 53
8.6 Long-Term Care ........................................................................................ 55
8.7 Pharmaceuticals........................................................................................ 55
8.8 Technology............................................................................................... 55
9 HEALTH SYSTEM REFORMS ..................................................................................... 57
9.1 Summary of Recent and planned reforms ................................................... 57
10 ANNEXES........................................................................................................ 60
11 REFERENCES ..................................................................................................... 1
Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

List of Tables
Table 2.1 Socio-cultural indicators
Table 2.2 Economic Indicators

Table 2.3 Major Imports and Exports
Table 3.1 Indicators of Health status
Table 3.2 Indicators of Health status by Gender and by urban rural
Table 3.3 Top 10 causes of Mortality/Morbidity
Table 3.4 Demographic indicators
Table 3.5 Demographic indicators by Gender and Urban rural
Table 6.1 Health Expenditure
Table 6.2 Sources of finance, by percent
Table 6.3 Health Expenditures by Category
Table 6.4 Population coverage by source
Table 7.1 Health care personnel
Table 7.2 Human Resource Training Institutions for Health
Table 8.1 Service Delivery Data and Trends
Table 8.2 Inpatient use and performance
F OREWORD
Health systems are undergoing rapid change and the requirements for conforming to the
new challenges of changing demographics, disease patterns, emerging and re emerging
diseases coupled with rising costs of health care delivery have forced a comprehensive
review of health systems and their functioning. As the countries examine their health
systems in greater depth to adjust to new demands, the number and complexities of
problems identified increases. Some health systems fail to provide the essential services
and some are creaking under the strain of inefficient provision of services. A number of
issues including governance in health, financing of health care, human resource
imbalances, access and quality of health services, along with the impacts of reforms in
other areas of the economies significantly affect the ability of health systems to deliver.
Decision-makers at all levels need to appraise the variation in health system
performance, identify factors that influence it and articulate policies that will achieve
better results in a variety of settings. Meaningful, comparable information on health
system performance, and on key factors that explain performance variation, can
strengthen the
Comparison of scientific foundations
performance across ofcountries
health policy
and at international
over time can and national
provide levels.
important
insights into policies that improve performance and those that do not.
The WHO regional office for Eastern Mediterranean has taken an initiative to develop a
Regional Health Systems Observatory, whose main purpose is to contribute to the
improvement of health system performance and outcomes in the countries of the EM
region, in terms of better health, fair financing and responsiveness of health systems.
This will be achieved through the following closely inter-related functions: (i) Descriptive
function that provides for an easily accessible database, that is constantly updated; (ii)
Analytical function that draws lessons from success and failures and that can assist
policy makers
forward in the formulation
recommendations to policyof makers;
strategies;
(iv) (iii) Prescriptive
Monitoring function
function that that brings
focuses on
aspects that can be improved; and (v) Capacity building function that aims to develop
partnerships and share knowledge across the region.
One of the principal instruments for achieving the above objective is the development of
health system profile of each of the member states. The EMRO Health Systems Profiles
are country-based reports that provide a description and analysis of the health system
and of reform initiatives in the respective countries. The profiles seek to provide
comparative information to support policy-makers and analysts in the development of
health systems in EMR. The profiles can be used to learn about various approaches to
the organization, financing and delivery of health services; describe the process, content,
and implementation of health care reform programs; highlight challenges and areas that
require more in-depth analysis; and provide a tool for the dissemination of information
on health systems and the exchange of experiences of reform strategies between policy-
on health systems and the exchange of experiences of reform strategies between policy-
makers and analysts in different countries. These profiles have been produced by
country public health experts in collaboration with the Division of Health Systems &
Services Development, WHO, EMRO based on standardized templates, comprehensive
guidelines and a glossary of terms developed to help compile the profiles.
A real challenge in the development of these health system profiles has been the wide
variation in the availability of data on all aspects of health systems. The profiles are
based on the most authentic sources of information available, which have been cited for
ease of reference. For maintaining consistency and comparability in the sources of
information, efforts have been made to use as a first source, the information published
and available from a national source such as Ministries of Health, Finance, Labor,
Welfare;
informationNational
is not Statistics
available Organizations or reports
from these sources then of national surveys.
unpublished In from
information case
official sources or information published in unofficial sources are used. As a last resort,
country-specific information published by international agencies and research papers
published in international and local journals are used. Since health systems are dynamic
and ever changing, any additional information is welcome, which after proper
verification, can be put up on the website of the Regional Observatory as this is an
ongoing initiative and these profiles will be updated on regular intervals. The profiles
along with summaries, template, guidelines and glossary of terms are available on the
EMRO HSO website at www.who.int.healthobservatory
It is hoped the member states, international agencies, academia and other stakeholders
would use the information available in these profiles and actively participate to make this
initiative a success. I would like to acknowledge the efforts undertaken by the Division of
Health Systems and Services Development in this regard that shall has the potential to
improve the performance of health systems in the Eastern Mediterranean Region.
Regional Director
Eastern Mediterranean Region
World Health Organization
1 E XECUTIVE S UMMARY
Kuwait occupies the northwestern corner of the Gulf. It is bound in the east by the Gulf
and in the southwest by Saudi Arabia and in the north and the east Republic of Iraq,
with short
with a totalcool
land area of 17818 square kilometers. The climate is intensely hot summer
winter.
The 2003 estimates showed total population to be 2,484,334 of national and non-
national (nationals constitutes about 37% of the total population estimate). The
population growth is estimated to be 3.36% in 2004. The population is distributed in 6
governorates with highest density in Hawelli (686,421 persons which represent 27.6% of
the total population). Kuwait is nearly completely urbanized with 97% of its population
living in urban area, with universal access to safe water and sanitation.
Kuwait is a small, rich, relatively open economy with proven crude oil reserves of about
98 billion barrels: 10% of world reserves. Petroleum accounts for nearly half of GDP,
95% of export revenues, and 80% of government income. Kuwait's climate limits
agricultural development. Consequently, with the exception of fish, it depends almost
wholly on food imports. In 2003 the GDP per capita estimated to be $18,100.
Kuwait is a country with small number of population, which gives good opportunity for
employment. The labor force accounted to 1.3 million in which 80% of them are non-
Kuwaitis. Unemployment was estimated to be 7% in 2002; these are mainly for short
period of time.
Great emphasis has been placed on education as a means for economic development.
Based on WHO/EMRO Country Statistical Profiles for 2003 the adult literacy rate was
91%. Thein female

universal which, itliteracy rate for
accounted was reported
100% 89%
as well thatsecondary
as the year. Primary education
level for is
both male
and female. With the high literacy rates in Kuwait, women have full participation in all
aspects of socio-economic activities including public and private sectors. However,
women have yet to be given the right to vote.
According to Ministry of Health, life expectancy for the Kuwaiti population (no available
data for non-Kuwaiti) at birth is 78.7, for males77.8 and for females79.9 in 2003. The
infant mortality rate is 9.4 in 2003, and under-five mortality rate 11.8 per 1000 for males
and 10.9 per 1000 for females.
Maternal mortality per 100 000 live births was 9.1 in 2003. Crud birth rate 17.7 per
1000, while crud death rate 1.8 per1000, and the total fertility rate in 2003 accounted to
2.2.Total population access to health services were 100% in 2003. There was no urban–
rural gap since over 95% of the population is urban.
Food is available in abundance and is affordable to all sections of the population.
However, there is evidence of under-nourishment, and some studies have reported a
significant evidence of anaemia, especially among young girls. Overweight and obesity
are significant health risk factors in Kuwait with a high prevalence especially among the
Kuwaiti element of the population.
Substantial epidemiological transition happened in regards of infectious and
communicable diseases. This is could be attributed to socioeconomic development, and
rapidly changing lifestyles. There were no reported cases of cholera, diphtheria, polio
and tetanus in 2000. The number of malaria reported cases was 233 in 2001. There
were a total of 111 of reported cases of tuberculosis in 2001. The cumulative reported
(to WHO) number of AIDS cases by the end of 2004 is 87 and that of HIV cases is 1019.
With the decrease in the incidence of communicable diseases and the increase in life
expectancy, the burden of disease has shifted towards non-communicable diseases and
injuries. Trends are showing steady increases in the incidence of coronary heart disease,
cancer and accidents and injuries (mainly road traffic accidents). In addition to this many
risk of ill health are showing alarmingly high prevalence; for example, diabetes, obesity,
dislipidemia and physical inactivity. Various national groups and communities have been
set up to tackle these problems. We anticipate that specific targets with plan of actions
to achieve target will produced. Mental disorders also represent a major public health
problem and in particular among non-Kuwaiti. The extent of somatization is not known,
but it is expected to be high in such a mixed population.
In 2003 the percentage of infants immunized against DPT was 98%, polio 98% and
measles was 99% with 100% vaccination coverage against HBV. These high coverage
rates could be attributed to the efforts of the MOH in reaching mothers, better provision
of knowledge and improved awareness of the public on diseases.
Both public and private sectors provide health and medical care, with primary health
care being provided by the public sector. All Kuwaitis have access to primary health care
services. There are 74 PHC throughout the state across 6 health regions that provide
polyclinic
100% services. females,
of pregnant Accordingtrained
to the health
Ministry of Healthattend
personnel data, all
antenatal carearound
births and is provided
98% to
of
the children were fully vaccinated. In 2003, the manpower rates per 10 000 population
were 19 for medical doctors, 3 for dentists, 2.6 for pharmacists, 40 for nurses and mid
wives, 21 for hospital beds and 3 for PHC units.
Kuwait is still relying and will continue to rely for many years to come on non-Kuwaiti
health professionals to support the expanding health system. The variation in quality is
huge and a system of recruitment to minimize variation is urgently needed. It will take
sometime before such a variation could be overcome.
Secondary care is provided through six regional hospitals with 2500 bed capacity. In
addition to this these are 9 specialist hospitals including maternity, infectious diseases,
mental health and cancer hospitals bringing the total beds available to 4575, with total
bed occupancy around 60 percent. These hospitals consume the largest proportion of
the public health budget, despite moderate bed occupancy and high pressure on primary
care services.
Despite the substantial improvement in health, the focus is still on programs of
expanding hospital services in both public and private sector. This is a costly in the long
term. The priority should be focused on reducing ill health and the burden of diseases
through programs that secure the health of the whole population. This can not be
achieved without shifting resources from curative to public health activities including
prevention of chronic diseases and reducing the risks of ill health.
Kuwait does not depend on external assistance for the financing of its health sector.
Kuwait is a net donor of funds for supporting the health sector of other Islamic countries
in the Region.
6
2 S OCIO E CONOMIC G EOPOLITICAL M APPING
2.1 Socio-cultural Factors

Table 2-1 Socio-cultural indicators
Indicators 1990 1995 2000 2002
Human Development Index: - 0.813 0.837 0.844
Literacy Total: 81.51 86.51 89.81 90.90
Female Literacy to total literacy: 72.08 79.40 84.30 85.90
Women % of Workforce 17.7 21.3 24.6 25.64

Primary School enrollment 70.89 71.32 - -
% Female Primary school pupils 48.37 48.93 - -
%Urban Population 94.92 95.53 96.01 96.17
Source: ªEastern Mediterranean Regional Office Database: reports from member states
Almost all of the population of Kuwait are Muslims, half being Sunni Muslims and a third
Shi'ite Muslim. There are small Christian, Hindu and Parsi communities, as well as other
Muslim groups. Roman Catholic, Church of England, Armenian, Greek, Coptic and Syrian
Orthodox churches cater for the expatriate communities.
On the eve of the Iraqi invasion, the United Nations Development Program placed
Kuwait at the top of its annual human development index with a life expectancy of 73.4
years, an adult literacy rate of 73 percent, and a real per capita gross domestic product
of US$15,984.
Kuwait has put large funds into its educational system, and it is also of high standard.
The general level of education among the population is high, and this applies to both
sexes. Education is free and compulsory for all. Kuwait has one university, with 15,500
students, the Kuwait University. Around 2,000 Kuwaitis study abroad. Kuwait's level of
illiteracy is seriously addressed by the government, and there are centers for schooling
of adults, attended by about 2% of the total population.
Great emphasis has been placed on education as a means for economic development.
Based on WHO/EMRO Country Statistical Profiles for 2003 the adult literacy rate was
91%. The female literacy rate was reported 89% that year. Primary education is
universal in which, it accounted for 100% as well as the secondary level for both male
and female. With the high literacy rates in Kuwait, women have full participation in all
aspects of socio-economic activities including public and private sectors. However,
women have yet to be given the right to vote.
2.2 Economy
Key economic trends, policies and reforms
Kuwait is a small, rich, relatively open economy with proven crude oil reserves of about
98 billion barrels: 10% of world reserves. Petroleum accounts for nearly half of GDP,
95% of export revenues, and 80% of government income. Kuwait's climate limits
agricultural development. Consequently, with the exception of fish, it depends almost

wholly on food imports. In 2003 the GDP per capita estimated to be $18,100.
With its vast reserves of oil and massive overseas investments, Kuwait's economy has
strong fundamentals that are the envy of many. Even in times of sluggish growth, the
continual trade and government revenue surpluses mean that there is enough liquidity
to ensure economic activity, although the fact that Government plays such a large role in
the country's economic activity is also one of its structural deficiencies. Oil accounts for
95% of Government revenues, 91% of export earnings and 50% of GDP.
However, with the oil markets at their current levels, and the removal of the former Iraqi
regime, confidence, private investment and activity have returned to the Kuwaiti
economy with real vigour. During 2003, the Kuwaiti economy recorded one of its best
years, which is continuing throughout 2004. GDP grew by 4.6%, the budget surplus
equalled 18% of GDP, the stock market rose by over 80%, private companies are awash
with profits and there is also a construction boom.1
employment. The labor force accounted to 1.3 million in which 80% of them are non-
Kuwaitis. Unemployment was estimated to be 7% in 2002; these are mainly for short
period of time.
There are few other sources of income for Kuwait than petroleum production, and
income from the country's investments abroad. The foreign investments come from a
fund that is based upon 10% of oil revenues. Industries of Kuwait are connected to
petroleum, and Kuwait is refining its oil. Agriculture and food production is limited, and
make up less than 2% of GNP. Fishing is becoming more and more important, and is at
the level of 9,000 tons annually. The infrastructure in the eastern part of Kuwait is well
developed, and comprise 4,700 km of roads, and an international airport near Kuwait
City.
Table 2-2 Economic Indicators
Indicators 1990 1995 2000 2002
GNI per Capita (Atlas method)current US$ - 18,200 16,280 16,340

GNI per capita( PPP) Current International - 20,110 $18,720 17,870
GDP per Capita - 14,738 12,586 11,598
GDP annual growth % - -2.18 -0.08 -3.28
Unemployment % - - 0.8 7
External Debt as % of GDP* 43.8
- 23.9 37.1
(98)
(98)
Trade deficit: - - - -
Source: *Economist intelligence unit limited 2004, Country profile 2004
Table 2-3 Major Imports and Exports
Major Exports: Oil and refined products, fertilizers
Major Imports Food, construction materials, vehicles and parts, clothing

Source: CIA factbook: http://www.cia.gov/cia/publications/factbook/geos/ku.html
2.3 Geography and Climate
Kuwait isGulf.
Arabian located
Theatland
the far
areanorthwestern corner
is about 17,818 of thekilometers.
square Persian Gulf, knownroughly
Shaped locally as thea
like
triangle, Kuwait borders the gulf to the east, with 195 kilometers of coast. Kuwait
includes within its territory nine gulf islands, two of which, Bubiyan (the largest) and
Warbah, are largely uninhabited but strategically important. The island of Faylakah, at
the mouth of Kuwait Bay, is densely inhabited. To the south and west, Kuwait shares a
long border of 250 kilometers with Saudi Arabia. The third side of the triangle is the 240
kilometers of historically contested border to the north and west that Kuwait shares with
Iraq.
Kuwait has a desert climate, hot and dry. Rainfall varies from seventy-five to 150
millimeters a year across the country; actual rainfall has ranged from twenty-five
millimeters a year to as much as 325 millimeters. In summer, average daily high
temperatures range from 42° C to 46° C; the highest recorded temperature is 51.5° C.
By November summer is over, and colder winter weather sets in, dropping temperatures
to as low as 3° C at night; daytime temperature is in the upper 20s C range.
The land was formed in a recent geologic era. In the south, limestone rises in a long,
north-oriented dome that lies beneath the surface. It is within and below this formation
that the principal oil fields, Kuwait's most important natural resource, are located. In the
west and north, layers of sand, gravel, silt, and clay overlie the limestone to a depth of
more than 210 meters.
The bulk of the Kuwaiti population lives in the coastal capital of the city of Kuwait.
Smaller populations inhabit the nearby city of Al Jahrah, smaller desert and coastal
towns, and, prior to the Persian Gulf War, some of the several nearby gulf islands,
notably Faylakah. 2
Map of Kuwait
IRAN
(N-Kuwait
IRAQ
KUWAIT norasSabiyah
AdDaurital
•NAbraq
AlJahrah •AgSaimiyah Persian
Hawalli
AlMaqua", Gulf
Salemy
AlAhmed,•AlFuhaytr
MinaandAan
g/AshShuaybah
•AWarn
SAUDIARABIA
30km
9
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2.4 Political/ Administrative Structure

Basic political /administrative structure and any recent reforms
Kuwait is a hereditary emirate and the ruling emir comes from the descendants of
Mubarak al-Sabah. The current emir is Sheikh Jabr al-Ahmed al-Jabr al-Sabah, who
succeeded his uncle in December 1977. The emir appointed Sheikh Saad Abdullah al-
Salem al-Sabah as his crown prince and prime minister; however, the position was, for
the first time in Kuwaiti history, separated in July 2003, when the emir’s half-brother and
long-serving foreign minister, Sheikh Sabah al-Ahmed al-Jabr al-Sabah, became prime
minister. Members of the ruling family hold key cabinet posts, including the defense,
interior and information portfolios. Laws passed by emiri decree must subsequently be
ratified by the National Assembly (parliament). Parliament can also initiate legislation.
The make-up of the cabinet is at the emir’s discretion, although members are appointed
by the prime minister. At least one elected member of parliament must be included in
the government. The 15-member cabinet formed in July 2003 included six members of
the ruling family.
The first National Assembly was elected in 1963; it is supposed to sit for four year terms.
However, the emir has dissolved the Assembly on three occasions (1976-82, 1986-92
and 1999). In the 1999 case, this was done entirely constitutionally and elections were
held shortly afterwards. A campaign to allow women to vote and stand for office has so
far failed to win sufficient parliamentary support. Cabinet members automatically
become members of the Assembly, unless they have already been elected, making a
total of 64 entitled to vote in the present parliament. In recent years the Assembly has
been pressing the government for greater transparency in financial matters. Members
have demanded a greater role in oil policy and more oversight of defense contracts.
Relations have been strained by MPs’ insistence on their right to question ministers,
most recently in July 2002.
The constitution provides for judicial independence by stating that “judges shall not be
subject to any authority”. It also states that sharia (Islamic law) is “a main source of
legislation”. In practice, all judges are appointed by the emir and those who have
Kuwaiti citizenship become judges for life. Some noncitizens are also appointed as
judges on the pardon or commute all sentences.3
Key political events/reforms

The Kuwaiti Constitution was promulgated on November 16, 1962, but several articles
have been suspended by the Emir over the years. The Constitution declares that Kuwait
is a sovereign Arab state, ruled by an Emir heir to Mubarak as Sabah (died 1915). The
Emir has executive power, exercising this through the Council of Ministers. The Emir
appoints the Prime Minister, and appoints and dismisses ministers on the
recommendation of the Prime Minister. The Prime Minister is usually the Crown Prince.
The most
finance andimportant positions
oil are filled in the government,
with members like Sabah
from the ruling foreignclan.
affairs, defence, interior,
The Emir also formulates laws, but all laws will have to be national assembly, Majlis. The
legal system was codified in 1960, and there are strong traces of influence from Sharia.
Even if it is liberal in some fields, as for women's position in the social context, it is
marked by much conservatism in other fields, like control of moral behaviour. The Emir
is also in charge of establishing public institutions.
10
The judicial system is divided into two categories, the constitutional court and the
ordinary courts. The two lowest ordinary courts are the Traffic Court and Summary
Court. Above the Summary Court is the Court of First Instance, then Court of Appeal and
highest the Court of Cassation.
Kuwait is divided into 5 governorates, Al Ahmadi (313,000 inhabitants, Farwaniya
(498,000 inhabitants), Hawalli (496,000 inhabitants), Al Jahra (252,000 inhabitants) and
Kuwait Capital (305,000 inhabitants) (all 1998 estimates). 3 of these are governed by
members from the Sabah clan.
Individual freedom is guaranteed to all Kuwaitis. All arrests, punishment or exile shall be
Individual freedom is guaranteed to all Kuwaitis. All arrests, punishment or exile shall be
imposed within the rulers of law. All Kuwaitis have the freedom of movement and can
live where they chose inside the country.
Freedom of opinion and expression is free and full within the boundaries of the law. The
Emir can under certain circumstances suppress the freedom of the press, but in general
Kuwait is acknowledged for one of the freest presses in the Muslim world.
There are
speech. still limitations
Kuwait is still veryonmuch
democracy,
marked but Kuwait
by the hasexercised
control a developed level
by the of freedom
hereditary of
Emir,
who is a sole ruler even if there is a government with ministers.
Trade unions are permitted, and private ownership of companies is allowed. The national
assembly has 50 members, and of the time being only 13% of the population has the
right to vote. Only literate natural-born Kuwaiti male citizens above the age of 21 can
vote, with the exception of servicemen and police. Candidates to the Majlis must be
above the age of 30 and literate. Members are elected for a period of 4 years. The Majlis
can be dissolved by the Emir, something that has happned twice. New elections must be
held within 2 months of the dissolution. In the meantime, the Emir rules by decree. The
consequence of Kuwaiti politics is that the power distribution between the Emir and the
Majlis has been under constant testing. In the elections for the Majlis in 1999, 20 seats
were won by Islamist candidates, 14 by liberals, 12 by pro-Government candidates and 4
by independent candidates. 4
11
3 H EALTH STATUS AND DEMOGRAPHICS
3.1 Health Status Indicators

According to Ministry of Health, life expectancy for the Kuwaiti population (no available
data for non-Kuwaiti) at birth is 78.7, for males 77.8 and for females 79.9 in 2003. The
infant mortality rate is 9.4 in 2003, and under-five mortality rate 11.8 per 1000 for males
and 10.9 per 1000 for females.
Maternal mortality per 100 000 live births was 9.1 in 2003. Crud birth rate 17.7 per
1000, while crud death rate 1.8 per1000, and the total fertility rate in 2003 accounted to
2.2.Total population access to health services were 100% in 2003. There was no urban–
rural gap since over 95% of the population is urban.
In 2003 the percentage of infants immunized against DPT was 98%, polio 98% and
measles was 99% with 100% vaccination coverage against HBV. These high coverage
rates could be attributed to the efforts of the MOH in reaching mothers, better provision
of knowledge and improved awareness of the public on diseases.
Food is available in abundance and is affordable to all sections of the population.
However, there is evidence of under-nourishment, and some studies have reported a
significant evidence of anaemia, especially among young girls. Overweight and obesity
are significant health risk factors in Kuwait with a high prevalence especially among the
Kuwaiti element of the population.
Table 3-1 Indicators of Health status

Indicators 1990 1995 2000 2002 2003
Life Expectancy at Birth: 74.88 74.2 76.8 78.4 78.7

HALE: - - 65.1 67 -
Infant Mortality Rate: 12.1 10.9 9.1 9.6 9.4
Probability of dying before 5th
16 14 11.8 11.4 11.4
birthday/1000:
Maternal Mortality Ratio: - 7.3 9.6 6.9 9.1
Percent Normal birth weight babies* 95.8 94.1 92.5 92 92.2
Prevalence of stunting/wasting* - - - 3/24
Source: *http://www.who.int/countries/kwt/en/index.html
UNICEF
Table 3-2 Indicators of Health status by Gender and by urban rural

Indicators Urban Rural Male Female
Life Expectancy at Birth: - - 73.2 78.9

HALE: - - 67.4 66.6
Infant Mortality Rate: - - 9.8 8.9
12
Probability of dying before 5th

- - 11.7 10.8
birthday/1000:
Maternal Mortality Ratio: - -
Percent Normal birth weight babies:
Prevalence of stunting/wasting: - - - -
Source: The world health report 2005
Substantial epidemiological transition happened in regards of infectious and

communicable diseases. This is could be attributed to socioeconomic development, and
rapidly changing lifestyles. There were no reported cases of cholera, diphtheria, polio
and tetanus in 2000. The number of malaria reported cases was 233 in 2001. There
were
(to a total
WHO) of 111ofofAIDS
number reported
casescases
by theofend
tuberculosis
of 2004 isin872001. Theofcumulative
and that HIV cases reported
is 1019.
Hetro-sexual transmission represents the most prevalent mode of transmission (65%).
With the decrease in the incidence of communicable diseases and the increase in life
expectancy, the burden of disease has shifted towards non-communicable diseases and
injuries. Trends are showing steady increases in the incidence of coronary heart disease,
cancer and accidents and injuries (mainly road traffic accidents). In addition to this many
risk of ill health are showing alarmingly high prevalence; for example, diabetes, obesity,
dislipidemia and physical inactivity. Various national groups and communities have been
set up to tackle these problems. We anticipate that specific targets with plan of actions
to achieve
problem target
and will produced.
in particular Mental disorders
among non-Kuwaiti. also represent
The extent a majorispublic
of somatization health
not known,
but it is expected to be high in such a mixed population.
Table 3-3 Top 10 causes of Mortality/Morbidity

Rank Mortality Morbidity/Disability
1. Diseases of the circulatory system Single spontaneous delivery

2. Other complications of pregnancy
Accidents and injuries
and delivery
3. Neoplasms Other symptoms sings & abnormal
clinical & laboratory find
4. Other pregnancies with abortive
Perinatal causes
outcome
5. Diseases of the respiratory system Other aneamias
6. Congenital deformities and
Other ischemic heart diseases
pregnancy and birth complications
7. Endocrine gland and assimilation Other maternal care related to fetus
diseases and delivery prob.
Chromic disease of tonsils and
8. Contagious and parasitic diseases adenoids
9. Urinary and reproductive system
Pneumonia
diseases
10. Digestive systems diseases Diabetes
Source: Country profile 2001 http://www.emro.who.int/mnh/whd/CountryProfile-KUW.htm
13
Kuwait Institute for Studies and Research, Kuwait and Social Development, (Kuwait
1995),
3.2 Demography
Demographic patterns and trends
The 2003(nationals
national estimates constitutes
showed total population
about 37% oftothe
be total
2,484,334 of national
population and non-
estimate). The
population growth is estimated to be 3.36% in 2004.
The population is distributed in 6 governorates with highest density in Hawelli (686,421
persons which represent 27.6% of the total population). Kuwait is nearly completely
urbanized with 97% of its population living in urban area, with universal access to safe
water and sanitation.
PopulationbyAgeGroup,Kuwait,1975-2025
3,500•
3.000
ThousandsofPeople
500
2,000
500
500
1975 2000 2025
el5years I15-65years D>65years

el5years I15-65years D>65years
Table 3-4 Demographic indicators

Indicators 1990 1995 2000 2002 2003
Crude Birth Rate per 1000 pop 24.8 25.9 19.7 20.1 17.7
Crude Death Rate per 1000 pop 2.4 2.4 2.2 2.7 1.8
Population Growth Rate % 3.6 6.9 3.8 2.3 5.1
Dependency Ratio % 0.6 0.6 0.5 0.51 34

% Population <15 years 36.6 41.4 25.8 24.8 23.7
Total Fertility Rate: 3.4 2.9 2.6 2.5 2.2
Source: http://www.who.int/countries/kwt/en/index.html
14
Table 3-5 Demographic indicators by Gender and Urban rural

Indicators Urban Rural Male Female
Crude Birth Rate: 17.7 14.8 22.2

Crude Death Rate: 1.8 1.9 1.6
Population Growth Rate: 5.1 6.1 3.7
Dependency Ratio: 34 27.3 46
% Population <15 years 23.7 20 29.6
Total Fertility Rate: 2.2 2.2
Source:
It is projected that the population of the Kuwaitis over the age of 60 years will increase
to 8% of the population by the year 2030 and to 25% by the year 2050. The prevalence
of chronic disease therefore will be on the increase in particular, cancers, coronary heart
diseases (angina, myocardial infarction, arrhythmias and heart failure) and disorders of
mental health.
Kuwaiti nationals have been a minority of the population since the influx of foreign labor
for oil-based development began in the 1960s. Many immigrants left after the Iraqi
invasion, notably the substantial Palestinian community, which used to number around
450,000 and exited in large numbers after the ruling Al Sabah family were restored to
power in Kuwait. Unlike their predecessors, most new immigrants are not accompanied
by their families and dependants. According to the Public Authority for Civil Information
(PACI), the rate of increase in the expatriate population slowed markedly in 1998, and in
1999 and 2000 Kuwait’s expatriate population declined at the rate of 2.8% and 4.7%
respectively. The fall in 1999 was the first time there had been a net expatriate
withdrawal since liberation in 1991. This largely reflected the decline in oil revenues in
1998, which impacted on private sector demand and domestic investment levels in 1999,
in turn leading to a decrease in demand for foreign labour that was felt the following two
years as well. However, in 2002 and 2003 the foreign population resumed rates of
growth in keeping with the post–war period. This was particularly marked in 2002, when
the increase reached 6.6%; and in 2003 it rose by only slightly less (6.2%). The influx of
expatriate workers reflected strong growth in the private sector, where the demand for
low-income expatriate labour increased in construction and the retail economy
specifically.
Figures from PACI for end-2002 show Kuwaitis accounting for 37% of the population,
down from 38.1% in 2000. (By comparison, expatriates constitute an estimated 70%
and 80% of the populations of Qatar and the UAE respectively, and in relatively
resource-poor Oman expatriate workers represented only 26.3% of the overall
population in 2001.) This demographic shift towards non-national Kuwaitis occurred
despite
half continuing
of the highthe
1990s, with rates of growth
population in the
rising indigenous
by 3.8% population
in 1995 during
and by 3.3% the second
in 2003.
PACI has not produced a breakdown of the size of the respective national populations
among non-Kuwaitis for some years. However, according to a Kuwaiti newspaper, Al
Watan, as of end-1999 the non-Kuwaiti Arab population was 38.5% of the total non-
Kuwaiti population, making Arabs the second-largest ethnic group among non-Kuwaitis,
after south Asians. Among the Arab group, Egyptians, at 19% of the overall non-Kuwaiti
total, were by far the biggest. However, the largest non-Kuwaiti national group was
Indians, at 19.8% of the total; Bangladeshis, Pakistanis and Sri Lankans comprised
15
10.9%, 7% and 6.9% of the total non-Kuwaiti population respectively. The total
population of south Asian workers was 44.7% of the total non-Kuwaiti population. Local
sources suggest that these proportions have remained at around the same level since
end-1999, with south Asians and Arabs representing about 45% and 40% of the overall
total respectively.
High rates of growth in the indigenous population are reflected in the fact that,
according to the latest PACI data, some 42.2% of Kuwaiti nationals were aged under 15
as of end-2001. Some 69.8% of the Kuwaiti population were under 30, with the likely
as of end-2001. Some 69.8% of the Kuwaiti population were under 30, with the likely
consequence that strong population growth in the national population will continue for at
least the medium term. The total population at end-December 2003 was, according to
PACI, 2.48m.
Population distribution: Cheap land and subsidized housing mean that Kuwaitis move
frequently. New neighborhoods are continually being developed, while established ones
become less popular. This pattern results in large swings in population between the
various governorates in the country. However, the country is small and over 90% of the
Kuwaiti population lives within a 500-sq km area bounded by Jahra, Kuwait City, Ahmadi
and Fahahil. 5
Source: Country Profiles for Population and Reproductive Health, Policy

Developments and Indicators 2005, produced jointly by UNFPA and Population
Reference Bureau
16
4 H EALTH S YSTEM O RGANIZATION
4.1 Brief History of the Health Care System

Kuwait achievements are so far relatively comparable to average European standards of
health and health care. This high level of health status and good standards and
accessible health care services was achieved through the generous welfare system and
education attainments developed since independence in 1961. Great strides have been
made in health, since 1910 in which, curative health services were provided by American
missionaries, till the time being. 6 One of the largest ministries in Kuwait, the Ministry of
Health was established in 1936. However, the history of healthcare in Kuwait is much
older - dating back to the first years of the twentieth century when the ruler, Shaykh
Mubarak Al Sabah the Great, invited doctors from the Arabian Mission of the Dutch
Reformed Church in the United States to establish a clinic. By 1911 the group had
organized a hospital for men and in 1919 a small hospital for women. In 1934 the thirty-
four-bed Olcott Memorial Hospital opened. Between 1909 and 1946, Kuwait experienced
gradual, albeit limited, improvement in health conditions. General mortality stood
between
and twenty
125 per and
1,000 livetwenty-five
births. per 1,000 population and infant mortality between 100
After the government began receiving oil revenues, it expanded the health care system,
beginning with the opening of the Amiri Hospital in 1949. The Kuwait Oil Company
(KOC) also opened some small health facilities. By 1950 general mortality had fallen to
between seventeen and twenty-three per 1,000 population and infant mortality to
between eighty and 100 per 1,000 live births.
In the 1950s, the government introduced a comprehensive health care system offering
free services to the entire population. Free health care was so extensive that it even
included veterinary medicine. Expenditures on health ranked third in the national
budget, after public works and education. As with education, the system relied heavily
on foreigners. Most of the physicians were foreigners, particularly Egyptians. Critics
charged the designers of the system with paying undue attention to acquiring the most
modern and expensive medical equipment, without regard to the country's health
priorities, and favoring treatment over prevention. Nonetheless, improvements in
available health care and in public health were dramatic. The number of doctors grew
from 362 in 1962 to 2,641 in 1988. The doctor-to-patient ratio improved from one to
1,200 to one to 600. Infant and child mortality rates dropped dramatically; in 1990 the
infant mortality rate was fifteen per 1,000 live births. Life expectancy increased ten years
in the postindependence years, putting Kuwait at a level comparable to most
industrialized countries. In 1990 life expectancy for males was seventy-two years and for
females seventy-six years. 7
4.2 Public Health Care System

Organizational structure of public system
The public health system in Kuwait is organized into two tiers; central MOH and regional
health offices.
17
Central MOH:
The Ministry of Health (MOH), located in the Capital region is responsible for planning,
financing, resource allocation, regulation, monitoring and evaluation as well as health
care service delivery. The Ministry of Health is the third largest public-sector employer
after the ministries of education and interior. During the Iraqi invasion, most medical
facilities were devastated and reduced to shambles. One of the Government's primary
tasks after liberation was to bring health care system back on rails in the shortest
possible time.8
The Ministry of Health operates through an administrative and a technical workforce and
has an extensive central organizational structure, headed by the Minister. (MOH
organizational chart is attached as annex 1). The Minister of Health is assisted by the
Undersecretary and twelve Assistant Undersecretaries. Central departments under the
direct supervision
planning of the
and follow up,Undersecretary include;
public relations, Technical
treatment department,
abroad, medical legal advisor,
council and
department of medical services. The Secretary General, Kuwait institute of medical
specialization report directly to the Minister.
The Assistant Under-Secretaries are administratively responsible for public health affairs,
dental health, health services, blood transfusion and laboratories, nutrition and drug
control, drugs and medical supplies, financial affairs, administrative affairs, legal affairs,
quality control affairs, and newly established health regions and private health services &
licensing department. The MOH overall structure therefore consists of twelve functional
divisions embracing 42 central departments and offices at the central level. A ministerial
council, headed
its members, by the
meets on minister
a weeklywith Under
basis Secretary
to discuss and Assistant
all issues under
related to Secretaries
the health as
system.
The health regions are represented by the newly appointed Assistant Under secretary of
health regions.
Currently, the Ministry of health is in the process of revising its organizational structure.
Few new departments have been added, like department of health regions, central
department of medial services and private health services and licensing department. Few
other departments have been either abolished or merged with others. Earlier eight
departments along with all the health regions were reporting directly to the
undersecretary. Recently, through a ministerial declaration, two separate departments
have been created, including a department of health regions, therefore shifting some
authority from the under secretary to the newly appointed assistant under secretaries.
Generally the organizational structure of the ministry is heavy at the top with some
evidence of duplication of roles and responsibilities between different departments. In
addition, there is a significant variation in distribution of responsibilities among assistant
under secretaries. The number of departments supervised by them varies from one to
eight departments leading to overburden in some cases. Roles and functions of each
department is clearly defined in the ministerial decrees issued at the time of establishing
new departments although in practice there is some overlap and duplication of work.
There is a need to organize the structure of MOH with a view to minimize the overlap
among various tasks and functions and with clear and equitable sharing of departmental
responsibilities.
There is good working relationship and coordination between different departments in
the ministry, evident by number of committees that meet regularly to discuss and
resolves issues of mutual interest. The council of assistant under secretaries that meet
on weekly basis is another forum to improve coordination between various departments.
Likewise, the links with other ministries including ministries of planning and finance are
18
well established and smooth. Recently established council of undersecretaries facilitates

this process. However, there seems to be a gap between the central departments in
Ministry of health and the health regions in terms of coordination, communication,
technical supervision and information sharing.
Administrative and financial rules and procedures in MOH are written down, clearly
defined and available. Job descriptions of all the staff are developed at the time of
creation of new positions and these are available within the ministry but not widely
distributed and most of the staff is not aware of their existence. There is good system of
performance evaluation of staff. Performance of all staff is assessed on annual basis by
the respective supervisor and graded based on defined criteria into excellent, good or
weak. There is a separate budget allocated for excellent performing staff, which gets a
bonus based on the recommendation of supervisor. Sometimes promotions are also
based on performance in addition to other considerations like certificates from
continuing medical education department. Weak performers are recommended for
refresher training and other administrative action if required. There are examples of
actions taken, including termination from service, for the staff found guilty of negligence.
Despite the computerization initiative, the communication processes are still based on
traditional paper based exchanges and all official correspondence and documents are
maintained as hard copies. There is no inter-departmental networking in place at the
ministry or its related departments. There is no central login-based intranet for access to
ministry documents, training materials, or other resources to facilitate efficient
communication.
Health regions:
Through a ministerial decree issues in 1984, Kuwait was divided into 6 health
areas/regions namely Capital, Hawali, Ahmadi, Jahra, Farwania and Al Suabah. Another
ministerial decree issued in 1998 revised the roles and responsibilities of health regions
and central departments in MOH. The Health region is considered a nearly independent
and central departments in MOH. The Health region is considered a nearly independent
decentralized administrative unit. It is responsible for all executive affairs in the area
according to the responsibilities assigned to it in terms of specialized health services as
well as administrative, financial, engineering services. The Health Area offers health
services assigned to it according to the laws and the policies of the Ministry of health
and internal work systems in the area. The main duties of the area include: 1)
implementing action plan of the ministry to ensure provision of health services to the
residents of the area; 2) Offering different levels and types of health care; 3)
Implementing training for medical, technical and administrative cadres; and 4)
Establishing and implementing a comprehensive computerized system of health
information in theinarea.
region to 687,805 The population
Farwania region. in the regions range from 175,493 in Mubarak
A health region is headed by the Director of Health region, who reports to the under
secretary of health. Recently a new position of assistant under secretary of health
regions is being created. The Area Director is responsible for all the health services in
the region according to the technical, administrative and financial authority delegated to
him through the ministerial decree. Each health region office supervises and manages at
least one general hospital and a number of primary health centres and specialized
clinics. In addition to specialized clinics in other 5 regions, most of specialized hospitals
are located in Sabah region. The regional health office also supervises private health
sector. The policies, plans and programs of the MOH are implemented through this
structure. Organizational chart of Health region is attached at annex 2.
19

" Useful
% Not useful
Departments of health planning and information, legal research, allied health services
and engineering affairs report directly to the Area director. The Area director is assisted
by the Administrative and financial affairs inspector, head of primary health care
services, head of general health services, head of dental services and Hospital director.
There is a hospital board of director responsible for oversight of all matter related to
regional hospital. Hospital director is assisted by a deputy hospital director with
responsibilities of carrying out any task delegated by the Hospital Director, replacing him
in his absence and participating in Quality Committees and following up on the decisions
of the board of directors of the hospital.

At the regional level, a board of directors has been established with main responsibilities
of accrediting the programs and executive plans submitted by the Area Director and
approving mid-term and annual reports; suggesting and accrediting policies of the area;
establishing committees, approvals of annual budget for the area and revising accounts;
follow up on training and continuing education plan and encouraging scientific research;
following up performance evaluation of technical staff; studying proposals related to
health education and interacting with the governmental and non- governmental
authorities; and identifying problems, suggesting suitable solutions, while ensuring that
all the citizens are satisfied with the health services provided.
Primary health care is delivered through a series of health centres, with general or family
health clinics, maternal and child care clinics, diabetic clinics, dental clinics, and
preventive care clinics, school health services, ambulance services and police health
services are also available.
Secondary health care is provided through six general hospitals. Tertiary health care is
provided through a number of national specialised hospitals and clinics. The
regionalisation of the health care delivery system is now complete so that each of the six
general hospitals, along with a number of health centres which refer to it, constitutes a
health region. The regionalisation of the health system, which covers six health regions,
has resulted in more efficient delivery of health services.
The health system is based on three levels of health care delivery: primary, secondary
and tertiary health care.
Primary Health Centres
There are 72 primary health centres spread over the country. The services offered by
them include general practitioner services and childcare, family medicine, maternity care,
diabetes patient care, dentistry, preventive medical care, nursing care and
pharmaceuticals.
Secondary Health Centres
Secondary healthcare services are provided by the six major hospitals: Sabah hospital,
Amiri hospital, Adan hospital, Farwaniya hospital, Mubarak Al-Kabeer hospital and Jahra
Amiri hospital, Adan hospital, Farwaniya hospital, Mubarak Al-Kabeer hospital and Jahra
hospital.
The structure of each one of this hospital include a general hospital, a health centre,
specialised clinics and dispensaries. The policy of each hospital is to provide the best
possible healthcare to all citizens and residents.
Specialised Health Centres
The specialised healthcare service centres in Kuwait include the following:
1. Obstetrics (delivery) hospital: for maternity

2. Chest hospital: for pulmonary ailments
20
3. Psychiatric hospital: for mental disorders

4. Ibn Sina hospital: for neurosurgery
5. Razi hospital: for burns
6. Kuwait Center for Allergies: for allergies
7. Kuwait Cancer Control Center: for cancer diagnosis and treatment
8. Hearing Impairments Center: for disorders connected with hearing
9. Hamed Al-Essa Transplant Center: for organ transplants
10. Sulaibikhat hospital: for physiotherapy and rehabilitation
Key organizational changes over last 5 years in the public system, and
consequences
With the issuance of the Law of Health insurance of the expatriates in 1999, which was
supplied in the year 2000, a position was introduced under the title of Health insurance
department, and in March 2006 another position was introduced under the title of
Assistant undersecretary for health care. Also new entities were introduced and others
were merged.
Planned organizational reforms

A comprehensive study of the organizational structure of the Ministry of Health is being
performed to cope with the requirements of developing health services.
4.3 Private Health Care System

Modern, for-profit
Despite the comprehensive services provided by the Ministry of health, private hospitals
and clinics thrive in Kuwait. Private sector providers focus on curative services, and have
little role in preventive interventions. There are 5 private hospitals in Kuwait with a total
bed capacity of 427. Total number of doctors in these hospitals is 254 and number of
nurses 707. In 2004, total number of outpatient visits in private hospitals was 798,985
(compared to 1.75 million in public sector hospitals). Data is not available on exact
number of private clinics. Most of the private hospitals and clinics are concentrated in
central and commercial areas like Farwania, Hawalli and the capital region and provide
secondary and tertiary curative care. MOH is regulating the construction of new private
hospitals to be built in other regions to ensure that they are equally distributed. Private
health services are generally perceived to be of better quality and mainly accessed and
utilized by the better-off Kuwaiti population.
Modern, not-for-profit
Oil companies’ hospitals include
- Ahmadi Hospital
- Texaco Hospital
- Kuwait National Petroleum Company (KNPC) hospital
Traditional
21
It has not been licensed in the private sector yet, and hence it is not applicable.
Key changes in private sector organization

The government is encouraging the private sector to increase its role in service provision
and to invest in the health sector through continuing policy of granting licenses with
quality control over the services provided. Public practitioners are allowed to practice in
the private sector in addition to their work in public facilities. Recently, the Ministry of
Health has approved applications of 35 private companies to set up private hospitals in
Kuwait. A decision is also taken, allowing cooperative societies, private hospitals and
Kuwaiti doctors to open private clinics for general practice in residential areas. A new
department of private sector and licensing has recently been established in Ministry of
health and there are plans to establish Health insurance hospitals and privatization of
some of the public health care services (e.g. medical laboratory, radiology, nuclear
medicine and nursing).
Public/private interactions (Institutional)

Some medical cases are being transformed from the private sector to the government
sector.
sector.
Public/private interactions (Individual)

None
Planned changes to private sector organization

Encouraging the private sector to invest in the health sector via continuing the policy of
facilitating granting licenses to health entities with quality control over the services
provided.
4.4 Overall Health Care System

Brief description of current overall structure
Kuwait has one of the most modern health care infrastructures in the region. The health
system consists of both public and private sectors. More than 80% of all health services
are provided by the public sector, mainly by the Ministry of health. Other than MOH,
Ministry of defence and Kuwait Oil Company have separate hospitals for their employees.
Ministry of social affairs through its hospital provide health services to the handicapped
and elderly. Private sector is small but rapidly expanding.
22
Figure1. Kuwait National health System
Planning
Guidance
Ministry Of Health Inspection
Training &
Research
Health regions
Public Sector Private Sector

MOH services & institutions For Profit
Health centres
• • Clinics
Polyclinics
• • Polyclinics
Regional Hospitals
• • Medical Centres
Specialized Hospitals
• • General Hospitals
• Home health care
facilities
Other public entities
•Ministry of defence
•Kuwait oil company
•Ministry of social affairs
At present, the healthcare network in Kuwait is the best in the Gulf region and among
the finest in the world. Kuwaitis receive medical services at government clinics and
hospitals free of charge. Public healthcare is maintained by an intricate network of
primary and secondary health centres and specialised hospitals and research institutions.
pharmaceuticals.
Secondary healthcare services are provided by six major hospitals: Sabah hospital, Amiri
hospital, Adan hospital, Farwaniya hospital, Mubarak Al-Kabeer hospital and Jahra
hospital. The structure of each one of this hospital include a general hospital, a health
centre, specialised clinics and dispensaries.9
Despite the excellent comprehensive services provided by the public health service,
private hospitals and clinics thrive in Kuwait. The MPH regulates standards and the fees
they may charge. The private hospitals and clinics have their own pharmacies. Most of
them are general hospitals with some specialist departments. Some have limited
equipment, such as ICUs, or specialists and refer patients to government hospitals for
special procedures.
Private clinics are usually staffed by doctors of a particular specialty. There are several
private dentists and dental clinics providing services to international standards.
Orthodontics is only available to expatriates through these dentists and clinics. The
Ministry of Health has approved the applications of 35 private companies to set up
private hospitals in Kuwait. A decision is also issued allowing cooperative societies,
private hospitals and Kuwaiti doctors to open private clinics for general practice in
residential areas.
23
Provision of health services:
The Public Sector

1. The Ministry of Health:-
Rendering health services is based on:
- The health areas that include sequence of service rendering. There are six health
areas as follows: Capital, Hawally, Farwaniaya, Ahmadi, Jahra, Sabah Specialized
Health Area.
- The three levels that guarantee the comprehension of the rendered services, as
the residential areas are being served by a group of health centers (that
represent the first level of service- Primary Health care) from which transfer
takes place to six general hospitals (area hospital) one for each area
(representing the second level of service- secondary health care), and then from
there to the group of specialized hospitals and medical centers affiliated to Sabah
specialized health care area representing the third level of service- triple health
care service).
- Free health care provision for citizens and through subscription to the health
insurance service for expatriate with the fees of one Kuwaiti Dinar for visiting the
health centre, and two Kuwaiti Dinars for visiting clinics of hospitals and
specialized health center for dental services, in addition to some additional fees
fro some particular services. These fees do not include diabetes injections,
bandages and vaccination in the primary health care centers.
2. Other Government Entities:

- Ministry of Defense (Military Hospital)
- Ministry of Social Affairs
- Kuwait Petroleum Corporation (Ahmadi Hospital) health services for staff of the
oil sector.
The Private Sector:

- Through private clinics, clinics, medical centers and general hospitals.
24
5 G OVERNANCE/O VERSIGHT
5.1 Process of Policy, Planning and management

National health policy and trends in stated priorities
Ever since its independence in 1961, the leaders of Kuwait planned for it to become a
welfare state, and in effect Kuwaiti citizens enjoyed one of the most comprehensive
welfare systems in the world. The health plan, as part of the total socio-economic
development plan and health policy, is based on three principles: maintenance and
promotion of health in the people; improvement of physical, mental and social well-being
of the people; and reducing morbidity, disability and mortality as much as possible. In
this respect, health goals have been defined as long-term and medium or short-term.
The health system is based on three levels of health care delivery: primary, secondary
and tertiary health care. Primary health care is delivered through a series of health
centers, with general

clinics, dental clinics, or
andfamily health care
preventive clinics, maternal
clinics, andhealth
school child care clinics,
services, diabetic
ambulance
services and police health services are also available. Secondary health care is provided
through six general hospitals. Tertiary health care is provided through a number of
national specialized hospitals and clinics. The regionalization of the health care delivery
system is now complete so that each of the six general hospitals, along with a number of
health centers which refer to it, constitutes a health region. The regionalization of the
health system, which covers six health regions, has resulted in more efficient delivery of
health services.
The Ministry of Health is responsible for the establishment and functioning of the health
care network.
The implementation of health strategies has had an effective impact on the health status
of the population, as can be seen from the decrease in mortality indicators and the
increase in life expectancy, as well as the decline in incidence of infectious diseases.
Kuwait has, in fact, become the welfare state it was designed to be, as it overcame
successfully, through its planning after liberation, the negative impacts of the Gulf War
on health facilities, health status and environment.10
Out of the government obligation to render health care to both the citizens and the
expatriates, and based on the liabilities of the Ministry of Health in this concern, the
general guidelines of the health policies in the State of Kuwait were set as follows:-
1) Health plan is an integral part of the general development plan of the State of
Kuwait.
2) The health care level should cope with the society values and should satisfy the
needs of its individuals
3) Facilitation of health care rendering and upgrading its level to match the highest
technical standards
4) Priority should be given to the needs of special groups of the citizens as the
handicapped, the elderly people, mothers and children
5) Encouraging popular and social participation in forming the health policies and
rendering health services
25
6) Development of health administration to render health care with the highest

standards of efficiency and effectiveness
7) Development of the human resources working in the health sector
8) Governmental monitoring and supervision of the health services rendered by the
private sector
9) Application of the technical standards for rendering health services in the required
level
10) Continuous co-operation with Arab and international entities.
In this concern, these policies were translated into programs and procedures that
resulted in the modern structure of the health services in the State of Kuwait and in the
support and development of the methods of operation in the health sector, in addition to
setting health programs that achieve the required goals within the scope of
comprehensive development plans.
Formal policy and planning structures, and scope of responsibilities

The department of planning and follow up in the Ministry of Health prepares health plans
based on the direction and within the framework of the general plan of the government
as prepared by the Ministry of Planning, which is approved by the council of Ministers
and authorized by the nationals.
Analysis of plans
▪
The eighties phase was distinguished by the health plans aiming at establishing and
expanding different health services.
▪
The first phase of the nineties was distinguished with the re-habilitation of the health
services after the liberation from the Iraqi invasion.
▪
the second phase of the nineties to date is distinguished with the health services that
aim at supporting the health economic and enhancing the level of services provided
5.2 Decentralization: Key characteristics of principal types

Within MOH: e.g. to district teams, central or district boards
In order to improve the efficiency, effectiveness and quality of services, Ministry of
health, Kuwait carried out a number of studies in various areas. The findings of the
studies highlighted the need to change the current, highly centralized model of service
delivery. Based on the findings and to ensure that all population of Kuwait have access
to best possible service and to improve the overall performance of health system, MOH
decided on decentralization. A Ministerial decree (No. 188) was issued in 1984 to
establish health areas/regions. Each region to be responsible for providing
comprehensive health services to the residents of its area.
As a first step, MOH established a health area committee with responsibilities of
identifying the health areas, studying the services provided, assessing essential steps
needed to establish a health area and establishing an organizational structure for the
area and identifying its relation with the departments and centralized authorities in the
ministry. The committee carried out a detailed study to establish scientific grounds for
dividing the country into health areas and identify needed capacity; define role of the
health areas; establish rules and procedures for the health area; define relationship
26
between health area and the centralized authorities according to the concept of
decentralization in establishment, and centralization in planning and guidance while
avoiding duplication of work; and to identify necessary steps needed to establish health
areas. The study was based on MOH organization chart, existing system of work in the
MOH and relationships between technical and administrative centralized authorities.
Based on the work and recommendations of the committee, Kuwait was divided into six
health areas.
Key Duties and functions of the Health Areas defined by the committee included;
implementing health plan of the ministry; identifying and studying the health problems;
providing comprehensive health care at different levels and types; developing a updating
database of organizations, individuals, costs; and technical and administrative training
for the staff
• Responsibilities of health areas:
Most administrative and technical procedures, earlier carried out by the centralized
authority, were delegated to health areas, specifically: technical and administrative
procedures; supervision of staff; investigating complaints and suggesting action;
procedures; supervision of staff; investigating complaints and suggesting action;
transfers within the area; performance evaluation of staff; approval of leaves;
suggesting promotions, raises and other bonuses/benefits, and other administrative,
technical and executive affairs which was carried out by the centralized authority.
• Main Responsibilities of Technical Centralized Authorities after establishing
Health Areas:
1. Planning; Suggesting general policy for services, and preparing plans and necessary
programs and submitting them to the ministry for approval; collaborating with
concerned authorities in developing job titles, job descriptions, and organization
structures;
internationalsetting technical
standards performance
and local standardsmechanisms
needs; suggesting in health services according
to improve to
technical
performance of staff and preparing budget for human resources for new projects.
2. Guidance: Regular supervision of the ministry units to assess the standards of
performance, and sending reports to the concerned area director and head of the
concerned centralized authority; studying technical reports and statistics of health
areas to ensure best services are provided and publishing scientific and technical
periodicals.
3. Rectifying: Rectifying the technical work in the units of the ministry and suggesting
ways and means to improve it.
4. Training and Scientific Research: Developing training programs for staff in all
departments, and suggesting post-graduate programs; encouraging scientific
research in the field of technical services, and developing necessary programs in
coordination with department of the health research.
5. Appointments, Transfers, Bonuses: Compiling all the needs of the health areas
according to the approved budget; advertising for the required staff and identifying
qualifications and conditions required; establishing a committee to interview
candidates; following up on procedures related to hiring in coordination with the
concerned authorities; distributing new appointees to the health areas and transfers
of staff from one health area to another after the approval of the officials of both
areas.
Through a ministerial decree (No. 310), issued in 1998, roles and responsibilities of the
health areas, area director and other officials were revised and more clearly defined. It
27
was decided that health areas would come under the direct supervision of the under
secretary. The responsibilities of board of directors for the health areas were also revised
and a separate decree was issued for the Al-Sabah Specialized Medical Area. The Health
Area is now considered a nearly independent decentralized administrative unit. It is
responsible for all executive affairs in the area according to the responsibilities assigned
to it in terms of specialized health services as well as administrative, financial,
engineering service. The revised duties of the area include: 1) implementing action plan
of the ministry to ensure provision of health services for the residents of the area; 2)
Offering different levels and types of Health care; 3) Implementing training for medical,
technical and administrative cadres; and 4) Establishing and implementing a
comprehensive computerized system of health information in the area.
The Area Director is responsible for all the health services in the area according to the
technical, administrative and financial authority delegated to him through the ministerial
decree. His main duties include:
1- Developing a program and executive health plans for the area.
2- Establishing temporary committees and teams to implement and follow-up
3- Recruiting, firing, internal transfers (within the health area), internal delegations of
duties, in accordance with laws and regulations for the health area in coordination
with administrative and the financial affairs departments in Ministry of health.
4- Implementing disciplinary actions after investigating and verifying the fact according
to the laws and the administrative regulations of the health area.
5- Preparing budget plan for the area according to the systems followed by the
ministry, and implementing the budget according to the accredited systems
6- Supervising the activities of the area funds, and submitting a detailed financial
statement in accordance with the financial regulations.
7- Continuous coordination with the board of directors and training & education
committees to improve educational and technical level of the staff of the area.
8- Direct communication with different departments of ministry, national authorities,
and the public cooperation, without adding any financial or intellectual commitments
to the ministry, without prior approval.
Head of the Primary Health Care Services, Head of the General Health Services, and the
Head of Dental Services in addition to being incharge of their respective areas have the
responsibilities of; implementing policy of the Ministry and health plan of the area;
assessing performance of staff; Daily follow–up on services provided to ensure patient
safety; Annual needs assessment of manpower, drugs, equipment, engineering services
and the health facilities; Suggesting staff transfers; approving leaves; suggesting
monetary and non–monetary benefits for the staff; supervising technical and training
activities and continuous education programs; strengthening Health promotion
programs; implementing emergency health plan; and ensuring that the citizens are
satisfied with the services. Administrative, Financial and Service Affairs Inspector
supervises all administrative, financial and service affairs in the area and coordinates
administrative work between the different health centres in the area. The Hospital
Director assisted by Deputy Hospital director reports to Area Director and is responsible
for supervising all the technical, administrative, financial activities in the hospital. The
director is also accountable to the board of directors of hospital for ensuring quality of
health service.
Since the Health Area is considered a decentralized authority, it implements all the duties
assigned without any interference from centralized authorities which has the main
responsibilities of planning, guidance and inspection over the area, without going into
the executive issues. There is direct communication between the Area director and the
28
under-secretary, and the director has the authority to call the assistant undersecretaries,
and centralized authorities in the ministry and other governmental authorities, while
informing the undersecretary and not bearing the ministry any financial obligations.
A board
board andof Assistant
health areas was
under established
secretary with the
for Health Undersecretary
Care as president
and Health Area Directors of
as the
its
members. Main functions of board include; strengthening relationships between health
areas and coordinating work between them and centralized authorities in the ministry;
establishing long-term work plans for expanding health services; identifying problems,
finding suitable solutions, and taking action; reviewing performance standards and their
feasibility; and reviewing administrative and financial regulations. The Board meets at
least once every 2 months, and whenever the need arises based on an invitation form
the head of the board. Decisions are made by the votes of the majority. The board could
delegate some activities to small committees within the board of directors.
•
Administrative
to Regulationsofofallthe
approve the appointments theHealth Area: TheinArea
staff nominated DirectorArea.
the Health is delegated
Doctors
are appointed by the approval of the specialized medical departments, concerned
head of the Department and the Area Director. Similarly Health Technicians and other
staff are appointed by the approval of the concerned technical committees, concerned
head of the Department, head of the sector and the Area Director. In all cases the
Administrative Affairs Department in the ministry has the final authority for
procedures of appointments. Area director has the authority to transfer staff within
the region, while the powers to transfer staff from one area to another are with
Administrative affairs authority after approval of concerned area directors. Transfer
outside the ministry needs approval from the undersecretary. Area director has
complete authority for granting leaves within the area. For investigation of a technical
mistake he needs to refer to the MOH. For promotions and raises, the area director
sends his nominations to the Administrative Affairs authority for approvals according
to the rules and regulations. The area director also has the authority to give bonuses
and approve termination and renewal of contracts. The approval has to be sent to the
Administrative Affairs authority in the MOH.
• Financial Regulation of the Health Area: According to the ministerial decree, the
health area is an administrative unit that has the financial authority regarding
expenditures and income through two separate bank accounts maintained in the local
banks. The funds are under the supervision and the inspection of the Authority of
Financial Affairs in the ministry. The Area Director is responsible for all the activities
related to the funds. A “Public Money Account” is used for transfer of funds from the
ministry according to the approved budget of the area. The Authority of Financial
Affairs deposits an instalment at the beginning of the fiscal year, which is balanced
out throughout the year. A separate “Other Activities Account” is maintained where
donations accepted by the area board and income from approved activities is
deposited. The expenses from the Public Money account is limited only to purchasing
and maintenance of furniture & equipment, stationery, urgent simple medical
equipment, agricultural, interior/exterior design, hiring of temporary staff and health
awareness activities. The health area can not purchase anything that is in stock and if
it is in the contract of the ministry. Funds can also be used for special national
occasions, gifts and purchasing incentive gifts for the excellent performing staff. The
Area board must approve any other expense. Any purchases of more than 5000KD
requires approval from the Authority of Financial Affairs and payment is made from
the general budget of the ministry. In all cases, estimates should be from registered
companies, and the receipts should be detailed. All Expenses should be in
29
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coordination with the Authority of Financial Affairs. Authority of Financial Affairs

inspects and settles the accounts on monthly basis. It must be provided with bank
statements, statements of all financial resources, and receipts. At the end of the fiscal
year, the Authority of Financial Affairs performs an audit of the financial statements
and expenditures.
Kuwait’s experience with decentralization is mixed. According to the MOH, the new
health region system has allowed better planning, management and more efficient use
of resources, which resulted in more efficient delivery of health services. However, there
are serious concerns about its impact due to the limited powers delegated to health
are serious concerns about its impact due to the limited powers delegated to health
areas. The authority delegated to manage health work force in the regions is variable.
The Directors of health areas have the authority to transfer staff (within the region),
approve leaves, conduct performance evaluation, reward well-performing staff, nominate
for continuing education and approvals of termination and renewal of contracts; they can
not recruit, penalize or dismiss the staff. They do not have the authority to be flexible
with salaries to attract qualified staff, especially nurses. For promotions and raise in
salaries, the area director sends his nominations to the Administrative Affairs authority in
MOH for approval, in accordance with rules and regulations.
Health regions develop annual plans and send their requirements regarding staff and
other resources to the MOH, however the funds and human resources received are often
not based on the needs. Packages of health services and standards of care are defined
by the MOH in consultation with the regions. Decisions about construction of new
hospitals and facilities are also combined. Continuing education and health information
system is highly centralized. There is duplication of efforts in data collection and
compilation and limited capacity at regional level to analyze and use data collected from
hospitals and health facilities. Strengthening of health information system and capacity
development in the area of strategic and operational planning in the regions will be
essential for the success of decentralization.
Fiscally, the system remains highly centralized and health areas rely almost entirely on
government financing. There are restrictions on use of revenue generated through user
fee, donations and other approved sources. Budgets are prepared by the health areas,
mostly on incremental basis and submitted to the MOH. Once approved an instalment of
funds is deposited in the designated local bank at the beginning of the fiscal year, which
is balanced out throughout the year. Authority of Financial Affairs in MOH inspects and
settles the accounts on monthly basis. According to the regional director, budget is
allocated for all regions and they are not aware of the amount allocated to their region.
Each time they need funds, regions have to give justifications. There is no flexibility
between line items without the approval of the MOH. Regional directors have the powers
to disburse up to KD 5000 ?? in accordance with the approved budget. They are required
to make payment of more than 100 KD through cheques and any donations received by
the area must be notified to the Authority of Financial Affairs. There are restrictions and
conditions for purchase of simple medical equipment. Medicines and other supplies are
also procured centrally and then distributed to the regional facilities. During discussions
some concern was raised regarding the misuse of resources if the procurement is
decentralized and regions are given more financial powers.
The regions are not empowered to authorize autonomous status to hospitals or launch
insurance plans. They have the authority to contract out maintenance, cleaning and
catering services to private companies. There are no regulations and means of
enforcement to regulate the private health facilities based on the existing norms and
standards. The regulatory functions are limited to registration and licensing. There are
30
no mechanisms for monitoring and supervision and enforcement of measures in the

event of non-compliance.
The health areas have well developed organizational structures with departments of
administration & finance, planning & information, legal research and engineering affairs
with laid out operational policies and procedures. Directors and managers are highly
qualified and experienced. However, there seems to be a limited capacity in health
system management. Coordination with central departments is weak and health
information system needs strengthening to support the decentralization process. There is
also a lack of clarity among regions as well as central departments about the rules and
regulations regarding decentralization and the extent of financial and administrative
authority.
Generally there are concerns among regions that overall health system is still highly
centralized; resources allocated to the regions are not enough and not based on their
needs; there is duplication of work and limited coordination between MOH and regions;
administrative and especially financial regulations are too restrictive; staff is appointed in
the regions without their consent or consultation; and they do not have enough
authority to efficiently mange the affairs of the regions.
The current level of transfer of authority and responsibility in the decentralized system
1
can be of
extent explained on the in
independence basis of themaking
decision decisionallowed
space model, which gives
by the Central MOH the range
to the and
health
regions. Table 1 provides a quick mapping of the current decision space available to the
Health regions in Kuwait.
Table1. Level of Decentralization:
Health system functions Level of Government
Finance Central Regional

Revenue generation ++ +
Budgeting, resource allocation ++ ++
Power of expenditure +++ +
Line item flexibility +++ -
Income from fee and contracts +++ -
Information and Planning
Prepare annual plans +++ ++
Health information systems design +++ -
Data collection, processing, and analysis +++ +
Dissemination of information to stakeholders +++ +
Service organization
Hospital autonomy - -
Managing insurance
Defining service schemes
packages +++
+++ --
Setting norms, standards, regulations +++ -
Monitoring, oversight of service providers + ++
Contracts with private providers +++ ++
Human resources
Recruit staff +++ +
Dismiss staff ++ -
Reward staff ++ ++
1
Bossert T. (1998) Analyzing the Decentralization of Decision Space in Developing Countries:
Decision Space, Innovation and Performance. Soc Sci Med; 47(10):1513-27.
31
Penalize staff +++ -

Determine salaries & benefits +++ -
Transfer staff ++ ++
Performance evaluation + +++
Continuing education ++ +
Procurement and Logistics
New equipment +++ +
Drugs & supplies +++ -
Repair and maintenance contracts + ++
Key: +++ Full authority; ++ Moderate; + Limited; - None
State or local governments
Not applicable
Greater public hospital autonomy
Not applicable
Private Service providers, through contracts

▪
The experience of finalizing some non-medical services, security, cleaning, transport
and alimentation
▪
The experience of privatization of some health services:
1. x-ray and medical laboratories in Adan Hospital
2. Nursing services in Adan and Mubarak Al-Kabeer HospitalMain problems and
benefits to date: commentary
Integration of Services
▪
There is a continuous expansion in the experience of expanding the capacities of
health areas
▪
Privatization experience is being evaluated.
5.3 Health Information Systems

Kuwait has a complex health information system. A lot of good quality data is generated
on morbidity, mortality, vital health statistics and utilization from all levels of health care
delivery. Detailed statistics are available for primary, secondary and specialized care.
However, there are separate systems of data collection for primary health care facilities
and secondary & tertiary health care hospitals and separate reporting systems for
preventive and curative care. Other than regional offices, there are 3 central
departments involved in data collection and management namely, department of
statistics and medical record (collects data from public and private hospitals), public
health department (concerned only with preventive services data), Primary health care
department (receives data on OPD from PHC centers). Various health Programs generate
their on reports which are not part of the routine information system. In addition,
Central Information System Department deals with computerization, networking and
developing software programs.
32
The department of statistics and medical record is the main department responsible for
management of information including data and statistics exchange and publications
within the ministry of Health. It undertakes compilation, statistical analysis and reporting
of health data in the country. The data is collected through its offices in the health
regions, which is compiled and analyzed on monthly basis. It regularly publishes
quarterly and annual health statistics reports. The department has health registration,
Medical records and health statistics sections. All the births and deaths in the country are
registered.
catchment areaFor health
each facility.
newbornIn aaddition
separate file all
to this, is the
prepared and maintained
people entering in also
Kuwait are the
registered. The department shares the responsibility of registration of expatriate workers
with Legal department in Ministry of health. Medical records section is responsible mainly
for all the records of country’s hospitals and clinics. It collects data, develop formats for
reporting and conduct trainings of staff in filling the forms and reports. Statistics
department is concerned with data analysis. The department of statistics and medical
record is mainly responsible for data collection from hospitals. Data from Primary health
care centers and Preventive services is reported separately to the respective
departments and then it reaches the department of medical records and statistics, where
all the data is compiled and reports are generated on quarterly and annual basis. These
reports are disseminated to MOH, regional health offices and sometimes to the hospitals
and clinics.
Information system department in MOH is responsible for computerization of PHC
centres, secondary hospitals, birth and death registration, wireless networking and
developing a database. Three subdivisions of the department include System
development, operations and technical support. System development subdivision has
different sections on projects, programming and follow up. Operations sub division is
responsible for planning of operations, implementation and statistics, and image
processing. Technical support subdivision is responsible for operating systems, database
and training sections. The department has computerized all the primary health care
centres. When a patient visits a clinic, his ID card is entered in the computer and his
data can be retrieved from the server. The doctor examines the patient and enters the
data can be retrieved from the server. The doctor examines the patient and enters the
patient’s information including diagnosis that is linked with the pharmacy for collection of
medicines. The birth and death registration system has also been computerized and
currently the department is in the process of computerization of regional and specialized
hospitals, wireless networking and developing a health and demographic database.
The department of public health in Ministry of health is mainly responsible for prevention
of diseases. It has 4 divisions. 1) Disease control division responsible for prevention and
control of communicable and non communicable diseases, environmental sanitation,
food handler’shealth
international services and epidemic
regulations and control. 2) Port and
also responsible forborder division,
screening which enforces
of expatriates for
communicable diseases, HIV/AIDS, TB and hepatitis. 3) Public health laboratory with
sections on microbiology, hemo-chemistry virology and malaria control and 4) Rodent
and insect control division. The public health department receives data on preventive
services directly from the health centres and hospitals and it issues a detailed weekly
report that includes EPI, disease surveillance and other preventive activities. The
information is also sent to the department of statistics and medical records.
The flow of data is quite intricate. From Primary health care centres, patient record and
outpatient data is entered in the computers by the statistical clerks and reported
manually to department
health directorate. of statistics
The outpatient dataand medical
include, newrecords andup
and follow copies
cases,sent to regional
nationality and
morbidity along with personal information of each patient. Data on preventive services
33
goes directly to the central department public health. From secondary and tertiary care
levels, number of outpatients and detailed inpatient data is reported to department of
statistics and medical records as well as to the regional health office, while preventive
services data flows separately to the public health department. Each regional and
specialized hospital has a statistical unit within a medical records department which is
responsible for collecting morbidity and inpatient data. Administratively, the unit belongs
to the region. Outpatient clinics and operation theatres have their separate data
collection and reporting system. In all, a hospital sends 8 different reports (forms) to the
department of statistics and medical records through regional office every month. They
send weekly reports to the director of the hospital. Hospitals also generate their own
detailed annual reports.
Figure3. Health information system organization and flow of information
Kuwait Health information system
Level H e a lt h m a n a g e m e n t A g e n c y H e a l th f a ci l i t y
Region Regional Health PHC centers

directorate
OPD Preventive
Regional hospitals
OPD & Inpatient Preventive
Specialized hospitals
OPD & Inpatient Preventive
Department of Preventive health

Central statistics & Private hospitals
department
medical records
The regional tier between the facilities and central departments is not well established.
Although the data from PHC centers and hospitals is sent to the regional health offices,
there seems to be limited capacity and facilities at the regional level for analysis and the
main responsibility for compilation and analysis still lies with the central department of
statistics and medical records. Regional offices receive the data, compile and send it to
the central department of statistics and medical records, which also receive data directly
from hospitals. Regional health offices produce their own reports. Ministry of health is
planning to integrate the data flow by actively involving the regional offices and to have
all data from facilities go first to regional offices and then to the central department.
There is no law or regulation that requires private health sector to report data. According
to the MOH, almost all the private hospitals report on a regular basis based on an official
letter from the ministry. Collection of data from private clinics is still an issue but the
Ministry is now working to resolve this issue and to ensure that data is received from all
private facilities. Same forms are used as in the public sector and the private sector
report on inpatients and number of outpatients.
34
Data reporting is almost 100% from public facilities. Timeliness of data is also not an
issue as most of the hospitals and centres send their reports within the designated time
(report for previous months is sent before 10th of next month). However, sometimes
there are delays in getting morbidity data from facilities and from private sector.
Operational policies and specific guidelines for data collection and reporting are available
and used in training of staff.
The quality and completeness of data is good. There are several mechanisms to verify
The quality and completeness of data is good. There are several mechanisms to verify
and validate the data from health facilities. The error rate is less than 5% and if the
information is found to be incorrect or incomplete, it is sent back to the concerned
facility. Monthly meetings are held with the staff of statistical departments in hospitals to
discuss and resolve issues related to information system. Regular training workshops and
refresher courses are also organized for the staff in how to fill in the forms and to
improve the data quality.
Data is analyzed on most of the internationally comparable indicators with a strong focus
on curative care. Preventive services data is not part of the routine health information
system and it is not reported in annual statistical report. Comparative analysis is
conducted between hospitals and health facilities as well as between regions. Data is
also analyzed overtime to see the trends. There are no specific guidelines for analysis of
data. The statistics section decides on what analysis to be done based on their
understanding of importance. All raw data is kept with this section and it can be
analyzed differently or in more detail upon requests. The feedback is provided to the
facilities and hospitals in the form of compiled quarterly and annual reports to inform
them of their performance. These reports are also sent to the regional offices and most
of the departments in the ministry of health. According to the MOH officials, the
information generated is used for decision making, planning, budgeting and research.
MOH health plans are also developed based on the information from routine information
system. There are other examples of changes in plans and decisions based on these
reports e.g. expansion of services or building new hospitals.
The information system is computerized only at the primary health care level and some
of the hospitals and specialized clinics. Data is entered in the computers but the reports
are sent manually and again entered in the computers in the department of statistics
and medical records for compilation and analysis, which is very time consuming and
labour intensive. There is a strong need to computerize the system at all levels and to
develop an integrated health information system, covering both curative and preventive
service from all levels of care.
5.4 Health Systems Research

Priorities of Health Research
▪
Applied research aiming at management and prevention of common diseases in
Kuwait.
▪
Applied research affecting the health of larger strata of the population.
▪
Basic health research that serves the developmental strategies of the country, in
particular those with industrial and economic applications.
▪
Field surveys aiming at determination of magnitude of common diseases in Kuwait in
order to assist health administration to set preventive and management plans for
such diseases.
35
▪
Research aiming at evaluation of existing health systems and procedures, and testing
new health systems and protocols.
▪
Multidisciplinary research involving health sciences and other disciplines like social,
environmental and safety.
▪
Promote health and health education in relation to leading causes of death in Kuwait,
and health behaviour and lifestyle.
▪
Thus research priorities in Kuwait can clearly define the health problems and
evaluated the appropriate service, the providers of such a service and evaluate those
who make use of it, along with enhancing the ways of supporting the continuity of
financing and improving it in a way that ensures the patients safety and consolidates
health with its comprehensive concept, by setting the right health strategies.
▪
Research priorities concentrate on fighting the main reasons of diseases and death:
diabetic mellites – heart diseases due to arteries – embolism – tumors- genetic
diseases – contagious diseases – accidents – psychological diseases- overweight –
mouth and dental health – osteopsathysosis – protection against diseases.
Research Units
▪
Kuwait Institute for medical specialization health systems researches unit

▪
The planning and follow-up department health systems researches unit
▪
Statistics and Medical Records department
▪
Food and Catering department
5.5 Accountability Mechanisms

▪
A system for cost accounting was introduced in the Ministry since the seventies
▪
The system depends on dividing the work centers and service centers in the ministry
to cost centers ( Treatment Prevention services)
▪
The theory of used power is applied to health services as it is considered suitable for
the work circumstances from the practical point of view due to its being connected
with the size of activity with disqualification of the non-used power.
▪
Analysis takes place on several levels :
1. Compiling Level: Treatment activity centers, prevention, assisting medicine,
general services, financial, administrative, etc.
2. Analytical Level: clinics, wards, x-ray, laboratories, alimentation, transport,
general services and management.
36
6 H EALTH C ARE F INANCE AND E XPENDITURE
6.1 Health Expenditure Data and Trends

Table 6-1 Health Expenditure
Indicators 1990 1995 2000 2002
Total health expenditure/capita, - - 537 552

Total health expenditure as % of GDP
- - 3.9 3.8
Investment Expenditure on Health - - - -

Public sector % of total health
- - 78 75.2
expenditure
The world health report 2005
Table 6-2 Sources of finance, by percent

Source 1990 1995 2001 2002
General Government - - 78.1 75.2

Central Ministry of Finance - - 78.1 -
State/Provincial Public Firms Funds - - - -
Local - - - -
Social Security - - 0 -
Private - - 21.2 24.8
Private Social Insurance - - - -
-
Other Private Insurance - - 5.7
Out of Pocket - - 21.2 94.3
Non profit Institutions - - - -
Private firms and corporations - - - -
External sources (donors) - - - -

The government spent 6.7% of its 2002/03 budget on health services, a significant rise
in value terms on the previous year, when it represented 6.3% of a smaller overall
outturn. Concerns about spiraling healthcare costs have been addressed through the
introduction of a law requiring expatriates to pay for the use of public hospitals and
clinics. The introduction of healthcare charges made a noticeable impact on actual
revenue received during the first nine months of the 2001/02 fiscal year. Income from
health services almost trebled to KD26.5m (US$86.3m) during this period from KD9.4m
during the corresponding months of 2000/01. The Ministry of Health is the third largest
public-sector employer after the ministries of education and interior, but only half of its
37
28,000 staff are Kuwaiti. The ratio of doctors and nurses per head of the population is
higher in Kuwait than in other Gulf countries, according to data for the numbers of
Kuwaiti staff provided in the latest Statistical Abstract published by the Ministry of
Planning.5
Trends in financing sources

▪
The cost of health service was increased during the recent years due to increase in
the cost of labor, medical equipment and medicine, in addition to the increase of
population and the increase of prices in general.
▪
Expatriates visits were relatively controlled via the application of visiting fees
▪
Financial revenue was achieved via the application of the visiting fees and the health
insurance system on expatriates.
Trends in health expenditures by category:
PROGRAMS 92/93 % 96/97 % 99/2000 %

The program of the 13,250,341 5.5 13,783,817 5.3 15,870,095 5.9
ministry head office
Program of preventive 13,214,213 5.5 11,560,790 4.5 9,666,006 3.6
health & environment
protection
Program of the first 138,940,518 58.5 144,998,778 55.9 142,288,247 53.3
case and public
hospitals
Program of hospitals 50,743,727 21.2 67,338,928 25.9 77,317,994 29.0
and specialized health
centers
Program of the 14,933,152 6.2 14,400,750 5.5 13,377,173 5.0
assistance technical
services
Program of health 1,313,148 0.5 1,134,183 0.4 1,092,004 0.4
researches, education
and training
Program of public 73,448,852 3.0 6,374,559 2.5 7,404,478 2.8
services
Total 2397433951 100 259591805 100 267015997 100
*Values in Kuwaiti Dinars
▪
During the time course of preparing the study the total cost of the health service
increased, despite the fact that the increase during the first period is larger than that
of the second period.
▪
A relative decrease in spending on the general health programs and primary health
care program took place compared to the relatively high cost of hospitals and
programs.
38
6.2 Tax-based Financing

Levels of contribution, trends, population coverage, entitlement
Not applicable
Key issues and concerns

Not applicable
6.3 Insurance
The government's policy of health insurance became effective in 1999 and was
implemented on both citizens and expatriates based on the ministry's intention to
establish hospitals for those covered by this health insurance. The ministry's aim was to
lease out these hospitals on contract basis to provide expatriates with medical facilities.
Kuwait's residents were to receive treatment at these specially designated insurance and
private hospitals. This was planned with the aim of decreasing the pressure on
government hospitals and giving them an opportunity to provide better health services
for those not covered by the health insurance system,
From 10th April, 2000 health insurance was made mandatory for expatriates. No
residence is renewed unless the premium for health insurance is paid and the renewal
period is also linked to the period of health insurance coverage. Expatriates holding
health insurance from local private insurance companies will be allowed to renew their
residence for the period of validity of the insurance. However, for holders of private
insurance, the Ministry will charge KD 4 for each visit to health clinic besides the one
dinar charge. They will also have to pay for medicine, laboratory tests and radiology
scans. Visit to the outpatient clinic will cost KD 6, stay at public hospital KD 10 per day,
KD 80 per day at an intensive care unit and KD 5 per day for stay at a psychiatric
hospital. Expatriates covered by private insurance companies will also have to pay KD 10
per visit to a birth registration clinic. The charge for normal delivery is KD 200 inclusive
of a three day stay at a hospital. Any overstay will cost KD.10 per day.
Insurance coverage exempts expatriates from paying daily inpatient charges when they
receive medical treatment in hospitals, in addition to exemption from charges of medical
operations, pharmaceuticals, and laboratory analysis and X-ray. They also receive 50%
subsidy on specialised tests and analysis such as CT-Scan, Nuclear Magnetic Resonance,
Sonar and hormonal analysis.
The Health Ministry intends to review the procedures of implementing its policy of health
insurance, Collection of charges against this health insurance and the procedures of
collecting the outstanding amounts from the insurance companies which have been
accumulating for the past five years will also be reviewed. 11
The law of Health Insurance No.1 of 1999 applies only on expatriates. All expatriates are
registered under the protection of governmental or private sector health insurance.
39
" Useful
% Not useful
Private Medical Insurance

Medical insurance, from companies such as Expacare, BUPA and ARIG, can be bought in
Kuwait. Local group insurance often requires a minimum of 15 persons, with an annual
premium of about KD75 per person for a cover of KD 5,000 for both inpatient and
outpatient treatment with an excess of 20%. For individuals there are some local
medical insurance schemes (about KD125 per year) but the cover provided, the
exclusions and age limits sometimes leave a lot to be desired.
Table 6-3 Population coverage by source

Source of Coverage 1990 1995 2000 2002
Social Insurance - - - -
Other Private Insurance - - - -
Out of Pocket - - - -
Private firms and corporations - - - -
Government - - -- -
Uninsured/Uncovered - - - -
Trends in insurance coverage

New plans for Insurance coverage for expatriate workers are being finalized.
Social insurance programs: trends, eligibility, benefits, contributions

The health insurance set out in law covers the following basic health services:
▪
The medical examination and the necessary treatment in clinics of general
practitioners and specialists
▪
Laboratory and radiological investigations
▪
Surgical operation excluding plastic surgery.
▪
Treatment medicines and hospitalization expense to ordinary and emergency cases
▪
Ordinary dental treatment
Private insurance programs: trends, eligibility, benefits, contributions

Same as above
6.4 Out-of-Pocket Payments

(Direct Payments) Public sector formal user fees: scope, scale, issues
and concerns
▪
Governmental health services are free for citizens.
▪
Expatriates pay the amount of K.D 1 upon visiting primary health care centers
▪
Expatriates pay the amount of K.D 2 upon visiting the clinics of general hospitals
and specialized hospitals
40
▪
There are some symbolic fees on some examinations
▪
Expatriates pay annual health insurance fee of K.D 50 for labour, K.D 40 for wife,
K.D 30 for children up to 18 yeas old and K.D 5 for housemaids and non-nationals.
(Direct Payments) Private sector user fees: scope, scale, type of

provider involved, issues and concerns
Average individual spending on health care services is about K.D. 2.250
Public sector informal payments: scope, scale, issues and concerns
Not applicable
Cost Sharing
Token fees have been established at the Public facilities to discourage frivolous use of
health facilities.
Via health insurance for the expatriates
6.5 External Sources of Finance

Kuwait does not depend on external assistance for the financing of its health sector.
Kuwait is a net donor of funds for supporting the health sector of other Islamic countries
in the Region.
6.6 Provider Payment Mechanisms

Hospital payment: methods and any recent changes; consequences and
current key issues/concerns
Governmental health services are financed through the governmental budget.
Payment to health care personnel: methods and any recent changes;

consequences and current issues/concerns
Salaries of the staff working in governmental health services are paid through the
governmental.
41
7 H UMAN R ESOURCES
7.1 Human resources availability and creation

Table 7-1 Health care personnel
Personnel per 100 000 pop 1994 1995 2000 2002 2003
Physicians 1.41 1.87 1.6 1.6 1.9

Dentists 0.18 0.28 0.30 0.30 0.3
Pharmacists N.A 0.26 0.33 0.26 0.21
Nurses midwives 4.39 5.0 4.1 4.1 4
Paramedical staff N.A 2.0 2.9 2.8 2.8
Community Health Workers N.A - - - -
Others N.A 3.1 4.3 3.5 3.4
Source: ªEastern Mediterranean Regional Office Database: reports from member states
Trends in skill mix, turnover and distribution and key current human
resource issues and concerns
In 2003, the manpower rates per 10 000 population were 19 for medical doctors, 3 for
dentists, 2.6 for pharmacists, 40 for nurses and mid wives, 21 for hospital beds and 3 for
PHC units. Table 1 gives the breakdown of health human resource in Kuwait, and its
distribution by Kuwait and non-Kuwait population.
During the study period the rates of medical doctors, dentists and supporting medical
services increased, while there was a relative decrease in the rates of nursing staff and
other human resources.
Table 1: Health Human Resource Profile in Kuwait - 2003

Cadre Kuwaitis Non-Kuwaitis Total
Physicians 1718 (40%) 2537 (60%) 4255
Pharmacists 152 (29%) 380 (71%) 532
Managers 6622 (91%) 669 (9%) 7291
Technicians 4245 (62%) 2650 (38%) 6895
Nurses 984 (11%) 8013 (89%) 8997
Support Staff 511 (69%) 229 (31%) 740
Ancillary staff 82 (11%) 693 (89%) 775
Total 14314 (49%) 15171 (51%) 29485
Source: Ministry of Health Kuwait
42
Kuwait has ratios of health professionals to population higher than the regional average
in all categories except for pharmacies. There is an excellent national system of
Continuing Professional Development (CPD) for all categories of health workforce.
Table 7-2 Human Resource Training Institutions for Health

Current Planned
Type of Number of *Capacity Number of Capacity Target
Institution* Institutions Institutions Year
Medical Schools 1 1
72 125 2025
- B.M.B. Ch
8 15 2025
- Masters/PhD
Postgraduate
1 300 1 600 2025
training institutions
Schools of Dentistry 1 24 1 40 2025
Schools of
1 38 1 35 2025
Pharmacy
Nursing Schools
1 360 1 360 2007
- Nursing institute
1 420 1 750 2007
- Nursing college
Midwifery Schools 0 0
Paramedical
1 120 1 360 2025
Training Institutes
Schools of Public
0 0
Health
Source:
Information regarding the paramedical training programs in this table pertains only to
the Faculty of Allied Health Sciences at the Health Sciences Center (HSC). The Public
Authority for and

but capacity Applied Education
planned andfro
capacity Training also has
their training a paramedical
program, training program,
is not available for HSC.
PAAET should provide the information from their program, and it should be added to the
‘Paramedical Training Institutes’ information in this table for the final submitted
document (i.e. the final document should list “2” institution, with the combined capacity
from both.
Accreditation, Registration Mechanisms for HR Institutions
Faculty of Medicine:
▪
Registration from the World Health Organization since 1978
▪
Planning registration with the World Federation for Medical Education
▪
Self-Evaluation Process and External Review by Harvard Medical, International,
completed and approved 2004/2005.
43
Faculty of Dentistry
▪
The faculty will undergo an assessment process with the Association of Dental
Education in Europe (ADEE). The Assessment group will also include member of the
American Dental Education Association (ADEA) in November 2005.
▪
Preliminary discussions is on with American Dental Associations for an accreditation
visit as soon as it begins oversees accreditation program
Faculty of Pharmacy
▪
The faculty is currently undergoing a self-evaluation process for the B.Pharm through
the ACPE (USA)
Faculty of Allied Health Sciences
▪
The four departments in the Faculty are currently preparing the documentation for
accreditation of their program. Accreditation of two programs is expected within the
next 1- 2 years. Two departments may opt for benchmarking their programs.
Kuwait Institute for Medical Specialization (KIMS)
▪
Self-evaluation of the training programs have been undertaken by the institution
▪
Review the postgraduate training programs by external reviewer
▪
Evaluation of the postgraduate training programs and the MPC Program (for
CME/CPD) by WHO expert have been completed
▪
MPC Program of KIMS has been granted substantive recognition by Royal College of
Physicians and Surgeons of Canada and recognized by The Royal College of
Pathologists, UK.
7.2 Human resources policy and reforms over last 10 years

Kuwait is still relaying and will continue to relay for many years to come on non-Kuwaiti
Kuwait is still relaying and will continue to relay for many years to come on non-Kuwaiti
health professionals to support the expanding health system. The variation in quality is
huge and a system of recruitment to minimize variation is urgently needed. It will take
sometime before such a variation could be overcome.
Faculty of Medicine:
▪
The faculty of Medicine works closely with Kuwait institute of Medical Specialization
and the Ministry of Health in determining the human resource needs of Kuwait with
respect with the number of graduating physicians each year.
▪
The number of medical graduates from the faculty of Medicine has averaged around
70 graduates per year over the past 10 years.
▪
The faculty of Medicine consists of over 170 faculty members, and has a specific
policy of increasing the percentage of Kuwaiti faculty members
▪
Currently the Kuwaitis comprise 47% of all faculty members and 76% of all clinical
faculty members
▪
The faculty plans to graduate an average of 24 students per year until the training
facilities permit an annual intake of 40 students.
▪
The faculty is new and therefore the human resources needs for training has been
largely expatriates
44
▪
Increase in the number of Kuwaiti faculty staff has been planned as follows:
- Transfer of qualified Kuwaiti dental specialists from the Ministry of Health to the
faculty as academic staff
- Introduction of Kuwait University Scholarship scheme for the Faculty of Dentistry
to train qualified Kuwaitis abroad in different Dental specialties.
Faculty of Pharmacy
▪
No information on HR policy and past reforms was provided by the faculty of
Pharmacy
▪
Faculty of Allied Health Sciences works closely with the Ministry of Health in
determining the human resource needs of Kuwait with respect to the number of
graduating professionals in each of the Allied Health professions each year.
▪
The faculty is moving towards Kuwaitisation of its teaching staff, and now has 41
Kuwaiti Assistant and Associate professors
▪
The average number of gradates from the Faculty of Allied Health Sciences over the
past 10 years is 60 graduates per year.
▪
Change of overall policy to ensure that the postgraduate training is offered to
prospective trainees on the basis of health care specialty needs of the country
instead of the individual trainee’s preference of specialty.
▪
The new postgraduate training programs have been established so that training is
now offered in nearly all the specialties of medicine, with training opportunities made
available locally or abroad, in collaboration with internationally recognized
postgraduate training institutions
▪
Acceptance of the need for a formal scheme for continuing education for health
professionals and the establishment of the MPC Program which now covers
physicians, dentists and pharmacists, and which could be expanded to benefit other
categories in due course
▪
Establishment of close links with other countries in the GCC region and the formation
of GCC Committee for Postgraduate Training, with the aim of collaboration among
training institutions and optimization of the resources.
7.3 Planned reforms

Faculty of Medicine
▪
Given the increasing population of Kuwait and the trends towards Kuwaitization of
thethe
of physician workforce
graduating in 125
class to Kuwait, the medical
per year by 2025school is planning to increase the size
▪
A new campus for the faculty of Medicine, complete with an affiliated teaching
hospital under the direction of the faculty of Medicine, is planned to become
operational in 2015
▪
Although there are no schools of Public Health in Kuwait, the Faculty of Medicine is
planning to introduce a Masters of Public Health Program within the next two years.
The program has been approved by the University, but is awaiting recruitment of two
or more essential faculty members before the program can be implemented.
45
▪
Curriculum reforms for the Medical School planned for the 2005 – 2010 period
include:
- Restructuring of teaching into a system-based curriculum and increased case-
triggered learning
- Phased integration of basic science teaching and clinical teaching
- Insertion of Evidence-based Medicine skills teaching and practice into the
curriculum.
curriculum.
▪
Increase in the number of graduating dental practitioners; the faculty plans to
increase the annual graduating dental practitioners to 40 as soon as necessary
faculty become available.
▪
Permanent Clinical Facilities: the faculty plans to have a permanent clinical facility for
the student education, clinical practice of faculty and research as part of the
Teaching Hospital Complex of the Health Sciences Centre by 2015.
▪
Postgraduate Dental programs: the faculty plans to provide postgraduate dental
education in all fields of Dental specialization from 2010.
▪
Curriculum reform: in line with the planned curriculum reform by the Faculty of
Medicine , the faculty will be embarking on restructuring of the undergraduate’s
dental curriculum,
▪
Continuing Dental education: the faculty plans to intensify its role in providing
avenues for continuing dental education in Kuwait and to serve as resource center
for knowledge and skills development for all dental practitioners in Kuwait.
▪
Outreach community Service: the faculty plans to provide outreach dental services
and education to the Community especially for the disadvantaged and underserved
population of the country.
Faculty of Pharmacy
▪
Kuwaitization Policies will be more rigorously applied, to achieve total kuwaitization
of pharmacists working in MOH by 2018.
▪
The new campus will allow for better clinical training and more expanded integrated
facilities in the new campus by 2025.
▪
Curriculum reforms will be on the agenda after the ACPE evaluation of the B. Pharm
Programme. Pharm D. and Post-graduate programmes may be started in the next 5
years, when the faculty reaches its critical mass of tutors and facilities and
curriculum review.
▪
The faculty is moving towards a teaching staff comprised only of Ph.D holders
▪
The faculty is planning to increase the number of graduates from each program in
order to fulfils the aim of providing a Kuwaiti workforce of Allied Health professionals
for the MOH, and for the private sector hospitals at a later stage.
▪
Two new undergraduate programmes in Speech Therapy and Occupational therapy
will be established when the needed resources are available. The faculty plans to
propose the establishment of additional programmes in the mid-term.
46
▪
The Faculty plans to establish Master’s programmes in addition to a Master’s in
Medical Laboratory Sciences which has already been approved. Specific Diplomas
and Ph.D programmes shall also be established.
▪
An extensive study on the health workforce needs of Kuwait has been completed so
that the data could be used as the basis for planning for undergraduate as well as
postgraduate training in the fields of medicine, dentistry and nursing. (details
available at www.kims.org.kw)
▪
The MPC program, which at present covers physicians, dentists and pharmacists will
be expanded to other health to other health professionals
▪
The measures already taken by KIMS to get health professionals to use online
learning will be expanded so that this form of learning will constitute a major
component of the learning media available to the practitioner. The format of the MPC
Program is being reviewed with the aim of encouraging reflective practice and
rewarding it within the scheme.
▪
Measures will be taken to enhance quality assurance in postgraduate medical
education
▪
Implementation of training will be reviewed to ensure that the guidelines for
postgraduate training and continuing education recommended by the World
Federation for Medical Education would constitute the basis fro training as applicable.
▪
Specialty training for health professionals will be expanded to include newer
specialists that are being recognized as playing a significant role in the delivery of
Health care services.
▪
Cooperation and collaboration with postgraduate training institutions and CMECPD
authorities in the other GCC countries will be promoted by providing guidance in
establishing CME programs where relevant and by sharing the extensive collection of
education
years. planning materials that have been published by KIMS during the past five
47
8 HEALTH SERVICE DELIVERY
8.1 Service Delivery Data for Health services
Table 8-1 Service Delivery Data and Trends
TOTAL (percentages) 1990 1995 2000 2002
Population with access to health services 100 100 100 100

Married women (15-49) using contraceptives - - 50* -
Pregnant women attended by trained personnel - 99 100 100
Deliveries attended by trained personnel 99 100 100 100
Infants attended by trained personnel
100 100 100 100
(doctor/nurse/midwife)
Infants immunized with BCG**** - 0 0 0
Infants immunized with DPT3 76 100 98 98
Infants immunized with Hepatitis B3 - 94 100 100
Infants fully immunized (measles) 63 98 99 99

Population with access to safe drinking water* 100 100 100 100
Population with adequate excreta disposal
100 100 100 100
facilities***
Source: *Country profiles for population and reproductive health. Policy developments and
indicators 2003
URBAN (percentages) 1990 1995 2000 2002

Married women (15-49) using contraceptives - - - -
Pregnant women attended by trained personnel - 98 100 100
Deliveries attended by trained personnel - 100 100 100
Infants attended by trained personnel 100 100 100 100
Infants immunized with BCG - 0 0 0
Infants immunized with DPT3 - - - -
Infants immunized with Hepatitis B3 - - - -

Infants fully immunized (measles) - - - -
Population with access to safe drinking water 100 100 100 100
Population with adequate excreta disposal 100 100 100 100
facilities
Source:
48
RURAL (percentages) 1990 1995 2000 2002

Married women (15-49) using contraceptives - - - -
Pregnant women attended by trained - 100 100 100
personnel
Deliveries attended by trained personnel - 98 100 100
Infants attended by trained personnel 100 100 100 100
Infants immunized with BCG - 0 0 0
Infants immunized with DPT3 - - - -

Infants immunized with Hepatitis B3 - - - -
Infants fully immunized (measles) - - - -
Population with access to safe drinking water 100 100 100 100
Population with adequate excreta disposal 100 100 100 100
facilities
Source:
Access and coverage

Access to primary care:
Owing to the small size of the country and the resources available, access to health care
is universal.
There is 100% access to P.H care. In each area in Kuwait, there is a health center.
Access to secondary care:
Same is true for secondary care
There is 100% access to secondary care. In each region in Kuwait, there is a general
hospital.
8.2 Package of Services for Health Care

Complete package is available for health care that includes;
▪
Preventive and promotive services
- Health education and nutrition
- Vaccination
- Growth and Development follow-up
▪
Curative Services at:
- Primary health care level
- Secondary health care level
- Tertiary health care level.
49
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8.3 Primary Health Care

Infrastructure for Primary Health Care
Primary health care is delivered through a series of health centers, with general or family
health clinics, maternal and child care clinics, diabetic clinics, dental clinics, and
preventive care clinics, school health services, ambulance services and police health
services are also available. Foreign residents are entitled to treatment here. The clinics
deal with preliminary examinations and routine matters and where necessary, patients
are referred to hospital specialists.
pharmaceuticals.
Settings and models of provision

Primary health care is provided through the health centers preventive & curative services
are provided to all population, Kuwaitis & non-Kuwaitis, to all age groups with special
care to mothers and children.
Public/private, modern/traditional balance of provision
Public-private ownership mix;

At present we don’t have this system.
Public Sector:
About 97% of PH care services are provided by Government, in a modern way of
provision.
Primary care delivery settings and principal providers of services; new models
of provision over last 10 years
In addition to the general practice services some health centers have mini clinics for
chronic diseases and for health promotion, also some health centers (10%) have applied
the family doctor system.
Public sector: Package of Services at PHC facilities
All items of the PHC are provided to the population mostly by the MOH, other items e.g.
supply of safe water, basic sanitation are provided by other ministries in collaboration
with the MoH.
Private sector: range of services, trends

Private sector: range of services, trends
There are many private clinics and hospitals in Kuwait. The Government monitors them,
ensures a high standard and regulates the fees charged. Most private hospitals have
their own pharmacies. Most private hospitals are also general hospitals with some
specialty departments.
Despite the excellent comprehensive services provided by the public health service,
private hospitals and clinics thrive in Kuwait. The MPH regulates standards and the fees
they may charge. The private hospitals and clinics have their own pharmacies. Most of
them are general hospitals with some specialist departments. Some have limited
50
equipment, such as ICUs, or specialists and refer patients to government hospitals for
special procedures.
Private clinics are usually staffed by doctors of a particular specialty. There are several
private dentists and dental clinics providing services to international standards.
Orthodontics is only available to expatriates through these dentists and clinics.
The Ministry of Health has approved the applications of 35 private companies to set up
private hospitals in Kuwait. A decision is also issued allowing cooperative societies,
private hospitals and Kuwaiti doctors to open private clinics for general practice in
residential areas.
Small number of private clinics are provided only curative services by family doctors or
by general practitioners
Referral systems and their performance

There is a referral system from primary health care to secondary health care but we still
have problems with the feedback from hospitals to the primary health care centers.
Utilization: patterns and trends

About 97% of the population is using Government health centers. 3% seek the
treatment directly from hospitals and specialized centers, private and governmental.
Current issues/concerns with primary care services

!
A variety of disease pattern due to presence of persons from different parts of the
world.
!
To introduce geriatric services at PHC level, and establish mini clinics for Chronic
health problems and for preventive & promotive services e.g. well baby clinic- breast
feeding clinics and no smoking clinics.
Planned reforms to delivery of primary care services

To provide all the health centers with maternal care, diabetic clinic, and laboratory and
mini clinics for chronic health problems.
8.4 Non personal Services: Preventive/Promotive Care

!
Availability: available
!
Affordability: free
!
Accessibility: accessible and acceptable
Organization of preventive care services for individuals

Department of General Health – The Central Administration for Primary Health Care and
Health Education Department are the entities concerned with the preventive services in
the MOH.
Environmental health
The Public Authority for environment is concerned with environment health.
Environment - current issues:
51
Limited natural fresh water resources; some of world's largest and most sophisticated
desalination facilities provide much of the water; air and water pollution; desertification
Environment - international agreements:
Party to: Climate Change, Desertification, Environmental Modification, Hazardous
Wastes, Law of the Sea, Nuclear Test Ban, and Ozone Layer Protection
signed, but not ratified: Biodiversity, Endangered Species, Marine Dumping.

The Environment Public Authority (EPA) was established in 1995. This law was,
later, amended in 1996. According to this amendment, the authority consists of the High
Council, which defines EPA’s aims and objectives and policy. It is headed by the First
Deputy Prime Minister and the Foreign minister and has the following members:
!
The Minister for Health
!
The Minister for Planning
!
The Minister for Oil
!
The Minister for Commerce and Industry
!
The Minister for Communications
!
The Municipality Chief
!
The Municipality Chief
!
The Chairman - the Director General of the Public Authority for the Agriculture
Affairs and Fish Resources
The High Council of the EPA also includes, for four renewable years, three qualified and
experienced individuals in the field of environment protection and the Director General is
the rapportteur of the council.
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The responsibilities of the EPA are to:
!
Prepare and apply public policy for the protection of environment and prepare
strategies and action plans to achieve sustainable development.
!
Prepare and supervise the execution of the complete action plan relating to the
protection of the environment.
!
Control the activities, procedures and practices concerned with the protection of the
environment.
Download now !
!
Identify pollutants and specify environmental criteria and standards and prepare
regulation and systems for the protection of the environment
!
Prepare and participate in directing and supporting environmental researches and
studies.
!
Identify the problems resulting from environmental pollution and deterioration with
the assistance of the state agencies.
!
Study and review the ratification or accession of the regional or international
conventions related to environmental protection.
!
Prepare an integral action plan for training citizens on the means and ways of
environmental protection
!
Study environmental reports submitted to it relating to environmental conditions of
the country.
The EPA has recently promulgated a 10-year strategy aimed at protecting Kuwait’s
environment, and addressing specific concerns about the atmosphere, water resources,
52
environment preservation, education and awareness as well as industry and power. The
strategy includes many laws aimed at protecting and maintaining buildings, heritage and
archaeological sites. Old mosques and historical buildings are being renovated. It also
provides a safe environmental framework to protect and preserve components of the
infrastructure and the urban environment. The strategy also includes education and
awareness programs on environment protection and preservation. 8
Health education/promotion, and key current themes

The Health Education Section is responsible for education & promotion. The focus for
this section is fighting chronic diseases, through changing attitudes and behaviors
related to unhealthy lifestyle. Thus, promoting healthy diet and exercise to adopt a
healthy life style.
Changes in delivery approaches over last 10 years

A program for health enhancement was recently introduced including 12 subsidiary
programs that aim at fighting the most important causes for morbidity and mortality in
the State of Kuwait.
Current key issues and concerns

See previous item
Planned changes
See above
8.5 Secondary/Tertiary Care

Secondary care is provided through six regional hospitals with 2500 bed capacity, each
serving about 300 000 people. In addition to this these are 9 tertiary care (specialist
hospitals) including maternity, infectious diseases, mental health and cancer hospitals
bringinghospitals
These the totalconsume
beds available to 4575,
the largest with total
proportion of bed
the occupancy around
public health 60 percent.
budget, despite
What is Scribd?
moderate bed occupancy and high pressure on primary care services.
'
The regionalization of the health care delivery system is now complete so that each of
the six general hospitals, along with a number of health centres which refer to it,
constitutes a health region. This new health region system has allowed better
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community involvement and better planning through identification of local health
problems. It has also allowed for better management and more efficient use of
resources. The regionalization of the health system, which covers six health regions, has
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also resulted in more efficient delivery of health services. Regional directors of health are
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involved in the planning process as well as in itemization of the budget and recruiting of
human resources. They are responsible for annually reporting on the activities of their
12
regions .
Public Hospitals
Read free for 30 days Kuwait is divided into five Health Regions. Each region has a general hospital -- the Amiri
Hospital in Kuwait City, Jahra Hospital in Jahra, Farwaniyah Hospital in Farwaniyah,
Mubarak Al-Kabir Hospital in Jabriya, and Adan Hospital in Fahaheel. Each general
hospital provides an outpatient service and a 24-hour emergency service.
Learn more 53
Kuwait also has several specialty hospitals, covering a range of specializations from chest
and heart diseases to neurosurgery, pediatrics, obstetrics and gynecology, burns,
cancers, radiology, nephrology, infectious diseases, ophthalmology, physiotherapy, and
psychiatry.
Dental Clinics
The main public dental clinic is behind the Amiri Hospital in Kuwait City. There are many
other public dental clinics throughout the country; most of which are attached to local
medical clinics.
Maternity Care
Many of the general hospitals run by the Government have maternity wards. The
government-run Al-Sabah Maternity Hospital in west Shuwaikh, is probably one of the
best maternity hospitals in the world, providing a comprehensive range of ante-natal,
delivery and post-natal care. The Al-Sabah Maternity Hospital is equipped with state-of-
the-art technology, including more than 100 ICUs, and a highly trained and dedicated
staff.
There are also several private hospitals offering maternity care. All maternity hospitals,
public or private, require a couple's marriage certificate for their records.
Blood Banks
The blood bank is situated in Jabriya. Equipped with the latest technology, it supplies
blood to public and private hospitals in Kuwait. Donors are always welcome. Relatives of
those undergoing operations are requested to make donations in order to maintain

supplies.
Opticians
Sight tests are usually free and prices for prescription lenses are fairly reasonable.
Common corrective lenses are available from stock and new glasses can be delivered
within 48 hours. Persons with complicated prescriptions may have to wait several weeks,
as the ground lens must be imported from abroad.
Hospital visiting hours vary and are normally restricted to the afternoon. The number of
visitors to a patient allowed during visiting hours is not usually limited, though
sometimes when things get extremely crowded only two visitors at a time are allowed in
together.
Health Care Charges

Kuwaitis receive medical services at government clinics and hospitals free of charge.
Before 1994 expatriates were entitled to free medical services but now they must pay for
certain procedures as well as prosthetic items.
Neither Kuwaitis nor expatriates are charged for medications obtained from pharmacies
in public hospitals and clinics on prescription from a hospital doctor, provided the
patient's
longer civil IDabout
provide card 80
number is shown
expensive drugsonfor
theexpatriates,
prescription. However
though a doctor may
an expatriate no
patient
can always ask the doctor for a prescription and then buy the medicine himself.
54
Table 8-2 Inpatient use and performance

1990 1995 2000 2003 2004
Hospital Beds/1,000 - 2.6 2.2 2.1 2
Admissions/1000 - 9.9 8.1 7.1 8.1
Average LOS (days) - 5.4 5.3 5.3 -
Occupancy Rate (%) - 67.6 67.2 65.5 -
Public/private distribution of hospital beds

The government sector provides 90% of the available beds (4575) in 15 hospitals
whereas the private sector is limited to 559 beds in 7 hospitals.
Key issues and concerns in Secondary/Tertiary care

!
Rehabilitation of general and specialized hospitals is taking place.
!
New departments were introduced for medical causality (emergency)
!
A computer program is under application for connection with the primary health care
centers and other utilities in the Ministry.
!
Programs are under the application for developing performance and health quality
control in hospitals.
Reforms introduced over last 10 years, and effects

Refer to previous item
Planned reforms
Refer to previous item
8.6 Long-Term Care
8.7 Pharmaceuticals
Percentage of purchase from the local & regional (gulf area) companies to the total
purchase price of medicines 9.3% while the percentage of purchase from foreign
companies to the total purchase price of medicine will be 90.7%
8.8 Technology
Trends in supply, distribution of essential equipment
The needs of the utilities of the MOH for medical equipments are being provided via the
purchasing system and maintenance contracts with the agent companies
55
Effectiveness of controls on new technology

Periodical upgrading of the medical equipment takes place via following-up the new
issues in the field
Reforms over the last 10 years, and results

A study of the renting with maintenance system for medical equipment instead of
purchase and maintenance.
Current issues and concerns

The national program for upgrading medical equipment is being carried out.
Planned reforms
The national program for upgrading medical equipment is being carried out.
56
9 HEALTH SYSTEM REFORMS
9.1 Summary of Recent and planned reforms

Currently there is a special interest in:
!
Continuity of financial and technical support via the application of economics of
health and privatization.
!
Maintaining health gains and development of services
!
Re-habilitation of health services and upgrading medical equipment
!
Introducing a comprehensive system for health information
!
Caring for the quality of health services
Determinants and Objectives

1. Structuring health system for guaranteeing comprehensive coverage of all citizens
1. Structuring health system for guaranteeing comprehensive coverage of all citizens
with a high quality service
2. Development of different levels of health services (preventive, treatment,
rehabilitative)
3. supporting infra-structure of health organizations
4. upgrading the level of technical and professional performance of medical and
technical cadres
5. Enhancement of health economics concerning service cost and finding other revenue
generating resources for the budget.
6. Interest in the general health in the society
7. Developing emergency medical services to reach the highest possible level.
8. Providing modern technologies
9. Establishing an information center equipped with a network that covers all hospitals
and is connected to primary health care centers
10. Providing effective and safe medicine for citizens
11. Development of private health sector
12. Aiding researching of supporting health systems to help decision
13. Makers identify points of strength and weaknesses as well as the problems and
opinions of service providers and beneficiaries, taking procedure and setting suitable
plans and programs.
Chronology and main features of key reforms

The referred to goals were embodied in the program of work plan of the Ministry for the
period from 1999 till 2010
Process of Implementation; approaches, issues, concerns

Program included in the program and work plan of the ministry till the year 2010.
57
1. The National Program for Hospitals Qualification:- includes the construction works,
amendments, comprehensive maintenance and increasing the number of beds
2. The National Program for Qualifying Primary Health Care Centers: includes
renewal of the building of primary health care centers.
3. Program of Expansion in Health Utilities: Execution of new projects for a number of
health centers and a public hospital.
4. Charity Projects Program: Establishing health utilities from the charity donations of
individuals and organizations
5. Accreditation and
provided health Quality
care Control
services Program:-
pursuant aims standard.
to official at the continuous development of
6. Program of Developing Working Force: aims at upgrading the level of staff working
in the technical and administrative fields via increasing the rates of trainings,
programs, symposium, conferences, in addition to the continuous medical learning
programs.
7. Health Insurance Program: Aims at expansion in the system of health insurance of
the expatriates via establishing three health insurance hospitals
8. Program of Encouraging the Private sector:- aims at continuing to encourage the
private
countryhealth sector and increasing its share in the health development of the
9. Information Program: aims at establishing the unified electronic medical file of the
patient by introducing the computer system to all the primary health care centers,
general and specialized hospitals as well as the other utilities of the MOH.
10. The National Program for upgrading medical Equipment: aims at replacement of all
the medical equipment with other developed and modern ones
11. Health Enhancement Program: Aims at limiting risks of non-infectious chronic
diseases like diabetes, cardiac diseases, cancer, in addition to enhancing positive
health behaviors.
12. Primary Health Care Program: aims at developing the Primary Health Care services
13. Getting Rid of Medical Waste program: aims at getting rid of the medical waste by
a modern scientific way methods which prevent environmental pollution and
protect the human health
14. The Emergency Medical Program aims at developing emergency medical services
via increasing the number of ambulance cares by adding new developed ones,
together with increasing the ambulance centers to cover all the areas, upgrading
the communication system in addition to introducing a helicopter ambulance
service to the field of medical emergencies

Progress with Implementation:
A good achievement percentage was achieved during the previous period and the other
executive programs are being completed
Process of Monitoring and Evaluation of Reforms

Currently, execution is being followed-up by the MOH in addition to an annual follow-up
by the Ministry Of Planning, the council of Ministers and the National Assembly.
58
Future Reforms
The program is continuous until 2010
Results/ Effects
The program is expected to be a new step towards improvement of the service, in
addition to the continuity of the financial and technical support of the service.
59

" Useful
% Not useful
10 ANNEXES
1. Organizational chart, Ministry of Health

2. Organizational chart Health areas (except AlSabah area)
3. Organizational chart, AlSabah specialized health area
3. Organizational chart, AlSabah specialized health area
60
11 REFERENCES
1
UK Trade and Investment Site:
https://www.uktradeinvest.gov.uk/ukti/appmanager/ukti/middleeast?_nfpb=true&portlet
_17_933_actionOverride=/pub/portlets/advancedGeneric/displayDetail&portlet_17_933p
athToItem=%2FBEA+Repository%2F327%2F226155
2
Kuwait country profile Library of congress: http://lcweb2.loc.gov/frd/cs/kwtoc.html
3
Country profile Kuwait: Economic Intelligence Unit
4
http://lexicorient.com/e.o/kuwait_3.htm
5
Country profile 2004The Economist Intelligence Unit Limited 2004.
6
WHO, 2004. Country Cooperation Strategy for WHO and the State of Kuwait 2005 –
2009
7
http://www.country-data.com/cgi-bin/query/r-7585.html
8
http://www.kuwait-info.com/sidepages/health_over.asp
9
Kuwait Information: http://www.kuwait-info.com/
10
Country profile Kuwait 2001 http://www.emro.who.int/mnh/whd/CountryProfile-
KUW.htm
11
http://www.arabtimesonline.com/arabtimes/kuwait/Viewdet.asp?ID=5437&cat=a
12
http://www.indiansinkuwait.com/kinfo163.asp
1
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Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Table 2.2 Economic Indicators

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

91%. Thein female

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

2 S OCIO E CONOMIC G EOPOLITICAL M APPING

2.1 Socio-cultural Factors

Women % of Workforce 17.7 21.3 24.6 25.64

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

agricultural development. Consequently, with the exception of fish, it depends almost

Table 2-2 Economic Indicators

Indicators 1990 1995 2000 2002

GNI per Capita (Atlas method)current US$ - 18,200 16,280 16,340

Table 2-3 Major Imports and Exports

Major Exports: Oil and refined products, fertilizers

Major Imports Food, construction materials, vehicles and parts, clothing

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

2.3 Geography and Climate

Start Free Trial

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

2.4 Political/ Administrative Structure

Key political events/reforms

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

3 H EALTH STATUS AND DEMOGRAPHICS

3.1 Health Status Indicators

Table 3-1 Indicators of Health status

Life Expectancy at Birth: 74.88 74.2 76.8 78.4 78.7

Table 3-2 Indicators of Health status by Gender and by urban rural

Life Expectancy at Birth: - - 73.2 78.9

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Probability of dying before 5th

Substantial epidemiological transition happened in regards of infectious and

Table 3-3 Top 10 causes of Mortality/Morbidity

1. Diseases of the circulatory system Single spontaneous delivery

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

1975 2000 2025

el5years I15-65years D>65years

Table 3-4 Demographic indicators

Dependency Ratio % 0.6 0.6 0.5 0.51 34

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Table 3-5 Demographic indicators by Gender and Urban rural

Crude Birth Rate: 17.7 14.8 22.2

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Source: Country Profiles for Population and Reproductive Health, Policy

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

4 H EALTH S YSTEM O RGANIZATION

4.1 Brief History of the Health Care System

4.2 Public Health Care System

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

Health Systems Profile- Kuwait Regional Health Systems Observatory- EMRO

well established and smooth. Recently established council of undersecretaries facilitates