The healthcare market in the Middle East and North Africa (MENA) region presents a complex, diverse and rapidly changing picture, rich in opportunities for foreign companies and institutions. The region has built some of the world’s most advanced medical facilities. At the same time, there is a need for improved primary healthcare services, and some countries such as Yemen and Sudan are still struggling to bring down infant and maternal mortality rates.
Improvements in health indicators are altering population structures and disease patterns. There have been huge drops in infant mortality rates, and life expectancy has risen. According to the 2009 Arab Human Development Report issued by the United Nations Development Programme, life expectancy across the Arab world averages nearly 68 years, up from 52 in 1970-75. But there are major variations: the UAE enjoys the highest figure, of 78 years, while in Yemen and Sudan life expectancy is only 61.5 and 57 years respectively, and Iraq 58 – the same as in 1970-75.
The overall population growth rate in the Arab world has fallen from 2.6 per cent in 1970-75 to 1.9 per cent in 2005-15. But this is still one of the highest growth rates for any region, increasing the pressure on health services.
The proportion of the population over the age of 65 is rising. An Economic and Social Commission for West Asia report on ageing in Arab countries notes that the number of people in the Arab world aged over 65 doubled from 5.7 million in 1980, to 10.4 million in 2000, and is expected to hit 14 million in 2010 and 21.3 million by 2020. There are increases in the incidence of age-related diseases such as heart disease, cancer and dementia.
Lifestyles featuring fast-food diets, a lack of exercise, and a high incidence of smoking are also changing disease patterns. Obesity is rocketing, helping push up rates of Type 2 diabetes; in the UAE, an alarming 20 per cent of the population is diabetic.
Persistently high rates of marriage between first cousins and other close relatives maintain the incidence of genetic diseases, such as the potentially fatal blood disorders thalassaemia, sickle cell disease and haemophilia, and a variety of other physical and mental abnormalities. It is estimated that one-in-12 of the population of the UAE is a thalassaemia carrier. Survival rates for those afflicted by congenital disease are increasing, thanks to improved medical care, placing an additional burden on health budgets.
Due to religious and social pressures against abortion – even if antenatal testing finds foetal abnormalities – the preferred approach to reducing incidents of disease is through genetic screening. Mandatory pre-marital genetic testing of couples has been introduced in a number of countries. In December 2009, Qatar became the final Gulf Cooperation Council (GCC) state to make such tests compulsory for all national and expatriate couples planning to marry in the country.
A report by management consultants McKinsey predicts that total GCC healthcare spending will increase fivefold, from $12 billion in 2007 to more than $60 billion by 2025. By then, the demand for hospital beds will have soared to 162,000, up from 114,450 beds in 2015 and 68,000 in 2006. Over the next two decades the population of the GCC is expected to double and the number of people aged 65 and over to rise sevenfold. The report warns that government-run hospitals and clinics are “ill prepared for a rapidly growing and ageing population, as well as for the rise in chronic diseases such as diabetes” and advocates changes in government policies and regulations to encourage private healthcare.
Some of the best-known names in the UK health field have set up GCC operations. One magnet for such institutions is the Dubai Healthcare City (DHCC), the world’s first healthcare free-zone, in which Dubai’s strategic collaborator is Partners Harvard Medical International.
Moorfields Eye Hospital NHS Foundation Trust founded a branch in DHCC in 2007, and Imperial College of London has established a diabetes centre in Abu Dhabi, wholly owned by the Abu Dhabi government’s Mubadala Development Company. The centre collaborates with MEHD on the treatment of patients with diabetes-related eye complications. Great Ormond Street Hospital for Children has had an office in DHCC for the past three years to complement and support its treatment services in London.
Kuwait is looking to Britain for help in expanding and developing its healthcare system. During an October 2009 visit to London, Kuwaiti Health Minister Dr Hilal al-Sayer signed a memorandum of understanding (MoU) with Guy’s and St Thomas’s NHS Foundation Trust.
Syria’s Ministry of Health reached an MoU with Britain’s Department of Health in 2008. Syria is in the throes of fundamental healthcare reform and plans a number of healthcare cities and other centres of excellence. It is also redesigning the public health system to accommodate imbalances, such as only a fifth of the rural population having ready access to public health services. Several UK universities and institutions have negotiated training and supply contracts with Syrian partners. Lebanon’s $600 million pharmaceutical and healthcare market – the largest in the Arab Levant and expanding at 6 to 7 per cent a year – is a magnet for UK exporters who have about 5 per cent of the market share.
Iraq is a difficult, but potentially rewarding, market as it tries to restore its health system. The Cornish health consultancy M J Medical was appointed in mid-2009 as lead design consultant on a $400 million project to build three 400-bed teaching hospitals in Baghdad, Diyala and Diwaniya. Libya is also trying to make up for lost time. The Libyan British Business Council was scheduled in February 2010 to take its first-ever delegation of UK healthcare business leaders to Tripoli to explore trade and investment openings.
Medical ‘tourism’ is a rapidly growing industry and several MENA countries offer cosmetic surgery, elective surgery, infertility treatment and dentistry. Lebanon is a well-established centre, but is facing competition from Morocco, Egypt and Tunisia. Turkey draws an estimated 200,000 medical tourists annually, while Jordan accommodates more than 250,000 patients. The Medical Tourism Association expects medical tourism to earn Jordan $650 million in 2009 and $1 billion in 2012.
Dubai’s DHCC hopes to win some of the $2 billion tourists from the Gulf are estimated to spend abroad each year, but faces stiff competition on price from Middle Eastern rivals as well as India, Singapore and Thailand.
As each country develops its own healthcare profile to meet its individual needs, the prospects for all aspects of medical provision in the MENA region are hugely promising in the transfer of knowhow, training, the building of clinics and hospitals and the export of pharmaceutical products and medical supplies.