How governance can make UAE a global leader in healthcare

Redesigning the UAE’s healthcare system should focus on driving the existing governance system to operate more effectively.

October 13, 2019 Jad Bitar, Managing Director and Partner and Emile Salhab, Managing Director and Partner, Boston Consulting Group Middle East

In today’s modern setting of transformative technologies, the tremendous surge in information and data is revolutionising healthcare globally and in the UAE. The country's healthcare system has evolved significantly in the last decade under the governance of a federal regulator – Ministry of Health (MoH) – and two Emirate-level regulators – the Abu Dhabi Department of Health (DOH) and Dubai Health Authority (DHA). Despite this, the country’s healthcare sector still faces significant challenges, some of which are driven by the multiplicity of stakeholders and interest groups. Adding weight to these organisational complexities, the country faces a heavy challenge when it comes to non-communicable diseases such as diabetes and obesity.

Furthermore, the unsustainable costs of care, paired with higher inflation rates, does not bode well for the future of the sector or for patient welfare. As healthcare costs skyrocket, patients are struggling to cope with the fiscal strains of treatment amidst other socioeconomic impacts of non-communicable diseases. This is creating an air of uncertainty for those under care, especially given the fact that chronic diseases are often long in duration.

The exorbitant costs of non-communicable diseases, including lengthy and expensive treatments for diseases such as obesity, are weighing down the healthcare sector’s ability to successfully combat premature deaths. According to the World Health Organization (WHO), 30 per cent of the world’s population is obese or overweight, with figures being more alarming in the Middle East. To date, more than 36 per cent of children in the UAE are obese, which is double the global average. Additionally, a study by the University of Washington’s Institute for Health Metrics and Evaluation revealed that 66 per cent of men and 60 per cent of women in the UAE are obese.

Examples like this reiterate the importance of the healthcare industry to the UAE’s future development. Moreover, the country aims to achieve a high-quality healthcare system, both regionally and globally (e.g. Dubai Plan 2021), in which effective industry governance will be essential, especially in line with the UAE’s National Agenda. However, the fragility of the healthcare system and the strain of costs on patients’ need to be overcome in order for a healthier outlook to prevail.

As such, the UAE has a tremendous opportunity to take a fresh look at its health sector governance; to not only achieve set goals and position the UAE healthcare system as regional (and global) leader, but also to guide the transformation of the sector in a way that all stakeholders can contribute. Our research has demonstrated that although specific governance challenges differ depending on contextual factors, nearly all health systems confront a common set of problems – which includes:

1. The healthcare environment is changing so rapidly that even best-in class systems present gaps in governance.
2. The evolution of governance systems has created overlapping responsibilities that lead to unclear accountability and conflicting directives from competing regulatory entities.
3. The relevant regulatory agencies often lack the expertise and capabilities required to cope effectively with today’s challenges.

Redesigning the UAE’s healthcare system should focus on driving the existing governance system to operate more effectively in a way that is comprehensive, clear and simplified.

Let’s not forget that the UAE has been on the forefront of healthcare transformation in the region when it separated operational institutions from supervisory and regulatory bodies. Such efforts reinforce the overarching role of the MoH as a regulatory and monitoring authority.

The Emirate of Abu Dhabi has led by example in distinguishing healthcare management from healthcare regulation. It has done this by carving out the General Authority of Health Services into three entities: the Abu Dhabi Health Services Company (SEHA), an independent public joint stock company that owns and operates all public hospitals and clinics across Abu Dhabi; Daman, an insurance company; as well as the Department of Health, which regulates the public and private healthcare sectors.

Dubai has taken tangible steps, with Law No. 6 and Decrees No. 17 and 18 of 2018 leading to restructuring the internal management of the DHA on par with global standards, specifically in terms of organisational units and their roles and specialties.  

As such, the UAE has a tremendous opportunity to take a fresh look at its health sector governance; to not only achieve set goals and position the UAE healthcare system as regional (and global) leader, but also to guide the transformation of the sector in a way that all stakeholders can contribute. Our research has demonstrated that although specific governance challenges differ depending on contextual factors, nearly all health systems confront a common set of problems.

Jad Bitar

Emile Salhab

Seven principles of effective governance design  

An effective healthcare governance system will define the rules and regulations to drive “appropriate” behaviours for actors in the system and will monitor performance in order to optimise the health value for the entire population. To bring this system to life, there are seven design principles that should inform any effort to redesign health sector governance:

  • Nationally holistic: Sector-wide governance of the health system.
  • Accountable: Clear roles and responsibilities, efficient allocation of resources and capabilities, system-wide monitoring, compliance, and enforcement.
  • Trusted: Data-driven decision making that is transparent, objective, and properly governed.
  • Dynamic: Agility to respond to needs and requirements promptly and effectively.
  • Complementary and cooperative: Encouragement of collaboration and cooperation.
  • Strategic and focused: Pragmatic and practical regulation and change.
  • Population centric: Equitable and outcome-driven to empower the population.

While some of these principles may sound obvious, the logic underlying them and the way they work together to create a coherent governance-operating model is essential. What’s more, these high-level principles will serve as a constant reference point in efforts to design the details of the governance system.

Four steps in redesigning health sector governance

The UAE’s roadmap to transforming its healthcare sector will require a specific and clear roadmap communicated to all stakeholders to ensure alignment and minimise disruption. The roadmap should hinge on four basic steps:

1. Assess healthcare system performance in terms of global benchmarks: Benchmarking other health system best practices for governance, as well as how these practices can be adapted to the UAE’s national context.
2. Define goals: The UAE needs to establish a baseline for current system performance and the existing governance model. For example, there is an urgent need for a sustainable, effective and trusted healthcare delivery model, while managing costs by reducing “leakages” in the system.
3. Redesign the governance model: Ensuring complementarity between federal and emirate regulators where a clear division of roles among the seven design principles will have multiple benefits, including improved steering of the system, lower overall costs, and increased cooperation.
4. Plan for implementation: As well as separating operational and regulatory functions, policy decisions in the UAE should also focus on strengthening prevention and wellness. The curative aspect of the system has improved significantly in the last decade. It’s time to integrate health prevention and maintenance in the governance of the system. Moreover, the further separation of operations and governance, if done effectively, can reap benefits to the population and the economy. Restructuring efforts have proven vital not just in increasing efficiency, but also towards reducing costs, size, units, departments and levels in the restructured institution, and improving overall competitiveness.

Globally, even the best-governed health systems can benefit from a renewed focus towards addressing critical gaps in the healthcare environment. In the UAE, this approach will be particularly beneficial. The result will be a more efficient, more responsive system that provides high-quality services to industry stakeholders, to the nation’s citizens, and to the transformative visions outlining the nation’s future progress.

References available on request.

The UAE’s roadmap to transforming its healthcare sector will require a specific and clear roadmap communicated to all stakeholders to ensure alignment and minimise disruption.