KUWAIT HEALTH SECTOR REPORT 2012
Kuwait Health Sector | Netherlands Embassy Kuwait & Bahrain
January, 2012 (Cees Kieft, Fadi Al-Ahmad, Ferosh Aziem)
Table of Contents
Market conditions ...............................................................................................................3
Government sector..............................................................................................................4
Private sector ......................................................................................................................4
Design / Build.....................................................................................................................4
Global Health Organizations...............................................................................................5
Medical Recruitment and Training......................................................................................5
Prevalent Diseases ..............................................................................................................6
Preventive Healthcare .........................................................................................................6
New Technologies and Medical Equipment ........................................................................6
International Standardisation ..............................................................................................6
E-Health Services and Systems...........................................................................................7
Upcoming Opportunities.....................................................................................................8
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Kuwait Health sector
Kuwait is facing many challenges in the health sector. According to a recent report from
McKinsey there is an increasing pressure on the health facilities. For instance currently
Kuwait has 19 hospital beds per 10.000 people. Although the population tends to be quite
young on average, this undersupply is a serious concern to the government given the
population growth rate and growing disease burden. For example, obesity levels have reached
80% for women en 70% for men. Kuwait has signalled its priority to remedy the
shortcomings in the health care provision when the sector was touted as the main beneficiary
of the US$108 billion infrastructure development plan that was approved in 2010. This
development/investment plan was approved to give the economy a big boost after the
financial crisis.
In January 2011 it was announced that the government was working on a strategy to bolster
the health care system with 3500 beds, new laboratory and surgical facilities. According to the
Ministry of Health the private sector will be instrumental in the development of the sector.
There is vast potential for companies offering a broad spectrum of healthcare oriented
services including medical equipment, hospital supplies, products and services, and
specialized applications. Quality and novel products are much sought after in the market, and
Dutch companies are highly regarded in this respect in Kuwait. That means there is an
apparent match between the demand and competences of Dutch healthcare companies.
This report has been prepared for the purpose of informing Dutch businesses about the
opportunities in the Kuwaiti health sector. It is based on observations, background research
and interviews that were held with the CEO’s of the top 4 healthcare companies in Kuwait.
The following sections provide descriptions about the sector, relevant trends and upcoming
projects.
Market conditions
The Business Environment Ratings (BER) for Q4 2011, ranked Kuwait as second of the 19
markets now surveyed in the Middle East and Africa (MEA) region. Kuwait, considered a
low-risk market, reflects a stable regulatory and economic environment, plus its harmonized
presence within the GCC. The BMI Q4 2011 reports quoted the Kuwaiti the pharmaceutical
segment as worth US$711mn, the Healthcare segment US$4.01bn and Medical Devices
segment as US$275mn.
Bureaucracy and minor political instability remain a hindrance to the execution of the
government’s plans. Nonetheless, projects are moving forward despite administrative
changes. In dealing with government initiatives in Kuwait, companies should take into
account a time lag of 15-18 months between scheduled dates and the actual execution.
A common GCC-wide Pharmaceutical import policy has been proposed by the Kuwaiti
government to alleviate cost pressures, in order to make pharmaceuticals more affordable in
the private sector.
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Government sector
The Kuwait government is the largest investor in the healthcare sector. According to
estimations of local companies, it accounts approximately for 80% of the sector’s total
investment. The government currently operates 15 general and specialized hospitals. These
healthcare facilities are distributed geographically all over the country to serve all the
commercial and residential areas. For an overview please refer to part A in the annexes.
Private sector
The private sector is expected to grow moderately in the upcoming years and is estimated to
take up a share of up 15-20%. Investment in the sector has been affected by the global
financial crisis to some extent. Even so, patients are avoiding the free government healthcare
services and are paying a premium for private healthcare due to some of the following
reasons;
Criteria Government Healthcare Private Healthcare Services
Services
Time Longer waiting time Less/no waiting time
Appointments Patients should schedule many Patients can complete their treatments in
appointments to complete a fewer appointments
single treatment
Prestige No Prestige Local patients are paying extra for the social
status associated with the hospitals visited
especially in the Gynecology field
Table 1: Government vs. Private Healthcare Services in Kuwait
The Kuwaiti government has organized the private healthcare establishments based on their
size and functionality. For a detailed description please refer to part B in the annexes.
Design / Build
The hospital expansion plan centers on the construction of 8 public hospitals and extensions
which are the responsibility of the Ministry of Health and 9 new towers for existing hospitals
that falls under the responsibility of the Ministry of Public Works. The towers will be annexed
to the Maternity Hospital, Al Sabah. Al Razi, Al-Amiri, Ibn Sina, Al-Adan, Al-Jahra and Al
Farawaniya hospitals, as well as Hussain Makki Juma Centre for Specialized Surgeries. The
new towers will increase the number of operating rooms to 70, and the number of beds in
intensive care units to 90 beds. The project will also increase the number outpatient clinics,
and improve the services related to x-ray, laboratories, sterilization units, and medical records.
They will also provide a centre for disasters and emergency and an isolation ward with a
capacity of 90 beds. Under construction is also the largest new public hospital, the Sheikh
Jaber Ahmad Sabah hospital (1300 beds).
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The Ministry of Health has recently signed a contract with Hill international one of the global
construction risk management companies that will provide project management and
consultation services for the construction of the 8 public hospitals en extensions. The three-
year contract has an estimated value of approximately USD 6.2 million.
Kuwait University is building a new medical campus and a training hospital with 600 beds.
Within the Kuwait University the vice president for planning Prof Malek Hussain and the vice
president of the Health Sciences Center, Prof Abdulla Behbehani are managing this project.
The health sciences center is the governing institution for the faculty of medicine, the faculty
of allied health sciences, the faculty of pharmacy and the faculty of dentistry.
Global Health Organizations
Every year the Kuwait government sponsors a huge number of patients seeking solutions for
critical medical situation outside the country. The government allocated a budget of approx.
1 Billion USD for medical treatments abroad for the year 2010. According to 2010 statistics,
3000 patients were sponsored by the government and 8000 patients availed medical
treatments from private funding. Thousands more are sent by similar programmes run by the
military, the police, the Kuwait Oil Company and the Emiri Diwan.
Recently a number of agreements have been signed by the Ministry Of Health with leading
hospitals to serve Kuwaiti patients who go abroad for treatment.
Medical Recruitment and Training
A major feature of the Health system in Kuwait is its heavy reliance on expatriate workers,
constituting 80% of all doctors and over 90% of all nurses. Local training facilities have
started producing some of the required allied health professionals However; continued
shortages of health professionals are inevitable in most areas. The manpower shortages have
plagued efficient healthcare service delivery in Kuwait.
With the construction of new public hospitals and extension towers an estimated 15,000
healthcare professionals will be needed only in the public sector.
The presence of highly diverse expatriate workforce raises serious problems, concerning
worker conflict, differential skills and competencies. Need for standardizing local training
facilities and improving the system of hiring expatriates.
Kuwait Institute for Medical Specialization (KIMS) is the authority responsible for organizing
all aspects of postgraduate training of health professionals in Kuwait. The institute is engaged
in a variety of activities, including specialty training at various levels in different medical
fields, medical education and professional development activities.
Also there are local private companies active to manage the needs of healthcare clients.
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Prevalent Diseases
Kuwait ranks 13th on a global scale in obesity and 7th in the number of people who have
diabetes that is related to obesity and genetic factors, according to the World Health
Organization’s statistics. The number of this kind of diabetic patients is dramatically
increasing every year. Levels have already reached 40 percent of the population, and reasons
behind obesity include lack of movement, desk jobs, and eating unhealthy, dense food. This
issue is expected to become even more pressing in the future, as 80% of Kuwaiti children are
obese.
Breast cancer is the number one type of cancer diagnosed in women in Kuwait. There is an
increase in breast cancer and related deaths. The Kuwait Cancer Control Centre is trying to
develop a patient-centered philosophy through collaboration and partnerships such as with the
University Health Network.
Preventive Healthcare
Following the global trend, there is an increasing demand for preventive healthcare which
could potentially be served by private sector clinics. The region possesses sufficient financial
means to shoulder the costs of preventive scans and medical check-ups.
New centres are anticipated to help in detecting cancer in its early stage for effective
treatment. The Ministry of Health plans to establish health centres at each district to conduct
periodical screening for breast cancer in women in an effort to reduce breast cancer in
Kuwait.
New Technologies and Medical Equipment
There is a huge potential for companies offering a broad spectrum of medical-dental-lab
equipment, hospital supplies, pharmaceutical products and specialized systems and
applications due to the planned upgrades and extension. There is also a demand for unique
products and new technologies, such as laser-treatment, nanotechnology and molecular
medicine. Laboratory testing is also a growing segment and will require testing equipment
and disposable tests.
International Standardisation
The Kuwait health sector is well regulated. There are guidelines and regular audits are taking
place to check whether the rules are adhered to. Companies in the sector are now also moving
towards ISO-compliance and bring in foreign expertise in order to obtain international
certifications. Services sought after range from upgrading existing procedures to
organizational restructuring and development of IT infrastructures.
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E-Health Services and Systems
At a Saudi e-Health conference 2010, the Undersecretary of the Kuwait Ministry of Health,
Dr. Ibrahim Al-Abdulhadi said that Kuwait has worked out plans for upgrading data systems
matching international standards in all sectors of Health ministry and promoting the
applications of the electronic health system at its departments.
Minister Dr. Hilal Al Sayer attributes great importance to developments in the domains of e-
health and genomic information. The Ministry of Health sought to set up an integrated
electronic communication network to link up all sectors and departments of the Ministry
including hospitals, medical centres and clinics.
The Ministry of Health has already begun applying the e-files system for preliminary health
care and plans to expand it to incorporate the engineering sector, the citizen’s service, the e-
communication and the work shifts system. The private sector is also expected to take up a
leading role in developing and implementing e-services.
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Upcoming Opportunities
1200 projects are scheduled for the second Annual Plan (2011 -12). The Government of
Kuwait is set to tender approximately 3 billion USD worth of healthcare projects over the next
year. These projects follow the similar framework used for the overall Annual Plan related
projects. These include:
1) The 9 Tower Extension Plan – The Ministry of Health in Kuwait is going to build nine
medical towers in various health zones throughout the country, aiming to extend hospital
capacity by 30 percent. The project includes 5 stages of which the tendering process for
the first stage has concluded as per December 2011. It is expected that the next stages
will be open for complete tendering of construction, medical equipment and medical
supplies. Table 5 in the annexes presents an overview of these stages.
2) Reform of the Health Insurance sector– with the establishment of new companies like
Kuwait Health Assurance Company (KHAC), a 1600 to 1800 bed health maintenance
organization, and the yet to be established Private Health Insurance Company for Kuwaiti
Nationals (PHICKN).
The establishment of KHAC and PHICKN are seen as strong contributors to the
diversification of health system finance in Kuwait. The 2011-12 Kuwait Government
budget will be the first time the Ministry of Health spends over one bn KD (3.3 bn USD)
on the operational expenditure (OPEX) of the public healthcare system.
With KHAC aimed at refinancing the healthcare costs of the expat population of Kuwait
and PHICKN aimed at addressing the healthcare finance needs of the national population,
the government of Kuwait is sending strong signals of cooperation to the private sector in
an attempt to curb the exponential increases in public healthcare spending.
Kuwait Health Assurance Company
The plan for KHAC is for the principal partner, Agility, to guarantee the management of
three hospitals (1600 to 1800 beds and 10 to 15 primary care clinics) as well as provide
Health Maintenance Organization (HMO) type plans for users. The KIA makes the
distinction between health maintenance and health insurance, whereby KHAC will be
incentivized to management the health (and prevention) of the expat population rather
than the treatment.
The Government has also mentioned the following benefits specifically for KHAC:
- Immediate patient flow (1.2 to 1.7 million) of expats
- Option for group purchasing with the Ministry of Health
- Unique Designation of a Health System (only license in Kuwait) for 10 years
- Grace period for licensing and implementation
- Sharing of existing Ministry of Health medical records
- Staff designation before entry into Kuwait
- Free transfer of clinical staff within the system
- Use of generic prescriptions
- Unit Dose System
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- Preapproved assurance plan premiums with inflation considerations
- Preapproved co-payments for primary care and emergency visits
- Heavily subsidized tertiary care for 5% of pre-approved government premium
Agility is mainly a logistics company and therefore expected to involve international
technical partners that have the required expertise and exemplary track records.
Private Health Insurance Company for Kuwaiti Nationals
The Private Health Insurance Company for Kuwaiti Nationals (PHICKN) endeavors to
achieve a similar level of diversified healthcare spending for the local national population
of Kuwait.
In August 2011, the Council of Ministers of Kuwait highlighted the government’s
intention to corporatise the healthcare insurance for Kuwaiti nationals by creating a
Kuwait domiciled company that will be 50% owned by the public with the remaining 50%
offered to a private sector consortium with a strong preference for a consortium that
includes an international technical partner with a proven track record in delivery of health
insurance products and solutions both regionally and internationally.
It is believed that the Government of Kuwait will heavily subsidize the premiums of the
nationals. Judging by the government’s previous lead time on KHAC, it is expected that
the PHICKN will be tendered in late 2013.
3) Strategic Public Private Partnerships – a 500 bed New Rehabilitation and Physical
Medicine Hospital (NPMRH) through a Design, Build, Finance and Maintain (DBFM)
The New Physical Medicine and Rehabilitation Hospital (NPMRH) project involves the
Design, Build, Finance and Maintenance of a 500-bed Physical Medicine and
Rehabilitation Hospital located in Al Andalus area, Kuwait. The project will also include
the provision of facilities management services and will have a term of no less than 25
years.
The project aims to meet the following key strategic objectives:
a) Build a centre of excellence in rendering Physical Medicine and Rehabilitation services
b) Promote the State of Kuwait as a regional and international centre for Physical
Medicine and Rehabilitation services
c) Increase and enhance the type and quality of services provided by Ministry of Health
d) Provide a comprehensive rehabilitation programme for Kuwaiti citizens with
disabilities, within their own home environment without language and cultural barriers
and thus curtail overseas treatment
An international management consultancy and auditing company won the contract to act
as lead consultants to the PTB. The results of the study are expected to be made public by
Q4 2011. The new hospital, as envisioned by the Ministry of Health, will provide: Tertiary
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rehabilitation, geriatric rehabilitation, extended care for persons with physical disabilities,
redevelopment of the prosthetic and orthotic manufacturing unit, supporting building
infrastructure and facilities; and the provision of facilities management services.
4) Project Tenders –including the following initiatives:
a) Anti-Smoking Centre
The Ministry of Health is performing studies to establish a centre that collects data on
smokers in the country and will conduct comprehensive surveys and awareness campaigns
on smoking. The centre will also include specialized clinics to treat smokers.
Approximately 7 million KD have been allocated for the project.
b) New clinics to diagnose cancer
The Ministry of Health plans to construct a medical facility in every health zone to
conduct the aforementioned periodic screening tests to rule out breast cancer. A medical
facility in each governorate is believed to help diagnose the disease in its early stages.
c) Maternity Hospital Planned for Jahra
The Ministry of Health has plans to build an integrated maternity hospital at the Jahra
governorate with a total capacity of 500 beds. The new hospital will provide top quality
medical services for women during pregnancy and after childbirth.
d) The K.O.C. - Ahmadi Hospital
This hospital is supposed to provide treatment for all oil sector employees and their
families. The tenders for its construction have already been awarded to the Sayed Hamid
Behbehani Company. SHBC is in the process of directly requesting for quotations of
medical equipment for several areas of the hospital such as:
Intensive Care section – 24 beds
Inpatient Suites & Wards – 278 beds
OBS/GYN Inpatients & Wards – 14 beds
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ANNEX A: DISTRIBUTION OF PUBLIC HEALTHCARE FACILITIES IN THE COUNTRY
There is at least one major general hospital in every governorate;
# Governorate Hospital Beds
1 Al Asimah Al Amiri Hospital 374
2 Al Asimah Al Sabah Hospital 438
3 Hawalli Mubarak Al Kabeer 409
Hospital
4 Farwaniya Farwaniya Hospital 523
5 Al Ahmadi Al-Adan Hospital 557
6 Al Jahra Al-Jahra Hospital 621
Total Beds 2,922
Table 1: Kuwait General Hospitals
The government also operates specialized hospitals as exhibited in Table 2 below;
# Hospital Specialization Beds
1 Al-Razi Orthopedic surgery 267
2 Physical Med. & Physical Med. & 78
Rehabilitation Rehabilitation
3 Maternity Hospital Maternity 375
4 Chest Diseases Hospital Chest Diseases 131
5 Infectious Diseases Hospital Infectious Diseases 151
6 Psychological Medicine Psychological Medicine 749
7 Ibn Sina Hospital Spinal Surgery 363
8 Kuwait Cancer Control Cancer Control 112
center
9 Allergy Center Allergy Center 128
Total Beds 2,354
Table 2: Kuwait Government Specialized Hospitals
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ANNEX B: CLASSIFICATION OF HEALTHCARE FACILITIES BY THE STATE OF KUWAIT
1) Private Hospitals: the Ministry of Health divides the Private Hospital into three categories;
a) General Private Hospital: is a private hospital that has a minimum of 60 beds where
patients can be admitted for treatment. The General Private Hospital must at least
provide all the following medical practices;
i) Internal Medicine
ii) General Surgery
iii) Pediatrics
iv) Gynecology & Obstetrics
v) Anesthesiology
b) Specialized Private Hospital: is a private hospital that has a minimum of 40 beds
where patients can be admitted for any specialized medical practices such as
Pediatrics, Ophthalmology, E.N.T., etc.
c) Private Dispensaries: are medical establishments that must at least one of the below
mentioned medical practices.
1. General Practice
2. Dentistry
3. Medical Labs and Bacteriology
4. Radiotherapy
5. Physiotherapy
The Dispensary should have at least 3 General Practice clinics and no more than 2
specialized clinics. The Manager of the dispensary must be a Kuwaiti General
Practitioner with at least 5 years of experience and not retired. The manager is required
to be full time employee for the dispensary.
o Private Clinics: are one room medical facilities that are managed by a doctor with any
medical specialty. The clinic shall provide waiting areas and an examination room for
patients.
2. Private Healthcare Centers: are medical facilities that can provide all the following
practices;
1. General Surgery
2. Internal Medicine
3. Pediatrics
4. Gynecology & Obstetrics
The license is only given to Kuwaiti doctors with at least 10 years of continual experience.
The Healthcare Center should have a minimum of 6 general or specialized clinics. The clinic
cannot provide overnight admission.
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9 Towers Extension Plan
# Hospital Budget Beds Operating Emergency OPD Labs Radiology Pharmacy Physio- Additional Services
(Mil. KD) Rooms Rooms Clinics therapy
Stage 1
1 Amiri Hospital 125 360 65 Yes Yes Yes Yes Nuclear Medicine, Medical
records
2 Al-Razi Hospital 40 192 Yes Yes Yes Administration Area, Anesthesia
Offices
Stage 2
3 Farwaniya Hospital 200 564 24 30 34 Yes Yes Yes Yes Morgue, Cardiac Cathertization,
Lab, IVF Unit
4 Infection Disease 55 255 Yes Yes All beds will be private rooms
Hospital for infection control purposes
Stage 3
5 Kuwait Cancer Center 215 600 10 20 52 Yes Yes Yes Yes A fully integrated new hospital
Stage 4
6 Al Jahra Hospital 90 300 Yes Yes Medical Offices , Auditorium
7 Al Adan Maternity 21 433 28 8 23 Yes Yes Yes Yes New Born Nursery, IVF,
Hospital Medical Records
Stage 5
8 Ibn Sina Hospital 100 300 10 Yes Yes Yes Neurophysiology department
9 Al Sabah Hospital 110 300 12 20 40 Yes Yes Yes Yes New Integrated Hospital
Total 1.145 3.334 84 78 214
Table 4: Nine Towers Extension Plan
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