One of the biggest challenges for health services worldwide is that of human resources. Finding and keeping the best doctors and nurses, administrators and technicians in an increasingly competitive and globalised sector requires a range of approaches. For Dubai, whose population and workforce has a high concentration of expatriates, personnel recruitment, retention and training is a particularly key issue.
The emirate has engaged in a series of programmes to expand its workforce in recent years, including continuous training and enhanced recruitment packages, and is expected to step up efforts in the coming years, as factors such as population growth continue to accelerate demand for health care.
By the Numbers
According to the latest available statistics from the Dubai Health Authority (DHA), the number of people registered as working in the emirate’s private health sector stood at 31,080 in 2017. Of this number, some 89% were non-Emiratis. There were 5862 physicians, 2012 dentists and 11,375 nurses. Around 64% of private health workers were under 40 years of age and women made up more than half of the sector’s registered human resources. Most doctors – 71% – in private practice in 2017 were specialists and the remainder were general practitioners (GPs).
In the public sector approximately 10,100 people were employed in DHA hospitals, primary health care centres (PHCs) and specialised centres in 2017. Some 1450 of these were physicians, 4551 nurses and 178 dentists. An estimated 80.5% of physicians and 99% of the nurses were non-Emiratis, while the majority of dentists – 63.4% – were nationals. In terms of gender, women accounted for around 42.6% of physicians, 83.2% of nurses and 73% of dentists.
In 2017 the DHA increased the number of doctors and nurses working in its hospitals by 1.1% in 2017. The private sector, too, saw increases. However, due to population growth, which stood at around 9.8% in 2017, the number of doctors and nurses per inhabitant actually declined, so overall there were 2.9 physicians and 6 nurses for every 1000 inhabitants in 2017 overall compared to 3.4 and 7.2 the previous year. The number of dentists, meanwhile, remained stable, at 0.8 per 1000 people in both years.
The statistics illustrate to some extent the challenge currently facing the health sector in ensuring service provision keeps pace with demand. In 2015 the DHA predicted that the emirate would need some 7323 more doctors and 8510 nurses over the following decade. The issue is further compounded by the relatively small size of the national, permanent population. Because only 8.2% of the 3m people living in Dubai in 2017 were Emirati, the local recruitment pool is a shallow one, meaning that to cover the needs of the expanding population, efforts must focus on recruiting and retaining staff from abroad. Certain cultural and social factors have also restricted the potential for local recruitment. Nursing in particular is not considered an appropriate career by many Emirati families, which may account for the fact that there were only 44 Emirati nurses working for the DHA in 2017.
According to some medical professionals, providing coverage for the expanding population poses particular challenges for recruitment in specialised areas. “It is not GPs that are a problem, but liver specialists, oncologists and neurosurgeons – people who are already doing well in their home countries. They are difficult to attract,” Dr Kishan Pakkal, CEO of International Modern Hospital Dubai, told OBG.
Expanding specialist care is key to tackling the rising trend of non-communicable diseases in Dubai and the UAE as a whole. In future years, the emirate will also face a challenge from its ageing population. According to World Bank estimates, while only 1.1% of the total population of the UAE was above the age of 65 in 2015, this figure will rise to 4.4% by 2030. Any shortage of specialists could also dampen efforts to expand the emirate’s medical tourism industry. “Investors have realised that general hospitals are not enough: specialisation is needed in order to enhance the quality of hospitals and expand their reach within the niche in which they operate,” Elhadi Hassan, chief financial officer of Moorfields Eye Hospital, told OBG.
Addressing Gaps in Care
To ensure the health sector has the human resources necessary to meet the increasing demands laid upon it, workforce and education is a fundamental pillar of the sector’s latest development plan, Dubai Health Strategy 2016-21. In addition to developing strategies to attract and retain medical personnel, the plan aims to increase the number of Emirati citizens working in the sector. It also intends to introduce continuous medical education programmes and issue guidelines for teaching hospitals and training courses. To expand specialist care it hopes to establish centres of excellence in the fields of oncology, cardiovascular disease, orthopaedics and neurology, among others, and enhance clinical training programmes for each specialty.
The 2016-21 strategy builds upon the Dubai Clinical Services Capacity Plan 2015-25, a 10-year programme designed to address gaps in health care provision across the public and private sectors, and serve as a tool for health care planning in Dubai until 2025. Based on a 2012-13 study the plan issued a series of key recommendations, including construction of three medical colleges and five nursing schools; the implementation of a two-year diploma for nursing assistants; and more training schemes for nurses in private sector institutions. The report also recommended improving working conditions for nursing staff, including bringing wages in line with GCC and European norms and introducing more flexible shift systems.
In order to tackle gaps in medical specialties the plan recommended that more support be provided to Emirati physicians to gain postgraduate qualifications overseas and locally, and that improvements be made to residency programmes. The strategy also examined geographical disparities in the provision of health care services, an issue never before addressed in Dubai. A study of the emirate’s districts revealed an over-concentration of medical facilities in areas such as Jumeirah, an affluent residential community on the coast, and undersupply in places such as Jebel Ali – where much of Dubai’s commercial and business activity is concentrated – Dubai World Centre airport and its surrounds; and the Marina – another affluent seaside neighbourhood. Based on the report’s findings, these areas have been given priority in the issuing of new medical centre licences.
Recent years have therefore seen a surge in the construction of medical training and education facilities as a result of strategic planning. Even prior to this the emirate had a number of well established colleges and medical schools offering degrees and training programmes. These include two women-only institutions: Dubai Medical College for Girls, which offers a Bachelor of Medicine, Bachelor of Surgery (MBBS) programme; and Dubai Pharmacy College, which conducts undergraduate and master’s level pharmacy degrees. There is also the Royal College of Surgeons in Ireland – Dubai, which provides master’s degree programmes in health care management.
In 2013 there was exponential growth in medical training and education infrastructure, with the opening of the Mohammed Bin Rashid Academic Medical Centre at Dubai Healthcare City. Facilities at the site include the Mohammed Bin Rashid University of Medicine and Health Sciences; the Al Maktoum Medical Library; and the Khalaf Ahmad Al Habtoor Medical Simulation Centre. The university offers MBBS programmes in partnership with Queen’s University Belfast and Mediclinic Middle East, as well as graduate programmes in the field of dentistry, which are conducted by the Hamdan Bin Mohammed College of Dental Medicine, a school within the university.
At the end of 2017 DHA officials told local media that it was making progress in achieving the workforce development goals of Dubai Health Strategy 2016-21. It said that the number of physicians per 1000 people had increased to 3.3 – significantly higher than the UAE-wide ratio of 2.7. At the same time officials said that the introduction of new technologies, such as telemedicine and RoboDoc, were enabling specialists and other health professionals to provide care from a distance, thereby improving access to medical services in areas with gaps in supply, or for people who are unable to travel.
In all its endeavours to expand human resources, the DHA has also been keen to involve private sector institutions and international health care providers. Bringing in outside expertise in medical training and education is vital to address current challenges, as well as the longer-term requirement of a larger Emirati employment pool. It is likely more colleges and specialist schools will be built in the coming years with a particular emphasis on providing the kind of high-quality, specialist care necessary to meet the needs of Dubai’s rapidly expanding – and changing – population.
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