Continuum of care: Further investment in specialty care expected as new services come on-line

Improvement to the continuum of care is one of the main areas of focus for the Health Authority – Abu Dhabi (HAAD) in its seven-point strategy. Fresh efforts to reduce existing capacity gaps in health care provision through the expansion of specialty care services is expected to transform the emirate’s already dynamic health sector.

A number of new specialty providers have opened their doors in 2015, most notably Cleveland Clinic Abu Dhabi, BrightPoint Royal Women’s Hospital and Danat Al Emarat Women’s and Children’s Hospital. Ongoing developments at Sheikh Khalifa Medical City (SKMC) have also helped expand the emirate’s continuum of care. At the same time, specialty care remains in short supply in the emirate’s Al Gharbia region, leading HAAD to seek new, incentivised partnerships with the private sector in a bid to address the shortage. Moreover, with Abu Dhabi’s population growth averaging 7.6% between 2005 and 2014, one of the highest rates globally, there is huge demand for health services, in particular specialty care.

Going Abroad

In December 2014, HAAD announced it had finalised a five-year strategy for health care development, running from 2015 to 2020, and emphasising seven critical pillars, including improvements to the integrated continuum of care, which will entail significant expansion of existing specialty care facilities.

A lack of available specialty care has long been a problem in Abu Dhabi, and until recently the emirate’s health care landscape was dominated by general hospitals and primary care facilities, leading many Emirati and expatriate residents to seek treatment abroad. According to a January 2015 report published by PwC, just 29% of expatriates surveyed would remain in the UAE if they needed treatment for a serious medical problem, with 64% of Asian expatriates and 61% of Western expatriates reporting that they would prefer to seek treatment in their home countries. Nearly 20% of respondents reported having travelled abroad for medical treatment. In July 2015, a survey of 1000 expatriates and Emiratis found that nearly a quarter of respondents travel abroad for medical treatment, despite 72.7% reporting that they are satisfied with the quality of care they receive in the UAE.

Specialty Gaps

With both expatriates and Emiratis saying they are satisfied with the care they receive in the UAE, high costs and limited specialty care options were identified as the primary factors behind patients seeking medical treatment abroad.

Inadequate specialty care options is especially pronounced in Al Gharbia region in the far west of the emirate, with Dr Maha Barakat, director-general of HAAD, telling media in December 2014 that Al Gharbia residents are suffering from a “painful” shortfall of specialty services. According to Dr Barakat, Al Gharbia is experiencing shortages in 21 of the UAE’s 28 identified medical specialties, compared to Abu Dhabi, where there are only two major gaps, and the Al Ain Region, where there are seven.

Space constraints are also a concern. It was reported by The National in October 2014 that expatriate patients were being turned away from SKMC, the largest hospital in the emirate, as a result of capacity constraints, with the hospital reporting 104,000 emergency room visits during the first six months of 2014, compared to 80,000 during all of 2013. This issue is a particular challenge within the maternal health segment; the 235-bed Corniche Hospital, which handles over a quarter of deliveries in the emirate, reported that it was operating at 30% above capacity in October 2014, with the facility taking steps in November of the same year to place a limit on its intake of new patients.

Specialty Expansion

The emphasis on an improved continuum of care is not a new one, and the government has long recognised the need to expand specialty service provision in the emirate. Abu Dhabi’s Executive Council announced plans to build 14 new hospitals in January 2012, with a host of new specialty care facilities built in recent years.

One such addition is the 250-bed NMC Royal Hospital, scheduled to open in Khalifa City in 2016. The Dh734m ($199.8m) hospital spans more than 75,000 sq metres, and will employ 800 staff working at more than 100 outpatient clinics, offering specialty services including cardiology, vascular, bariatric, neurosurgery, gastroenterology, endocrinology, paediatrics, psychiatry, gynaecology, and obstetrics, among others. The hospital opened its outpatient wing in September 2015.

Cleveland Clinic Abu Dhabi

Perhaps the most significant addition to the specialty care segment is Cleveland Clinic Abu Dhabi, which opened its doors to receive patients in March 2015. The hospital offers complex and critical care in more than 30 specialisations across 12 institutes, including five centres of excellence that address the most pressing health care needs in the emirate, including heart and vascular, neurological, digestive disease, eye, and respiratory and critical care.

“We are the first to provide such a wide range of complex health care services in Abu Dhabi,” Dr Tomislav Mihaljevic, CEO of Cleveland Clinic Abu Dhabi, told OBG. “We have the capacity to treat conditions such as epilepsy, stroke, inflammatory bowel disease and more, and we have one of the most experienced robotic heart surgery teams in the world.” With five clinical floors, three for diagnostics and treatment, and 13 floors dedicated to critical and acute inpatient units, the hospital has 364 beds and is expandable to 490.

“The majority of our patients are from Abu Dhabi, about 80%,” Dr Mihaljevic told OBG. “Additionally, we have been able to attract patients from more than 38 different countries to date.”

Indeed, it is anticipated that the hospital will help reduce the number of individuals who may otherwise have required treatment abroad by as much as 30%. In order to achieve this, Cleveland Clinic Abu Dhabi has placed an emphasis on the importance of maintaining high standards of health care delivery. “The most important thing is to understand that reputations cannot be mandated, only earned,” Dr Mihaljevic told OBG. “We are going to achieve this by maintaining the highest standards of quality.”

In addition to improving the quality of care available in Abu Dhabi, HAAD is actively encouraging health care providers to develop services to address the specialty gaps that cause individuals to seek treatment abroad. The authority is in the process of implementing a detailed plan to reduce the need for patients to travel outside the UAE for their health-care needs by 30%. In addition, the entire Mubadala health care network is committed to the development of future Emirati health care leaders through knowledge and skills transfer. The hospital has seen a significant amount of success in terms of physician recruitment: more than 9000 doctors applied for 175 positions at the new hospital.


Ongoing developments at SKMC, the largest health facility in the emirate, are also expected to help address capacity gaps. Launched in 2005 and managed by Cleveland Clinic since 2007, the 586-bed acute care hospital offers 14 outpatient specialty clinics accredited by Joint Commission International, in addition to a 125-bed behavioural science pavilion and urgent care centre, both in Abu Dhabi.

SKMC has also been active in introducing specialty service offerings to reduce the number of patients seeking treatment abroad. For instance, the hospital’s cardiac rhythm team reported successful completion of its 1000th cardiac ablation in May 2015, after rolling out a new cryoablation procedure to complement the standard catheter ablation in October 2014. SKMC will also be home to a new women’s hospital slated for construction, with health authorities planning to demolish Corniche Hospital over the medium term, according to press reports.

Maternal Medicine

Paediatric service gaps are also narrowing, with SKMC’s Institute of Cardiac Sciences reporting that it had successfully completed its 2500th surgery during the summer of 2015, after launching a paediatric cardiology programme in April 2007. In March 2015 SKMC launched a new paediatric dialysis unit, comprising nine dialysis stations with capacity for 27 patients daily.

The construction of two new hospitals, BrightPoint Royal and Danat Al Emarat, has further bolstered maternal and paediatric facilities in the emirate. The first hospital dedicated entirely to women, the 100-bed BrightPoint Royal, was inaugurated in May 2015, almost a year after opening outpatient services in July 2014. Owned and operated by NMC Healthcare, the hospital offers labour, delivery, recovery and postpartum rooms, avoiding the need to transfer between departments during delivery. There is also a foetal medicine centre with 4D ultrasound technology, neonatal intensive care units (NICU), maternity education programmes, fertility clinics and a specialised care baby unit. Over 90% of its staff are female.

Danat Al Emarat, owned by United Eastern Medical Services, opened in August 2015. The 150-bed hospital offers a level two NICU, as well as 10 delivery suites and four operating theatres. Coupled with BrightPoint Royal, it has already made an impact on capacity constraints at Corniche Hospital. “There has been a lot of collaboration between all three maternity hospitals. Overall, we have achieved our goal of shifting low-risk patients to the other maternity centres. As planned, Corniche will be down by about 10% in volume in 2015. At the same time, there are still challenges in creating capacity for neonatal care,” Linda A Clark, CEO of Corniche Hospital, told OBG.

Rural Recovery

Although these developments certainly paint a positive picture for the future of advanced specialty care in Abu Dhabi, the next challenge for HAAD will be to address service gaps in underserved regions, which presents new opportunities for private investment. Dr Barakat told media in December 2014 that the authority has identified 10 rural areas in need of health clinics, with the body planning to tender construction and management of these clinics to the private sector. HAAD chairman Dr Mugheer Al Khaili also stated that incentivising development of new health care facilities, including offering a partnership with the government, will further underpin expansion into underserved regions.

“We are constantly looking at every possible expansion opportunity. It is very difficult to pinpoint one specific region, but looking at the population, the distance patients from Al Gharbia region must travel to receive treatment, and the complications that arise from diabetes, having a facility located nearby would certainly be extremely beneficial to patients,” Mazen Al Dahmani, general manager of Imperial College London Diabetes Centre, told OBG.