Clean break?

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The last few weeks have seen a shake-up in the organisation of healthcare in the United Arab Emirates (UAE), and in particular the Northern Emirates. The ministry of health (MoH) has handed over responsibility for day-to-day administration of public hospitals to a new body, the Emirates Health Authority (EHA). The EHA is currently awaiting formal approval by the Federal National Council (FNC). Until then, an executive committee is taking over the role of service provider.

The new structure will allow the MoH to concentrate on licensing, supervising, auditing and legislating, and bring the UAE in line with international practice. Perhaps more importantly, it will bring the Northern Emirates in line with their larger neighbours Dubai and Abu Dhabi, whose own health services are currently administered by independent bodies.

Under the new system, supervision of healthcare will be divided into three new offices: Support Services, including human resources and legal affairs department; Licensing, which will include the registration and accreditation of new drugs; and Public Health Policy, which will deal with the state response to disease control, health insurance and regulation. The chief executives of each office will fall under the authority of the director general of the MoH.

Despite the reform, rumours are beginning to circulate that Sharjah, the third largest emirate in the UAE, may imitate Dubai and Abu Dhabi by breaking away from the federal MoH, and form its own independent authority. According to unnamed sources within the ministry, friction is building over current funding measures for the emirate, which some Sharjah officials feel do not adequately compensate what they say is the highest hospital footfall in the Northern Emirates.

In particular, reports state that some hospitals are worried the EHA will "short-change" Sharjah's facilities. Under the new system, which sees an increased role for the private sector, Australian consultants VHA global have taken over the management of some of Sharjah's largest facilities. The introduction of private health care to the remaining emirates (Abu Dhabi has already implemented it) is likely to see the role of the private sector expanded further. Sharjah may feel that in such a climate, it will be better placed to regulate its own healthcare provision directly.

Two of Sharjah's main hospitals - Al Qassimi and the new teaching hospital due to open this year - already have independent boards of directors and maintain their own budgets, meaning that the need for further localisation is perhaps overstated.

According to Dr Alan Sandford of Al Qassimi Hospital, there are no immediate plans for breaking from the MoH. "We are developing more autonomy, but as far as I am aware we will continue to remain part of the ministry," he told news agencies.

Regardless of the future of healthcare supervision in Sharjah, the MoH has some ambitious plans for the UAE's health provision. Over 35 initiatives are due for implementation over the next three years, including the establishment of an electronic network to link hospitals and health centres, and the development of a national health database to hold patients' records. Individual emirates such as Ras Al Khaimah have also earmarked as much as $2bn over the next five years to upgrade their healthcare facilities.

Perhaps the greatest healthcare challenge facing the UAE in coming years though will be addressing public awareness of non-communicable diseases such as cardio-vascular disease and diabetes. As much as a quarter of the UAE's population has some form of diabetes according to the World Health Organisation. Addressing issues such as these will require the development of a unified policy by the federal government: creating the EHA should give the ministry of health sufficient space to do so.

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