As GCC countries look to rationalise public spending and stimulate private enterprise, public-private partnership (PPP) opportunities are opening up across a range of industries. After the Gulf’s health care systems coped relatively well with the Covid-19 pandemic, attention has returned to finding the most efficient ways to provide coverage to the region’s growing population. In Kuwait, the Health Assurance Hospitals Company ( Dhaman) PPP is set to play an integral role in the country’s health care services as it ramps up operations in 2023.

Private Partnerships

PPPs are expected to play their part in broader efforts to widen the private sector’s participation in Kuwait’s economy as part of New Kuwait 2035, the country’s long-term economic plan. In 2014 Kuwait established Dhaman, the region’s first PPP health care organisation, to develop an integrated health care system with insurance programmes, as well as build and operate a nationwide network of primary health care centres and hospitals. Dhaman’s objectives were to reduce the burden on the national budget, improve the operation of health care services and facilities, and expand access to high-quality health care. Dhaman’s services target the nearly 2m foreign residents working in the private sector and their families, although they are also available to Kuwaiti citizens.

New Infrastructure

Government bodies hold a 24% stake in Dhaman through the Kuwait Investment Authority and the Public Institution for Social Security, while strategic private sector partners hold a 26% stake. Kuwaitis will have the opportunity to buy remaining shares through an initial public offering, although a date for one has yet to be set. The PPP’s stated share capital was KD230m ($756.9m) as of November 2022.

The pandemic and resultant disruption to supplies and human resources posed challenges to the completion of the first phase of construction, which included building five primary health care centres around the country, and two hospitals in the Ahmadi and Jahra governorates with a combined total of 600 beds. Despite these challenges, according to Thamer Arab, CEO of Dhaman, the first phase is expected to be completed as scheduled by the end of 2022. The third primary health care centre in Dajeej opened in 2020, while the fourth and fifth centres in Jahra and Fahaheel opened in June 2022 and November 2022, respectively. Dhaman aims to increase the number of primary health centres from five to 15 within five years to meet expatriate demand, with Dhaman covering the costs.

Mandatory Insurance

Dhaman’s facilities and health insurance programme are part of a new health care system in Kuwait that shifts the responsibility for the health care of its large expatriate population – foreigners account for 70% of Kuwait’s residents – to ease pressure on the public health care sector.

Dhaman’s most basic treatment costs are expected to be covered by a KD130 ($428) annual insurance fee for expatriates, to be levied as early as 2023. Under the current system, residents pay for medical check-ups, lab tests, hospital stays, medications and other services at public hospitals and polyclinics in addition to paying an annual KD50 ($165) insurance fee.

Dhaman has made assurances that the higher costs will benefit the sector and enhance services. However, as companies are currently required to pay the KD50 ($165) insurance fee for their employees, they would therefore need to pay more not just for their employees but for their family members as well, a significant expenditure in a country where the average expatriate salary was KD343 ($1130) per month as of June 2022. Some employers could force employees to cover the cost themselves; there have been reports of workers being asked to pay the KD50 ($165) fee out of their own pocket when renewing their visas.

Nevertheless, building new facilities and expanding basic service coverage is expected to strengthen Kuwait’s overall health security by offering integrated health care services for residents throughout their time in the country, in addition to improving public finances.