With one of the largest relative youth cohorts in the Gulf – the share of the population under 35 stood at 50% as of 2022 – Kuwait has a vested interest in achieving positive learning and health outcomes for nationals and foreign residents alike. As was the case around the world, the Covid-19 pandemic posed specific and immediate challenges for educators and medical workers in the country, which the government is working to address in parallel with ongoing efforts to achieve the development targets set by New Kuwait 2035, the long-term development roadmap launched in 2017 (see Economy chapter).
The so-called education gap experienced after many young students were forced to adjust to online learning virtually overnight is a particular concern for policymakers, and a mix of in-person and online solutions are being explored to help learners catch up.
Meanwhile, in the health care space the authorities are working to address the rising incidence of lifestyle-related diseases and mental health disorders through a combination of preventive care and awareness-raising initiatives. Given the growing burden of care in the country, the health care sector will be an important target for foreign investment in the coming years, as identified by the Kuwait Direct Investment Promotion Agency (KDIPA).
The Ministry of Education (MoE) is responsible for overseeing and managing the education sector, running from the pre-primary level through to primary, intermediate and secondary learning. The Supreme Education Council (SEC), meanwhile, is an independent government body established in 2016 that is charged with helping to steer the strategic direction of sector policy. The SEC is chaired by the minister of education, a post occupied by Hamad Abdulwahab Al Adwani since October 2022. He also serves as the minister of higher education and scientific research. In addition, the MoE collaborates with the National Centre for Educational Development (NCED), a body that carries out school inspections and administers international tests.
The Ministry of Higher Education (MoHE) oversees the tertiary education segment, including both public and private universities. The latter category of institutions is required to be licensed by the Private Universities Council (PUC), which in turn is overseen by the MoHE. The PUC conducts periodic reviews of licensed higher education institutions in the country, among other responsibilities.
The Kuwait Authority for Partnership Projects (KAPP), for its part, oversees private sector participation in the segment in the form of public-private partnerships (PPPs), which are an important avenue for meeting growing education demand in the country – particularly in new cities under development (see Construction & Real Estate chapter). While it operates at the macro level to encourage investment in the country, the KDIPA also plays a role in promoting investment-led development of the sector.
Education Budget & Policy
Public education expenditure gradually trended upwards in the years leading up to the pandemic, rising from KD1.3bn ($4.3bn) in FY 2009/10 to KD2.1bn ($7bn) in FY 2019/20. In the national budget for FY 2022/23, approved in November 2022 following parliamentary elections that September, the education sector was allocated KD2.2bn ($7.2bn). This marked a decrease from KD2.6bn ($8.6bn) in the previous budget, as part of government efforts to rein in consecutive fiscal deficits seen during the course of the pandemic.
As one of the first countries in the Gulf to formalise education in the early 1910s, the right to education is enshrined in Kuwait’s 1962 constitution. Primary through secondary education is compulsory and free of charge for Kuwaiti nationals in public schools, though foreign students may also enrol. Kuwait University is the only public institution at the tertiary level. The rest of the segment is private universities.
Despite the country’s high relative spending on education in recent decades, its learning outcomes and international rankings have often lagged behind global and regional high-income peers. The sector has therefore been the target of several waves of reforms, the most recent of which is grouped under New Kuwait 2035. Education is an important part of the development blueprint’s human development pillar, one of seven identified by the plan.
The roadmap seeks to overhaul the education system and rewrite the national curriculum to align it more closely with the future needs of the private sector. There are also plans for a National Manpower Development Centre that would provide training and skills development for more than 30,000 nationals, with the goal of preparing two-thirds of the labour force for private sector jobs. This points to the prospect of a fundamental shift in national labour patterns in the years ahead: as of late 2022 some 70% of Kuwaitis were employed in the public sector.
As the government works to achieve a more balanced budget, private spending and investment in education will be crucial to cater to growing demand. Investment-friendly incentives such as 100% foreign ownership of education facilities are designed to court international participation in the sector. The tertiary segment has been the primary area of focus to date, as indicated by the preponderance of foreign universities in the segment, though the KDIPA has pointed to technical and vocational institutions and training centres as another likely area for growth.
According to the most recent statistics from the MoE covering the 2020/21 academic year, there were 62,941 non-Kuwaiti and 354,743 Kuwaiti students enrolled in 656 public schools from kindergarten through to secondary education, representing a 15:85 ratio of foreign students to Kuwaiti nationals. In the private education sphere, the pattern was roughly the opposite: there were 174,970 non-Kuwaitis and 67,565 Kuwaitis across 565 schools, representing a 72:28 distribution.
At the tertiary level, there were 35,196 students enrolled in bachelor’s degree programmes at Kuwait University as of the second semester of the 2020/21 academic year; 30,517 – or 87% – of the students were Kuwaitis, with foreign students comprising the remaining 4679, or 13%. According to the most recent MoE figures for private higher education, there were 15,280 students enrolled in bachelor’s degree programmes as of the second semester of the 2019/20 academic year, of which 14,727 were Kuwaiti and 553 were non-Kuwaiti.
As in many Gulf markets, foreign teachers play an important role in instruction in Kuwaiti schools. In the 2020/21 academic year there were 23,595 non-Kuwaiti teachers and 50,663 Kuwaiti teachers in public schools between kindergarten and the secondary level, with foreign teachers comprising roughly 32% of the total. In private schools, meanwhile, there were 13,080 non-Kuwaiti teachers to 271 Kuwaiti ones, for a ratio of 98:2.
At the tertiary level, Kuwait University had 1695 academic staff as of the second semester of 2020/21, of which 222 were non-Kuwaiti and 1473 were Kuwaiti. Meanwhile, in private higher education there were a total of 857 academic staff as of the second semester of 2019/20, according to the most recent MoE figures, of which 785 were non-Kuwaiti and 72 were Kuwaiti nationals.
Foreign teachers are likely to remain an important source of talent for the sector given the government’s goal of building 71 new schools between the 2020/21 and 2024/25 academic years. In mid-2022 the government renewed the residence permits of some 4500 foreign teachers working in government schools for two years rather than the usual one, under a new decentralised system for staffing approvals initiated by the MoE.
At the same time, the country is eager to boost the local recruitment of educators from Kuwaiti or other Middle Eastern backgrounds, which offer shared linguistic and cultural benefits. In March 2022 the MoE announced plans to open the door to hiring another 1000 teachers locally to help fill staffing shortages for the 2022/23 school year. Kuwaiti applicants from local teacher preparation colleges were to be prioritised, followed by children of Kuwaiti women; Bidoon, or stateless persons; GCC citizens; and then other expatriates. Jordanian and Palestinian applicants were reported to be among those targeted by the hiring drive.
Adjusting to remote learning was an understandable hurdle during the early months of the pandemic in 2020. As of August of that year the education of some 1.6bn students across more than 190 countries had been disrupted by the health crisis, with 100m students between the ages of five and 17 affected in MENA countries, according to a report from the UN. The Kuwaiti government has explored strategic partnerships and certifications to improve digital readiness among both educators and learners in the intervening years.
Approaching the autumn of 2020, Kuwaiti and several other GCC countries sought to continue using a hybrid model of in-person and e-learning. In October 2020, for example, the MoE partnered with US tech giant Microsoft to provide more than 400,000 teachers and students with Office 365 and Teams software to enable remote learning.
“Although progress is being made, more work is required to recognise fully online programmes in Kuwait and acknowledge the differences compared to conventional programmes with online elements,” Rawda Awwad, president of the American University of Kuwait, told OBG. “This includes having different time patterns for faculty and students, deploying new ways to engage with and evaluate students, and understanding in which scenarios a flexible online programme is a better option.”
Efforts to improve teachers’ IT skills have continued beyond the immediate crisis period. In April 2022 the MoE accredited a new digital literacy certificate, the Talal Abu-Ghazaleh International Diploma in IT Skills, which specialises in digital skills training and certification in the Arab world. It offers an alternative to the Cambridge International Examination’s International Computer Driving Licence.
Like in many other countries, the discussion over how to strike an optimal balance between in-person and remote learning is continuing. “The advantages of online learning have been demonstrated during the pandemic, although it is clear that online learning can never replace the benefits of face-to-face interactions. Students require an appropriate education environment to receive the full learning experience, and this cannot be achieved with online programmes alone,” Khalid Al Begain, president of the Kuwait College of Science and Technology, told OBG.
The lockdowns necessitated by the pandemic were a disruption to many of the education initiatives under way in Kuwait at the time. However, this also has the potential to create space for a fresh reimagining of sector priorities and the development of more creative approaches to learning that will prepare the next generation of graduates for knowledge-based career paths outside the public sector. While the government remains committed to providing quality education for a growing population, private sector involvement will remain crucial for overall capacity building, not only in the traditional university space, but potentially also in technical and vocational training and beyond.
The Ministry of Health (MoH) oversees the heath care sector and is responsible for providing most medical services in the country, as well as regulating private health care activities. A combination of health centres and clinics deliver primary care, while secondary care takes place at six general hospitals: Al Adnan Hospital, Amiri Hospital, Farwaniya Hospital, Jahra Hospital, Mubarak Al Kabeer Hospital and Sabah Hospital. Tertiary care, for its part, is delivered by specialist facilities in the country or by treatment overseas, the latter of which poses something of a challenge for sector finances and has been the target of new restrictions.
Health Budget & Policy
The MoH was allocated KD2.7bn ($8.9bn) in the FY 2021/22 national budget, the second-largest amount for any individual ministry that year. This was up 3.8% from KD2.6bn ($8.6bn) in FY 2020/21. Historically, publicly funded overseas medical treatment for Kuwaitis has weighed on sector finances, though policymakers have taken steps in recent years to cut down on the practice.
Restrictions on receiving care abroad have had a measurable impact: the country’s overseas medical portfolio shrank from 9356 cases in 2015 to 5564 in 2019 and 4702 in 2021. Some 2238 cases were recorded in the first half of 2022, with the total projected to fall below 4500 by year’s end, less than half the equivalent figure seven years earlier.
In early 2022 the MoH issued three new ministerial decisions to regulate the registration and distribution of medical devices, as well as health products and supplies, and streamline procedures surrounding prescriptions. Medical devices will now fall into one of four categories based on their intended use, allowing for more tailored regulatory conditions by category, while the control systems for health products and supplies will be brought in line with evolving international standards.
The new regulations for prescriptions will require the scientific name to be included on the packaging, rather than the brand name of the drug. It is anticipated this will encourage patients to explore generic options and cut down on the incidence of medical errors, given how frequently the branding of medications can change.
Increasing local content in the pharmaceutical segment is a priority Kuwait shares with many of its GCC peers. The region is largely reliant on imported medicines, and many governments are actively pursuing strategies to boost domestic pharmaceutical manufacturing to reduce dependence on overseas supply (see Industry chapter).
According to an April 2021 report by UAE-headquartered Mashreq Bank and US-based consultancy Frost & Sullivan, the health sector goals under New Kuwait 2035 are expected to trigger increased investment in infrastructure and local capacity. Generics, for example, are projected to increase their share of the market to 60%, with 20% of revenue captured by domestic firms. The report forecast that domestically produced pharmaceuticals would comprise 35% of the market by 2030, up from 15% in 2021.
As of 2021 the MoH employed 61,353 medical staff, of which 28,279 were Kuwaiti and 33,074 were non-Kuwaiti. Nurses were the largest cohort, numbering 21,490, and skewed heavily foreign, at 20,413 compared to 1077 who were nationals. Administrators comprised the second-largest group, with 11,585, followed by medical technicians (10,321), doctors (9762), dentists (2298) and pharmacists (1667), among others. As is the case in many GCC countries, attracting and retaining trained health care providers is a challenge for the sector, and many hospitals rely on foreign talent to bridge human resource gaps. While Kuwaitis were the largest group of MoH employees in 2021, there was also substantial representation from India (16,927), Egypt (8547) and the Philippines (2056).
Policymakers have had to strike a balance between Kuwaitisation priorities and critical staffing requirements at hospitals and clinics. In October 2021 the Civil Service Commission lifted a ban on recruiting non-Kuwaitis to fill 214 job vacancies at the MoH – specifically, 131 nursing roles, 57 doctor positions, 23 technician openings and three pharmacist postings.
Given the prevalence of the use of English in the country and the relative weight of the expatriate population – roughly 70% of residents in Kuwait are foreign – India and Bangladesh have been two important source markets for medical staff recruited from abroad. In mid-2022 local media reported that some 2700 Indian nurses would be joining Kuwaiti private hospitals that year, per an agreement that was signed prior to the pandemic but delayed by the health crisis. Another 654 nurses were in the process of being recruited from Bangladesh, with this cohort also slated to start throughout the course of 2022.
In line with many high-income countries, lifestyle-related diseases are the leading cause of death in Kuwait; non-communicable diseases (NCDs) accounted for 79% of deaths as of 2019, per the most recent data from the World Bank.
Hypertension and other cardiovascular diseases are among the most prevalent conditions, with more than one in four people in the country having been diagnosed with the former. Diabetes is also relatively common, occurring at a rate of one in five, which has important implications for care and life expectancy, given the risks of comorbidity and the eventual burden that could be placed on the system as the young population ages. According to a June 2022 analysis from BMJ Global Health, NCDs cost the broader GCC economy $50bn in 2019 alone.
Nonetheless, life expectancy at birth in Kuwait has maintained a positive trajectory in recent decades, reaching 76 years in 2020, up from 74 in 2010, 73 in 2000 and 59 in 1960. The infant mortality rate has made similar gains, declining from 97 per 1000 live births in 1960 to 30 by 1980 and eight as of 2020.
Public & Private Care
As of 2022 the country was home to six general public hospitals and 15 specialised hospitals, along with more than 80 primary health care centres located across health zones. To address rising demand for medical services, and in anticipation of the growing burden of care as the population ages, the government has sought to expand health care infrastructure through a combination of public and private investment schemes.
The MoH has been focused on reinvigorating some of the infrastructure projects that stalled during the pandemic. In September 2022 alone local media reported that the ministry inaugurated the West Abdullah Al Mubarak Health Centre, the Abu Fatira Health Centre and the Sabah Al Ahmad City Health Centre-C. This followed the launch in the previous month of the first operational phase of the newly expanded 955-bed Farwaniya Hospital.
As of early 2022 a number of projects were under way to expand hospital bed capacity further, with a reported KD221.5m ($728.9m) in funding earmarked for 11 projects. The MoH was working on seven construction projects at the time, five of which were in the implementation phase and two in the preparatory phrase. Of these, construction on a new 789-bed maternity hospital in the Al Sabah health district of the Capital Governorate was well under way, having reached 65% completion in May 2022. The KD220m ($724m) facility, which will replace an older hospital one-third its size, is expected to open in the first quarter of 2023.
Mental health has also been a focus of new infrastructure development. Specialised clinics are being opened in primary heath care centres around the country to address the rising incidence of mental health issues for patients and to provide support and services to families. As of January 2021 work was under way on 13 new clinics, which would bring the total number to 35 across all health zones.
Medical treatment is provided free of cost to Kuwaiti nationals at public facilities; however, health insurance is mandatory for foreign residents. One of the most notable recent developments in this space is the new health insurance system for expatriates, which is slated to go into effect as soon as early 2023 (see analysis). The updated regulations require expatriates to pay a KD130 ($428) annual health insurance fee in lieu of the current KD50 ($165) fee when renewing their visas. This will then increase by KD20 ($65.80) every two years, to reach KD190 ($625) per person after nine years of residency.
Under the plan expatriates will receive care from the Health Assurance Hospitals Company (Dhaman), a joint-stock entity that took over the provision of non-emergent health care for foreign nationals in 2014. Dhaman is partially owned by the government via the country’s sovereign wealth fund, the Kuwait Investment Authority, along with the Public Institution for Social Security, a local holding company and private Kuwaiti investors. It operates an expanding network of hospitals and health centres, in addition to the compulsory health insurance scheme.
As was the case in the education sector, the pandemic called greater attention to the potential for digitalisation in the provision of medical services. With private clinics and hospitals closed to contain the spread of the virus in the early months of the crisis, telemedicine became an important resource for patients looking to access consultation and care without having to step foot in a public hospital emergency room.
Telemedicine had already been identified as a national priority under New Kuwait 2035, which envisioned a telemedical electronic portal under the auspices of the MoH. In December 2021 the ministry launched the Q8Seha mobile app to provide patients with test results and scans, and allow them to choose doctors and schedule appointments.
Non-government actors have also made notable forays into the e-health space. The private Dar Al Shifa Hospital, for example, rolled out an electronic patient record system in 2017, leading to improvements in patient satisfaction. The start-up Sihaty, meanwhile, was created by The Taken Seat, a Kuwaitbased regional digital venture builder. The Sihaty platform allows users in Kuwait and Saudi Arabia to consult doctors remotely. Afterwards, doctors can prescribe medications and arrange for them to be delivered to patients via the app. Since launching in 2020 the app has been downloaded more than 200,000 times. The health-tech outfit received $1.3m in a pre-Series A investment round in August 2021 from a number of angel investors from the MENA region. It plans to use the funds to develop a model for assigning a family doctor to each user to help manage chronic conditions more effectively over time, as well as to deploy a new mental health service.
As Kuwait progresses beyond the emergency footing adopted in the education and health care sectors during the pandemic, policy focus is returning to the longer-term ambitions outlined by New Kuwait 2035. Above all, the transition to a more diversified, knowledge-led economy will require a healthy and well-educated population, which policymakers are striving to achieve in a fiscally balanced manner. Although the recovery in global energy prices is likely to offer some additional budgetary breathing room to Kuwait and other oil-producing nations in the GCC, private partnerships and investment will continue to be key to the staffing, training and outcome-oriented assessment needed to guarantee quality and efficiency in both spheres.