Obstacles for primary health care in Saudi Arabia

Name of the Student
Professor’s Name
Research Proposal
2nd November 2016
Identification of Different Obstacles that Limits the Quality of Primary Care in Saudi Arabia
Abstract
Although Saudi Arabia is ranked before Australia and Canada regarding healthcare facilities, its ranking is still poor amongst the economically rich nations. The government of Saudi Arabia is exploring different opportunities for improving the health care facilities across the country. One of the major focuses of the Government of Saudi Arabia is to ensure appropriate primary healthcare amongst its citizens. However, the literature suggests that there are ample opportunities to improve the quality of primary care services in Saudi Arabia. The present research proposal would evaluate the obstacles that limit implementation of quality healthcare services. The proposed research would involve a mixed methodology approach. Different subjective and objective parameters (related to the implementation of quality healthcare) would be evaluated in the proposed research. The proposed study would be the first one to objectify the barriers and obstacles that limit the quality of primary care services in Saudi Arabia. Hence, the proposed study would provide useful insights to the Ministry of Health, for ensuring the quality of primary healthcare in Saudi Arabia.
Keywords: “Obstacles” “Barriers” “Quality” “Primary Care” “Saudi Arabia” “Research Proposal.”
Introduction
Saudi Arabia is one of the largest countries in the Middle East with an approximate population of 28 million.

The Government of Saudi Arabia has given a high priority to ensure appropriate healthcare services for its residents. Saudi Arabia is ranked at the 26th position as per the WHO ranking on the quality of healthcare facilities. Although Saudi Arabia is ranked before Australia and Canada regarding healthcare facilities, its ranking is still poor amongst the economically rich nations. This is a paradigm as because the economy of Saudi Arabia is quite high and stable. The natural resources of Saudi Arabia and increased demand of crude oil in the international market assures a stable economy for Saudi Arabia. Hence, the Government of Saudi Arabia is exploring different opportunities for improving the health care facilities across the country.
One of the major focuses of the Government of Saudi Arabia is to ensure appropriate primary healthcare amongst its citizens. The Government has taken different initiatives in improving the status of primary healthcare facilities across the nation. As a result, there has been a significant increase in the number of primary health centers (PHC) across Saudi Arabia. However, the major issues with PHCs are the lack of integration and the lack of consistency in delivering quality healthcare. Such situations often lead to negative health outcomes in concerned stakeholders. The present research proposal would evaluate the obstacles that limit implementation of quality healthcare services. Moreover, the proposed research would focus on establishing a robust integration process amongst primary health centers. Based on the findings of the proposed research, a set of recommendations would be presented to the Government of Saudi Arabia. The recommendations would aim to improve the quality of primary healthcare across Saudi Arabia.
Review of Literature
Historically, the Government of Saudi Arabia has prioritized their healthcare system. However, the major priorities were attributed to therapeutic/curative care. On the contrary, the provisions for primary healthcare and preventive healthcare were limited before the 1980s. To address such anomalies, the Ministry of Health adopted a new strategy for ensuring primary and preventive health amongst its residents. The new strategy was in accord to the Alma-Ata declaration of the WHO in 1978. The new strategy endorsed on developing a network of primary health care centers across the nation. Such strategy helped to develop 2259 primary health care facilities within 2013, and the numbers are still on the rise. The ratio of PHCs on the population of Saudi Arabia is 7.53: 100,000. This means that approximately eight primary health centers are allocated per 100,000 individuals. However, the ratio widely differs across different demographical regions. For example, the ratio is highest for Al-Baha region (22.42: 100,000, while the ratio is lowest for Jeddah (2.63: 100,000).
Despite the increase in a number of primary healthcare centers, the quality of primary healthcare has remained an area of concern. Moreover, there has been a marked increase in the GDP per capita. The GDP per capita in 2000 was 10,000 U.S. dollars compared to 26,000 U.S. dollars in 2014. Considering the GDP per capita and the economic status of the nation; Saudi Arabia should be deployed quality healthcare services for its residents. However, the healthcare expenditure per capita (for Saudi Arabia) is significantly lesser than comparable countries. The government expenditure on healthcare is poised at 6.6% of GDP. Appropriate and quality funding on healthcare systems is an area of major concern for the Government of Saudi Arabia. Lack of appropriate funding is attributed to the lack of identification of healthcare needs in Saudi citizens.
Al-Ahmadi and Roland (p. 331-346) conducted a comprehensive review to evaluate the quality of primary healthcare in Saudi Arabia. The authors identified 128 studies for conducting the comprehensive review. The components of quality were analyzed regarding access and effectiveness of primary healthcare facilities. The effectiveness was reported both regarding interpersonal care and clinical care. The authors concluded that healthcare services related to maternal health, immunization compliance and control of epidemic diseases met quality standards. However, management of chronic diseases, the pattern of referral and continuing health education did not meet quality standards. The authors concluded that different factors were responsible for the lack of quality standards. Such factors include ineffective management, organizational factors, ineffective implementation of evidence-based practice, lack of opportunity in enhancing professional development, lack of competence in healthcare professionals for referring patients to secondary/tertiary care facilities and a lack of organizational culture. The authors reported that there was a substantial variation in the quality of primary care services across Saudi Arabia. The authors endorsed that effective management and administrative initiatives may improve the quality of primary healthcare across Saudi Arabia. Moreover, professional development of healthcare professionals was also mandated by the authors of the study.
Methodology
Study Design and Sampling
The proposed research would involve a mixed methodology approach. Qualitative and quantitative parameters would be evaluated for conducting this study. The study would be conducted as a descriptive study. The study participants would include the concerned stakeholders associated with primary healthcare services. Broadly, the study participants would include healthcare consumers, healthcare professionals and with administrative responsibilities for ensuring primary healthcare services.
Procedure
The structured interview would be conducted with standardized questionnaires for evaluating the qualitative responses of study participants. The structured interview would try to identify the different barriers/ obstacles in accessing or delivering quality primary healthcare services. Different health databases would be accessed for collecting appropriate quantitative data. Moreover, quantitative data would also be obtained prospectively during the duration of the study. The study would primarily evaluate the status of chronic care, the quality of referrals and the status of implementation of evidence-based practice. Such points of reference were evident from a review of the literature. Different interventions would be implemented to address the barriers/obstacles amongst study participants. A feasibility study would be conducted after addressing these controllable barriers/obstacles. The status (quality) of primary healthcare would be once again evaluated regarding qualitative and quantitative parameters.
Research Questions and Hypothesis Testing
The study would explore different research questions. The research questions that would be broadly addressed through this study are:
Whether the quality of primary healthcare depends on upon infrastructural, personal, financial, informational, demographic or clinical barriers?
H0= Quality of primary healthcare does not significantly depend on upon infrastructural, personal, financial, informational, demographic or clinical barriers (p>0.05).
Ha= Quality of primary healthcare significantly depends on upon infrastructural, personal, financial, informational, demographic or clinical barriers (p<0.05).
Whether implementation of proposed interventions (introduction of evidence-based practice, developing health information systems like Electronic Health Records and increase in awareness level/sensitization strategies) improves the quality of primary care?
H0= Implementation of proposed interventions does not improve the quality of primary care (p>0.05).
Ha= Implementation of proposed interventions significantly improves the quality of primary care (p<0.05).
Statistical Tests and Software
Pearson’s correlation coefficient would be extrapolated between the dependent and the independent variables. The dependent variables considered for the present study would include different parameters for assessing the quality of primary healthcare. On the other hand, the independent variables would include different identifiable obstacles or barriers as per the subjective and objective responses of study participants. Chi-square tests would be implemented for comparing the quality of healthcare services before and after implementation of the interventions.
Grants/Funds
The Government of Saudi Arabia would be approached to cover the expenses of the present study. The expenses are mainly related to travel, installation of statistical software, costs required to implement evidence-based practice and Electronic Health Record systems in selected study sites.
Proposed Outcomes
The proposed study would be the first one to objectify the barriers and obstacles that limit the quality of primary healthcare in Saudi Arabia. Hence, the present study would provide useful insights for the administration and the Ministry of Health, Saudi Arabia. Based on this study, the Government of Saudi Arabia could implement different initiatives for improving the status of primary healthcare across the nation. More importantly, the study would propose certain tools to measure the quality of healthcare services. Such tools would aid the Government of Saudi Arabia in planning future interventions that would ensure the quality of primary healthcare services.
Works Cited
Al-Ahmadi H & Roland, M. Quality of primary health care in Saudi Arabia: a comprehensive review International Journal for Quality In Health Care, 2005 (17.4): pp. 331-346