31 Jan 2013

Leaders in Healthcare 2013

Your Excellencies,

Distinguished Guests,

Ladies and Gentlemen,

I am grateful to have the opportunity to be among so many distinguished members of the medical community. I am especially pleased to see so many familiar faces, particularly those of you whom I know have travelled far to attend this year's conference. To you, I extend a personal welcome to the UAE, particularly the Emirate of Dubai.

The Middle East is facing an unprecedented surge in demand for healthcare products and services. Socio-economic development characterised by increasing income and access to modern amenities and services has led to changes in our populations’ nutritional and lifestyle habits, increasing the prevalance of lifestyle related medical conditions such as diabetes, obesity, cancer and heart disease.

Also as living standards improve, healthcare providers are faced with heightened expectations for more and better quality services.

Today, the citizens and residents of the UAE, particularly Dubai, have very high expectations. Not only do they continue to enjoy a very high and comfortable standard of living but they have seen what our leadership can do and has offered in all walks of life.

And it is a fact that our leadership has long expected the same standards in healthcare. Our people expect nothing but the best from the healthcare community.

The UAE has come a long way in many disciplines. We host many world class sporting events without batting an eyelid, we have become a centre for global business and finance where multinational companies have established headquarters to act as hubs serving the entire region, and we pride ourselves on our excellent tourism, with attractions to suit national, regional and international tastes.

However, despite these successes, our attempts to develop a world class healthcare system is not without its challenges. Most countries of the Middle East face major challenges in several areas related to health system strengthening, which include health financing, health workforce, access to standards of health care including medicines, and other medical products.

This week Dubai hosted a high-level meeting, organized by the World Health Organization and other United Nations agencies, to highlight the very serious situation in the region with regards to maternal and child health. Did you know that every day in this region 2500 children and 107 mothers die unnecessarily, largely because they do not have access to adequate health care? And that among the countries most seriously affected are some of our own neighbours? Can we be sure that in our own countries, our most vulnerable populations groups have that access?

Another challenge for our region is the rising trend in noncommunicable diseases, and the risk factors for such diseases, including childhood obesity. All our countries have agreed with WHO a framework for action to implement the United Nations Political Declaration on Noncommunicable Diseases, in order to tackle the rising trend. This includes agreement on integrating interventions into primary health care.

At the same time, we need to be alert to the potential for outbreaks of infectious diseases, to ensure continuing investment in public health and to be prepared to respond to emergencies.

The perfect healthcare system does not exist, and we are in the enviable position that we can learn from the mistakes of others and form partnerships to develop a system to be proud of.

Some would say our expertise in developing real estate and leisure facilities has given us the false impression that we can develop centres of excellence simply by building them and labelling them as such. However, His Highness Sheikh Mohammed has always reminded us that healthcare is simply too important to be regarded as real estate development. He has also stated that healthcare is more about serving the needs of our growing population rather than profit which is key to making our healthcare system sustainable.

Such thinking is well aligned with the values and principles promoted globally by the World Health Organization. Sustainable health systems need clear vision from policy-makers, evidence with regard to the key health challenges in the country, and strategies and plans based on evidence of what the population health needs really are.

The challenges of developing our healthcare system in the UAE are similar to those faced by our sister Gulf States. Collectively, our desire remains to offer the best care to our people, to train and retain the top doctors while providing the optimum habitat for the medical community to evolve.  However, we must adopt a new approach and up our game; often easy to plan, much more difficult to execute.

In order for us to succeed, we need to recognise where we went wrong before, but we do not have to start from the beginning again. We recognize our mistakes, duplications, and the models that have failed. Every system has issues, every country has to step up to face their own respective challenges.

We certainly do not need to go through all the developmental stages and experience the mistakes of other healthcare systems. No one would suggest that we must learn how to use a telex or a fax machine before we can use email or a mobile phone – we don’t have to re-invent the wheel but rather embrace revolution as well as evolution.

So, what went wrong for us?

Despite importing many international experts into the region, we failed to have unqualified success. The majority of European and North American models simply failed to meet our expectations. It is not constructive to blame others for our lack of success, and the lack of good planning is nearly too obvious to mention.

What is most relevant is the fact that we imported top management from different institutions without bringing or training the indigenous middle and lower tiers of management necessary for implementing many of these complex systems. We brought (and were sold) the labels but not the content, the consultants but not the workers, those seeking to close a deal rather than build a relationship. To put it simply, we didn’t explain our needs, and they didn’t understand our culture.

This was a recipe for failure.

So, where are we today?

We have established good relationships with many international partners who are keen to help us develop further, and are keen to gain experience from our patients who have certain pathologies in higher prevelance than in the Western world.

However, our very young heathcare system must reduce its dependency on existing international models. We need to adapt these models to suit our local needs. We need to develop successful partnerships if we are to achieve our goal of developing a world class sustainable healthcare system.

Just because the problems which health partnerships are tasked with tackling are complex does not mean that the way these partnerships are structured and act should also be complex. Time and again, shared goals, clarity, transparency and simplicity are the main ingredients of a successful partnership. Emphasis on structure must not outweigh the focus on outcomes. Partnerships are more successful where they are seen as a means to an end rather than an end in themselves.

A partnership is “a relationship based upon agreements, reflecting mutual responsibilities in furtherance of shared interests.”  Partnerships only work when both parties benefit from the relationship, and those expected benefits are made clear in advance. Partners must understand that they will share both the risks and the benefits of any joint venture, and how this sharing will occur must also be specified in advance. 

If partnerships are to be successful, systems must be put in place to ensure that the clear mutually agreed objectives are met and the risks mitigated. It is often difficult to be a good partner.

Given the effort that is required to form and maintain a successful partnership, one might sensibly ask why bother? This is particularly true, given the air of mistrust that has soured many of the recent partnerships in the region.

However, a shift in philosophy about the roles of the partners, and the recognition of the interdependence between international institutions and countries with financial resources but high burden of disease has made partnerships attractive once again. We need them to teach us what they know, and they need us to better understand diseases more prevalent in our communities, thus allowing them to do translational research. For instance, the increasing occurrence of road traffic injuries in Gulf countries has become a serious public health problem and is responsible for almost 15% of all lives lost every year.

A good partner would invest time and effort in understanding our culture with all itsnuances. They would be willing to share the pain as well as the gain, the risk as well as the benefits. They would have a long-term vision and commitment in line with ours and would operate within the spirit of collaboration. In summary, our perfect partner would win our trust and respect, establish a long-term relationship, not make a quick sale.

In return…

Our partners should expect that we, too, will work in the spirit of collaboration to develop long-term successful relationships.

We will recognize the absence of an environment necessary for learning, one that facilitates knowledge transfer. We are fast on track to providing this at Dubai Healthcare City, the heart of which lies in education and research.

This region is decision driven, and decisions are made swiftly but after careful consideration. On top of which the decision makers are also accessible.

We will not over promise and under-achieve, but rather be honest about our capabilities, strengths as well as our weaknesses.

We will set the bar high enough so that we can improve and reach it, but not too high so that failure is the only outcome.

We will share our resources but most importantly, our most prized assets with our chosen partner – our people; patients and doctors.

We are keen to learn, but not at any price.

This will  create the necessary environment that will entice the best brains in the business to come and settle in Dubai; high moral standards, a fertile environment for research and development, and most of all an environment in which they can learn but also pass their knowledge to the younger members of the tribe.

Money is not the only incentive – those who come for money, leave for money. What does an accomplished equestrian want to do, an accomplished entrepreneur, a talented musician?

They want to be recognized and rewarded, but also they want to be able to pass their knowledge onto others. Doctors want to teach. We hope to create the perfect environment for that to happen.

In summary, the UAE is an exciting place to live. We have the foundations to make our healthcare system a world class one. “World Class” is frequently used but remains very difficult to define; it can only be truly measured by those experiencing it – our patients, and our people.

My final message to  you therefore is that our healthcare systems need to respond first and foremost to our population needs, based on clear evidence, and should ensure universal health coverage for everyone. We need to take the principles into account in order to build our  national capacity, develop long-term and trusted partnerships, and plan and provide healthcare services based on population needs. Only then are our future investments likely to yield sustainable benefits.

Thank you.