Health Care Section of UAE Vision 2021 Critique
UAE’s health care system is envisioned to be among the best in the world by the year 2021. The initiative of Vision 2021 augmented as UAE moved towards the edge of the top most growing economies in the world. A report released in 2013 by World Health Organization (WHO) ranked UAE at number 17 of the leading countries in happiness, out of 156 countries (UAE Vision 2021, 2016). Of course, health is one of the essential ingredients for happy lives. Thus, the incentive to a better nation is improving healthcare in UAE into world-class levels. That is the reason why healthcare is part of UAE’s vision 2021. The country is akin to the fact that success of her citizens depends entirely on a healthy body and mind. To achieve Vision 2021, the healthcare system annexed 10 key national performance indicators to the project (UAE Vision 2021, 2016). The indicators are: number of deaths from cardiovascular diseases, prevalence of diabetes, prevalence of obesity among children, average healthy life expectancy, prevalence of smoking tobacco, number of deaths from cancer, percentage of accredited health facilities, health care quality index, number of physicians, and number of nurses (UAE Vision 2021, 2016). However, only five years remaining to the target point, vision 2021 is still sluggish. It then begs the question; whether the national indicators that were selected as key could drive the 2021 vision of world-class healthcare system. The review of the appropriateness of detailing each national indicator in correspondence to baseline data is critical to driving strategic objective. Therefore, below is a discussion of the five key indicators which are intended to improve the healthcare by the year 2021.
Critique of the Appropriateness of Detailing any of the Five Indicators
- Prevalence of diabetes
Currently, diabetes is a major worldly pandemic, and indeed, it is a threat to the UAE population. However, detailing it as one of the key indicators that encompass vision 2021 is being insensitive to numerous health issues that UAE should put at the forefront if at all it has to improve its overall health (Qiao, 2012). Findings in Loney et al. (2013) study suggest that in addition to chronic diseases, there are a myriad and fundamental health issues facing the UAE population. For instance, injury related issues and respiratory disorders acquired from exposure to fumes, dust, and gasses are issues of health concern. Although health issues such as diabetes, cardiovascular diseases, cancer, and obesity also confront the population, they should be classified under one key indicator; chronic diseases. Classifying them singly as key indicators driving vision 2021 is a failure to notice the urgency of other health issues; if at all, the ministry is determined to achieve vision 2021. It is apparent that chronic diseases almost require similar preventive measures that should be handled under one umbrella (Qiao, 2012). Globally, various studies also document fundamental health issues the society is grappling with (Brown, 2016; Qiao, 2012).
In a review of available diabetes information, the International Diabetes Federation (2015) report indicated that UAE has 1 million cases of diabetes as at 2015. The prevalence of diabetes among adult population alone (20-79 years) was 14.7%, slightly lower than 16.28% of 2016. Clearly, within a very short time, cases of diabetes in UAE rose by 1.58% (International Diabetes Federation, 2015). In contrast, there were 415 million cases of diabetes recorded worldwide (International Diabetes Federation, 2015). In comparison, although diabetes is a global issue, UAE should not focus on it singly. The ministry of health should realize that working on the lifestyle culture of her population would avert issues such as diabetes, cardiovascular, cancer, and obesity. The moderate prevalence negates the appropriateness of diabetes as a national key indicator for vision 2021.
In its definitions, the health ministry defines diabetes prevalence as a measure of the population between the age of 20 and 79. I real sense we realize that definition ignores other age group despite the fact that diabetes affects people of all ages. It could have been better if this indicator reflected the general public. On the same note, the only source for diabetes statistics is the International Diabetes Federation which is overwhelmed in its role of giving clear information of diabetes prevalence in the whole world. This bring a lot of questions on its mandate in giving correct statistics that will help UAE achieve 2021 health vision. In 2012, the federation projected to lower diabetes related cases to 19.02% by 2014. In real sense, UAE continues to experience more deaths from diabetes. This shows the less effort the concerned ministry had put to curb the rising cases. In its 2021 vision, UAE aims to lower this pandemic to 16.28%. Looking unto the 2012 results the 2012 results, this will be a very slight change meaning that other key health issues should have been given priority instead. The key sponsor for his vision is the ministry of health. Track records indicates that the health ministry had failed to realize it obligations in bettering health service. Therefore, I see this as the biggest challenge in achieving the set targets by the year 2021. In order to realize the set goals in lowering diabetes cases, the government should seek aid from well-established health organizations.
- Prevalence of Obesity amongst Children
Children face numerous health issues in addition to obesity. Although a serious problem among UAE children, making it a key indicator for vision 2021 alone neglects the list of other conditions children are grappling with them. The strategic objective for UAE’s vision 2021 should have focused on the entirety of health issues facing children such as low birth weight, infant deaths, and malnutrition, among others. Focusing only on obesity among children cannot make any difference regarding improving healthcare provision for children. As indicated in UAE Vision 2021 (2016), the indicator measures the proportion of children between 5 and 17 years of age considered obese. In a review of provided data, the ministry defines obesity as a BMI greater than +2 standard deviations in children. The body indicates, as of 2014, 13.7% of children between ages 5-17 were obese. The ministry of health targets to prevent rising cases of obesity to a manageable prevalence of 12% by 2021.
However, the ministry seems to place little interest on numerous other health cases affecting children in UAE. According to Bell (2013), various chronic diseases affect one out of three children in UAE. Obesity is not the only health problem that affects UAE children drastically. The study done by Dr. Abdulla at Zayed Hospital indicated that 14.2% of UAE children and teenagers from age 6-19 were facing numerous health issues. Whereas 19.8% were obese, 14% were suffering from at least one chronic illness (Bell, 2013). Unfortunately, the study found out that there were no measures put in place by the government to check the kind of health issues afflicting children. Analysis of countries in the MENA region shows increasing child mal-conditions prevalence, in addition to high rates of malnutrition in early childhood. Malnutrition in children actually should be detailed as a national disaster (AlBlooshi, Shaban, AlTunaiji, Fares, AlShehhi, AlMazrouei & Souid, 2016). Worldwide prevalence of childhood malnutrition increased from 4.2% in 1990 to 6.7% in 2010. The trend has worsened by 2015, and it is projected to continue surging drastically by 2021 (Browne & Flanigan, 2010). According to Browne and Flanigan (2010), the rate of rate of malnutrition in middle-income countries remains relatively higher as compared to obesity. For example, in UAE, the prevalence of malnutrition among children is two to three times greater than that of obesity (Browne & Flanigan, 2010). Therefore, urgent measures to limit the escalation of childhood malnutrition are needed than obesity. Although there has been the focus in micronutrient and malnutrition deficiencies by the ministry of health, the vision 2021 strategic objective incorporates should address them urgently.
Obesity among children should be defined as the condition whereby kids are living with overweight which is caused by food and genetic problems. Therefore, defining obesity among children using the BMI will be difficult for some people to understand the meaning of obese among children. Also, the age of obese children should not be limited between the ages of 5 and 17. The ministry of health is the main source of giving statistics on the rising cases of obesity among UAE children. At some times, the credibility of figures might be compromised since the ministry is obliged with a lot of responsibilities making it difficult to give correct figures and estimates on how it is committed to avert the condition. For instance, the ministry deals with a lot of issues and does not give much concern to the rising obese cases among children. Results of the year 2012 indicated that obesity prevalence among UAE children was 13.17%. This figure is not correct since independent organizations indicate a higher percentage. This is underestimating this key indicator towards realizing an obese free nation. And when comparing with its target for 2021, we realize that the government is doing less to reduce obesity among kids. New overweight continues to be reported each day. Reducing figures to entice the public on its work, the ministry imply that, this indicator should have not been in the top five priorities since there many health challenges affecting children. Therefore, the targets for vision 2021 should be less than the current stated 12% to show commitment towards a health nation. Also, the key sponsor for this vision in the ministry of health. Again, this raises questions on whether the ministry has enough funds to realize the set goal by 2021. In the past, the government has not attained set goals in the health sector. This is a worrying trend that questions its capability in achieving the 2021 vision. The government should identify sponsors to show its commitment to realizing its strategies.
- Prevalence of smoking any tobacco product
Smoking prevalence varies considerably across countries and among youth and adult populations. As at 2013, Cleland (2013) reports a growing trend of smoking among UAE youths, indicating that a quarter of all smokers start smoking before age 10. The ministry of health had launched a campaign against smoking amongst the youth, though the trend is still on the rise. According to statistics from the ministry of health, as found in Cleland (2013), 28% of people below 18 years smoke tobacco products. The ministry’s Vision 2021 reports 21.6% prevalence of smoking among men and 1.9% among women. In view of this, and the conservative culture, smoking is not a worrying issue as compared to particular critical lifestyles that threaten health in the country. Actually, smoking can be addressed more in homes and schools than by the government. Perhaps, the government should only support some awareness programs to raise concern about the issue. As such, the issue should not be urgent than the issue of nutrition and exercise programs in schools. Although globally, smoking has increased significantly, it is clear that exercise programs contribute to the reduction of addiction. As such, they should be the point of focus as compared to smoking. Smoking is purely an addiction problem, which the ministry should address through proper intervention programs. Furthermore, trends in tobacco use in middle-income and industrialized countries have gone down by 1% each year. UAE is no exception. The ministry should focus on establishing nutrition programs and improve PE programs in schools to facilitate a fitness nation that taking smoking as a key indicator.
This indicator is defined using the amount of tobacco consume by an individual on daily basis. The definition does not clearly elaborate parameters set to lessen tobacco usage among UAE population. On the other hand, it ignores the fact that the affected people are not only the users, but also the general public. We understand that it is difficult to undertake a survey to show the number of cigarettes each age group consumes. Therefore, the age factor does not real matter when it comes to the number of cigarettes an individual uses in a single day. Therefore, this definition should be improved to depict the clear message that tobacco products affects people indifferent of their age or gender. The ministry of health is the main source of figures showing tobacco consumption among men and women in UAE. Previously, the credibility of surveys by the ministry of health were questionable. This worries if these figures are correct given that the people given the responsibility to undertake surveys fake figures. In 2012, results indicated that the percentage of men smoking tobacco had fallen to 21.6% in the year 2010 as that of women fall to 1.99%. This figures are not correct bearing in mind that currently, a larger percentage in various researches conducted in UAE reveal a worrying trend of female engaging in tobacco smoking. In its mission, the ministry of health envisions to lower the percentage to 15.7 and 1.66 in women by the year 2021. This is a nice move though it has not clearly shown how it will achieve this as the social media is influencing more youth to indulge in tobacco smoking. Also, the ministry of health is the main sponsor for this indicator. More should be done to attract other sponsors like non-governmental organization in fighting tobacco smoking among the UAE population rather than shouldering all key indicators to the ministry of health.
- Healthcare Quality Index
Healthcare services in UAE have improved significantly in the last two decades. The provision of quality care is anchored in UAE’s economic growth trajectory and vision for her people. The country further seeks to improve the quality of healthcare delivery in the Vision 2021 strategic objective. UAE Vision 2021 (2016) defines health care index as an indicator measuring the quality of healthcare in three Legatum Prosperity terms, health preventive care and infrastructure, essential health outcomes, and mental and physical health satisfaction. Regarding quality healthcare index, UAE is ranked number 34 worldwide in the year 2015. The ministry targets to improve the quality of healthcare and projects to be ranked number 20 in the year 2021. According to Kirsten and Karch (2012), healthcare expenditures in the many parts of the world remain low by international standards; however, healthcare systems in UAE have undergone rapid changes. The progress is driven by a sharp increase in demand for healthcare due to changing attitudes toward lifestyle diseases and to increased life expectancies. However, improving quality health index depends on numerous factors such as technology, education, infrastructure, cost, and so forth. For UAE to enhance its quality, all these factors must be incorporated into their healthcare system.
Healthcare quality indication should be defined as the state whereby the healthcare sector has sufficient number of nurses, facilities, technology and training so as to better service delivery. Entirely, this indicators should look into different way on how the country can offer qualified health services to patients. Legatum Prosperity is the source of information regarding to healthcare quality. It ranks countries in regard to the quality of service in the healthcare sector. Though, the organization thus not put into consideration of key factors that lead to betterment of quality delivery in healthcare. The results of 2012 ranked UAE in position 34 among countries that offer quality service in the healthcare sector. This results cannot be relied on since UAE faces numerous challenges in assuring better health service to its citizens. In its visions, UAE aims to be ranked among the top 20 countries offering quality services in the health sector. If indeed this was a priority in its strategy, the country should have aimed to be among the top 5 nations with improved healthcare. Again, the ministry of health is the main sponsor in realizing that UAE improves healthcare quality by 2021. The country could have done better improving healthcare quality index if the sponsor was an independent organization with lesser responsibilities.
- Percentage of health facilities.
In its 2021 vision, UAE intends to increase the number of health facilities across the country. This is intended to make it easier for the UAE citizens to access health services closer to their homes. In this strategy, the country envisions to increase funds so as to enhance infrastructure development in the health industry. Though this is seen to be a brilliant idea, the health ministry should have looks at training more nurses to reduce the nurse to patient ratio. Currently, the number of nurses serving 100 patients is wanting. Therefore, UAE should have made steps to recruit more health workers and train them to offer good service in the hospitals. Also, the amounts of money set aside for this strategy should be diverted for purposes of purchasing medicines to the already existing health centers. Normally, hospitals face challenges since the government does not provide enough drugs for the patients. Therefore, this should be a priority in the healthcare vision.
Clearly, this indicator was defined as the share of public and private hospital among the UAE population. The definition is not precise in stating that this is a strategy geared to ensuring all citizens receive health services easily. It only looks at distribution of hospitals across the country ignoring other key factors. The health facilities should be accredited by relevant authorities to ensure that people receive professional treatment which is not mentioned in the indicator’s definiion. The source of this idea is the ministry of health. Its main concern should be on how to improve service in the existing health centers across the country. Results from the year 2012, indicated that UAE was 48% in ensuring accessibility to health services among its citizens. This is quite a small percentage bearing in mind that the health sector is so critical to any nation. By the year 2021, UAE intends to improve the number of accredited health facilities to 100 percent. This can only be achieved if the government sets aside enough funds for improving infrastructure and technology as well as accrediting private hospital that meet health standards. The ministry of health as the main sponsor of this strategy might not be enough. More stakeholders should be called into give aid.
Suggesting Alternative Indictors
Of course, the ten indicators envisioned in Vision 2021 are fundamental issues that threaten the well-being of UAE citizens and the success of its health care system. However, when weighing five of the proposed indicators, they are less prevalent than major global issues challenging the health care system. The five indicators that can be substituted are the number of deaths from cardiovascular diseases, average healthy life expectancy, the number of deaths from cancer, the percentage of accredited health facilities, and the number of physicians. The rationale for substituting each indicator has been explained in subsequent analysis. Further, alternative indicators have been suggested based on global baseline data indicating the most serious healthcare issues today. Below is a discussion of major suggestion to the above indicators.
- Number of deaths from cardiovascular diseases per 100,000 population/alternative indicator is ‘technological advancement in healthcare systems.’
According to Brown (2016), the age of new technology has made significant proliferations in the healthcare system. For example, machines have been developed that provide chemotherapy, radiotherapy, ultrasound scanning, and numerous healthcare functions for the prevention and cure of diseases. These machines are vital in treatment, yet, most of them are extremely expensive. With the rising cases of cancer, medical data indicates that UAE lacks enough radiotherapy and chemotherapy machines (UAE Vision 2021, 2016). On the other hand, the issue of assessing the number of cardiovascular deaths is mundane. Even though cardiovascular diseases are rampant, a focus on obesity and smoking will solve the problem. Therefore, this indicator can be substituted with a focus on technological advancement. The government should source new technological machines to help health staff diagnose ailments easily. This will help them to start offering treatment at the right time thus saving many lives. Also, the ministry of health should ensure to offer relevant training to the nurses so that they develop skills in operating technological machines which enhance fast service delivery for the people. Results from 2012 are biased since they ignore facts that cardiovascular deaths are increasing each and every day. The ministry of health should look for sponsors so that this condition can be reduced.
- Average healthy life expectancy/alternative indicator is ‘patient-centered care’
It is completely nonsensical to spend time in mapping the average healthy life expectancy of a nation when the people are vulnerable to poor treatment. Merlino (2015) observes that the healthcare system across the world has embarked on a journey, 10 years ago, to improve patient satisfaction. Patient-centered care is the key to patient satisfaction. To improve the healthcare system, patient-centered care is the most important quality. It is one of the main elements to indicate improved healthcare. Apparently, it is missing in the UAE’s vision 2021 agenda and should be incorporated as an alternative to the ‘average health life expectancy’ indicator. The health staff should be taught to show compassion and love for their patients as this enhances their recovery. At the same time, keeping patient’s information confidential is key in keeping trust that helps them share freely with their doctors.
Life expectance should be defined as the average number of years an individual is guaranteed to live given that there are many health issues that arises at different ages. The WHO is the main source for statistics showing average life expectancy in different nations. Their credibility is highly questioned given that they are limited with staff. Results of 2021 showed that life expectancy was at 73 years. Actually, the results are questionable with the rising number of deaths at younger ages. It is a few people who live to the stated age. As its target, UAE word to increase life expectancy to 73 years. This is not a simple task given that the nation failed to offer better health services to its citizens. Well-established organizations should be key drivers since the ministry has many tasks and this indicator might seem not meaningful.
- Number of physicians per 1,000 population/alternative indicator is ‘improving the quality of physician education.’
Indeed, the need to increase the number of physicians in UAE is undisputable. However, anticipating the provision of quality care requires the country to have quality physicians. The country must have well-trained physicians to spearhead quality care. UAE can have a huge number of physicians but who are quacks because they do not have quality training. For example, numerous hospitals in UAE are unable to implement Evidence-Based Practice (EBP), because they lack the necessary training to do so. Instead of focusing on training many physicians, 2.9 physicians per 1000 population as a key indicator, the Vision 2021 plan should focus on training quality physicians by improving education programs offered in medical schools. On the same note, the ministry of health should hire professional health staff from other nations so as to improve the physicians to patient ratio. This is key to making UAE a world-class health hub.
The definition should have been improved by stating that the indicator is concerned in ensuring that each and every individual accesses service from a qualified physician when in need. The definition ignores the fact that quality is paramount besides increasing the number. The WHO gives statistics based on continental average. Therefore, UAE should not use this as a correct measure to know the number of physicians needed. The 2012 results indicated 2.53 physicians among 1000 populations. Again, this is not true since many citizens do not get a chance to see physicians. And, aiming to increase the number to 2.9 is a clear indication that the nation is not committed in achieving the set vision goal. Also, the ministry of health should allow other stakeholders like private hospitals to help curb the deficit in the number of physicians.
- Number of deaths from cancer per 100,000 population/alternative is ‘spearheading nutrition awareness programs.’
The world acknowledges that cancer has become a pandemic (AlBlooshi et al., 2016). Epidemiological data suggests a rising curve of cancer cases in UAE (UAE Vision 2021, 2016). As observed, WHO report indicates that 99 people die from cancer per 100,000 populations as at 2012. Of course, this is a worrying figure. The ministry of health thus seeks to reduce the death cases to 64.2 deaths per 100,000 populations. However, the ministry has not indicated how it is going to reduce those deaths. Indeed, it is good to have such a vision; however, more focus would be placed on how to reduce such deaths. The answer is nutrition awareness. Often, cancer is a lifestyle disease. Curbing smoking and obesity is one way of bringing up a healthy people. The key indicator, therefore, should focus on nutrition awareness programs, which if incorporated into the culture of UAE people would address cancer deaths, naturally. Training the people on health risks that heighten cancer can save many cancer deaths seen in the UAE population. The definitions should be improved by defining what cancer, causes is and how it affects people than dwelling on deaths. The ministry of health is not competent enough in giving correct figures of this pandemic. In 2021, results stated that there were 99 among 100000 people. This is not true, in fact, cancer cause over 1000 deaths among the said population and in some cases deaths are unreported. In its 2021 vision, the ministry targets to reduce the number of deaths to 64 per 100,000 population. Also, this is an over ambitious target which will never be achieved as it understates the correct figures of cancer deaths. About sponsorship, the ministry should target partners like the media, private investors to help sensitize in financial aid as well as educating people on the health risks caused by cancer.
- Number of Deaths from Cardiovascular related ailments per 100,000 people.
In the recent past, the world has witnessed rising number of deaths from cardiovascular ailments. This has also been a major threat to the UAE population according to the World Health Organization reports. Therefore, the ministry of health should have not left this indicator out in its top five priority. The current situation needs the government to intervene by putting research into the causes and ways to avert this situation. It should also, invest in modern technology used in developed countries so that all patients with cardiovascular problems access decent treatment. The definition for this problem should be more accurate in state the number of deaths per 100,000 population. This can be better in putting the right measures to curb the situation. The world health organization is the source of this information. Since it deals with health issues throughout the globe, its statistics cannot be entirely dependent on in fighting this pandemic. The results of 2021 are not correct by stating that there was only 297 reported deaths from cardiovascular disease. The disease is among the major causes of deaths in the population. Therefore, this figure could have been correct if it incorporated independent reports from hospitals and other organizations. Why should the ministry target to reduce deaths to 158 among 100,000 people? Actually, in its 2021 targets, the ministry should strive to avert deaths from the ailment completely. And, this will be achieved if it called for the corporate world to give sponsorship as it is overwhelmed with a lot of responsibilities. The World Health Organization should be given the mandate to foresee this dream come true by 2021.
Conversely, along with education, infrastructure, sustainable environment, public safety, fair justice system, unity, and a competitive economy envisioned in Vision 2021, health services are considered a fundamental means for the realization of UAE’s national agenda. The provision of quality healthcare is viewed by the government of the UAE as serving a number of goals. It is an effective means of enhancing the welfare of UAE population. Better healthcare depends on quality education and training, which in turn improves the quality of the labor force, thereby increasing the indigenous supply of workers needed for the development process. As noted in the alternative section, a comprehensive and free health care for UAE citizens is a positive distributive measure through which the government can share its wealth to the people. Clearly, it should be a fundamental element of Vision 2021 if at all such a dream could be realized. Furthermore, the manner in which a government moves to distribute wealth and income can have serious side effects. Given the burst of hospital and health facility construction of recent years, it comes as no surprise that the lion’s share of the UAE budget is allocated to the ministry of health to drive the vision 2021 agenda. The vision can be attained by focusing on the right indicators.
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