Health Improvement Strategy 2015_2018

1. Demographic change • Population growth: as a result of the increasing population in the Kingdom of Bahrain that reached in 2013 (‎1,253,191) and the high proportion of non-Bahrainis that reached Health Improvement Strategy 50.94% of population in the same year, there was an increase in both the demand for health services and the expectations of patients. For instance, Salmaniya Medical Complex -Ministry of Health’s major governmental hospital- provides medical consultation services to approximately 1,500 patients per day in Out-Patient Department OPD in addition to the treatment of more than 1,000 cases in the same complex’s wards. The primary healthcare provides consultation services to more than 8,000 cases per day, which means that approximately 25% of the total population of the kingdom is utilizing Ministry of Health services per month. • The increase in life expectancy rate: There is a significant increase in the life expectancy rate in the Kingdom that reached to 75.3 years in 2013 compared to 73.4 years in 2000. Therefore there is an increase in elderly population and health care needs.

2. Escalating rate of chronic Non-Communicable Diseases (NCDs) • The Non-Communicable Diseases, which include the (diseases of cardiovascular, cancer, diabetes and chronic respiratory diseases, etc.), are becoming a serious threat to the overall Health System, being considered the principal cause of death. In addition, these diseases and their complications pose an economic burden on countries and on their health systems as a result of the high treatment expenditure implicated due to prolonged periods of treatment and its negative impact on the productivity of the individuals, which negatively affects the progress of society. Figure(1) show the percentage of deaths among The Non Communicable diseases(NCDs) Deaths 6 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health 24% Disease of the The NCDs mortality rate 34% 3% Circulatory System represent 63% of the Diabetes 24% 15% Cancer total causes of death in Respiratory Bahrain* Other NCDs Figure(1): The percentage of deaths Among The Non Communicable Diseases(NCDs)

3. Sustainability of Health financing During the last twelve years (2000 - 2012) the government spent approximately BD 1.677 billion (including projects) on healthcare, whereas the allocation to the Ministry of Health from the total government budget (including projects) reached 7.6% for the year 2013. The recurrent expenditure of Ministry of Health has increased by 192.16% between 2001 and 2012; reaching in the year 2013 to approximately 249.8 million Bahraini Dinar BD compared to 88.4 BD million in 2004. Also, the per capita GDP in 2009 was BD 7319 (U.S.D $ 19,413.7) and it increased to BD 10065 (U.S.D $ 26697) in 2013, on the other hand, there was an escalating in the Health care cost with limited alternatives of health financing. Figure(2) shows the total MoH expenditure in BD (million) between 2004 and 2013. Figure(2) Total MoH expenditure in BD (million) between 2004 and 2013 *Source: MoH-Health statistics report 2013 7 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health

4. Technological development and medicines • As a result of technological development in the field of diagnostics, Ministry of Health expenditure on surgical tools, laboratory and radiology reached to BD 8.8 million in 2012, compared to 4 million BD in 2001, with an increase of 210%. • In 2012, Ministry of Health medication list consisted of 1,107 items. The medication expenditure augmented due to increase in the consumption rate. In addition, in 2012 the medication expenditure reached to about BD 31.5 million compared with 6 million BD in Health Improvement Strategy 2001, with an increase of 425%. Showcasing the efforts of Ministry of Health to enhance the quality of care services and the commitment to provide the cutting- edge developments in technology to the population of Bahrain.

5. Limitation of the partnership between the public and private sector and investment in health Promotion and integration partnership with key-stakeholder in Private Health Sector is a key-factor to enhance the quality service level and reduce economic burdens in the Ministry of Health. Proactive medical tourism and increment on health investment is the bottom line of successful policies and strategies through its main gate which is the Economic Development Board (EDB) and the National Health Regulatory Authority (NHRA). Implementing the health insurance considered one option for health financing, decrease economic burden on MoH and it also helps in increase the choice for citizen and residence to select other public or private health facilities.

6. Shortage in specialized health workforce The MoH reach levels of Bahrainization of 82%, achieving the expected targets promoted by the government on regard the professionalization of Bahraini population. However despite an increment of 35 % on manpower in 2013, still there is a substantial gab in the actual workforce needs to cope with the overall rising needs of sub-specialities. Needed to be remark, the insufficient specialized physicians in key areas, such: emergency, anesthesia, intensive care, palliative care, Oncology, Radio-diagnosis, Obstetrics,Gynecology and haematology. Moreover, there is a need in areas of nursing, pharmacy and other allied heath, etc. 8 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health MOH-SWOT Analysis Strengths • Supportive leadership and a functioning supreme council of Health that stewards the health system • Structured legal framework. • Advanced infrastructure in terms of new technologies and facilities. • Highly qualified national health professionals in Public Health Sector. • High accessibility and respond to populations needs for health. • Comprehensive& well established primary healthcare services. • Secondary health care services within an educational and medical complex that contains most specialties. Internal Origin • Presence of long term Strategic human resources plan. Weaknesses • Limitation in integration, communication and coordination between Primary and Secondary Health Care. • Limitation in clinical and health research capabilities. • Limitation in medical privileges • Limitation in availability and implementation of standard guidelines for treatment. • Health information system including civil registration and vital statistics is inadequately analyzed or used for informed decision making. • Limitation in specialized medical facilities • Limitation in implementing training plans. Opportunities • Transparent political environment that encourages dialogue discussion and change. • Partnership with national, regional and international organizations (e.g. private health facilities, The Health Minister’s Council For GCC States, EMRO-WHO, World Bank, etc.) • Partnership with educational institutes. • Increase competition among healthcare providers. • Increased awareness towards investment in health within the presence of regulatory framework. • Direction towards improving the current health system through the government • Direction towards improving the current health financial funds by Supreme Council. External Origin • Developing a new system for performance evaluation and linking it to incentives. • High investment in health information system and technologies for improving efficiency (I-Seha). • The presence of a national body (National Health Regulatory Authority)to regulate the professions and health services.. Threats • Demographic and epidemiological transitions with dramatic rise in Non-Communicable Diseases- NCDs, and associated risk factors (e.g. obesity, and tobacco consumption among men and women, etc.). • Limitation in technical and financial resources. • Global shortage of health professionals • Fast technological advancement accompanied by high cost of medicines and medical devices. • Increases demand on health services more than the rate of supply. 9 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Vision All population have access to quality Health Care throughout life time Health Improvement Strategy Mission The Ministry of Health, in partnership with stakeholders, promotes individuals and community’s health, ensures the availability of high quality, sustainable and affordable health care services according to an approved policies and optimal use of resources using the high standard evidence-based and accredited health care services. Values Four interrelated principles guide the above aspiration:

1. Patient first: The patients are the axis of this mode. Proactive identification and adequate responce to the actual and future needs on respect of the health rights are primary targets.

2. Safety: Ensuring the highest levels of safety and accredited services according to international standards.

3. Excellence: To enhance, promote and develop quality services, through the optimal use of available resources, seeking to achieve the best efficient /effective models.

4. Community partnership: Partner along with key- stakeholders to achieve the strategic objectives. 10 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health HEALTH IMPROVEMENT STRATEGY The strategic analysis undertaken has resulted in the development of six strategic objectives for the Ministry of Health. These are detailed below and will form the backbone of all future decision making. All forthcoming service development proposals will be tested against these objectives and they will drive the service development strategy: Strategic Objectives

1. Sustaining population’s health through health promotion and prevention

2. Integrating services in the health system throughout Ministry of Health and with other governmental and private institutes

3. Putting quality first

4. Access for all to healthcare services

5. Enhancing Ministry of Health,s role in policy making and governance

6. Health service sustainability 11 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Indicators of achieving the Strategic objectives 1. Mortality rate due to Non-Communicable Diseases 2. Life expectancy at birth 3. Infant mortality rate 4. Maternal mortality rate Health Improvement Strategy

5. Mortality rate due to Communicable Diseases

6. Prevalence of Non-Communicable Diseases 7. Incidence of Communicable Disease 8. Vaccination rate for children

9. Electronic health record for each health user

10. Required time for the response, handling and recovery of disasters and emergencies

11. The proportion of executed training agreements of the total training agreements

12. Percentage of implemented “Patient Safety Policies and Procedures”

13. Attain International Accreditation for Ministry of Health’s facilities

14. Percentage of attended patient complaints according to approved mechanism

15. Number of operated health facilities out of MoH plan 2015 -2018

16. Number of referral cases from primary to secondary health care

17. Percentage of adopted and implemented clinical guidelines according to the approved plan

18. Number of new and updated organizational structures according to the approved plan

19. Percentage of new-registered cancer cases in the National Cancer Registry System

20. Percentage of executed to the approved annual training plans

21. Operational Warehouse Management System (WMS) in the Ministry of Health

22. Periodic National Health Accounts Report 12 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health 13 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No.1 Sustaining population,s health through health promotion and prevention 14 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No.1 , Sustaining population s health through health promotion and prevention Improving the health of the population is a national priority and will be accomplished through the Ministry’s continuing efforts to enhance the capacity of the primary care services. The goal is to not only to provide curative services but also promotion and awareness of the benefits of healthy life style habits to the population, through a greater focus on health screening programs and the development and enforcement of public policies. Expenditure on preventive care and health promotion has not match the needs up to date. Changing disease patterns call for reallocation of some resources from curative to preventive services to make better use of available resources and decrease the cost of secondary and tertiary care, which is more expensive. Investing in health promotion and prevention services is a proven, cost-effective route to reduce long-term costs and is an important element of strategic objectives number 2, which focuses on integrating services throughout the health system. When the integration of preventive services and health promotion is well-developed, the community becomes actively involved and supportive and the use of secondary and tertiary services can be diminished. The proposed initiatives will offer high-quality services in the areas of prevention, treatment and rehabilitation. Indicators of achieving the objective:

1. Mortality rate due to Non-Communicable Diseases

2. Life expectancy at birth

3. Infant mortality rate

4. Maternal mortality rate

5. Mortality rate due to Communicable Diseases CDS

6. Prevalence of Non-Communicable Diseases NCDS

7. Incidence of Communicable Disease

8. Vaccination rate for children Partners to achieve the goal General Organization for Municipal Councils Private Health Sector Youth and Sports Ministry of Social All Governorates Ministry of Education Development Information Affairs Authority 15 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No.1 , Sustaining population s health through health promotion and prevention Initiative No. 1: Justification /Aim of initiative Programs • Promote healthy lifestyles among 1.1.1 Encourage healthy Promotion of healthy all population groups and to lifestyles among the lifestyles to maintain reduce the incidence of Non- various segments of health and reduce Communicable Diseases NCDs society. Health Improvement Strategy the incidence of • Reduce economic and social Non-Communicable burden on health system. Diseases NCDs • Healthy, active and productive Ownership: individuals in the community. 1.1.2 Modify the behavior Undersecretary Office • Enhance the quality of individual’s of people who suffer life from risk factors for • Rational utilization of health Non-Communicable services. Diseases-NCDs factors • Reduce incidence and complication (increased weight of non-communicable diseases. - obesity - physical • Enhance quality of life for inactivity- Redundancy). individuals suffering from non- 1.1.3 Enable persons with communicable diseases or who are non-communicable in risk of such diseases. diseases to self-care with their illness. Initiative No. 2: • Enhance community’s health 1.2.1 Implementing the through early detection and national plan for the Strengthening the role disease prevention prevention of non- of Primary Health communicable diseases. Care in prevention of Non-Communicable 1.2.2 Continue to provide Diseases NCDs integrated care for Ownership: Sickle Cell Disease Assistant patients. Undersecretary for Primary Care and Public Health 16 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No.1 , Sustaining population s health through health promotion and prevention Initiative No.3: Justification /Aim of initiative Programs • Enhance protection against 1.3.1 Strengthening Enhance protection Communicable Diseases CDs and the prevention of Against Communicable newly emerged diseases Communicable Diseases Diseases CDs, and by maintaining a newly-emerged diseases percentage of 99% of Ownership: the vaccinated children Assistant over the age of 5 years Undersecretary for through the expansion Primary Care and of the expanded Public Health immunization program. 1.3.2 Continuity of activation of the International Health Regulations. 1.3.3 Expansion in the protection of food poisoning program. 1.3.4 Strengthening the Public Health Laboratories. 17 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes 18 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes Countries around the world struggle to meet the challenges posed by the complexity of medical problems, which often exhibit co-morbidities and require attention from more than one provider. Combined with demographic and lifestyle shifts, the need to treat patients cost-effectively and as close to home as possible and in the right kind of facility presents considerable challenges to the healthcare system and its resources in Bahrain. To address such challenges, the MOH will need to develop more efficient arrangements to integrate its services across the Kingdom. Integration of healthcare has many interpretations and Bahrain follows the WHO definition of integrated healthcare: “the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.” For comply with this statement, greater integration of the healthcare system needs to be achieved, where is patients are treated in a more holistic manner - at the most appropriate setting for their medical needs, by the right providers who are able to coordinate their treatment seamlessly. This requires well-developed policies and protocols which encourage, wherever appropriate, patient treatment at facilities other than hospitals. The integrated care system in Bahrain will be built on four principal pillars: policies and protocols which specify roles and responsibilities of the different healthcare providers; developed linkages between patient-centred collaborative healthcare providers (public and private); the active involvement of the public in the development and location of health facilities; and a governing structure and supportive IT systems that promote and enable alignment of healthcare providers towards integrated care. Indicators of achieving the objective:

1. Electronic Health Record For Each Health User

2. Required time for the response, handling and recovery of disasters and emergencies

3. The proportion of executed training agreements of the total training agreements 19 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes Partners in achieving this objective Supreme Council of Health Ministry of Finance Civil Defense Department Health Improvement Strategy King Hamad University National Health Regulatory Bahrain Defense hospital Hospital Authority Information Affairs Civil Service Bureau Private Health Institutes Authority The Supreme Council for Governmental and Private Ministry of Interior the Environment Health Education Institute Legislation and Legal Opinion Commission Affairs 20 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes Initiative No. 1: Justification /Aim of initiative Programs • Constantly improve emergency 2.1.1 Raise the preparedness Enhance integration and disasters plans by keeping up and response level for in the Emergency and with new developments and face the emergencies and Disaster Management possible risk with all stakeholders. disasters and recovery. System in Ministry of • Ensure the readiness of the health Health facilities to immediate respond to Ownership: these risks. Undersecretary Office • Ensure a safe health infrastructure while continuing to deliver health services, and promote the capabilities of national health human resources in the field of emergency and disaster management. Initiative No. 2: • Improve health services through 2.2.1 Develop Health the provision of care based on Research Management Develop Health evidence and scientific research System and link it with Research Management results. concerned stakeholders. System and link it with • Collaborate between bodies involved in research and studies concerned stakeholders with proper utilization of available resources. Ownership: • Publish studies and research Undersecretary Office findings. Initiative No. 3: • Improve the level and the quality 2.3.1 Develop and implement of health care services provided a robust and integrated Develop and implement by public health sector while Health Care System. a strategy for services reducing its cost. 2.3.2 Establish an electronic integration throughout • Provide more coherent and network among all Health Ministry of Health satisfying health services as facilities in the ministry. viewed by health services 2.3.3 Improve capacity of Ownership: receivers with assurance of their Internal audit and Assistant satisfaction. monitoring. Undersecretary for 2.3.4 Develop the Training and Planning telecommunications system in all Ministry of Health facilities. 21 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes Initiative no 4: Justification /Aim of initiative Programs • Improve the level and the quality 2.4.1 Develop and Develop and implement of provided Health Care services implement an action Health Improvement Strategy an action plan for by governmental health sector in plan for health services Health services the Kingdom of Bahrain while integration between integration between reducing its cost. Ministry of Health and Ministry of Health and • Strengthen the rational use of other governmental other governmental public health services. institutions. institutions. 2.4.2 Promote integration Ownership: between the Ministry of Health with media Undersecretary Office and other relevant institutions. 2.4.3 Develop a monitoring system to follow-up the implementation of national and international agreements and memorandums of understanding. Initiative No. 5: • Review the process of 2.5.1 Develop services strengthening and enhancing integration system Enhance partnership collaboration between the public between the Ministry of with the private health and private health sector in the Health and the private sector Kingdom of Bahrain to facilitate health sector and other the patient’s health journey relevant institutions. Ownership: between the two sectors. 2.5.2 Develop and improve Undersecretary Office • Ensure patient’s attainment coordination and of required service in the partnership mechanisms appropriate time with high level between Overseas of quality and efficiency. Treatment Office and • Encourage competitiveness other related health throughout health sector. institutions. 22 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes Initiative No. 6: Justification /Aim of initiative Programs • Create National Electronic 2.6.1 Implementing the new Develop Support and Medical record files to enable requirements which are Health Information physicians to speed up diagnosis currently not included Technology Systems. and make the best therapeutic under the National Ownership: decisions. Health Information • Enable electronic drug program (I-Seha). Assistant prescribing to minimize 2.6.2 Launch the I-Seha Undersecretary for medication errors during applications, and apply Training and Planning dispensing. the requirements of • Ease appointment booking the programs and the process by linking clinic›s expansion of support registration system, patient›s services. wards, and laboratory and 2.6.3 Develop Management radiology department. Information System • Estimate health services cost (MIS). for each patient based on the provided service. • Enable decision makers in the ministry to track patient journey that should result in developing best plans for efficient and effective utilization of health resources. • Automate all Non-Clinical Services and departments according to its requirements. • Facilitate the work of Non-Clinical Services and departments though selecting the appropriate information technology system. • Data Integration among Non-Clinical Services and departments to ease data exchange. 23 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic objective No. 2: Integration of services in the Health system throughout Ministry of Health and with other governmental and private institutes Initiative No. 7: Justification /Aim of initiative Programs 2.7.1 Manage and monitor Enhance the security • Enable Information Systems the security and and protection of management and control of data confidentiality of the information systems Health Improvement Strategy usage and exchange according information network at Ownership: to standardized policies and the Ministry of Health. procedures. Assistant • Protect the net users from Undersecretary for suspicious electronic sites by Training and Planning ensuring that these sites are authorized and in accordance with Ministry of Health and Civil Service Bureau policies. • Ability to constantly evaluate and develop the level of efficiency of the Health Information Security Systems. Initiative No. 8: • Increase health services quality 2.8.1 Manage the monitoring through efficient information and control of the Develop the management. electronic information infrastructure of health • Readiness to accommodate network. information and the the fast development in supportive technology communication devices. 2.8.2 Develop and maintain • Complete the linking between Data Center and Ownership: ministry’s new and old facilities. implementation Assistant Technology Database Undersecretary for Program. Training and Planning 24 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health 25 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 3: Putting Quality First 26 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 3: Putting Quality First Quality is at the backbone of the delivery of healthcare services. On a national level, increased emphasis has been placed on quality and patient safety through policy reform and regulatory changes. This includes the establishment of the NHRA and the accreditation by Accreditation Canada, of the MOH’s primary healthcare facilities, the SMC and the Psychiatric Hospital. To build on these recent efforts, the Ministry will implement a number of initiatives to further improve the quality framework of Bahrain’s healthcare. Recently, NHRA took over the regulating role of the healthcare sector. It is important that the healthcare providers and professionals cooperate with NHRA in developing and complying with such regulations and guidelines. While certain MOH facilities spent considerable time and effort in realigning their processes in order to attain accreditation by Accreditation Canada, it is vital that the recommendations made are implemented and a continuous culture of improvement is promoted in order to retain such accreditation and improve the quality of care in these facilities. Finally, further emphasis will be placed on patient safety. Government bodies and regulators will lead the development and enforcement of minimum guidelines and regulations with regards to quality. However, it must be noted that each health provider is ultimately responsible for putting in place the appropriate systems and controls to ensure quality. For some health providers, depending on their size, types and services offered, additional regulation might be necessary. While the NHRA licensing and accreditation process will lay the foundation for patient safety, healthcare providers will ultimately be responsible for ensuring patient safety. To support good practice and patient safety, the Ministry will ensure that its facilities have clinical standards, that guidelines and key performance indicators are in place for common conditions; that its healthcare professionals have access to the up-to-date guidelines on clinical practice; that a formal process for clinical audits, both internally and externally, is in place; and that legitimate non-health needs of patients are well catered for, including considerations of confidentiality and dignity. Moreover, the MOH will ensure that evidence based practice is adopted for various aspects of patient care through establishing a formal process for reviewing, updating and approving actions related to enhancing patient care. Indicators of achieving the objective:

1. Percentage of implemented “Patient Safety Policies and Procedures”.

2. Attain International Accreditation for Ministry of Health's facilities.

3. Percentage of attended patient complaints according to approved mechanism. Partners in achieving this objective National Health Regulatory Civil Service Bureau CSB Authority NHRA 27 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 3: Putting quality first Initiative No. 1: Justification /Aim of initiative Programs • Maximize patient safety 3.1.1 Support and develop Maximize patient safety throughout Ministry of Health clinical audit in all throughout Ministry of facilities. Ministry of Health Health›s facilities • Provide high quality health care facilities. and safe culture that ensures Health Improvement Strategy Ownership: 3.1.2 Reporting medical errors, patient safety. detecting their root cause Undersecretary Office • Minimize medical errors which analysis and follow-up the & is considered a national priority taken corrective measures aspired by both citizens and 3.1.3 Assess and develop a Assistant officials. Undersecretary for training plan to promote Training and Planning patient safety culture. 3.1.4 Develop and review patient safety policies and procedures based on World Health Organization WHO safety initiatives. Initiative No. 2: • Assure quality of services 3.2.1 Ensure the availability provided to health recipient of effective policies in Ensure the quality of is achieved by implementing clinical and administrative services provided in of health protocols, clinical departments. Ministry of Health›s guidelines and identification 3.2.2 Ensure the complying facilities of performance monitoring of Non-Clinical Service indicators. providers with the approved Ownership: • Ensure quality of health protocols and agreed Undersecretary Office services by carry out auditing to contracts. & ensure compliance of services 3.2.3 Continue accreditation of all with approved policies and relevant Ministry of Health All Assistant procedures. facilities. Undersecretaries • Ensure health care providers 3.2.4 Accomplish National are registered and qualified Health Regulatory according to local rules and Authority NHRA standards regulations. and requirements to all • Ensure existence of a centralized Ministry of Health facilities. system for prompt response to patient complaints. 3.2.5 Develop a centralized Patient Complaints System at Ministry of Health. 28 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health 29 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 4: Access for all to healthcare services 30 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 4: Access for all to healthcare services The Kingdom of Bahrain has made steady progress over the past four decades in providing improved access to Primary and Secondary Care and has been able to establish a strong healthcare infrastructure. However, all facilities are experiencing accelerating demand as the population grows and the prevalence of certain diseases and conditions increases. The organizational model for primary healthcare will be improved in order to further emphasize the preventive elements of healthcare and the skills required to identify and help individuals change behaviors that are deemed to be health risk factors. Secondary care consists of services (elective or emergency) provided by medical specialists in a hospital or other Secondary or Tertiary Care setting. Patients are usually referred from a primary care professional. With the rapid increase in population in the Kingdom of Bahrain, timely access to these services is becoming a key issue. Indicators:

1. Number of operated health facilities out of MoH plan 2015 -2018

2. Number of referral cases from Primary to Secondary Health Care Partners to achieve the goal National Health Regulatory Ministry of Works Authority Technical Kuwaiti Office Ministry of Finance Initiative No 1: Justification /Aim of initiative Programs Improve access to • Manage challenges of 4.1.1 Improve access to Primary and Secondary population growth, demographic Primary Health Care Health Care changes, shortage of specialists services. Ownership: and increase demand on 4.1.2 Improve access to - Assistant healthcare services requires Secondary Health Care Undersecretary for smart solutions to ease accessing services. Primary Care and Public and attaining of health care Health services in the kingdom of & Assistant Bahrain. Undersecretary for Hospitals Affairs 31 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No.5: EnhancingMinistry of Health’s role in policy making and governance 32 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 5: Enhancing Ministry of Health’s role in policy making and governance The complexity of the Health system requires an effective governance process to function effectively. This includes the allocation and definition of responsibilities and roles associated. Currently the MOH is sharing all the high level roles in the Health System in Bahrain, with the greatest emphasis on service provision. Over time, the MOH will place an increasing focus on its policy-making role in support of its overall responsibility to maintain and sustain the health status of the population and improve the health system’s performance. It will also address other social determinants that affect the health of the population with concerned stakeholders to ensure health is in all policies. The MoH will give consideration to greater delegation of its responsibilities for provision either through greater operational autonomy for provider services within the Ministry or by outsourcing, or making other similar arrangements with the private, government and NGO sectors. These developments will allow the Ministry to place a greater focus on evidence-based health policy making, establish partnerships with external stakeholders improve the collection, analysis and utilization of health information and implement governance best practices. By enhancing its policy making role, the Ministry will place much greater emphasis on ensuring that national health policies required to govern the health system are in place and are adequately formulated based on sound evidence and health system research outcomes. The Ministry will also ensure that health policies are implemented and evaluated on a regular basis and that each of the priorities in the National Economies Strategy “NES”, which are reflected in Bahrain’s Healthcare Agenda, are fully supported by effective policies (including clarity about responsibility for outcomes). This will require the more effective use of data and resources, greater co-ordination across different parts of the Ministry to promote integration, more effective dialogue with stakeholders and the development of specific health policies to meet the most pressing needs to improve and maintain the population health status. To allow a more consistent approach, enhanced policy making will involve an evidence based development process and will be undertaken in a manner that unifies health policy- 33 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 5: Enhancing Ministry of Health’s role in policy making and governance making standards and that is informed by communication with various parts of the health system. It should involve participation from representatives of relevant stakeholders and be based on up-to-date facts and data. All healthcare policies will be publicly available and shared nationally. Health Improvement Strategy MOH policies will be action-oriented frameworks that will take into account the identified goals and objectives, the methodology required to accomplish the objectives, the concerned entities responsible for implementing the policies and the monitoring and evaluation methodologies. Indicators of achieving the objective:

1. Percentage of adopted and implemented clinical guidelines according to the approved plan

2. Number of new and updated organizational structures according to the approved plan

3. Percentage of new-registered cancer cases in the National Cancer Registry System Partners to achieve the goal Supreme Council of Health Cabinet Office Public and private health Civil Service Bureau education institutions Fatwa and Legislation Ministry of Finance Authority 34 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 5: Enhancing Ministry of Health’s role in policy making and governance Initiative No 1: Justification /Aim of initiative Programs Enhance the Ministry • Review and update current 5.1.1 Review and study of Health’s governance governance and leadership the governance and and leadership system to align with international leadership system in best practice. the ministry including Ownership: organizational structures, policies, Undersecretary Office general procedures & and supervision of its All Assistant implementation. Undersecretaries 5.1.2 Enhance the Organizational performance management system. 5.1.3 Develop and implement a doctors clinical privileges system. 5.1.4 Improve the national health policies and training procedures. 5.1.5 Governance Salmaniya Medical Complex SMC and all Health Centers. 35 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 5: Enhancing Ministry of Health’s role in policy making and governance Initiative No. 2: Justification /Aim of initiative Programs Enhance evidence- This is basically due to the 5.2.1 Develop and update based decision-making awareness to the importance of the clinical guidelines quality of healthcare services and based on scientific Ownership: providing equal social services to evidence in various Health Improvement Strategy Undersecretary Office citizens to enable them to contribute aspects of patients & and benefit from the growth process. health care. As the evidence based policies 5.2.2 Capacity Building of Assistant and decisions are an approach for health professional in Undersecretary for better decision making and it is decision-making based Training and Planning characterized by: on evidences. • Systematic approaches: to assure availability of evidence-based 5.2.3 Develop and improve decisions and assure usage and access ability to monitor of such evidences. information to promote • Transparency: Stakeholders evidence based decision could review the evidences used making. in decision making and evaluate 5.2.4 Enhance and its implications. improve cancer cases • Introduce and develop set of registration. key performance indicators (KPIs) of primary and secondary health care facilities that can be measured and constantly reported. • Increase health facilities capacity to accomplish the process of performance measurement and reporting in relation to specific indicators. This is achieved through provision of necessary training to health institutes. • Develop and submit the Dashboard System reports of these indicators to high officials in the Ministry of Health. 36 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health 37 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 6: Health service sustainability 38 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 6: Health service sustainability The rising costs of healthcare in the Kingdom of Bahrain which – as in most countries is way ahead of the normally used price indices – means that the future sustainability of the healthcare system is a major issue, both for government financing and for the continuing provision of quality service. This matter requires extensive analysis of a range of longer- term funding options, including consideration of the effective fund sourcing, efficient training and allocation of the growing number of skilled healthcare professionals required to provide services. Additionally, improving management and planning systems are needed to ensure cost-effective procurement and the continuing availability of high quality facilities and equipment. The MOH will introduce enhanced and robust programs to ensure the effective utilization of the financial resources available to operate, enhance and sustain the health system. These will include the introduction of improved billing mechanisms, the upgrade of storage systems and other cost management programs. MOH, as a public provider of healthcare, has identified the shortage of skilled and qualified healthcare professionals in Bahrain as an impediment to its sustainability and will develop and implement a strategic plan to meet this challenge. As part of this plan, the Ministry will introduce measures to retain talented health professionals through the greater use of professional development and performance management opportunities, and will consider changes to staff compensation to meet recruiting shortfalls. Compensation of the workforce of the MOH is a key factor influencing the workforce shortage; the MOH has identified this matter and will continue in its efforts to motivate staff and improve retention levels. The Ministry will introduce new programs to target the effectiveness, efficiency and transparency of its procurement systems. Health purchasing, whether of drugs, equipment or technology, involves considerable expenditure and there are significant opportunities to increase savings that could be re-directed to other priority needs in the system. Increasing the effectiveness, efficiency and transparency of procurement systems will be beneficial to the health system. Specific programs, such as those that aim to reduce the number of out-of-stock inventory items, also contribute to the quality of services. 39 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 6: Health service sustainability The MOH plans to enhance existing inventory and storage systems by improving stock management and minimizing damage to medical items. Such improvements to the Ministry’s inventory management will help ensure and maintain effectiveness and efficiency. Although the future role of the Ministry will move to a greater focus on policy making and regulation, not merely service provision, the change will be gradual. Health Improvement Strategy During the transition, it is essential to maintain and improve the services provided to develop the health sector and to avoid disruptions in healthcare service provision during this process. The MOH is aware of the need to provide safe and dependable environments for patient care, especially during times of cost containment and the implementation of increasing regulations and guidelines. Over the next four years, the MOH will be upgrading the engineering services and facilities and replacing major parts of its medical equipment inventory, revamping the emergency power system in primary and secondary facilities and introducing further automation and computerization of the medical equipment inventory management system. Indicators of achieving the objective:

1. Percentage of executed to the approved annual training plans

2. Operational Warehouse Management System (WMS) in the Ministry of Health

3. Producing National Health Accounts Report periodically Partners to achieve the goal General Organization for Tenders and auctions Council Supreme Council of Health Social Insurance Health Training and educational Eastern Mediterranean Regional institutes inside and outside the Central Bank of Bahrain Office for the World Health Kingdom of Bahrain Organization-EMRO Electricity and Water Ministry of Works Ministry of Finance Authority The National Health Ministry of Education Civil Service Bureau Regulatory Authority -NHRA 40 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 6: Health service sustainability Initiative No. 1: Justification /Aim of initiative Programs Develop and Enhance The Health Finance Management 6.1.1 Establish infrastructure Health Finance System will contribute to the for the implementation Management System following: of a new Billing • Facilitate all patients and visitors System. Ownership: financial transactions by making 6.1.2 Establish infrastructure payment of fees in one spot only. for the implementation Assistant • Financial evaluation of the of Costing System. Undersecretary for efficiency and effectiveness of Financial & Technical 6.1.3 Implement National ministry’s departments in order Resources Health Accounts to decide its fate. programs. • Provide an image about different health expenditure aspects in 6.1.4 Establish a Health general in both governmental and Economics Unit. private sectors. 6.1.5 Follow up on the application of Social Health Insurance Project. Initiative No. 2: • Will contribute in maintaining 6.2.1 Upgrade vaccines level of vaccine storage following and medical supplies Improve the Ministry of World Health Organization›s storage according Health’s Inventory and standards by establishing a new to World Health Material Management vaccine warehouse. Organization WHO Systems • To eliminate dependencies on the standards. Ownership: private sector for storage 6.2.2 Develop an automated • To facilitate the administrative Inventory Management Assistant procedures and inventory System. Undersecretary for management which will result in Human Resources and enhancing the quality of work. Services 41 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 6: Health service sustainability Initiative No. 3: Justification /Aim of initiative Programs Improve Human • To ensure the provision of health 6.3.1 Prepare annual training Resources potentials and medical services for all the plan to improve throughout the Ministry population, it is necessary to Ministry of Health’s of Health develop clear training policies staff competencies. in line with the rules and 6.3.2 Support continuing Ownership: Health Improvement Strategy regulations of Civil Service professional Assistant Bureau CSB. education programs Undersecretary for • These policies will control for professionals at Human Resources and and regulate the development Ministry of Health. Services & Assistant of objective training plans 6.3.3 Support and develop Undersecretary for according to priorities and within training programs for Training and Planning allocated resources to fulfil the residents and dentists. training needs for health care 6.3.4 Promote the principle services professionals. of equal opportunities • Ensure effective coordination for workers in the between MoH and the ministry in all areas of educational and training the appointment and institutes through agreements include functional, and within the approved standards scholarships, activities and the allocated resources and events related. to ensure the accessibility of population to a high quality of 6.3.5 Enhance Performance specialized health services. Management System • Implement the employee through Civil Performance Management Services Bureau CSB System will contribute in framework. increasing the performance and 6.3.6 The implementation of quality of work particularly work the human resources projects. plan 2010- 2020. • Improving the work by identifying strengths and weaknesses and to find appropriate training opportunities for staff development. 42 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective No. 6: Health service sustainability Justification /Aim of initiative Programs Initiative No. 4: • Ensure ministry›s continuity in 6.4.1 Develop power plants development of its infrastructures in Ministry of Health’s Maintain and develop by renovate, repair and maintain facilities. the Ministry of Health of all health facilities and infrastructure and 6.4.2 Improve and main medical equipment. Ministry of Health’s equipment • Improve patient care and infrastructure. safety work environment for 6.4.3 Improve buildings and employees. Ownership: fire systems and reduce risks in all medical Assistant facilities at the Ministry Undersecretary for of Health. Financial & Technical 6.4.4 Improve the quality Resources and effectiveness of the medical devices performance in the Ministry of Health facilities. 6.4.5 Develop and improve the inventory system, registration and tracking of medical equipment. 43 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Summary of the Implementation Plan for the Health Strategy of the Ministry of Health (2015- 2018) Strategic Objective Initiative Ownership 1

1. Promotion of healthy lifestyles to maintain health and reduce the incidence of Non-Communicable Diseases Undersecretary Office Sustaining NCDs population’s health Health Improvement Strategy through health 2. Strengthening the role of Primary Health Care in promotion and prevention of Non-Communicable Diseases NCDs Assistant Undersecretary for prevention Primary Care and Public Health

3. Enhance protection Against Communicable Diseases CDs, and newly-emerged diseases

1. Enhance integration in the Emergency and Disaster Management System in Ministry of Health Undersecretary Office

2. Develop Health Research Management System and link it with concerned stakeholders 2

3. Develop and implement a strategy for services integration Assistant Undersecretary for Integrating services throughout Ministry of Health Training and Planning in the health 4. Develop and implement an action plan for Health system throughout services integration between Ministry of Health and other Ministry of Health governmental institutions. and with other Undersecretary Office governmental and private institutes 5. Enhance partnership with the private health sector

6. Develop Support and Health Information Technology Systems.

7. Enhance the security and protection of information Assistant Undersecretary for systems Training and Planning 3

8. Develop the infrastructure of health information and the supportive technology Undersecretary Office &

1. Maximize patient safety throughout Ministry of Health’s Assistant Undersecretary for Putting facilities Training and Planning quality 4 first 2. Ensure the quality of services provided in Ministry of Undersecretary Office & Health’s facilities All Assistant Undersecretaries Assistant Undersecretary

1. Improve access to Primary and Secondary for Primary Care and Access for all to Health Care Public Health & Assistant healthcare services Undersecretary for Hospitals Affairs 44 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Strategic Objective Initiative Ownership 5 Undersecretary Office &

1. Enhance the Ministry of Health’s governance and Enhancing leadership All Assistant Ministry of Undersecretaries Health’s role in policy making Undersecretary Office & and governance Assistant Undersecretary

2. Enhance evidence-based decision-making for Training and Planning Assistant Undersecretary

1. Develop and Enhance Health Finance Management System for Financial & Technical Resources 6 Assistant Undersecretary

2. Improve the Ministry of Health’s Inventory and Material for Human Resources and Management Systems Services Health service Assistant Undersecretary sustainability for Human Resources

3. Improve Human Resources potentials throughout the Ministry of Health and Services & Assistant Undersecretary for Training and Planning Assistant Undersecretary

4. Maintain and develop the Ministry of Health for Financial & Technical infrastructure and equipment Resources 45 HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Health Improvement Strategy HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health HEALTH IMPROVEMENT STRATEGY (2018 - 2015) KINGDOM OF BAHRAIN Ministry of Health Health Improvement Strategy HEALTH IMPROVEMENT STRATEGY (2018 - 2015) For more information: Ministry of Health, Directorate of Health Planning Assistant Undersecretary for Training & Planning Tel. +973 17 286275, Fax. +973 17 286608, P.O. Box 12 www.moh.gov.bh autp@health.gov.bh