SGH Group Prof. Dr. Dr. Fried 26 th November 20051 - بسم الله الرحمن الرحيم Reality and Vision for Promoting Healthcare Education in Middle East & Africa.

SGH Group Prof. Dr. Dr. Fried 26th November 2005 1

- الرحيم الرحمن الله الرحيم بسم الرحمن الله بسم

Reality and Vision for Promoting Healthcare Education

in Middle East & Africa by Transfer of German Technology & Experience

Seminar The promotion of Investment in the Arab Countries and the Transfer of

Technology through the Arab-European Cooperation

Khartoum 26th – 27th November 2005

Prof. Dr. Dr. h.c. Fried OelschlegelVice-President for International Projects

Saudi German Hospitals Group, Jeddah, Kingdom of Saudi Arabia


A common ethical understandingA common ethical understanding

الناس احيا فكأنما احياها ومنالمائده ” جميعا

“And if anyone saved a life, it would be as if he saved the life of all mankind “ Al-Maidah (32)

This verse from The Holy Quran should be the guiding philosophy in Medicine and Medical Education; this means – we have not only to talk about the development of the resources – we have to understand it as an ethical obligation in face of the mankind


A

Realities

in Health Care & Health Care Education


Hard facts & figures Hard facts & figures ( sources : WHO – World report 2004 )

Country Population in Mill

Expenditures in Health Care as % of GDP

Total Expenditures per Capita in US$

Students Medicine

Per 100.000

Nurses per 100.000

Physicians per 100.000

Hospital beds per 100.000

ETHIOPIA 73,0 3,6 3 n.a. n.a. n.a. 0,2

SUDAN 40,1 4,0 14 2 58 9 110

EGYPT 77,5 4,8 66 16 265 222 217

SAUDI ARABIA

26,4 5,3 448 19 323 153 224

UAE 3,4 3,7 767 16 352 169 219

KUWAIT 3,62 4,3 630 52 420 160 220

IRAN 68,0 4,4 259 11 161 119 163

IRAQ 26,0 3,7 121 NA 121 63 131

GERMANY 82,4 10,9 2817 37 495 336 657

USA 295,7 14,6 5274 59 955 270 360

CANADA 32,8 9,6 2931 22 750 210 410


the Gap

The WHO has recommended a minimum standards in year 2004:

The expenditures for health should be 5 % of the GDP The expenditures for health per capita should be more than 500USD 1 doctor should treat 360 inhabitants or less 1 nurse should care 200 inhabitants or less The number of medicine students should be 1 student per 400

inhabitants

Not any country in Middle East and Africa is fulfilling these recommended standards !


The countries in Africa (including the MENA- countries) are suffering from under-developed health care systems. The permanent lack of professionalism mastering the system, lack in

Health care educationHealth promotion & disease preventionHygiene & sanitationQuality management and standardizationprivate practice disciplineFinancing & AccessTechnical resourcesMedical professionalsManagement professionals


Governmental hospitals are failing to meet the needs Fragmented market, small and in-effective facilities Gap in the systems of quality assurance and control by the

government Gap in the information and transparency in medical statistics Rising healthcare cost and a vague pricing systems Medical Insurance on the Horizon – access to the system Emergence of Corporate Hospitals. Acute and lasting shortage of health professionals in the region. Alarming situation in Life Style diseases e.g.... Obesity, back pain,

Aids, all other (old and new) infection diseases

“Home made” and ignored problems


The countries in Middle East as fast – developing countries are suffering under the late consequences of the earlier colonial times

A governmental but poor, insufficient and fragmented health care system; the Government has encouraged Private Sector since long. The dominance (more than 80 %) of “Expatriate's“ as medical professionals (nurses, physicians) in this system The available resources for medical education don’t cover the needs of the national markets (in quality and quantity) Emergence of Professionally managed Private Hospitals and Medical Centers/Corporate health care groups are helping the government and baring some of the load. Recently Governmental hospitals are competing with Private Sector….not even on equal terms (Govt. Hospitals receive\ subsidies/grants e.g.…in KSA)


A world phenomenaA world phenomena

More important than the lack of money; is the lack of professionals worldwide

There is worldwide shortage in

Physicians

Nurses

Technicians

Health Care Managers

And there is also a worldwide “grey“ and “black“ market to recruit professionals in poor countries for more wealthy countries. This modern trade with human excellences under the cover of “Globalization“ is creating additional problems for the countries in Middle East and Africa.

This “ brain – train” is a new form of exploitation.


Also Europe is suffering under

■ limited capacities in health care education■ limited human and financial resources for promoting high quality in teaching and medical research■ Over aging of the health care professionals who are in duty■ Unattractive compensation for a stressing jobs■ Strong tendencies for switching to paramedical jobs by professionals ( industry, administration)■ Loss of ethical values and orientations in favour of business in health careInvestments in Health Care & Health Care Education are achieving a new quality of demands. Such investments are mandatory worldwide and necessary to the life safeguarding of the mankind and no longer arbitrary. They represent a global challenge and must be mastered by cooperation's globally between all countries: the rich and the poor.


Also these are realities:

There are very limited ( governmental )investments of the EU in health care and health care education in this region; such supporting investments in Middle East and Africa are focused on software and not in hardware

Under the pressure of Globalization and the own “ home made “ economic problems Middle East and Africa can not expect a changing policy in Europe regarding these matters in the next ten years – or may be never.

The countries in Middle East and Africa have to reflect their own strengths and opportunities and should use the existing opportunities to improve their health care systems and the health care education as the most important prerequisite to tackle the problems of tomorrow.


The new day breaks in the middle of the night: Five hopes and new approaches ( 1 )1.The universities in Europe are under economic pressure to develop new ideas in business fields as knowledge & experience transfer2.The EU-Countries had to learn that there are fast growing immigration problems which can not be solved within their countries but only in the immigrants countries itself – main reasons for immigration are the economical and social problems in the developing countries 3.The government in many countries of Middle East & Africa have recognized that a comprehensive privatization in their national service sector as Health Care, Education, Transport and Energy is the most important catalyst and engine for a strong and lasting economic upswing


The new day breaks in the middle of the night: Five hopes and new approaches ( 2 )4.Strong private international investors groups disposal of large assets by the Petrodollar look for investments. Investments in Healthcare are safe and successful investments if they become handled by private management of professionals. Financings investments in Healthcare and Education do not represent any actual problem if the prerequisites for that are suitable and correct.

5.

Important prerequisites for entrepreneurs investments in Healthcare and Healthcare Education - and by this way in transferring technology and experience – are the real willingness to “open the doors for private investments“ by reduction of bureaucracy, readiness to overtake governmental responsibility through equities (land, loans, shares) in addition to fighting all forms of corruption.


B

Privatization as a Chance

in Health Care & Health Care Education


Private Sector Provides Sustainable Business ModelPrivate Sector Provides Sustainable Business Model

History has shown beyond any doubt that only with the major role of the Private Sector; an Industry gets a sustainable Business Model:

Healthcare & Pharmaceutical Industry

Medical Services

Health Education

Health Research

or any other Industry

Private sector is the only way to meet global challenges &

International competition. Saudi Arabia and other countries in the Middle East and Africa are going to be members in the WTO sooner or later.


Privatization …..Privatization …..

Provide more choices for individuals Take portions from business/commercial activities run by the government, allowing the government to focus on laws and regulations Improve the investment scenarios in health industry Attract foreign Investments Create more employment opportunities Lower costs, higher (and proofed) quality and more effective treatment in private sector than in governmental sector Competition and demands focused markets that will lead to better quality health care. Implementing performance standards and cost management; the increasing healthcare costs are a nightmare for the governments all over the world; in the private sector this problem can be managed professional


Private sector development …..

It is crucial for economic growth

Economic growth creates jobs

Healthcare education creates more and more qualified jobs for women and more opportunities to improve their positions in the society

Women in labor force in %

1980 1999 2004

Saudi Arabia 08 15 17

Middle East & Africa 24 27 32

World 39 41 43


Impact and Challenges of the WTO on private healthcare sector investment ( 1 )

1. Influence of global players on the initial stages

2. Small players in the tertiary care could be wiped out

3. Entry of organized international health care provider chains ( APIO, RHOEN, HELIOS, AMEOS) and HMO’s in the polyclinic sector threatens the existing players who are stone age organizations in terms of systems, standards and facilities

4. A lot of merges & acquisitions will be possible; the wave of privatization will come and nobody can stop it

5. Good hospitals locally (although lacking in world class sophisticated system) will accept (concentration process to producer- supplier – and provider chains) merging with major players


Impacts and Challenges of the WTO on private healthcare sector investment ( 2 )

6. Strong regional brands will compete successfully due to their competitive advantages

7. Development of a new cultural identity through new business fields for the region

8. Lower operating costs leads to competitive prices

9. Better adaptation to the regulatory requirements and bureaucratic processes

10. Long term approach due to national and international interest compared to short term outlook of foreign companies that will operate in the region

11. Emergence of Healthcare Hubs like Dubai Healthcare


Opportunities for Private Healthcare Industry.

Financial : High liquidity in Capital MarketParticipation of Financial InstitutionsPublic Private PartnershipMandatory Medical InsuranceDemand exceeding supply

Medical : Health Tourism

Life Style ManagementLife Style Diseases : Diabetes,, Hypertension, CancerGeriatric Medicine- Gerontology.Rehabilitation.Preventive Medicine.Single specialty hospitals.Quick Medical Centers, Fitness Centers.


Why Investors invest in Healthcare Industry and how the Why Investors invest in Healthcare Industry and how the government can attract & support their activities?government can attract & support their activities?

Other Industries are saturated but Healthcare is not fully tapped, it is labor intensive (more job creations)

Healthcare Market is a stable industry, such Industry can attract business from countries like, North Africa, countries like Sudan….

The government should/ could : Supporting the private investors through long term loans, Land…etc. By simplifying and fast licensing and registration processes. Create and implement better and more effective regulations for business and

standardized medical standards and scientific regulations for different industries including Healthcare and Healthcare education

Provide government guarantees for borrowing from private banks. Improve access to low-cost credit and simplified loan application processes Provide incentives to Private Sector to serve in underserved or remote areas. Active support from banks, financial institutions and development banks.


FUTURE of Healthcare depends on

F: Funds & Financing (Capital) to be attracted and managed ….Private Sector can play significant role.U: United coordination action (Public Private Partnership)T: Technology.U: Universal Health (Quality healthcare for all)R: Research (Clinical and Non Clinical, Pure science-applied policy research)E: Education (Medical & Health Management)


C

Visions

to promote healthcare & health care education

by transfer of

German technology & experience


Basic approaches :

Germany is the world leader in Export

German Healthcare industry is focused on export

German Healthcare education organizations are interested in new business fields & using the export experience

Privatization in Middle East & Africa open new opportunities and markets for business

EXPORT

2004

Total

in Mio $

Per

capita in Mio $

Products

in Mio $

Services

in Mio $

Germany 893.300 10.836 648.891 212.237

France 419.000 6.907 323.344 92.591

UK 347.200 5.744 268.366 59.199

Japan 538.800 4.228 388.736 112.677

USA 795.000 2.688 568.479 226.954

Russia 162.500 1.133 85.205 62.473

Equity capital will discover the region

The government covers the role as guarantor for foreign investments

The common acceptance of win-win-principles will be a guideline for further projects


Transfer today Health care education Guest professors (DAAD)

Student (exchange)CurriculaSupporting of some facilities (GUC, JGU)

Health care Visiting Professors (legal / illegal)Patient transfer (to Germany)Financial support of some projects (HIV, Primary health care )

Investments in health care facilities ( hospitals etc )

in planning

Investments in fixed assets It’s a well developed market, Medical devices (SIEMENS)

Investments in industrial assets ( branches of German industry )

in planning

Pharmaceutical Industry Not branches, not distribution and supply chain; the business is in the hands of national wholesaler

Medical research Private issues of rare scientists; not any DFG-project

Cooperation projects With some German universities and hospitals (Patient transfer, 2nd opinions )

Cooperation on 3rd markets No projects

Medical societies & events In a well process (MEDICA, ArabHealth) and so on


D

SGH-Group : a forerunner

in transfer of German technologies and experience in Health Care & Healthcare

Education


مصر

نيجيريا

اليمـــن

الكـويت

تركيـا

اإلمارات

سوريا

السودانعمان

المغربالبحرينتونسإيران

الجزائر ليبيا باكستان

Hospital Projects : running – under construction – in planning

Morocco , Tunisia, Algeria, Egypt, Libya, Sudan, Nigeria, Ethiopia, Turkey, Iran

Kingdom of Saudi Arabia, UAE, Kuwait, Bahrain, Oman, Syria

Pakistan

Morrocc

Pakistan

China – a white spot; how long ???

Where we are : Where we are :

Turkey


Basic Infrastructure (Water, Electricity, Roads, Communication, Security…..)

Medical Service Medical Education (the whole range) Medical research Pharmacy Health Care Research, Management & Consulting Medical Network over the borders

SGH : Fields of business as Health Care DeveloperSGH : Fields of business as Health Care Developer


Like the Genesis : ….Like the Genesis : ….at the beginning the earth was at the beginning the earth was dessert and empty…dessert and empty…


We start always with such teams of Health Care Developers !


And these are our results: …..


The running facilities :The running facilities :

SGH Jeddah 217 beds ; first teaching hospitalSGH Jeddah 217 beds ; first teaching hospital


SGH Aseer – 400 bedsSGH Aseer – 400 beds


SGH Hospital Riyadh; 300 beds


SGH AL-MADINAH - 300 bedsSGH AL-MADINAH - 300 beds


SGH Sana ( Yemen ; 300 beds )


Projects under planning and construction : SGH Hail ( the rural model–150 beds)


SGH Dubai

300 bed’s hospital + 3 German Centre for Medical Excellence


SGH Cairo – the other key project beside SGH Dubai

Key – projects are cluster with a comprehensive offer of general medicine linked with Centre of Medical Excellence in Joint Venture structures together with German Universities


Projects in the Projects in the pipeline ….., …..,

SGH Kuwait SGH Pakistan SGH Nigeria, Ethiopia, Sudan, Chad….


And we did and will continue transferring the German technologies and experiences as you can see


Health care education Starting the 1st of five planned Private Medical College (BMC) 2006 with 4,000 Students; 7 running SGNA Institutes with 700 studentsAvicenna – Foundation for Education; Guest professors from GermanyStudent exchange (Site Visit Program with Germany)German Teaching Curricula

Health care Visiting Professors (legal) program with German institutionsNot Patient transfer (to Germany) but transfer of German Professors to the patients

Investments in health care facilities ( hospitals etc )

in planning with German Universities “Centre of Medical Excellence“ ( three are under construction ! )

Investments in fixed assets SGH is the biggest private client of SIEMENS et all in this region

Investments in industrial assets ( branches of German industry )

At present a feasibility study for a set up an industrial project (more than 100 Million USD) in medical products with German market leader

Pharmaceutical Industry In planning a pharmaceutical hub together with a well known German global player in pharmacy

Medical research Research projects (mainly in genetic diseases) with Universities in Germany, Switzerland and USA in planning, Kick off : December 2005

Cooperation projects Two agreements with German Universities to develop a “Strategic Public Private Partnership” which includes: Medical Education, Medical Treatment and Medical Research

Cooperation on 3rd markets No projects till yet

Medical societies & events In process (MEDICA, ArabHealth) and so on


SGH focuses on building more Centers of Excellence in

Health Care (Hospitals, Medical Centre, Star Clinics)

Health Care Education (Medical Colleges, SGNA- Institutes)

Health Care Management (FBA, HMRI, SEDI)

in a close cooperation with German Companies and Organizations using all ways and kinds of transfer of technologies and experience

The success has touched a nation (KSA) and we are making all efforts so that our Significant will touch a community and the region ; including Yemen, Sudan, Ethiopia, Nigeria, Chad and so on

Significant touches a nation, a community, the region


Our recommendations for Leaders in Healthcare are :

1. Encouragement of public private partnership. 2. Defining roles (clear roles for private and public sectors for

Healthcare Industry)3. Treat Healthcare the way other industries are treated with

industrialized structures, professional management and strategic goals on a strong competitive market

4. Governments has to support Private Sector by providing free land, long term loans to suitable (supporting) conditions, subsidized utilities for the industry.

5. Long Term Strategies for regional healthcare investments.6. Governments has to reduce bureaucracy, licensing processes and

simplify registrations.7. Built up strategies alliances with the “Strength“ in this businesses –

with partners from Germany, Europe and wherever you will find professionals


SGH group is committed to industrialize Healthcare in Middle East and Africa using all opportunities to enforce the transfer of German

technology and experience to support the improvement of quality and economic efficiency in this important market.

COOPERATION is the KEY – ESSENTIAL to tackle the CHALLENGES of the future – for us and the next generations.

SGH group has developed many different kinds of cooperation; also now we are looking for support by individuals, investors and

governments to follow up our strategies to use Healthcare and Health Care Education as an important source for a successful economic and

ethical development of the countries in Middle East and Africa


To built up the future

needs to believe in future !

Thanks for your attention.

SGH Group Prof. Dr. Dr. Fried 26 th November 20051 - بسم الله الرحمن الرحيم Reality and Vision for Promoting Healthcare Education in Middle East & Africa.

Documents

sgh group

mankind slide

medical education

kingdom of saudi arabia

healthcare education

medical statistics

arab countries

students medicine