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Healthcare in the Sultanate of Oman

Guiding Principle

The Articleprovides an overview of the general healthcare situation in the Sultanate ofOman. In the last three (3) decades most probably no other country has achieved so much in such a little time in terms of healthcare inOman. His Majesty Sultan Qaboos kept hispromise in 1970 to put priority in the development of health and education of the country. This is recognized in a study of the World Health Organization (WHO), covering 191 countries and published in the year 2000. The Sultanate ofOmanwas ranked first in the world for its efficient health system and for effective utilization of the available financial resources in the health services. AdditionallyOmanwas also rated eight (8) forproviding the most comprehensive healthcare at world level.

This has been achieved always having kept a focus on economy and efficiency.

I. Rules and Regulations related to Healthcare

There are several laws and regulations specifically related to the healthcare inOman. The most important ones are:

1.   The Constitution of the Sultante of Oman

The Oman Constitution was adopted by Royal Decree No. 101/1996 and issued on November 6th, 1996 by Qaboos Bin Said, Sultan of Oman. The official title of the Constitution is called “The White Book. The Basic Law of the Sultanate ofOman”.

Article 12 of the Constitutionsprovides:

“The State guarantees assistance for the citizen and his family on cases of emergency, sickness, incapacity and old age in accordance with the social security system. It also encourages society to share the burdens of dealing with the effects of public disasters and calamities.

The State cares for public health and for the prevention and treatment of diseases and epidemics. It endeavours toprovide healthcare for every citizen and to encourage the establishment of private hospitals, clinics, and other medical institutions under State supervision and in accordance with the rules laid down by Law.”

2.   The OM-Labour Law

The Omani Labour Law comprises the Labour Law, Royal Decree 35 of 2003 and various regulations issued as Ministerial Decrees (MD) by the Ministry of Manpower (“MOM”). Recently someprovisions of the Omani Labour Law, Royal Decree 35/2003 were amended by Royal Decree No. 63 of 2009.

The Omani Labour Law entitles all employees, regardless of their nationality, to certain type of medical treatment, being at the employer’s expense. Additionally all Omani nationals are entitled to receive free medical treatment at government-owned hospitals and clinics.

Art. 33 of Omani Labour Law (OM-LL) is regulating medical treatment for employees within the company. Each employer shall provide medical facilities for all his workers and employees in the company. Should the number of employees in one place or one town exceed one hundred (100), the employer shall employ a qualified nurse toprovide first aid. Furthermore the employer shall also provide a doctor to visit the employees and treat them at a place suitable for treatment. In case the number of employees exceeds five hundred (500), the employer is obliged toprovide its employees also with all other facilities of treatment, including the consultation of specialist doctors or a surgery operation and special medicines if required. Irrespective the wide scope, the medical treatment shall be free of charge. However, costs for dental, ophthalmic and maternity treatment shall be excluded from the provision of free services.

In accordance with Art. 66 OM-LL and subject to the Social Insurance Law, an employee is entitled to sick leave in total not exceeding ten (10) weeks within one (1) year of service regardless whether the sick leave is divided or continuous. In case of sickness by an employee, his/her full wage has to be paid for the first and second week of sickness, ¾ (three quarters) of full wage for the third and fourth week, half of the full wage for the fifth and sixth week, ¼ (one quarters) of the full wage for the seventh week up to the tenth week. The sickness of an employee shall be alwaysproved by a medical certificate to the employer. In case of any disputes, the matter shall be transferred to the Medical Commission as per Art. 43 of OM-LL. Thereafter the medical certificate shall generally be issued by the Medical Commission pursuant to a decision of the Minister of Health in co-ordination with the Minister for the purpose of implementation of the law.

3.   Social Insurance Law

The Social Insurance Law was promulgated by Royal Decree No, 72/91 and came into force on July 1st, 1992. In one of its articles it is stipulated that a public authority shall be formed under the name of “Public Authority for Social Insurance” (PASI) enjoying administrative and financial independence, to be responsible for the implementation of this law. The Social Insurance Law shall provide socialprotection by ensuring peace of mind and social stability for the insured person as well as for his/her dependents. Pursuant to the Social Insurance Law, the Public Authority for Social Insurance (PASI) will pay social service benefit to only Omani nationals aged 15 to 59 employed in the private sector under a permanent employment contract. Excluded from the Social Insurance Law are foreign workers, household workers and artisans. By subscribing into the Social Insurance System the employee will be insured against old age, disability and death followed by various stages including insurance against work injuries and occupational diseases in addition toproviding insurance coverage to the Omani nationals who are working abroad and alike. Private employers are required to make monthly contributions towards the PASI Fund. Currently the monthly contribution made by the employer amounts to 10.5% of the basic salary. Employees and the Omani Government contribute the requisite balance into the insurance fund. Contributions paid by the employee amounts to currently 6.5% of the basic salary. For Omani nationals working abroad, the monthly contributions to be paid is computed at 16% of the presumed monthly income schedule.

At the end of the employment service, the Omani employees are entitled to receive social service benefits based on their last drawn aggregate basic salary.

4.   Other Laws

a)   Law of Narcotics & Psychotropics control & its Executive Rule (Royal Decree No. 17/99 on March 6, 1999)

The law includes specialprovisions governing the import, export and transfer of narcotic drugs and psychotropic substances for some government departments and specialized institutes, research centers and licensed hospitals.

The most important features of this law is the organizational formation of a national committee of narcotics and psychotropic substances. One of the most important terms of reference of this national committee is planning for prevention actions and treatment measures fighting illicit use of narcotic drugs and psychotropic substances.

b)   Royal Decree No. 41/96 Regarding the issuance of the Law of Pharmacy Practice & Organization of Pharmaceutical Institutions

III. Healthcare in the Day to Day Life

In terms of healthcare,Omanis now one of the worlds advanced nations.

Oman has invested in the last years consistently into a national health service and sustained that investment over time. Up to date a network of 180 local, district and regional health facilities staffed by over 5000 health workersproviding healthcare to the Oman citizens, which coverage is also now being extended to foreign residents. The current healthcare system includes a government healthcare, which represents 87% of the hospitals and 90% of outpatient services, 49 hospitals with more than 4542 beds, including 13 hospitals of reference, in addition to 127 health centers and 13 health complexes. All cities and major towns have at least one (1) modern hospital with state-of-the-art equipment and highly trained staff. Many of the doctors inOmancome from Europe,USA,Egypt,IndiaandPakistanwho offer a high ratio of medicalprofessionals to patients. Their qualifications are verified by the Ministry of Health and Ministry of Interior before they are allowed to practice.

There are several different types of hospitals inOman, including public, private and military establishments. The costs for hospitals vary considerably depending whether a hospital is super-luxurious or more modest. Most of the private hospitals in Oman have accident and emergency units in addition to their out-patient departments. However patients are more likely to be directed towards public hospitals. For example a routine check-up usually costs around $ 60 with additional costs for any tests required.

Hospitals are listed in telephone directories and yellow pages, and most addresses can also be found in tourist publications.

The Sultanate’s healthcare system operates on three (3) levels, which are:

1. Effective, high quality primary healthcareprovided by the health centres, policlinics and local hospitals in all the Sultanate’s governorates and regions.

2. Secondary healthcareprovided by the referral hospitals in all Oman’s governorates and regions, as well as other hospitals in some of the main wilayats (districts), which offer specialist healthcare requiring a higher level of specialized skills.

3. Tertiary healthcareprovided by the majority hospitals inMuscat(RoyalHospital,KhoulaHospitaland Al Nahda Hospital), which operate as nationwide referral hospitals. Ibn Sina Hospital inMuscatis a tertiary hospital for psychological and nervous disorders.

In addition the Sultanate of Oman operates extensive in child immunizationprograms against tuberculosis, polio, diphtheria, whooping cough, tetanus, measles, viral hepatitis and other diseases. This is expressed in the fact that over 98% of infants are fully immunized and life expectancy at birth, which was less than 60 years towards the end of the 1970s, is now about 74 years. The under-five mortality rate has also dropped by a staggering 94%.

IV. Healthcare in the Public Sector

The Ministry of Health (MOH) is the main healthcareprovider in the Sultanate. It is responsible for theprovision, the coordination and stewardship of the health sector. The MOH is required to ensure the overall development of the health sector in relation to other key social sectors. The Ministry develops policies andprograms for the health sector, and it implements these in coordination with all other related ministries, health services institutions under the government as well as in the private sector. In addition to the MOH, the Ministry of Defence, Royal Oman Police, Petroleum Development Oman and the Sultan Qaboos University also provide healthcare mainly for their employees and dependents.

The MOH performs curative as well as preventive,promotive and rehabilitative functions.

1. Asprovider of curative care, it runs hospitals and health centres at national, regional, sub-regional and local levels. The MOH makes primary medical care available through health centres, extended health centres and local hospitals. The regional referral hospitals mainly provide secondary medical care, while the national referral hospitals (The Royal Hospital, etc.) mostlyprovide tertiary medical care. According to the assignment, stipulated in the Constitution (Art. 12) of the Sultanate of Oman, the MOH ensures that no Omani citizen is denied the benefit of medical care. It sponsors patients for treatment abroad, as far as the required treatment facilities are not available in the country. The Treatment Abroad Committee is in charge to allow such sponsoring.Oman’s public health serviceprovides free or very low cost healthcare for nationals. These facilities are basically also available for foreigners. The MOH undertakes drug control supported by its Directorate General of Pharmaceutical Affairs (DGPA&DC) and drug procurement and distribution through its Directorate General of Stores (DGS). The responsibility of the MOH includes also the registration of drug manufacturers andproducts, control of narcotics and other controlled drugs, as well as the issuance of the necessary customs clearances for import and re-export of drugs. In line with the new drug policy, the MOH is responsible for price control in the retail market.

2. The Ministry of Health recognizes the importance of the preventive,promotive and rehabilitative components of healthcare, and provides all the required services through its infrastructure to the fullest extent possible. The MOH regularly monitors the incidence and prevalence of all communicable diseases through its epidemiological & disease surveillance directorate, notifies the concerned national and international authorities, and undertakes necessary prevention action. High risk groups such as pregnant mothers or children under the age of five areprovided with necessary immunization and nutrition supplements.

3. Special programs are conducted to fight serious communicable diseases like leprosy, tuberculosis, poliomyelitis, tetanus and malaria, considering the rapid economic and social development in Oman, and the emergence of new healthproblems, special programs on non-communicable diseases have been organized to fightproblems like obesity, cardiovascular disorders and diabetes, and to inform and educate the people so that they share a responsibility in preserving good health by adopting healthy life-styles and food habits. The MOH alsopromotes good health through its health education campaign and school health services or the issuance of medical fitness certificates. The MOH alsoprovides physiotherapy and rehabilitation services as an essential component of the Sultanate’s care services, in order to prevent disability, reliving pain, developing, improving or restoring function and contributing to the health of the society inOman.

IV. Healthcare in the in Private Sector

The MOH is convinced that the private sector can play a significant role in healthcareprovision in the Sultanate of Oman. The large spectrum of activities is ranging from investment in Primary, Secondary and Tertiary healthcare to Human Resources and Health Education and Training. The MOH received already many applications from companies who are interested to invest in the private sector.

At present, there are 3 private hospitals and 491 clinics operating inOman. The policy of the MOH is to encourage investment in the private health sector, ranging from private hospitals to pharmaceuticals. Recently, the MOH had invited a number of private sector clinic owners for discussion on the possibility of investing in establishing a Physiotherapy and Rehabilitation centre in the private sector.

Regarding the supervision of private hospitals, monitoring is maintained both during the planning, construction and the actual running stage in the form of technicalprotocols and the selection of doctors, nurses and paramedical staff. The MOH advises private hospitals also about patient care and ensures through periodic visits the excellent quality of the medical service.

V.  Recent and Planned Reforms in the Heathcare in the Public and Private Sector

Health services organization and management systems are continuously revised in reference to the decentralization policy through a variety of initiatives:

1.   Public Sector

  • Strengthening the management of regional directorates through leadership development and training.
  • Incorporating elements of social care, geriatric care and other home based services (long-term care).
  • Further modernization and strengthening of national referral hospitals.
  • Continued use of Total Quality Improvement (TQI) initiatives and covering more hospitals under TQI.

2.   Private Sector

1. Pursuing Omanisation of the health workforce in the private sector.

Since the private health sector is almost fully operated by expatriates, the MOH is planning to explore the big employment potentials for Omani graduates of MOH educational institutes and Universities in this sector.

2. Promoting greater public-private interactions and a greater private sector involvement in healthcare.

These goals are for example achieved through the extension of training facilities and the provision of technical support in order to start hospitals and clinics. It is the aim of the Government to improve and adapt its healthcare system constantly, in line with highest international standards.

January, 2010 Hanka Jahn & Alessandro Gugolz
Meyer-Reumann & Partners – Dubai & Oman Office
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