Literature review of the bureaucracy at the Ministry of Health, KSA

The bureaucracies of the Middle East take place upon to perform two essential parts for the state. Initially, they are relied upon to give a regularly increasing cluster of administration capacities fundamental to everyday activities. Besides, they are taking over upon to design and to execute complex monetary and social projects substantial to future development. In the event that the organization neglects to give required administrations, the political framework will discover it progressively hard to adapt to the demands of the subjects. By a similar token, if the organization can't assume a compelling advancement part, the financial disengagements of the present time will be quickened, giving future generations with monetary, social and political issues of stunning extents. The involvement of bureaucracy at the Ministry of Health has had a negative impact on the life of the citizens. The KSA citizens are deprived of health care facilities that they should have been provided, this is due to the incompetence of national health care centers, while the private clinics are providing expensive services to the people. The example of Saudi Arabia is a learning case for bureaucracies around the world where the bureaucracy failed to perform in the healthcare sector. This essay shows the negative side of the bureaucracy at the Ministry of Health in Saudi Arabia and its impact on the life of the citizen.

If the role of the bureaucracy has a significant impact to the financial and social advancement of the Middle East states, it would give off an impression of being especially critical to the monetary and social improvement of states in which the private segment of the economy has made the negligible duty to long-haul progress. On the off chance that the administrations can't assume the dynamic part in financial improvement, the possibility of those states accomplishing satisfactory levels of monetary development is remote. The part of the organization in the advancement of Saudi Arabia would give off an impression of being less critical. With a yearly spending plan of 225 billion dollars, the Saudis are having an appropriate financial framework. The issues of boosting the utilization of rare capital assets would have all the earmarks of being negligible, for capital assets in KSA have been a long way from scarce. The historical backdrop of health care services in the Kingdom goes back to 1949 when few medicinal members around 111 specialists and less than 100 doctor's facility beds were notarized. Ever after, the country has got vast improvements in the association of its healthcare's sector. Considerable improvements have conveyed wellbeing administrations to each side of the tremendous kingdom. The financial plan of the Ministry of Health (MOH) expanded to sixty overlaid in 1998, which accounted for 6.2% of the national spending plan. Around $3.2 billion was spent on healthcare in 1998. Despite all this progress over the decades, the healthcare sector didn’t see the expected healthcare reforms due to the negative role of bureaucracy. The dominance of sovereign ministries such as the Ministry of Finance on the work of other ministries which has a huge negative impact on the performance on their works such as placing constraints that delay projects in the Ministry of Health.

Government services are given by more than 10 ministries, including the MOH. The organization of these organizations isn't uniform, and some of them directed by specialized bodies. In any case, the assortment of administrative structures could be a wellspring of improvement. Better coordination among these associations would result in more judicious use of open resources and aptitude, to the best-favored outlook. Healthcare services include all things considered, transparently financed, and paying little mind to an extended spending assignment for these pivotal organizations, the genuine typical utilization per capita is required to reduce. This is a consequence of a rapidly increasing population and declining government assets. Along these lines, diverse wellsprings of financing are crucial. The governing body, thusly, is the legislature, along these lines, is continuing with its arrangement for the usage of the co-agent medical coverage conspires, starting at now being associated with the private sector. The plans for privatization of healthcare organizations are on the starting stage, yet there are so far various issues to be settled. There is a distinct requirement for capable wellbeing administration and an inventive way to deal with wellbeing organization and financing. The bureaucracy has a negative role in the healthcare sector and that is evident from the facilities lacked in hospitals and healthcare organizations. Like the other sectors, the healthcare sector too is totally dependent on oil revenues, which puts the country's projects under threat in case of low oil prices. The kingdom can’t rely on oil only. The government should have attracted private and foreign investment in the healthcare sector, which they didn’t. Foreign investment in the healthcare sector would have invited improvement and progress in healthcare technology. The lack of using modern technology is another issue facing the healthcare sector in the Kingdom. The hospitals and health centers in the kingdom lack modern pieces of equipment and machines to treat patients. The Ministry of Health should have invested in importing modern equipment, which they neglected, and the result in the unsatisfactory performance of the healthcare sector. The foreign experiences could have been a source to bring modern types of equipment to KSA hospitals eventually improving the conditions of the health centers in the kingdom.

In the article published in Al Arabiya “Has Health fallen into the trap of bureaucracy?” the author explained that the Ministry of Health, like other government agencies, is not free from bureaucratic problems. These restrictions are imposed on these entities, which lead to the deterioration of administrative authority in them. These restrictions are often undeclared and ignored. When government agencies fail to provide the services required, they always refer to factors beyond their control that have prevented them from achieving their objectives, thus giving full responsibility for any failure that may occur. For example, the case of the death of the obesity patient Majid al-Dosari, may God have mercy on him, with which the public opinion in the Kingdom interacted, people wondered why Majid and his sister Rana were not treated abroad, despite the existence of a royal order to do so. This due to the dark tunnel of the bureaucracy, as the writer claims (Al Arabiya, 2013). The Ministry of Health, KSA is not immune to such bureaucratic matters. Like the case of Majid's death, an independent body should be involved in the investigation. The competent authority is the National Anti-Corruption Authority, in accordance with article 3, paragraph 1, of the organization of the authority, which includes that the functions of the Commission follow up the execution of requests and directions identifying with public issues and the interests of subjects to guarantee compliance to the royal orders. Furthermore, Khalaf al-Harbi, in his article “The bureaucracy, has led to leakage of talent out of the Ministry of Health”, said “I received this letter from a consultant doctor:” (Alweeam, 2012). "Briefly, I am a doctor in the Ministry of Health, such as many doctors who have fellowships in several specialties and professionally classified by the Saudi Commission for Health Specialties on an advisory basis, but unfortunately we suffer from the absence of jobs in the name of consultant, There are no vacant numbers, that is, we do the job of consultant, but some of us are still on the job and the salary of a resident or specialist. In contrast, doctors are recruited from outside the country as consultants and take the salaries of consultants, even if they have specialist jobs. To clarify more if a Saudi doctor got Fellowship and experience required to be a consultant and apply for an upgrade to an advisory position, it remains in a long list of waiting may take years to reach the role, while the non-Saudi doctor does not need to enter the list.  This has unfortunately led to the leak of talent outside the ministry to seek justice" (Alweeam, 2012).

However, many healthcare systems in developing countries and societies exhibit poor performance because of healthcare organizations’ lack of readiness to achieve the effects of change and regulate the quality and progress of the change process. It also has been observed that the initiatives carried out by healthcare service organizations have had only modest positive results, and their limited success is attributable to their inability to analyze successfully the workforce's perceptions of change. Further, there are various contexts of change readiness that derive from narrow or broad belief systems. In a narrow system, the potential for change is present, while a broad belief system includes appropriate leadership, social ties, resources, skills, knowledge, and organizational ability, all of which are required to implement change successfully. On the other hand, the formation of a higher council for health services increases the bureaucracy in the issuance of health decision, and explains that a health systems expert called for reconsidering the recommendation of the Shura Council, which finally approved the recommendations of the Health Affairs Committee on the annual report of the Health Services Council. The majority approved the formation of a Supreme Council for Health Services, headed by the Prime Minister and recommended the provision of financial and administrative support to the Council of Services in order to fulfill the role required of it in full independence in order to achieve the objective for which it was established. In addition, the Shura Council proposed discussing the health strategy in its economic aspects within the Higher Economic Council and forming an independent committee headed by none of the heads of the existing health sectors, including the Ministry of Health, to review the health sector strategies and present their visions within a limited period of no more than one year. Concluding that this idea was applied in Canada almost a decade ago, where he commissioned an independent figure to form a team that developed an independent vision rose to the Council of Ministers and was discussed in parliament and various states.

Ahmed Aljamaa in his article “Health's Bureaucracy” mentioned according to the former minister Ghazi al-Gosaibi in his famous book Life in the Administration "that among the most difficult positions he has held in his long administrative life was the Ministry of Health, recounting the extent of the suffering he met in it, and how he was standing helplessly does not know what he might do in this The calamity that he despaired of solving until he reached the point of describing this period in the most miserable days of his life." states the solution stems from the root of the problem, which lies not in the weakness of budgets, nor in the competencies, nor even in the presence of that saving minister, but in its existence as a bureaucratic service institution  (Al-Hayat, 2014). Again, this is not only to weaken their productivity but also to focus on one of their services without the other, to enhance their priorities, trying to improve medical services in vain at the expense of awareness, control and other services there. The bureaucracy didn’t implement the strategies as it should have been implemented. If the solution, the health sector must be removed from the custody of the Ministry of Health and out of the mantle of bureaucracy and guardianship that does not fit as a diversified sector of services scattered parties receives a number of high-caliber destination and this will help reform the healthcare sector in KSA (Al-Hayat, 2014). There are many other issues in the healthcare sector in the Kingdom that need to be addressed. The efficiency of the work process is one of them. The work done in hospitals is too slow – at times it takes days and even weeks to complete tasks that should have been done in a day. The reason could be the inefficient operational system in the hospitals. The hospitals and health centers need a proper and efficient operating system so that the proficiency could be improved. The poor communication between departments is also another reason why things aren’t done on time and properly. Some employee is either unqualified or is not trained properly. The reason is management’s incompetent and the bureaucracy is to be held responsible for this.

In April 2016, Saudi Arabia launched an ambitious program, Vision of 2030 designed to address three themes; a vibrant society, an ambitious nation, and a thriving economy. To achieve this vision, the country announced an interim development plan called the National Transformation Program that establishes strategic objectives for all key sectors of the economy, including healthcare. One of the vital aspects is the introduction of healthcare sector reforms. The plan emphasizes the need to make efficient use of healthcare facilities and ensure that quality health care, including preventive services, is available. It also focuses on encouraging private sector investment in sectors funded previously by the government. To ensure that the objectives of the Saudi Vision 2030 are met, a team was formed to establish a change management strategy, set plans and priorities, and then eventually implements the action desired. The plan envisages that leadership in healthcare organizations will support all initiatives related to the transition plan and ensure that transformational change plans are implemented consistent with established goals. Each initiative would have its own performance indicators to ensure that the managers implement these changes smoothly. Significantly, organizational change is an important process that involves creating positive change on the part of an organization’s followers. Most modern organizations wish to change without interruption to provide high-quality service for customers. Organizational change requires detailed planning to ensure that it is not only positive but also is accepted by all in the organization. At the same time, organizational readiness for change serves as the vital factor in the efficient implementation of complex change in a healthcare setting. The private sector, which has been marginalized over the years by the bureaucracy for providing health services, must be relied on in the next stages. Not only engaging them with government capital and health facilities and hospitals but also to provide them with encouraging loans, along with large facilities at this sensitive stage of the principle of control, until the process of full monopoly on the health system disappears.

Concluding, the bureaucracy has failed to perform in the healthcare sector in the Kingdom and now there is the resistance of some employees to change, especially older people. In contrast, there is a new generation of employees want to see reforms in the healthcare sector and that could only be possible if healthcare is freed from the bureaucracy’s influence and professionals are appointed to look after the health care matters. Nevertheless, the dominance of sovereign ministries such as the Ministry of Finance on the work of other ministries has a huge negative impact on the performance of their works and this need to be sorted out. Most of the issues were related to bureaucracy’s incompetence and lack of interest in updating the hospitals with modern machines and technology which had a negative impact on the lives of the Saudi citizens. With the high hand of Crown Prince and Chairman of the Council of Economic and Development Affairs, Mohammed bin Salman bin Abdulaziz Al-Saud, still there is a great hope to eliminate bureaucracy by achieving the goals of Saudi Arabia’s Vision 2030.