Matters of Health
By Sindhu Nair

The National Health Authority (NHA), formed recently, is responsible for the medical services provided,  supervising the provision of public health services in the country and also medical treatment of Qatari nationals abroad.
Qatar Today meets Dr Micheal Walsh, CEO, NHA, a doctor by profession who has been in health care for 25 years.

Q. What are the areas of concern  identified, and how will it be redressed?

A. There are a number of issues that we intend to work upon to ensure the smooth functioning of the organization. The NHA has to first set itself up as an organization. It was formed by an Emiri Decree in mid-2005.  We also supervise the Hamad Medical Corporation, private medical facilities, laboratories, pharmacies, councils of auxiliary medical professions, hospitals, primary health care centres and other public medical treatment utilities. According to the decree, we have to move the former Ministry of Public Health into the NHA. We have just started the process. The ministry of Public Health has more than one thousand staff and it is a big process to get them together under one umbrella of NHA. We also need to recruit new employees in some areas.
The areas of concern are health insurance financing, national health insurance, information technology and quality of health care. We are planning to involve Qatari employees in the revamp, but some of the sections are completely new to this sector and hence we will have to depend on expertise from other countries as well. We are hoping to complete this integration by mid next year.

The second issue that we will be looking at is the improvement of the primary care corporations and make them both integral to and independent of HMC. We want to set it up as a primary care concept, which holds well on its own. This will also take some time. We are aiming to have to have it established by April 2008.
We plan to build two شWellness Centresص. This is a new style of primary care centre, where, in addition to having the traditional health care and medical services, there will also be social services offered to those who might need it. We also intend to strengthen the mental health facilities within the centres. We intend to include counselling where required.
All this is part of the primary care strengthening process and this will again need time to be completed.

Q. How do you intend to upgrade the primary health centres? Will more specialists be on call in these clinics?

A. This is still in the planning stages, but we want to build on the work already commenced at HMC.  There are some primary care centres, which are quite old and we will be refurbishing them or might even replace them. Everything is in the planning stages. But what we are sure of is that we are reviewing the centres, we will be upgrading them and we will be investing more in this area.
Part of the project is also to come up with a five-year plan for primary care, which is more about studying the number of workers, their requirement, the training or upgradation they will need, the facilities these centres will need and so on.

Q. How do you assess the facilities of the primary centres and the professionals working there now? Does this restructuring mean that the facilities being provided till now were not up to the mark?

A. I wouldnصt ever say it was below standards. We have licensing authorities who strictly maintain the standards of all professional practitioners in the organisations. But we need to attract better trained faculty and also train them to work in these centres. There is a misconception, even among professionals, that the primary centres are the Ø´the poor cousinsص of the bigger systems. This has to change. The facilities to be provided here should be the best so that the patients will be confident enough to come here for any treatment and not go to the emergency department of Hamad for any minor treatment that are not so critical.
Some of the facilities of the primary units match those provided by HMC. Some have to be upgraded but overall these centres would function better if they were independent units and not refer to HMC for every issue. There will always be cases referred to HMC but many patients can be catered for in primary care rather than attending HMC.

Q. Does HMC manage the primary unit or does it fall under the NHA?

A. We are planning to have a Primary Care Corporation and it will function separately. The HMC has its set of directors and the HMC Board decides any move it makes. In a number of areas the HMC Board required approval from the NHA Board before proceeding. The new Primary Care Corporation is not yet finalised, we are working on these matters.

We are responsible for the development and performance of the health system. The role encompasses regulation, policy and planning, funding and financial management, system performance monitoring and improvement, stewardship of public health, research, and international representation. We report half-yearly to HHSheikha Mozah, and annually to the Cabinet. We are governed by a Board. The Chairperson of which is Dr Ghalia bint Mohammed Al Thani, the Vice Chairperson is Dr Khalid bin Jabor Al Thani along with seven other Board members. The Board meets regularly to review progress reports from the NHA Chief Executive, to monitor performance against the NHA strategic plan, and to consider matters referred to it by the NHA Senior Management Team or by other parties.

Q. Are there plans to promote national health insurance amongst nationals and expatriates alike?

A. Well, there is, but it is too early to comment on it. Our third area of priority is the issue of health insurance. But we are waiting for an approval from the Council of Ministers for this. We have already submitted a proposal. If the Council agrees to it, there will be lot of work to tabulate all the cards and get all the information in the data base. It is at this stage that technology becomes another area of priority. We need our IT to be upgraded. That becomes our fourth priority. We are working with ictQatar and HMC to come up with an e-health strategy for the whole of Qatar. To try and make sure that we have a single information system that would cover the whole of Qatar for healthcare. What we are looking at is to transfer information between clinics and primary care units and also the HMC. We will need a unique number for the formulation of this and it will again require a lot of work, but the systems are being geared up.

Qatar can afford the technology and the latest advancements in it, but to gear the people and get them used to this system will require some time and effort. But I can't give you any details on the plan; we could give you more information as soon as we get the approval.

|Q. Where does the JCI accreditation stand at this point? How much of its recommendation have been carried out. Can you give a brief on the accreditation process?

A. Joint Commission International is an independent, not-for-profit organization, for standards-setting and accrediting body in health care. Since 1951, the Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commissionصs comprehensive accreditation process evaluates an organizationصs compliance with these standards and other accreditation requirements. Joint Commission accreditation is recognised nationwide as a symbol of quality that reflect as an organizationصs commitment to meeting certain performance standards. To earn and maintain the Joint Commissionصs Gold Seal of Approval, an organization must undergo an on-site survey by the survey team at least every three years, and meet with a book of standards. This is done periodically. Sometimes if the hospital is struggling they come back every two years. After this survey they give a report and we need to make the changes they suggest. HMC has decided to have this accreditation and recently JCI was here, surveying the premises. We are awaiting the reports. NHA supports this initiative, where in high standards are met and good practises followed.

Q. Is the Trauma and Accident unit a part of your focus and how is this unit geared to meet increasing causalities in the country?

A. HMC recently signed a five year contract with a US organisation called the UPMC (University of Pittsburgh Medical Commission), to provide staff and information to the Trauma and Accident Unit for the improvement and better management of this section.  The NHA's role is not so much as to what happens inside the unit but with the prevention of deaths, as such. Qatar has very high figures in the number of death caused by road mishaps and also due to workplace-related accidents, compared to international standards.

According to figures from the Planning Council, in 2004, there has been 181 deaths caused due to motor accidents, this is out of a total of around 1,341 deaths, which is about 13 percent. This is very high Ø° globally it is closer to five percent.

Q. What are the statistics on lifestyle diseases and do you undertake any campaigns to curb the rise of these diseases?

A. The other disease areas which we need to focus on is deaths caused by long-term conditions like cancer, 137 deaths were reported due to various kinds of cancer in 2004.

Deaths due to cardiovascular systems, the heart and the blood vessels were reported to be 256. The rate of deaths due to breast cancer is also unusually high here. Death due to diabetics, life style disorder is also quite high. We have to focus on these areas and bring the death rates lower.
What we have to focus is early detection in the case of long-term diseases and give good specialised treatment. In the case of lifestyle diseases, we need better education drives, making people aware of the dangers of the diseases. Diabetes, Heart Disease and Cancer will be our main focus. Anti-smoking campaigns should get stronger and there should be a lot more of emphasis on exercise and healthy eating.

Q. What about infant mortality rate? 

A. The infant mortality rates in Qatar are improving. It is under nine  deaths per 1000 live births in 2004. A decade ago it was around 13 deaths per 1000 live births, so the figures are getting better. The best around the world is about five deaths per 1000 live births, so we are getting to the world best practises in infant mortality. Good antenatal screening and detecting of any problems are the only steps that we could focus on. We are already doing a fairly good job, but there is always room for
improvement.

Q. What guidelines does the NHA follow regarding infectious diseases?

A. We just have to make sure that there is no global infectious disease infiltrating the country like the Avian flu. We have to be ever-vigilant. The other area is to focus on safety on food imported form other countries. For this we need to work with the other organizations too... This is an area that the Ministry of Public Health did quite well in, and we need to continue this good work.

Q. Are there any figures available on Sexually Transmitted Diseases, especially HIV infections?

A. No figures as such are publicly available. But very recently a council chaired by Dr Ghalia has been formed, which will address this issue. It just had its first meeting, so there is more to come...

Q. Do you think the NHA here is maintaining a strict vigil on the quality of the medical professionals? 

A. There is a permanent licensing committee within the NHA, headed by Dr Khaled bin Jabor Al Thani and they are in the process of reviewing all the professional licenses and also the licences of pharmacies. But we have always had a good licensing board.

Q. What control will NHA exercise over private practitioners and clinics?

A. We already have decided on this. We have given the permission for Qatari professional to practise privately. The private clinics also need a license from NHA to practice. They have to meet the guidelines before they get a licence.
The facilities here are very good; the challenge here is to develop the people. More Qataris have to be trained, mostly in managerial skills to take over some of the roles