“Health policy forum” Access to Health Care Promoting Primary Care

1. “Health policy forum” Access to Health Care Promoting Primary Care Abdullah Alkhenizan, CCFP, ABHPM, MSc. DCEpid. Professor, AlFaisal University Chairman Department of Family Medicine and Polyclinic King Faisal Specialist Hospital and Research Center 1

2. Objectives To highlight the importance of primary health care in the health care system. To highlight challenges of primary health care in Saudi Arabia. To highlight suggested changed to improve primary health care in Saudi Arabia. 2

3. Primary Care • Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, not limited by problem origin. • Health promotion, disease prevention, health maintenance, counseling, patient education. • Variety of health care settings (outpatient, ER, inpatient, long-term care, home care). • Family physicians, General practitioners. • Internists, pediatricians

4. Importance of Primary Care • Revitalizing the Nation’s primary care system is foundational to achieving high quality, accessible, efficient health care for all Americans. • National Strategy for Quality Improvement in Health Care Report to Congress April 2012 • The WHO report 2008 : primary health care now more than ever.

5. Even More in Our Country • Diabetes • Hyperlipidemia. • HTN • Smoking • CAD • Sedentary life style. • Cancer screening. • Disease prevention.

6. Health Care System in Saudi Arabia Levels of Care Primary Care 2090 Secondary Care 415 Tertiary Care 20

7. Utilization of PHC services • 54.9 million visits to PHC centers. • 11.4 million visits to the hospitals • 5:1

8. Current Status of PHC • 33% of PHC centers are equipped with X rays. • 72% of PHC centers are equipped with labs. • Very basic labs: CBC, EP, VS. INR, Hba1C, Lipid. TSH. • Average 27 patients/physician/day,Can reach 72 • 3155 GPs, 1729 with FM training. • Board certified FM (<1%). MOH Stat Book 2010

9. We need more Primary Care Physicians President Obama June 15 2009

10. Shortage of Qualified PHC Providers • PHC not new any more, 1978. • The right balance of PHC physicians and specialist (50%). • Canada 53%, UK 45%, Australia 50%,US 30%. OECD Factbook 2011-2012 • 600 board certified PHC physicians (<1%)

11. Certified PHC Physicians Out of Practice • Poor incentives for PHC physicians working as clinicians. • Non clinical work is more rewarding. • Poor work environment. • Commitment (6-10 clinics per week). • Weak training programs (lack of confidence).

12. Training in Family Medicine • Hospital oriented. • Lack of primary health care system. • Lack of clinical focus. • Non practicing trainers! • A very limited number of scholarships 80s-90s-2000s.

13. Scholarships • 1% of scholarships in family medicine. • 1% to 50%?! • There are 13000 medical students expected to graduate over the next 5 years. • Should be targeted. • We should aim at 6000 family physicians over the next 5 years. • Scholarships in family medicine (NZ, Australia, Ireland, South Africa)

14. We need to reward medical students who choose a career as a primary care physician. President Obama June 15 2009

15. KFSHRC-FM Experience • Consultant based clinics, USA, Canada, UK. • Family medicine clinics. • Occupational health: Pre-employment, Cytotoxic, Drivers. • Infection control: TB Surveillance, needle-stick injuries. • ER coverage. • Health outreach clinics. • Palliative care, home health care.

17. Light at the End of the Tunnel • Committed Leadership. • Promising plans: • Infrastructure • IT • New ideal PHC centers • Budget. • Scholarships.

18. Conclusion Improve work environment. Encourage family physicians to go back to their clinics. Improve and expand local training. Target medical students. Scholarships. 3% to 50% Golden opportunity to provide efficient high quality primary health care in our country. 18

19. Thank Youakhenizan@kfshrc.edu.sa