بسم الله الرحمن الرحيم Reality and Vision for Promoting Healthcare Education

1. بسم الله الرحمن الرحيم • 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 Oelschlegel • Vice-President for International Projects • Saudi German Hospitals Group, Jeddah, Kingdom of Saudi Arabia

2. A common ethical understanding • ومن احياها فكأنما احيا الناس جميعا ” المائده • “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

3. A • Realities • in Health Care & Health Care Education

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

5. 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 !

6. 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 education • Health promotion & disease prevention • Hygiene & sanitation • Quality management and standardization • private practice discipline • Financing & Access • Technical resources • Medical professionals • Management professionals

7. “Home made” and ignored problems • 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

8. 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)

9. A 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.

10. 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 care • Investments in Health Care & Health Care Educationare achieving a new quality of demands. Such investments are mandatory worldwide and necessaryto the life safeguarding of the mankind andno longer arbitrary.They represent a global challenge and must be mastered by cooperation's globally between all countries: the rich and the poor.

11. 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.

12. 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 transfer • 2. • 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

13. 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.

14. B • Privatization as a Chance • in Health Care & Health Care Education

15. Private 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.

16. 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

17. 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

18. Impact and Challenges of the WTO on private healthcare sector investment ( 1 ) • Influence of global players on the initial stages • Small players in the tertiary care could be wiped out • 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 • A lot of merges & acquisitions will be possible; the wave of privatization will come and nobody can stop it • Good hospitals locally (although lacking in world class sophisticated system) will accept (concentration process to producer- supplier – and provider chains) merging with major players

19. Impacts and Challenges of the WTO on private healthcare sector investment ( 2 ) • Strong regional brands will compete successfully due to their competitive advantages • Development of a new cultural identity through new business fields for the region • Lower operating costs leads to competitive prices • Better adaptation to the regulatory requirements and bureaucratic processes • 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

20. Opportunities for Private Healthcare Industry. Financial : High liquidity in Capital Market Participation of Financial Institutions Public Private Partnership Mandatory Medical Insurance Demand exceeding supply Medical : Health Tourism Life Style Management Life Style Diseases : Diabetes,, Hypertension, Cancer Geriatric Medicine- Gerontology. Rehabilitation. Preventive Medicine. Single specialty hospitals. Quick Medical Centers, Fitness Centers.

21. Why Investors invest in Healthcare Industry and how the 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.

22. 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)

23. C • Visions • to promote healthcare & health care education • by transfer of • German technology & experience

24. 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 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

25. Transfer today

26. D • SGH-Group : a forerunner • in transfer of German technologies and experience in Health Care & Healthcare Education

27. تركيـا سوريا المغرب تونس إيران البحرين باكستان الكـويت الجزائر ليبيا مصر الإمارات عمان اليمـــن السودان نيجيريا Where we are : China – a white spot; how long ??? Turkey Morrocc Pakistan 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

28. SGH : Fields of business as Health Care Developer • 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

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

30. We start always with such teams of Health Care Developers !

31. And these are our results: …..

32. The running facilities : SGH Jeddah 217 beds ; first teaching hospital

33. SGH Aseer – 400 beds

34. SGH Hospital Riyadh; 300 beds

35. SGH AL-MADINAH - 300 beds

36. SGH Sana ( Yemen ; 300 beds )

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

38. SGH Dubai 300 bed’s hospital + 3 German Centre for Medical Excellence

39. 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

40. Projects in the pipeline ….., SGH Kuwait SGH Pakistan SGH Nigeria, Ethiopia, Sudan, Chad….

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

43. Significant touches a nation, a community, the region 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

44. Our recommendations for Leaders in Healthcare are : • Encouragement of public private partnership. • Defining roles (clear roles for private and public sectors for Healthcare Industry) • Treat Healthcare the way other industries are treated with industrialized structures, professional management and strategic goals on a strong competitive market • Governments has to support Private Sector by providing free land, long term loans to suitable (supporting) conditions, subsidized utilities for the industry. • Long Term Strategies for regional healthcare investments. • Governments has to reduce bureaucracy, licensing processes and simplify registrations. • Built up strategies alliances with the “Strength“ in this businesses – with partners from Germany, Europe and wherever you will find professionals

45. 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

46. To built up the future • needs to believe in future ! • Thanks for your attention.