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The Arab Hospital

Editor’s introduction This issue looks at the growing epidemic of diabetes in the Gulf. According to the International Diabetes Federation, Bahrain, Egypt, Kuwait, Oman, Saudi Arabia and United Arab Emirates are all in the top 10 for diabetes prevalence worldwide; a startling statistic. In 2010 7.7% of the MENA population are estimated to have diabetes, double the international average, and this is set to double. Diabetes is already responsible for 11.5% of adult deaths in the region. The Gulf Diabetes Specialist Center in Bahrain was the first hospital dedicated to tackling diabetes and MEH looks at the work of the Center and speaks to its Medical Director about the challenge facing the region as changing lifestyles result in the increasing prevalence of this deadly disease. In our featured interview this month we spoke to Jon Newton of the Royal Buckinghamshire Hospital about the spinal injury rehabilitation work of the renowned hospital. With half of its patients coming from the Middle East the hospital has a particular interest in the region. Also in this issue we review the exciting recent developments in the Libyan healthcare system, and look at one of the leading suppliers of surgical instruments to the Gulf region, Timesco of London.

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April 2010 contents Special feature: Diabetes in the Middle East Interview with Medical Director of the Gulf Diabetes Specialist Center in Bahrain, and analsis of the increasing prevalence of the disease in the Gulf region Company profile: Timesco of London UK surgical instrument manufacturers enjoying outstanding success in the Middle East Interview with Jon Newton, Chief Executive of Royal Buckinghamshire Hospital Spinal injuryand neurological rehabilitation specialist centre Country profile: Libya An overview of the country’s healthcare system since centralisation, the growth of the private sector, and future healthcare developent stategy

Guy Rowland, Editor

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Gulf Diabetes Specialist Center Gulf Diabetes Specialist Center (GDSC) is the region's first medical center devoted entirely to the treatment of diabetes and its related complications. The Gulf Diabetes Specialist Center is an outpatient medical center specifically designed to provide diabetes prevention programs and also multidisciplinary education and treatment for people with diabetes and their families. The facilities are run by specialists and cover the full range of functions from the management and treatment of adult and pediatric diabetes to metabolic disorders. The center was opened under the patronage of the Prime Minister of Bahrain, Sh. Khalifa Bin Salman Al Khalifa by Deputy Prime Minister, Sh. Abdulla Bin Khalifa Al Khalifa. Mr. Khalid M Kanoo initiated the alliance and helped develop the plans for the Gulf Diabetes Specialist Center. He worked to secure the land and the funding and realize Bahraini Government approval for the project. The Gulf Diabetes Specialist Center was opened as an affiliate to Joslin Diabetes Center, Boston, USA in Jan 2004. In Dec 2008 the Center started to run its services independently an expanded from covering diabetes only, to cover all the endocrinology disorders; like thyroid diseases and cancers

,osteoporosis, and other related disorders. GDSC has the advantage of being owned by strong and financially reliable organisations in the Bahrain Development Bank and GOCI (general insurance organisation and pension funds). These bodies represent 75% of the shares and the remaining 25% are owned by well know companies and investors in Bahrain and the GCC. Ahmed Alrashid, Operaions and Development Man-

ager, explains, “This backing gives unlimited support to the centre to develop and protect medical services from the effects of profit and loss as an overriding concern, and allows the centre to concentrate on the quality of our services and its international standards, as the priority and main target.� Mr Alrashid added, “Most of our patients are from the Bahrain, whether Bahrini people or residents, and the availability of the

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determined but what has changed is the environment in the last 2 decades leading to more sedentary lifestyle and poor eating habits that led to an epidemic of Obesity. Obesity is the strongest risk factor for diabetes. The prevalence in the Gulf countries is considered the highest in the world and it is thought it will double in the next two decades. We can increase diabetes awareness and diagnose it earlier to prevent the devastating complications of the disease nut we can also prevent the disease by changing the poor eating habits, improve lifestyle towards healthier ones and prevent obesity.”

insurance relation with almost all the insurance companies in Bahrain and the region give more accessibility for the patients of varying economic status; also a considerable number of other GCC citizens and residents are accessing the services of the center.” Diabetes in the Gulf In Bahrain prevalence rate of diabetes mellitus is 14.4% of the population, double the MENA av-

erage of 7.7% [International Diabetes Federation 2010] [World Health Organisation]. GDSC Medical Director is Dr. Wiam Hussein , a consultant endocrinologist from Cleveland, USA , who is one of the best known names in the treatment of diabetes and endocrine disorders in the Middle East. Asked about the causes of a high prevalene of diabetes in the region Dr Hussein told MEH, “Diabetes type 2, the most common type, is genetically

Asked about research that the GDSC has been involved in Dr Hussein said, “The center is a private center but we do encourage research in diabetes and other related disorders. We were involved in a genetic study with the university to study the common diabetes genes in Bahrain. We also studied the percentage of controlled diabetes subjects in the center- and found we were matching the best numbers in the USA- compared to ones that are low in other general practices. Finally, we received a grant and are undergoing a telemedicine study in the control of diabetes plus other international research in the safety of combining diabetes medications (ongoing).” On the subject of how the GDSC helps to raise awareness of diabetes in the Gulf region Mr Alrashid told MEH, “We have in our policy that the education about all

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aspects of diabetes, particularly regarding prevention is of high priority. We therefore have a specialised department for education that educates the patients , holding group sessions. For the community we have our publications ,seminars for both patients and non patients

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, and a screening campaign throughout the year in malls and other public places. We also visit companies and organisations to screen their staff, and engaging in electronic education through social networking sites is one of our main focuses.

Diabetes prevalence in the MENA region: International Diabetes Federation report Six countries in the Middle East and North African Region are among the world’s 10 highest for diabetes prevalence and a similar situation applies for the IGT prevalence. These countries are Bahrain, Egypt, Kuwait, Oman, Saudi Arabia and United Arab Emirates. The ageing of populations, together with socio-economic and lifestyle changes, has resulted in the dramatic increase in diabetes prevalence. Over the past three decades, major social and economic changes have occurred in the majority of these nations. These include progressive urbanization, decreasing infant mortality and increasing life expectancy. Rapid economic development, especially among the more wealthy oilproducing countries, has been associated with tremendous modification in lifestyle towards the westernized pattern reflected by changes in nutrition, less physical activity, tendency to increased obesity and more smoking .

Diabetes and IGT prevalence The explosion of diabetes in the MENA Region is mainly due to type 2 diabetes. As with many other countries with high diabetes prevalence, the onset of type 2 diabetes tends to occur at a relatively young age. An estimated 26.6 million people, or 7.7% of the adult population, will have diabetes in 2010, with the number expected to nearly double in the next 20 years. Similarly, the number of people with IGT is also expected to rise markedly by 2030, raising the likelihood of further increases in the prevalence of diabetes as the century proceeds. Reliable data for type 1 diabetes in children were also available in a number of countries in this region. By far the largest contribution to the total number of children with type 1 diabetes comes from Egypt whose estimates accounts for almost a quarter of the region’s total of 54,000 cases. The range of reported incidence varies from 22.3 per 100,000 aged 0-14 years

per year in Kuwait to less than 1 per 100,000 aged 0-14 years in Pakistan. Mortality Diabetes is the expected cause of some 290,000 deaths in this region, which will account for 11.5% of all deaths in the 20-79 age group in 2010. More women than men are expected to die from diabetes-related causes. In the 50-59 age group, mortality attributable to diabetes in women accounts for more than 20% of all deaths. Healthcare expenditure In spite of the high estimates of diabetes prevalence in the MENA Region, the total healthcare expenditure for diabetes is expected to be only USD5.6 billion for the whole region. This is projected to account for only 1.5% of global spending. People with diabetes in the 50-59 age group are expected to incur the highest costs. National Diabetes Programmes A high percentage (80%) of countries that responded to the IDF member association survey indicated the existence of a national diabetes programme. In the majority of these countries, the NDP had been implemented.

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Company profile: Timesco of London Timesco is one of UK’s most progressive Surgical and Medical Companies. Timesco is recognised as one of the leading producers and suppliers of theatre quality (O.R) Surgical Instruments, Laryngoscopes and Diagnostic products. Other ranges include Dental, Electro Medical, Gynaecology, Colorectal, E.N.T. etc. products, all of which are covered by Timesco’s unrivalled Lifetime guarantees. Timesco is family owned business and has been established for more than 45 years. Their first office was near Oxford Street. In 1980 Timesco moved to Pentonville road near Kings Cross station in London where the staff increased to 10. Timesco’s growth in product ranges meant another move to bigger premises in 1995 to Knights Road in the Docklands and the total number of staff increased to 35. Timesco relocated to new purpose built head office in Basildon in April 2007 and now have over 80 people working in administration and sales. A spokesperson says, “Timesco prides itself on supplying excellent quality products at competitive prices. All our surgical and medical instruments are manufactured under strictly controlled production procedures. This is to ensure the highest level of quality and

The OPTIMA CLX

service. Timesco’s team of International Territory Managers and internal sales staff are dedicated to servicing export customers and offer assistance with all exporting requirements, including consolidating freight, documentation and after care customer service etc. “Timesco is accredited to ISO 13485 and ISO 9001:2000 which allows us to CE mark all of our products. We also hold a manufacturers license from the FDS in USA.

“Timesco’s goal is to serve the healthcare needs of all our consumers in all cultures throughout the world, to develop new, innovative medical technologies that will save or improve the quality of life, whilst meeting the highest standards of quality and products safety at all times.”

A commitment to quality The spokesperson explains, “We understand the importance of the fact that our instruments are intended for use on patients. We

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are driven by a clinical need and not aesthetic trends. Our instruments have been developed over decades by working with clinicians in all areas of surgery to ensure that, above all else, our instruments perform as they should, time and time again. This has produced the high specifications and tolerances we maintain as standard. “Because instruments are “hand tools” it is vital to meet the needs of the user as well as the patient. The vast ranges that we produce have been continually improved and evolved to provide a tool for the trade for virtually any practitioner.”

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Territory Managers with detailed and specialist product knowledge and decades of experience in a variety of hospital departments. A very skilled support team works closely with each Territory Manager to provide a personal level of service to all customers.

Arab Health 2010 Timesco Territory Manager, Misbah Jabbar, who is based in Dubai and looks after Timesco’s distributors and customers in the Middle East and Africa, told MEH,

To deliver the highest quality products, consistently, Timesco have an extensive quality control department at the Basildon facility. Each reusable instrument sold undergoes a series of QA and QC checks and tests to ensure the product is fit for purpose and meets their exacting quality standards.

Meticulous product inspection ensures the very highest level of quality control throughout the production and finishing processes. The lifetime guarantee on reusable instruments is Timesco’s commitment of quality to customers around the world. Timesco market their products directly to the NHS and private sector through a highly skilled direct sales team and customer support teams. The Hospital Sales Team consists of 8

Callisto and Europa laryngoscopes

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“Timesco exhibited at Arab Health 2010 once again and were very busy with our current and prospective customers. We also had visits from many Ministers of Health throughout the region and were honoured to welcome Lord Darzi to our stand. «Our market share in the Gulf is now the second largest, with increasing demands for Timesco prodcuts across the region. This year we launched the new LED Type of Laryngoscope. The LED light gives a more clear picture to see the tracea in side of the mouth. The is a unique product from Timesco, and has been very well received by our end users. «Every year we add new products to our range to meet the demands of the end user. Now Timesco has dealerships in all Middle East and a few African countries, with excellent results from all the GCC market. Saudia Arabia is our biggest market in the region.

Mr Jabbar added, «The single use fibre optic laryngoscopes, Callisto, were exhibited more extensively as well as the New Optima CLX system which is the revised design on the Optima 1 laryngoscopes along with ever expanding ranges of Surgical Instruments, Laryngoscopes and Diagnostic products. Timesco’s XLED handle which was launched this year, was very popular at the show.” The

new

XLED

laryngoscope handle, has been developed to provide bright-white illumination, whilst retaining all the advantages of existing Timesco laryngoscope handles. The XLED bulb provides over 30,000 hours of use, emits up to 3,720 lux and maximises battery life due to its low power consumption. Unlike other systems, the XLED bulb is easily removed allowing the whole handle to be efficiently cleaned via autoclaving. www.timesco.com

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Interview with Jon Newton Chief Executive of the Royal Buckinghamshire Hospital MEH: How did you become Chief Executive of Royal Bucks, and what is your background and interest in rehabilitative medicine? Jon Newton (JN): I have been in private healthcare since 1982 initially at the level of Finance Director and from 1986 at Hospital Director/Chief Executive level. My background is in financial and general management which has provided a very good experience base for managing private hospitals. II joined the Paddocks Hospital (Buckinghamshire) in 1986 as Director and this was my first experience of managing a rehabilitation unit. At that time the Paddocks Hospital was the main private hospital in the UK for spinal cord injuries and treated many patients from the Middle East. Subsequently, I managed two other hospitals before leaving healthcare in 1993 to return to work in the finance industry.

cialised spinal injuries unit in the UK and has over 30 years experience in this field. Specialist Consultants in Spinal Cord Injuries from the nearby UK National Spinal Injuries Centre at Stoke Mandeville Hospital lead the multidisciplinary team in the Royal Buckinghamshire Hospital in the rehabilitation of British private patients as well as many overseas patients, particularly from the Middle East.

It was whilst I was with the British firm of the international accountancy organisation BDO that I was approached by the Royal Buckinghamshire Hospital to take over its management in 2005. I was very happy to return to managing a private hospital and particularly one with such a good reputation for Spinal Cord Injury and Neurological Rehabilitation.

Approximately 50% of our patients are from the Middle East. One of the hospital’s key objectives is to reach out to Middle East countries, where there is little experience in spinal cord injury rehabilitation, to share our expertise. We want to develop cooperative relationships with major Middle East hospitals (both government and private) and Ministries of Health and Defence.

The Royal Buckinghamshire Hospital is now the only private spe-

MEH: What have been your main achievements at Royal Bucks, and what is your vision for the future of the hospital? JN: Rehabilitation is a very positive treatment environment because patients are motivated to achieve goals in a treatment plan they have agreed with the multidisciplinary team. The hospital does not claim to be able to perform miracles and can only work within the limitations set by the severity of the injury to achieve realistic gains in mobility, dexterity and function to enable patients to perform the normal activities of daily living as much as possible. The more effort patients put into actively participating in the rehabilitation programme specially designed for their injury, the greater the potential result of a much improved active life than they may have thought possible at

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About Royal Bucks The Royal Buckinghamshire Hospital (Royal Bucks) was once the main hospital for Buckinghamshire. The main building, dating from 1862, was the first civilian hospital incorporating the design ideas of Florence Nightingale. It has been private since 1994 when it became home to The International Spinal Injuries and Rehabilitation Centre. Since then it has been extensively modernised. The Centre has a well equipped and spacious rehabilitation gymnasium, and an occupational therapy department. New facilities have been added including an 8.5m hydrotherapy pool and out-patient clinic. The International Spinal Injuries & Rehabilitation Centre, housed at the Royal Buckinghamshire Hospital in Aylesbury, provides patient centred interdisciplinary rehabilitation programmes for patients with spinal injury, head injury, strokes and neurological conditions. the beginning of their injury. Rehabilitation is about dealing with the reality of an injury, which can be life changing, and following a personalised programme to achieve as much independence as possible. My main achievements have been to improve the hospital services and facilities by focusing on patients’ needs through increased staff training, new equipment and refurbishment. The last unan-

nounced inspection by the UK National Regulators resulted in the award of the highest 3 Star Excellent rating. It is very important that our rehabilitation programmes and hospital processes are kept under constant review to ensure that we deliver the best quality care to our patients at all times. MEH: What do you offer your staff in terms of education and training? JN: Clinical staff at the hospital are given access to a range of training courses in order to maintain and enhance their professional competence. For nursing and care staff this includes university degree level modules in spinal rehabilitation and clinical procedure courses, for example the

Peristeen Rectal Irrigation System in which staff at the Royal Bucks Hospital were part of the pilot group before the product was launched. For therapy staff external and internal training on updating physiotherapy treatment techniques and developments in therapy aids is funded by the hospital. Some examples are: Physiotherapy Functional Electrical Stimulation (FES) bike – This is a therapeutic activity that uses transcutaneous electric current to initiate muscle contractions of paralysed lower limbs in persons who have sustained spinal injury or have been affected by a stroke or multiple sclerosis.

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Foot Drop Stimulator – switch controlled stimulator designed to correct foot drop in gait retraining. Posture and seating clinic – In conjunction with Occupational Therapy this provides comprehensive consultation, evaluation and fitting of wheelchairs, pressure cushions or specialised seating devices for patients with various physical disabilities. We have a specialised pressure mapping system which is a mat with sensors connected to a computer which gives greater accuracy when making clinical decisions regarding the choice of wheelchair and cushions. Occupational Therapy FES Stimulation –The Restorative Therapy FES bike can be utilised to stimulate muscles of the upper limbs for strengthening and restoration of movement. SAEBO – Allows individuals suffering from neurological impairment, e.g. stroke, the ability to incorporate their hand functionality by providing a dynamic splint for functional grasp and elbow movements.

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Smart-Nav Head Control System – To operate computers for high level Tetraplegic patients. This projects a cone of infrared light (invisible to the human eye). The user’s reflective dot visible to the small infrared camera inside the Smart-Nav enables the SmartNav to follow the motion of the dot and instructs the computer to move the cursor in real time. MEH: What training do you give to patients in taking care of their conditions? JN: Patients, relatives and carers are provided with oral, written and visual training (diagrams, video/DVDs) to ensure that they understand their condition and that their care needs can continue safely when they leave the hospital. Even when a patient is 100% dependent on others for help, we empower them with the correct knowledge so that they can verbally direct their care and be able to evaluate their own condition. This training will cover a range of issues such as bowel and bladder management, skin care, safe transfers (bed/chair, chair/car, floor/chair etc), self maintenance therapy exercises etc. MEH: What are the latest treatments offered by the hospital, and how do you see the future direction of rehabilitative medicine? JN: There are a number of research and experimental projects which could have a significant effect on the future of rehabilitation. Stem Cell Research could result in potentially huge gains for para-

plegic and tetraplegic patients if a technique can be developed to enable nerve pathways to regenerate. Re-growing damaged tissue and nerves would probably be a slow, delicate process and there would still need to be intensive rehabilitation therapy input to regain mobility and re-educate function. This research is still very experimental and is unlikely to have a beneficial impact on major disability for many years. NESS H200 Hand Rehabilitation System The NESS H200 is an advanced

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therapy system designed to use mild electrical stimulation to improve the way your arm works. It may help you get the most out of therapy, and reduce complications including muscle spasms. It may make it easier for you to drink from a glass, reach for things, write, and use two hands again. It is beneficial for patients with Stroke (hemiplegic), Traumatic brain injury, Spinal cord injury (C5 and C6) and Other neurological disorders of the central nervous system (e.g., Parkinson's Disease

and other upper motor neuron injuries) Virtual Reality Virtual reality is an interactive, computer generated environment that simulates the real world. Accessible via an interface that has been adapted to the human senses, it provokes in the user the sensation of immersion. A dataglove wired with fibreoptics to record the degree of bending of fingers and wrists, a headmounted display, and an exoskeleton surrounding the user's limbs to give feedback, project the user into the virtual environment and report back on his or her actions within it. The user can react intuitively to

the virtual world, any actions being detected by position and movement sensors placed strategically on his or her body. A computer calculates the changes occurring in the virtual world. It has been found successful with stroke , brain injuries , incomplete spinal injuries patients e.g. P5 Gloves. Robotic Therapy In rehabilitation, robotic therapy has been used for some years for upper limb rehabilitation of stroke victims and amputees with some success in restoring a degree of function. However, the status of a patient’s motor system at the beginning of therapy is very much related to how treatment will affect them. Robotics development is becoming very sophisticated and

its application in rehabilitation will increase the range of function it is able to assist with. Lokomat Gait Trainer The Lokomat is a robotic treadmill to help patients, with central nervous disorders and spinal injuries to gain back their independence. The Lokomat works by suspending the patient in a harness attached to an overhead frame to stabilize balance. The legs and feet are held within two metallic arms attached to a frame suspended over a treadmill. Computer-controlled motors in each joint of the arms produce walking motions for the patient. The Lokomat uses sensors to measure the position and force produced by the legs during walking.

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Healthcare Industry News Philips unveils the UK’s first Imagination Light Canvas Philips has supplied the new renal unit at Birmingham Children’s Hospital with a pioneering “Imagination Light Canvas” – thought to be the first of its kind in the UK. This LED based wall of light is a key element in generating a sense of wellbeing within the unit which has been designed specifically with a holistic approach in mind to lessen the tension, anxiety and stress young patients typically feel when entering a hospital environment. The Imagination Light Canvas is a revolutionary,

light wall, 3 metres by 1.5 metres, and is simply operated via a standard PC giving staff the flexibility to select from a menu of interactive and static scenes. The 144 individual LED points used within the canvas are thus brought to life in a myriad of colourful animations and shapes. Deliberately positioned opposite the main entrance to the renal unit’s reception area, it is the first thing that visitors see on arrival, thereby creating immediate distraction, interest and curiosity.

Dubai Mall Medical Centre opens new department The Dubai Mall Medical Centre, the flagship healthcare centre of the Emaar Healthcare Group and Methodist International partnership, has opened a new Complementary & Alternative Medicine (CAM) department. Focused on the holistic wellness of visitors in addition to offering specialised services that meet modern lifestyle requirements, the CAM Department is headed by Dr Heather Eade, Naturopathic Medicine Practitioner, with extensive experience working in Canada and Saudi Arabia previously. The CAM Department at The Dubai Mall Medical Centre addresses a variety of conditions including gastro-intestinal problems, skin conditions, reproductive concerns, hormonal ab-

normalities, as well as lifestyle issues like smoking cessation, weight loss, and stress management. “A recent healthcare survey in the UAE reports that nearly a third of the Emirati population is obese and that one in every four Nationals is diabetic. This is an indication of the need for modifying lifestyles, in which complementary and alternative medicine can play a pivotal role,” said Omar Al Shunnar, chief executive officer, Emaar Healthcare Group. Conveniently located within The Dubai Mall, the 60,000 sq ft premium multi-speciality medical centre is focused on offering an integrated healthcare experience, and is the largest out-patient facility in the region.

GE Healthcare, Gulf Capital join hands to create the region's largest chain of diagnostic centers GE Healthcare, the healthcare business subsidiary of General Electric Company (GE), has signed a strategic alliance agreement with Gulf Capital, one of the largest private equity firms in the Gulf, to develop the largest regional chain of medical diagnostic and healthcare service centers. GE Healthcare will offer strategic support to Gulf Capital's healthcare portfolio company investments, and the two companies will collaborate closely to roll out and grow these investments into regional platforms offering worldclass services. The partnership will focus on a two-pronged approach of acquiring existing companies as well as launching greenfield operations with extended services including medical imaging, laboratory services, physiotherapy, dialysis services and oncology. The agreement provides Gulf Capital with access to the full range of GE Healthcare's international commercial offerings, solutions and services. The strategic alliance will focus on the delivery of world-class health care services in Egypt and Saudi Arabia, two of the most populous countries in the Mena region, followed by an expansion at a later stage in other high growth markets.

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Libya The Libyan Arab Jamahiriya is located in north Africa on the southern coast of the Mediterranean sea between 18° and 33° north latitude and 9° and 25° east longitude, with total land area of 1 775 500 square kilometres, which makes it the third largest country in Africa. Since 1999, when the UN Security Council suspended more than a decade of sanctions, Libya’s image has changed dramatically. And as it pursues a policy of diversifying its income away from oil and gas, it is attracting more foreign interest than ever before. In fact, there has never been a better time for international companies of all sizes and make-up to turn their attentions to Libya. While the State dominates the economy, the private sector is growing fast, assisted by organisations such as the Libyan Businessmen Council which raises awareness of the opportunities for foreign investors and provides access to potential Libyan partners. Reform is underway with modernisation in the banking sector while the Libyan Investment Authority is emerging as a $100 billion Sovereign Wealth Fund and the government is committed to investing for current and future generations. Libya has more than 45 international oil companies engaged in production and exploration, and is rapidly and

massively increasing investment in infrastructure. Many other sectors are also experiencing growth, including transport and telecommunications, while plans to develop defence capabilities, encourage tourism, improve healthcare, expand financial and legal services, and extend education and training programmes present a wide range of business and investment opportunities for foreign companies. Libya consistently ranks as North Africa’s top performing economy, with little debt, a healthy capital surplus, a relatively small, adaptable and highly educated population, and carefully planned budget expenditures. Despite the recent global downturn, Libya has weathered the storm and continues to experience growth in key sectors. The fall in the oil price may slow the current rate of expenditure but its commitment to diversify its income promises increased opportunities outside of the oil and gas industry.

Geographically, Libya is close to Europe – a huge consumer market and source of supply. This location also makes it an ideal transit zone for companies seeking to export to Africa through its Free Trade Zone in Misratah. The Libyan health care system Health care, including preventive, curative and rehabilitation services, is provided to all Libyan citizens free of charge by the public sector. Major hospitals are located in urban areas. However, underfunding led to a decline in the quality of services during the last decade of sanctions. In 2002, the Government announced that it was substantially increasing the development budget for health services, although this is still awaiting full implementation. Many hospitals operate at a very low occupancy rate, employ excess staff and use resources inefficiently. The ratio of population to hospital beds is the

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highest (3.9 per 1000) among countries of the Region. It should be noted that the country has achieved high coverage in most basic health areas. Mortality rate for children aged under 5 years fell from 160 per 1000 live births in 1970 to 20 in 2000. In Egypt, the equivalent figure is 43 and in Tunisia, 28. Immunization records are also good. In 1999, 97% of oneyear- old children were vaccinated against tuberculosis and 92% against measles. However, concern has been raised that over the past 3 years the rate of coverage has slowed down. Centralisation of healthcare Until March 2006 the administration of national health services in Libya was decentralised, and the responsibility of Libya’s 32 independent shabiyats or municipalities. Since March 2006, the government body responsible for overseeing Libya’s National Health Service and for deciding polices and implementing programmes and long-term strategy has been The General People’s Committee for Health and Environment (GPCHE). Its Secretary, HE Mohammed M Al-Hijazi, is empowered to manage Libya’s national health services with responsibility for policy formation and implementation, strategic programme development, budgeting and financial management. The private sector A growing private health sector is emerging. The Government has decided to encourage the expansion of private clinics and hospi-

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Total population: 6,039,000 Gross national income per capita (PPP international $): 11,630 Life expectancy at birth m/f (years): 70/75 Healthy life expectancy at birth m/f (years, 2003): 62/65 Probability of dying under five (per 1 000 live births): 18 Probability of dying between 15 and 60 years m/f (per 1 000 population): 176/107 Total expenditure on health per capita (Intl $, 2006): 270 Total expenditure on health as % of GDP (2006): 2.9 tals. In addition, serious attempts are being made to introduce family physician practices complying the necessary rules and regulations. Drugs and medical equipment used to be supplied solely by the National Pharmaceutical and Medical Equipment Company, which is a public company. The Government has decided to allow private hospitals and specialized private companies to import drugs. The National Committee for Drugs is charged with reviewing the national standard list of drugs and to formulate the norms and standards for drug safety. Until very recently private medical insurance has not been permitted

in Libya, as it is seen as contrary to the socialist principles on which the state was founded. But partly as a direct attempt to combat the damaging effects of medical tourism and partly due to pressure from the World Health Organisation (WHO), medical insurance markets are now slowly opening up in Libya. LIBO is Libya’s first completely private insurance business. Incorporated in 2005, it now generates annual revenues of around LD16million (£8m). Recognising Libya’s lack of high quality medical facilities as the key impediment to the local health insurance market, the company has invested in the construction of a 100-bed private hospital on the outskirts of Tripoli. Offering private medical treatment exclusively to LIBO policyholders and staff, the hospital is scheduled to open later this year. According to the company, this move alone has increased sales of health policies by more than 20% and demonstrates the potential of this business model in a market crying out for high quality, local and affordable healthcare provision. This change was crucial because it basically created the system necessary for international trade and investment to thrive; prior to March 2006, the system was subject to chronic underfunding and financial corruption was rife. This led to a lack of even basic medical equipment and a shortage of qualified staff. At the same time, low wages meant Libyan hospitals and poly-

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clinics were typically failing to attract and retain high quality medicine graduates and other healthcare professionals who would choose more lucrative and better served positions overseas. So, for example, while technical equipment (such as a MRI or CAT scan machines) might be purchased by the local health authority for an urban hospital, it was often the case that there was no qualified technicians to operate and maintain it. Prior to March 2006, there were also no consolidated healthcare records. The National Development Plan In the past 12 months, however, there has been a renewed commitment by the Libyan authorities to invest state funds and resources in the development of a modern, efficient and comprehensive national healthcare service. The five-year National Development Plan (2008-2012) is specifically aimed at modernising the country’s essential infrastructure through partnership with overseas expertise. Around US$35Billion (£22bn) has been allocated to this programme, with particular focus on the construction and equipping of healthcare institutions. Integral to this progamme is the creation of a national network of Primary Healthcare (GP) Surgeries and Polyclinics. The development of Primary Care institutions in Libya is essential, not least in order to take away some of the workload from the country’s hospitals which are commonly used as walk-in clinics by local people.

The Tripoli Medical Center, for example, a specialised tertiary care and medical student training hospital, estimates that up to 40 per cent of its resources are currently spent providing basic primary care services. Plans are also in place to build and refurbish secondary and tertiary care institutions (i.e. hospitals and specialist care clinics); and unlike the ‘false start’ of 2002, the necessary funds and the political will now seem to be in place for this ambitious programme to succeed – a situation which also promises to create lucrative partnership opportunities for companies with proven expertise in large-scale healthcare projects. Libyan Health Secretary Mohammed Al-Hijazi has often expressed his admiration for the British National Health Service and has publicly stated his intention to follow the UK’s lead in terms of combining public and private funds, resources and expertise to deliver better, more efficient

services, higher returns on investment and lower total cost of ownership with respect to hi-tech medical equipment and ICT systems. His aim is to employ comparable procurement models to those developed in the UK over the past decade in developing health services in Libya. The widespread adoption of PPP and PFI-style projects (as well as more focused investment schemes similar to NHS LIFT for improving and developing frontline primary and community care facilities) are seen as key to the future of the Libyan healthcare system. This article is based on extracts from research conducted for the Libyan British Business Council by Pieter J Preston entitled “Opportunities and challenges in the Libyan healthcare sector [May 2009].” Further information from the Libyan British Business Council (www.lbbc.org.uk) and World Health Organisation.

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