Selected priority supply-side interventions

TABLE 8.1 Summary of findings on labor market supply and labor market demand

Labor market supply

DIMENSION PHYSICIANS

Availability • The modeling shows that the projected number of Saudi physicians will exceed those needed in 2030, even with 100 percent Saudization replacement. Gender balance • With no policy change, the number of Saudi female physicians will grow, but the number of male physicians will grow faster. • Increases in employment in the private sector are largely driven by the female labor force. Currently more males work in the private sector, but in the future more females will be employed by the private sector.

Sector distribution • Most of the physician supply increase will be absorbed by the MOH, with increased employment in the private sector. • Increased employment in the private sector will largely be driven by female physicians, which is contrary to the current situation.

Geographic distribution • The geographic distribution of the workforce is critical since most physicians will still be located in urban areas.

Level distribution

Labor market demand General financing to absorb employment • Although the number of primary care physicians will grow, the majority of growth in the supply of physicians will remain at the hospital level.

• On the physician demand side, modeling shows that the projected financing to absorb physicians in the private and non-MOH public sectors will be more than enough, even with 100 percent Saudization. The demand in the MOH sector is likely to be much less than in the other sectors.

MOH labor market demand

Source: World Bank. Note: MOH = Ministry of Health. • The finding that much of the growth in the supply of physicians would end up in the

MOH sector (and very little in the private sector) may well put pressure on the MOH wage bill.

NURSES

• There will be a shortage of nurses in relation to needs, even with 100 percent Saudization.

• With no policy change, the number of female nurses will grow rapidly, whereas the number of male nurses will remain relatively constant. • Although it remains low, the number of Saudi female nurses in the private sector will more than double (the number of male nurses will increase by less).

• Most of the increase in nurses will be in the MOH sector, with a very small increase in the private sector.

• Although this could not be modeled, chapter 1 on the current distribution shows that nurses remain highly unevenly distributed across rural and urban areas, especially when considering only bachelor and advanced nurses.

• With no policy change, the increase in nurses will be mainly in hospitals, with a decrease occurring at the primary level.

• On the nursing demand side, modeling shows that the projected financing to absorb nurses will be more than enough, even with 100 percent

Saudization. • Modeling also shows that as we increase productivity and Saudization and increase retirement age, there will still be enough financing to absorb nurses. • The finding that much of the growth in the supply of nurses would end up in the MOH sector (and very little in the private sector) means that the MOH will continue to bear the brunt of the wage bill for health workers.

as generating greater value for money for existing public sector funds. The interventions discussed cover both education and labor market solutions, highlighting the importance of health planners working in close collaboration with the education (and financing) sectors during the development and implementation of the interventions.

SELECTED PRIORITY SUPPLY-SIDE INTERVENTIONS

This section discusses some of the supply-side interventions that should be prioritized to ensure that the projected Saudi workforce meets needs for their availability and distribution across gender, sector, and care level

(primary versus hospital). The interventions focus solely on a select number of key priority solutions for Saudi nurses and Saudi physicians (rather than all solutions) in light of government ambitions to work toward Saudization.

Scale up aggregate supply

A key policy priority is to scale up the number of bachelor and advanced nurses. The availability of Saudi physicians will be more than sufficient to meet basic health needs, but not so for Saudi bachelor and advanced nurses. The scale up of bachelor and advanced nurses needs to be prioritized, and within that, five strategies could be prioritized: (1) scaling up training capability (specifically clinical sites) to increase production, (2) increasing reliance on private schools for production, (3) using a bridge program to help existing diploma nurses become bachelor or advanced nurses, (4) increasing the productivity of nurses already in the labor market, and (5) considering optional delayed retirement. Although the immediate need is to scale up Saudi bachelor and advanced nurses, strategies 1, 2, 4, and 5 could be relevant for scaling up the number of physicians as well.

Scale up clinical sites One of the main bottlenecks in training more Saudi health workers and increasing the aggregate supply is the lack of clinical sites at which health workers can conduct their practical training. This limitation applies to training of both physicians and nurses. hands-on training with direct access to patients and participation in patient care (including experience with physical exams, diagnosis, treatment plan development, and procedures) is essential for creating confident health workers who can efficiently deliver high-quality care. This clinical site shortage affects both preservice education (nursing and medical school, and so on) and postgraduate training (physician residencies and fellowships; and nursing certificates, master’s degrees, and doctoral programs).

This shortage of clinical sites exists in Saudi Arabia (and in most other countries) because health workers’ clinical practica have traditionally taken place almost exclusively in public academic or referral hospitals. This practice ensures that students are able to see large numbers of complex patients and have access to highly skilled instructors. however, as more countries move toward selfsufficiency in training health workers, the number of public academic hospitals is becoming insufficient to teach the increased number of students. In addition, a low student-to-patient ratio is desired so that students can interact with and examine the patients and be actively involved in their care. Therefore, clinical sites need to be expanded both to private hospitals and to all levels of the public health system, including primary care.

To ensure high-quality clinical practica in these new clinical sites, a number of measures need to be taken. These measures include ensuring that clinical sites have a legal education mandate, ensuring this education right is communicated in patient rights and responsibility documentation, ensuring case-based teaching and mentoring, designing standardized clinical practice curricula, ensuring availability of methods to document the clinical experience, and ensuring availability of transportation and accommodation. box 8.1 provides details on each of these dimensions.