In the beginning,
there was the Mission Hospital.
American Mission Hospital started almost 100 years ago.
And then the government actually started some clinic.
One of these clinics was a boat actually, which accompanied the pearl divers,
who usually spend more than four months of the year in the sea, for pearl fishing.
And in the 40s, that was the first hospital actually built by the government.
And since the beginning, actually the services was free for Bahrainis and
subsidized for non-Bahrainis.
Right now it is almost the same, and we have actually a number of beds,
around 2,600 for a population of around 1.5 million.
Almost half of the population is non-Bahrainis and
all of them working men, actually in the working age.
And that's why their need is that much.
And the number actually is growing in Bahrain, but we are actually planning to
have much more beds in the future and much more teaching beds actually at
the beginning of university hospital, they are building it right now.
It's like the National Health Service in Britain actually,
the service actually is paid by the government.
And the treatment is free for Bahrainis and subsidized for the non-Bahrainis.
And actually we have now, as I said,
the number of beds around 2,600 beds for the population.
And we have actually a percentage of doctors that we have 2.4 doctors
per 1,000, and almost 6 nurses per 1,000, which I think is a good percentage.
And actually Bahrain has the advantage over other Gulf states that the manpower
that are working in the Health Service, actually, most of them are Bahrainis.
And that is, I think, a good advantage we're having.
And we said, success rate in Bahrain, last one recorded was good.
But actually the most what we are trying to do now is to improve the system and
modernize it.
The way we are developing the system right now actually is not that efficient.
Because actually there is no costing,
there's no calculating exactly of the cost.
And the escalation of unit cost per year is almost 10%,
actually increase in the costing of the system.
And I think one of the most important thing is actually to
have two main factors.
To have proper costing, proper control of the costing system.
And proper affirmation, actually,
to check all the aspects of health expenditure and health quality.
And that's, I think, the two most important factors that we need to do it.
For the form actually based on maybe four pillars.
The first actually is the funding.
The hospitals, and the health centers, and
the Ministry of Health actually getting a budget from the government.
And they are just spending it directly,
without real accounting on how they are spending it.
What we are trying to do now, actually, is to split the buyer from the provider.
And actually there's going to be an accurate calculation of how much
we are spending.
Because this buying-selling mechanism with a detailed
information system will give us much more control on exactly what we are spending.
And for what, for whom, how we are going to spend it and
how we need to control it.
The other pillar actually is a question of, as I said,
the health information system.
And the health information system actually is the pillar of the whole reform.
What I do have actually health information system in the hospitals which is covered,
in most of the government hospital and the private hospital.
And all the government hospital now are almost paperless.
But what we need to do much more, a step more.
And we actually try to make what we call national electronic medical record.
And this actually accumulate all the information of the patients in one record.
And it is going to be available for all doctors in Bahrain to go and
to get into this report.
And build on it when they are actually seeing any patient in the Bahrain,
both in the primary healthcare and in the secondary healthcare.
And that is very important information.
It's going to be national record medical repository for
all information of the health.
That will include the information that comes from
the National Health Insurance Information System,
which controls all the claims that comes from the provider to the buyer.
And also, the paying from the buyer to the provider, so that they
actually will give us all the information about the financial side of it.
And of course, about the quality of service.
So you are going to have a lot of indicators and parameters to monitor it
to ensure that we are getting a good service for the population.
One of the most important things that we can use in this also is the system for
payment for performance.
And that's, I think, that is one our aims actually to build up this system.
So actually there is always some incentives for the providers to give much
better information, both in the primary health care and the secondary health care.
The other problem that we are facing and we must do it,
actually a question of autonomization of the government hospital.
Right now the government hospital is actually working in some kind of
bureaucratic kind of way.
Because they have the regulation of the Ministry of Finance,
regulation of the Ministry of Health, regulation of the Civil Service Bureau.
And that's actually tied them up actually from doing a good job.
That's why we are trying to move from this system to a more freedom system for
which we call it optimization.
And the most important thing, actually, is the governance of the whole system.
And that's very important, and therefore that I sure I said, the pillar for
the governance is the information.
We are getting it from the information system,
both in the financial side and in the delivery side.
That's why you are having actually four main departments.
Most important department is the IT departments,
actually controlling all this information system.
And from the information of this that we are getting from this department,
we are having three other departments.
The first department is the health economy department, which is going to
be a responsible unit to look into the details of the expenditure
of the system in all levels.
I mean, in the whole level, in the hospital level,
in the private sector level and
also in the prime healthcare level, all this is going to be available to us.
The other department is actually the quality department.
And actually the quality department, we already have now a Quality Committee,
which is actually putting all the parameters and indicators and guidelines.
And the department's going to look to implementing of this and
detecting all these kind of rare parameters and
working to develop the pay for performance system.
The planning department,
which is going to look into how many doctors we need in the future.
How many nurses we need, and how many other parameters working in the field.
And that, I think,
is the most important thing, that we need to plan everything very carefully.
Ban Ki-moonDistinguished Chair Professor
