Saudi Arabian and Romanian Healthcare Systems Comparisons

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Introduction

Health is a fundamental component of national sociopolitical systems of different countries worldwide. Consequently, politicians make attractive promises during election times concerning the plans they have in place for their national health care systems. Unfortunately, their promises are usually based on false assumptions that they know what is best for their health care systems. Health is also a major issue of the emerging international political system led by United Nations whose World Health organization (WHO) agency manages global health affairs in member countries. World Health Organization defines health system as the organization of people, institutions and resources (both financial and non financial) whose purpose is to offer health care services to meet the health needs of target populations (Sharma & Atri 2010, p.386; Johnson & Stoskorpf 2010, p.3). It is important to note that health according to WHO refers to a state of complete physical, mental and social wellbeing of an individual or group of individuals and not absence of an undesirable physical condition that requires medication as most people assumes (Johnson & Stoskorpf 2010, p.3).

Health care system like any other constructed human system is complicated and requires qualified staff, finances, information, supplies, transport, communication and general management and direction (Johnson & Stoskorpf 2010, p.3). Health care systems operate within unique social, cultural, economic and political environments. There are as many health systems as the number of countries in the world which differs considerably in size, form and scale. Consequently, health systems have organizations, procedures and results that differ considerably from one country to another (Johnson & Stoskorpf 2010, p.3). The purpose of this essay is to establish similarities and differences between Saudi Arabias and Romanias healthcare systems.

Similarities and differences between Saudi Arabia and Romania health care systems in the light of major national factors

Saudi Arabia is a Muslim Kingdom located in West Asia. It is the home of Islam and its population is entirely of Sunni. Saudi Arabia is a perfect example of a country where Islamic system of law or Sharia is sternly followed. Saudi Arabias economy is mainly dependent on oil which accounts for over 85% of sales abroad (Shoult 2006 , p.19).Currently, the country is pursuing policies of economic diversification and is striving to raise the role of the private sector at a time when the rate of unemployment is recognized at four percent. Shoult argues that since Saudi Arabia boasts a quarter of the worlds oil reserves, the Kingdom is expected to hold on to its position as the worlds largest oil producer for the near future. Crude oil represents approximately 40% of Saudi Arabias GDP. Shoult (2006 ,P.19) notes that every year about 75-90% of Saudi export revenue is drawn from exports of crude oil, natural gas and refined products Shoult (2006,P.20).

Politically the country has been facing new political challenges particularly since the Sep 9/11 terrorist attacks on United States. Pressure has been put on the government to get rid of the Islamic Charities, amend school national curriculum, and enhance popular or civic participation especially with respect to the social status and role of women in the society Shoult 2006, p.19). Shoult (2006, P.21) explains that private sector players and foreign investors have to be conventional to the governments Saudiization programme intended at making employment opportunities for its rapidly increasing population.

It is important to note that the government and religion in Saudi Arabia have immense influence on virtually every aspect of Saudis day to day life. For instance Campagna (2006) argues that independent reporting on politics continues to be almost absent in Saudi Press even though print media from time to time pass judgment on the performance of low-level government departments and public institutions. However, critical reporting of the royal family, friendly foreign governments, widespread corruption, oil revenue distribution and local and regional divisions are highly limited Campagna (2006). For instance, Campagna (2006) argues that even though majority of newspapers in Saudi Arabia are owned by private investors the state remarkably influences what is disseminated and approves appointment of senior media officials like editors-in-chief. Consequently, there is no opposition journalism in Saudi Arabia. In a nut shell, the contexts in which human systems including health systems as well as business systems operates are to a large extent shaped by the intensive religio-political nature of Saudi Arabias society.

According to WHO and World Organization of National Colleges, Academies and Academic Associations of General Practitioners Saudi Arabia has a health care system in which the government is at the centre stage of health care services provision through a number of agencies (2008, p.136).Like other private sectors in different industries, private health sector is also growing (WHO et al 2008, p.136). Oxford Business Group (2008,p.186) observes that has recognized that privatization is important in ensuring that a health care service of high quality is available, accessible and affordable by majority in the long term. However, Oxford Business Group (2008, p.186) opines that even though the process of privatization will take long, as the government seeks to trim down its participation in the sector opportunities for private venture and investment in the health care market in the wider Gulf Cooperation Council (GCC) will prove attractive. In Saudi Arabia the duty of the Ministry of Health is to provide an all-inclusive preventive, curative and rehabilitative health care. The ministry also shoulders the responsibility of taking care of the heath human resources in a ways that will inspires up to standard performance WHO et al (2008, p.136).The Ministry of Health gets approximately 10 % of government total expenditure. According to WHO et al (2008, p.136) Saudi Arabias total spending on health is 77% which comes from the government and 23% from private sources.

According to Oxford Business Group (2008,p.186)pressures of Saudis population that is growing at a fast rate and Saudi Arabias increasing affluence are combining to put greater strains on Saudi health care system which is largely funded by the state. For example, over the next 10 years Saudis population is anticipated to grow by about 30% from 23m to around 30m consequently bringing about an increasing demands on the provision of health care services Oxford Business Group (2008, p.186).Even though wealth will bring about greater longevity, it will not reduce the need for health care if available statistics in the developed countries is anything to go by (Oxford Business Group 2008, p.186).Trend of a raising life expectancy is in fact expected to increase the strain up on resources in Saudi Arabia as demand for expensive treatments increases (Oxford Business Group 2008,p.186). For example, a report by (Oxford Business Group 2008, p.186) points out that diseases attributed to affluence and developed societies Such as cancer, diabetes and heart diseases are already rampant in Saudi Arabia and that in near future this trend is likely to continue. Furthermore, as a more learned and educated population becomes aware of the different treatments available more demands will be placed on the kingdoms healthcare system (Oxford Business Group, p.186).

Romania is ruled on the basis of multi-party democratic system and of separation of powers between the legislature, executive and the judiciary (Shen 1997, p.16; Nunberg, Bar bone & Derlien 1999, p.94). The country is a parliamentary democracy with executive powers vested in the Prime Minister (Shen 1997, p.16). The president is chosen through a popular vote for a maximum of two terms (Shen 1997, p.16). Romania is one of Eastern European countries that fell under the iron fist of the Communist rule (Shen 1997, p.16; Nunberg et al 1999, p.94) observes that during the 42 years when Romania was under Communist rule the country underwent extensive social changes and cultural transformation. He however argues that the countrys deep-rooted cultural values like strong religious beliefs and a enthusiasm for learning continued relatively intact while under the totalitarian state. Shen argues that despite the transitional social unrest that has been common in former Communist states that have been undergoing liberalization, Romania has succeeded in instituting a functional and democratic government (Shen 1997, p.16; Nunberg et al 1999, p.94; Tanchev et al 2008, p. 24).

Romania had a GDP of approximately $254 billion and a GDP per capita of $11,860 for the year 2010 (World Bank, 2008). After the fall of the Communist rule in 1989 the country underwent a decade of economic instability and decline brought in part by an obsolete industrial base and a lack of structural reorganization Shen (1997, p.16). Karatnycky et al (2009, p.310) argues that even though there are indications of an economic recovery and stabilization, Romania still has a long way to go.

According to Marshall Cavendish Corporation (2009, p.1573) after the collapse of Communism, Romanias health care system had many challenges to deal with including inequality between rural and urban health care services and a slow transition from a highly nationalized health care system to a decentralized and localized system Schubert, Hegelich and Bazant (2009, p.67). Even though Romania has high-quality health staff, the systems outdated equipment and extensive corruption has hindered positive progress (Cleaf 2007, p.4). While in Saudi Arabia the government gives health care main concern in planning and budgeting Romanian politicians have pushed health care to the bottom of the priority list (Oxford Business Group 2008, p.165). In addition, recurrent ministerial change around and turnovers has caused considerable delays and instabilities in the development agenda of the health care system. While in Saudi Arabia Ministry of Health budget accounts for 10% of the countrys expenditure, Romanian health budget account for less than 5% of the countrys GDP. For instance, in 2008 health budget accounted for 4.5% of the countrys expenditure which was a 27% increase from that of year 2007 (Oxford Business Group 2008, p.165).

While there are concerted efforts by the government in Saudi Arabia to create a bigger room for privatization of the health sector, there is a lack of commitment on part of the Romanian government with respect to defining the role of the private health sector in the economy. Private health sector in Romania has progressed slowly compared to Saudi Arabias that is currently developing at a renowned pace in environments that are increasingly becoming conducive to private domestic and foreign direct investment. In Saudi Arabia preventive care has been part and parcel of the health care system and is even envisaged in the mission statement of Ministry of Health while in Romania preventive care is a relatively recent part of the current health care strategy. The two countries however are currently facing similar challenges including lack of enough beds and doctors per head and both requires significant investment if these bottlenecks are to be conquered (Oxford Business Group 2008, p.165).

Although there is an evident physical upgrade that is taking place in Romania, there is a basic challenge of shortage of human resources supply to the system because medical professionals continue to leave Romania to work in other countries where there are attractive salaries Oxford Business Group (2008, p.165).On the other hand, cases of brain drain in Saudi Arabia are relatively fewer. In fact, Saudi Arabia is one of the oil rich Asian economies that are importing highly skilled manpower from developing countries because of its attractive salaries in virtually all industries. While in Saudi Arabia there are cases of a rise in diseases associated with affluence and developed societies like diabetes and cancer, case studies show that a considerable number of Romanian families from certain communities are often affected by poverty diseases (Fleck & Rughinis 2009, p.108).In some communities lack of drinking water, congested housing and low incomes all increase health risks for many people.

There is disparity in access to health care services in both Saudi Arabia and Romania between rural and urban areas and between various social groups. Urban families in Saudi Arabia and Romania can easily access health services compared to those living in rural Romania and nomadic communities in Saudi Arabia. In the two countries one of the main challenge facing the health care system is inequalities between rural and urban health care (Marshall Cavendish Corporation 2009, p.1573; Oxford Business Group 2010, p.285). In Romania, apart from the unequal access to health services experienced between the urban and rural areas some social groups do not access services equally with other privileged groups. For instance, Chew-Graham, Baldwin and Burns (2008, p.168) argue that special health needs of the mentally ill has not always been recognized and respected by the general services in Romania. These scholars further add that stigma is still a big stumbling block in guaranteeing access to good care for the mentally sick patients in Romania.

Major external influences impacting on delivery of health services in Saudi Arabia and Romania

Provision of health services is influenced by a combination of internal and external factors in virtually all countries all over the world. While internal factors are more critical in determining how health services are provided to target populations, external factors impacts significantly on delivery of health services. In Romania for instance impacts of liberalization spearheaded by Western countries that followed collapse of Communist rule in that country cannot be underestimated. For example, Bara et al (2003, p.38) argue that numerous changes have taken place in Romanian health care system due to shift from a centrally planned, state system to a more decentralized health insurance system with private elements. Even though privatization has been slow, Romanian citizens have alternative sources of health care services apart from the state controlled hospitals and clinics Jones (2006, p. 143). In Saudi Arabia privatization is increasingly gaining ground in the health care sector a move that has attracted foreign investors whose ventures influences provision of health services in that country (Voinea &Pamfilie, 2011).

Apart from privatization which is attracting external investors who end up influencing provision of health services in these two countries, international resolutions made by global and regional health organizations like EU and WHO which the two countries ratify inevitably impacts up on health care service provision especially with regard to children and the less privileged in the society (United Nations General Assembly 2006, p.76).In Saudi Arabia even though majority of the doctors and health workers are local a considerable number are trained outside their country. Also there is a high number of foreign health professionals from other countries who are attracted by financial rewards in Saudi Arabia. This trend which is a product of globalization forms one of the major external influences up on Saudi health system. In Romania a major external influence on her health systems has been implementation of an integrated management system in conjunction with WHO. The HIV/AIDS scourge put strains up on health systems of all nations in the world including Saudi Arabia and Romania. The number of patients seeking medication tends to rise where prevalence of HIV/AIDS is high as a result of opportunistic diseases. Furthermore health professionals and workers get infected and affected by the deadly virus thereby blocking their urgently needed services United Nations (2006, p.769).

Conclusion

Both Saudi Arabia and Romania have healthcare systems that are complicated and comprehensive even though they have evolved and progressed differently. These differences can best be explained by their diverse national conditions like politics, economy and demographics and different histories. However, the two health systems are undergoing significant changes such as privatization of the health sector which will inevitably impact on delivery of health services in the two countries.

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