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Building the health workforce: Saudi Arabia's challenges in achieving Vision

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Article  in  International Journal of Health Planning and Management · August 2019

DOI: 10.1002/hpm.2861

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Received: 22 April 2019 Revised: 23 June 2019
DOI: 10.1002/hpm.2861
REVIEW
Building the health workforce: Saudi Arabia's
challenges in achieving Vision 2030
Fahad Albejaidi | Kesavan S. Nair
College of Public Health and Health
Informatics, Qassim University, Al Bukayriyah,
Saudi Arabia
Correspondence
Kesavan S. Nair, College of Public Health and
Health Informatics, Qassim University, Al
Bukayriyah 51941, Saudi Arabia.
Email: ksnair2005@gmail.com
Int J Health Plann Mgmt. 2019;1–12.
Accepted: 18 July 2019
Summary
Background: Saudi Arabia's Vision 2030 represents a major
structural shift in all economic sectors. Health care is one of
the largest sectors significantly contributing to achievement
of the vision
Objectives: To provide an overview of health workforce in
Saudi Arabia and identify various critical issues and chal-
lenges that need to be addressed in achieving health system
goals envisaged in the Vision.
Methods: This paper is based on extensive review of litera-
ture conducted to stimulate pertinent descriptive informa-
tion on health workforce in Saudi Arabia.
Findings: Saudi nationals constitute 44% of all health work-
force and 29.5% of all physicians employed by the health
system. Among Saudi nationals, there is a significant under-
representation of females except in the nursing profession.
The health workforce is beleaguered with numerical inade-
quacy, skill imbalance, gender disparity, and access issues.
Conclusion: Health system needs to adopt a rigorous
approach by investing heavily on medical, nursing, and other
specialized fields of education. Planning for the health
workforce needs to adopt appropriate strategies that reflect
all aspects including the number, skills, and gender distribu-
tion for meeting the future health needs of population to
facilitate achievement of Vision.
KEYWORDS
health workforce, vision-2030, saudization, medical education
wileyonlinelibrary.com/journal/hpm © 2019 John Wiley & Sons, Ltd. 1
2 ALBEJAIDI AND NAIR

1 | I N T RO D UC T I O N

Since the launch of first development plan in 1970, the Kingdom of Saudi Arabia has accorded top priority to the
development of health care services at all levels, and its commitment is reflected in increased budget allocation to
the Ministry of Health (MOH) from 2.8% in 1970 to 7.6% in 2017.1,2 Rapid expansion of health care delivery system
in the country has led to significant improvement in health status of the population almost comparable with some of
the developed nations.3 Between 1983 and 2017, life expectancy has improved from 66 to 74.9 years; infant mortal-
ity rate per 1000 live births drastically declined from 52 to 6.3; below 5 years, children mortality rate declined from
63 to 8.9; and maternal mortality rate declined2 from 3.2 to 1.2.
Despite these achievements, the government faces many challenges in providing quality health services to the
fastest growing population. The annual population growth rate of the country as per census 2010 is 3.2%, with a
total fertility rate of 3.04.4 The improvement in life expectancy of population has added new challenges of meeting
health care requirements of increasing number of elderly population which is projected to increase from 3% in 2010
to 18.4% by 2035.5 The country has recorded sharp increase in chronic and lifestyle-related diseases such as coro-
nary heart diseases, cancers, obesity, diabetes, mental illnesses, and hypertensions. Mortality due to road accidents
recorded 4.7% of all mortalities, which is one of the major causes of death among young population in the kingdom.6
All these challenges are likely to create considerable pressure on health infrastructure and requirements for trained
health workforce in the future.
Traditionally, the country's health system has been dependent on foreign workforce. Since the discovery of oil in
the middle of the past century, Saudi Arabia attracted millions of foreign workforce in different sectors of economy
as it lacked efficient and skilled workforce at that time. During the period of boom in oil prices in the late 1970s, its
economy witnessed a drastic expansion in government expenditures on development plans as a result of sharp
increase in oil revenues.7 These development plans were focused on power generation, infrastructure projects, tele-
communications, trade, and social development, for which the government relied mostly on foreign workforce. With
the enormous increase in government expenditures to meet the objectives of development plans and persistent
growth of the private sector to diversify the economy, the country became dependent heavily on unskilled, skilled,
and highly skilled workforce from foreign countries. Overreliance on foreign workers caused a huge transformation
in socio, economic, and demographic structures of the economy.8 One of the biggest problems was the increasing
unemployment rate among Saudi nationals, and according to government data, unemployment increase among Saudi
nationals was 11.6% in 2016 to 2017.9 Another problem is the large remittances outflow from the country, which
according to the World Bank Report 2011, Saudi Arabia has the distinction being the second largest source of remit-
tance outflows with US$26 billion, after the United States of America.10 The continuous dependence of foreign
workforce and persistent unemployment among Saudi nationals compelled the government to adopt Saudization
program in the early 1970s, but it came to implementation in the sixth development plan (1995-1999). During the
period, private sector companies employing more than 20 employees were mandated to reduce the number of non-
Saudis by 5% per annum.11 However, the actual enforcement of localization focusing on the private sector, known
as Nitaqat Program, was introduced by the government in 2011, and subsequently, the Saudization level in the pri-
vate sector has recorded a marginal increase from 10% in 2011 to 13% in 2012.12
Presently, the MOH has been the major source of public provider of health services through its network of 282
hospitals (43 080 beds) and 2631 primary health centres.2 The other government health services providers, including
referral hospitals, security forces medical services, army forces medical services, national guard health affairs, hospi-
tals managed by the Ministry of Higher Education, ARAMCO hospitals, Royal Commission for Jubail and Yanbu
health services, school health units of the Ministry of Education and, the Red Crescent Society, together operate 47
hospitals with 12 279 beds.2 Health services provided through the MOH is supervised by the directorate general of
health affairs established in each of the 13 administrative regions of the country. Apart from implementing the poli-
cies, plans, and programs of MOH, these directorates also play a key role in workforce recruitment, their
ALBEJAIDI AND NAIR 3

development, supervision, and evaluation of performances.13,14 The private health sector delivers services ranging
from basic medical care to specialized services in the urban areas and cities through a network of 158 hospitals with
17 622 beds, 2767 general/specialized polyclinics, and 61 clinics.2
The adoption of the new strategic plan “Vision 2030” in 2016 has added new challenges as well as opportunities
for the health system.15 It gives a new direction in identifying priorities, strategic goals, and objectives across all eco-
nomic sectors in the kingdom. Saudization of workforce is one of the key aspects of the vision. The National Trans-
formation Program (NTP) 2020, implemented as one of the executive programs to achieve the vision, has identified
challenges encountered by all ministries and build institutional capacity for realizing the goals.16 The NTP, adopted
for the health sector in 2016, identified 15 strategic objectives and 16 key performance indicators (KPIs). The strate-
gic objectives of NTP related to health workforce development accorded higher priority to medical education and
training and recommended establishment of educational institutions and partnering with reputed international uni-
versities including the private sector. While emphasizing the role of private sector participation and increase in the
share of spending through alternative financing methods and provision of services, the NTP sets a target of 35% to
be achieved by 2020. To implement the NTP in desired expectations, the MOH developed a long-term road map
called the Health Sector Transformational Plan (HSTP).17 The Health Sector Transformation Strategy (HSTS) devel-
oped by the MOH identifies key policies including health workforce development program and allied them with the
challenges they strive to address in the health care sector. The policy goals of health workforce development pro-
gram aims to support the transformation of the workforce necessary to enable a value-based health care approach,
which require a major increase in work capacity, redistribution, and diversification of workforce capacity across dif-
ferent regions. In line with the vision, MOH has also planned to augment an additional 100 000 Saudi workforce by
2030.15 However, the achievement of this target and reducing dependence of foreign workforce in health sector,
particularly for specialized professionals becoming a huge challenge for Saudi Arabia.
The objective of this paper is to provide an overview of health workforce in Saudi Arabia and identify various
critical issues and future challenges that need to be addressed in achieving health system goals envisaged under the
Vision 2030. The inferences based on this paper will be a valuable step towards planning and development of health
workforce and relieving government resources on foreign health workforce dependence in Saudi Arabia.

2 | METHODOLOGY

This paper is based on extensive review of literature conducted to stimulate pertinent descriptive information on
health workforce in Saudi Arabia. The major emphasis was given on the existing status of health workforce, issues,
and major challenges come a long way in implementing Saudi Vision 2030. The publications of WHO, World Bank,
government reports, annual statistics of Ministry of Health, academic articles related to the area of focus were used.
The relevant literature thus collected from multiple sources was used as a way of triangulation to give credibility to
the analysis. A literature search was also conducted through electronic database to identify peer-reviewed studies
on health workforce and health care system in Saudi Arabia.

3 | H E A L T H W O R K F O R C E I N SA U D I A R A B I A : P R E S E N T S C E N A R I O

Health sector in Saudi Arabia has grown rapidly during the past few years as compared with other Gulf Cooperation
Council (GCC) countries. The country spends the highest percent of GDP on health (4.16% in 2015) among GCC
countries.3 The number of physicians per 10 000 population of 9.4, which was one of the lowest among GCC coun-
tries during 2005-2012, has increased to 24.9 during 2007-2013 (Figure 2). And this figure is comparable with other
countries in the GCC except Qatar.3,18
According to the report of MOH, there was a total number of 423 940 health workforce employed in the Saudi
Arabian health sector in 2017, out of which, 70.7% were engaged in the public sector.2 Distribution of health
4 ALBEJAIDI AND NAIR

workforce according to different categories reveals that physicians constitute 23.1%; nurses, 43.8%; pharmacists,
6.6%; and allied health personnel comprises 26.4% (Table 1). Saudi nationals constitutes 29.5% of all physicians
including dentists (98 074) and 36.7% of all nurses (185 693) employed in the country in 2017. There were 28 312
pharmacists and 111 861 allied health personnel in the Kingdom in 2017, of which Saudi nationals constitutes 22.2%
and 74.7%, respectively. In contrast to the public sector, a miniscule share of Saudi nationals, 8.9% of physicians and
5.8% of nurses, were employed in the private sector in 2017.
MOH has been the major employer of health workforce in the country; it employed 47.5% (46 605) of physicians
including dentists, 56% (103 990) of nurses, and 53.3% (59 646) of allied health personnel in various health facilities
in the kingdom in 2017. Saudi nationals represent a lower share among physicians employed by the MOH during
2010–2017 (Figure 1). Almost 80% of allied health workforce in the country were employed by the public sector
(53% by MOH and 27% by other government agencies), and they are mainly composed of workforce in laboratory,
pharmacy, radiology, dental, public health, health services management, health informatics, social services,
surgical operations, anesthesia, and nutrition. Besides this workforce, there are personnel employed in technical,
administrative, and supportive categories in the MOH, regional directorates, and health facilities owned by the
government.
Gender composition of health workforce reveals there is underrepresentation of female in all ca3tegories. The
data shows female constituted 29.7% and 37%, respectively, of all physicians (both Saudi nationals and non-Saudi
nationals) employed by the MOH hospitals and primary health centers. With regard to physicians employed by the
private health sector, data shows 34.8% of them are females. Among Saudi nationals, there is again underrepresenta-
tion of female physicians in the public and private sectors. Out of all Saudi physicians employed by the MOH in
2017, female comprised 34.3% and 32.7% in hospitals and primary health centers, respectively; whereas in the pri-
vate sector, Saudi female comprised 31% of all Saudi physicians Figure 2.

4 | HEALTH WORKFORCE PRODUCTION

Health services in Saudi Arabia began to progress after the foundation of the country in 1932, from a reliance on tra-
ditional medicine towards a modern health care system with the health workforce drawn primarily from the neigh-
boring countries.19 Later, with the commencement of 5-year economic development plans, many Saudi citizens with
high-school diplomas were awarded scholarships to study medicine and allied health sciences from universities
abroad. This scheme continued until 1967 when King Saud University established the first medical college in Riyadh.
The implementation of a revolutionary strategy of “Saudization” in the 1970s aimed at training and development of
Saudi nationals to replace foreign workforce in all economic sectors including health.19,20 With this goal, a number of
medical, dental, nursing, pharmacy, and health sciences schools have been established across the country. Presently,
in the public sector, there are 26 colleges of medicine, 18 colleges for dental sciences, 14 nursing colleges, 20 col-
leges for pharmacy sciences, and 49 colleges for allied health professions imparting education to 81 254 students,
42.5% of them are females (Table 2).2 In 2016-2017, a total number of 12 537 students were graduated from these
institutions, of which 55.5% were females (Figure 3). The establishment of these institutions were primarily aimed at
imparting necessary skills and to substitute the foreign workforce in the health care system with qualified Saudi citi-
zens.13,21 Over the years, the budget allocation for training and scholarships has increased manifold times and pro-
fessionals employed by MOH were offered scholarships to pursue higher studies abroad. To some extent, these
strategies have led to improvement in skills of local health workforce and decreased the rate of turnover among
them in health facilities.14
Medical education sector in Saudi Arabia witnessed rapid changes during the past few years with the establish-
ment of more medical colleges across the country. The initial phase of medical education in the country followed a
teacher-centric approach with traditional curriculum and poor teaching environment.22 The 2000 period witnessed a
paradigm shift in medical education with student-centered learning, community-oriented, and outcome-based
 ALBEJAIDI AND NAIR

TABLE 1 Health workforce in government and private sectors in Saudi Arabia, 2017

Ministry of Health Other Government Sector Private Sector Total

Workforce S NS Total S NS Total S NS Total S NS Total

Physicians 16 760 29 845 46 605 9123 8506 17 629 3013 30 827 33 840 (100) 28 896 (29.5) 69 178 (70.5) 98 074 (100)
(36.0) (64.0) (100) (51.7) (48.3) (100) (8.9) (91.1)
Nurses 60 240 43 750 103 990 5156 30 652 35 808 2679 43 216 45 895 (100) 68 075 (36.7) 117 618 (63.3) 185 693 (100)
(57.9) (42.1) (100) (14.4) (85.6) (100) (5.8) (94.2)
Pharmacists 3589 264 3853 1558 746 2304 1134 21 021 22 155 (100) 6281 (22.2) 22 031 (77.8) 28 312 (100)
(93.1) (6.9) (100) (67.6) (32.4) (100) (5.1) (94.9)
Allied 55 471 4175 59 646 22 147 8067 30 214 5933 16 068 22 001 (100) 83 551 (74.7) 28 310 (25.3) 111 861 (100)
Health (93.0) (7.0) (100) (73.3) (26.7) (100) (27.0) (73.0)
Personnel
Total 136 060 78 034 214 094 37 984 47 971 85 955 12 759 111 132 123 891 (100) 186 803 (44.0) 237 137 (56.0) 423 940 (100)
(63.6) (36.4) (100) (44.2) (55.8) (100) (10.3) (89.7)

Source: Statistical Year Book 2017, Ministry of Health, Saudi Arabia.

Abbreviations: S, Saudi nationals; NS, non-Saudi nationals.
5
6 ALBEJAIDI AND NAIR

F I G U R E 1 Physicians per 10,000

population in GCC countries

TABLE 2 Medical and health educational institutions and students in the public sector, 2017

Students Total

Educational Institutions Numbers Saudis Non-Saudis Male Female Total

Medical colleges 26 21 651 313 12 765 9199 21 964
Dental colleges 18 6280 66 3531 2815 6346
Pharmacy colleges 20 11 752 149 5699 6202 11 901
Applied science colleges 22 28 145 406 13 439 15112 28 551
Nursing colleges 14 7865 90 1407 6548 7955
Health & rehabilitation 1 724 10 0 734 734
Rehabilitation 2 588 01 0 409 409
a
Public health & health informatics 6 3375 19 1951 1443 3394

Source: Statistical Year Book 2017, Ministry of Health, Saudi Arabia.

a
Include one course on tropical medicine.

F I G U R E 2 Share of Saudi
Nationals in Health Work force MOH
hospitals (2010-2017)

education. Medical education in this period moved into a new phase when the Ministry of Higher Education (MOHE)
took steps to develop higher education in general and medical education in particular.15 Apart from establishing new
medical colleges in the public sector, the MOH also invited the private sector to contribute in higher education in
the country. By 2008, three private medical colleges were established and currently there are 28 private institutions
imparting training in disciplines such as medicine, nursing, medical laboratory, dental, pharmacy, nuclear medicine,
ALBEJAIDI AND NAIR 7

F I G U R E 3 Students graduated in
public sector institutions (2016-2017)

radiology, biomedical engineering, health management, and emergency medicine across the country. During this
phase, the National Commission for Assessment and Accreditation (NCAAA) was established for accreditation of all
higher educational institutions and programs in the country. In order to improve knowledge and skills of medical pro-
fessionals with the latest developments in medical fields, the government introduced continuous medical education
(CME) with assistance of CME bodies.23 With the continuous increase in demand for medical care followed by
expansion of health delivery institutions across the country, overall intake of medical students has increased mani-
fold times. However, the health sector faced many challenges in its pursuit to build up its own health care workforce,
which has become a major challenge in fulfilling the goals of Vision 2030.
Saudi Arabia's first school of nursing was established in 1926, followed by the school of health and emergences
in 1927, but the formal nursing training began in 1954 with a 1-year program.13 The first Bachelor of Science in
Nursing (BSN) was established in the country in 1976. Generally, nursing as a career is being considered more as a
women's profession, but in Saudi Arabia, there is limited participation of women in the nursing profession.24 With
the increased demand for nursing workforce, more number of nursing colleges have been set up to attract Saudi
nationals into the nursing profession. In order to attract male nursing professionals, the government established a
BSN program for men in 2004.25 Currently, many universities in the country are offering BSN courses for both male
and female students. International scholarships are offered to enable prospective candidates for higher studies in
universities abroad.26
Despite these initiatives, nursing courses tend to have low levels of enrolment because of the poor image of
nursing as compared with other professions.26,27 There are growing concerns with regard to performance of nursing
services in the country. Social perception on nursing profession has been one of the major reasons in the shortage of
nurses in the country. Studies have highlighted factors such as low paying job, long working hours, night shifts, and
strict social traditions as the reasons for less acceptance among female. Studies have also indicated that a significant
number of Saudi nurses have a tendency to leave their jobs because of reasons like social stigma associated with the
profession, lack of promotional avenues, long hours of work, and for higher studies.21,28-31
As far as pharmacy education is concerned, there was only one pharmacy school in 2000 imparting pharmacy
education. With the paradigm shift in pharmacy education, institutions imparting pharmacy sciences has increased to
8 ALBEJAIDI AND NAIR

27 in 2017, and majority of these institutions are in the public sector.2,32 The number of pharmacists employed in
government health facilities has recorded a sharp increase and unlike other categories of health work force, Saudi
pharmacists constituted 93% of all pharmacists employed by the MOH in 2017. With regard to quality of pharmacy
education, many of the undergraduate pharmacy programs in the country have been accredited by international
accreditation bodies.32,33 With the increasing demand for specialized pharmacists, Saudi Commission for Health Spe-
cialists (SCFHS) initiated general and specialized pharmacy residency programs, few of the programs have been
accorded accreditation by the American Society of Health System Pharmacists.32,33 Currently, there are five phar-
macy colleges offering master degrees in the field of clinical pharmacy and three of them in pharmaceutical sci-
ences.33 Despite this progress, there will be shortage of this category of workforce in the future. A study estimated
that 100 000 pharmacists were required to meet the demand for pharmacists in health care and the industrial sector
in 2015, which will be a huge challenge for the government.32

5 | DISCUSSION

The analysis of data on health workforce in this paper provides information that are crucial for the health workforce
planning and development in Saudi Arabia. The analysis shows that health workforce in Saudi Arabia display various
attributes like gender composition, geographic, and public-private distribution. The Saudi nationals constitute 44% of
all health workforce and 30% of all physicians engaged in the health sector in 2017. In order to achieve Vision 2030
and NTP, a huge number of Saudi nationals will be required in the health system.
Education of women and their empowerment are considered a significant determinant of health and in many
developing countries the frontline functions of promoting health, and basic preventive health care are performed by
women. Health workforce in Saudi Arabia is dominated by male, in contrast to female predominance in other devel-
oping countries. Female workforce constitutes only 31.4%, 37.2%, and 25%, respectively, of physicians, pharmacists,
and allied health professionals employed by MOH in 2017.2 There is however, limited information available on the
age distribution of health workforce employed at various facilities. A recent study in Najran City of Saudi Arabia has
shown the mean average age of health workforce employed in hospitals as 35.81 years.34 The study showed only
17.7% of health workforce are Saudi nationals. Although female comprised 68% of all health workforce, only 10.9%
of them were Saudi nationals. These figures show that concerted efforts are required to increase women participa-
tion in the health sector to 30% as set by Vision 2030.
Implementation of Saudization program in the health sector is one of the fundamental objectives of Vision 2030.
In 1992, the Kingdom had issued a royal decree demanding that Saudi nationals be educated or trained in all areas of
employment to replace existing foreign workforce and their escalating salaries.21,30 In this context, a reasonable suc-
cess has been achieved in other sectors like education, but the health sector lags behind in achievement of
Saudization targets, and a great effort is required to achieve the targets set through establishment of new medical
schools and health educational institutions, encouraging Saudi nationals to take up health professional jobs, creating
positive environment in educational programs, institutions, and teaching hospitals. The proportion of Saudi nationals
in MOH workforce has increased marginally over the last decade but in the case of nursing profession, the efforts to
attract and retain more Saudi females in this profession encountered impediments like unpleasant working condi-
tions, narrow options for balancing work and family responsibilities, and poor perception of nursing as an occupa-
tion.26 Further, a large number of doctors, nurses, and paramedical staff in the Kingdom migrate to Western
countries after a few years because of better job prospects and training facilities. Numerous doctors, nurses, and
paramedical staff in Saudi Arabia relocate to Western countries for several years to take advantage of more stable
work opportunities and training facilities in those countries.35,36
The health system almost suffers from skill imbalance, creating inefficiencies and regional imbalances as
population-based health workers are neglected in rural and far flung areas. There is also unequal distribution of
health workforce with urban concentration, particularly in larger cities. Unlike in other countries, diversity in health
ALBEJAIDI AND NAIR 9

workforce does not exist. A majority of health workforce is recruited from other countries, there are differences in
religion, culture, social values, and language which creates barriers between health care providers and
patients.24,26,37 A recent systematic review indicates the prevailing communication barriers between patients and
health care providers as most of providers lack cultural competencies. The review also recommended strategies
addressing patient-provider communication to improve clinical management practices and prevention of adverse
events among patients.38
The ratio of health workforce to population in Saudi Arabia has improved over the last decade, but the increase
is not impressive while comparing with other GCC countries. Huge influx of pilgrims during the Haj season could
intensely change the health workforce/population ratio as physicians, nurses, pharmacists, and allied health person-
nel are drawn from the different parts of the country. The pilgrimage poses special problems, not only in terms of
the number of people, but also the special health problems associated with this diverse group.13 The Saudi health
system is unique in that medical consultations are overwhelmingly doctor-patient encounters, unlike in other settings
where there are different pattern of health workforce mix like for example physicians, clinicians, and nurse practi-
tioners in the United States; physicians and barefoot doctors in China; and physicians and medical auxiliaries in most
Asian and African countries.13 Within the country, access to health workforce is also unequal. Many factors influence
geographical variation that is observed in health worker density. Regions with teaching hospitals and population that
can afford to pay for health services invariably attract more health workforce than regions without such facilities or
organizations. Hence, health worker density is likely to be higher in urban areas where higher income is common.
Rapid development of health system could be one of the reasons that led to shortage of trained health work-
force, as recruitment of workforce was not in tandem with the increased requirement of health facilities in the coun-
try. In order to meet the requirements, the government has set a target for 2030 of physician to a population ratio of
1:500, with 60% of all doctors in the country being Saudi nationals; this target compares with the WHO recommen-
dation of 1:600.39 With the changing demographic and health scenario, the country requires a huge number of spe-
cialized health professionals in selected disciplines to meet future challenges. According to the MOH report, there is
also serious scarcity of physicians in family medicine as only 5% of all physicians practices the family medicine.2 In
the pharmacy sector, a recent study has estimated the total requirements for 12 078 clinical pharmacists in all sec-
tors by 2030 with MOH hospitals and primary health centers requiring highest demand for clinical pharmacists.40 In
order to meet the health care requirements of the fast growing as well as changing composition of population, the
country requires huge number of health facilities and trained health workforce in the fields such as mother and child
health, obstetrics, gynecology, and pediatrics. Increasing number of elderly population because of improved life
expectancy requires more number of medical specialists for treatment of chronic and long-term care. An Oxford
review estimated that the country requires an additional 20 000 hospital beds by 2035 to meet many of its future
health challenges.41 This means a huge number of Saudi nationals will be required to achieve the objectives of Vision
2030.
NTP 2020 envisages increased participation of the private sector in health care provision through alternative
health financing models. Currently, the private health sector, which owns 32% of hospitals and 24% of hospital beds,
is likely to play a crucial role in future health care provision but it is observed that private sector hospitals are con-
centrated in regions like Riyadh and Jeddah with 40 hospitals in each regions (50.6% of all hospitals in the Kingdom).
Riyadh region has highest number of private hospital beds (30.8%) in the country. Emergence of lifestyle-related dis-
eases such as diabetes, hypertension, obesity, cardiovascular, and kidney diseases have created new opportunities
for growth, and the private sector is gradually expected to play an important role and, hence, the need for more
skilled health care professionals. But with the limited supply of medical specialists in the country and poor inclination
to work with the private hospitals, this sector may face major challenges in attracting and retaining well-qualified
Saudi and non-Saudi medical professionals.
Considering the above challenges, more realistic health workforce development plans and long-term strategies
are formulated in the HSTP by the MOH in line with NTP 2020. As envisaged in HSTP, workforce development
should guide investment in medical education and allied health sciences for meeting the future requirements of
10 ALBEJAIDI AND NAIR

health system. Strategies should expand coverage by ensuring numeric adequacy, developing appropriate workforce
mix, and encouraging rural and social outreach. Emphasis should be on career focused education, motivating Saudi
nationals to pursue medical profession and increasing capacity of medical, nursing, and allied health institutions. It is
also important to raise the educational standards of medical, nursing, and allied health institutions in the country
through reforming curriculum and improving teaching learning environment in accordance with the international
standards.

6 | CO NC LUSIO N

Vision 2030 serves as a road map for economic development in Saudi Arabia. The vision envisages a shift in
share of Saudi Arabian nationals in health workforce from existing one third to two thirds in 2030 by adopting
new strategic approaches, key performance indicators, and targets. The HSTP clearly identifies the future training
and development needs career planning and talent management areas for the health workforce in Saudi Arabia.
In order to meet the huge demand for health workforce, public-private partnerships needs to be expedited in
training and development as envisaged in NTP and HSTP. To achieve the targets set by the vision, the govern-
ment needs to adopt rigorous approaches by investing heavily on medical, nursing, and other specialized fields of
health education. Emphasis should be given on increasing number of scholarships for studies abroad, establishing
more residential and CME programs, and encouraging citizens to take up health care profession. A well-defined
career path for clinical and support staff, improvement in employment regulations and create opportunities to
attract more qualified resources are required. To sum up, the government's priority needs to be on identifying
region-wise requirements for different categories of health workforce in the future, developing comprehensive
plan for training, skill development, and creating capabilities needed to perform different tasks. Besides, it is also
important to conduct a continuous evaluation of the performance of health workforce based on accepted criteria
to measure the work efficiency.

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How to cite this article: Albejaidi F, Nair KS. Building the health workforce: Saudi Arabia's challenges in
achieving Vision 2030. Int J Health Plann Mgmt. 2019;1–12. https://doi.org/10.1002/hpm.2861

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