MINISTRY OF PUBLIC HEALTH STATE OF ANNUAL REPORT 2017 MINISTRY OF PUBLIC HEALTH STATE OF QATAR ANNUAL REPORT 2017 EXECUTIVE SUMMARY TABLE OF CONTENTS

Foreword 2 Abbreviations 3 Executive Summary 4 1. Strategic Transformation 12 1.1 National Health Strategy 2018 - 2022 13 1.2 National Primar Primary Health Care Strategy 2013 - 2018 14 1.3 National Mental Health Strategy 2013 - 2018 14 1.4 Qatar National Diabetes Strategy 2016 - 2022 14 1.5 National E-Health and Data Management Strategy 15 1.6 National Continuing Care Design Strategy 15 1.7 National Laboratory Integration and Standardization Strategy 15 1.8 Qatar Public Health Strategy 2017 - 2022 15 1.9 National Cancer Framework 2017 - 2022 16 1.10 National Oral Health Strategy Road Map 16 1.11 National Autism Plan 2017 - 2021 16 2. Health Sector Governance, Regulation and Management 18 2.1 Governance 19 2.2 Business Planning and Performance 19 2.3 Health Sector Financing 20 2.4 Health Insurance 20 2.5 International Engagement 21 3. Public Health System Capacity 22 3.1 Infrastructure 23 3.2 Workforce 26 3.3 Connecting the System 29 4. Services: Delivering More and Better Care 32 4.1 Health Promotion and Disease Prevention 38 4.2 Communicable Diseases 39 4.3 Non-Communicable Diseases 40 4.4 Injury and Trauma Management 44 4.5 Child and Adolescent Health 46 4.6 Women and Maternal Health 46 4.7 Occupational Health and Safety 47 4.8 Home Health Care 47 4.9 Organ Donation and Transplantation 48 4.10 Treatment Abroad 49 © Ministry of Public Health 4.11 Food and Environment Health 49

Ministry of Public Health, Qatar 4.12 Emergency Preparedness and Response 49 P.O. Box 42 4.13 Pharmaceutical Services 50 , Qatar www.moph.gov.qa 4.14 Laboratory and Diagnostic Services 51 References 52 Printed in Qatar, 2019.

1 EXECUTIVE SUMMARY

FOREWORD ABBREVIATIONS

CD Communicable Disease The public healthcare system in Qatar is committed to the continuous CME Continuing Medical Education improvement of health outcomes for the well-being of the population of Qatar. The Ministry of Public Health works closely with its partners – Hamad CPD Continuing Professional Development Medical Corporation, Primary Health Care Corporation, Naufar and the Qatar HMC Hamad Medical Corporation Council for Healthcare Practitioners – to provide excellent quality of care and to HHC Home Health Care encourage the population to become their own health advocates. This Annual MC Medical Commission Report provides an account of our achievements in 2017. MOPH Ministry of Public Health The year 2017 was an exceptional year. The blockade imposed on Qatar NHS National Health Strategy provided an important opportunity to test our resilience and strength. We are NCD Non-Communicable Disease proud to report that Qatar’s health system withstood all challenges. We ensured PHCC Primary Health Care Corporation uninterrupted healthcare services delivery and medications supply. We also successfully strengthened our food safety measures to facilitate the volume of QCHP Qatar Council for Healthcare Practitioners new products entering Qatar. We continued to transform our healthcare system QPHS Qatar Public Health Strategy by smoothly transitioning to the new National Health Strategy 2018-2022 and QRCS Qatar Red Crescent Society implementing other key strategies. To meet current and future demands, we QAR Qatari Riyal opened four new hospitals in 2017 and we expect to open four new primary healthcare centers and one more hospital in 2018. We thank His Highness The WHO World Health Organization Amir, Sheikh , for his leadership and clear direction. We are also thankful to our colleagues from other governmental organizations and the health sector as a whole, public and private, for their collaboration and dedication.

We are proud of our achievements in all health areas and are delighted that our progress is recognized internationally. Having made truly remarkable progress over the past years, our ambition is to continue this trend for the future and move Qatar’s health system forward to provide better health, better care and better value for Qatar’s population.

Her Excellency Dr. Hanan Mohamed Al Kuwari Minister of Public Health

2 3 EXECUTIVE SUMMARY EXECUTIVE SUMMARY

In line with the Qatar National Vision 2030 to achieve a comprehensive world-class healthcare system whose services are • Finalization and beginning of implementation of the priorities. The National Permanent Pricing Committee was accessible to the whole population, the Ministry of Public Health (MOPH) and its partners - Hamad Medical Corporation Qatar Public Health Strategy 2017-2022. To finalize established in 2017 to review the healthcare services pricing (HMC), Primary Health Care Corporation (PHCC), Naufar and Qatar Council for Healthcare Practitioners (QCHP) - are the Strategy, the MOPH launched the first of their kind standards in the private sector. committed to continuously improving the health of Qatar’s population and the care it receives. Each year we report on our public consultations across all citizens and residents progress, reflect on our challenges and set plans in motion to achieve our ambitious goals. of Qatar and consulted widely with the World Health During 2017, the MOPH was actively engaged Organization and Institute for Healthcare Improvement in international health affairs. Six Memoranda of In 2017, the health sector successfully overcame challenges imposed by the blockade and demonstrated its resilience. experts. The implementation of the Strategy is being Understanding were signed with healthcare systems to Under the strong leadership of His Highness The Amir, Sheikh Tamim bin Hamad Al Thani, with the overwhelming support overseen by the Public Health Committee. cooperate in the areas of healthcare research, health of the people of Qatar and the commitment of all organizations, we strategically managed these challenges. The health information systems and epidemiology, quality and system ensured uninterrupted delivery of healthcare services and further improved its performance. The public health system • Consolidation of the outcomes of the National Cancer standards of healthcare provision, healthcare financing, introduced new services and significantly expanded its infrastructure. To guide the development of the Qatar health system Strategy 2011-2016 and the Qatar National Cancer exchange of expertise and experts. The MOPH participated over the next five years, the National Health Strategy 2018-2022 was developed, while implementation of existing health Research Strategy (2012) under the umbrella of the in the second Global Ministerial Summit on Patient Safety strategies and frameworks continued as planned. This report highlights these and other achievements of the public health National Cancer Framework 2017-2022. To ensure and the World Health Assembly. Further, the MOPH system during 2017. strong leadership, the National Cancer Committee reinforced its commitment to improve patient safety across and the Qatar Cancer Research Partnership were re- the healthcare system on the international level by signing established in 2017 to align with the Framework. the third Global Patient Safety Challenge of the World STRATEGIC TRANSFORMATION In addition to the National Health Strategy 2018 - 2022, Health Organization, under the theme Medication without work continued on the implementation of current long- • The National Oral Health Strategy Road Map was Harm. The MOPH actively participated in the meetings During 2017, we consolidated our achievements under term plans and preparation of new strategic initiatives, approved in 2017 for implementation from 2018 of the World Health Organization Regional Office for the the National Health Strategy 2011-2016 and prepared including: onwards. Implementation activity commenced ahead of Eastern Mediterranean and in meeting sessions of the Arab the health sector for transition to the next stage of the formal start date with the launch of the Qatar Child Health Ministers Council. development. The National Health Strategy 2011-2016 was • Continued implementation of the National Primary Oral Health Survey. The implementation of the Road officially closed in May 2017 with a completion rate of 80%. Health Care Strategy 2013-2018. Nine additional Map is overseen by the National Oral Health Committee. A special event to acknowledge the dedication, support recommendations were completed and turned into PUBLIC HEALTH SYSTEM CAPACITY and tremendous efforts to transform Qatar’s health system business-as-usual, bringing up the completion rate to • Launch of the National Autism Plan 2017-2021 under was held at the MOPH. At the same time, the transition to 84%, from 75% at the end of 2016. the patronage of His Excellency the Prime Minister and The year also marked expansion in facilities, growth in the next stage of development, to be driven by the National the Minister of Interior of Qatar, Sheikh Abdullah bin the health workforce, and implementation of key new Health Strategy 2018-2022, was in full preparation for launch • Continued implementation of the National Mental Nasser bin Khalifa Al Thani, and in collaboration with services. HMC successfully completed the mobilization in early 2018. Health Strategy 2013-2018. The completion rate key Ministries and Qatar Autism Families Association [1]. stage and opened the majority of intended services to increased to 83%, from 64% at the end of 2016, with the public in the new Hamad bin Khalifa Medical City The National Health Strategy 2018-2022 was developed successful closure of an additional four pledges. complex. The new hospitals, Qatar Rehabilitation Institute, in close alignment with the Qatar Second National HEALTH SECTOR GOVERNANCE, REGULATION the Ambulatory Care Center and the Women’s Wellness Development Strategy 2018-2022. The MOPH engaged in • Implementation of the Qatar National Diabetes AND MANAGEMENT and Research Center, represent the biggest expansion of wide-scale consultations across the health sector for the Strategy 2016-2022 commenced. To oversee the healthcare facilities. They significantly increase bed capacity, development of the Strategy. Seven subgroups and task Qatar National Diabetes Strategy 2016 - 2022, the The MOPH continued to improve regulatory and provide faster access to specialized treatment and overall, teams comprising membership from across the health MOPH established the National Diabetes Committee planning services and frameworks to achieve its improve public health sector capacity to provide highest sector, with intergovernmental participation, where relevant, and three subcommittees. By the end of 2017, the objectives. In 2017, the healthcare system was governed quality of healthcare1. His Highness The Amir, Sheikh Tamim worked around the content themes. In its final form, the Strategy achieved 50% completion of Phase 1 outputs. by the Executive Board, which was supported by eight Bin Hamad Al Thani, officially inaugurated the new Medical National Health Strategy 2018-2022 focuses on seven Committees dedicated to specific areas of the health sector City complex of HMC in December 20172 [2]. priority population groups, identifies five cross-cutting • Continued implementation of the Continuing Care responsibilities and operations. The MOPH implemented strategic priority areas and nineteen national targets, to be Design Strategy and resource mobilization to support Phase 2 of the government performance standards. PHCC completed construction of two new health centers to achieved by 2022. implementation of the National E-Health and Data be opened in early 2018 and construction of another two Management Strategy, and the National Laboratory The MOPH also established and delivered the first Health health centers scheduled for 2018 were nearing completion. The National Health Strategy 2018-2022 sets a clear Vision Integration and Standardization Strategy. Sector Business Planning Cycle through the production of Naufar completed and commenced operations of its new of Our Health, Our Future. It calls for improved health for a Public Health Sector Planning Framework, which sets out facility. The MOPH completed construction of Ras Laffan Qatar’s population, meeting the needs of existing and the guidance for coordinated planning across the sector to hospital; and construction of Mesaieed hospital was nearing future generations by means of an integrated system that achieve transformational change in accordance with sector completion. aims to achieve better health, better care and better value for all. 1 Opening of the new Medical City complex adds additional 500 new beds with 3,000 highly trained clinical and support staff to care for patients [2]. 2 All three hospitals commenced operations ahead of the official opening [2]. The Qatar Rehabilitation Institute was the first out of three hospitals to open its doors. It started with outpatient services in 2016 and commenced provision of inpatient services in 2017.

4 5 EXECUTIVE SUMMARY EXECUTIVE SUMMARY

HMC commenced the provision of a number of new sector facilities obtained licenses to provide healthcare Qatarization continued to be the focus of recruitment and PHCC also developed and delivered the first two batches of specialist services, including the Breast Care Clinic, the services in Qatar and 650 private facilities renewed their retention. Nearly half (48.7%) of the MOPH and Qatar Council the Foundation Level Medical Arabic Language Skills course Tobacco Control Center3 and the National Obesity Center. licenses. for Healthcare Practitioners employees were Qatari nationals, to non-Arabic speaking physicians. HMC, in partnership with PHCC concluded a Family Medicine Model pilot and is while HMC, PHCC and Naufar successfully increased their the Joint Commission International, organized a yearlong preparing for the roll out to new and existing centers. To streamline and facilitate the facility licensing process, the Qatari national workforce to 12.1%, 21.2% and 18.0% of foundational quality management workshop for HMC’s Beautiful Smile service and psychological support services MOPH closely cooperated with the Ministry of Economy and their total workforces, respectively. PHCC developed a new chief executive officers, senior leaders, clinicians and other were expanded to additional health centers, while post- Commerce and successfully moved its facilities licensing training program to include comprehensive information frontline clinical staff. natal six-week check-ups and SMART health checks became renewal services to the Single Window4, a project aligned with technology skills, and the Excellence in Job Performance available at all PHCC centers by the end of 2017. the cross-government initiative to streamline and facilitate program, which covers communication, customer service, Across the health sector, QCHP recorded additional 6,501 the procedures for commercial registration and licenses. report writing and time management skills. Six hundred and healthcare practitioners’ activated accounts (23.8% growth Healthcare providers outside the core public health service forty Qatari staff completed the program. The first cohort of from the end of 2016) with 567,539 continuous professional also expanded availability and scope of services. Sidra The public health sector workforce increased by 8% to Qatari Program Support Managers successfully completed development activities reported (176.5% growth). Medicine was preparing for the launch of inpatient services 34,503 staff in total to serve demand for its services. The their in-post two-year training at the MOPH and graduated in early 2018 and two new private hospitals, Turkish hospital increase spanned across all clinical workforce categories from the program. and Dr. Moopen’s Aster hospital, successfully entered Qatar’s including physicians, nurses, dentists, pharmacists and health market in 2017. Over 200 newly established private allied health professionals.

3 The official inauguration is planned for early 2018. 4 The Single Window project was launched in 2011 and is a one-stop-shop initiative led by the Ministry of Economy and Commerce which aims to streamline and facilitate the procedures for commercial registration and licenses [36].

6 7 EXECUTIVE SUMMARY EXECUTIVE SUMMARY

SERVICES: DELIVERING MORE AND combined knowledge and expertise within each of the Exchange Program was developed and implemented In 2017, the MOPH conducted 1,520 pharmaceutical facility BETTER CARE partner organizations in the public health sector to raise connecting HMC, PHCC and Sidra Medicine. The Program inspections (6% growth) and more than quadrupled a safety standards across the whole system towards achieving is a new technology network, which enables the exchange number of drug quality tests (31,720 or 329% growth) with The public health sector strives for excellence in patient zero preventable harm. of patient information between providers, facilitates an opening of the microbiology unit. In addition, the MOPH safety and quality of healthcare to meet the highest access to a more complete patient record, supports quality conducted 2,313 communicable diseases surveillance visits international standards. The public healthcare system is committed to preventing improvement initiatives and overall significantly improves (17% growth) and 1,357 environmental health inspections ill-health, improving health awareness and enabling efficiency of healthcare services delivery. Both initiatives are (17% growth). In 2017, PHCC achieved the prestigious Diamond people to become their own health advocates. In 2017, embedded in the Clinical Information System, which was Accreditation Certificate from Accreditation Canada the National Screening Programs Committee approved successfully rolled out across the entire public health system The public health sector is increasingly operating under International. Naufar achieved accreditation from the the National Screening Framework and Operating Model, in 2016. the principle of Better Together, which places the patients’ Commission on Accreditation of Rehabilitation Facilities, after in order to streamline and govern all national screening wellbeing at the center of health services. The concept successfully completing its readiness assessment in 2016. programs in Qatar. The Framework and Operating Model, The National Informed Consent Policy also explicitly brings together specialists from primary, secondary and HMC moved into its second year of the Joint Commission which is binding on all parties involved, aligns current recognizes patient rights and responsibilities and tertiary care, to ensure smooth transition of patients and International accreditation for all its hospitals achieved national screening programs within a framework of agreed explicitly involves patients in shared decision-making. continuity of care, as the patient moves through different in 2016, and the Ambulance Service and Stroke Service policy, and provides guidelines and specifies requirements The National Informed Consent Policy was finalized in 2017 levels of care according to the needs at any point in time. both received reaccreditation by the Joint Commission for establishing and sustaining national screening programs. and approved for pilot testing in early 2018 by the Health Since its inception, Better Together principle has been International in 2017. The Echocardiology Laboratory at the Sector Regulatory Committee and the Permanent Licensing extended to areas such as dermatology, ophthalmology, HMC Heart Hospital has been accredited by the European In 2017, multiple education and health promotion campaigns Committee. The Policy determines accountability on both dental, physiotherapy, cardiology and mental health. The Association of Cardiovascular Imaging for Transthoracic, were run throughout the year, to encourage the population of sides and ensures that healthcare providers abide by legal, accumulated knowledge and experience under Better Transesophageal and Stress Echocardiography at an Qatar to live healthy lifestyles. The MOPH launched a multi- professional and ethical obligations to sufficiently inform Together will serve as a significant foundational block for Advanced Level, which is the highest level of accreditation staged Start Now wellness campaign focusing on reduction the patients in order to help them make informed voluntary implementing Integrated Model of High-Quality Care and and has been achieved by only 12 laboratories in the world5. of non-communicable diseases in Qatar and building a decisions to accept or refuse a treatment or a procedure. The Service Delivery under the National Health Strategy 2018- culture of health. The campaign promoted positive health Policy was developed in collaboration with the Permanent 2022. The MOPH advanced the development of a National impacts of maintaining regular physical activity (Start Now, Licensing Committee members, QCHP and representatives Infection and Prevention Program, a National Action Plan to Be Active) and educated the public on the importance of from healthcare facilities. To further support treatment of non-communicable Combat Anti-Microbial Resistance, and commenced official choosing a balanced diet with the right nutritional values diseases and associated risk factors, the MOPH developed implementation of the Patient Safety Friendly Hospital (Start Now, Eat Healthy), and overall promoting healthy Substantial progress was made across all spectrums the bylaws for the implementation of the Law No. 10 of 2016 Initiative assessment. The MOPH also developed and lifestyle attitudes (Start Now, Be Healthy). The public health of healthcare services delivery. The volumes of services on Control of Tobacco and its Derivatives and developed published an additional 16 National Clinical Guidelines and sector explored every opportunity to engage the community provided increased to meet the demand for healthcare. clinical guidelines to treat tobacco dependency. The new associated pathways, resulting in 30 guidelines in total by and promote healthy attitude and actively participated in the The public health system delivered 326,898 of inpatient HMC Tobacco Control Center will boost system capacity to the end of 2017. In 2017, fifty public and private healthcare Qatar National Day and the Qatar National Sport Day. The discharges (6% growth) with 57% of those being discharges support people to quit smoking and to enhance research for providers participated in the Health Services Providers activities created platforms to raise awareness about healthy with a length of stay less than 24 hours, 5.4 million of tobacco control. Being the first World Health Organization Agreement. practices, to promote healthcare services through medical outpatient visits (9% growth) and 166,175 home health care Collaborating Center in Qatar, the Center will have an check-ups, to share health tips and educational material and visits (25% growth). Diagnostic services performed 46.5 important role in educating the community on the impact of The third Qatar Patient Safety Week was conducted in presented opportunities to meet clinical experts. The public million of laboratory tests (16% growth) and pharmacies tobacco and will adopt newly introduced innovative clinical September 2017, under the theme United for Patient was actively supported during the Holy Month of Ramadan dispensed over 20.8 million of prescribed medications (30% services such as laser therapy. Safety. The event was conducted in partnership with public by the healthy lifestyle campaign Our Future lies in Our growth). The emergency departments saw fewer visits for and private organizations to emphasize the importance of Health and by the designated Ramadan health website. patients (1.7 million) compared to 2016 (1% decline), which PHCC actively assists its patients to improve their health patient safety and joint efforts to understand and overcome could be indicative of a growing importance and quality of and wellbeing through multiple specially designated clinics challenges, share knowledge and achieve improvements. To further empower patients, the public health sector worked services provided in the primary care. The trends are being for Health Coaching, Healthy lifestyle, Health Education, The fifth Annual Forum on Quality and Safety on the establishment of the MyHealth patient portal, for the monitored continuously, to allow for dynamic adjustment in Dietetics and Diabetes Education. These services were in Healthcare organized by HMC in partnership with the launch in early 2018 under the patronage of His Excellency clinical services provided by the health system and for timely enhanced by the new SMART check-up assessment Institute for Healthcare Improvement attracted nearly 3,000 the Prime Minister and the Minister of Interior of Qatar, intervention where required. For these purposes, in 2017, the program, which was rolled out to all health centers in healthcare professionals from Qatar and internationally. The Sheikh Abdullah bin Nasser bin Khalifa Al Thani [3]. MyHealth MOPH established a monthly public health system reporting 2017. The smoking cessation clinics were provided in 7 Forum centered on the themes of Better Health, Better Care enables patients to access their electronic personal health framework, to actively monitor trends and developments health centers, where 1,584 patients were assisted and 208 and Better Value. record and empowers patients to make more informed in health services provision across operational and quality successfully quit smoking. decisions about their well-being. The establishment of the domains. The National Patient Safety Collaborative was launched My Health portal followed a successful pilot conducted in 2017. The collaborative is designed to harness the at HMC and PHCC. In parallel, the Health Information

5 In addition, the Heart Hospital’s laboratory is the first and only to be accredited outside Europe.

8 9 EXECUTIVE SUMMARY EXECUTIVE SUMMARY

To further improve clinical care for diabetic patients, the To further reduce incidence of communicable diseases, the number of kidney and liver transplant operations, thus MOPH developed six6 clinical guidelines and associated the MOPH maintained a vaccination coverage above helping to reverse trends in need for treatment abroad8. pathways. HMC officially opened the National Obesity 90% in all national immunization schedules for children Both HMC and PHCC organized blood donation and organ Treatment Center to deliver holistic, multidisciplinary care under-five, and conducted an annual Tetanus, Diphtheria donation campaigns. By the end of 2017, the number of for patients in need of medical management, lifestyle and Pertussis campaign for students and annual influenza registered donors increased to 259,470 or by 45% since 2016. modifications, bariatric and endoscopic procedures. vaccination campaign for all high-risk groups. To further build health sector capacities in vaccinations, a Vaccine Our efforts and the progress we make are recognized A group of Patient Educators from HMC graduated from the Management training course and the firstAdverse Event locally and globally. The improvements in the healthcare Diabetes Education and Self-Management for Ongoing and Following Immunization training workshop were conducted services delivery are well reflected in rising satisfaction Newly Diagnosed program and became the first certified with the support of international experts. An introduction levels across the public healthcare system. PHCC recorded educators of the program in the Middle East and Gulf of a new vaccine for Human Papilloma Virus was approved 92% satisfaction levels compared to 83% in 2016. Overall region. PHCC commenced a rigorous training for diabetes with the launch scheduled in 2018. The MOPH developed satisfaction with HMC services have improved from 83% to clinical guidelines. Food Borne Disease Outbreak Investigation guidelines and 87% and reached as high as 93% satisfaction in the domain trained relevant personnel for food poisoning outbreak of Treatment and health care professionals. Naufar recorded In November 2017, HMC and Qatar Metabolic Institute investigation and response. 95% satisfaction level across all its services. As measured by hosted the second Qatar Diabetes, Endocrinology and the Legatum Prosperity Index9, in 2017, Qatar’s performance Metabolic Conference, which brought together more HMC opened a travel clinic, the first of its kind in Qatar, at in the areas of basic physical and mental health, health than 700 local and international experts in the fields of the Communicable Disease Center, to provide counselling, infrastructure and preventative care was ranked as 13th best endocrinology, obesity, osteoporosis, and diabetes. vaccinations and other preventative measures to travelers as in the world [4], moving up from already high 15th position well as assessment and medical care for travelers returning in 2016. To improve mental health and wellbeing, mental health with travel-related infections. care pathways were developed for treating children and These key achievements of the Qatar public health system adolescents, perinatal services and substance misuse in a To maintain Qatar’s readiness for any health emergency, during 2017 demonstrate our commitment to provide secondary care setting. To increase capacity and improve the National Health Emergency Management Plan and the population of Qatar with world-class healthcare. The access to inpatient care, HMC opened a new mental Essential Emergency Stockpile were finalized and delivered full Annual Report provides a detailed account of our health service facility and dedicated mental health beds to the Permanent Emergency Committee. The budget for progress. were added at Rumailah Hospital and Residential the Emergency Stockpile was secured. Together with HMC Community Compounds. and PHCC, the MOPH disseminated and trained on the national emergency management framework through a Psychological services were also integrated into the series of workshops. The National Emergo Train team7 was primary care setting and the community level in order established. The MOPH participated in the multi-agency to reduce stigma and to allow patients to access mental Hamad International Airport Emergency Exercise Delta Oryx health services outside a hospital setting. Two mental and supported the creation and the revision of hospitals and health community hubs were established to offer specialist polyclinics emergency plans. mental health assessment, treatment and care to people with severe or long-term mental health problems in their Overall, the year 2017 witnessed significant advancements home or community. Two psychological support clinics were in public health sector capacity and capability to deliver integrated and introduced at PHCC centers. highly specialized services. In addition to the above, HMC performed Qatar’s first ever allogeneic hematopoietic stem Naufar conducted outreach programs, the Qatar National cell transplantation. Following the successful Qatar’s first- Family Day and Ramadan Family Support Event, to ever liver transplant from a living donor performed towards highlight the role of the family in the society, personal life the end of 2016, a second liver transplant from a living and in the patient’s recovery process. Naufar hosted its donor was conducted in 2017. Further,in June 2017, eight first International Addiction Conference, under the theme patients successfully underwent liver and kidney transplant Opioid Addiction: Interdisciplinary Treatment Informed operations in one week, which is a record number of by Wellness with 20 international experts and over 160 transplant procedures in one week for HMC. All patients were delegates in the field of addiction science and allied health discharged home and monitored by the transplant teams fields participating in the conference. as part of their follow-up care. During 2017, HMC doubled

8 In 2017, HMC performed 55% of required liver and kidney transplant operations and 45% were conducted overseas, while 2016 statistics show 45% and 55% 6 Five clinical guidelines for diabetes mellitus in children and adolescents, diabetes mellitus type 2 in adults and the elderly, diabetes mellitus type 1 in adults and accordingly. the elderly, diabetes mellitus in pregnancy, chronic complications of diabetes mellitus were published in 2017 and diabetes in special situations is scheduled 9 The Legatum Prosperity Index consists of nine Pillars of Prosperity. The Health Pillar measures country’s performance in three areas: basic physical and mental for publication in early 2018. health, health infrastructure and preventative care [4]. In 2011, the first year of the National Health Strategy 2011-2016 implementation, Qatar health was placed 7 The Emergo Train Team is composed of senior instructors from the public health system who participate in the planning and implementation of training on 20th position. activities using the Emergo Train Kit. The Emergo Train System (https://www.emergotrain.com/) is a simulation system used for education and training in emergency and disaster management.

10 11 STRATEGIC TRANSFORMATION

During 2017, we consolidated our achievements under the National Health Strategy (NHS) 2011-2016 and prepared the health sector for transition to the next stage of development. The NHS 2011-2016 was officially closed in May 2017 with a completion rate of 80%. Prior its closure, all projects underwent a thorough analysis to assess progress and achievements, to understand key learnings and to propose next steps for continued improvement.

A special event to acknowledge the dedication, support and tremendous efforts to transform Qatar’s health system was held at the Ministry of Public Health (MOPH). At the same time, the transition to the next stage of development, to be driven by the NHS 2018-2022, was in full preparation for the launch in early 2018.

NATIONAL HEALTH The progress is further outlined below. 1.1 STRATEGY 2018 - 2022 National Health Strategy 2018 - 2022: Vision and Strategic Priorities The NHS 2018-2022 was developed in close collaboration Box 1 with the Qatar Second National Development Strategy The NHS 2018-2022 sets a clear vision of Our Health, Our Future. 2018-2022. The MOPH engaged in wide scale consultations It calls for improved health for Qatar’s population and meeting the across the health sector for the development of the Strategy. needs of existing and future generations. The Strategy will shape Seven subgroups and task teams, comprising membership an integrated system and model of care, which is patient-centered, from across the health sector and intergovernmental values patient experience and empowers patients to share in participation, worked around the content themes. In its responsibility for their health. The Triple Aim of achieving better final form, the NHS 2018-2022 focuses on seven priority health, better care and better value underpins the implementation population groups, identifies five cross-cutting strategic approach for the Strategy, helping to ensure we focus on improving priority areas and nineteen national targets, to achieve by STRATEGIC health and healthcare in a sustainable way [5]. 2022.

TRANSFORMATION In addition to the NHS 2018-2022, work continued The NHS 2018-2022 focuses on seven priority population groups: 1 on implementation of existing long-term plans and 1. Healthy Children and Adolescents preparation for new strategic developments. 2. Healthy Women leading to Healthy Pregnancies 3. Healthy and Safe Employees All strategic plans and frameworks are being aligned with 4. Mental Health and Wellbeing 5. Improved Health for People with Multiple Chronic Conditions the NHS 2018-2022. During 2017, the MOPH and the public 6. Health and Wellbeing for People with Special Needs health sector worked on: 7. Healthy Aging

• Continued implementation of the National Primary and identifies five system-wide priorities which aim at improving Health Care Strategy 2013-2018, the National Mental health and health outcomes for all people living in Qatar: Health Strategy 2013-2018, the Qatar National Diabetes Strategy 2016-2022 and the Continuing Care Design 1. Integrated Model of High Quality Care and Service Delivery Strategy; 2. Enhanced Health Promotion and Disease Prevention 3. Enhanced Health Protection • Mobilization and preparation for the implementation 4. Health in All Policies of the National E-Health and Data Management 5. Effective System of Governance and Leadership Strategy and the National Laboratory Integration and Standardization Strategy;

• Development and finalization of the Qatar Public Health Strategy 2017-2022, the National Cancer Framework 2017-2022, the National Oral Health Strategy Road Map and the National Autism Plan 2017-2021.

13 STRATEGIC TRANSFORMATION STRATEGIC TRANSFORMATION

NATIONAL PRIMARY HEALTH CARE of mental health research governance, and the development of NATIONAL E-HEALTH AND DATA NATIONAL LABORATORY INTEGRATION 1.2 STRATEGY 2013 - 2018 mechanisms to facilitate service user and family participation 1.5 MANAGEMENT STRATEGY 1.7 AND STANDARDIZATION STRATEGY in mental health policy, planning and promotion. Further The National Primary Health Care Strategy was set to progress was made in open recommendations, including: The National E-Health and Data Management Strategy The National Laboratory Integration and Standardization address health challenges of the future with the goal of the development of mental health awareness campaigns aims to establish a world-class, sustainable, integrated Strategy set a work plan towards the integration and establishing a health system in Qatar, founded on excellent and availability of information resources, the development of and secure national E-Health ecosystem for Qatar standardization of laboratories work, in order to improve primary care. Its vision is comprehensive, integrated, person- eleven mental health promotion and prevention programs, and explicitly recognizes the need for concurrent and the health of individuals, families and communities. The centered primary healthcare, which works in partnership the establishment of community mental health services now coordinated execution of series of activities and goals in implementation of the Strategy is expected to commence with individuals, families, and communities to advance available in two geographical hubs, and the enhancement order to move forward towards the desired end state. To under overarching NHS 2018-2022 system-wide priority health and wellbeing. The Strategy is driven by the Primary of inpatient services through availability of additional beds, support the alignment and interaction of E-Health initiatives Integrated Model of High-Quality Care and Service Delivery. Health Care Corporation (PHCC). dedicated to mental health services. across the Qatar healthcare system, the MOPH will deliver a comprehensive and patient-focused E-Health model During 2017, nine additional recommendations were that improves the way patients receive care. The Qatar QATAR PUBLIC HEALTH completed and turned into business-as-usual, bringing QATAR NATIONAL DIABETES Health Information Exchange Hub will enable healthcare 1.8 STRATEGY 2017 - 2022 the completion rate to 84%, from 75% at the end of 2016. 1.4 STRATEGY 2016 - 2022 practitioners and patients to participate equally in managing The completed recommendations cover development and improving individuals’ healthcare. During 2017, the Qatar Public Health Strategy (QPHS) 2017- and implementation of clinical guidelines, development In 2017, implementation of the Qatar National Diabetes 2022 was finalized and its implementation commenced. and training of PHCC workforce and establishment of joint Strategy 2016-2022 commenced. The Strategy addresses In 2018, the Strategy will be refreshed and its implementation The Strategy aims to further develop an integrated and working protocols with HMC for selected areas. Significant the growing health challenge for Qatar, through six will commence with the appointment of an MOPH E-Health comprehensive system, that can effectively address current advancements were also made in the remaining open priority areas including awareness and prevention, patient Department Director. Wider recruitment, in addition to and future public health challenges, and to optimize the recommendations, including: the successful conclusion empowerment, care delivery, workforce capability and active engagement with the cross-government Qatar Smart health and well-being of all citizens and residents with of the Family Medicine Model pilot at Leabaib Health capacity building, information management, and research. Program13, will also be planned. particular attention to sub-populations at risk. The QPHS and Wellness Center, the expansion of the Beautiful Smile To oversee the Strategy, the MOPH established the National 2017-2022 consists of 4 strategic enablers and 16 health service to additional 7 health centers and the roll out of Diabetes Committee and three subcommittees. areas with 63 health objectives. Its progress is being psychological support services. Other advancements include: NATIONAL CONTINUING CARE monitored against key performance indicators, which are the expansion of post-natal six-week check-up service at all The Qatar National Diabetes Strategy 2016-2022 is being 1.6 DESIGN STRATEGY driven by strategic initiatives and projects. The Public Health PHCC centers, implementation of SMART Health Check implemented in two Phases. The first Phase consists of 20 Committee provides oversight and leadership to ensure the service in all health centers, roll out of regional specialist activities, and implementation began in 2017. The second The National Continuing Care Design Strategy presents QPHS 2017-2022 is implemented effectively using the World centers for ultrasound, laboratories, ophthalmology and Phase consists of 22 activities and is expected to commence a series of recommendations to deliver world-class Health Organization (WHO) global monitoring framework. It cancer services, and the introduction of e-referrals from all after the related activities in Phase 1 are completed towards personalized, coordinated and integrated care closer to receives monthly progress reports on the implementation of PHCC health centers to the first five HMC hospital sites. the end of 2018. home. It promotes the development of interconnected the strategy from the Public Health Implementation Group. services and processes that support and empower patients By the end of 2017, the Strategy achieved 50% completion to live healthy, active and fulfilling lives. Implementation During 2017, the MOPH conducted an intensive work NATIONAL MENTAL HEALTH of Phase 1 outputs. Under Pillars 1 and 2: Awareness and of the Strategy also calls for expanded use of mobile and on re-baselining and refining QPHS 2017-2022 strategic 1.3 STRATEGY 2013 - 2018 Prevention, a draft national agenda with key messages to information technology to support healthcare delivery in the objectives, key performance indicators, targets, structure support diabetic and pre-diabetic patients was developed community. In 2017, in partnership with Ooredoo, a six-month and benchmarks. These included the first of their kind public The National Mental Health Strategy aims to promote good and it is expected to be implemented from 2018. Addressing tele-monitoring pilot was conducted to test innovative use consultations across all citizens and residents of Qatar, and mental health and wellbeing, to prevent mental illnesses and Pillar 3: Care Delivery, the MOPH developed and published of technology, to enhance quality and efficiency of home close collaboration with the WHO and the Institute for to develop tailored, quality services that can be accessed the National Diabetes Clinical Guidelines and associated health care delivery. A post-pilot survey showed that 86% of Healthcare Improvement14. More than 15,000 responses when mental health issues occur. The Strategy implementation pathways10. Further, a patient referral and discharge criteria patients/caregivers are willing to consider tele-monitoring were received over five months of public consultation15 is overseen by the Public Health Committee, through the document11 was developed and agreed for HMC and PHCC. as part of their plan of care. period, which significantly contributed to and reinforced National Mental Health Strategy Implementation Committee. In addition, a pilot program to coordinate care for complex the Strategy’s objectives16. In addition to consultations on patients with diabetes commenced, building on PHCC and During 2017, the Strategy completion rate increased to 83%, HMC dedicated capacities. Under Pillar 4: Human Capital and 13 Qatar Smart Program or TASMU is designed to accelerate the achievement of all the pillars of the Qatar National Vision 2030. This program will serve as a from 64% at the end of 2016, with successful closure of additional Capacity Building, a national diabetes education curriculum platform for the realization of a digital economy and a smart future [22]. four recommendations. The completed recommendations was established with six continuing professional development 14 An independent not-for-profit organization that collaborates with health systems around the world to help them achieve significant results in quality, safety, and innovation [23]. 15 QPHS consultations were launched at the fifth Annual Middle East Forum on Quality and Safety in Healthcare in May 2017. cover: the integration of mental health services within primary accredited e-learning courses made available through a national 16 For example, over three quarters of respondents (77%) definitely believed that healthy living educational programs in schools will benefit the community. This care settings, the development and implementation of a mental on-line training platform. To accommodate for high demand supports Healthy Lifestyle Objective HL4, which aims to increase regular physical activity amongst school communities. Similarly, 81% of respondents definitely health promotion and prevention action plan, the establishment volumes12, a supporting student portal was also established. believed that education and support of mothers before, during and after giving birth would benefit the community. This reinforcesMaternal and Child Health Objective MC1, which aims to improve the health and wellbeing of women and children by establishing post-natal depression screening programs, maternal and child health profiling and care. Respondents also emphasized for the need of stricter law enforcements. For example, over a half of respondents (58%) ranked smoking among the top three issues that would benefit from stricter law enforcement. This supports the Tobacco Control Objective TC2, which aims 10 Five clinical guidelines for diabetes mellitus in children and adolescents, diabetes mellitus type 2 in adults and the elderly, diabetes mellitus type 1 in adults and to implement a tobacco law enforcement framework aligned with the WHO Framework Convention on Tobacco Control. Nearly all respondents (92%) either the elderly, diabetes mellitus in pregnancy, chronic complications of diabetes mellitus were published in 2017 and diabetes in special situations is scheduled strongly agreed or agreed that road accident deaths could be reduced if there were stricter law enforcement for unsafe driving behavior. This supports the for publication in early 2018. Road Safety Objective RS1 for strengthened road traffic law enforcement, as well as education and prevention programs. 11 This is being prepared for a scale up into a National Referral and Discharge guideline for Diabetic patients. 12 Approximately 35,000 learners.

14 15 STRATEGIC TRANSFORMATION STRATEGIC TRANSFORMATION

the QPHS 2017-2022 design, it is expected that WHO will of overall health. It creates a holistic design with four key for licensing of facilities, which provide services for the contribute to the Strategy implementation through technical domains and three foundational enablers. The domains individuals with Autism Spectrum Disorder. HMC reduced support, once specific areas are defined and agreed on. By cover population level prevention, targeted prevention waiting times for the assessment and diagnosis from 4-6 the end of 2017, twenty-five of the QPHS 2017-2022 projects initiatives, address sustainability of dental workforce and months to 2-3 months at its Child Development Center. began implementation17, and ten projects were on schedule quality and safety for patients and practitioners. The The Center also commenced provision of specialized against plans. framework identifies strong leadership and governance, training to organizations and trained Qatar Airways crews, integration, and information technology and research, as HMC Ambulance Services, and staff members at schools foundational enablers to facilitate implementation. in 2017. Special training20 was also provided to parents NATIONAL CANCER and caregivers on latest technology for Autism Spectrum 1.9 FRAMEWORK 2017 - 2022 The implementation activity commenced with the launch Disorder to be used in medical and social education. The of the Qatar Child Oral Health Survey in 2017, ahead of MOPH also organized a three-day special event, which The outcomes of the National Cancer Strategy 2011-2016 the formal start date. This nationwide survey focused on included workshops and exhibition with the participation and the Qatar National Cancer Research Strategy were oral health for 4-8 year old children18 and sought to gather of regional experts from and , to raise consolidated under one umbrella and in 2017, the National information on the prevalence of oral disease. It also awareness, provide parent support, and demonstrate and Cancer Framework 2017 - 2022 was launched. To ensure informs dental health authorities about desirable forms explain medical, educational and social services for Autism strong leadership, the National Cancer Committee and the of prevention, supports evidence-based services and Spectrum Disorder individuals. Qatar Cancer Research Partnership were re-established in programs planning, and provides a baseline for evaluation of 2017 to align with the Framework, which consists of 9 cancer service programs effectiveness. The survey was successfully During the National Autism Awareness Month, PHCC hosted care and research domains, a guide of 61 recommended completed in December 2017. In addition, a National Policy a series of activities to engage the public in taking actions activities and 25 success measures. The domains represent statement for the use, management and waste control of to support people with Autism Spectrum Disorder. PHCC the complete patient care pathways for cancer and are amalgam was finalized and approved by the National Oral professionals shared useful information and consultative based upon the WHO Cancer Care Continuum. The Health Committee. Scoping and implementation planning advice on autism and autism-specialized services. Lectures success measures capture effectiveness of the Framework completed for various oral health public awareness on autism awareness were given in health centers and and are being developed into a series of detailed program campaigns, which is expected to commence in 2018. students were educated though the school health program implementation plans and measurable outcomes. The initiative. National Cancer Framework 2017-2022 includes public education, awareness and prevention activities to support NATIONAL AUTISM PLAN The health sector initiatives in implementation of the National long-term objectives. It reinforces the need for rapid 1.11 2017 - 2021 Autism Plan were actively supported and complemented by diagnosis and multi-disciplinary sub-specialized precision partner organizations21, as stipulated by the Plan. cancer treatment, supported by local access to world The National Autism Plan 2017-2021 was launched in 2017, leading clinical research programs. In the Framework, under the patronage of His Excellency the Prime Minister cancer research components have been integrated with and the Minister of Interior of Qatar, Sheikh Abdullah bin the strategies for clinical services provision, as befits an Nasser bin Khalifa Al Thani and in collaboration with key academic health system. Ministries and Qatar Autism Families Association [1]. The National Autism Plan aims to improve the lives of individuals with Autism Spectrum Disorder and support their families. NATIONAL ORAL HEALTH The Plan strongly advocates that individuals on the autism 1.10 STRATEGY ROAD MAP spectrum have the right, now and in the future, to receive the right care and support and to have the same opportunities The National Oral Health Strategy Road Map was approved as their peers, within a society that accepts them. The in 2017 for implementation from 2018. The execution of National Autism Plan has specified 44 recommendations to the Road Map is overseen by the National Oral Health be implemented by 2021. Committee. During 2017, advancements were made across regulatory The Road Map provides a comprehensive design for the framework, operational services, awareness and technology future oral health and delivery of dental healthcare for support to enhance care for individuals with Autism Qatar, and aims to ensure that oral health is an integral part Spectrum Disorder. The MOPH introduced new standards19

20 Conducted by Mada Assistive Technology Center. The Center is a non-profit organization committed to connecting persons with disabilities to information and 17 Although the QPHS was approved in the 4th quarter of 2017, 18 of the 25 projects began implementation as early as the 1st and 2nd quarter of 2017. These were communication technology [35]. either transferred from the NHS 2011-2016 or were routine public health projects integrated into the QPHS 2017-2022 for formal monitoring and continuation. 21 These include Mada Assistive Technology Center, the Ministry of Education and Higher Education, the Ministry of Administrative Development, Labour and 18 There were 1,361 Qatari and non-Qatari children of both genders surveyed across 60 private and public schools and a response rate of 57% was achieved. Social Affairs, the Ministry of Culture and Sports, the Ministry of Interior, , Qatar Social Work Foundation and Shafallah Centre for Children 19 The standards were developed in cooperation with HMC and are based on the international best practice. with Special Needs and the Ministry of Awqaf and Islamic Affairs.

16 17 HEALTH SECTOR GOVERNANCE, REGULATION AND MANAGEMENT

In line with the Amiri Decree No. 10 of 2016, we continuously improve the MOPH regulatory and planning services and frameworks to achieve our objectives.

The MOPH’s functional responsibilities include: regulating and monitoring the entire health system, supervising and managing public health programs, managing food and environmental health, ensuring that the nation is prepared for any public health emergency, and conducting communicable diseases screening at the MOPH Medical Commission (MC) for newly arrived residents.

In addition, the MOPH supervises and funds Hamad Medical Corporation (HMC), Primary Health Care Corporation (PHCC) and Naufar. It also funds Qatar Council for Healthcare Practitioners (QCHP), which regulates the standards of healthcare professionals practicing in Qatar.

The MOPH also delivers healthcare for worker population, at designated health centers and MC units, operated by the Qatar Red Crescent Society (QRCS), a member of the International Federation of Red Cross and Red Crescent Societies.

GOVERNANCE BUSINESS PLANNING AND 2.1 2.2 PERFORMANCE

The current governance of the health sector was first Based on the Amiri Decree No. 10 of 2016, the MOPH HEALTH SECTOR established in 2016 and further enhanced in 2017, through established the Planning and Quality Department and key the addition of new committees. The Executive Board is appointments were made in 2017. The main role of the GOVERNANCE, chaired by Her Excellency the Minister of Public Health and department is to work on the MOPH corporate performance, 2 the membership consists of senior leaders from the MOPH, assure quality and improve the level of services provided by HMC and PHCC. The purpose of the Executive Board is to the MOPH. The establishment of this Department further REGULATION AND establish, maintain and communicate the strategic vision supports the MOPH and the Qatar health sector in achieving of the Ministry. It has the responsibility to agree the vision, the Qatar National Vision 2030 goals and objectives, and is mission, strategy and policy and agree on a forward plan part of the countrywide initiative to enhance the Government MANAGEMENT with clear objectives to deliver the organization’s purpose. sector. In line with the Department objectives, a plan to The Board is also accountable for setting clear targets for support and broaden the culture of quality within the MOPH improving health outcomes and to monitor progress. has been developed and implementation has commenced. In cooperation with the Ministry of Administrative Development, The Executive Board has established a range of Committees Labor and Social Affairs, the MOPH implemented Phase with delegated authority to oversee elements of the 2 of the government performance standards, which were organization. This enables the Board to gain assurance over developed under the guidance of the Council of Ministers. To the majority of the MOPH and health sector operations. In further raise standards and quality, the MOPH is working on 2017, these included: the Audit Committee, the Emergency obtaining the International Organization for Standardization Preparedness Committee, the Health Sector Finance 9001:2015 accreditation. and Budget Committee, the Health Sector Regulation Committee, the Health Sector Workforce Committee, At a national level, the MOPH established and delivered the the Public Health Committee, the Supreme Committee first public health sector business planning cycle through the for Healthcare Communications and the World Cup 2022 production of a Public Health Sector Planning Framework, Healthcare and Anti-Doping Committee. supported by the strategic priorities workshop to develop coordinated plans for the public health sector in 2019. The Planning Framework sets out the guidance for the way in which the health system must work together in planning to achieve transformational change in accordance with sector priorities each year, and includes a timetable with checkpoints that aligns with the sector budgeting process.

18 19 HEALTH SECTOR GOVERNANCE, REGULATION AND MANAGEMENT HEALTH SECTOR GOVERNANCE, REGULATION AND MANAGEMENT

In 2017, the MOPH established a monthly Public Health Public Health Sector Expenditure and System Reporting Framework, which actively monitors trends Table 1 Budget HEALTH INSURANCE INTERNATIONAL ENGAGEMENT and developments in healthcare services provision across Entity (QAR millions) 2016 2017 2.4 2.5 operational and quality domains. This allows to carefully Expenditurei Ministry of Public Health and monitor trends, to dynamically implement adjustments 3,196.2 3,426.8 Keeping in line with the Amiri Decree No. 10 of 2016, the During 2017, the MOPH was actively engaged to clinical services the health system provides and to Qatar Council for Healthcare Practitioners MOPH developed the Health Financing and Insurance in international health affairs. Six memoranda of Hamad Medical Corporationw 11,785.3 10,794.9 ensure timely intervention where required. The Reporting Department organizational and governance chart and understanding were signed with other healthcare systems26 Primary Health Care Corporation 2,195.8 2,015.1 Framework will be further extended to the private and semi- Naufar 143.8 171.7 initiated recruitment of relevant skilled staff to design, to cooperate in the areas of healthcare research, health public healthcare providers over the period of 2018 - 2019 in Total 17,321.1 16,408.5 implement, supervise and regulate the new Health Insurance information systems and epidemiology, quality and alignment with the NHS 2018-2022. Budgeti Scheme. standards of healthcare provision, healthcare financing and Ministry of Public Health and 3,297.5 3,613.3 exchange of expertise and experts. The MOPH participated Qatar Council for Healthcare Practitioners During 2017, the Scheme design was advanced with in the second Global Ministerial Summit on Patient Safety Hamad Medical Corporation 12,018.7 12,193.5 technical and actuarial support from external consultants and the World Health Assembly. Further, the MOPH HEALTH SECTOR FINANCING Primary Health Care Corporation 2,646.3 2,437.4 2.3 Naufar 423.6 216.0 and collaborations with stakeholders to ensure robustness reinforced its commitment to improve patient safety across Total 18,386.1 18,460.2 and sustainability of the new scheme. the healthcare system on the international level by signing In 2017, the public health sector spent 16,408.522 million Income the third Global Patient Safety Challenge of the WHO, Ministry of Public Health and Qatari Riyals (QAR), which was within the budget of 18,460.2 106.7 79.4 As a result, significant progress was made in advancing under the theme Medication without Harm [6]. The MOPH Qatar Council for Healthcare Practitioners QAR [Table 1]. Similarly, expenditure for major capital National Health Insurance Scheme readiness. The planning actively participated in the meetings of the WHO Regional Hamad Medical Corporation 357.2 383.6 works23 1,448.2 million QAR was within the budget of 3,603.8 and preparatory stage was completed in 2017 and Office for the Eastern Mediterranean and in the 47th and Primary Health Care Corporation 34.5 39.1 million QAR. In 2017, the public health sector collected Naufar 0.0ii 0.2 included finalization of draft Schedule of Benefits, data 48th meeting sessions of the Arab Health Ministers Council. 502.3 million QAR in revenues24, which was similar to 2016 Total 498.4 502.3 handling requirement for the scheme, provider readiness The MOPH Leadership conducted multiple engagements income levels. Note: and eligibility criteria for enrollment, pricing strategy with leaders of other health and regulatory systems to i - Includes payroll, operating expenditure and minor capital works. and framework. The National Coding Committee was ii – Reported income for Naufar is QAR 0.01 million. enhance bilateral and multilateral cooperation27. In addition, The Sector Finance and Budget Committee oversaw the established under the Ministerial Decree, which sets the the MOPH signed a memorandum of understanding with budget implementation of 2017 and the preparations for Clinical Coding Standards for reporting under the National Qatar Fund for Development28 under which the MOPH 2018. To ensure cohesive planning across the sector, a Health Insurance scheme. Policies on communications and contributes its technical expertise and assistance in Budget and Planning Working Group was formed under the engagement, complaints and disputes resolution, which identifying, delivering and monitoring international projects Committee. The 2018 budget consolidation was prepared will facilitate public awareness and interaction with all of Qatar Fund for Development associated with healthcare, in early 2017 for the entire public health sector based on the stakeholders in the insurance scheme, were defined. including emergency management29. performance-based budgeting framework and allowing for the anticipated activities of the forthcoming NHS 2018-2022. The draft Health Insurance Law has been finalized and upon The Committee also developed the proposals for services, its approval the Scheme will enter the implementation which should be consolidated and shared across the public stage. The implementation stage includes selecting a health health sector. This initiative will ensure cost effectiveness insurance provider and rolling out the scheme in several and efficiency savings. stages covering eligible population groups.

As the regulator of the health sector, the MOPH established the National Permanent Pricing Committee25 with the aim of conducting an ongoing review of the healthcare services pricing standards in the private sector.

26 These include memoranda signed with New Zealand, the Republic of Indonesia, the Republic of Poland, the Republic of Tajikistan, the Republic of the 22 Expenditure and Budget exclude Chapter 4 for Major Capital Expenditure. Philippines, and the United Kingdom of Great Britain and Northern Ireland. 23 Responsibility for the expenditure management under Chapter 4 Major 27 These include the French Republic, the Kingdom of Sweden, the Republic of Austria, the Republic of Cuba, the Republic of Djibouti, the Republic of India, the Capital Works is shared with the Public Works Authority Ashghal and the Republic of Korea, the Republic of the Philippines, the Republic of Turkey, the Sultanate of Oman, the United Kingdom of Great Britain and Northern Ireland Private Engineering Office; and therefore is excluded from Table 1. and the United States of America; and international agencies including the WHO and the Medecins Sans Frontieres. 24 Income is derived from operational revenues such as licensing and 28 The Qatar Fund for Development finances and supports international projects in several countries and in various fields including healthcare [24]. certificate fees and issuance of health cards or co-payments by patients. 29 The focus on emergency management is important, as even if the service itself is not related to emergency management, the services are often provided in All revenues are transferred to the Ministry of Finance on a monthly basis. relation to humanitarian crises or in insecure locations. 25 Ministerial Decree No.18 of 2017.

20 21 PUBLIC HEALTH SYSTEM CAPACITY

During 2017, there was a significant expansion in facilities, growth in the health workforce and the services to address health needs, in line with the Qatar National Vision 2030.

INFRASTRUCTURE Center, the Women’s Wellness and Research Center and 3.1 Qatar Rehabilitation Institute, adds an additional 500 new beds with 3,000 highly trained clinical and support staff to During 2017, the public health sector opened new care for patients [2]. hospitals and specialized care facilities, and completed significant renovations in existing facilities to improve HMC also completed an extension of Magnetic Resonance access to healthcare services. The MOPH revised and Imaging facilities at the Heart Hospital, opened the National improved policies and regulations to streamline access Obesity Treatment Center and the Bayt Aman31 facility for private healthcare providers. The expansion of the and commenced service provision at the Tobacco Control public health sector infrastructure will continue in future Center32. according to business plans and healthcare needs. Overview of Newly Opened Box 2 Hospitals in 2017 By the end of 2017, the public health system operational The Ambulatory Care Center offers patients a new approach capacity included 13 general and specialized hospitals under to surgical and clinical care in Qatar, providing day care surgery, HMC, 23 health and health-and-wellness centers under selected inpatient surgical care and clinical care in a single PHCC, 3 primary care health centers and 4 MC units under dedicated location. Patients are able to leave the hospital within 23 the MOPH and one center for wellness and treatment of hours of receiving surgery or a medical procedure and recover in the comfort of their own homes. behavioral disorders under Naufar [Table 2]. HMC operated five pediatric emergency centers for young patients and The Women’s Wellness and Research Center is the region’s PUBLIC largest tertiary hospital dedicated to providing women in Qatar with Ambulance and Life Flight services. Continuing care was specialized care through all stages of their lives. This new hospital provided in specialized facilities, such as Enaya Specialized offers a range of surgical and clinical services from preconception HEALTH SYSTEM Care Facility and Enaya Continuing Care Centers. Both HMC to childbirth, post-natal care and beyond. At the center of this care 3 and PHCC provided home healthcare services. is a passionate multidisciplinary team of highly trained clinicians specializing in gynecology, obstetrics, and newborn care.

CAPACITY HMC successfully completed the mobilization stage and Qatar Rehabilitation Institute is the region’s largest tertiary rehabilitation hospital, providing world class integrated opened the majority of intended services to the public rehabilitation services and the most technologically advanced in the new Medical City complex. His Highness The Amir, patient-centered care. At the heart of this care is a passionate multi- Sheikh Tamim Bin Hamad Al Thani officially inaugurated disciplinary team of clinicians working together to coordinate and the new Medical City complex of HMC in December 2017. deliver a personalized package of advanced rehabilitation services tailored to every one of our patient’s individual circumstances. Opening of three new hospitals30, the Ambulatory Care

30 All three hospitals commenced operations ahead of the official opening [2]. The Qatar Rehabilitation Institute was the first out of three hospitals to open its doors. It started with outpatient services in 2016 and commenced provision of inpatient services in 2017. 31 Bayt Aman facility commenced its operations in June 2016, ahead of its official opening in 2017 [8]. 32 The official inauguration is planned for early 2018.

22 23 PUBLIC HEALTH SYSTEM CAPACITY Public Health Sector Table 2 Operational Facilities, end 2017

Facility Location Entity Medical Commission Facilities 1 Medical Commission Center (includes Medical Commission Food Handler facility) Doha MOPH 2 Doha New Medical Commission Unit i Doha MOPH 3 Medical Commission Unit i MOPH i PHCC completed construction of Muaither and Al Overview of Newly Opened Specialized 4 Ras Laffan Medical Commission Unit Al Khor MOPH Wajbah health centers, to be opened in early 2018. Health Centers Box 3 Health Facilities in 2017 1 Abu Baker Al Siddiq Health Center Al Rayyan PHCC Construction of another two health centers, 2 Abu Nakhla Health Center Al Rayyan PHCC and Qatar University, scheduled for 2018 was nearing National Obesity Treatment Center will deliver holistic, 3 Airport Health Center Doha PHCC multidisciplinary care for patients in need of medical management, 4 Health Center Al Daayen PHCC completion. Opening of these new health centers will lifestyle modifications, bariatric and endoscopic procedures. Clinics 5 Al Jumailiya Health Center Al Rayyan PHCC add 229 consultation and examination rooms, including 91 previously located at other facilities will now operate together 6 Al Kaaban Health Center Al Khor PHCC for Family Medicine clinics, 12 for specialized care, 16 for within the National Obesity Treatment Center to provide a unique 7 Health Center Al Rayyan PHCC 8 Al Khor Health Center Al Khor PHCC multidisciplinary service that will facilitate and integrate the care of diagnostic services, 41 for dental services, 26 for maternal 9 Al Rayyan Health Center Al Rayyan PHCC patients. Opening of the facility marked an important milestone in and child consultations, 43 for walk-in services. In 2017, 10 Al Shamal Health Center Al Shamal PHCC the journey towards fighting obesity in Qatar [7]. 11 Al Sheehaniya Health Center Al Rayyan PHCC PHCC also completed construction and fit-out of its new 12 Health Center Doha PHCC Bayt Aman is a care facility for expatriate workers who are in the final headquarters and relocated its services to a new facility. 13 Al Wakra Health Center Al Wakra PHCC stages of recovery following illness. The facility can accommodate 14 Gharrafat Al Rayyan Health Center Al Rayyan PHCC up to 12 guests at a time and is staffed 24 hours a day, seven days a 15 Leabaib Health Center Al Daayen PHCC PHCC also completed multiple intensive renovation week by a charge nurse and patient care attendants. It is designed 16 Leghwairiya Health Center Al Khor PHCC projects across all of its health centers in compliance with to help individuals who have completed their clinical treatment at 17 Madinat Khalifa Health Center Doha PHCC HMC to fully recuperate and re-adjust to their normal routines so 18 Mesaimeer Health Center Al Rayyan PHCC applied accreditation standards, to enhance Infection and they are better able to return to living their everyday lives [8]. 19 Omar Bin Khatab Health Center Doha PHCC Prevention Control measures, and to support sustainability 20 Health Center Doha PHCC 21 Umm Ghuwailina Health Center Doha PHCC and provisions for PHCC Disaster Planning Mitigation 22 Umm Slal Health Center PHCC measures. Overview of Primary Health Centers 23 Health Center Doha PHCC Box 4 Completing Construction in 2017 24 Al Hemaila Medical Center i Doha MOPH 25 Workers Health Center – Mesaimeer i Al Rayyan MOPH Naufar completed and commenced operations of its new Muaither and health centers add to the PHCC portfolio 26 Workers Health Center – Zekrit i Al Sheehaniya MOPH hospital facility. The state of the art center for wellness and of the most modern, biggest and unique health centers. These health Hospitals 1 Ambulatory Care Center Doha HMC treatment of behavioral disorders consists of 127 residential centers integrate services beyond the medical curriculum and focus on the vision of fostering a healthier community through self-care 2 Al Khor Hospital Al Khor HMC 3 Al Wakra Hospital Al Wakra HMC rooms, of which 20 became operational, and includes clinics and awareness, and lifestyle behavior modification. In addition to 4 Communicable Disease Centre Doha HMC and over 50 individual and group treatment/therapy rooms. comprehensive health services provided through family medicine 5 Hamad General Hospital Doha HMC All Naufar clinical and operational services were successfully clinics, these centers also provide wellness services that focus on 6 Heart Hospital Doha HMC transferred to the Naufar permanent facility. health promotion and are equipped with gymnasium, swimming pool, 7 National Centre for Cancer Care and Research Doha HMC sauna, steam and massage services. The centers also offer specialized 8 Psychiatric Hospital Salwa Road Doha HMC clinics and have laboratory, pharmacy, radiography, panorama and 9 Qatar Rehabilitation Institute Doha HMC The MOPH completed construction of Ras Laffan ultrasound sections. Once opened, Al Wajbah health center will also 10 Rumailah Hospital Doha HMC hospital and was nearing completion of the construction offer the Psychological Support Clinic [9]. 11 The Cuban Hospital HMC 12 Women’s Hospital ii Doha HMC of Mesaieed hospital. Both hospitals also include health 13 Women’s Wellness & Research Center Doha HMC centers and MC units. Healthcare providers outside core public health service 14 Naufar Al Rayyan Naufar Other Specialized Facilities iii expanded availability and scope of services. Sidra 1 Bayt Aman Villa Doha HMC In 2017, the MOPH closely cooperated with the Ministry Medicine was preparing for the launch of inpatient services in 2 Blood Donor Service Unit Doha HMC of Economy and Commerce and successfully moved its January 2018, and two new private hospitals, Turkish hospital 3 Bone and Joint Center Doha HMC 4 Enaya: Residential Community Compound 1 Muaither HMC facilities licensing renewal services to the Single Window33, and Dr. Moopen’s Aster hospital, successfully entered the 5 Enaya: Residential Community Compound 2 Muaither HMC a project aligned with the cross-government initiative to Qatar health market in 2017. Almost 650 facilities outside 6 Enaya Specialized Care Centre 1 Doha HMC 7 Enaya Specialized Care Centre 2 Doha HMC streamline and facilitate the procedures for commercial the public health sector successfully renewed their licenses 8 Hamad Dental Center Doha HMC registration and licenses. To further improve the licensing in 2017 and over 200 newly established private sector 9 Hamad General Hospital Pediatric Emergency Centre Airport Doha HMC 34 10 Hamad General Hospital Pediatric Emergency Centre Al Daayan Al Daayan HMC processes and the capture of data, the MOPH updated its facilities obtained licenses to provide healthcare services 11 Hamad General Hospital Pediatric Emergency Centre Al Rayyan Al Rayyan HMC operational policies and procedures. This includes merging in Qatar. Under the Qatar Health Care Facilities Master Plan, 12 Hamad General Hospital Pediatric Emergency Centre Doha HMC all medical services under one facility license, which will the MOPH continued to monitor and update information on 13 Hamad General Hospital Pediatric Emergency Centre Al Shamal Al Shamal HMC 14 Patient Recovery Centre (Bayt Al Dhiyafah) Hamad Bin Khalifa Medical City Doha HMC 35 commence in early 2018. facilities and their parameters through the GeoMed . 15 Patient Recovery Hostel Cuban Hospital Dukhan HMC 16 National Obesity Treatment Center Doha HMC 17 Tobacco Control Center Doha HMC 18 Central Food Laboratory Doha MOPH 19 Central Food Laboratory - Branch Abu Samra MOPH 20 Microbiology Unit of Quality Control Laboratory Doha MOPH

Notes: i. Operated by QRCS in 2017. ii. Expected to be merged with Women’s Wellness and Research Center in 2018. iii. Other specialized facilities are major non-hospital providers of distinct treatment, diagnostic or research functions. These may be physically or administratively integrated with the hospitals. 33 The Single Window project was launched in 2011 and is a one-stop-shop initiative led by the Ministry of Economy and Commerce, which aims to streamline and facilitate the procedures for commercial registration and licenses [36]. 34 Inclusive of hospitals (2), health centers (36), pharmacies (27), optic shops (16), company clinics (19), first aid units (100) and nursing/medical agencies (20). 35 GeoMed is the geographical information system application of the Ministry of Public Health. With more than 150 functions and 9 interfaces, it is used as an important strategic planning tool to capture, store, review, and display data related to healthcare in Qatar.

24 25 PUBLIC HEALTH SYSTEM CAPACITY Public Health Sector Workforce, PUBLIC HEALTH SYSTEM CAPACITY Table 3 by Organization and Healthcare Profession Category

Entity 2016 i, ii 2017 2016-17 (%)iii Physicians Ministry of Public Health and Qatar 44 44 0% Council for Healthcare Practitioners WORKFORCE QATARIZATION will be trained over a three-year period. The PHCC’s five- Hamad Medical Corporation 2,957 3,172 7% year corporate strategic plan will pay a particular attention 3.2 Primary Health Care Corporation 634 665 5% Qatarization continued to be the focus of recruitment on workforce development capacity and capability and Naufar 10 9 -10% Qatar values its human capital. Sufficiently staffed, and retention. Nearly half (48.7%) of the MOPH and QCHP form the foundation for enhanced workforce planning and Total 3,645 3,890 7% adequately qualified, productive and efficient, capable employees were Qatari nationals, while HMC, PHCC and sustainability for 2018-2022. Dentists and motivated workforce is the key to ensure that the Naufar successfully increased their Qatari national workforce Ministry of Public Health and Qatar - - - health sector provides safe and high quality healthcare Council for Healthcare Practitioners to 12.1%, 21.2% and 18.0% of their total workforces, PHCC conducted an electronic learning awareness campaign services to its population. Hamad Medical Corporation 108 111 3% respectively. Overall, Qatarization rates increased to 15.3% at all 23 PHCC health centers. This is part of the electronic Primary Health Care Corporation 129 177 37% across the public health sector through the net recruitment learning strategy aimed at ensuring all clinical professionals The MOPH, HMC, PHCC, Naufar and QCHP employed in Naufar 1 1 0% of 546 Qataris, which represents 12% growth in total Qatari have access to credible and internationally recognized total 34,503 professional staff by the end of 2017, an 8% Total 238 289 21% employment in the public health sector. HMC and PHCC led research, resources and learning materials. It launched an increase since 2016. The increase spanned across all clinical Nurses on recruitment with a net addition of 269 and 176 Qatari e-library to facilitate this. The e-library comprises of nine workforce categories, including physicians, nurses, dentists, Ministry of Public Health and Qatar staff members, respectively. electronic Learning portals allowing professionals to access 36 35 -3% pharmacists and allied health professionals [Table 3]. Council for Healthcare Practitioners research and best practices. Hamad Medical Corporation 9,222 9,945 8% To support its Qatari recruits, PHCC developed a new In 2017, a Ministerial Resolution was issued, adding 49 Primary Health Care Corporation 1,796 1,818 1% training program to include comprehensive information HMC, in partnership with the Joint Commission new scopes to the allied health profession category36. Naufar 61 78 28% technology skills, and the Excellence in Job Performance International38, organized a yearlong foundational quality Expansion of the allied health profession category allows Total 11,115 11,876 7% program, which covers communication, customer service, management workshop for HMC’s chief executive officers, more health professions to be included in the licensing and Pharmacists report writing and time management skills. Six hundred and senior leaders, clinicians and other frontline clinical staff. registration process, thereby ensuring that the standards of Ministry of Public Health and Qatar forty Qatari staff completed the program. The first cohort of HMC also conducted a series of computer skills courses for - - - professional behavior, competence and ethics are enforced Council for Healthcare Practitioners Qatari Program Support Managers successfully completed its entire staff to support efficient ways of working. HMC’s uniformly across all allied health profession practitioners Hamad Medical Corporation 700 748 7% their in-post two-years training at the MOPH and graduated Post-Graduate Year One Pharmacy Residency program and all healthcare practitioners operate under the umbrella Primary Health Care Corporation 316 332 5% from the program. has been accredited by the American Society of Health of QCHP system. Following approval of complementary Naufar 4 6 50% System Pharmacists satisfying entrenched standards for the medicine practitioner guidelines in 2016, QCHP commenced Total 1,020 1,086 6% methodical training of pharmacists to attain professional registration and licensing of complementary medicine Allied Health Professionals TRAINING, PROFESSIONAL DEVELOPMENT competence. These, and other training programs and Ministry of Public Health and Qatar practitioners in general hospitals and medical polyclinics. 127 124 -2% AND ACCREDITATION achievements, give boost to quality improvement initiatives Council for Healthcare Practitioners across HMC and align closely with ongoing investment in Hamad Medical Corporation 4,151 4,859 17% The public health sector continued to provide training quality improvement education and training for staff. Primary Health Care Corporation 632 707 12% and development programs to its staff, to bring all Naufar 40 36 -10% employees to a highest standard and ensure consistency The fifth annual Middle East Forum on Quality and Safety Total 4,950 5,726 16% in the services delivered, to keep employees updated in Healthcare organized by HMC, in collaboration with the Non-Medical Workforce with current trends and to enhance employee confidence Institute for Healthcare Improvement, attracted nearly 3,000 Ministry of Public Health and Qatar 1,353 1,386 2% Council for Healthcare Practitioners and productivity. To ensure safe care is delivered healthcare professionals from Qatar and internationally. The Hamad Medical Corporation 7,829 8,264 6% through a competent workforce, stringent licensing and conference featured more than 50 workshops, plenaries, Primary Health Care Corporation 1,846 1,894 3% accreditation policies were adopted. and lectures as well as the quality poster exhibition and Naufar 68 92 35% competition. The forum’s exhibition area, The Knowledge Total 11,096 11,636 5% PHCC developed and delivered the first two batches of the Zone, featured stands from Hamad Healthcare Quality Total Workforce, by Organization 2016 i, ii 2017 2016-17 (%)iii Foundation Level Medical Arabic Language Skills course to Institute, the Ambulance Service and the Academic Health Ministry of Public Health and Qatar non-Arabic speaking physicians. In addition, an Excellence System. The rich diversity of information was delivered 1,560 1,589 2% Council for Healthcare Practitioners in Effective Communication and Teamwork program37 was through the participation of representatives from the Hamad Medical Corporation 24,967 27,099 9% developed to support non-clinical skills for clinical healthcare MOPH, PHCC, QCHP, Qatar University, Sidra Medicine, Primary Health Care Corporation 5,353 5,593 4% professionals via an Inter-Professional Education format. In Qatar Biobank, the World Innovation Summit for Health and Naufar 184 222 21% 2017, 504 healthcare professionals participated in 13 Inter- other academic and healthcare providers. Total 32,064 34,503 8% Professional Education sessions and all PHCC clinical staff Notes I. Allocation of healthcare practitioners and non-medical workforce is being aligned with QCHP classifications. This explains differences between previously reported 2016 workforce by individual categories. For example, Pharmacist Assistants were previously 36 These scopes are governed by Law No. 8 of 1991 regarding the Regulation reported under Pharmacists, while QCHP classifies this category under Allied Health Professionals. of the Allied Health Professions including Nurses. Prior introduction, the scope of practice and registration requirements for these professions II. Workforce count for 2016 differs from previously reported as this has 37 The program also supports Accreditation Canada International criteria. were developed and updated by experts in the respective disciplines with been adjusted to reflect Human Resource management processes a representation of QCHP. This was followed by a thorough review and which were underway at that time. 38 Joint Commission International is a world leading international body that helps institutions across the world to achieve peak performance in patient care [25]. approval by the Permanent Licensing Committee over 2016-2017 period. Joint Commission International accreditation is considered the gold standard in global health care [25]. III. Annual growth rate, calculated as a net increase or decrease in the value of an indicator during the reporting period, relative to the value of an indicator at the beginning of the period, measured in percent.

26 27 PUBLIC HEALTH SYSTEM CAPACITY PUBLIC HEALTH SYSTEM CAPACITY

sessions, workshops and webinars on occupational health Journal online CPD/CME learning modules, for licensed CONNECTING THE SYSTEM Overview of the Academic Health System Box 5 and safety, infections prevention and control, and awareness physicians and nurses, for another year starting from 1 3.3 and preparedness for Middle East Respiratory Syndrome - December 2017. The Academic Health System of Qatar was launched in 2011 to foster Corona Virus. The MOPH and its partners work intensively on the relationship between healthcare, academic and research partners Naufar secured QCHP accreditation for several of its CPD connecting the healthcare system to improve care from across Qatar. Its partners include HMC, PHCC, Sidra Medicine, In 2017, QCHP commenced implementation of its strategic courses. This includes training courses on Primary Nursing delivery and efficiency, and to empower the patients to Qatar Biomedical Research Institute, Qatar University, Weill Cornell plan which was developed in 2016 in line with the MOPH and Self-Awareness in Clinical Communication. PHCC make informed decisions about their health and well- Medicine - Qatar, College of North Atlantic - Qatar, and University of corporate objectives. The strategic plan addresses QCHP obtained QCHP accreditation for Minor Surgery course being and the care they receive. The public health sector Calgary - Qatar [10]. The System has a mission to become the leading mission of developed in collaboration with Weill Cornell Medicine is working to bring information technologies, quality healthcare system in the region by: Ensuring health care practitioners are competent and safe to deliver quality health care services in Qatar, and - Qatar and trained 57 physicians under this four-course initiatives and communications with the public, together, • Changing the manner in which current and future generations of healthcare professionals are being educated; the vision of Becoming an internationally recognized body program. The course supports the delivery of minor under dedicated centralized initiatives. • Engaging in innovative research that leads to new discoveries and for accreditation and regulatory services by 2022. The plan surgical primary care services to patients at PHCC health treatments; is driven by four themes focusing on sustainable growth, centers, thereby improving patient access to minor surgery The successful rollout of the Cerner Clinical Information • Delivering the safest, most effective and most compassionate excellence and quality, partnership and engagement, treatments locally, reducing the need for secondary care System, which was completed in 2016 across all HMC care to all patients and their families. and high performing organization. The plan includes 17 referrals. hospitals and all PHCC health centers, enabled the next HMC and the Academic Health System partners are central to the programs and initiatives. Its performance will be monitored stage of system connection. In 2017, the Health Information 48 delivery of Qatar National Vision 2030, the National Health Strategy against 35 key performance indicators and targets. In line The public health sector trained an equivalent of 140,395 Exchange program, a new technology network that enables 2018-2022 and the National Cancer Framework 2017-2022, supporting with its objectives, QCHP has already become a member staff members, a 62% increase compared to 2016. This the exchange of patient information between providers, was the health and well-being of Qatar’s population. The transformative of the Council on Licensure, Enforcement and Regulation40 equates to 4.1 training sessions per one staff member, a 51% implemented between HMC, PHCC and Sidra Medicine. power of academic health can be seen through the success of HMC’s and the International Association of Medical Regulatory increase from 2.7 observed in 2016. Most of the training was The program offers many benefits, including enabling clinical institutes, which provide patients with routine healthcare Authorities41. conducted in-house (99% of all training sessions). clinicians at all locations to review patient information as well as the most specialized services for managing and treating collected at any of the connected organizations, therefore complex diseases, illnesses and injuries. The Royal College of Physicians and Surgeons of Canada Across all health sector, QCHP recorded additional 6,501 reducing the need to duplicate diagnostic tests, supporting has recognized the Qatar’s Continuous Professional healthcare practitioners’ activated accounts (23.8% growth quality improvement initiatives by enabling access to a The MOPH finalized Phase I of the Competency framework Development (CPD) accreditation system as substantially from the end of 2016) with 567,539 CPD activities reported more complete patient record, and in overall significantly design, which followed successful completion of the equivalent to the College’s Continuing Medical Education (176.5% growth). QCHP maintained or outperformed all improving the efficiency of health services delivery. This project Establishing and Implementing Performance (CME) accreditation program, effective from 1 January targets for processing licensing applications49 and recorded technology will also allow for the next step of connecting a Management System at Corporate and Individual Level39. 2017 through 202042. This confirms QCHP’s standards are low number of complaints on licensing process50. patient to the system, which will be accomplished through The Framework is a key component of a new individual in line with internationally accepted standards. To create the MyHealth patient portal, which is scheduled to be performance management system and serves as a base for a competitive environment, QCHP also commenced the These initiatives in training and retaining workforce showed launched in 2018. transformation of the MOPH human resources function to tendering process with the Gulf Bridge Service, as an positive results. For example, PHCC employee satisfaction become actively responsive and supportive of succession additional primary source verification service provider43. rate51 increased to 78% in 2017, compared to 72% in 2014. The electronic referral system has been rolled out from all planning. It also encourages improvements in individual The MOPH conducted its first employee satisfaction survey52 PHCC health centers to five HMC hospital sites53 and, in 2017, performance and works on identifying competency gaps QCHP increased the number of CPD/CME opportunities in 2017 and recorded 74% satisfaction rate. more than 50% of the referrals to HMC outpatients clinics and development plans for workforce planning. The MOPH available for healthcare practitioners in Qatar, by were electronic based. Implementation of the electronic also commenced implementation of the Coaching and accrediting 895 CPD/CME courses44, and awarding CPD/ referral system also commenced between Sidra Pediatrics Mentoring program, a strategic talent development tool CME accreditation to two new providers45. In total, nine and three PHCC health centers. Moreover, PHCC connected that will enhance productivity, engagement, efficiency providers were reviewed for accreditation, re-accreditation46 additional 60 government school clinics to Cerner, bringing a and overall performance. The MOPH MC conducted a or upgrading the accreditation cycle47 from 3 to 5 years. total number of connected schools to 90 by the end of 2017, targeted training for its staff through capacity-building Further, QCHP provided free access to the British Medical thus further closing the gaps in information connectivity and patient information flows. To further improve the efficiency 39 This aims at driving and promoting excellent performance across all levels in the MOPH, aligning individual performance with departmental objectives, and of health services delivery, PHCC completed the rollout of promoting clear understanding for individual contribution to the MOPH strategic objectives. the regional specialist centers for ultrasound, laboratory, 40 Council on Licensure, Enforcement and Regulation is an international body providing resources, networking opportunities, publications, and research services for stakeholders involved with professional and occupational regulation [26]. QCHP first became a member in 2016. ophthalmology and cancer. 41 The International Association of Medical Regulatory Authorities is an international body that supports medical regulatory authorities to protect, promote, and maintain the health and safety of the public by ensuring proper medical professional standards [37]. 42 The agreement was reached in 2016 for recognition from 2017. The agreement is also supported by two other important agreements, where QCHP accredited 48 Accounts for all sessions and all participants, where one staff member can be trained at multiple sessions. activity and the College’s Maintenance of Certification credit are recognized as mutually equivalent, as well as, fulfillment of accreditations cycles between the 49 The actual performance during 2017 against [targets] was: 19 days on average for processing licensing applications [target 20], 9 days on average for processing two programs are recognized as equivalent and substitutive of each other. renewal applications [target 15], 12 days on average for processing evaluation applications [target 25], 15 days on average for processing change place of work 43 Primary Source Verification is the process of conducting background check for education, training, experience and other credentials for healthcare practitioners requests [target 15] and 10 days on average for processing change scope of practice applications [target 20]. applying to work in Qatar. The agreement is expected to come into force in 2018. 50 In total, 39 complaints were received during 2017, while 69 complaints were recorded in 2016. 44 There were 712 accredited CPD/CME courses at the end of 2016; 183 or 25.7% more courses were made available in 2017. 51 The Survey was online based; satisfaction level of 78% is obtained through averaging out all satisfaction levels (from 1 to 5 converted to the percentage), across 45 These are Qatar University - Health and Dr. Moopen’s Aster Healthcare. all questions and all participants. 46 These are University of Calgary - Qatar and Al Emadi Hospital. 52 Conducted in the first quarter of 2017, online, Strongly Agree and Agree with positive statements around work culture and attributes are considered as 47 These are PHCC, Weill Cornell Medicine - Qatar and Aspetar. Satisfied. 53 These are Heart Hospital, Cuban Hospital, Communicable Disease Center, Al Wakra Hospital and Qatar Rehabilitation Institute. The connection to other sites will continue in 2018.

28 29 PUBLIC HEALTH SYSTEM CAPACITY PUBLIC HEALTH SYSTEM CAPACITY

To further support digital connectivity across the entire In addition, the public health sector is increasingly operating The Supreme Committee for Healthcare Communications, health sector, the MOPH E-Health department, established under the principle Better Together, which reemphasizes established in 2016, provides a strong platform for media, in 2017, commenced development of a national health the placement of patients’ wellbeing at the center of marketing and campaigns across the entire public health platform. The platform brings together public and private health services, and ensures smooth transition of patients system. Throughout 2017, the Committee has overseen healthcare providers; and unifies health data for better and continuity of care between the primary, secondary and a wide range of collaborative initiatives involving the patient treatment. This will further enable healthcare tertiary care levels. The concept of Better Together was MOPH, HMC and PHCC, all aimed at supporting the practitioners and patients to participate equally in managing initiated in 2015, following a successful Al Wakra SMART people of Qatar, to be better informed about health issues. and improving individuals’ health and healthcare. Based on Diabetes Pilot54. The SMART project developed foundations These included joint efforts in implementing the Start technological advancements, this network of information for systematic cooperation between specialists from HMC Now campaign and the QPHS 2017-2022 consultations. will also support nation-wide capabilities in developing and and PHCC, by introducing a multidisciplinary approach, The Committee brought together collective resources implementing digital innovations. which brings together specialists from primary, secondary across the various organizations with the aim of pooling and tertiary care to ensure the most suitable healthcare is resources and expertise to deliver joint messages and In 2017, HMC Medical Research Center launched an provided to a patient. This approach also reinforces care events for national and international health days and days innovative online portal for researchers in Qatar, ABHATH. continuity as patient moves through different levels of care of significance. These included the Qatar National Day, This is an online research submission system and is available according to the needs at any point in time. the Qatar National Sport Day and the World Immunization to all researchers within and outside HMC and enables Week, which were organized and celebrated jointly researchers to self-manage their work with an easy and fast Since 2015, the Better Together principle has been applied between the MOPH, HMC and PHCC. self-service platform. It simplifies processes and connects to multiple services including dermatology, ophthalmology, researchers by providing a single focus point for research dental, physiotherapy, cardiology and mental health. submission. Working groups and joint protocols between HMC and PHCC, and recently Sidra Medicine, were developed The National Patient Safety Collaborative was launched in and agreed. The Better Together approach boosted 2017. It is designed to harness the combined knowledge collaborative working and improved communication and expertise within each of the partner organizations in between healthcare providers; assisted in establishment of the public health sector, to raise safety standards across the community based outreach clinics and technology initiatives whole system towards achieving zero preventable harm. to support smooth patient pathways. It also improved an The focus areas of the collaborative include reducing sepsis access to services and reduced a number of steps and time related mortality, improving management of patients at risk required to access needed care. for venous-thromboembolism, and improving patient flow and access. Encouraging collaboration and the focused The initial evaluations showed that patient satisfaction knowledge exchange between partner organizations will under Better Together initiatives increased, no-show rates support the spread of learning and lead to more sustainable declined and both patient-provider and provider-provider improvement development. confidence and trust have been boosted. The efficiency has also increased, as services were shifted to a more appropriate level of care and waiting times declined.

The accumulated knowledge and experience under Better Together will serve as a significant foundational block for implementing Integrated Model of High-Quality Care and Service Delivery under the NHS 2018 - 2022.

54 The project was focused on the diabetes care, where HMC and PHCC formed multidisciplinary teams to manage approximately 10,000 patients diagnosed with or at risk of developing diabetes. The project emphasized patient education and protocol standardization [27].

30 31 SERVICES: DELIVERING MORE AND BETTER CARE

The MOPH and its partners continued to improve the quality of services at all care levels by building an integrated system, designed to achieve better health, better care and better value for all. Substantial progress was made across all spectrums of services delivery in 2017.

The volumes of provided services increased to meet the demand for healthcare. The public health system delivered 326,898 of inpatient discharges (6% growth) with 57% of those being discharges with a length of stay less than 24 hours, 5.4 million of outpatient visits (9% growth) and 166,175 home health care visits (25% growth) [Table 4]. Diagnostic services performed 46.5 million of laboratory tests55 (16% growth) and pharmacies dispensed over 20.8 million of prescribed medications (30% growth) [Table 4]. The emergency departments saw fewer visits for patients (1.7 million) compared to 2016 (1% decline), which could be indicative of a growing importance and quality of services provided in the primary care [Table 4]. The trends are being monitored continuously, to allow for dynamic adjustment of clinical services provided by the health system and for timely intervention where required. For these purposes, in 2017 the MOPH established a monthly Public Health System Reporting Framework, to actively monitor trends and developments in health services provision across operational and quality domains.

To ensure that services are standardized and compatible with international best practices, several important accreditations were secured at the public health sector. In addition to the Joint Commission International accreditation awarded for all HMC hospitals in 2016, the HMC Hospitality Department56 accomplished the International Organization for Standardization 9001:2015 certification for its quality management system57 in 2017, and a number of specialized services58 successfully qualified for accreditations or reaccreditations. PHCC achieved the Diamond Accreditation for all services from Accreditation SERVICES: Canada International59. The accreditation highlights PHCC’s commitment towards ensuring quality and safety of patient care according to international standards. Naufar achieved Commission on Accreditation of Rehabilitation Facilities60 accreditation, after successfully completing its readiness assessment in 2016. This accreditation is valid for the next three DELIVERING years. This accreditation is significant as it indicates Naufar’s commitment to providing and continually improving services 4 according to the standards applied by the Commission.

MORE AND Further, measures were taken across the public health sector to enhance safety and quality in facility operations, practitioner performance, medication management and services. To achieve the planned health sector goals and outcomes, steps were BETTER CARE taken to engage with the patients and align services based on the patient’s needs.

55 Tests are different from visits as a single visit can result in multiple tests performed. Laboratory tests here include those performed by the MOPH health centers (0.56 million), MOPH Medical Commission (1.32 million), MOPH quality control laboratories (0.53 million), HMC (39.03) million and PHCC (5.04 million). 56 HMC’s Hospitality Department consists of nine sub-departments and a corporate office. It offers services to all HMC and administration sites 24 hours a day, seven days a week. 57 The International Organization for Standardization 9001:2015 standard specifies requirements for a quality management system. Organizations undergo certification process to demonstrate the ability to consistently provide products and services that meet customer, statutory and regulatory requirements. The standard requirements also contribute to organization aims to enhance customer satisfaction through the effective application of the system, including processes for improvement of the system [28]. 58 These include Ambulance Services, Stroke Services and Echocardiology Laboratory at HMC Heart Hospital. Further details are given in relevant sections. 59 Accreditation Canada International is the international arm of Accreditation Canada, a not-for-profit, independent organization in operation since 1958 [29]. The accreditation program comprises of over 30 service-specific standards and is applicable to a wide variety of healthcare providers, from multi-specialty hospitals to ambulatory specialty clinics. 60 Commission on Accreditation of Rehabilitation Facilities is an international accreditor of health services, assisting providers to improve services quality and meet internationally recognized standards [30].

32 33 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

MINISTRY OF PUBLIC HEALTH research institutions. The assurance is legally binding and transfers decreased by 1%, 2% and 7% respectively, while of mental health and wellbeing and the support family enforces adherence to national and international research the number of ambulance calls increased by 12%. HMC physicians can provide to people suffering from depression, The MOPH continued to develop key policies to ensure regulations. During the reporting period, the MOPH also expanded its capacity to increase service provision in 2017 as well as existing opportunities for psychological referrals quality and effectiveness of services delivered at all care issued three clinical trial reviews. It conducted an annual through the opening of three new specialized hospitals: and support. PHCC also held the International Primary levels and across all health service providers. It developed training program to promote research ethics, with more Qatar Rehabilitation Institute, the Ambulatory Care Center Health Care Conference combining both research and 30 National Clinical Guidelines covering key health areas to than 200 participants from various research stakeholders. and the Women’s Wellness and Research Center. family practice streams. standardize care and held awareness sessions at multiple health facilities to introduce these guidelines. Consultations The MOPH continued its collaboration with QRCS to In 2017, HMC processed 3,897 complaints of which 46% In 2017, PHCC conducted sixteen clinical audits including are underway to develop further National Clinical Guidelines provide healthcare to the worker population, at dedicated were processed and closed within 7 days, another 53% eight re-audits, displaying PHCC’s commitment to in the areas of diabetes, cancer, oral health, geriatrics, MOPH health centers and MC units. Under the agreement, within 30 days and 1% after 30 days. Further, it received 4,906 systematically review and align patient care to the highest mental health and rehabilitation. 876,845 patient visits were recorded for outpatient, urgent notes of appreciation either by phone, e-mail and letter or expected quality. It developed clinical guidelines and care, laboratory, radiology and other services [Table 4]. in person. HMC’s overall patient satisfaction level reached protocols for several services, to ensure consistent and The National Informed Consent Policy was finalized in 2017 of 87% in 2017, from 83% in 2016 [Figure 1]. It recorded an standardized service delivery. This includes 35 guidelines and approved for pilot testing in early 2018 by the Health The MOPH also continued to monitor drug, food and water 89% satisfaction level for inpatient services, and 84% for developed for walk-in services, guidelines for urgent care Sector Regulatory Committee and Permanent Licensing quality through its quality and safety laboratories; and outpatient services [Figure 2 and Figure 3]. conditions, depression and generalized anxiety disorder Committee. The Policy guides the healthcare provider conducted 531,426 quality tests in 2017 [Table 4]. The MOPH that are aligned with the National Clinical Guidelines. These to provide a patient with sufficient information about the MC recorded 2.0 million laboratory tests and radiology policies and guidelines are publicly available. treatment and mandates the patient’s explicit consent prior procedures. Further, improved applicant satisfaction levels PRIMARY HEALTH CARE CORPORATION to undergoing such treatment. Thus, the Policy not only and improved wait-times were recorded at the MOPH MC In 2017, PHCC recorded over 2.9 million patient visits, explicitly recognizes patients’ rights and responsibilities, but compared to 2016. The average satisfaction rate61 increased PHCC continued to provide comprehensive, integrated, or 11% more compared to 2016 [Table 4]. The share of also highlights the healthcare provider’s legal, professional from 67% in 2016 to 84% in 2017. The average waiting time62 person-centered and affordable care to its patients in appointments in total visits remained stable at 30.3% (30.8% and ethical obligations in shared decision-making. The to perform a test, for both walk-in and appointment based line with its mission. PHCC is in the process of transitioning in 2016) [Table 4]. PHCC saw 72.6% of patients classified as Policy was developed in collaboration with the Permanent minutes applicants, decreased from 23 minutes in 2016 to to a Family Medicine Model64 of care, which places the priority65 within 30 minutes and 93.3% within 60 minutes66. Licensing Committee members, QCHP and representatives 15 in 2017. The number of applicants (both walk-in and patient and family at the center of all forms of care [11]. The PHCC also recorded 5.2 million67 laboratory tests and from health facilities. appointment based) seen within 30 minutes63, increased pilot was concluded at Leabaib Health and Wellness Center. radiology procedures, resulting from 664,811 patient visits from 82% in 2016, to 89% in 2017. To further enhance the The learnings from the pilot were evaluated and are being for laboratory and radiology services. Under the Patient Safety Friendly Hospital Initiative, an patient experience, the MOPH equipped its MC office with used to inform roll out plans to new and existing health assessment was conducted in two non-government sector two electronic cash machines, allowing patients who do not centers. The piloted model involved two Family Medicine To further improve patient experience, PHCC enhanced health facilities, to evaluate their quality and safety standards. have a bank credit card to conduct transactions electronically Model teams per health center, operating across morning the appointment system, to allow patients to book The assessment to review the procedure for the Health at the MC premises. and afternoon shifts for easy access, covering all patients appointments with general family physicians through the Services Performance Agreements continued throughout registered with the center. appointment system. This facility is now available at all 2017 and by the end of the wyear, 50 healthcare providers, health centers. These appointments aim to maintain an from the public, semi-public and private sectors participated HAMAD MEDICAL CORPORATION To further promote awareness and importance of Family average consultation time of 15 minutes per patient, giving in the Health Services Performance Agreements. Medicine, PHCC celebrated the World Family Doctor Day the physician more time to address the patient’s needs. To In line with its vision, HMC continued to deliver safe, to acknowledge the vital role family doctors play in the ensure compliance with this target, PHCC is monitoring In September 2017, the MOPH organized and conducted effective and compassionate care to its patients. delivery of comprehensive and continuing healthcare for the average consultation times on a monthly basis. the third Qatar Patient Safety Week, under the theme HMC recorded 114,404 discharges with a length of stay community. The events included lectures across schools and United for Patient Safety with the participation of more than exceeding 24 hours, 187,598 discharges with a length of awareness campaigns in places of public gatherings, media PHCC held three patient engagement forums68 sessions 1,000 delegates. The event was conducted in partnership stay below 24 hours, 24,738 newborn discharges, 64,545 coverage and interviews, active engagement through social in 2017, at Rawdat Al Khail, Umm Slal and Al Wakra health with public and private organizations, to emphasize the HHC visits and 1.8 million outpatient visits, an increase of networks. Significantly, the education campaigns during centers. These sessions provide important community importance of patient safety, to explore joint efforts, 6%, 6%, 6%, 34% and 12% respectively, compared to the Family Doctors’ Day also emphasized the importance feedback and pave the way for better services. to understand and overcome challenges and to share year 2016 [Table 4]. HMC also recorded over 1.1 million knowledge. emergency department visits, 598,885 pediatric emergency 64 In the Family Medicine Model approach, services are no longer provided by separate standalone clinics, rather, by a multidisciplinary team, with a clear center visits, 258,608 ambulance calls and 2,339 life flight relationship to the patient or family. Appointments for services are made with a member of the team to which the patient is assigned. Services are provided within the scope of the family medicine specialist. When a patient is present for a consultation, the opportunity is used to also provide other services the patient To further facilitate implementation of the research activations and transfers in 2017 [Table 4]. Compared to may require rather than having the patient return for another visit. This results in an improved, standardized coordinated approach to service delivery. Increased standards, in 2017, the MOPH granted 26 local and 13 2016, the number of emergency department visits, pediatric emphasis is placed on health promotion and the prevention or mitigation of chronic conditions [11]. 65 PHCC introduced the triage system in 2016, where trained staff members allocate patients to the emergency/priority/routine classifications. The emergency foreign health research assurances to local and international emergency center visits and life flight activations and patients (0.3% of all triaged patients in 2017) are immediately transferred to HMC and patients who are classified as ‘routine’ are given an opportunity to schedule an appointment. 61 Applicants’ experiences were evaluated through an online survey. Satisfaction for accessed services was measured at three levels reflecting Satisfied, Not Sure 66 Corresponding statistics for entire 2016 are not available as roll out of clinical information system across all PHCC health centers was completed in mid-2016. and Dissatisfied. The reported rate is an average across all services used by applicants. 67 Tests and procedures are different from visits as a single visit can result in multiple tests and procedures performed. In 2017, PHCC performed 5.04 million 62 The waiting time is calculated from the time when the applicant registers, to the time the first test or procedure (blood test or x-ray examination) is performed. laboratory tests and 0.15 million radiology procedures. 63 The total number of applicants seen within 30 minutes during the reporting period as a percentage of total number of applicants during the reporting period. 68 These forums focused on new PHCC services such as electronic medical records, triage and patient classification, the 107 hotline, patient appointment process, wellness centers and cancer screening. PHCC is developing key performance indicators to monitor the progress of engaged and empowered communities.

34 35 SERVICES: DELIVERING MORE AND BETTER CARE Patient Satisfaction, Public Health Key Services, 2016-2017 Figure 1Sector, 2015-2017 Table 4 Key Services Entity 2016 2017 2016-17 (%)i Health Centers Visits, General ii PHCC 2,477,640 2,741,942 11% Visits, Specialized iii PHCC 158,527 194,049 22% Visits, Home Health Care PHCC 84,759 101,630 20% PHCC also marked the World Customer Service Week by Visits, Laboratory PHCC 429,089 525,505 22% conducting education programs targeting their customer Visits, Radiology PHCC 109,378 139,306 27% service employees on the importance of the role played Prescriptions iv, v PHCC 4,213,362 5,706,784 35% by customer service in the healthcare industry. This is Visits, Outpatient vi MOPH 542,314 447,130 -18% an opportunity to focus on providing the best customer vi Visits, Urgent Care MOPH 83,177 78,700 -5% service, and move towards building an institutional culture Visits, Other vi MOPH 152,640 190,953 25% centered on customer service. PHCC recorded an overall Notes: Visits, Laboratory vi MOPH 89,628 107,554 20% patient satisfaction level of 92% in 2017 which is an increase 1. HMC overall satisfaction is measured aggregating the average of Visits, Radiology vi MOPH 44,830 52,508 17% inpatient satisfaction and outpatient satisfaction rates. of 9 percentage points since 2016 (83%) [Figure 1]. PHCC Prescriptions vi, vii MOPH 1,708,049 1,970,636 15% 2. PHCC measured satisfaction using a scale of four levels, Very satisfied, 69 Hospitals processed and closed 1,052 complaints. 56% of those were Satisfied, Dissatisfied and Very Dissatisfied. Satisfaction rate includes Ambulance Calls HMC 231,900 258,608 12% monitored and closed within 7 days (67%), 30 days (19%), those who rated the services Very Satisfiedor Satisfied. Mobile Doctor Services HMC 19,193 N/Aviii N/Aviii and more than 30 days (14%). 3. Naufar clinical and operational services were centralized in 2017. Hence, 2016 data is not available. Life Flight Activations and Transfers HMC 2,504 2,339 -7% 4. Naufar, satisfaction was measured using a scale of 1-5, where, 1=Very Visits, Outpatient HMC 1,586,396 1,781,642 12% Unsatisfied, 2=Unsatisfied, 3=Neutral, 4=Satisfied and 5=Very Satisfied. Visits, Emergency Department HMC 1,117,675 1,109,137 -1% Satisfaction rate includes those who rated the services Satisfied or Very NAUFAR Satisfied. Visits, Pediatric Emergency Center HMC 610,689 598,885 -2% Visits, Home Health Care HMC 48,302 64,545 34% Naufar continued to provide wellness and treatment for Discharges, >24 Hours HMC 107,487 114,404 6% behavioral disorders in a healing environment. In 2017, Discharges, <24 Hours ix HMC 177,547 187,598 6% Inpatient Satisfaction, it significantly expanded capacity through the opening Discharges, Newborn HMC 23,382 24,738 6% HMC, by Domain, 2017 x of its brand new hospital, a state of the art facility for Figure 2 Tests, Laboratory HMC 34,639,366 39,034,288 13% Procedures, Radiology x HMC 560,457 N/Axi N/Axi wellness and treatment of behavioral disorders consisting Prescriptions iv HMC 10,045,469 13,104,692 30% of 127 residential rooms and over 50 individual and group Discharges, Inpatient Naufar 166 158 -5% treatment therapy rooms [12]. Opening of the facility Visits, Outpatient Naufar 6,060 22,996 279% centralized Naufar clinical and operational services. In 2017, Visits, Laboratory Naufar 7,848 8,792 12% Naufar recorded 158 inpatient discharges, 22,996 outpatient Prescriptions iv Naufar 5,127 6,780 32% visits, and 8,792 laboratory visits [Table 4]. It achieved a 95% Other Specialized Facilities patient satisfaction level for inpatient, outpatient and overall Tests, Drug Quality xii MOPH 7,400 31,720 329% services [Figure 1]. Tests, Food and Water xiii MOPH 542,919 499,706 -8% Tests, Laboratory xiv MOPH 1,359,390 1,324,102 -3% Procedures, Radiology xiv MOPH 749,479 708,902 -5% Notes: Notes: I. Annual growth rate, calculated as a net increase or decrease in the value of an indicator during the reporting period, 1. The satisfaction scale had five levels,Excellent, Very Good, Good, Fair relative to the value of an indicator at the beginning of the period, measured in percent. and Poor. Satisfied includesExcellent, Very Good and 50% of Good, II. Number of patient visits to general practitioners only. Excludes specialized visits. whereas, dissatisfied includesFair, Poor and 50% of Good. III. Include visits to all specialized clinics. Excludes general, radiology, laboratory, pharmacy and home health care visits. IV. Prescribed medication by separate line item. V. PHCC 2016 data is sourced both manually and from Cerner as Cerner data was available only from Cerner implementa- tion date for all health centers (August 2016). Outpatient Satisfaction, HMC, VI. Reflects services provided by QRCS at MOPH health centers. Figure 3 by Domain, 2017 VII. Captures the number of prescriptions issued. VIII. HMC reports that 2017 data is only available up to March 2017 (5,845). IX. Includes day case surgeries, dialysis and zero length of stay. X. HMC captures tests and procedures, not visits. XI. As of the end of the reporting period, HMC was in the process of data validation following implementation of the new Radiology Information System/Picture Archiving and Communication System. XII. Includes physical and chemical tests performed on pharmaceutical products. XIII. Includes microbiology, chemistry, water, molecular biology and radiation tests. XIV. Processed at MOPH MC unit.

69 The remaining 44% were also processed and closed, however the duration was not monitored.

Notes:

1. The satisfaction scale had five levels,Excellent, Very Good, Good, Fair and Poor. Satisfied includesExcellent, Very Good and 50% of Good, whereas, dissatisfied includesFair, Poor and 50% of Good.

36 37 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

HEALTH PROMOTION AND DISEASE promoted positive health impacts of maintaining regular In partnership with Qatar media, healthy lifestyle messages COMMUNICABLE DISEASES 4.1 PREVENTION physical activity (Start Now, Be Active), educated the were also communicated throughout the year. This included 4.2 public on the importance of choosing a balanced diet with the MOPH yearlong awareness campaign72 devoted Well-planned, targeted and timely screening programs the right nutritional values (Start Now, Eat Healthy) and to healthy food conducted in cooperation with Qatar The Global Burden of Diseases Study 2016 estimated that are invaluable to public health. Effectively implemented overall promoting healthy lifestyle attitudes (Start Now, Be Television. PHCC also launched the How to Keep Health in Qatar communicable diseases (CDs) contribute to less screening programs have the potential to prevent ill Healthy). The campaign messages encouraged to switch in Summer campaign, focused on the importance of than 5% of the total burden of disease76 [16], indicating health, disability and death and improve the quality the preferences towards healthy and balanced nutrition maintaining body health and right nutrition during summer, successful efforts to manage these largely preventable of life [13]. Based on these underlying principles, in 2017, including preparation of healthy homemade foods and to channeled through the social media platforms73. infectious diseases. CD prevention is also one of the 16 the National Screening Programs Committee approved the involve children in the process in order to develop healthy health areas highlighted in the QPHS 2017-2022. National Screening Framework and Operating Model, in order habits from early age. The campaign ran for nearly a year In addition to statewide awareness campaigns, the MOPH to streamline and govern all national screening programs in and was organized in collaboration with HMC and PHCC also conducted lectures74 upon request at kindergartens, The MOPH finalized and distributed National Event Based Qatar. The National Screening Framework and Operating with the close support of the Supreme Committee for schools and workplaces. The Public Health Committee also Surveillance Guidelines across all public and private health Model thus provides a set of key principles and key essential Healthcare Communications. approved a conduct of Public Health Seminar Series, with facilities to ensure consistency in identifying and reporting requirements for establishing and sustaining national screening guest speakers from the MOPH, international visitors or public health concerns. It conducted 2,313 CD surveillance program. It is binding on all the relevant parties involved in The public health sector explored every opportunity to Qatar institutions presenting information on topical issues. visits77. PHCC introduced an electronic reporting system developing, introducing and managing national screening engage the community and promote healthy attitude and at its health centers, which allows direct reporting to the programs. All currently existing screening services (e.g., cancer, actively participated in the Qatar National Day and the The QPHS 2017-2022 also actively supports health MOPH on CD cases, for faster action. SMART health check, newborn and others) are thus aligned with Qatar National Sport Day. Under the Qatar National Day promotion. In 2017, the MOPH’s activities under the QPHS the Framework and Operating Model, and the development theme Promise of Prosperity and Glory, all public healthcare concentrated on reducing risk factors for chronic NCDs and To further reduce the incidence of CDs, the MOPH and implementation of new screening initiatives are to be done providers organized activities across their facilities70 and in development of supporting regulations, including for the distributed National Immunization Guidelines across all in compliance with the Framework and Operating Model. public places, highlighting Qatari heritage. The celebrations youngest members of the society. The QPHS particularly public and private health facilities to ensure consistency provided an opportunity to demonstrate public health advanced activities and projects under its Healthy Life and quality of immunization, and maintained a vaccination The Framework emphasizes that the condition being sector commitment to patient centered care, improve health Style Objectives: Reduce the risk factors for chronic non- coverage above 90% in all national immunization schedules, screened through the National Screening Programs should awareness and enable people to become their own health communicable diseases (unhealthy nutrition and physical for children under five years of age. In 2017, the MOPH be an important health problem, there should be a safe and advocates [14]. Similarly, the MOPH and all public healthcare inactivity) and Formulate and promote culturally appropriate recorded 663,101 vaccines being administered on children simple screening test, the treatments must be useful for providers participated in the Qatar National Sport Day, thus and sustainable policies and legislations aimed at promoting aged 0-6 years, PHCC administered 662,374 vaccines for those who test positive of the condition screened and the strengthening the concepts of physical activities to become food diversity, healthy eating habits and increasing physical the public, HMC recorded 13,478 vaccines provided to its program delivers expected benefits at a reasonable cost [13]. part of the community’s culture. Medical teams from HMC activity in the population. staff and the MOPH MC recorded the provision of 81,968 The Framework also highlights that all national screening and PHCC71 provided opportunities for biometric screening, vaccines to applicants. programs should clearly define measurable expected medical consultations and general advice promoting culture To further improve awareness, educate public and support health benefits, develop robust mechanisms for inviting of regular exercise. The activities created platforms to raise healthy lifestyle, the MOPH commenced implementation75 of The MOPH conducted the annual Tetanus, Diphtheria and patients supported by effective promotion and awareness awareness about healthy practices, promote healthcare Food and Beverages guidelines for health facilities, trained Pertussis campaign for students and the annual Influenza campaigns to ensure a high level of uptake of screening through medical check-ups, health tips and educational 30 healthcare practitioners on unified nutrition messages Vaccination Campaign for all high-risk groups. It also services. It should take into account relevant ethical, socio- material, opportunities to meet clinical experts [15]. based on Qatar Dietary Guidelines and 70 students during obtained approval to launch a new vaccine for Human economic and legal considerations and conduct quality the Nutrition Day. Papilloma Virus in 2018. Further, a Vaccine Management assurance, program monitoring and ongoing evaluation as The public was actively supported throughout the Holy training course and the first Adverse Event Following defined in the Framework and Operating Model. Month of Ramadan. The Supreme Committee for Healthcare To further assist population of Qatar in building healthy Immunization training workshop were conducted by the Communications re-launched the Ramadan health website, lifestyle habits, PHCC commenced providing wellness care MOPH with the support of international experts, to build The public healthcare system is committed to improve Qatar’s first educational, promotional and awareness in additional two health centers in 2017 (Rawdat Al Khail and health sector capacities on vaccinations. Food Born Disease health awareness and to enable people to become their creating online resource portal, devoted to highlighting Umm Slal), following the pilot of this project in Leabaib health Outbreak Investigation guidelines were developed and own health advocates. In 2017, multiple education and the importance of maintaining a healthy lifestyle during center in 2016. Wellness care includes weight management relevant staff were trained on food poisoning outbreak health promotion campaigns were run throughout the year Ramadan. This was supplemented by healthy lifestyle and provision of healthy eating advice, gymnasium and investigation and response. to encourage population in Qatar to live healthy lifestyles. campaign Our Future lies in Our Health carried out in swimming facilities. PHCC is expected to further extend the collaboration with Weill Cornell Medicine, Qatar and Al provision of wellness care in 2018, in newly built Muaither With the WHO collaboration, the MOPH developed The MOPH launched a multi-staged Start Now wellness Meera retail chain. The campaign aimed at increasing public and Al Wajbah health centers. the Human Immunodeficiency Virus patient monitoring campaign. The focus of the campaign was to support awareness on shopping wisely and reading food labels. system and Human Immunodeficiency Virus case reporting reduction of non-communicable diseases (NCD) in Qatar Education messages were aired on Qatar Radio during through building a culture of health. The campaign Ramadan to promote and support healthy lifestyle. 72 During the campaign, a nutritionist from the MOPH participated in a morning show twice a month to raise awareness on various nutrition and health topics, supported with theoretical and practical lessons. 73 This included publication of information cards with recommendations on how to stay healthy and prevent any summer related risks. 70 PHCC partnered with Qatar Civil Aviation Authority in celebration activities, to raise awareness and healthy lifestyle education. 74 There were 360 lectures conducted in 2017 (435 in 2016) on topics such as healthy life style, nutrition, physical activity, smoking, personal hygiene, heat stress, 71 PHCC partnered with the College of the North-Atlantic - Qatar to celebrate the Qatar National Sport Day in 2017. prevention of chronic and communicable diseases. 75 This was accompanied by an inclusive press conference promoting the guidelines with representatives from HMC, PHCC and private hospitals. 76 Measured in disability-adjusted life years, results are based on the Global Burden of Diseases 2016 study. Subsequent updates to Global Burden of Diseases might produce different point estimates. 77 These visits are conducted in governmental, semi- governmental and private sector health facilities including emergency departments, hospital units, clinics and other.

38 39 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

database, to enable systematic surveillance and in-depth Campaign in September 2017 for PHCC employees and the endoscopic procedures. Clinics previously located at other The Strategy also established a national diabetes education analysis of cases in Qatar. The MOPH, also with the partnership annual International Infection Prevention Week80 in October facilities, are now consolidated to operate together within curriculum, based on Qatar specific needs and a national on- of the WHO, developed the Qatar Viral Hepatitis Strategic 2017 for healthcare providers, PHCC employees and the the National Obesity Treatment Center to provide a unique line training platform for delivery of the diabetes education Framework78. Qatar has been on the right path in controlling community in general. multidisciplinary service that facilitates and integrates curriculum. A suite of six CPD accredited electronic learning, hepatitis, and this strategic framework is a continuation of the patient care. scenario based diabetes courses, which are available to all already developed action plans to address the disease with healthcare professionals in Qatar was also developed and the aim of eliminating viral hepatitis as a major public health NON-COMMUNICABLE DISEASES PHCC equipped all NCD clinics with clinical guidelines made available on the platform. A student portal was also threat in Qatar by 2030. The official launch of the framework 4.3 for the most common NCDs, in order to standardize care. developed to accommodate a volume as high as 35,000 is scheduled for 2018. The MOPH also collaborated with the These include Clinical Guidelines for Diabetes, Asthma, learners. Ministry of Interior and implemented a hepatitis C screening The MOPH is working to ensure a coordinated national Dyslipidemia, Hypertension and Acute Coronary Syndrome. campaign among prisoners. NCD prevention approach through the NHS 2018-2022 NCD care is also a part of routine primary healthcare In November 2017, Qatar Metabolic Institute hosted the and the QPHS 2017-2022, across the entire health sector. consultations, through the Family Medicine Model including second Qatar Diabetes, Endocrinology and Metabolic The MOPH increased partnership with the WHO by The NHS 2018-2022 identifies people with multiple the management of other conditions. Conference, which brought together local and international engaging several WHO Joint Program Review Missions for chronic conditions as one of the seven key population experts in the fields of endocrinology, obesity, osteoporosis, 2016-2017, with the aim of acquiring technical support from groups requiring priority and the QPHS 2017-2022 In 2017, the SMART health check83 service was rolled out to and diabetes. More than 700 physicians, allied health the WHO Regional Office for the Eastern Mediterranean focuses on NCD prevention and control through its 16 all PHCC health centers and 3,740 patients were referred to professionals, and scientists working in healthcare, research, on public health initiatives. This included development health areas. these clinics. All patients referred to the clinic underwent the and academic organizations attended the event, which of the Health Risk Assessment System and National Polio SMART assessment84 and 2,257 of these patients returned examined strategies and approaches for the prevention of Outbreak Preparedness and Response Plan, which began The MOPH conducted 1,218 tobacco inspections at public for a follow-up consultation85 with a physician. Following diabetes and disease management and provided the latest implementation in August 2017; finalization of the Qatar places and processed 155 violations as per the widened the consultation, a significant portion of these patients was updates on other endocrine topics. National Outbreak Investigation Guidelines in October 2017; scope of the new Tobacco Law. PHCC continued to provide referred for subsequent treatment within PHCC and 147 review of the Qatar National Surveillance and Response smoking cessation services at its seven dedicated clinics. referrals were made to secondary care. Patients attending A group of Patient Educators from HMC graduated from the System; enhancement of national capacity on the Indicator In 2017, PHCC recorded 2,428 patient visits at tobacco PHCC NCD clinics are also provided with treatment and NCD Diabetes Education and Self-Management for Ongoing and Based and Event Based Surveillance for Health Care cessation clinics (1,898 in 2016) and assisted 1,584 patients management advice at the three PHCC wellness centers. Newly Diagnosed program87. The eight educators became Workers; and advancing the development of the National to quit smoking (909 in 2016). This is an increase of 28% and the first educators in the Middle East and Gulf region to Generic Guidelines for Outbreak Investigation. 74% respectively since 2016. As a result, in 2017, 208 patients PHCC conducted several QCHP accredited CPD events be certified under this program. The program was created quit smoking. HMC and Naufar assisted 798 and 95 patients to increase awareness and workforce capacities, such as by the National Health Service, United Kingdom to deliver The MOPH advanced the development of a National respectively, to quit smoking. the Management of Hypertension Symposium, the World engaging, easy to understand patient education to people Infection and Prevention Program and drafted the National Asthma Day event and the Heart Day Workshop; and trained with type 2 diabetes and those who are at risk of developing Action Plan to Combat Antimicrobial Resistance in Qatar, in Joint working protocols81 were established between HMC and 838 PHCC physicians and other staff as well as 634 external type 2 diabetes. collaboration with the WHO Regional Office for the Eastern PHCC for cardiology, diabetes, mental health, dermatology, healthcare professions. Mediterranean and other stakeholders. To share Qatar’s ophthalmology, dental and physiotherapy services. experience, a report on Antimicrobial Resistance Progress CANCER and Plans in the State of Qatar79 was finalized to be presented HMC began operations of the new Tobacco Control Center82 DIABETES to the Council of Arab Health Ministries. in Hamad Bin Khalifa Medical City, boosting the capacity to Commitment to deliver effective cancer care, prevention support people to quit smoking. The center was officially In 2017, implementation of the Qatar National Diabetes and research continued in 2017. The National Cancer In 2017, HMC opened a Travel Clinic, the first of its kind in designated by the WHO and is the first WHO Collaborating Strategy 2016-2022 began and by the end of 2017, the Framework 2017-2022 was launched in 2017, which Qatar, at the Communicable Diseases Center. Travelers Center in Qatar. The center ensures the best quality of care Strategy achieved 50% completion of its Phase 1 outputs. provides complete patient care pathways for cancer and visiting overseas countries where vaccinations and other and management for smoking cessation in Qatar through the To further improve clinical care for diabetic patients, the measures effectiveness of the programs. In addition, preventive measures are required can visit the Clinic to appropriate treatment as well as education and evidence- MOPH developed six86 clinical guidelines and associated preventive measures are highlighted by the QPHS 2017- obtain counselling, vaccinations, certification and other based research. The center, the first of its kind in Qatar, also pathways. Further, a patient referral and discharge criteria 2022. preventative measures before they travel [17]. houses newly introduced innovative clinical services such as document was developed and agreed upon between HMC laser therapy to help people stop smoking. and PHCC. This document is expected to be scaled up into PHCC cancer screening services aims to identify cancer in PHCC conducted several awareness building programs for a National Referral and Discharge Guideline for Diabetic the primary care setting and lessen the stress on secondary its patients on CD, as well as training programs to healthcare In 2017, HMC’s National Obesity Treatment Center Patients. care resources thereby allowing it to be utilized for those workers on CD management. This included the eighth Hand was officially inaugurated. The Center delivers holistic, Hygiene Campaign in May 2017 for healthcare providers multidisciplinary care for patients in need of medical 83 The SMART health checks is a preventative screening program, designed to assist patients with early detection of common risk factors for ill health; and early and health center visitors, the Seasonal Flu Vaccine management, lifestyle modifications, bariatric and diagnosis and treatment of common health problems such as diabetes and hypertension. 84 Patients referred to a SMART clinic receive an initial questionnaire based assessment, which captures the patient’s personal, family and social medical history 78 This Framework aligns national hepatitis response in Qatar with the global and regional strategies. It was developed to address local priorities, whilst followed by laboratory tests. maintaining the focus on global and regional strategic commitments. Its vision is to free Qatar from new hepatitis infections, provide affordable access to care 85 A SMART consultation is a consultation appointment with a physician, approximately a week after conducting the SMART assessment, where the client is given for those living with chronic hepatitis conditions and ensure effective prevention, care and treatment. their results and is appropriately being followed up. 79 Includes the development of a National Action Plan, establishment of technical working groups, activation of the recommendations of the 86 Five clinical guidelines for diabetes mellitus in children and adolescents, diabetes mellitus type 2 in adults and the elderly, diabetes mellitus type 1 in adults and and the Declaration of the High-Level Meeting of the United Nations General Assembly on Antimicrobial Resistance, building capacities and creating awareness. the elderly, diabetes mellitus in pregnancy, chronic complications of diabetes mellitus were published in 2017 and diabetes in special situations is scheduled 80 The campaign supports the national effort to improve the health of individuals and society through preventative measures. Twenty-three health centers for publication in early 2018. participated in the campaign, creating awareness and providing educational material for healthcare professionals and visitors. 87 The program, which involves two years of training, is run in partnership with Leicester Diabetes Centre, at the Leicester General Hospital, England, United 81 This follows the Better Together working concept. Kingdom. 82 The official inauguration is planned for early 2018.

40 41 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

who need the care most. In 2017, PHCC provided the Breast public awareness of common asthma triggers and effective Researchers from HMC in collaboration with Qatar University new psychologists and to utilize HMC psychologist resources and Bowel Screening services for its second year, screening asthma management strategies. developed an innovative information technology system at the clinics. This collaboration offered patients with closer- 12,272 patients for breast (6,494 in 2016) and 10,501 patients based on artificial intelligence, which is capable of predicting to-home care, removed some of the stigma associated with for bowel conditions (3,847 in 2016). This is an increase of The MOPH, together with HMC, PHCC and the Ministry of the future growth of damaged areas of the brain following an mental health and resulted in a greater patient attendance 89% and 173% respectively since 2016. In 2017, 1,564 and Education and Higher Education, implemented the Asthma acute stroke. The system is able to predict the future infarction rate at the clinics. 725 patients screened for breast and bowel conditions Friendly Schools Program for 2017-2018 in 112 schools in growth for the patients, therefore providing important data respectively, were identified as cancer positive. This was Qatar, for children aged 6 to 12 years. To enhance capacities to support doctors when determining a suitable treatment PHCC screened 18,633 patients for mental health conditions 13% of the patients screened for breast cancer and 7% of the health workers engaged in this program, Training of plan. This study, which was published in the prestigious in 2017. This included screening for depression and anxiety. of patients screened for bowel cancer. All cancer positive Trainers workshops were conducted for 150 school nurses journal Scientific Reports, is an important milestone in clinical Nineteen percent of these patients were prescribed with an patients were offered referrals to the secondary care for and their supervisors in collaboration with the MOPH, HMC research and in the treatment of acute stroke patients. intervention, which was either a psychotropic prescribing advance investigations. and PHCC. intervention or a psychological therapy. Five percent of PHCC International Training Centre received accreditation the screened patients were referred to secondary care, Further, during 2017 cancer screening services expanded, The MOPH MC started performing basic echocardiography from the American Heart Association to deliver Advanced suggesting that a significant number of patients with as opportunistic cervical cancer screening88 was offered for examinations for those with abnormalities in X-ray results Cardiovascular Life Support and Advanced Cardiovascular common mental illnesses are managed in the primary care women aged 21-70 years at Well Women clinics in all PHCC and requiring further investigation. This measure is expected Life Support Instructor course to enhance the skills of PHCC setting. health centers, screening 3,877 eligible women. to reduce the number of referrals to the Heart Hospital89 and nurses and physicians providing emergency services. The to allow prioritization of care for those who most need it. accreditation is valid for two years. PHCC strengthened its mental health staff capacity. Four of PHCC also established a patient helpline at the National its staff participated in Dementia Champions’ session, an Breast and Bowel Cancer Screening Call Center, to allow for In 2017, HMC Stroke Services received the International educational and awareness meeting focusing on dementia convenient and easily accessible cancer care and conducted Patient Safety and Quality Recertification by the Joint MENTAL HEALTH and managing patients with dementia. PHCC’s dementia a patient satisfaction survey for Cancer services with the aim Commission International. Recertification represents a working group members and dementia champions also of improving services. significant milestone as HMC Stroke Services became first The Qatar National Mental Health Strategy 2013-2018 contributed towards the development of the Qatar National of its kind in the Middle East to be re-certified by the Joint achieved and overall completion rate of 83%. This is an Dementia Plan. HMC inaugurated the new Breast Care Clinic at the National Commission International; and it endorses the fact that the increase of 19% percentage points since December 2016. Center for Cancer Care and Research. The clinic, which program is delivering consistent and quality care since first Twelve pledges experienced an increase in completion In October 2017, PHCC initiated an awareness campaign, began receiving referrals in late 2016 from the National gaining Joint Commission International certification in 2014. rates and all eighteen milestones were either complete under the theme Mental Health in the Workplace to mark Screening Program and PHCC, provides diagnoses and or fully on track against plans. World Mental Health Day, to raise staff awareness. PHCC arranges treatment of breast cancer for women in a single The Echocardiology Laboratory at the Heart Hospital also conducted awareness programs for the public by convenient location. Women visiting the clinic have access became the first laboratory outside Europe to receive In 2017, HMC commenced mental healthcare at the Male sharing educational material and engaging the public in to specialized services including ultrasound, core biopsies, advanced accreditation level, by the European Association of Acute 4 facility. The facility is expected to ease demand for PHCC mental health clinics on the importance of looking clinical breast examinations and breast tomosynthesis, an Cardiovascular Imaging90, for Transthoracic, Transesophageal emergency department admissions and manage mental after mental health. advanced type of mammogram, that offer better cancer and Stress Echocardiography. This is the highest level of health patient transfers. detection resulting in the need for fewer biopsies. accreditation provided by the Association, and it recognizes Naufar hosted its first International Addiction Conference, optimal clinical services, extensive teaching and research The first psychological support clinics were piloted at the Opioid Addiction: Interdisciplinary Treatment Informed Qatar’s first allogeneic hematopoietic stem cell in echocardiography. This achievement is extraordinary the Rawdat Al Khail and Leabaib Health Centers, where by Wellness, which was also accredited by QCHP. Twenty transplantation was performed at HMC National Center for because only 12 echocardiography laboratories in the psychological support services were rolled out based on International experts and over 160 delegates in the field of Cancer Care and Research by an expert multi-disciplinary world have received this level of accreditation. In addition, a Stepped Model of Care. The Stepped Model of Care addiction science and allied fields attended the conference, team. Allogeneic stem cell transplantation represents a new the laboratory is the first and only to be accredited outside approach is a least intrusive and more effective intervention. providing a platform for professionals in similar disciplines, milestone in HMC’s efforts to provide the very best cancer Europe. The necessary care is initially provided by primary care to create networks, engage in discussions and share care and treatment in Qatar. physicians and psychologists and later stepped-up to more expertise and knowledge. HMC opened a four-bed ST-segment Elevation Myocardial intensive interventions or referral to secondary care where Infarction unit at the Heart Hospital, to receive low risk required. All PHCC health centers are able to refer patients Naufar conducted an Umrah trip for eligible91 patients, as RESPIRATORY AND CARDIOVASCULAR post primary percutaneous intervention patients. Each year to these services. Under the concept Better Together, joint part of its rehabilitation program, to encourage continued DISEASES the hospital admits and treats 950 Myocardial Infarction working protocols were established between PHCC and abstinence through spiritual and religious contact. The patients, which represents 66% of admissions to the Cardiac HMC, allowing for smooth transitioning of patients who group of patients was supported by Naufar’s spiritual lead The QPHS 2017-2022, identifies respiratory and Intensive Care Unit. This novel approach provides the best require secondary care to HMC. The protocols also allow and three Naufar addiction counsellors during their journey. cardiovascular disease prevention and management intensive and general cardiac care without having to transfer HMC to support PHCC with the recruitment and training of as two of the key 16 health areas. The MOPH launched patients between units. the National Campaign for the Asthma Awareness to raise 91 Patients who maintained strict personal discipline.

88 Age eligible women who attend all PHCC health centers are opportunistically referred for Cervical Cancer Screening through the Well Women clinics. 89 In the past, MC visitors were referred to the Heart Hospital for this procedure. 90 The European Association of Cardiovascular Imaging is an international body that provides individual certification and laboratory accreditation for professional excellence in Europe and formal acknowledgement from a scientific society [31].

42 43 SERVICES: DELIVERING MORE AND BETTER CARE EXECUTIVE SUMMARY

Naufar conducted two outreach programs, the Qatar INJURY AND TRAUMA MANAGEMENT In 2017, HMC Ambulance Service received several Ambulance Response Times National Family Day and the Ramadan Family Support 4.4 recognitions. It received reaccreditation by the Joint Figure 7 (Response <15min) - Urban, HMC, Event, to highlight the role of the family in the society, Commission International, which means HMC Ambulance 2011-2017 92 personal life; and in the patient’s recovery process . The The public health sector continued to strengthen urgent Service is now part of a very small group of ambulance 95% objective of these programs is to help develop a supportive care provision and trauma management. The QPHS services across the world holding this prestigious network between Naufar and patients’ family members 2017-2022 also specifically focuses on road safety and accreditation [18]. In addition, HMC Ambulance Service through reducing barriers. related public health initiatives. Medical Communication Center received successful re- accreditation as an Accredited Center of Excellence by HMC officially launched the Qatar Trauma Registry, the first the International Academy of Emergency Dispatch94. The ORAL AND EYE HEALTH and only national trauma registry in the Arab region. The re-accreditation follows an initial recognition in 2014, when registry provides a database that documents the injuries of this prestigious accreditation was awarded in the Middle The National Oral Health Strategy Road Map was trauma patients and the acute care they receive. Clinicians East for the first time. The reaccreditation formally endorses approved in 2017 for implementation from 2018. and other public health officials can access the data, which the consistent quality of service provided by teams in the 2017 Target Implementation activity commenced ahead of the formal allows better decision-making toward managing trauma Ambulance Service Medical Communication Center. Each start date with the launch of the Qatar Child Oral Health incidents, delivering a more integrated and enhanced care, year, the Ambulance Service Medical Communication Survey. The implementation of the Road Map is overseen thereby improving the efficiency and quality of trauma care Center receives more than 200,000 calls at the National by the National Oral Health Committee. delivery in Qatar. Command Center.

Qatar celebrated eighth Gulf Cooperation Council Oral The MOPH finalized the Action Plan of Road Safety 2018- To enhance primary care walk-in service scope, PHCC rolled Health week, under the theme Teeth, Health and Beauty 2022 for health sector, which feeds into the National Road out minor injury services for walk-in patients at all health Ambulance Response Times in March 2017. PHCC conducted community awareness Safety Strategy93 2018-2022 and received the National Traffic centers. It began 24-hour services at all five walk-in clinics Figure 8 (Response <15min) - Rural, programs to educate the public about the health problems Safety Committee approval for implementation, scheduled that it took delivery of from HMC in 2016; and made minor HMC, 2011-2017

associated with oral and dental diseases and to encourage to be launched in 2018. The Committee has representations injury services available at these clinics. them to adopt positive behavior for oral and dental care. from many Ministries and government organizations and is led by His Excellency the Prime Minister and the Minister Through the three MOPH/QRCS health centers95, a range of 75% To ensure wider access to care, PHCC implemented the of Interior of Qatar, Sheikh Abdullah bin Nasser bin Khalifa services is provided for the male labourer community. Urgent Beautiful Smile service in seven more health centers, making Al Thani. The MOPH also participated in a virtual training care services are open 24 hours at these health centers and fourteen health centers providing this service to children workshop for the preparation of the forth Global Status are treated by emergency room specialist physicians and aged 0-12 years by the end of 2017. Report on Road Safety conducted by the WHO Regional emergency room nurses [19]. Cases range from cardiac Office for the Eastern Mediterranean. It also commemorated concerns to trauma management. In addition, the minor The public health sector promotes improvements in eye the World Day of Remembrance for Road Traffic Victims and procedure units are well staffed to treat minor injuries [19]. health through screening and awareness campaigns. participated in the second public health Seminar titled Road The Urgent care and minor injury units are supported with 2017 Target To promote better eye health and screening, the MOPH Traffic Accidents in Qatar: Reflections on a success story. referral links where priority patients can be referred to HMC conducted several programs across Qatar. This includes the immediately [19]. In 2017, these three workers’ health centers World Glaucoma Week held in March 2017, where about 450 recorded 43,080 patient visits96 related to minor injuries and participants were screened, the World Sight Day celebrated 78,700 urgent care visits97 and 82% of the urgent care cases in October 2017 in collaboration with Qatar University. Visual were managed at the three workers’ health centers, while screening programs were conducted for schoolchildren 18% (13,960) were referred to HMC [19]. where 85,566 students were screened. School eye health workshops were conducted in March 2017 and December HMC continued to significantly exceed the national 2017, providing training for 122 schools nurses. emergency medical service targets, both inside and outside Doha. They exceeded the targets by up to 22 percentage PHCC rolled-out regional specialist centers for ophthalmology points [Figures 7 and 8]. services to provide quality and safe individualized care whilst using resources efficiently.

94 The International Academy of Emergency Dispatch is a nonprofit standard-setting organization promoting safe and effective emergency dispatch services worldwide [32]. 92 These programs were specifically designed for female family members, as they play a significant role in supporting long term recovery of the patient and re- integration into family and society. Naufar also conducts similar programs for male family members. 95 Al Hemeila, Mesaimeer and Zikreet workers’ health centers. 93 The National Road Safety Strategy 2013-2022 was launched in 2013, with a five-year action plan. In 2017, at the completion of 5 years and taking into account 96 Aggregate of minor injury visits to Al Hemaila, Mesaimeer and the significant reduction in road traffic related mortality, the National Road Safety Strategy 2013-2022 action plans were reviewed. The MOPH finalized and workers’ health centers [19]. submitted the updated action plan for the health sector with objectives to enhance the Road Traffic Incident database system, awareness for vulnerable road 97 Aggregate of urgent care visits to Al Hemaila, Mesaimeer and Zekreet users, post-crash response and re-evaluation of drivers’ health fitness after rehabilitation. workers’ health centers [19].

44 45 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

CHILD AND ADOLESCENT HEALTH WOMEN AND MATERNAL HEALTH PHCC continued to provide screening for pregnant women Management Guidelines and Recommendations and 4.5 4.6 under its antenatal screening program. The program established guidelines on conducting medical examination recorded a patient compliance100 rate of 92% for screening for seafarers and prescribed fitness certificate requirements. The NHS 2018-2022 identifies children and adolescents Both the NHS 2018-2022 and the QPHS 2017-2022 of infectious diseases, 98% for screening of hemoglobin as one of the seven priority population groups and the recognize the importance of women’s health. The NHS level and 90% for screening of fasting blood sugar. The MOPH participated in the symposium on The Challenges QPHS 2017-2022 actively supports maternal and child 2018-2022 identifies women as one of the seven priority of the Right to Health and Occupational Safety, organized health objectives as one of the key health areas. population groups and the QPHS 2017-2022 focuses on by the National Human Rights Committee - Qatar. A number public health initiatives surrounding maternal and child of recommendations were made including activating the HMC performed an advanced procedure for the first time health as one of the key 16 health areas. National Committee for Occupational Health and Safety in Qatar, to correct the abnormal spinal curvature of a nine- and preparing a unified electronic system to document year-old child’s spine by inserting state-of-the-art MAGEC In 2017, the MOPH activities concentrated on reducing risk cases of injuries and occupational diseases recorded in growing rods98. HMC also introduced a first of its kind factors for chronic NCDs and development of supporting Qatar. Around 50 participants from the government sector Play Therapy Program at Al Wakra Hospital. This program regulations, including for the youngest members of the took part in this symposium. helps short and long-term inpatient children to understand society. Under Baby Friendly Hospital Initiative, 23 healthcare their illness through the use of puppets, props and toys. providers were trained and accredited as assessors, for It also helps them express any fears they may have about implementing the Initiative. The MOPH also developed a HOME HEALTH CARE treatment and helps them to adjust to being in a hospital draft law to regulate marketing of breastmilk substitutes. 4.8 environment. This is considered to be an effective way to meet the emotional needs of children who have an illness In 2017, the Women’s Wellness and Research Center, the HMC and PHCC continued to work towards bringing or require surgery. region’s largest tertiary hospital dedicated to providing care closer to home, through their home health care specialized care for women through all stages, was (HHC) programs. PHCC enhanced child health services, by providing opened. The hospital offers a range of surgical and clinical OCCUPATIONAL HEALTH AND SAFETY additional clinics for children aged 9 months to 2 ½ years. services from preconception to childbirth, post-natal care 4.7 HMC inaugurated the new HHC satellite office at Al Wakra Following the development in 2016, PHCC fully adopted and beyond, provided by highly trained multidisciplinary Hospital. The office serves as a base from which healthcare the Child Health Notebook at all health centers, in order to clinicians. The NHS 2018 - 2022 supports healthy and safe teams conduct home visits and provides administrative maintain uniformity in patient record keeping. employees as one of the seven population groups support for patients and families in Al Wakra and in the HMC introduced a new prenatal program at Al Wakra requiring priority. The QPHS 2017 - 2022 also promotes surrounding region. The office is caring for over 600 patients In 2017, PHCC increased the number of schools with a school Hospital to improve the experience for maternity patients, occupational health as one of the key 16 health areas. a month across Al Wakra municipality. health nurse from 92.5% in 2016 to 97.4%. PHCC rolled out by giving pregnant women the opportunity to feel better the Cerner system in 60 governments schools during 2017, prepared and more confident about giving birth. The The MOPH continued to promote healthy lifestyle among HMC signed a memorandum of understanding with the bringing the total number schools with Cerner to 90 as of the program includes a tour of the facility with the opportunity to workers, through the Workplace Wellness Program. It Sports and Social Activities Support Fund-Daam101 to end of the year. The objective is to introduce the system in meet caregivers and receive relevant educational material. conducted 417 occupational health awareness visits to establish the Daam Specialized Care Center. Under the all governmental schools, enabling school nurses to access educate workers in workplaces and commemorated the day memorandum, the facility construction is fully funded by patient health records. PHCC rolled-out the post-natal 6-week check-up service99 of Health and Safety at Workplaces with the participation Daam donations. The facility with 67 beds will be located to all PHCC health centers, offering services to both Qatari of the Ministry of Administrative Development, Labour and in the Hamad Bin Khalifa Medical City and will join Hamad’s and non-Qatari patients. PHCC also introduced counselling Social Affairs and HMC. It also conducted QCHP accredited existing Enaya Specialized Care Centers. It is expected to services on breastfeeding in maternal and child health training workshop on Basic Services for Occupational and open in late 2019. It will expand the capacity of the current clinics. It completed service specifications for the baby- Environmental Health, for general practitioners and family Enaya facilities while also providing more comfort for friendly initiative, which provides breast-feeding support doctors. This was conducted in partnership with the WHO patients who require long-term medical care outside of the to both patients and staff. It also initiated activities to mark Regional Office for the Eastern Mediterranean in February hospital setting. World Breastfeeding Week, under the theme Sustaining and in May 2017. Breastfeeding Together, Aiming to Promote, Protect and HMC and PHCC, following the principles of Better Together, Support Breastfeeding Mothers. Community members, The MOPH established a number of training workshops on are working on the establishment and refinement of joint pregnant women, new mothers and their families were heat stress management in multiple languages to educate scopes of services and remits for HHC. To enhance the educated about the health benefits of breastfeeding and on employers and employees on heat stress types, signs and capacities of the staff involved in the provision of HHC, the importance of supporting breastfeeding mothers. symptoms, prevention methods and provision of first aid PHCC conducted a training for 84 HHC nurses in the at workplace. Around 200 safety supervisors and 20,000 Management of Unique Needs of the Elderly in Healthcare, workers from different companies benefited from these with the collaboration of the University of Calgary - Qatar.

98 This is a highly advanced treatment technology for correcting spinal deformities in pediatric patients. The benefit of using MAGEC rods rather than traditionally workshops. It also issued a booklet outlining Heat Stress Cerner information management system for HHC was growing rods is that the length of the MAGEC rods can be extended via remote control when required in a pain-free process, without the need for further surgical procedures. 100 The percentages are the client compliance to physician’s order. 99 The 6-week post-natal check service includes a physical and psychological assessment, health education and counselling on breastfeeding, nutrition, physical activity and family planning. 101 The Sports and Social Activities Support Fund was established by the Amiri Decree no. 44 of 2010, to support social and sports activities and enhance sustainable social development in alignment with Qatar National Vision 2030 [33].

46 47 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

piloted in the three health centers at Omar Bin Al Khattab, Home Health Care Visits, ORGAN DONATION AND system of registering treatment abroad request approvals. Al Rayan and Leabaib. Figure 4 2016-2017 4.9 TRANSPLANTATION This ensures patient privacy and accommodates multiple users of the service at the same time. The system also allows 102 In 2017, HMC recorded 64,545 HHC visits, which is a 34% The public health sector continued to deliver highly for archiving all treatment abroad appeals. increase since 2016 (48,302 visits in 2016) and treated all of specialized services. Following Qatar’s first ever successful its 1,812 patients with a multidisciplinary care plan in the liver transplant from a living donor performed in the end HHC setting [Figure 4 and Figure 5]. This was an increase of of 2016, a second liver transplant from a living donor was FOOD AND ENVIRONMENT HEALTH 202% since 2016 (600 patients). conducted in 2017. Further, in June 2017 eight patients 4.11 successfully underwent liver and kidney transplant operations In 2017, PHCC provided HHC through all 23 health centers in one week, a record number of transplant procedures in The MOPH continues to monitor food safety to prevent through multi-disciplinary teams and patient cases were one week for HMC. All patients were discharged home and food-borne disease and food contamination. In 2017, managed and reviewed regularly. It recorded 101,630 HHC monitored by the transplant teams as part of their follow-up there were 1,357 routine inspections in food establishments, visits in 2017 (84,759 in 2016), which is an increase of 20% care. to ensure their compliance with food safety standards and since 2016 [Figure 4]. PHCC provided HHC to 814 patients, to protect consumers from substandard food handling which is an increase of 24% since 2016 (655 patients) and In total, 27 transplant operations were performed by HMC practices. all patients were treated with a multidisciplinary care plan in 2017, of which 19 were kidney transplants and 8 were liver [Figure 5]. In 2017, PHCC were managing 121 patients transplants. This is a 108% increase in transplant operations The MOPH developed a color coding system highlighting through six of its health centers situated outside Doha103. The Percentage Home Health Care since 2016 where 13 transplants were performed. An food allergies to be used in school canteens. This is part Patients with Multidisciplinary Care remaining 693 patients were being managed within Doha. Figure 5 increased capability and capacity for transplantation services of the which the Plan, 2016-2017 Qatar Healthy School Canteen Guidelines, For the second consecutive year, 98%104 of the patients/ also contributes to reduction in treatment abroad105. MOPH is currently developing with the recommendations of families were satisfied with the overall HHC provided by the Ministry of Education and Higher Education to maintain PHCC. Both HMC and PHCC organized blood donation and organ health standards in school canteens across Qatar. donation campaigns. By the end of 2017, 259,470 people were registered as organ donors, a 45% increase since 2016 The MOPH Central Food Laboratory increased its scope by (178,715 donors). adding eight more analytical methods, which are compliant with International Standardization Organization 17025:2005 standards for testing and calibration laboratories [20]. The TREATMENT ABROAD analytical methods include testing for antibiotics, heavy 4.10 metals, the identification of pork and legionella and other microbiological tests. To ensure a robust treatment abroad system and to provide better services for patients seeking care, reform The MOPH signed a memorandum of understanding in and enhancements were continued across the treatment the field of food safety with the Republic of Turkey106. The abroad system. areas of corporation under this memorandum includes ensuring the safety and compliance of foods imported from The MOPH formalized the guidelines for treatment the Republic of Turkey and facilitating the control of foods abroad and made these available to all customers, with imported from the Republic of Turkey, at the port of entry. the objective of simplifying procedure and help clients understand the process and their rights. The guidelines cover a full spectrum of application process, from submitting EMERGENCY PREPAREDNESS AND request to procedures after approval, thereby streamlining 4.12 RESPONSE the application process. Routine monitoring and review of treatment abroad activities continued, to systematically To maintain Qatar’s readiness for any health emergency, track implementation and outputs and to measure the several initiatives were carried out across the health 102 Home health care includes: full clinical assessment; patient and family health education; monitoring of vital signs; monitoring of blood glucose; effectiveness of initiatives taken. sector. The National Health Emergency Management insulin administration; vaccination and injections administration; Plan and Essential Emergency Stockpile were finalized and phlebotomy; monitoring prothrombin time and international normalized ratio; and wound management. In 2017, 3,392 requests were approved for treatment abroad delivered to the Permanent Emergency Committee, and the 103 These are Al Wakrah, Al Khor, Al Daayen, Al Shamal, Al Kaaban and Al (3,176 approved requests in 2016). The MOPH and the Amiri budget for the Emergency Stockpile was secured. Karaana health centers. Diwan adopted the HMC International Medical Affairs Office 104 A scale measuring five levels of satisfaction was used. The options were Not satisfied, Little Satisfied, Fairly Satisfied, Very Satisfied and Extremely Satisfied. Those who rated Fairly Satisfied, Very Satisfied and Extremely Satisfied were considered as being satisfied with the services. 105 In 2017, HMC performed 55% of required liver and kidney transplant operations and 45% were conducted overseas, while 2016 statistics show 45% and 55% accordingly. 106 This is following the memorandum of understanding signed with the Republic of Turkey in 2016 in the areas of medical information systems, hospital quality management, pharmaceuticals, medical equipment and devices, organ and cell transplantation, genetics and laboratory medicine, medical tourism, emergency services and disaster management.

48 49 SERVICES: DELIVERING MORE AND BETTER CARE SERVICES: DELIVERING MORE AND BETTER CARE

The MOPH supported Sidra Medicine, Aspetar and the PHARMACEUTICAL SERVICES PHCC enhanced safety, quality and effectiveness in as scans from radiology, cardiology and endoscopy to be Ministry of Interior in drafting their hospitals and health 4.13 medication management, through its health centers shared among all healthcare providers in the country. This centers’ emergency preparedness plans. It also contributed improvement project for medication management national clinical imaging platform brings together patient to the Hamad International Airport emergency exercise, The MOPH continued to ensure a safe and high and pharmacy109. The project ensures relevant staff imaging data from various medical specialties into a single which is a multi-agency exercise conducted every two quality pharmaceutical environment in the health follow Accreditation Canada International medication repository and enables it to be shared with PHCC and Sidra years as per Qatar Civil Aviation Authority requirement system, through its routine activities surrounding drug management standards and educates them on best Medicine. for licensing. It participated in all aspects of the exercise registration, inspection, release and quality assurance practice policies and procedures. PHCC also implemented including planning, observation, final evaluation and processes. HMC and PHCC worked towards the delivery a medication reconciliation process at all clinics and fast- For the first time in Qatar and the Arab region, HMC development of the action plan. of standardized pharmacy services to the public. tracked the medication dispensing process at all health launched the Centralized Hemovigilance Program, a new centers. PHCC has successfully met Accreditation Canada program that monitors blood transfer procedures in the The National Emergo Train team was established and the The MOPH issued 109 pharmaceutical and herbal company International medication management criteria. country. It is designed to improve the quality of the blood MOPH conducted a Train the Trainers workshop for staff registrations and continued to evaluate and register local transfusion chain, primarily focusing on providing an extra members from the MOPH, HMC and its Ambulance Service and imported pharmaceutical and herbal products. In total, PHCC increased the number of health centers providing 24 level of safety for donors and recipients. and PHCC, on emergency and disaster management 645 pharmaceutical and herbal products were registered. hours pharmacy services to five. These include Al Gharafa, using the Emergo Train System. The Emergo Train System It conducted 1,520 pharmaceutical facility inspections Al Shamal, Al Sheehaniya, Al Kabaan and Airport health PHCC fully implemented a Radiology Information System111, is a simulation system used for education and training in and processed 80 violations, in addition to suspending centers. Picture Archiving and Communication System for radiology emergency and disaster management. It is used worldwide activities. The price for 984 registered pharmaceutical and reporting to ensure the efficient management of medical to test and evaluate incident command systems, disaster herbal products were reviewed to improve affordability of imagery. PHCC rolled-out regional specialist centers for preparedness, the effects on the medical management pharmaceuticals available in the market. services including for ultrasound and laboratories. Regional system and resilience within an organization [21]. specialist centers provide individualized care whilst using The Quality Control Laboratory of the MOPH was equipped resources efficiently, as diagnostic professionals and The MOPH together with HMC and PHCC conducted with a new Ultra-Performance Liquid Chromatography clinicians work in collaboration, which drives up quality and three workshops on National Health Emergency Response machine to improve accuracy in pharmaceutical sample patient safety. to disseminate and train stakeholders and partners on the analyses. The MOPH participated in the proficiency-testing National Emergency Management Framework. Ninety-two program of the European Directorate for the Quality of PHCC continued to achieve better turnaround times for senior and mid-level management professionals from the Medicines to ensure that its pharmaceutical performance radiological tests maximizing resources to conduct more MOPH, HMC, PHCC, QRCS, Sidra Medicine, Aspetar, Qatar testing capacities are comparable with industry standards. tests. It completed 96% radiological reports in less than Petroleum and the Ministry of Interior participated. 24 hours and 85% reports in less than 72 hours, which is The MOPH initiated the electronic Common Technical an increase of 23 and 1 percentage points respectively, The MOPH signed a memorandum of understanding Document project supported with necessary training. The LABORATORY AND DIAGNOSTIC compared to 2016. with Qatar Fund for Development in 2017, to outline the Project is an international standard format made available 4.14 SERVICES cooperation mechanisms between the two entities. The for pharmaceutical clients for submitting applications, objective of the cooperation is to benefit from the MOPH amendments, supplements, and reports on drug registration, The MOPH, HMC and PHCC are enhancing the provision technical expertise on emergency management and health; to the respective national drug regulatory authority. The of laboratory and diagnostic services through expansion as well as assistance in identifying, delivering and monitoring MOPH, HMC and industry stakeholders completed the of existing capacities, improving access and efficiency, projects. pilot Phase of the Qatar National Drug Coding System107 and offering new range of services. project to examine the viability of the system and to obtain The MOPH continued to show its commitment to providing stakeholder feedback. The MOPH equipped its MC with three additional machines support to health emergency management both nationally to detect serum creatinine levels in kidneys. The test is and internationally, as requested by different governmental HMC’s post-graduate Year One Pharmacy Residency important to assess whether kidneys function properly and institutions in Qatar. It provided technical assistance to the Program was accredited by the American Society of Health detect any impairments. The MOPH MC was also equipped humanitarian committees of the Internal Security Force System Pharmacists108 in May 2017, becoming the second with the Picture Archiving and Communication System110 (Lekhwiya) and the Ministry of Foreign Affairs, where the healthcare provider in the region to achieve the prestigious and connected with all PHCC centers. This electronically MOPH supported the timely and effective conduct of accreditation. The accreditation establishes and evaluates transfers radiology images processed in PHCC centers to humanitarian aid missions, with the right medications, staff a set of embedded standards for the methodical training the MOPH MC for reporting. This ensures efficient and fast and equipment supplies, in alignment with international of pharmacists to attain professional competence whilst service to the applicants. best practices. delivering patient-centered care and medication safety in pharmacy operational services. For the first time in Qatar, a National Clinical Imaging Platform has been developed by HMC to enable clinical images such

107 Qatar National Drug Coding System is the national terminology of drug concepts and products. It provides multiple benefits including but not limited to, supporting the Qatar National Formulary, the e-prescription system, health insurance claims, operational/regulatory activities of the MOPH and pharmacies 109 The project has three work streams: patient safety and quality improvement; patient experience and workforce development; and patient safety and quality of around the system and data management. service provision. 108 American Society of Health System Pharmacists is an internationally recognized non-governmental, non-profit pharmacy association that has been accrediting 110 Picture Archiving and Communication System is a healthcare technology for storing, retrieving, managing, distributing and presenting short and long-term pharmacy residency and training programs since 1962. It has been a driver for excellence, bridging education, research, and practice [34]. medical images. 111 Radiology Information System is a networked software system for managing medical imagery and associated data. The Radiology Information System is especially useful for tracking radiology imaging orders and billing information and is often used in conjunction with Picture Archiving and Communication System.

50 51 REFERENCES REFERENCES

Hukoomi Qatar e-Government, “PM Launches National Autism Plan,” 18 April 2017. [Online]. Available: https://portal. Emergo Train System, “Welcome to Emergo Train System,” [Online]. Available: http://www.emergotrain.com/. [Accessed [21] [1] www.gov.qa/wps/portal/media-center/news/news-details/pmlaunchesnationalautismplan?searchText=autism. [Accessed 20 September 2018]. 17 December 2018]. Ministry of Transport and Communications, “TASMU,” [Online]. Available: http://www.motc.gov.qa/en/node/14067. [22] Hamad Medical Corporation, “HH The Emir Officially Opens HMC’s New Medical City Hospitals,” 19 December 2017. [Accessed 25 November 2018]. [2] [Online]. Available: https://www.hamad.qa/EN/news/2017/December/Pages/HH-The-Emir-Officially-Opens-HMCs-New- Medical-City-Hospitals.aspx. [Accessed 17 July 2018]. Institute for Healthcare Improvement, “About IHI,” [Online]. Available: http://www.ihi.org/about/Pages/default.aspx. [23] [Accessed 22 November 2018]. Hukoomi Qatar e-Government, “PM Launches MyHealth Patient Portal,” 27 March 2018. [Online]. Available: http://www. [3] hukoomi.qa/wps/portal/media-center/news/news-details/pmlaunchesmyhealthpatientportal. [Accessed 17 July 2018]. Qatar Fund for Development, “About Us,” [Online]. Available: https://qatarfund.org.qa/en/about-us/. [Accessed 10 [24] The Legatum Institute Foundation, “The Legatum Prosperity IndexTM 2017,” 2017. [Online]. Available: http://www. September 2018]. [4] prosperity.com/rankings. [Accessed 10 July 2018]. Joint Commission International, “About JCI,” [Online]. Available: http://www.jointcommissioninternational.org/about/. Ministry of Public Health, “National Health Strategy 2018-2022,” 2018. [Online]. Available: https://www.moph.gov.qa/ [25] [5] [Accessed 9 September 2018]. HSF/Documents/short%20report%20eng%2020.03.2018.pdf. [Accessed 17 July 2018]. Council on Licensure, Enforsement and Regulation, “About CLEAR,” 2018. [Online]. Available: https://www.clearhq.org/ World Health Organization Regional Office for the Eastern Mediterranean WHO EMRO, “Regional launch of the third Patient [26] page-1720381. [Accessed 14 July 2018]. [6] Safety Challenge “Medication without harm”,” 20 September 2017. [Online]. Available: http://www.emro.who.int/omn/oman- news/regional-launch-of-the-third-patient-safety-challenge-medication-without-harmq.html. [Accessed 17 July 2018]. Thoumi, A; Udayakumar, K; Patel, H; Abou Samra, A; McClellan, M, Implementing Accountable Care to Achieve Better [27] Hamad Medical Corporation, “Minister of Health Officially Opens National Obesity Treatment Center,” 24 October 2017. Health at a Lower Cost, Doha: World Innovation Summit for Health, 2016. [7] [Online]. Available: https://www.hamad.qa/EN/news/2017/october/Pages/Minister-of-Health-Officially-Opens-National- Obesity-Treatment-Center.aspx. [Accessed 27 November 2018]. International Organization for Standardization, “ISO 9001:2015 Quality management systems -- Requirements,” [Online]. [28] Available: https://www.iso.org/standard/62085.html. [Accessed 9 September 2018]. Hamad Medical Corporation, “Hamad Opens New Care Facility for Expatriates Returning Home,” 25 January 2017. [8] [Online]. Available: https://www.hamad.qa/EN/news/2017/January/Pages/Hamad-Opens-New-Care-Facility-for- Accreditation Canada, “About Accreditation Canada,” [Online]. Available: https://accreditation.ca/intl-en/about/. Expatriates-Returning-Home.aspx. [Accessed 30 October 2018]. [29] [Accessed 25 November 2018]. Primary Health Care Corporation, “PHCC is Opening the Registration at Al Wajbah HC,” 11 February 2018. [Online]. [9] Available: https://phcc.qa/portal_new/index/index.php?limit=news222. [Accessed 17 July 2018]. [30] CARF International, “About CARF,” [Online]. Available: http://www.carf.org/About/. [Accessed 18 September 2018]. Hamad Medical Corporation, “Academic Health System: Partners,” [Online]. Available: https://www.hamad.qa/EN/ [10] Education-and-research/Academic-Health/Partners/Pages/default.aspx. [Accessed 22 November 2018]. European Association of Cardiovascular Imaging, “About the EACVI,” [Online]. Available: https://www.escardio.org/Sub- [31] specialty-communities/European-Association-of-Cardiovascular-Imaging-(EACVI)/About. [Accessed 9 September 2018]. [11] Primary Health Care Corporation, “PHCC Annual Report 2016,” PHCC, Doha, 2018.

International Academies of Emergency Dispatch, “Welcome to the Academy,” [Online]. Available: http://www. [12] Naufar, “About us,” [Online]. Available: http://www.naufar.com/About-Us. [Accessed 9 September 2018]. [32] emergencydispatch.org/. [Accessed 9 September 2018]. National Screening Programs Committee State of Qatar: Screening Advisory Sub Group, “National Screening Framework [13] and Operating Model,” MOPH and PHCC [internal], Doha, 2018. Al Meezan - Qatar Legal Portal, “Emiri Resolution No 44 of 2010 establishing the Social and [33] Sporting Activities Support Fund DAAM,” [Online]. Available: http://www.almeezan.qa/LawArticles. Hamad Medical Corporation, “Patients, Families, and Staff Invited to Celebrate Qatar National Day 2017 with HMC,” 10 aspx?LawTreeSectionID=10459&lawId=2847&language=en. [Accessed 19 November 2018]. [14] December 2017. [Online]. Available: https://www.hamad.qa/EN/news/2017/December/Pages/Patients-Families-and-Staff- Invited-to-Celebrate-Qatar-National-Day-2017-with-HMC.aspx. [Accessed 16 July 2018]. American Society of Health System Pharmacists, “About ASHP,” [Online]. Available: https://www.ashp.org/About-ASHP. [34] Hamad Medical Corporation, “Hamad Medical Corporation Prepares to Celebrate Qatar National Sports Day 2017,” 12 [Accessed 9 September 2018]. [15] February 2017. [Online]. Available: https://www.hamad.qa/EN/news/2017/February/Pages/Hamad-Medical-Corporation- Prepares-to-Celebrate-Qatar-National-Sports-Day-2017.aspx. [Accessed 17 July 2018]. Mada Assistive Technology Centre, “About Mada,” [Online]. Available: https://mada.org.qa/en/Pages/AboutMada.aspx. [35] [Accessed 23 December 2018]. Institute for Health Metrics and Evaluation, “Global Burden of Disease Study 2016: GBD Compare,” [Online]. Available: [16] http://vizhub.healthdata.org/gbd-compare/. [Accessed 30 September 2018]. Ministry of Economy and Commerce, “His Excellency the Minister Launches the “Single Window”,” 26 May 2011. [36] [Online]. Available: https://www.mec.gov.qa/en/news-and-media/news/Pages/201505241943094322.aspx. [Accessed 17 Hamad Medical Corporation, “Travel Clinic,” [Online]. Available: https://www.hamad.qa/EN/Hospitals-and-services/ July 2018]. [17] Communicable-Disease-Center/Our-services/Prevention-Services/Pages/Travel-Clinic.aspx. [Accessed 17 September 2018]. International Association of Medical Regulatory Authorities, “About Us,” 2018. [Online]. Available: https://iamra.com/. [37] Hamad Medical Corporation, “Our Accreditations,” [Online]. Available: https://www.hamad.qa/EN/About-Us/Our- [Accessed July 14 2018]. [18] Accreditations/Pages/default.aspx. [Accessed 01 November 2018].

Qatar Red Crescent, “Qatar Red Crescent Medical Affairs Division Workers Health Center Annual Report January- [19] December 2017,” QRCS, Doha, 2018.

International Organization for Standardization, “ISO/IEC 17025:2005 General requirements for the competence to [20] carry out tests and/or calibrations, including sampling.,” [Online]. Available: https://www.iso.org/standard/39883.html. [Accessed 16 September 2018].

52 53