Building a Healthy Future

BUSINESS SWEDEN

THE UAE & SAUDI ARABIA BUILDING A HEALTHY FUTURE OPPORTUNITIES AND CHALLENGES FOR TACKLING THE GROWING BURDEN OF NCDs THROUGH SYSTEMATIC TRANSFORMATION OF HEALTHCARE PROVISION BUILDING A HEALTHY FUTURE OPPORTUNITIES AND CHALLENGES FOR TACKLING THE GROWING BURDEN OF NCDs THROUGH SYSTEMATIC TRANSFORMATION OF HEALTHCARE PROVISION

Layout/grafik:Layout/Graphics Business Sweden Communications Foto:Business Sid Sweden 1, www.istockphoto.com. Marcom & Digitalisation Sid 3, Anders Thessing, www.thessing.se Tryck:Photos Åtta45, 2017 iStock by Getty Images ADD IMAGE INTRODUCTION HEALTHCARE BURDEN A CATALYST FOR CHANGE

Global urbanisation and a shift towards in 2018 to encourage a continuous relation- desk-based working are fuelling the prevalence ship between family physician and patient and of a global health epidemic 1 driven by a group the authorities are looking into reducing capac- of “silent killers”, the most prevalent being ity gaps. Similarly, Saudi Arabia has vast expan- cardiovascular disease, cancer, respiratory disease, sion plans outlined for primary and patient-cen- and diabetes. These belong to a group collectively tric care. known as non-communicable diseases (NCDs). Opportunities exist to drive systematic Annually, 41 million people die from an NCD, change as well as providing solutions for aware- accounting for 71% of all deaths globally 2. ness initiatives, primary healthcare develop- Estimates suggest that the economic burden of ments, new forms of care and expansion of spe- these diseases will exceed USD 30 trillion over ciality care. Swedish actors who commit to the next 20 years 3. establishing a presence in the market will have The Middle East holds the unenviable position the scope to influence the restructuring process of expecting the highest NCDs growth globally; if they can swiftly identify opportunities and predicted at 100–150% over the next ten years 4. connect with the right stakeholders. The increased healthcare burden will put unprec- A local presence which enables collabora- edented strain on existing healthcare structures tive partnerships with local authorities and pri- and systems. Reforms must be implemented to vate operators will be a necessity to win tenders create an agile and cost-efficient system which and stay competitive. Private Public Partner- can meet the long-term healthcare demands and ships (PPPs) are becoming increasingly common minimise the cost burden. and present vast opportunities in the B2G sector. While the prevalence of NCDs is increas- While challenges exist, a strategic, insight driven ing across the entire Middle East, this report will approach to market entry can help mitigate risk. focus on the region’s two biggest economies, the Geopolitical tensions create an unstable envi- Kingdom of Saudi Arabia (KSA, to be referred to ronment while a lack of transparency makes it as ‘Saudi Arabia’) and the United Arab Emirates hard to identify decision makers and getting (UAE) who have started restructuring and trans- access to the right stakeholders takes time. The formation programmes to shift their healthcare countries have developed fast, resulting in lag- systems towards a value-based and patient-cen- ging or sometimes, lacking legislation, especially tric approach. The importance of the healthcare related to regulations on e-health and evolving reforms and transformation are reflected in their healthcare in general. respective long-term strategies: Vision 2030 and Having a presence across the Middle East, National Transformation Program 2020 in Saudi and specifically in the UAE and Saudi Ara- Arabia, and Vision 2021 in the UAE. To support bia has given Business Sweden a realistic and the long-term strategic goals, they are actively in-depth understanding of regional and coun- seeking innovative solutions and best practice try-specific opportunities and challenges. This from other countries. local knowledge is helping Swedish healthcare Both countries are actively working to companies, with the right expertise and solu- improve quality and efficiency. Abu Dhabi has tions, to connect with public and private pro- initiated work towards raising the quality, specif- viders to meet the region’s complex and evolving ically within primary care and polyclinics, while healthcare needs. a new patient-centric standard implemented A significant change to the Saudi Arabia

4 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE structure will see the Ministry of Health shift The WHO has identified and attributed eight power from central ownership to 20 geographi- measurable ‘lifestyle’ factors to the rise in NCDs: cal clusters. Stakeholder engagement will be even more critical as Swedish companies will need to Alcohol consumption identify and build relationship on a cluster by cluster basis. Physical inactivity This report aims to examine the current and future healthcare landscape in the UAE and Saudi Arabia and present a roadmap for how Raised blood glucose Swedish actors can strategically position themselves, enter the market, grow market share and Tobacco use create a sustainable long-term presence in a complex and transformational region. High blood pressure MODERN LIFESTYLES FUELLING THE GROWTH OF NCDs, THE SILENT HEALTH KILLERS Obesity The modern, urban world is fast paced and efficiency seeking. Industrial advances and High cholesterol, and digitalisation have driven unprecedented social change. Individuals have the luxury of driving High or low energy supply adequacy to work, ordering food and entertainment on demand and working digitally, often not having to leave the house. Whilst the economic benefits Prevention is the strongest weapon available to of these changes are plentiful, the health reper- tackle the worrying upward trend of NCDs. But cussions are reverberating across the globe. prevention will not eliminate NCDs as urbani- Poor management of cardiovascular dis- sation and longer-life expectancy will inevitably ease, cancer, respiratory disease and diabetes continue to fuel their prevalence. poses a substantial risk to the health and wel- The cost burden of NCDs is often com- fare of citizens across the world. This is applica- pounded as patients frequently suffer from ble both at the individual and the healthcare pro- co-morbidities that require long-term treatment. vision level. Policymakers are shifting their focus Indirect costs related to loss of labour market to NCD prevention and management with the resources and productivity contribute to a wider aim of delivering improved patient outcomes and social and economic burden. cost efficiencies for healthcare systems. While The global challenge posed by NCDs has not this shift presents short-term structural and eco- gone unnoticed. The UN Global Targets and the nomic challenges, it is crucial for long-term sus- UN Sustainable Development Goals aim to sup- tainability. The entire healthcare business ecosys- port policy to decrease the occurrence of NCDs tem, from pharmaceutical to MedTech, can grow by 1/3 by 2030. National and regional lawmakers market share by contributing solutions for pre- across the Gulf, specifically those within the UAE vention and improved patient care pathways and and Saudi Arabia, are taking action and imple- life-expectancy. menting plans to tackle the burden of NCDs.

4 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 5 GLOBAL MEGATRENDS SHAPING HEALTHCARE

Global megatrends are redefining nearly and the UAE have rapidly shifted from rural, every industry and sector: where we live, desert dwelling to modern, city living populations how we live, how we consume and inter within a relatively short period of time. While act and the choices we make are all being development, investment and infrastructure has shaped by three major global mega also been rapid, in some areas it still lags. trends. Digitalisation, urbanisation and Healthcare is a primary example where infra- sustainability are changing the way indus structure is not fit for purpose at scale or able to try and society produces and consumes, meet the changing healthcare needs created by and this is presenting challenges and urbanisation. Urbanised lifestyles are associated opportunities across the globe. And the with access to and consumption of more unhealthy UAE and Saudi Arabia are no exception. food while at the same time people are more seden- tary with desk-bound work. These lifestyle behav- URBANISATION: THE NORMAL, iours are having a direct impact on the increase BUT SUPER-SIZED in prevalence of NCDs in the general population Since the mid-1980’s, Saudi Arabia has been in both Saudi Arabia and the UAE. To meet the experiencing rapid urbanisation 9 and the UAE needs of an urbanised population with projected has seen a similar expansion since the mid-1990s 10. demographic changes, both countries are trans- So, while urbanisation is not a ‘new’ megatrend forming their healthcare systems to value-based as it is in other countries in the wider region, healthcare models. the intensity and scale present in both countries However, structural change driven by national is a factor that has put a vast deal of pressure policy initiatives are complex and require long- on infrastructure, particularly healthcare. The term, market proven solutions. A whole ecosys- Middle East in general is considered one of the tem shift requires co-operation between all actors world’s most urbanised and both Saudi Arabia across public and private sectors.

POPULATION GROWTH (IN MILLIONS)

40 37 36 35 SAUDI ARABIA 35 33 31 32 29 30 28 26 25

15 12 12 10 10 11 UAE 10 8 8 9 9

0 2008 2010 2012 2014 2016 2018 2020f 2022f 2024f

6 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE DIGITALISATION: CONNECTED % OF POPULATION LIVING IN URBAN AREAS, 2019 PRACTICE DRIVING OPERATIONAL AND BEHAVIOUR CHANGE Every aspect of modern life, from business and 84% 86% industry to individual behaviours, is being transformed by digitalisation. This global megatrend is forcing industries and governments to rethink core services, ensuring both providers and end users are protected by the law, but also that technology is implemented and used in a way that not only adds business and economic value but enhances life and promotes sustainability. Digitalisation is permeating development in all aspects of the healthcare sector and opens up new forms of operability of services. It has SAUDI ARABIA UAE proven particularly useful for integration of, and between levels of, care. This allows for more efficient utilisation of resources and patient-centric care which ultimately accelerates efforts to tackle NCDs. Digitalisation also provides patients with more autonomy and improves access to health- POPULATION PYRAMIDS SAUDI ARABIA & UAE care. Digitalisation can address many challenges within the scope of care needed to deliver disease 2 0 100+ 0 1 prevention and management, but requires stable 2018 and advanced ICT infrastructure which is lack- 20 1 95–99 0 4 2050 (PROJECTED) ing in both Saudi Arabia and the UAE. 92 7 90–94 1 32 330 21 85–89 4 122 SUSTAINABILITY: POTENTIAL FOR TRANSFORMATION 791 47 80–84 6 254 Globally, sustainable business solutions are 1,547 97 75–79 16 412 increasingly becoming the defining feature 2,326 144 70–74 32 455 for success. Sustainability is no longer a niche 2,573 278 65–69 46 400 selling point for certain sectors, but a necessary 2,871 479 60–64 135 377 requirement for securing new contracts with governments and making a long-term impact. 3,018 796 55–59 300 353 Legislation and regulation are forcing change, but 2,757 1,159 50–54 340 446 customer demands are accelerating innovation 2, 836 1,655 45–49 415 700 and implementation. 3,244 2,156 40–44 742 985 There is vast potential for delivering sus- 3,541 2,181 35–39 1,181 1,344 tainable healthcare systems by delivering high quality care and improved public health without 3,372 1,946 30–34 1,373 1,665 having a negative impact on the environment or 2,957 1,665 25–29 1,151 1,380 current and future generations. Across the entire 2,598 1,318 20–24 728 754 value chain there is scope to improve and inno- 2,418 1,159 15–19 407 520 vate with solutions in procurement, diagnostics, 2 398 1,286 410 502 operations, med devices, pharmaceuticals, waste 10–14 and hazardous chemical management as well as 2,432 1,474 5–9 496 520 disease prevention, health promotion and public 2,438 1,528 0–4 503 543 health services. SAUDI ARABIA UAE

6 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 7 LOCAL TRENDS DEFINING FUTURE HEALTHCARE MODELS

Both Saudi Arabia and the UAE have several The fast-paced development in both countries notable challenges applicable to general business means healthcare regulations and legislation in complexities and specifically related to the general are in a catch-up mode, particularly relat- healthcare sector. ing to e-health provision and solutions. Efficient The GCC region’s substantial oil wealth has implementation and use of any digitalised tools is given both Saudi Arabia and the UAE a finan- reliant on well-developed ICT infrastructure. In cial edge in attracting medical talent from abroad some Middle Eastern countries, digitalised inte- through highly competitive job offers. This has gration of care is still in the distant future. facilitated high-end care for the wealthy segments But alongside these challenges, there are con- of society but has resulted in a high turn-over of siderable opportunities that Swedish healthcare medical personnel. There is a significant deficit companies can act on to grow a local presence and in local medical staff and expertise which needs become significant partners in helping to over- to be tackled with investments in educating local come the growing prevalence of NCDs and be key medical staff. players in the wider transformational journey. In both countries, this has hindered systemic change and the development of a cost-efficient and CHANGE TOWARDS modern system. The scarcity of specialised local VALUE-BASED HEALTHCARE resources has not gone unnoticed and is driving a Current healthcare structures are predominantly push for increasing localised expertise and building regulated centrally, and the provision of services a long-term local workforce. While the local work- is the responsibility of the respective healthcare force capability is being built, the systems will be ministries. But outcome focused healthcare is strained in terms of local expertise and will have to becoming the preferred model which will cater continue to rely on a foreign workforce. for more specialised, strategic and cost-efficient The foreign workforce often has medical biases planning and delivery of care. The ambition to towards products and treatment options based on separate regulatory bodies from providing bodies their individual experiences, rather than the local hopes to help achieve this. context; influencing purchasing decisions but also Saudi Arabia initiated large-scale restructur- the practice of care. ing in 2019, which will see the Ministry of Health, As the markets make advancements in the model which has been responsible for two-thirds of the of care, the market runs the risk of not matching healthcare provision, hand over healthcare provi- expertise with relevant work tasks. To develop the sion to twenty geographical clusters. The Minis- system, regulators frequently impose unnecessarily try of Health (MoH) will retain the overall man- high professional qualifications to practice health- date and authority as overarching regulator. By care. Healthcare regulations fail to recognise the dif- 2030, these clusters, which are currently being ferent layers of professional expertise required to per- created, will be organised as Accountable Care form specific roles. For example, nurses are often Organisations (ACOs) will encourage co-opera- required to hold a post-graduate degree to be able to tion, not competition, between healthcare provid- work. International healthcare providers often see ers. ACOs will include healthcare facilities that will these formal requirements as a barrier to recruitment deliver care at all levels and will operate through a and access to suitable resources. value-based payment model encouraging integrated

8 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE working methods and referral systems between places a focus on patient-centred care, patient healthcare providers. safety, accessibility and effectiveness of health- The UAE’s vision is also value-based health, but care. The DHA also focusses on value-based care on a smaller scale. The regulation framework is not and tracks process outcomes. This patient focus uniformed across the country, which is creating approach is seen as an enabler to reach the target of challenges with the Ministry of Health and Preven- becoming both the regional healthcare hub and a tion responsible for the northern emirates and the global destination for healthcare tourism. Dubai Health Authority (DHA) and Department To support these strategies, both countries of Health (DoH) holding responsibility for Dubai are looking to expand their evidence-based care and Abu Dhabi respectively. practices. At the core of evidence-based care is Value-based care is proving a hot topic in the an approach to develop best practice based on UAE with authorities seeing it as a critical path accumulated knowledge. Traditionally, this has towards reaching their goal of improving quality of been achieved by assessing treatment options, care. In Abu Dhabi, the DoH has launched several patient diagnosis and patient preferences and initiatives, which aim to establish a base of quality values, to deliver patient-centric outcomes and for all healthcare providers. This structural change ecosystem effectiveness.

EDUCATION SCREENING

OPPORTUNITIES

PREVENTION EARLY DETECTION

8 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 9 SHIFT TOWARDS PREVENTATIVE National screening for major NCDs MODEL TO REDUCE COSTS AND Screening programmes have a proven track record SAVING LIVES in reducing the impact of NCDs, particularly The governments of Saudi Arabia and the UAE when they have a focus on early detection in have widely recognised that moving towards a high-risk population groups. In a move to combat preventative healthcare model is a major step the prevalence of diabetes in the UAE, the in halting the acceleration of the prevalence of government has applied patient-centred care of NCDs. The strategic transformational plans diabetes management with key targets established incorporate four key elements that are critical for to screen 10,000 high-risk individuals, educate a preventative model to deliver long-term change. 90 nurses and send 25 doctors on global training Patient education, national screening pro- programmes. The nurse and doctor training grammes, early detection goals and prevention education is based on the Johnson and Johnson of NCDs all present substantial opportunities Diabetes Institute curriculum and programme. for Swedish healthcare companies in the new Accessibility to healthcare can be impacted by healthcare model. both geographic and economic factors. There are challenges for both Saudi Arabia and the UAE to Early detection is key to reducing make healthcare screening programmes accessible costs and saving lives for nationals and non-nationals. The distance peo- Prevention is one proven approach to reducing ple have to travel to clinics as well as fees for those loss of life and lowering costs associated with without health insurance, can be a huge barrier NCDs. Highly functional primary healthcare for people engaging in preventative screening. (PHC) is pivotal in tackling NCDs and is widely accepted as the cornerstone of every successful Awareness initiatives to improve healthcare system. Healthcare models with strong patient education PHC deliver better health outcomes, efficiency Country wide marketing, awareness and pre- and improved quality. WHO data shows that vention campaigns aimed at raising awareness of in countries where primary healthcare centres primary care and changing patient behaviours are are prioritised, NCD associated mortality and primarily being driven at a government level and hospitalisation rates are reduced. This evidence is delivered by the respective health ministries and a motivator for both Saudi Arabia and the UAE other government entities. to improve their primary care provision. These programmes, while still in the early stages, have the potential to dramatically improve Accessibility is vital early detection and prevention. Early detection of Removing barriers to access of care is vital if early breast cancer is one of the key indicators of suc- detection rates are to be increased. Digitalisation, cessful treatment, yet six out of 10 patients in including digital booking systems, are improving the region are only diagnosed once the disease access to care and availability of patient care has spread. Awareness programmes have a wider records. It is also providing a platform to dissem- objective to increase early detection but to also inate information on healthier lifestyle choices. improve successful treatment rates and drive cost While mobile screening clinics have been used in efficiencies. both Saudi Arabia and the UAE, expanding hospi- Several awareness programmes have been ini- tal healthcare provision or providing other creative tiated and directed at children with the hope that solutions is needed to increase accessibility. early education and lifestyle changes will stem the Accessibility is being extended to care deliv- upward trend of NCDs. Nutrition plays a crit- ered within the home environment. Many ical role in fighting obesity and steps have been patients could benefit from home care with doc- taken to improve knowledge of food content and tors receiving data from MedTech devices and its effects. nurse led care to tailor the treatment for conditions such as: Challenging existing patient behaviours and expectations Dialysis Understanding patient behaviour is fundamental to understanding the healthcare systems in the Diabetes monitoring GCC. On average, patients are poorly educated and lack the routine of seeing a general practitioner in a primary care setting. Primary care has Wound care very little traction with the general population and patients prefer to seek specialised care advice or Respiratory treatment go directly to the hospital emergency department.

10 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE This has been in part driven by the provision pathways creates new opportunities for services, of low-quality treatment at primary care level, products and knowledge transfer. It is also a piv- resulting in a reduced level of patient trust and otal step towards developing a more cost effi- reliance. Additionally, many patients with NCDs cient and agile system by reducing patient hospi- practice poor self-management of their disease, tal admissions. often leading to further complications and Sweden has a competitive edge as a leader co-morbidities. Disease management education and role model in delivering initiatives driven is being increasingly viewed as a key aspect in the to deliver best practice and value-based care. fight against NCDs. Changing deeply entrenched Saudi Arabia has a proven track record of knowl- patient behaviours can take many years and edge gathering from Swedish experts. Technical this is one of the primary challenges facing the and high-level delegations regularly visit Sweden systems in the GCC. to meet and collaborate with Swedish health- Swedish expertise and experience are assets in care companies. In Saudi Arabia, Skåne Care is demand for knowledge transfer engaged in restructuring primary care while Dia- Evidence based research and knowledge is verum runs over 35 dialysis clinics. In the UAE, highly valued and can provide unique opportu- Swedish value-based healthcare pioneer, GHP nities for Swedish healthcare providers to become Specialty Care, manages four hospitals in the part of strategic and operational transformation emirate of Ajman. programmes. As a part of the restructuring towards a more value-based healthcare model, both Saudi Ara- EXPANDING SPECIALISED CARE bia and the UAE are looking to expand their evi- FOR TAILORED PATIENT PATHWAYS dence-based care practices. This is delivered by While prevention and early detection of NCDs is a system built on developing best practice based a global priority, specialised care at secondary and on accumulated knowledge gained by assess- tertiary levels will still come under considerable ing treatment options, patient diagnosis and strain to deal with the current and imminent patient preferences and values. The overarch- prevalence rates. ing goals are patient-centric outcomes and over- Patients presenting with NCDs will require all effectiveness. specialist treatments, surgical intervention, pro- Restructuring to achieve this will lead to an fessional expertise and well-developed pallia- expansion of the healthcare system with a focus tive and home care to improve quality of life and on delivering improved primary and speciality end of life. Cancer and cardiovascular disease care, new primary healthcare clinics, screening demand the most specialist care but all NCDs centres and dialysis centres. cause secondary health concerns which require more advanced management. Three key areas of Specialised care demands expertise specialised care have been identified as pivotal in Increased specialisation requires provision of successful management of NCDs. new types of healthcare to manage the complex range of needs of NCDs, including home care, New forms of care provision and palliative care and geriatric care. These types of knowledge exchange services have generally been completely lacking, The demand for specialised and new forms of or in a few selected cases, provided at existing care has already driven an increase in the number general hospital facilities. These new treatment of specialist departments and hospitals. In 2018, pathways and options create new service offerings the Saudi Arabian government allocated state as well as a demand for new products. funds for the construction of 36 hospitals and Partnerships between healthcare authorities two medical cities, with a collective total of and other public and private entities are being 11,500 beds. High-end healthcare infrastructure actively sought in e-health, telehealth and mobile is also an investment priority in the UAE. Both applications. These push the boundaries of tradi- countries boast large public and private entities tional healthcare provision and information into that have excellent reputations in specialised care: other areas of patient lives such as food choices The King Faisal Specialist Hospital and Research and exercise routines. Centre in Riyadh and Jeddah and the Dubai Hospital (completion expected in 2020). Private Public Partnerships (PPPs) The shift towards specialised care extends to Privatisation is seen as a critical pillar of struc- further provision in home, palliative and geriat- tural change and as a driver to improve quality of ric care. These types of services have been largely care while simultaneously reducing costs. There absent or limited in scope through existing gen- is a shift towards Private Public Partnerships eral hospital facilities. New interest in these care (PPPs) to deliver new modes of care within the

10 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 11 transformed healthcare structures. Collaborative model, including replicating services of the Swed- partnerships with local authorities and private ish Agency for Health Technology Assessment operators will be increasingly commonplace, and Assessment of Social Services (SBU). The but primarily with companies who have a local UAE’s approach will place primary responsibil- presence. Tenders are likely to be awarded to ity for HTA with the different Emirati health companies who can work closely with government authorities to tailor their own plans. agencies and delivery partners, not necessarily favouring ‘local’ players, but those who can Strategic practitioner education programmes demonstrate competitiveness in the market. A shift in the education focus means opportuni- To achieve this, Saudi Arabia opened its doors ties exist across the whole healthcare ecosystem to in 2018 to fully owned foreign companies oper- deliver improved learning and knowledge sharing ating on the market while the UAE has imple- programmes, from primary care practitioners mented similar initiatives soon after. Relinquish- to specialists to strategy and policy and change ing the requirements for local content has shifted management. attention to attracting foreign investments and Knowledge and education about disease pre- made that process easier and more lucrative. Both vention, healthy lifestyles choices and the bene- countries have invested in Public Private Partner- fits of physical activities have been limited. The ships (PPPs) to increase private sector participa- need to educate primary care practitioners is crit- tion and tackle the growing concern of health- ical as this is where the dissemination of social care funding. education will start. While there are initiatives Since the UAE enacted a law in 2015 encour- to deliver awareness programmes in school and aging PPPs across a wide spectrum of sectors, include sport in the school curriculum, there is new contracts have been offered for service, man- a lack of resources to adequately meet ambitious agement, leasing, as well as to build, operate and goals. transfer healthcare services. While in Saudi Ara- Formal and informal training for medical staff bia, PPPs have been offered on an ad hoc basis. is required to equip both doctors and nurses with The shift to a more formalised approach is hap- the expertise and knowledge to be able to manage pening and the first official tender was floated in the increasingly complex medical conditions they May 2019 for radiology services. Projected growth are treating. This training can happen locally, in the PPP arena is expected in both countries in regionally or in Sweden through structured pro- the immediate future. grammes. Peripheral training in the optimisation Transparency has been an issue within the of medical device use is also in demand. PPP tender processes and Swedish suppliers have On a strategic level, knowledge exchange is in reported difficulty in breaking through the tra- high demand to inform decision making, market ditional approach where informal decision mak- positioning, procurement and tender deals as well ers still play a role. A local presence and a collabo- as operational practices. rative stakeholder engagement approach will help to break down informal and formal barriers to Procurement expertise to deliver cost becoming competitive in the PPP tender process. efficiencies and improved patient outcomes Significant business opportunities lie within Digitalisation – a new healthcare future provision and procurement. Procurement bodies Both Saudi Arabia and the UAE are spearheading and hospital management for both public and digitalisation initiatives to modernise care. The private actors will be important counterparts for first step is the digitalisation of medical records Swedish companies. The expansion of secondary and disease registries but integration across and tertiary care will require niched state of the healthcare providers is still lacking. Sweden’s art procurement as well as bulk procurement use of an advanced digitalised medical records of both pharmaceuticals and medical devices. system, high uptake of MedTech and innovative Medical consumables usually represent large digital solutions present opportunities for knowl- volume procurement and with the changing edge transfer and solution implementation. With landscapes, new players in the market have a both countries having recently established online good chance to tap into this potential. Swedish portals or apps for online booking services, there healthcare providers can leverage opportunities is an appetite for further digitalisation to improve to collaborate with local authorities to provide patient access to care. experienced support, both from operational and Both countries have initiated Health Tech- educational perspectives. Expansion of physical nology Assessment (HTA) knowledge exchange. facilities opens up potential for new MedTech Saudi Arabia is planning for a separate national devices, procurement of equipment and services HTA agency with interest shown in the Swedish and provision of pharmaceuticals.

12 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE 12 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE THE MIDDLE EAST: COMPLEXITIES IN A VARIED REGION

BUSINESS IS CONDUCTED The highly-skilled foreign workforce often bring IN A GLOBAL CONTEXT medical biases towards products and treatment In an increasingly global world, successful market options based on their individual experiences, engagement requires a multifaceted analysis of rather than the local context. This influences pur- conducting business in changing and intercon- chasing decisions but also the practice of care. nected markets. Evaluating market potential in On the other side, the low-skilled foreign work- Saudi Arabia and the UAE must therefore consider force often have a lack of labour rights, often work- the socio-political developments on both markets, as ing under poor conditions but they accept this as a well as their broader geopolitical contexts. 'trade off' to support and lift them and their fami- To a large extent, the Middle East acts as the lies out of poverty. facilitator of the global industrial market, with Both of these issues present challenges for 42.9% of the world’s crude oil exports coming from Swedish companies who must consider the CSR the region 5, while Saudi Arabia is one of the most and human rights aspects of working within these prominent OPEC members, alongside Iran. The contexts. region has a significant opportunity to contrib- Both countries struggle with nepotism, corrup- ute to positive global economic development, but it tion and a lack of transparency. This presents CSR hinges on maintained regional stability and efforts challenges for businesses when they assess whether to generate transparent trade and international co- human rights are being upheld and respected. Even operation. In worst case scenarios, instability can international organisations such as the Interna- lead to Swedish companies re-evaluating their oper- tional Labour Organisation (ILO) struggle to eval- ations and presence in the region. Examples of this uate the situation. include the re-imposed sanctions against Iran and It is undoubtedly so, that political and human the Saudi-led blockade against Qatar. rights are restricted, with arbitrary detentions, and For conducting successful and sustainable busi- severe punishments for expressing criticism again ness in the region, awareness of the geopolitical the establishment and engaging in public assembly. context must also be coupled with an understand- Saudi Arabia ranks 172 and the UAE 133 out of 180 ing of political and economic developments in the countries on the 2019 Press Freedom Index. respective countries. For international companies, However, both countries are undergoing a gen- it is imperative to have insight into the historical erational shift. With close to 40% of the respective and cultural contexts which explain practices and populations under the age of 35, reforms are inevi- business decisions. This context will influence how table; both to cater for calls of social reforms and to decisions are made and business is conducted. align economic activity with the needs of a growing and ageing population. SOCIO-POLITICAL LANDSCAPE The leadership in both countries recognise Swedish companies have successfully conducted this, and recent years has started to paint a more business in Saudi Arabia and the UAE over the past nuanced picture of conducting business in the 70 years. As relatively complex markets, engagement region. As part of the crown prince’s Vision 2030, has always required in-depth market knowledge on Saudi Arabia has embarked on a substantial journey the part of the Swedish company in question. to establish a “thriving economy”, diversified away

14 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE Cause of death NCDs comparison

SAUDI ARABIA UNITED ARAB EMIRATES SWEDEN

CARDIOVASCULAR CANCER RESPIRATORY DIABETES OTHER NCDs OTHER CAUSE OF DEATH

from oil dependency. This has led to the removal of NCDs A GROWING BURDEN red tape, simplifying and making the local market ACROSS THE MIDDLE EAST more attractive. And these efforts have been fruit- While NCDs pose a global challenge, the need for ful. In the World Bank’s 2020 Ease of Doing Busi- efficient management varies across geographies. In ness Index, Saudi Arabia climbed thirty places. general, the Middle East region and particularly, the This positions them as the fastest changemaker in Gulf Cooperation Council (GCC)1 countries, are the world. UAE, having pursued a role as a regional forecast to have the world’s highest NCDs growth. trade hub since the early 2000s, is already ahead, The Middle East’s rapid urbanisation, demographic coming in at sixteenth place globally. changes and lifestyle shifts will continue into the The reforms are very much need driven also foreseeable future. from the outside. The international way of con- The GCC countries are in a good position for ducting business is to a large extent, both formally structural change. In many countries, development and informally, regulated through international of affordable healthcare for their citizens has been standards related to the sustainable development underpinned by significant oil and gas wealth. These goals and broader CSR issues. Global companies countries are taking the biggest strides in shift- and foreign investors put larger emphasis on adher- ing healthcare provision to minimise the impact of ence to these global agreements and neither Saudi NCDs. Both Saudi Arabia and the UAE have made Arabia nor the UAE wants to lose out on this type prevention of NCDs a key part of their reform agen- of big business. As a result, we see the opening of das (Vision 2030 6 and National Transformation both economies, including on issues such as gender Program 2020 in Saudi Arabia 7, and Vision 2021 in equality, much due to the realisation that the econ- the UAE 8), but they also have separate NCD pro- omies require female labour to sustain themselves. grammes developed with the support of the WHO.

NCD RISK FACTORS SAUDI ARABIA UAE SWEDEN

Alcohol consumption 0.4% 1.1% 28%

Physical inactivity 53.1% 41.4% 25%

Raised blood glucose 17.4% 15.1% 7%

Tobacco use 27.9% 29% 18%

Raised blood pressure 23.3% 21.1% 26%

Overweight 69.7% 67.8% 22%

High cholesterol 39% 57.6% Data unavailable

Average energy supply adequacy 135% 126% 126%

14 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 15 FRAMEWORK FOR COLLABORATION AND MARKET GROWTH

Both Saudi Arabia and the UAE are focused on often find access to the health network and transforming healthcare provision through systemic authorities relatively difficult, particularly when change; shifting towards a preventive model, trying to work with larger companies. However, improving primary care and expanding speciality distributors can only facilitate to a certain extent and new forms of care. Both markets are increas- with market screening or pushing for continuous ingly seeking foreign investment and solutions sales and on-the-ground stakeholder identification to deliver change. Opportunities in knowledge and relationship building crucial for successful exchange, healthcare provision, procurement, and market entry and growth. Investing time and strategic partnerships exist across the healthcare money in the market will provide connections ecosystem. The impact of NCDs has and will to opportunities connected to the restructuring continue to shape and define whole healthcare programme and transformation. systems, both strategically and operationally. Alongside stakeholder engagement, under- While socio-political issues are largely unavoid- standing the regulatory frameworks and require- able, general market structures are improving and ments is essential for Swedish companies to gain a market challenges can be overcome by preparation foothold in the UAE and Saudi Arabia. This foun- and knowledge attainment in advance of market dation means opportunities and experience in entry. Coupled with positive economic reforms, suc- working directly or indirectly with distributors or cessful collaborations and partnerships are achieva- local partners will bring distinct benefits in future ble with a realistic, approach to market growth. tender processes. However, network building is often required MARKET EXPANSION WITH with state entities, not just private companies and A STRATEGIC APPROACH in some cases where innovative and specialised The Business Sweden Middle East healthcare products are involved, the process can involve net- team supports Swedish companies by providing working directly with hospital level providers. thorough market analysis, giving full awareness While the number of reputable entities operating of the trends shaping specific industries, relevant within each area of care is limited and identifying competition and current market status to allow for them is relatively simple, stakeholder management enough preparation before entering the market. can be challenging. This ensures a solid and suitable business case When doing business in relationship driven can be made for both Saudi Arabia and the UAE markets, long sales processes and a long-term markets which will accelerate dialogues with mind-set is required. Understanding that payment local stakeholders by having an attractive and terms can be three times as long as in Sweden and competitive offer. often paid over-due can take some adjusting to. It is also important to manage expectations and not BUILD RELATIONSHIPS always expect quick gains as business can stall due AND LOCAL PRESENCE to the complex geopolitical situation. As with most markets in the Middle East, Saudi Working together with local partners and Arabia and the UAE are relationship and distrib- being present in a changing market such as Saudi utor driven markets and international companies Arabia or the UAE can be a successful tool from

16 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE Four areas of development present key opportunities for Swedish companies in the Middle East

PUBLIC PRIVATE INFRASTRUCTURE PROFESSIONAL SPECIALISED & NEW PARTNERSHIPS EXPANSION EDUCATION FORMS OF CARE

CURBING RISING MEET INCREASING DEVELOPING CATERING FOR STATE COSTS DEMAND FOR CARE LOCAL SKILLS NEW NEEDS

RISE OF NCDs WILL INVOLVE LIFE-LONG DISEASE MANAGEMENT AND CO-MORBIDITIES

a growth perspective and to positively influence financial arguments that prove cost efficiency structural change. For this reason, early engage- are beneficial. Innovation and expensive ment can support Swedish healthcare compa- solutions are often compromised in favour of nies in securing sizeable market share in the pres- cost efficiencies,particularly in pharmaceuticals. ent and to build a reputation to reap rewards also However, the push towards generic options and in the long term. It also opens the doors for posi- budgetary impact analyses do not always factor in tively shaping policy and social reform. encompassing KPIs such as long-term effects of surgery or correlated treatments. It is important BUILD RELATIONSHIPS for Swedish actors to counteract this position by AND STRATEGIC APPROACH showcasing competitiveness from a quality and A proven business case backed up with evidence lifecycle cost perspective. from a reference case is nearly always required Once established in the market, our dedicated and often pilot periods will be requested by the healthcare team supports with both accelerat- local counterpart. While both Saudi Arabia and ing sales, partner management and interim busi- the UAE are looking for qualitative products, ness development to fully help your business and price still shapes the industry and strong growth ambitions.

16 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 17 WHO TO TARGET?

Swedish companies looking to enter precise and targeted partnerships. either the UAE or Saudi Arabian healt For all companies looking to be active in the hcare sectors will find that the main market, it is important to ensure registration and counterparts for many initiatives will be compliance for product specifications, imports government owned healthcare entities. and use. Companies need to familiarise them- In Saudi Arabia, two thirds of the health selves with the Saudi Food and Drug Authority care system sit under Ministry of Health (SFDA) before entry to the market. associated entities, and only 10-15% is The National Unified Procurement Company fully privatised. In the UAE, the majority (NUPCO) is the current Ministry of Health’s of healthcare providers are private, yet procurement organisation for pharmaceuticals governmental expenditure on health and medical devices and this role is evolving fur- care accounts for almost 70% of the total ther to take over procurement for the Ministry of healthcare spending. In reality, govern Defence, the second largest healthcare provider in ment-related entities are the main coun the country. NUPCO is also aiming to quantify terparts when entering the market. and map out healthcare needs and resources across the Kingdom. Eventually this will enable unified, SAUDI ARABIA strategic procurement across the market. Although Saudi Arabia’s Ministry of Health will NUPCO as well as the Saudi Food and Drug remain a key regulatory and policy actor, the Authority (SFDA) work very closely together and restructuring of the healthcare system towards are also important players from a cost-efficiency Accountable Care Organisations means that perspective. While the market needs to grow, at gradually the Ministry will shift direct respon- the same time the Saudi government is keen to sibility for healthcare provision in the country. keep healthcare costs down. This is a primary This shift of mandate has begun and is currently motivation for a value-based healthcare model, spearheaded by the Vision Realization Office but also runs the risk of favouring procurement (VRO) at the Ministry of Health. The VRO of generic and less advanced medical technology, oversees and steers the implementation of Vision something which both NUPCO and SFDA will 2030 to modernise provision of care, including monitor and oversee. the de-centralisation of the system. For the time Currently there are close to 500 hospitals in the being, the VRO will retain control of most of the country. A number of these are key hospitals which healthcare budget and allocate parts to the newly stand out as prominent care facilities, and include: established Health Holding Company (HHC). – King Faisal Specialist Hospital The HHC is currently responsible for enacting and Research Center specific initiatives and programs of reforms, effectively guiding the geographical clusters being – King Abdulaziz Medical City, and set up and becoming functional. – Prince Sultan Military Medical City. HHC and individual clusters are quickly becoming new key entities for cooperation with These existing facilities, coupled with large Swedish companies in the field of provision of care infrastructure projects, like the crown prince’s and localised policy initiatives. As this happens, futuristic mega-city, NEOM, present significant Swedish companies will need to have a greater opportunities for Swedish companies. However, understanding of the demographic and socio- access to some of the most prominent hospitals is economic variations across the country. A deep not easy and requires networking and stakeholder understanding of the market and stakeholder engagement at both executive level and with engagement will be critical and enable more individual healthcare professionals.

18 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE UAE It is also responsible for: ownership and manage- The structure of the healthcare sector in the UAE ment of public hospitals and clinics in the emirate mirrors that of the government, consisting of of Dubai, overseeing and setting healthcare policy authorities on the federal and emirate levels. The and strategy, development of medical education and Ministry of Health and Prevention (MoHAP) research, regulating and licenses all healthcare facil- develops policies at the federal level and regulates ities and services, regulating the cost of healthcare, UAE’s federal healthcare laws, approves all import and running special programmes in the emirate of and registration of medical devices and pharmaceu- Dubai and its free zone, Dubai Healthcare City. ticals, licenses and registers healthcare specialists, There are currently over 130 hospitals in the UAE laboratories, clinics, and hospitals. MoHAP also and about 4,000 health centres, with approximately provides healthcare services and regulatory over- 70% privately owned. Almost 90% of all hospitals sight in the northern emirates of Ras Al Khaimah, in the UAE provide general medicine, with a minor Ajman, Umm al Quwain, Sharjah and Fujairah presence of specialised hospitals. The remaining which lack their own healthcare infrastructure. 10% is divided into: The Ministry of Presidential Affairs (MoPA) is a – Diagnostics national entity which provides support and consul- – Daycare Surgery tation to the UAEs president. The ministry meas- ures the performance of other ministries, authorities – Psychiatrics, and public enterprises and determines and evalu- – Obstetrics (Maternity) & Childcare ates the implementation status of government policies – Ophthalmology, and and programmes. These results are submitted to the UAE President. In the northern emirates, the Medical – Neuro-Spinal Office of MoPA owns and operates three hospitals via As a part of being able to provide a world-class different operators and at least one specialty clinic. healthcare system, the UAE market is penetrated by The Department of Health (DoH) is the key international hospitals such as the Cleveland Clinic, regulative body of the healthcare sector in the emir- Mediclinic, Medcare, American Hospital (member ate of Abu Dhabi. It shapes the regulatory frame- of Mayo Clinic Care Network), Aster Hospitals. work for the emirate’s health system, inspects There are also local hospitals focused on healthcare against regulations and enforces standards, while excellence and keen on attracting the best talents Abu Dhabi Health Services Company (SEHA) is in and having the newest technologies and solutions. charge of service provision. In Abu Dhabi, the DoH is a financially and administratively independent KEY TAKEAWAYS FOR body that creates requirements for healthcare facili- A TARGETED APPROACH ties, health insurance, clinicians, and health services Regardless of the type of healthcare company while overseeing the management of health services trying to enter the Saudi Arabian and UAE at the policy level in the emirate. SEHA is the larg- markets, it is important to become familiar with est public provider, it owns and manages most of the varying entity mandates and development the public healthcare facilities in Abu Dhabi and trends. It is important to engage early with certain is expected to implement the policies, projects and key entities who have significantly large mandates strategies approved by the DoH. and those entities pivotal for being able to operate In Dubai, the Dubai Health Authority (DHA) on the market. Even well advised and experienced is responsible for setting the strategic plans for companies run the risk of facing regulatory or the overall development of the healthcare sys- compliance related obstacles from time to time and tem, and for monitoring and evaluating perfor- good channels of communication are useful to clear mance while ensuring compliance with regulations. up confusions and to gain market insights.

18 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 19 SUMMARY STRATEGIC GROWTH A REALITY

The commitment to transforming the healthcare successful market entry. As distributor resources systems in both Saudi Arabia and the UAE to and capabilities vary across the healthcare land- value-based, patient centric-care models present scape, it is crucial that companies clear opportunities, but must be approached – do their homework and conduct due using an informed and long-term approach. diligence to find the best possible Reducing cost and increasing quality are primary distributor in each market, drivers for governments with an overarching need to reduce and manage the impact of the – Identify other brands the distributor increasing prevalence of NCDs. Incentivising represents and reach out to a few of them for privatisation, encouraging PPPs, raising awareness references. and increasing early detection are all part of – Understand the role and position the the broader healthcare transformation which is established network of your potential needed to meet population and demographic distributor in the market has and, changes. Digitalisation is set to play a pivotal – Establish if the distributor will dedicate a role in both short- and long-term solutions across salesperson for your product. all levels of healthcare access and provisions, presenting opportunities to support infrastructure Entry to market and market share growth can be as well as innovation. attained if a strategic approach and strong busi- Education, awareness and early detection about ness case is presented to the right stakeholders and NCDs is emerging as the cornerstone of the trans- decision makers. The potential long-term benefits formation which will help to deliver long-term effi- of having a local presence and established relation- ciencies and improvements to patient care and ships with authorities and healthcare providers in outcomes. While opportunities in knowledge both Saudi Arabia and the UAE are multifaceted. exchange, strategy development, healthcare provi- By utilising established and trusted partners with sion and procurement exist across the entire health- expertise in the region, Swedish healthcare com- care ecosystem, Swedish companies must consider panies have the potential to expand their global and overcome systemic challenges and cultural reach while contributing to systematic change complexities in order to be sustainable long-term. through the transformation of national healthcare Not all Swedish companies will be able to have structures. Partnership working and collaboration a direct presence in the market. Both Saudi Ara- on a high-level strategic and operational level has bia and the UAE are still, to a large extent, distrib- the power to reducing the impact of NCDs on a utor-driven markets and it is pivotal to find a reli- large scale, helping to tackle one of the growing able distributor with a good network to ensure healthcare burdens of the modern age.

“There is enormous potential for Swedish healthcare companies to expand global reach while contributing to systematic change, but a long-term view and investment in building local relationships is crucial.”

20 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE CONSIDERATIONS FOR SUSTAINABLE BUSINESS PRACTICE

CULTURAL AWARENESS SUSTAINABILITY LEGAL COMPLIANCE Informal business practices Environmental strategy Local, regional or national Accepted social norms Sustainable economic laws Local process growth Trade agreements or tariffs Social and community Tax regulations

The global demand and drive towards sustainable stability, it is important to have a region-specific business growth is becoming a critical factor for sustainability strategy. success. Sweden and Swedish companies have and A tailored sustainability strategy must address continue to hold a strong reputation in this area, economic, human rights and labour condition and it should be a key aspect of any global growth issues and how your company aims to work with plans. local suppliers to address these. It should also out- While every market has unique characteristics line how you plan to meet and exceed environ- that influence business operations, growth oppor- mental sustainability in accordance with applica- tunities and long-term viability, there should be ble global and regional legislation. a standard approach to building strategies for Both Saudi Arabia and the UAE have unique sustainable growth that are market and region and different legislative systems which defines and specific. impacts how international companies can oper- Before you enter any market within the Mid- ate. Different signed trade agreements and tar- dle East, it is advisable to have a strategy in place iffs also exist that may affect different parts of the to manage both macro and micro market related healthcare industry and regions. A complete anal- issues. This strategy should address all or a combi- ysis of your legal responsibilities and the implica- nation of, sustainability, legal and customs prac- tions of these should be conducted before entering tices. In both Saudi Arabia and the UAE, there is the market. a shift towards adopting and enforcing sustaina- Conducting business in both Saudi Arabia and ble business practices across the environment, eco- the UAE is heavily influenced by cultural prac- nomic and social spheres and these changes need tices. And these often differ between the coun- to be considered in a strategic approach. tries. Building relationships with potential key To reduce the risks of business malpractice stakeholders and getting an understanding of cul- and ensure you continue to meet international tural nuance is as important as knowing the for- and Swedish standards and maintain economic mal business structures.

20 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE | 21 ABOUT BUSINESS SWEDEN

Business Sweden’s purpose is to help Swedish companies grow global sales and international companies invest and expand in Sweden. Swedish companies can trust us to shorten time to market, find new revenue streams and minimise risks. We offer strategic advice and 3 hands-on support in more than 50 markets and 600 management consultants. Business Sweden has three offices in the Middle East: Saudi Arabia, Iran and the UAE and covers the Middle East and Egypt markets in the region. Business Sweden is owned by the Swedish Government and the industrial sector, a partnership that provides access to contacts and networks at all levels.

2 1 THREE OFFICES IN THE MIDDLE EAST

1 Saudi Arabia

2 United Arab Emirates

3 Iran

IF YOU WANT TO KNOW MORE, PLEASE CONTACT:

MASSOUD BIOUKI LINN BOMAN LINNÉA STRAND NICLAS CARLSSON LINA BALSYTE Market Area Director Middle East Middle East Middle East Middle East and Trade Commissioner Healthcare Team Healthcare Team Healthcare Team Healthcare Team massoud.biouki@ linn.boman@ linnea.strand@ niclas.carlsson@ lina.balsyte@ business-sweden.se business-sweden.se business-sweden.se business-sweden.se business-sweden.se

22 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE BUSINESS SWEDEN

GLOSSARY AND NOTES 1 Gulf Cooperation Council: Cooperation Council for the Arab States of the Gulf originally (and still colloquially) known as the Gulf Cooperation Council, is a regional intergovernmental political and economic union established in 1981 and consists of all Arab states of the Persian Gulf except Iraq, namely: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. 2 Saudization: Announced in 2016 as part of the Vision 2030 reforms, the newest policy of the Kingdom of Saudi Arabia implemented by its Ministry of Labor, which requires Saudi companies and enterprises to fill up their workforce with Saudi nationals up to certain levels. A key element of the plan is to reduce the number of unemployed Saudi nationals. Companies who fail to comply may not be awarded government contracts however there is push back from businesses about implementation and avoidance tactics.

ENDNOTES 1 NCDs definition as per WHO: “Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.” 2 World Health Organization (WHO) 3 World Economic Forum 4 World Health Organization (WHO) 5 www.worldstopexports.com/worlds-top-oil-exports-country 6 Saudi Vision 2030 7 Saudi Arabia National Transformation program 2030 8 Vision 2021 9 www.sciencedirect.com/science/article/abs/pii/0264275185901155

22 | BUSINESS SWEDEN | BUILDING A HEALTHY FUTURE 10 lcluc.umd.edu/hotspot/urbanization-dubai 2020 250 2020

We help Swedish companies grow global sales and international companies invest and expand in Sweden.

BUSINESS SWEDEN Box 240, SE-101 24 Stockholm, Sweden World Trade Center, Klarabergsviadukten 70 T +46 8 588 660 00 [email protected] www.business-sweden.com