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Revolutionising Bahrain’s healthcare system

Interview - March 13, 2014
With Bahrain’s Economic Vision 2030 providing a clear direction for the continued development of the Kingdom’s economy, in doing so it has also pointed to the need for the regulation of the whole healthcare system by an independent health regulator. The National Health Regulatory Authority (NHRA) fulfills exactly this role. Speaking to United World,CEO Dr. Bahaa Eldin Fateha explains how the NHRA are revolutionizing the country’s healthcare
We are closely analysing the key sector that are contributing to Vision 2030. Healthcare, as a pillar of Vision 2030, is a tool to improve quality of life in Bahrain. How does this institution fit with the new concepts that both the Crown Prince and the society of Bahrain are trying to introduce to further advance the economy through Vision 2030?

Dr. BAHAA: The National Health Regulatory Authority (NHRA), is literally the offspring of the Economic Development Board. Vision 2030 aims to attain quality in different sectors: health, education, and economic wellbeing. I concentrate on our part – health. To have the best health services you must have a credible regulatory system that is accepted by the people of Bahrain. If people trust that there is a watchdog for the health system they will have confidence in that health system.

NHRA is an independent body that monitors adherence of healthcare providers to relevant healthcare standards and regulations which have been approved by the Board of NHRA. We have to make sure that they are operating according to the pre-set rules i.e. healthcare facilities follow facilities standards, and those who work within these facilities are licensed to practice each in his/her designated specialty. Pharmaceuticals should be effective and safe, and we assure that through our Pharmacovigilance section of NHRA. NHRA also address patients’ complaints and follow them through. In this regard, I must emphasize that NHRA advocate blame-free and discipline-free environment. We try to identify those reasons why mistakes occur so we can overcome them and bring more stability to the system and more understanding to the persons who are using this system.

On the other hand, talking about health promotion and prevention of diseases is another matter. In this situation we are not talking about patients, but about healthy individuals in the community who are looking to improve their quality of life and to promote their health status. They have the right to go to a system that is properly monitored to provide care.

We realized that the public prefer that the monitoring system is independent from healthcare provider. In this regard, NHRA satisfies this requirement as we are not healthcare providers and are not linked to any healthcare provider in the Kingdom.

Talking about pharmaceuticals, NHRA has moved to make sure that every medication in Bahrain is registered and priced by the pharmacy section of NHRA. We have a strong preventive program to stem out any possibility of having counterfeit medicine in Bahrain, and we have excellent success in this regard, based on the regular inspection of pharmacies and hospitals in the kingdom by inspectors of the Authority.

NHRA is responsible for monitoring health services.

First the facility – we license the facility to make sure that the building satisfies the requirements of healthcare facility, so also equipment within the building should be certified and installed according to the manufacturer recommendations. We also make sure that the facility operate according to valid and up-to-date policies and procedures and apply safe practices across the entire spectrum of services.

Second, healthcare professionals in the facility should be licensed to practice, and hence should have passed all the necessary requirements to obtain a valid license including passing a license exam if needed. Validity of the license vary by specialty, and it is renewable annually for physicians and every two or three years for other healthcare professionals.

We are introducing, first on trial basis then it will become compulsory, the continuous medical education (CME) points as a requirement to maintain the license to practice. We also have to make sure that the infrastructure is there to support the needs of all categories of specializations to obtain CME points.

Third, medications: No medication is allowed in Bahrain unless the manufacturer, the company and the medicine itself are registered at NHRA. We are member of the GCC Central Committee on medicines. Accordingly, if a company and/or its products are registered centrally in the GCC, therefore it becomes a simple matter to register it in Bahrain. I must emphasize that the medicine in Bahrain is 100% safe, genuine, coming from a factory we recognize and priced according to the Bahrain and GCC standards. We have recently unified the prices across the GCC which led to significant reduction in the prices of medicines in Bahrain. This will especially help patients with chronic diseases, such as hypertension or diabetes.

Another thing that we monitor is patient complaints and follow them through to the satisfaction of the complainer. As mentioned earlier, we look for systems’ improvement and not to blame individuals.

We recently developed our healthcare facilities’ standards for hospitals, medical centers, clinics and pharmacies. These standards are user-friendly and according to the feedback from different facilities, they have been very helpful in minimizing systems’ errors.

NHRA is also responsible to approve experimental medical research that involves human beings. Our objective is to make sure that the medical experimental research will not, under any circumstances, put the patient’s health or life at risk. Currently, we approve only multinational research studies after careful review of the research protocol by ethics and research committees.

Your task is not only improving or raising the standards. It is mainly a change in culture of how things are done. It implies a lot more than changing regulations or enforcing standards.

Exactly. We are looking into a new environment with a different way of thinking where transparency is the norm. Patient safety, systems’ efficiency and high quality are the main objectives of any successful system, and we strongly believe that this is attainable in Bahrain.

It is about making people own their way out of their problems. Now that we had covered the internal structure and functions of the organization, what are the cooperation schemes in place with other organizations both locally and worldwide?

We did not develop this on our own but through international cooperation. We have excellent support from Irish Development International Company, which is backed by the Irish Medical Council, the Irish Medicines Board, and the Irish Research Council, all their experience was communicated to us. For 3 years we have been exchanging information and cooperating with their experts in developing the new healthcare standards in Bahrain. Technology transfer was at its best because after developing the standard, IDI helped in training our staff, and the end result is a set of standards that work.

On the other hand, as a member of the GCC, we are represented in every committee addressing the health sector including, but not limited to, Pharmaceuticals, alternative medicine, health planning, healthcare standards, …etc.

In this context of internationalization, are the doors open for foreign investment?

The door is widely open. Bahrain welcomes foreign investment in the health sector and NHRA helps by facilitating the understanding of the work and healthcare environment in Bahrain.

What is then the sort of link that you have with the MoH?

NHRA and the Ministry of Health, as well as any healthcare provider, work to complement each other without interfering in the jurisdiction of each other. The Minister of Health represents NHRA on the Ministerial Council and in the Parliament. However, each entity has its own rules and regulations. The Ministry of Health provide services, among the many tasks they provide, while NHRA monitor the provision of this service, in addition to other functions as stated earlier.

Our interviewees have agreed that since the economy is less reliant on oil there is need to further diversify by finding new comparative advantages. Education is one of the sectors in which Bahrain has to become a hub. However, there is also a chance for heath to become another advantage of the country in terms of being the preferred option for health treatments in the Gulf, a health centre for people seeking treatment for different diseases that don’t exist in their home countries. What is your perspective in this regard?

This is exactly what we aim for. Thus, you have to improve your public and private health care facilities. We have to make sure that there are advanced medical services provided to the people and visitors of Bahrain and at the same time there is an active, powerful and independent monitoring mechanism, which will give stability to the system and comfort for the systems’ users.

Given the positive outcome and positive feedback that this organization has received since its inception, what are your ambitions for 2030?

When we reach the year 2030 we hope that NHRA will be the most active and at the same time hidden, unnoticed, organization. This can be achieved when monitoring become a regular activity that is welcome by all and conducts its full operations without distracting anyone or causing inconvenience to anyone. By then the culture will have been changed and monitoring and regulation will have become an integral component of the system.