Primary healthcare in the Kingdom of Saudi Arabia: challenges in health system reform

Author: Bader Alqhtany

Alqhtany, Bader, 2019 Primary healthcare in the Kingdom of Saudi Arabia: challenges in health system reform, Flinders University, College of Medicine and Public Health

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This study focused on understanding the effectiveness of the Kingdom of Saudi Arabia’s (KSA) 2005 National Policy for Health under the Ninth Development Plan (2010–2014) and its implementation at the primary healthcare level. This study also identified challenges associated with the implementation of, and any existing barriers to, delivering universal healthcare services at the primary healthcare level in Saudi Arabia. A thorough literature search revealed that no research had been undertaken to evaluate the effectiveness of the 2005 National Policy for Health. The research undertaken within this thesis adopted a framework model devised from the Ouagadougou Declaration on Primary Healthcare and health systems in Africa, which provided a structured methodology to analyse the effectiveness and challenges of the 2005 National Policy for Health.

Using a mixed methods approach, the researcher collected data from face-to-face interviews and an adapted survey tool from the Canadian primary healthcare practice-based surveys. The qualitative component included interviews with participants across two levels, interviews with 12 regional Ministry of Health primary healthcare directors, and data from 90 primary healthcare centres directors/managers. The survey instrument was adapted to a Saudi context after conducting a pilot study in an adjacent region. The survey data were analysed using descriptive statistics, and the qualitative data were analysed using thematic analysis.

The results showed that the 2005 National Policy for Health has been successful in expanding primary healthcare centres, with the establishment of 2,301 primary healthcare centres. However, many elements of the strategic plan—including mission, core values and objectives—are missing. The mission, core values and objectives were not effectively communicated by the Ministry of Health (MoH) or understood by the participants. The barriers to effective universal healthcare in KSA include a lack of autonomous oversight by the primary healthcare sector, including financial control and a lack of health technology, integrated health information systems and basic telecommunications systems, including phones and the internet. There were also issues with staffing, particularly specialised skills, and the primary healthcare system lacked public–private partnerships.

By examining the effect of the 2005 National Policy for Health, and investigating the barriers and challenges facing primary healthcare in KSA, this study extends the scholarly discourse of understanding the role and functionality of primary healthcare within KSA. Furthermore, this study discusses the effectiveness and efficiency of delivering universal healthcare in KSA. At a theoretical level, this study developed an adapted framework model using the nine criteria set out in the Ouagadougou Declaration as a method of assessment, along with eight domains that are linked to the literature and discussed using deductive reasoning (Chapter 7). This study identified inherent systemic issues, such as the lack of infrastructural resources, stemming from leadership and policymaking, which are impacting the operational effectiveness and clinical delivery of care. These systemic issues have impeded the benefits of developing primary healthcare centres (PHCCs).

Keywords: Saudi Arabia, healthcare services, primary healthcare, healthcare system

Subject: Primary Health Care thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Medicine and Public Health
Supervisor: Dr. Angelita Martini