The turn of 2019-2020 went down in history as a pandemic of the new coronavirus infection COVID-19. This emergency situation posed a threat to national and international security. The COVID -19 pandemic turned out to be one of the most unexpected events in healthcare service. This is due to the fact that the virus had three characteristics at the same time, which allowed it to affect healthcare around the world. The coronavirus combined various characteristics of a virus that had never before infected people on a permanent basis. Unexpected effects on healthcare service were due to its extreme effectiveness in relation to human-to-human transmission and relatively high morbidity and mortality rates, especially among the elderly and those with comorbidities. The only way against its uncontrolled spread was a global lockdown. The COVID-19 pandemic required the adoption of decisive, coordinated, global measures in healthcare services.
As part of the pandemic, a significant event in healthcare services for Saudi Arabia was the spread of a new genetic line of SARS-CoV-2 in the country. This strain spread across Arabia 56-70% faster than the source, and led to the death of patients more often than the classic COVID-19 virus (Banaj, 2018). It also overcame the natural immunity of the already ill population. The COVID-19 pandemic has revealed the weaknesses of Saudi Arabia’s healthcare systems, while accelerating the development of innovative approaches in medicine. Pharmaceutical companies and small biotech startups have launched dozens of clinical trials aimed at finding a solution to combat coronavirus. Some of these developments will influence what the healthcare of the future will be like in Saudi Arabia.
Impact of Infectious Outbreaks on the Health System
The number of infectious diseases and the associated mortality rate are declining, but they continue to pose a serious threat around the world. Some infectious diseases (such as tuberculosis) occur in Saudi Arabia, placing a heavy but predictable burden on the country. The health threats posed by outbreaks and epidemics, and the fear and panic that accompany them, come with a variety of economic risks.
The first, and perhaps the most obvious, is the cost to both public and private healthcare systems of treating the infected and controlling the disease. A serious outbreak can overwhelm the health system in Saudi Arabia, limiting the ability to address current issues and exacerbating the problem. In addition to shocks to health care, epidemics keep sick people and their caregivers from working or reduce their efficiency, causing productivity to fall.
Fear of infection can lead to social isolation, the closure of schools, businesses, commercial establishments, the cessation of transport and public services. All this undermines the economic and other socially significant areas of activity in Saudi Arabia. Fear of the spread of even a relatively small outbreak of the disease can lead to a decrease in trade volumes (Neef and Pauli, 2020). The number of tourists and other visitors to the region may decrease. Besides, some long-term epidemics limit foreign direct investment (Coppola, 2020). The authorities and physicians of Saudi Arabia are proposing a number of reforms in providing medical care to the population and responding to the spread of infectious diseases. The COVID-19 pandemic has exposed some of the health concerns in the country.
Public Health Emergency
First of all, it must be noted that it was the COVID-19 pandemic that created the public health emergency in Saudi Arabia. This is due to many reasons, one of which is the unpreparedness of the entire healthcare system and the lack of specialists. In addition, a separate dangerous element is the contagiousness and severity of the disease that affects existing doctors and volunteers, which also exacerbates the crisis of care in Saudi Arabia. In 2022, the situation came under almost complete control thanks to the retooling of organizations, the emergence of a large number of people willing to help, and the development of a vaccine (Raju, 2021). However, it is not possible to designate a way out of an emergency. The fact is that the virus creates new strains that differ from the previous ones and create new waves of victims in Saudi Arabia, both human and economic.
Possible Frameworks for Disaster Risk Reduction in Healthcare
The Hyogo Framework & The Sendai Framework for Disaster Risk Reduction
To combat disasters in 1994, the first UN World Conference on Disaster Risk Reduction was held in Yokohama. It resulted in the adoption of the Yokohama Strategy and Action Plan for a Safer World: Guidance on Disaster Protection, Preparedness, and Mitigation. The Yokohama Strategy became the first international document that fixed the main directions of the world community’s activities in the field of disaster risk reduction (Yokomatsu and Hochrainer-Stigler, 2020). Further development of the system of principles and directions of activity of the international community and individual states in disaster risk reduction was reflected in the Hyogo Framework for Action for 2005-2015 (HFA). The conference was attended by over 6,500 delegates from 186 countries, 25 heads of state, vice presidents and heads of government, more than 60 ministers, as well as the UN Secretary General and Emperor of Japan Akihito (Yokomatsu and Hochrainer-Stigler, 2020, p. 101). It is important to note that this Hyogo Framework was a preparatory stage for the development of a full-fledged program.
The main document for disaster risk reduction is the Sendai Framework for Disaster Risk Reduction 2015-2030 (SRR). The result of the implementation of the PSA is a significant reduction in disaster risk and lives’ losses, loss of livelihoods, and deterioration in the health of people (Yokomatsu and Hochrainer-Stigler, 2020). To achieve the result of the implementation of the PDS at the global, national and local levels, global targets have been defined:
- Achieve a significant reduction in disaster deaths by 2030 to the average number of such deaths per 100,000 people was less than in 2005-2015;
- Reduce, by 2030, direct economic losses from disasters in relation to the global gross domestic product (GDP);
- By 2030, reduce disaster damage to critical infrastructure and disruption to essential services, including health and education facilities, including by strengthening their resilience;
- Increase international cooperation with developing countries by providing them with sufficient and continuous support to support their national efforts to implement this framework by 2030 (Yokomatsu and Hochrainer-Stigler, 2020);
- By 2030, improve the availability of and access to multi-hazard early warning systems and disaster risk information and assessments.
Resilient Health System
Promoting better health is an inherent duty of every country. However, at the time of the activity of the second strain, Saudi Arabia could not cope with the problem of providing the population with medical services on its own. Therefore, the use of the resilient health system software framework in this case will be aimed at the most important areas for improving the health of various segments of the population.
First of all, it is fighting SARS-CoV-2; achieving the goals within the resilient health system in Saudi Arabia is extremely important, as they reflect universal human values and rights, including the right to health. Providing the population with medical services is of great importance for all its social strata. Prompt and effective treatment is crucial to prevent the dangerous virus and increase the likelihood of recovery of those who become ill in Saudi Arabia (Shammah, 2018). It is the desire to achieve this goal that determines the vector of development of healthcare systems in the country. This, in turn, leads to an increase in its sustainability and an increase in opportunities to ensure universal access to medical services. One of the main elements of the Saudi Arabian healthcare system, which cannot be ignored, is the provision of medicines to the population. Of particular importance are medicines used in the treatment and prevention of deadly diseases, such as COVID-19.
Within the resilient health system framework, universal access to health services is not only the result of the sustainability of health systems. The desire to provide such access to the citizens of Saudi Arabia makes it necessary to reform the healthcare system, as well as other state and even interstate institutions (Felemban et al, 2021). In particular, economic initiatives can increase the availability of medicines for the population. In addition, the development of educational systems will undergo reform – indicators at the stages of prevention of diseases will be improved.
Disaster Risk Reduction
The modern world community is actively developing, new spheres of international relations, their regulators and forms of interaction are emerging. Along with different countries, as subjects of international law, international intergovernmental organizations also work. International disaster protection is one of the areas of interstate cooperation (Alruwaili et al, 2021). The work is also carried out in the format of various conferences, in which Saudi Arabia also participates. Such events, as a rule, have a narrow topic, for example, problems related to the SARS-CoV-2 strain, and gather specialists in their field.
One of the most effective forms of international cooperation in the field of healthcare for Saudi Arabia is precisely such meetings in the field of disaster protection. The Disaster Risk Reduction Platform is a bilateral multi–stakeholder forum (Liu et al, 2021). It reviews progress, shares knowledge, and discusses recent developments and trends in disaster risk reduction. The opportunity to participate in the platform is open. Any interested person, scientist, organization or commercial enterprise can register and apply for specific events within the framework of the forum (Mansour et al, 2020). Therefore, it is quite effective to review progress, exchange knowledge, discuss the latest developments and trends of Saudi Arabia with other countries.
It is the work with the global platform that can become a regular global forum for the exchange of information, coordination of actions and evaluation of the results achieved by Saudi Arabia. Multifactoriality is aimed at solving disaster risk reduction with the involvement of experts and practitioners (Ghayebzadeh et al, 2020). The adjustment of plans for further work and the formation of new joint projects will allow Saudi Arabia to reduce the risk of disaster. Such events make it possible to unite in one place specialists from different fields involved in disaster protection (Wang et al, 2021). In addition, it is possible to show problems and the possibilities of their solution at the local level inside Saudi Arabia, which is of particular importance if there is no other format for these questions.
Disaster Risk Management
One of the ways to improve the efficiency and quality of medical care is the introduction of a risk management system. It allows to identify, assess the consequences and develop counteraction tactics aimed at limiting accidental events that cause physical and moral damage to potential patients (Baker et al, 2019). In order to form the organization’s resilience to accidents, accidents, and losses, a risk management concept was formed. It makes it possible to detect hidden sources of danger and develop countermeasures.
One of the fundamental principles of quality management in Saudi Arabia in the conditions of SARS-CoV-2 is the use of a process approach. It is optimal to assess risks in the context of business processes existing in the state. As a rule, there are two main groups of processes: basic (therapeutic) and auxiliary (Alruwaili et al, 2019). Some healthcare service risks in Saudi Arabia are associated with the process of providing medical care. They may relate to diagnostic risks: risks of incorrect diagnosis, or defects in information interaction (Antoni et al, 2018). Therapeutic risks are also widespread: risks of pharmacotherapy, risks of interaction of specialists and continuity of medical care. The risks of auxiliary processes in Saudi Arabia are related to finances: lack of funds, failure to provide reports on time. Moreover, there is a problem is poor-quality cleaning of medical institutions and the occurrence of nosocomial infections.
The essence of risk management is to build a system of measures to counteract risks. For Saudi Arabia, two approaches to risk management are applicable: human-oriented and systemic (organizational). The human-oriented approach focuses on individual mistakes related to forgetfulness, incompetence, inattention or immorality (Bajow et al, 2018). The organizational approach focuses on the conditions in which people work and is based on building a protection system that prevents mistakes or compensates for their consequences.
Disaster Cycle
The disaster cycle hypothesis implies that there is a frequency of global disasters in the health sector. Since the 14th century, in every 20th year of the new century there has been a strong outbreak of a deadly infectious disease (Dano, 2020). In the last 700 years, every 20th year of the century, a massive epidemic of a deadly disease broke out (AlQahtanya and Abubakarb, 2019). History is cyclical and that there are special periods when the probability of an outbreak of a deadly disease or the outbreak of war is much stronger than at other times. Thus, the health authorities of Saudi Arabia should take this fact into account and have increased readiness in designated periods of time.
SARS-CoV-2 will continue to circulate in the population for a long time, until the appearance of effective vaccines and etiotropic treatment. As a result, medical organizations in Saudi Arabia need to adapt their work practices to new conditions and problems and prepare for the emergence of new strains (Farghaly et al, 2022). According to the disaster cycle framework, new variations of the virus will continue to appear.
Pharmaceutical companies in Saudi Arabia are able to help healthcare prepare for situations like the current pandemic. First of all, this is feasible through increasing the efficiency of the pharmaceutical business. This increases both patient satisfaction and trust in companies on the part of partners. One of the main tools for increasing efficiency is digitalization and automation of processes. Disaster cycle framework provides training in some areas at once. For Saudi Arabia, one of these areas is electronic document management (Tammar et al, 2020). On the one hand, this makes it possible to refuse many face-to-face meetings that are undesirable against the background of an unstable epidemiological situation (Sultan et al, 2021). On the other hand, the working time that used to be spent on servicing contracts and other interactions with customers is reduced (Nofal et al, 2018). The transfer of processes to an electronic format provides tangible savings. Healthcare minimizes expenses that do not bring added value to the healthcare services. For example, the costs of courier services or forwarding correspondence are reduced.
Healthcare Crisis Management
The anti-crisis management framework is viewed from the perspective of healthcare management in the context of a general crisis. The basis of crisis management is an assessment of the current situation and prospects, allowing to make informed management decisions. At this stage, specific economic calculations are not yet required (Harthi et al, 2020). Based on the knowledge of the general forms of manifestation of the crisis, its impact on various aspects of healthcare. It is also necessary to assess the main problems that healthcare has already faced or that it will have to face.
The next stage is to identify specific priorities for Saudi Arabia. In the most general terms, they will consist in ensuring the provision of the previous volumes of medical care without reducing the quality, preserving both personnel and logistical medical potential. At the same time, taking into account the specifics of the country (sources of financing, territorial location), additional priorities may be either obtaining additional income and minimizing costs. This is followed by the development of an action plan to overcome the crisis situation (Brinjee et al, 2021). To make it vital, it is necessary to make a large number of specific management decisions in various areas of activity. It is advisable, in particular, to develop recommendations on certain areas of rationalization (optimization of the wage fund, the consumption of medicines in Saudi Arabia, etc.).
Fundamentally important anti-crisis tasks are to increase income and reduce costs, therefore, an important place in the development of an anti-crisis strategy should be given to financial services. The economic service, the department of paid services and other departments in Saudi Arabia should work in the mode of generating new ideas (Azeez et al, 2020). Of course, the implementation of the adopted plans must be ensured. However, what is meant is not the desire to carry out all the planned activities, but constant monitoring of the situation and correction of the decisions taken.
Public Healthcare Emergency
The implementation of health regulations in the field of combating infectious diseases in Saudi Arabia corresponds to the public health emergency framework. It defines the strategy of its implementation in modern conditions. The emergence of SARS-CoV-2 required the adjustment of the basic conceptual apparatus in the field of anti-epidemic preparedness and rapid response (Rizqillah and Suna, 2018). In Saudi Arabia, specialized anti-epidemic brigades were also used. There was a need to define a unified object of supervision and control at the national level. Within the framework of the public health emergency framework, on the one hand, it must comply with an international standard (Almukhlif et al, 2021). On the other hand, it should be isolated for practical purposes from the widely interpreted concept of emergency adopted in Saudi Arabia.
The purpose of using public health emergency is to prevent the international spread of diseases, protect against them, and fight them. In addition, Saudi Arabia has been guided by it in the process of taking public health responses that are commensurate with and limited to public health risks. At the same time, they should not have created unnecessary obstacles to international transportation and trade. The basic principle is proactive risk management aimed at early detection and elimination of an outbreak of an infectious disease before the formation of an international threat (Thobaity et al, 2019). The conceptual novelty of public health emergency in Saudi Arabia is the definition of such a concept as a public health emergency of international importance as a global object of supervision and control. The structural and functional organization of healthcare service is designed to prevent, verify and eliminate such emergencies in Saudi Arabia (Alyami et al, 2021). The tactics of using this framework allows to solve problems when providing assistance to territorial health care structures in a wide range of crisis situations in the emergency zone.
The Role of the Disaster Risk Reduction System in Saudi Arabia
The reason for the special position of Saudi Arabia is the location of the country’s territory in a zone of increased risk of natural disasters. The population of Saudi Arabia suffers from drought and sandstorms, characteristic of the desert climate. This explains the relevance and necessity of the disaster risk reduction system for the state. In particular, the strategy to reduce the risk of disasters and their consequences allows the state to not lose a huge amount of the population due to a lack of food due to reserves (Raju, 2021). In addition, Saudi Arabia is rapidly moving out of poverty, which leads to the availability of food and quality housing for the vast majority of the population. As a result, all this led to a decrease in mortality and casualties among people.
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