The Middle East and North Africa region is composed of a diverse mix of countries, ranging from very poor nations to wealthy oil exporting countries. Public-private mix in financing and provision of health services is important in the low- and middle-income countries of the MENA region, while the wealthier oil-exporting countries tend to have National Health Service systems

The countries in his region can be divided into the following groups:

1. Countries typified by substantial capital, rapid development, and a small indigenous population, such as Saudi Arabia, Kuwait, UAE, Qatar and most Gulf states
   
2. Countries with less capital, more people, a quantitatively larger medical infrastructure, and more trained medical personnel, such as Lebanon , Egypt, Israel, and Algeria.
3. Countries whose extensive medical service plans have been halted or greatly decreased in scope because of civil strife or war, such as Iraq, and Iran.

The total population in the Middle East region is 171,398,000 with a total annual budget of $13,026,821,445 from the Ministry of Health. The total expenditure on healthcare including private hospitals amounts to $36,524,663,000. The Middle East's healthcare sector is expanding rapidly, and it has an impact on both the economies and the lives of the people of this region. The estimated value of this sector is $74 billion, and this is expanding at 16 per cent annually. The sector is emerging as one of the fastest-growing and most attractive markets for the world's hospital equipment and services companies, according to executives of the medical exhibitions and conferences to be held in the region.

The region's healthcare sector is witnessing major medical projects within the Middle East, including Dubai Healthcare City (DHCC) and the International Medical Centre (IMC) in Jeddah. The reasons behind this expansion are population and the emergence of countries as potential destinations for healthcare tourism.

In the Gulf according to WHO the UAE is experiencing a population growth of 14.1 per cent with an annual budget $439,218,000 from Ministry of Health while the total expenditure on healthcare is around $2,879,318,000. Along with this trend, the Dubai Health Care City has invested Dh350 million into its infrastructure and Phase one of DHCC has already started. The other countries in the Middle East, including Saudi Arabia with a population growth rate of 3.3 per cent has an annual budget of $3,568,456,000 from its Ministry of Health while the total expenditure on health care is $9,572, 864,000. Qatar's statistics show that the population growth is only 3.2 per cent, while the Ministry of Health's annual budget is $308,616,000 and the total expenditure on health care is $413,952,000.

In response to growing demand for a wider variety of dedicated medical training programs, a number of international medical schools have started programs in the area. These include, Harvard Medical International (HMI) which established a post-graduate medical education and research centre in Dubai in partnership with DHCC and which will be opened in 2006. In addition Cornell University has established a Medical School in Qatar and the Irish college a school in Bahrain.

The Middle East is an emerging market with expenditure on health care predicted to rise to new heights in the next three years. With the private sector growing fast, and health insurance spreading into the market, there is a new focus on quality to raise the level of medical care provided in the region. The importance of this market is further emphasized by the latest World Bank figures detailing health expenditure patterns in the region

Health Expenditure Patterns - MENA Region

Medical Technology

Medical facilities in the region are relying more and more on technological innovations that are pushing medical facilities to higher levels of operational sophistication. A number of important pharmaceutical companiesy, are trying to establish a base in DHCC. These include GlaxoSmithKline, Johnson & Johnson, and Novartis Pharma Services.

Market research is relatively new in the area, but it is crucial for the success of these new ventures and for promoting new products. They usually include the following objectives:

	Assess the competitive marketplace into which a product will be launched or in which a product competes.
	Demonstrate the clinical, economic, and quality-of-life values of a product relative to alternatives.
	Support the positioning and pricing of a product.

The rapid development over the past few years, of ever more sophisticated medical equipment for diagnosis and treatment has been breathtaking. This rapid development is being transferred rapidly to the area. Patients are benefiting from the rapid introduction of technology. Even robots will be introduced that will help doctors in the near future in various elements and areas, like hospital rounds, surgical work and others.

The Medical IT market

There has also been rapid growth in the medical IT market in the past few years. The new generation of technology offers medical institutions the opportunity to save time, reduce the risk of medical errors, and offer higher standards of care, and it is heartening to see so many institutions in the region in the first wave of early adoption.

There is a move worldwide towards computerised patient records and the need to improve efficiency. Technology companies, seeing a new pool of untapped profits, are more than happy to help. The Medical IT market is flourishing rapidly in the area with a lot of interest in developing a comprehensive computerized health information system. A number of countries in the area have already started the process, which will take several years to complete. Electronic medical records could substantially reduce deaths each year due to medical errors. Many of these fatal errors stem from simple mistakes like the dispensing of wrong medicines because of sloppy handwriting or delayed treatments because of paperwork holdups.

Currently in the United States it is estimated that less than 15 percent of doctors currently use high-tech tools like electronic medical records or electronic ordering systems for procedures or drugs, according to government surveys. The benefits that better technology could bring to health care are a topic of discussion everywhere from your local hospital to Governmental officials. President Bush has made improving health care technology a national priority. He wants to spend millions on grants and other incentives to establish a nationwide health records system within 10 years that would help doctors track and share information on every U.S. citizen. Most industries in the world have used information technology to make their businesses more cost-effective, more efficient and more productive, whereas health care hasn't.

Numerous technology companies are injecting themselves deeper into the health care industry. Last month, Intel created a new ''digital health'' division and put a top manager in charge of it. Intel is exploring everything from systems using tiny radio transmitters that help hospitals track patients and equipment to CD-like ''bio-discs'' that could contain a person's health records and even blood samples.

Health Care System

The development and implementation of critical healthcare reforms and strong policy making processes, has resulted in health systems that are more effective, efficient, and equitable. Today, health organizations must balance quality care and accountability in an environment of increased costs allied to limited resources and funding. Healthcare policy comprises the priorities, regulations, and administrative framework of a healthcare system. Changes in policy may reallocate resources among levels of care, allow greater local participation in care financing and provision decisions, adopt more efficient payment systems, and help ensure quality of care through appropriate incentives and monitoring. If designed and implemented correctly, these changes expand access to healthcare, thus improving general health and well-being. There is a need in the region to using Careful and Creative Analysis to Improve Policymaking. Additionally we need quantitative and qualitative research to provide policymakers with reliable information about the effectiveness of existing policies and potential strategies for action..

Health Care Reforms

Countries engaged in health system reform often make significant changes in the way health services are organized. System reform may include decentralization, which allows local governments, health facilities, private sector health providers, and community organizations to focus more on services, such as primary and preventive care, hospital care, incentives for health worker motivation and supervision, and health policy and regulation.

Reform poses both challenges and opportunities for health system policymakers and managers who seek to prevent and treat major threats to maternal and child health, provide effective family planning and reproductive health practices, and protect people from the rapid spread of HIV/AIDS and other infectious diseases.

Cultural Sensitivities

The involvement of non-Arab firms in the healthcare sector is increasing gradually. In addition, international agencies can be expected to step up efforts to tackle the problems of population growth and changing patterns of disease emanating from demographic transitions. As a result, the sensitivities of Islamic and Arab culture towards issues such as reproductive health, maternal and child health, as well as sexually-transmitted diseases, will become ever more evident in the coming year. An understanding of the roots of prevalent attitudes towards health and the taboos that exist is becoming increasingly crucial for the success of both business ventures and international aid agency efforts in the Middle East.

This will, in turn, lead to a continuing growth in opportunities for foreign private-sector firms in the Middle East, and an extension of international aid agency activities in the region.

In conclusion the health sector in the region will continue to expand in the future, in order for adequate preparation there is a need for:

	Better informed and more participatory policy processes in health sector reform;
	More equitable and sustainable health financing systems;
	Improved incentives within health systems to encourage agents to use and deliver efficient and quality health services; and
	Enhanced organization and management of health care systems and institutions to support specific health sector reforms.

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