|
HUMAN RESOURCES DEVELOPMENT REVIEW
Background
Human resource is a key
input to the health care system in the Sultanate of Oman as it is to
other health care systems around the world. The Ministry of Health
spends about 70% of its recurrent budget on the salaries and allowances
of its staff. Human resource is critical in the health sector, not only
because of the money spent on it, but also because of its highly
specialized nature. Quality and quantity of health care provided to the
people depend largely on the adequacy of health manpower and their
active involvement in health care delivery. In the early part of the
Omani Renaissance, the Sultanate imported health workforce from other
countries in large numbers, because its educational infrastructure was
inadequate at that time. The Sultanate adopted
this policy in order to accelerate health services development
and fulfill the aspirations of the people of Oman. His Majesty Sultan
Qaboos has advocated Omanization as a national strategy for
self-reliance, in order to sustain the social and economic development
achieved in the Sultanate. Ministry of Health (MoH) attaches significant
importance to human resource development as a strategy for achieving
effective health services development. With a view to achieving total
self-reliance in human resources, MoH continues to pursue a number of
strategies:
1.
Basic education in nursing and paramedic professions.
2.
Post-basic specialized training in nursing & midwifery.
3.
Continuing professional development of staff.
4.
Collaboration with SQU and Oman Medical Specialty Board.
5.
Collaboration with international colleges / boards.
6.
Overseas education and training for different
professions and medical specialties.
Medical Education
Medical education in
Oman commenced in the year 1986.Prior to that the Omani students had to
go abroad in order to pursue medical degrees. The College of Medicine &
Health Sciences, Sultan Qaboos University (SQU) enrolled its first batch
of 45 students for MD in 1986. The program consists of 4 years’ training
in health sciences followed by 3 years’ training in clinical medicine.
The first batch graduated
in June 1993. Altogether 876 students earned their MDs from SQU
over the period 1993 to 2005. About 60% of these graduates are females.
See Table-1.
Table 1: Graduates from College of
Medicine & Health Sciences, SQU during 1993 to 2005
|
Year |
2005 |
2004 |
2003 |
2002 |
2001 |
2000 |
1999 |
1998 |
1997 |
1996 |
1995 |
1994 |
1993 |
|
|
91 |
84 |
78 |
74 |
88 |
59 |
75 |
82 |
63 |
56 |
41 |
40 |
45 |
Source: Office of Dean, SQU College of
Medicine & Health Sciences
Medical education has so far been mainly the responsibility of SQU,
which increased its intake to 120-141 in 1999-2005. MoH actively
collaborates with the SQU College in numerous ways including the use of
its major hospitals for clinical practice and internship etc. Omanis are
also sent abroad for undergraduate medical education. Recently a private
medical college viz. Oman Medical College has been established. This
college enrolled 89 students in 2004. MoH supports this college by
permitting it to use the Sohar Autonomous Regional Hospital as its
clinical practice area. The college also receives direct or indirect
support from the Government.
Postgraduate medical education commenced in Oman with the establishment
of the Oman Medical Specialty Board (OMSB) in 1994, as the highest
supervisory body of all postgraduate medical training programs in Oman.
OMSB is now being reconstituted by the Government to implement a Royal
Decree enhancing its status to a statutory body chaired by HE the
Minister of Health. The Board has spearheaded development of
postgraduate residency programs in the country with the active support
of the Ministry of Health, SQU, Royal Oman Police Medical Services and
the Armed Forces Medical Services. The Ministry of Health has signed
MoUs with a number of countries and international colleges, which run
local chapters, hold local examinations with MoH support or facilitate
overseas training and experience of Omani physicians. Many residents
have already cleared all requirements of OMSB and international
boards/colleges, and earned their full memberships of such bodies. Many
Omani physicians have also studied locally or abroad and earned their
masters or doctorate degrees.
Education in Other
Health Professions
Health professional education started in Oman in the year 1959, when a
missionary nurse attached to the then American Missionary Hospital
trained 16 Omanis to work as nurses. In 1970, Ar Rahma Nursing School
was
established as the first health-training institute in Oman.
Individuals only with primary education were enrolled as students. The
first batch of 5 nurses graduated in 1972. MoH started supervising the
nursing school thereafter. During the period 1972 to 1981, only 83
nurses graduated. To keep pace with the development of the health
care infrastructure, and the need to reduce dependence on manpower
import, MoH decided to accelerate human resources development and began
to coordinate its efforts to train medical and paramedic staff locally
and abroad. A Directorate of Education and Training (since renamed
Directorate General of Education and Training or DGET) was established
within MoH as the focal point for health professional education. The
Ministry’s first major institution viz. the Institute of Health Sciences
(IHS) was established in 1982.The nursing school was considered a part
of IHS. Nursing education was initially offered at two levels.
The students who completed primary education (grade 6) were
eligible for admission to the Assistant Nurse program of 2 years’
duration. This program was discontinued in 1989, and the last batch of 8
nurses graduated in 1991. The
General Nursing program, conducted initially for preparatory
school leavers, was later developed to accept only those who complete
secondary education after 12 years of schooling. The program lasts for 3
years followed by 6 months of internship. This program has
continued since then.
Training in Medical Laboratory Sciences was offered by IHS since its
commencement in 1982. Training in Radiology and in Physiotherapy was
introduced in 1986 and in Dental Surgery Assistance in 1993. In 1991,
regional nursing institutes were established in different regions in
order to ensure equitable opportunities for admission to all students
across the Sultanate, to facilitate regional development, and to ensure
proper distribution of nurses in different health regions. In addition,
MoH also set up new institutes for education in other allied professions
viz. the Oman Institute of Public Health (1991), the Oman Institute for
Assistant Pharmacists (1991) and the Oman
Institute of Medical Record Technology in Muscat (2002).
Enrollment in general nursing has grown dramatically over the years
consequent to the growth of educational facilities. There were 1,565
students studying general nursing in 2005 (all grades combined), which
was almost 7 times that in 1990. SQU has been conducting a bachelor’s
degree program in Lab. Technology. It has recently mounted also a BSN
program with an intake of about 50 per year, with provision for direct
admission of diploma graduates to a higher grade. Table 2 shows numbers
enrolled in the first grade in the different basic and post-basic
programs run by MoH institutes.
Table 2: Students Enrolled in First
Grade in Ministry of Health Training Institutes*
|
Health Profession |
2005/2006 |
2004/2005 |
2003/2004 |
2002/2003 |
|
Total for Basic Nursing (All
Institutes combined) |
560 |
=SUM(ABOVE) 546 |
517 |
562 |
|
|
46 |
39 |
41 |
40 |
|
Radiology |
31 |
30 |
30 |
30 |
|
Dental
Surgery Assistance |
16 |
16 |
17 |
17 |
|
Physiotherapy |
21 |
19 |
0 |
20 |
|
Medical
Records Technology |
20 |
20 |
20 |
14 |
|
Pharmacy
Assistance |
55 |
54 |
54 |
55 |
|
|
=SUM(ABOVE) 189 |
=SUM(ABOVE) 178 |
=SUM(ABOVE) 162 |
=SUM(ABOVE) 176 |
|
Post-Basic Nursing |
|
|
|
|
|
Nephrology Nursing
|
22 |
20 |
22 |
20 |
|
Midwifery |
75 |
=SUM(ABOVE) 72 |
=SUM(ABOVE) 49 |
=SUM(ABOVE) 41 |
|
Critical
Care Pediatric Nursing |
25 |
28 |
20 |
22 |
|
Nursing
Administration |
27 |
26 |
26 |
0 |
|
Critical
Care Nursing (Adult) |
30 |
23 |
0 |
0 |
|
Mental
Health Nursing |
15 |
16 |
0 |
0 |
|
Total for Post-Basic Nursing |
=SUM(ABOVE) 194 |
=SUM(ABOVE) 185 |
=SUM(ABOVE) 117 |
=SUM(ABOVE) 83 |
|
|
10 |
14 |
15 |
16 |
|
Total Post-Basic Training |
=SUM(ABOVE) 204 |
=SUM(ABOVE) 199 |
=SUM(ABOVE) 132 |
=SUM(ABOVE) 99 |
|
Overall
Number of Students Enrolled |
953 |
923 |
811 |
837 |
*
Based on the information provided by
Directorate of Health Information & Statistics, DGP
Health Manpower Production under Ministry of Health
709 students earned their basic diplomas in a health profession from MoH
institutes during 2005. This figure is about 15 times the total number
qualified in 1990. Table 3 shows that altogether 7,079 students
qualified from MoH institutes over the years. General nursing graduates
represented about 74% of all graduates.
Table 3: Basic Professional Education
Outputs from MoH Institutes up to 2005*
|
Year |
Nurse
|
Nutrition |
Med. Rec. Tech. |
Med. Lab. Sc. |
Radiography |
Physiotherapy |
Dental Surgery
Asst. |
Public Health
Inspect. |
Health Education |
Pharmacy Asst. |
Overall |
|
Up to
1983 |
126 |
|
|
|
|
|
|
|
|
|
126 |
|
1984 |
52 |
|
|
|
|
|
|
|
|
|
52 |
|
1985 |
54 |
|
|
|
|
|
|
|
|
|
54 |
|
1986 |
37 |
|
|
8 |
|
|
|
|
|
|
45 |
|
1987 |
37 |
|
|
8 |
|
|
|
|
|
|
45 |
|
1988 |
50 |
|
|
12 |
|
|
|
|
|
|
62 |
|
1989 |
27 |
|
|
11 |
|
|
|
|
|
|
38 |
|
1990 |
26 |
|
|
6 |
11 |
5 |
|
|
|
|
48 |
|
1991 |
37 |
|
|
28 |
2 |
0 |
|
|
|
|
67 |
|
1992 |
59 |
|
|
25 |
8 |
8 |
|
|
|
|
100 |
|
1993 |
116 |
|
|
31 |
12 |
10 |
|
34 |
|
|
203 |
|
1994 |
193 |
|
|
12 |
16 |
9 |
10 |
35 |
|
33 |
308 |
|
1995 |
221 |
|
|
17 |
11 |
10 |
12 |
32 |
27 |
35 |
365 |
|
1996 |
331 |
|
|
15 |
30 |
9 |
10 |
29 |
33 |
33 |
490 |
|
1997 |
276 |
|
|
19 |
16 |
12 |
14 |
34 |
38 |
28 |
437 |
|
1998 |
305 |
|
|
20 |
13 |
16 |
12 |
0 |
0 |
35 |
401 |
|
1999 |
373 |
30 |
|
24 |
19 |
21 |
14 |
0 |
0 |
35 |
516 |
|
2000 |
438 |
32 |
|
32 |
22 |
0 |
12 |
0 |
0 |
50 |
586 |
|
2001 |
442 |
0 |
|
23 |
20 |
0 |
13 |
0 |
0 |
48 |
546 |
|
2002 |
417 |
0 |
|
27 |
29 |
1 |
15 |
0 |
0 |
44 |
532 |
|
2003 |
522 |
0 |
|
33 |
30 |
0 |
13 |
0 |
0 |
47 |
645 |
|
2004 |
531 |
0 |
14 |
29 |
28 |
0 |
16 |
0 |
36 |
49 |
703 |
|
2005 |
554 |
0 |
18 |
40 |
29 |
0 |
16 |
0 |
0 |
52 |
709 |
|
Total |
5,224 |
=SUM(ABOVE) 62 |
32 |
420 |
296 |
=SUM(ABOVE) 101 |
157 |
=SUM(ABOVE) 164 |
=SUM(ABOVE) 134 |
489 |
7,079 |
*
Based on the information provided by
Directorate of Health Information & Statistics, DGP
Growth in
Manpower Stock and Omanization Prospects
The most important benefit of the production of national workforce is
the increased self-reliance of the health sector in human resources, and
the prospect of eventual Omanization of all important health
professions. It is remarkable that the stock of Omani physicians in the
Sultanate has grown from only 86 in end-1990 to 813 in end-2005. The
number of Omani nurses has risen from 406 to 4,680 during the same
period. The Sultanate has achieved most of the gains in these categories
in the last fifteen years, mainly due to indigenous production. The
number of Omani dentists has grown from 10 (end-1990) to 69 (end-2005).
The number of Omani pharmacists has grown from 7 to 75 during the same
period. The increases in the categories of dentists and pharmacists were
entirely due to the education of Omanis abroad. Despite substantial
expansion in health facilities and the consequent need for additional
manpower, the increases in the stocks of Omani manpower have helped in
raising Omanization levels in several categories, as it is evident from
Table 4. Needless to say, the availability of local manpower production
facility in case of physicians and nurses helped in improving the
Omanization levels in these professions during 1990-2005. However, the
reverse is true in case of dentists and pharmacists, for which local
production facility was not available so far. The Omanization levels in
these categories increased less significantly during this period. [See
Figure 1]. This clearly demonstrates the importance of investment in
educational facility for realizing the coveted goal of creating a
sustainable health system infrastructure without compromising on the
Omanization policy. The prospects for increased self-reliance in the
dentist and pharmacist categories have brightened with the recent
establishment of the Oman Dental College and the initiation of B. Pharm.
courses in the private sector.
Table 4: Trends in Omanization in Different
Health Manpower Categories 1990-2005 (MoH)*
|
Code
No & Categories |
2005 |
2000 |
1995 |
1990 |
|
|
% Omani |
No.
Omani |
Total |
% Omani |
No.
Omani |
Total |
% Omani |
No.
Omani |
Total |
% Omani |
No.
Omani |
Total |
|
1
Health Administrators |
95% |
123 |
129 |
92% |
86 |
93 |
93% |
95 |
102 |
N.A. |
N.A. |
N.A. |
|
2
Doctors |
27% |
813 |
2,981 |
19% |
422 |
2,253 |
13% |
230 |
1,800 |
9% |
86 |
994 |
|
2.1
Medical Administrators |
57% |
27 |
47 |
63% |
12 |
19 |
53% |
9 |
17 |
90% |
9 |
10 |
|
2.2
Specialists/Consultants |
23% |
254 |
1094 |
12% |
102 |
820 |
8% |
46 |
587 |
8% |
25 |
325 |
|
2.3
Medical Officers |
29% |
532 |
1840 |
22% |
308 |
1,414 |
15% |
175 |
1,196 |
8% |
52 |
659 |
|
3
Dentists |
41% |
69 |
168 |
30% |
32 |
106 |
17% |
13 |
77 |
25% |
10 |
40 |
|
4
Pharmacists |
49% |
75 |
154 |
28% |
22 |
78 |
13% |
8 |
63 |
21% |
7 |
33 |
|
5
Nurses |
59% |
4,680 |
7,909 |
36% |
2,379 |
6,619 |
15% |
744 |
5,128 |
12% |
406 |
3,512 |
|
6
Medical/Health Assistants |
67% |
4 |
6 |
67% |
6 |
9 |
38% |
15 |
40 |
18% |
18 |
101 |
|
7
Physiotherapists |
64% |
79 |
123 |
72% |
86 |
120 |
63% |
35 |
56 |
19% |
6 |
32 |
|
8
Sanitary Inspectors |
86% |
144 |
168 |
90% |
187 |
207 |
70% |
128 |
182 |
34% |
52 |
152 |
|
9
Radiographers |
60% |
239 |
401 |
47% |
126 |
268 |
28% |
52 |
183 |
14% |
17 |
123 |
|
10
Laboratory Technicians |
52% |
451 |
873 |
37% |
261 |
707 |
31% |
159 |
513 |
20% |
63 |
323 |
|
11Asst.Pharmacists |
69% |
478 |
690 |
51% |
242 |
479 |
26% |
90 |
345 |
9% |
15 |
160 |
|
12
Medical Orderlies |
100% |
182 |
2,184 |
99% |
1,588 |
1,598 |
98% |
1,954 |
2,002 |
94% |
1,719 |
1,821 |
|
13
Other Para-Medical Staff |
86% |
714 |
831 |
77% |
438 |
572 |
73% |
360 |
495 |
81% |
363 |
449 |
|
14
Other Technical Staff |
56% |
100 |
179 |
44% |
80 |
180 |
47% |
140 |
301 |
43% |
208 |
487 |
|
15
Other Support Staff |
96% |
3,223 |
3,374 |
94% |
2,830 |
3,013 |
92% |
3,712 |
4,024 |
89% |
3,126 |
3,516 |
|
16
Teachers/Tutors |
26% |
69 |
268 |
20% |
41 |
201 |
8% |
11 |
140 |
N.A. |
N.A. |
N.A. |
|
Grand
Total |
66% |
13,443 |
20,438 |
53% |
8,826 |
16,503 |
50% |
7,746 |
15,451 |
52% |
6,096 |
11,743 |
*
Based on the information provided by
Directorate of Health Information & Statistics, DGP [N.A.: Figure not
available.]
Figure 1: Trends in Omanization 1995-2005
It is noted from
the above that the overall Omanization level in the physician category
in the Ministry of Health has increased from about 14% in end-2000 to
about 27% in end-2005.
The overall Omanization
level among medical specialists (i.e. physicians employed as junior
specialist to senior consultant level) is 23% in end-2005, increased
from 12% in end-2000. Table 5 shows the Omanization levels in various
specialties. It is noted that in several key specialties (e.g.
Anesthesiology: 1%, Obstetrics & Gynecology: 13.1%) the Omanization
level is still very low.
Table 5: MOH
Medical Specialists by Specialty as of 31 December 2005*
|
Speciality |
2005 |
2000 |
|
Total |
Omani |
% Omani |
Total |
Omani |
% Omani |
|
Surgery |
|
|
|
|
|
|
|
General Surgery |
81 |
18 |
22.2% |
70 |
10 |
14.3% |
|
Orthopedics |
66 |
8 |
12.1% |
51 |
7 |
13.7% |
|
Urology |
13 |
2 |
15.4% |
9 |
1 |
11.1% |
|
Cardio - Thoracic
Surgery |
11 |
3 |
27.3% |
8 |
2 |
25.0% |
|
Plastic
Surgery/Burns |
14 |
3 |
21.4% |
12 |
1 |
8.3% |
|
Neurosurgery |
10 |
1 |
10.0% |
10 |
0 |
0% |
|
Pediatric Surgery |
8 |
1 |
12.5% |
9 |
1 |
11.1% |
|
Ophthalmology |
68 |
11 |
16.2% |
56 |
7 |
12.5% |
|
ENT |
54 |
6 |
11.1% |
40 |
3 |
7.5% |
|
Anesthesiology |
100 |
1 |
1.0% |
80 |
1 |
1.3% |
|
Emergency
Medicine |
9 |
6 |
66.7% |
|
|
|
|
Acupuncture |
1 |
0 |
0.0% |
0 |
0 |
0% |
|
Medicine |
|
|
|
|
|
|
|
General/Internal
Medicine |
125 |
44 |
35.2% |
90 |
18 |
20% |
|
Cardiology |
16 |
5 |
31.3% |
18 |
3 |
16.7% |
|
Chest diseases |
6 |
2 |
33.3% |
1 |
|
0% |
|
Diabetes Mellitus |
17 |
1 |
5.9% |
9 |
|
0% |
|
Nephrology |
28 |
5 |
17.9% |
21 |
3 |
14.3% |
|
Gastroenterology |
7 |
1 |
14.3% |
9 |
1 |
11.1% |
|
Dermatology |
25 |
15 |
60.0% |
18 |
9 |
50.0% |
|
Neurology |
3 |
1 |
33.3% |
4 |
1 |
25.0% |
|
Psychiatry |
27 |
4 |
14.8% |
17 |
0 |
0% |
|
Oncology |
8 |
1 |
12.5% |
5 |
1 |
20% |
|
Pediatrics |
|
|
|
|
|
|
|
General Pediatrics |
142 |
35 |
24.6% |
114 |
16 |
14% |
|
Neonatology
|
14 |
4 |
28.6% |
11 |
1 |
9.1% |
|
Obstetrics &
Gynecology |
107 |
14 |
13.1% |
86 |
4 |
4.7% |
|
Diagnostic
Specialties |
|
|
|
|
|
|
|
Clinical
pathology/Hematology |
23 |
9 |
39.1% |
22 |
2 |
9.1% |
|
Biochemistry |
4 |
2 |
50.0% |
1 |
0 |
0% |
|
Microbiology |
8 |
3 |
37.5% |
3 |
0 |
0% |
|
Histopathology |
11 |
1 |
9.1% |
7 |
0 |
0% |
|
Radiology/Radio
Diagnosis |
43 |
10 |
23.3% |
32 |
5 |
15.6% |
|
Epidemiology |
10 |
6 |
60.0% |
6 |
4 |
66.7% |
|
Public
Health |
29 |
14 |
48.3% |
12 |
10 |
83.3% |
|
Family &
Community Health |
38 |
38 |
100.0% |
0 |
0 |
0% |
|
Hospital
Administration |
11 |
5 |
45.5% |
7 |
3 |
42.9% |
|
Quality
Control |
2 |
0 |
0.0% |
0 |
0 |
0% |
|
Health
Statistics |
1 |
0 |
0.0% |
1 |
0 |
0% |
|
Nutrition |
1 |
1 |
100.0% |
0 |
0 |
0% |
|
Total Specialists |
1,141 |
281 |
24.6% |
839 |
114 |
13.6% |
*
Based on the information provided by
Directorate of Health Information & Statistics, DGP
Omani physicians are
pursuing specialty education under the Oman Medical Specialty Board and
appearing in various international examinations. They are also deputed
abroad for pursuing higher education. Hence, it is expected that
Omanization levels in various specialties will rise in the future. The
Ministry of Health is determined to make every effort to achieve
appreciable Omanization in the medical specialists’ category in order to
reduce physician import and achieve total self-reliance. The Ministry
intends to increase the scope of providing overseas experience and
on-the-job training to young Omani physicians. For this purpose, it
perceives the need for increased fellowship resources.
Click
here to download the Ministry’s 7th Five-year Plan
study report on the requirement of medical specialists
Click
here to download the Ministry’s latest study report on the
desired production schedule for training of medical specialists
under OMSB or overseas up to 2020 |
