Population: 33.6 million (2018)
GDP: $683.83 Billion (2018)
Currency: Saudi Riyals (US$1 = SAR 3.75)
Language: Arabic (official); English (widely spoken)
The Saudi healthcare sector is the largest in the Near East. Education and healthcare spending still accounts for the largest share of the Saudi 2018 budget, at more than 36% of the total budget. With the drop in oil revenues, however, the Saudi Government scaled back the levels of spending across the board. However, the budget for healthcare and social development increased nearly 10% in 2018 to reach a total of $39.2 billion. Public spending still dominates at 79%, though the private sector is quickly catching up and growing at a faster pace, mainly due to the launch of the National Transformation Program (NTP) in 2016, which aims, among other objectives, to expand the privatization of government services, including healthcare.
Saudi Arabia's healthcare landscape will continue to evolve as the government pursues reforms in the sector. Boosting health privatization initiatives will be a central part of the Kingdom's economic diversification efforts, intended to reduce its dependence on the public sector. The healthcare sector contributed $20.8 billion to the Kingdom’s GDP in 2015. The sector is projected to grow by 13.7% by 2025. Recently, the government decided to privatize all its public hospitals and introduce Public-Private Partnership programs, as included in the government’s NTP 2020 objectives:
Imports of medical devices accounted for more than 98% of the market at $1.8 billion, and American companies top the list of suppliers with a 21% share of total imports. Local manufacturing is still limited to consumables, including bandages, gloves, syringes, and some furniture including non-electrical beds. The NTP envisages boosting and supporting local manufacturing through foreign investments in the healthcare sector, especially for pharmaceuticals and medical devices.
The Kingdom of Saudi Arabia accounts for 59.4% of the purchases of pharmaceutical products in the Arabian Gulf and will remain a key market for many leading multinational pharmaceutical companies in the Near East. In addition to the demographic and epidemiological driving factors, the transition to an increasingly privatized and comprehensive healthcare system will drive the demand for both patented and generic drugs.
Spending on the Health IT sector is also expected to maintain positive growth, especially the government’s resolve to finalize various projects including the standard e-Health card, patient digital records, doctors’ prescriptions, and insurance claims. Industry sources estimate annual spending on modernizing and upgrading the e-Health infrastructure at $500 million, likely to double in the years ahead, budget permitting. One of the NTP’s objectives is to increase the percentage of patients with a digital health record from 0% to 70% by 2020.
Vison 2030 & National Transformation Program (NTP)
The Government of Saudi Arabia seeks to expand the private sector’s role in providing healthcare services under its Vision 2030 and its National Transformation Program. Some goals include plans to expand the privatization of government services, incorporate health IT and digital records, double the number of qualified Saudi nurses by 2020, and increase the number of licensed medical facilities from 40 to 100 by 2020.
Healthcare Policy Issues
The Kingdom of Saudi Arabia seeks to expand the private sector’s role in providing healthcare services under its ambitious Vision 2030 and its National Transformation Program. Saudi Arabia’s deteriorating environment for intellectual property protections in pharmaceuticals, however, dampens the positive signals sent to entrepreneurs, investors, and innovators in the private sector. Due to unresolved intellectual property infringement issues impacting innovative pharmaceutical companies, Saudi Arabia is on the Watch List of USTR’s Special 301 Report, which was released in April 2018.
Although American exporters are not required to appoint a local Saudi agent or distributor to sell to Saudi companies, it is strongly recommended that all new-to-market U.S. companies consider partnering with a local company for the purposes of monitoring business opportunities, navigating import and standard testing regulations, and identifying public sector sales and contract opportunities.
The U.S. Department of Commerce in Saudi Arabia regularly assists U.S. companies identify market opportunities and qualified business partners. It also provides advocacy and commercial diplomacy services to U.S. firms and promotes greater transparency in commercial matters and public procurement by engaging Saudi regulatory and standards bodies and Saudi public institutions.
Imported medical devices are charged a 5% customs duty; in some instances, however, imported equipment is exempt from this duty, notably if the shipment is bound for a government entity and/or a government project. Additionally, and as of January 1, 2018, a 5% VAT was introduced on all goods and services that are bought or sold by businesses with a few exceptions. The General Authority of Zakat & Tax has exempted medicine and medical devices of the VAT for “only those items that are specified/procured by the Ministry of Health and the Saudi Food and Drug Authority.”
Shipping: Saudi Arabia gives preference to national carriers for up to 40% of government-related cargos. Two local companies take full advantage of this situation.
Standards and labeling: As part of the GCC Customs Union, the six Member States are working toward unifying their standards and conformity assessment systems. However, each Member State continues to apply its own standard or a GCC standard. A new ICCP mandates that a Certificate of Conformity must accompany all consumer goods exported to Saudi Arabia. Labeling and marking requirements are compulsory for any products exported to Saudi Arabia. The Saudi Arabian Standards Organization (SASO) is responsible for establishing labeling and other guidelines. The Ministry of Commerce and Investment implements SASO guidelines through its inspection and test laboratories at Saudi ports of entry.
Current Market Trends
Based on data from industry and the World Health Organization (WHO), Saudi Arabia, like other countries in the Arabian Gulf, continues to exhibit lifestyle change trends within its morbidity statistics. Non-communicable diseases, such as diabetes, cardiovascular diseases and cancer have become the main causes of death, estimated to account for more than 78% of total deaths. Additionally, the Kingdom has one of the world’s highest rates of traffic accidents, ranked at 23rd globally with a car accident occurring every second, while 17 people are killed in crashes every day on average.
Saudi Arabia, like other countries in the Arabian Gulf, continues to exhibit negative lifestyle trends which are affecting morbidity statistics. Non-communicable diseases such as diabetes, cardiovascular disease and cancer have become the main causes of death among Saudis; their incidence is rising due to a sedentary lifestyle, obesity, high tobacco use, and poor dietary choices. Type-2 diabetes has a 14.4% prevalence rate and 2.5 million people are expected to be diabetic by 2030. The latest World Health Organization (WHO) figures indicate that 33.7% of Saudi adults are obese and 68.2% are overweight.
The demand for healthcare products and services is mainly driven by government initiatives and affluent lifestyle changes. According to the International Diabetes Federation, Saudi Arabia has an 18.5% prevalence rate, with 3.85 million cases of diabetic adults in 2017. The British medical journal, the Lancet, has placed Saudi Arabia in third position worldwide in terms of obesity, and the latest figures from the medical community indicated that Saudi Arabia has one of the highest percentage of bariatric procedures including sleeve gastrectomy, gastric bypass, and the placement of gastric band.
In turn, those figures have been the key drivers for various equipment and services, namely:
The public sector dominates the supply of healthcare services in Saudi Arabia and accounts for the majority of healthcare expenditures. The public healthcare sector represents approximately 79% of bed capacity. Industry sources expect the private sector to grow at a faster pace than the government sector, enhanced by the latest government policies to encourage more private sector involvement in the provision of healthcare services. The latest figures suggest that the MoH bed capacity will almost reach 73,768 beds by 2020; the private sector will add 13,875 beds raising its capacity to 26,000 by 2020, while other government organizations will total 20,000 beds in 2020.
The number of hospital beds currently stand at 68,000 for all hospitals in Saudi Arabia the number is expected to grow to 119,000 beds by 2020. Moreover, a private group of investors is developing Riyadh’s Medical Village over a 250,000 sq. meter area, consisting of eight 130-bed hospitals, 60 outpatient clinics, and other amenities and services. Currently, the healthcare budget stipulates the construction of 36 new hospitals (8,950 beds) and two medical cities (2,350 beds) that are expected to be completed by the end of 2018. The Ministry is expected to build an additional 18 hospitals with a bed capacity of 9,904 over the next two years.
Notwithstanding, the Saudi Government’s NTP’s five-year plan (2016-2020), which stipulates the following objectives:
The Saudi market is completely dependent on imports for medical devices; U.S. suppliers enjoy some advantages, including competitive prices, language, and exchange rate. European suppliers are aggressively gaining market share due to their close proximity to the market, and perceived better customer support.
On the other hand, the pharmaceuticals sector is characterized by a growing domestic manufacturing base, mainly for generic and OTC drugs, as well as licensing arrangements with branded research-based foreign innovative drug manufacturing firms.
The Saudi domestic pharmaceutical industry lacks R&D capabilities, and it remains focused on producing basic formulations of off-patent preparations to feed into the generics market. The lack of R&D is compounded by an unpredictable IPR regulatory system and, recently a vague pricing structure, which is affecting the introduction of many new research-based products into the market.
Nonetheless, government policies are biased in favor of domestic producers, providing them with exemptions, including interest-free funding, subsidized utility charges, and no import duties on raw materials and intermediate products.
Industry sources project domestic production to contribute 40% of the market by 2020 in line with the National Transformation program objectives to localize the industry.
The demand for healthcare services has continuously outpaced supply and both the public and private sectors are struggling to accommodate growing demand. A growing population, compulsory health insurance coverage, and the prevalence of diseases are serving to boost the demand for services and hospital bed occupancy. According to the Council of Cooperative Health Insurance (CCHI) and the 2018 Knight Frank report, 27 insurance companies are operating in the Kingdom with around 11 million beneficiaries including Saudis and expatriates, the overwhelming majority of which account for the latter. The insurance reform, however, could swell the pool with more than a million Saudi civil servants plus about 5 million dependents. Gross premiums reached $5 billion in 2015, 20% more than in 2014.
Additionally, the Executive Board of the Health Ministers’ Council for the GCC states (HO in Riyadh) release an annual tender valued at several billions of dollars for the following items:
Major players in the Saudi healthcare sector include:
The Saudi Food & Drug Authority (SFDA) monitors and controls the import and distribution of medical devices, pharmaceuticals, and food products. For medical devices, the SFDA will usually accept, register, and authorize the marketing and sale of any device that complies with applicable provisions of the SFDA‘s Interim Regulations and relevant regulatory requirements
applicable in one or more of the countries of the Global Harmonization Task Force (GHTF), which includes Australia, Canada, Japan, USA, and EU/EFTA. More information on the registration process can be found at https://www.sfda.gov.sa/en/pages/default.aspx
The Ministry of Health (MOH) is the major government agency entrusted with the provision of preventive, curative and rehabilitative healthcare for the Kingdom’s population. The Ministry provides primary healthcare (PHC) services through a network of healthcare centers throughout the kingdom. It also adopts the referral system which provides curative care for all members of society from the level of general practitioners at health centers to advanced technology specialist curative services through a broad base of general and specialist hospitals. The MOH also undertakes the overall supervision and follow-up of healthcare related activities carried out by the private sector. Therefore, the MOH can be viewed as a national health service (NHS) for the entire population.
The private sector provides health services through its health facilities including hospitals, dispensaries, laboratories, pharmacies and physiotherapy centers throughout the kingdom. Saudis and public sector expats are eligible for a comprehensive package of benefits including, public health, preventive, diagnostic, and curative services and pharmaceuticals with few exclusions and no cost sharing. Most services including state of the art cardiovascular procedures, organ transplants, and cancer treatments (including bone marrow transplants) are covered. Sponsors/employers are responsible for paying for an extensive package of services for private sector expatriates. In 2005, health insurance was made compulsory for all non-Saudi nationals working in the country under the Cooperative Health Insurance Act. In 2008, this act was extended to include Saudi nationals working for the private sector. Enforcements of this compulsory coverage include fines for non-compliant companies and a refusal to renew working permits without insurance. By mid-2017, mandatory health insurance for all Saudi and non-Saudi employees and their families in the private sector became effective as the Government is moving towards privatizing the healthcare care services. The MOH plans to privatize all its services through the National Transformation Program 2020 which will increase the private sector contribution to the health sector from 25-35% and change government hospitals to semi-public companies. As a result of this privatization program, around 20 million Saudi citizens will need insurance coverage by 2020.
Delayed Payments: Companies who have significant experience with government contracts here report they have carried SAG receivables for years. The problem has become more visible following the sustained decline in oil prices over the last three years and ongoing government austerity measures. The SAG continued to delay payments to major contractors throughout 2016, though made progress by setting aside $28 billion and making some payments to clear arrears starting in October 2016. Moreover, on January 20, 2018, the Ministry of Finance launched “Eitimad” a unified digital services platform that allows government entities and private sector contractors to make full use of the Ministry’s advanced procurement e-services, enhancing the speed of process, ensuring accuracy of data and increasing the ease of doing business. However, should payment problems or delays persist, U.S. companies should contact the U.S. Commercial Service at the Embassy in Riyadh or Consulates in Dhahran or Jeddah.
Procurement is subject to the 2006 Government Tenders and Procurement Law and its 2007 implementing regulations. There is no central procurement office. Each ministry or autonomous agency contracts directly with suppliers within the framework of the regulations. However, the Ministry of Finance provides oversight and is required by law to review all contracts valued at 5 million riyals or more and contracts with execution periods of longer than one year.
Under the regulations, all purchases must be made through public tender unless specifically exempted. Tenders are announced in the official gazette, two local newspapers, various electronic media, and foreign media as necessary. Bids may be submitted in sealed envelopes or electronically by the specified date, and they must be accompanied by a bid bond of between 1% and 2% based on the terms of the tender. Bids are valid for 90 days. The regulations require equal treatment of national and foreign goods.
Contracts are generally awarded to the lowest bidder that meets the conditions set forth in the tender; however, if the lowest bid is 35% lower than the purchasing agency's estimates or prevailing market prices the bid must be excluded unless the bidder satisfies the agency that it can perform the obligations of the contract. Bids also may be excluded if the purchasing agency believes that the bidder's contractual obligations would exceed its ability to execute the contract. Once a contract is awarded, the winning bidder must supply a performance guarantee equivalent to 5% of the contract value. Once a contract is awarded, the purchasing authority may increase by up to 10% or decrease by up to 20% the total value of the supplier's obligation, subject to strict criteria.
Bid guarantees and performance guarantees may be in the form of a guarantee from a local bank or a guarantee from a foreign bank submitted through a local bank. Cash guarantees are acceptable only in certain urgent cases. A guarantee is not required for direct purchase contracts unless the purchasing agency deems it necessary. Although Arabic is the official language, English is spoken and understood widely. Firms resident or working in Saudi Arabia must conduct all official business with the government in Arabic. The tender regulations state that bids may be in any language, but in practice, tender announcements generally specify the language of the bid.
Selling to the Government
In Saudi Arabia, every government agency has its own full contracting authority. So, foreign companies interested in bidding on a government project must make themselves known to that specific government agency/ministry offering the project. When a project becomes available, the government agency/ministry selects bidders from a list of prequalified/known companies and invites them to bid for that particular project.
The Saudi Government Contracting and Procurement Law states that all qualified companies and individuals will be given equal opportunities and will be treated equally. The law also affirms that all government bids must be announced in the official gazette Umm al-Qoura (Arabic), in two local newspapers, as well as in electronic media. There is no central tender board in Saudi Arabia except “Monafasat” which is E-Government Procurement project, which is considered one of the projects under the broader e-Government initiative in the Kingdom of Saudi Arabia (http://www.saudiegp.sa/cms/page/key/about_project). There are a number of governmental healthcare purchasing agencies in Saudi Arabia including the Ministry of Health, Ministry of Interior, Ministry of Defense and the Ministry of the National Guard. The Ministry of Finance operates as a central government procurement portal where all government tenders are listed.
The tender regulations require that preferences be given in procurements to Saudi individuals and establishments and other suppliers in which Saudi nationals hold at least 51% of the supplier’s capital. The tender regulations also give a preference to products of Saudi origin that satisfy the requirements of the procurement. In addition, Saudi Arabia gives priority in government purchasing to GCC products. These items receive up to a 10% price preference over non-GCC products in all government procurements in which foreign suppliers participate. In addition, several royal decrees strongly favoring GCC nationals in the award of government procurement contracts have been issued. Foreign suppliers that participate in government procurement are required to establish a training program for Saudi nationals.
Links for Saudi healthcare purchasing agencies:
Name of event: Global Health Exhibition 2018
Dates: September 10-12, 2018
Location: Riyadh International Exhibition Center, Riyadh, Saudi Arabia
Description: The show is a three-day exhibition and conference, showcasing the latest products, technology and services that the sector has to offer. This is the only event with the full support of the Ministry of Health and will cover the full spectrum of healthcare. The show is still young and this would be the third year running.
Name of event: Saudi-American Healthcare Forum
Dates: April 1-2, 2019
Location: The Ritz Carlton Hotel & Conference Center, Riyadh, Saudi Arabia
Description: The conference is a three-day high-powered event focusing on various healthcare themes and issues and drawing on high level officials and executives from both the public and private sectors in the U.S. and Saudi Arabia.
1. What is SAGIA and how does it support U.S. healthcare companies?
SAGIA is the government agency that is responsible for providing an attractive and lucrative investment environment for investors in order to promote investment in the Kingdom of Saudi Arabia, thereby expanding the economic landscape. SAGIA is the first line of contact for any U.S. healthcare company that is seeking to invest in the Kingdom because SAGIA can provide information for U.S. companies on the Kingdom’s investment climate and investor requirements.
2. Do U.S. manufacturers require a partner to operate in Saudi Arabia?
U.S. manufacturers may operate with or without a partner. To be eligible for 100% foreign ownership, particular requirements must be met, which can be sought from SAGIA. Any company with a foreign investment license will enjoy all of the privileges of a local Saudi company.
3. What are Saudi Arabia’s healthcare priorities over the next 3-5 years?
A Healthcare Investment Plan has been developed that identifies more than 40 opportunities for healthcare investment in different areas, among which include service provision, education and training, medical device manufacturing, pharmaceuticals manufacturing, support services, and digital and Information management. The recent National Transformation program also highlighted a number of initiatives and programs for the healthcare sector.
4. Is there a government-to-government collaboration in the area of healthcare?
U.S.-Saudi bilateral healthcare cooperation is robust. The Saudi Ministry of Health and the U.S. Department of Health and Human Services renewed an umbrella memorandum of understanding in September 2015. That broad agreement is currently supporting the two healthcare systems through additional data sharing, research collaboration, disease surveillance and infection control, subject matter experts exchange and training, and joint leadership to enhance global capacity to fight all types of biological threats under our common Global Health Security Agenda.
Global Health Exhibition, September 10-12, 2018, Riyadh, Saudi Arabia
Arab Health, January 28 – 31, 2019, Dubai, UAE
Sub-Sector Best Prospects
Pharmaceuticals for diabetic care, cardiovascular, antibiotics, and cancer treatment offer the best prospects.
With the change in the Saudi Arabia trade paradigm that is focusing more on job creation and economic diversification, the export and shipping of pharmaceutical products into the Saudi market no longer translates into commercial success. Local production, technology transfer, conducting clinical trials locally, and the training/education of the Saudi labor force are becoming the new normal in the life sciences/pharmaceutical products industry. The 2030 Vision and NTP has placed the Industrial Clusters (IC) as the leader government entity to develop five industrial sectors including the pharmaceutical and biotech industry.
Accordingly, the IC has identified the following opportunities in the pharmaceuticals industry:
Name: Maher Siblini (Sector Lead)
Position: Senior Commercial Specialist
Phone: +966.11.488.3800 x 4302
Name: Anwar Shaqhan
Position: Commercial Specialist
Phone: +966.12.667.0080 x 4259
Name: Mohammed Shujauddin
Phone: +966.13.330.3200 x 3137
Healthcare spending (including investment)
US$ 34.4 billion
... as percent of GDP
5.3 % of GDP
... of which spent on pharmaceuticals/consumables
Hospitals, Procedures, Healthcare Professionals UN
Number of hospitals
Number of hospital beds
... available beds per capita
...of which in general hospitals
Number of surgical procedures
Life expectancy men/women
Percent of population older than 65
3.7 deaths/1,000 population
Ischemic heart disease
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