The Institute for Health Metrics and Evaluation (IHME) partnered with the Kingdom of Saudi Arabia (KSA) Ministry of Health (MOH) to develop the KSA Health Interview Census. The census, to be carried out in 2016, will collect data from 5 million households in the country and consists of three parts: a household survey, health facility survey, and patient exit interview. This study aims to provide the MOH with a better understanding of health needs at the local level so that health services can be tailored to communities’ needs.
The household survey will collect local data on socio-demographic characteristics, tobacco use, diet, physical activity, functional health, maternal and child health, chronic and infectious diseases, mortality and health, and health facility access and satisfaction. The health facility survey focuses on health system capacity, service delivery, bottlenecks, and the costs of care per patient. The patient exit interview will collect information on reasons for the visit, previous health conditions, and satisfaction.
IHME and the MOH have piloted the Saudi Health Interview Census twice. IHME trained over 200 MOH staff members from all regions of the Kingdom on the questionnaire, protocols, software usage, enumeration, and proper data collection techniques using IHME-created manuals. As part of the first pilot, IHME staff accompanied surveyors in visiting and interviewing households in a small community in Riyadh. The second pilot is being conducted nationwide, and data collection was completed in June 2015.
The census is essential for the mission of the MOH. It will provide a range of needed information for health planning and services at the local level. The main purpose of the census is to provide health services while collecting information for better operation and planning for the MOH.
Aims include the following:
Early detection of diseases among Saudis
The MOH is using the census as an early detection program to identify persons at risk and with undiagnosed and uncontrolled conditions. Indeed, the Saudi Health Interview Survey (SHIS) conducted in 2013 showed that 1,119,027 Saudis aged 15 years or older (8.6%) had undiagnosed high blood pressure and 751,684 (5.8%) had undiagnosed diabetes. Moreover, it showed that 979,953 (7.5%) have borderline diabetes and 5,222,051 (40%) have borderline high blood pressure. In addition, 397,541 (3.0%) individuals with diabetes and 390,338 (3.0%) with high blood pressure had their conditions uncontrolled. The MOH will check individuals in the household and direct them to the proper medical facility for follow-up.
Increase awareness for health risks and disease management among the Saudi population
The census presents a unique opportunity to create awareness in the Kingdom about risk factors and proper case management in that information about diseases and proper referrals will be provided to respondents during the course of the census interview.
Identify bottlenecks at the health facility level
The census will provide detailed information on the available services at each clinic, with their frequency of use. It will identify shortages of supplies of medication, if any. Moreover, it will enable MOH to measure efficiency at the clinic level by comparing resources provided and services delivered.
Identify patients’ perception of and satisfaction with health services
The exit interview will enable MOH to better understand patients’ concerns and their satisfaction with services provided. It will measure their perception of the quality of services provided and issues that will impact future use. Moreover, it will enable MOH to gauge whether they are likely to recommend the services to others in their family or circle of friends.
Link the household information to the facility information
The census will allow the linkage of data from households to health facilities. This is a superb opportunity to inform the MOH of bottlenecks in health services and programs. A key ingredient for the success of health programs and policies is to understand the current disease and injury patterns and risk factors at the population level and how the health system is responding to these challenges. The linkage will allow the MOH to identify these bottlenecks at the local level and design and implement interventions and policies tailored to each situation. Additionally, this linkage will allow the MOH to increase the efficiency of health care and public health program delivery by maximizing outputs (services and programs) while controlling inputs (resources needed). Indeed, this would allow for a strategy to design a system to meet demand at the local level.
The census results could be leveraged into a powerful economic and planning tool for the MOH as it continues to meet the evolving preventive and treatment-based needs of its citizenry. For example, IHME has the capacity to project demand for services, assess the utility and feasibility of offering these services and their related expenditures, and calculate potential efficiencies and cost reductions for the next 15 years. Most important, the impact on the health system of changing health-seeking behaviors, according to various scenarios, could be assessed. For example, SHIS showed that 75% of Saudis have never received a periodic health examination. Should improvements in health-seeking behaviors be realized, the impact to the larger health system – from the number of facilities and health care workers needed, to the demand for pharmaceuticals – could be projected. In addition, the health facility survey could enable an assessment of operational expenditures by the number and type of services provided. Indeed, facilities could be ranked on their efficiencies at present, as well as for the next 15 years, under various models. Finally, through a collaborative arrangement, IHME and the MOH could design a visualization tool to forecast services and expenditure given the current situation. This will illustrate alternative health expenditure scenarios based on current and future strategies and allow the MOH to realize the impact of various criteria on expenditures during the course of the next 15 years.