the 8th five - year plan for health developmentthe 8th five-year plan for health development covers...

MINISTRY OF HEALTH

SULTANATE OF OMAN

THE 8th

FIVE - YEAR PLAN

FOR HEALTH DEVELOPMENT (2011 – 2015)

THE NATIONAL STRATEGIC PLAN

H. M. PHOTO

As it is well known that a healthy mind

is in a healthy body, health should be a right of

every citizen. Since July 1970, we have decided to

attach high priority to the development of health

of the Omani people.

H.M. Qaboos bin Said

Sultan of Oman

Paste Here

Map of Sultanate of Oman

INDEX

Contents

Page

- Foreword …………………………………………………………………............ I

- Introduction ……………………………………………………………………... III

- Chapter One:

National Health Policy of the Sultanate of Oman …………………............

1

- Chapter Two:

Strategic Directives for Health Development in Oman (2011 – 2015)…....

4

- Chapter three:

Visions, Goals and Objectives of the Eight 5-Year Plan for Health

Development (2011– 2015) …………………………………….....................

10

- Chapter Four:

Domains of the Eight 5-Year Health Development Plan ………………….

19

Vision One: Delivery of High Standards of Health Care to the Community …. 20

▪Domain 1: Primary Health Care ………………………………………………... 21

▪Domain 2: Secondary and Tertiary Health Care ……………………………… 28

▪Domain 3: Pharmaceutical Care ………………………………………………... 37

▪Domain 4: Nursing Care ………………………………………………………… 50

▪Domain 5: Laboratories …………………………………………………………. 61

▪Domain 6: Blood Services ……………………………………………………….. 68

▪Domain 7: X ray Services ……………………………………………………….. 74

▪Domain 8: Rehabilitation Services ……………………………………………… 80

Vision Two: Quality Assurance of Health Services and Patient Safety ……….. 86

▪Domain 9: Quality Assurance / Improvement and Patient Safety…………….. 87

Vision Three: Alleviation of Risks Threatening The Public Health …………... 97

Domain 10: Communicable Diseases ……………………………………………. 98

▪Domain 11: HIV/AIDS and Sexually Transmitted Infection (STI) ……..……. 114

▪Domain 12: Malaria ……………………………………………………………... 124

▪Domain 13: Non-Communicable Diseases ……………………………………... 129

▪Domain 14: Eye Health ………………………………………………………….. 140

▪Domain 15: Ear Health ………………………………………………………….. 149

▪Domain 16: Oral and Dental Health ……………………………………………. 154

▪Domain 17: Mental Health ……………………………………………………… 160

▪Domain 18: Genetic Diseases …………………………………………………..... 169

▪Domain 19: Environmental and Occupational Health ………………………... 178

▪Domain 20: Accidents and Injuries …………………………………………….. 185

Contents

Page

Vision Four: Promoting Woman and Child health & maintaining the health

of elder lies 190

▪ Domain 21: Woman Health 191

▪ Domain 22: Child Health 198

▪ Domain 23: Elderlies care 207

Vision Five: Dissemination of Healthy lifestyles in the Community 214

▪ Domain 24: Health Education and Communication 215

▪ Domain 25: Adolescent and Youth Health 223

▪ Domain 26: School and college health 230

Vision Six: Better Nutrition for All 242

▪ Domain 27: Nutrition 243

Vision Seven: Joint Action for Better Community Health 252

▪ Domain 28: Community Participation 253

Vision Eight: Achieving Excellence in The Managerial Processes 259

▪ Domain 29: Health Management 260

Vision Nine: An Efficient Health Information and Research System to Meet

the Needs of the Health System 265

▪ Domain 30 : Health Information and Statistics 266

▪ Domain 31: Health Studies and Research 272

Vision Ten: Achieving Integrated Digital Environment 283

▪ Domain 32: Information Technology 284

Vision eleven: Availability of Qualified Human Resources in Suitable

Numbers to Work in Health Institutions 295

▪ Domain 33: Human Resources Development and Omanization in the Health 296

▪ Domain 34: Health Educational Institutions in Ministry of Health 308

Vision twelve: Improving the Health services Provided by the Private Health

Sector According to a Health System That is Based on Excellence, Quality

and the Scientific and Practical Efficiency; and to Ensure theRights of

Patients and their Safety.

322

▪ Domain 35: Health services for the Private Health Sector 323

I

FOREWORD

Since the dawn of the blessed renaissance of the year 1970, the Government of

sultanate of Oman is committed to put the infrastructure of extensive revolution in the country

which results in achieving marked health development for Omani citizen. Since that time up

to today health services in the sultanate achieved a marked significant developments in

quantitative as well as in qualitative terms. The people of Oman are now enjoying state-of -art

medical services provided through a comprehensive and effective health system.

I am pleased to introduce this document on the occasion of the celebration of the

fortieth anniversary of the Omani renaissance. This document presents the general outlines of

the health development programs of the eighth five-year health development plan of Oman

(2011 – 2015).

It may be used as a guide for health workers for performing their duties and

responsibilities with a view to reaching the goal accepted by all of us, which is achieving a

satisfactory level of health for all, as per the directions of his highness the builder of Oman

renaissance.

The ministry of health is committed to make primary health care the first and basic

entry point for achieving health for all, as expressed in the continuation of the world health

organization. At the same time the ministry gives attention to the development of health care

services at secondary (specialist) level and at tertiary (super/ sub-specialty) level. As regards

the mechanism for high quality health care delivery, the ministry has adopted the

decentralization policy for the provision of health services at regional level. The ministry

support the health system at the wilayate level with a view to ensuring equitable distribution

of health services to all segments of the community. Thus all are able to fulfil their health

services needs. The ministry of health has also given special attention to the strategies of

support and development of the national human resources with the goal of enhancing the

Omanization in the ministry of health.

The ministry of health has relentlessly continuously up to date preparing health

development plans every five years starting from 1976 within the framework of the

comprehensive five-year development plans of the sultanate. These plans have led to the

achievement of the health, an economic and social goal which drives Oman to a higher level

of development and welfare throughout years of blessed renaissance. This marked the

beginning of significant developments of health services in Oman in quantitative as well as

qualitative term. The Omani people are now enjoying state-of-the- art medical services

provided through a comprehensive and effective health system.

Eighth five year plan methodology followed the seventh five year plan which adopted

the principles of strategic planning process for national health development which is an

important remarkable methodology in health sector. This methodology follows the principles

of strategic planning which enable us to clearly define our visions, long term goals and

objectives, and help us delineate the strategic directions of work during the next five year

aiming for development of the health system, improvement of the quality of health care and

modernizing various health services components.

Health care support system is a high priority for the Ministry of Health for the next

five years. This includes the administrative process, decentralization and hospital autonomy.

Also, promotion of the primary health care services is high in our work priorities, in addition

to expansion of its coverage to meet the needs of the community comprehensively. The

Ministry will also focus its attention to the dissemination and strengthening of health

promotion with a view to supporting the prevention and control of non-communicable

II

diseases and accidents, and sustaining the achievements in the control of communicable

diseases.

It is well known that policies and strategic plans are of no benefit or value if these are

not translated into operational plans to be implemented, monitored and evaluated. So the

Eighth health plan is characterized by its insistence on the involvement of all concerned

officials at various planning stages, including analysis, prioritization, setting the objectives,

monitoring and evaluation of the alternatives, defining the strategies and activities, provision

of resources and monitoring and evaluation of achievements at the local, regional and central

level.

It was also stressed that supportive local plans should be prepared at Wilayat level

relying on the process of “bottom–up planning” which is used now by the “Wilayat health

committees” in the Sultanate to plan community health projects with the participation and

coordination of the community and health workers.

The 8th Five-Year Plan for Health Development covers 35 specific health fields or

domains to implement the strategic and operational action plans. Each of these domains has a

national comprehensive plan and several operational plans at the regional levels in addition to

supportive plans at Wilayat levels. This specific planning methodology ensures the accuracy

of all the details using several different indicators to evaluate the objectives, strategies and

activities.

I take this opportunity to express my thanks and appreciation for the efforts of all

those who participated in the preparation of this plan.

I do hope that with the blessings of Allah, all concerned will use this document as the

blueprint for their concerted action to achieve all the objectives of this health development

plan.

With the blessings and guidance of Allah

Dr. Ahmed Bin Mohammed AL- Saidi

Minister of Health

III

INTRODUCTION

The Sultanate of Oman started five-year health development planning from the year

of 1976. Since then seven 5- year plans were implemented: (1976-1980), (1981-1985), (1986-

1990), (1991-1995), (1996-2000), (2001-2005), (2006-2010).

The first three plans were generally service extension plans aiming at strengthening

the health services structure. The fourth plan contained detailed programming. It included 23

programs; each one directed to the reduction of one health or health-related problem from the

priority list of problems in the Sultanate. In the same way, the fifth and the sixth plan were

formulated as systematically scientific plans designed mainly to implementing programs;

each of these programs was directed to the reduction of one or more of the priority problems

in the Sultanate.

The policy-makers initiated the preparatory phase of the 7th Five-Year Plan for

Health Development after reviewing its previous experience with the planning process in

meeting the Ministry‟s long-term visions and goals. The central administration concentrated

on the priority health polices based on the information available about the progress in

improving the health level of the Sultanate. Also, the health plan of Oman considered the

National, Local and Regional / GCC directives to enable monitoring and evaluation of our

efforts and comparison of our achievements with that of other nations and regional countries.

The 7th Five-Year Plan for Health Development follows a new planning process and

includes several important health domains, some of which are included for the first time in

the health plan. In addition, several new strategies are presented under related domains

instead of formulating Programs directed to the reduction or control of selected health

problems.

Review and analysis of the previous central, regional and Wilayat health plans

revealed that, the basic activities in each Program were implemented at the level of each

health institution. This was actually a common factor in the entire plan. So when formulating

the new 7th Five-Year Plan for Health Development, we decided to divide and separate the

planning stages to the central and operational levels in order to make the operational plans

extensions not repetitions of the national strategic plan (general outline) relating to each field.

This was supplemented with supportive community plans at Wilayat level. It is well known

that the planning process should proceed step by step. So, in order to prepare the 7th Five-

Year Plan for Health Development in a scientific way, we have pursued the same planning

principles and methodology throughout the planning process.

The 8th

Five-Year Plan for Health Development follows the same planning principles

and methodology of the 7th Five-Year Plan for Health Development. Preparation of the 8th

Five-Year Plan for Health Development was started at the beginning of 2010, after the

issuance of the Ministerial Decision No. 3 ; year 2010. Thereafter, twenty steps were laid

down to prepare the plan at three levels: central, regional (health regions) and local (Wilayat).

All the steps were scrupulously pursued throughout the following 15 months with the

participation of the responsible officials at all levels.

IV

Generally, the 8th

Five-Year Plan for Health Development rests on three pillars:

First – National Strategic Plan: This plan is concerned with the visions, goals, general

objectives and strategies at the national level and expected results after implementation using

evidence-based-management philosophy. This helps in focusing on gradual steps to evaluate

the cause-effect relation between the short, intermediate and long-term outcomes and

impacts, resource utilization and activity sharing.

Second – Regional Operational Plans: These “detailed plans” based on the strategic plan to

be implemented by the concerned directorates at the regional or central levels. These plans

include the targets, the operational activities, the needed resources and also the indicators for

monitoring and evaluation and the timetable for implementation.

Third – Local Supportive Plans: These plans will be designed at Wilayat level by the

“Wilayat health committees” to support the regional operational plans. Local Supportive

Plans will be in the form of short-term health projects planned for one year, depending on

community participation and cooperation between the related sectors and using the pyramidal

planning process or “bottom-up-planning” that is used by Wilayat health committees in

Oman since 2003.

Despite the extension of the domains of the 8th

Five-Year Plan for Health

Development involving a great number of activities, we hope our efforts will succeed, and the

Sultanate will be able to continue to reach higher levels of achievement in the health field.

Thus, it is hoped, the health conditions of the people of Oman will improve further, and this

will be reflected in our health status indicators.

DR. Ali Bin Talib AL- Hinai

Under Secretary for Planning Affairs

1

Chapter One

NATIONAL HEALTH POLICY

OF THE SULTANATE OF OMAN

2

Chapter One

National Health Policy of the Sultanate of Oman

In the light of the health situation analysis in the Sultanate, the achievement of the

previous health plans and the assessment of persistent problems and difficulties, the national

health policy for the next five years (2011 – 2015) was formulated as under:

A. The work and activities of the Ministry of Health (MoH) and all other health related

agencies are to be directed for achieving the following goals:

1. Provision of the best levels of primary and specialized health care to the

population of the Sultanate.

2. Reduction of mortality and morbidity rates of different diseases with a view to

attaining life expectancy similar to that of the developed countries.

3. Taking necessary measures for the prevention of infectious and parasitic diseases

aiming at their eradication especially among children and school pupils.

4. Applying the latest methods for the prevention, early case finding and prompt

treatment of chronic diseases aiming at the reduction of their magnitude and

complications.

5. Provision of health care necessary for the elderlies and disabled people.

6. Provision of preventive measures and treatment of all types of accident cases.

7. Development and training of Omani workforce in all health professional

categories in order to achieve high levels of Omanization or self-sufficiency in

health workforce.

8. Development of Information Technology and speed the access to electronic

system data.

B. Steadfastly pursuing the following directives:

1. Considering primary health care the first and basic entry point for all levels of

health care.

2. Improve quality of health services to all the population.

3. Assuring the suitable distribution, accessibility and acceptability of all levels of

health services.

4. Promotion of community involvement in all activities of health care (in a gradual

way).

5. Assuring coordination and good cooperation among the different agencies that

provide health or health related services.

6. Reducing the waste in material and human resources within the health system.

7. Gradual extension of delegation of authority and responsibility to the Wilayat

level.

3

8. Encouraging the private sector to participate effectively in the appropriate aspects

of health work.

C. Directing important attention to the following priorities, and formulating and

implementing suitable plans to manage them:

1. Promotion of primary health care services and ensuring its quality.

2. Prevention and control of non-communicable diseases and accidents involving the

main causes of morbidities, mortalities, and disabilities.

3. Development of comprehensive maternal health and reduction of morbidities and

mortalities of children.

4. To promote the decentralization policy and hospital autonomy initiative.

5. To promote the health awareness of the community and establish a culture of

healthy lifestyle.

4

Chapter Two

STRATEGIC DIRECTIVES

FOR

HEALTH DEVELOPMENT

IN OMAN

(2011 – 2015)

5

Chapter Two

Strategic Directives

For Health Development In Oman

(2011 – 2015)

Since 1970 the Ministry of Health in Sultanate of Oman has been ensuring the

availability of promotive, preventive, curative and rehabilitative health services for all

population aiming to improve the health status of the Omani citizens and residents along the

following lines:

Provision of comprehensive health services in the field of public health and personal

health considering primary health care as the basic entry point for health care.

Assuring equity in the distribution of health services and burden of health expenditure

to cover all ages, social and economic levels of the community.

Fulfill the health and health related needs and expectations of the people.

Continuation and promotion of all aspects of health development through community

participation and inter-sectoral cooperation.

Health Planning in the Sultanate of Oman:

Since 1976 and the blessed renaissance, the Ministry of Health started its five-year

health development plans, in order to achieve its mission and carry out its responsibilities for

social and economic development through developmental planning. The effect of five-year

health development plans on the development of health services and improvement of the

health status of the people has been observed to be significant. This development reflects the

abiding impact of health planning and management since the dawn of the blessed renaissance

in spreading the health services and provision of health care to all people.

The first stage of the health planning in Sultanate of Oman extended from 1976 to

1990, in which three 5-year plans were implemented. These plans were focused on extension

of the health services infrastructure, since prior to the blessed renaissance there were no

sufficient numbers of health institutions to combat the prevailing unsatisfactory health status.

The second stage of planning started at 1991 and included 3 five-year health plans

(the fourth, fifth and sixth ones), which completed by the end of 2005. This stage was

characterized by several main directions formulated after comprehensive review of the health

system in 1990. “Decentralization in provision of health services” was one of the main

directions, and it was implemented through establishing 10 general health directorates in the

regions, with delegation of financial and administrative authorities according to definite roles

and controls. In 1993 local directorates at Wilayat level was started followed by hospital

autonomy in the year of 2000.

The preparation of plans of the second stage followed “the managerial process for

national health development”. These plans included different Programs each directed to one

priority health or health related problem. The general framework of the 4th, 5th and 6th plans

was prepared at the central level. The 5th and 6th plans included 10 detailed regional plans

while the 6th plan included 19 Wilayat plans, in line with the decentralization policy adopted

by the Ministry of Health.

6

The second stage plans of Ministry of Health were concentrated on qualitative

development besides the quantitative and geographical expansion of health services. The

decentralization policy in health services helped in empowerment of the administrative

machinery and promoted the planning process at the local level. The direct effect of this

policy was observed as the size of health services expanded all over the Sultanate during this

stage (1991 – 2005). During the second stage construction and development of several

hospitals was also undertaken in all the regions in order to provide specialty services mainly

secondary care and limited tertiary health care in each health region. Human resources

development through the establishment of health institutions dealt with the training and

qualification of staff in the field of general nursing, medical laboratories, radiography,

assistant dentists, assistant pharmacists and health inspectors.

The Future Challenges in the Sultanate of Oman:

Despite the significant progress in the field of health throughout the previous 04 years, the

health system in Sultanate of Oman is still facing many challenges, like many other health

systems in the world. These challenges may be briefly summarized below:

1. Shortage in the Basic Inputs of the Health System:

The difficult topography and terrain of Oman, the wide dispersal of the population all

over the Sultanate and the importance of providing basic health services to all the people

close to their dwellings pose a great challenge to the stakeholders. The situation can be

comprehended well when you consider that the total population is less than 1000.

Accordingly, special strategies and tools should be adopted to provide suitable and easily

accessible health services to these population settlements. For this situation, the Ministry of

Health started to operate a number of small health centers to serve inhabitants of settlements

with less than 1000 people. This reflects the economic burden to provide the needed health

services to these target groups of people.

The main challenge facing the Ministry is insufficient Omani health workforce. The

problem is aggravated especially because of the recent epidemiological changes in the

Sultanate that has resulted in a tremendous need for highly qualified and specialized

professional doctors. Also, there is increasing difficulties in the recruitment of expatriate staff

particularly physicians and specialists. So, it is necessary to ensure sufficient availability of

qualified medical Omani staff; therefore, supporting Omanization for the highly advanced

specialties is a need.

2. Health Services Expenditure:

The balance between the increasing demand for the health development needs and the

high cost of the health services provided due to continuous progress in the technology of

health care including the advanced information technology, equipment, curative and

diagnostics means, and the chemicals and therapeutics; constitute a great challenge to all

countries without exception. This in turns needs consideration and adoption of alternative

strategies for mobilization of health financial resources in order to prevent undesirable

changes in the health indicators.

It is known that the Ministry of Health is responsible for about 82% of the total health

expenditure in the country constituting the highest such percentage among all GCC countries.

This situation increases the difficulties facing Oman especially with the presence of the

strong governmental commitment to continue such high health expenditure that the entire

burden to achieve the target balance will fall on the government.

7

3. Health Problems:

“The double burden of morbidity” is a significant challenge facing the Sultanate of Oman,

which could be considered a specific characteristic feature of the newly developing countries.

It carries the burden of the present epidemiological changes and the health problems resulting

from unhealthy lifestyles typical of the developed countries. The main diseases resulting due

to these changes are: obesity, cardiac and coronary diseases, hypertension, diabetes, cancers,

chronic kidney diseases, brain stroke, and geriatric diseases. Also, there are groups of

diseases related to the changing age distribution of the population, and to the harmful

practices of the youth, which cause road accidents & injuries, sexually transmitted diseases,

mental health problems and psychiatric disorders and addiction. All these diseases need

expensive treatment for long periods sometimes for entire life. In addition to this group of

diseases, the Ministry of Health should carry the burden of the preceding health problems,

which still persist in varying degrees. These include malnutrition, genetic diseases and

congenital abnormalities, newborns‟ health problems, and also some communicable diseases

such as diarrheal diseases, respiratory infections, viral hepatitis etc.

In spite of the great efforts made in the field of health education, still there is a need for

more education. There is also the need for social marketing for health and health services

with greater coordination between different sectors in order to face the challenges of

unhealthy lifestyles and harmful practices in the Omani community responsible for many

diseases.

Faced with the future challenges:

Faced with the main challenges of the health sector in the Sultanate, the health

planners suggested a set of priorities and strategic alternatives for the next 5 years, which

reflected the urgent need for capacity building. Some of these priories were selected to direct

the available resources for achieving real changes in the present epidemiological situation and

morbidity burden in the Sultanate by using the available and cost-effective mechanisms, as

many health problems such as non-communicable diseases have a negative effect on the

social, economical and health achievements gained during the years of renaissance.

As the selected strategic directions for the 7th

- 5 years (2006-2010), the 8th

– 5 year

plan (2011 – 2015) take into consideration the good level of health coverage in Oman, the

epidemiological changes in the present and emerging diseases, the national health policies

and the efforts of the Oman Government to achieve high coverage and high quality health

services at affordable costs to all people through supporting and strengthening the inputs of

primary health care in the Sultanate.

Considering the current challenges five strategic objectives were identified in order to

evaluate the success of the health sector in Oman. These strategies help in managing the

impacts of the present transitional period and the expected health and economic changes

resulting from the local, national and regional developments. In addition to the role of the

Ministry of Health in adopting theses strategies, the implementation mechanisms for the

suggested strategies include the support of all partners such as other health related sectors,

non-governmental organizations, educational institutions, the private sector and the national

Government.

8

The identified strategic objectives are:

a. Support of the health system including promotion of the primary health care

services & its quality and supporting the decentralization strategy and hospital

autonomy.

b. Strengthening and support of the prevention and control measures for the non-

communicable diseases and the accidents including the main causes of mortality;

morbidity and disability, and encouraging healthy lifestyles such as proper

nutrition, physical activity, and quitting of smoking, drugs and substance addiction.

c. Strengthening of the links between national health and population policies, and

focusing on reproductive health problems in order to reduce maternal and neonatal

mortalities.

d. Sustaining the significant achievements in the field of communicable diseases and

promotion of the early detection methods for AIDS as well as the surveillance of

diseases that could cause epidemics and enhancing the responsiveness and

preparedness for the emergency cases.

e. Strengthening and spreading the concept of health promotion including

dissemination of health education and promotion of communication means with the

community.

The strategic directions during the period from (2011 – 2015) include:

1. Keeping and improving the present health level through:

The expansion of the primary health care infrastructure.

Adopting effective strategies to reduce the morbidity rates of the priority

health problems.

Continuing the support of the policies and mechanisms aiming at empowering

the women in different fields.

Continuing the efforts of health education to individuals and families.

Promoting cooperation between the Sultanate of Oman and national

organizations especially for program of promotion of healthy lifestyles.

Attaching significant importance to the efforts of health promotion, nutrition

and reproductive health.

Supporting the cooperation with the health related sectors and encouraging the

community based initiatives projects.

2. Improve the cost effectiveness in health expenditure through:

Improve management and the Redistribution of the hospital‟s beds.

Early detection and treatment of non-communicable diseases.

Improving cost measurement and control tools.

9

3. Increase the financial resources through:

Recover the high costs of some health services such as car accidents through

health insurance system.

Collecting small or minimum charges from the service clients.

4. Improve self-reliance in the field of human resources through:

Expansion of the education and training Programs for different health sectors.

Rational distribution of manpower in the health institutions.

5. Improve the efficiency of health system through:

Promotion of decentralization in the health services administration.

Promotion of hospital autonomy.

Supporting the management training of health administrators.

Encouraging scientific studies and health systems research.

6. Improve the cost effectiveness of health services provided through:

Expansion of primary health care network and restructuring of the hospital

sector.

Monitoring of the utilization of financial resources.

Promotion of the referral system, quality assurance, control of costs &

computerized information system.

7. Supporting the private health sector through:

Provision of soft loans and technical support for the private.

Privatization of some governmental health services.

10

Chapter Three

VISIONS, GOALS AND OBJECTIVES OF

THE EIGHTH 5 - YEAR PLAN FOR

HEALTH DEVELOPMENT

(2011 – 2015)

11

Chapter Three

Visions, Goals and Objectives

Of The 8th

Five Year Plan For Health Development

(2011 – 2015)

In the light of identified objectives and strategic directions for health development in

Oman (2011-2015), the first stage of preparatory phases of the 8th five year health

development plan was initiated by reviewing and reformulating the specific health policies

encompassing the key health fields. Also, situation analyses covering all aspects of health

(demographic, social, economic, and environmental), health resources and epidemiological

situation were undertaken. This task was accomplished with the cooperation of senior

responsible staff in the Ministry – HQ and in regions, the supervisors, and central programs

managers and coordinators. This enabled the planners to prepare a comprehensive and

informative document about the Sultanate‟s health profile.

In the second stage of health planning, the work priorities for each health field were

defined. Ranking of the priority problems was done according to its importance with the help

of the specified task forces at central and regional levels. Follow this stage the framework for

the 8th

five year health developmental plan (2011-2015) was finalized including the suggested

visions (12 visions) and expected goals.

Visions and Goals and objectives of the 8th five-year plan for Health

Development:

Visions:

1. Delivery of High Standards of Health Care to The Community.

2. Quality Assurance of Health Services and Patient Safety.

3. Alleviation of Risks Threatening The Public Health.

4. Promoting Woman and Child Health and Maintaining the Health of Elderlies.

5. Dissemination of Healthy Lifestyles in the Community.

6. Better Nutrition for All.

7. Joint Action for Better Community Health.

8. Reaching to Distinction in Administrative Practices.

9. An Efficient Health Information and Research System to Meet the Needs of Health

System.

10. Achieving Integrated Digital Environment.

11. Availability of Qualified Human Resources in Suitable Numbers to Work in Health

Institutions.

12. Improving the Health Services Provided by the Private Health Sector According to a

Health System that is Based on Excellence, Quality and the Scientific and Practical

Efficiency; and to Ensure the Rights of Patients and their Safety.

12

Goals:

1. Developing Pillars of The Health System.

2. Provision of High Quality Health Services.

3. Reduction of Mortality and Morbidity Rates of Diseases and Accidents to the Lowest

International Levels.

4. Improving Health Care Provided to Women and Children and Elderlies.

5. Increasing Health Awareness, Correcting Attitudes and Establishing Healthy

Behaviors and Practices in the Community.

6. Improvement of the Nutritional Status of Omani Society.

7. Mobilization of the Community and Health Related Sectors for Health Promotion.

8. Development of Health Administration upon all levels.

9. Strengthening the System of Statistics, Health Information and Research.

10. Facilitate and speed the access to electronic system data.

11. Ensuring the Availability of Adequate Numbers of Suitably Qualified, Trained and

Efficient Workforce.

12. To Support the Private Health Sector in Order to Provide Preventive, Curative and

Promotive Health Services to All Members of Community According to International

Quality Standards and Licensing. And to Supervise the Private Health Establishments

as per the National Legislation and Regulations in Order to Ensure the Efficiency of

Health Services Provided and their Consistency with Government Health Services to

Fulfill the Needs of Community Members.

The strategic plan and the Operational plan:

After defining the visions and health goals for the period (2011- 2015), the general

framework and the strategic plan for the 8th

five year health developmental plan (2011-2015)

were completed. This included the formulation of general and direct objectives for each

domain in the plan (35 domains), defining the strategies for achievement of the goals in a

comprehensive and precise scientific manner, and defining the expected results from each

strategy and selecting the indicators of evaluation depending on process of “result- based –

management”.

The third stage included the implementation of the operational plans at the regional level,

which involved the targets and activities to achieve the general objectives of each field as

well as the indicators of monitoring and evaluation, the resources and timetable.

The fourth stage includes the technical revision of the general objectives, the targets,

strategies and the activities at all levels. This stage also included revision of indicators of the

objectives, activities and expected results as well as identification of data needs (research and

studies or other resources). The feasibility of provision of financial and technical resources

needed for its implementation at all levels was also explored and highlighted.

13

Domains and objectives of the 8th five-year plan for health development:

The working groups reviewed all the available information and the evidences from

statistics and scientific studies, and agreed upon selecting 35 domains and their general

objectives. These domains deserve more attention throughout the next 5 years. The domains

and objectives of the 8th

five –year plan for Health Development are as follow:

Primary Health Care:

1. To strengthen the PHC infrastructure.

2. To provide high quality PHC services to the community.

Secondary and Tertiary Health Care

1. To develop the infrastructure of the hospitals.

2. To Improve and expand secondary and tertiary health care services.

3. To develop and improve the readiness of hospitals to respond to emergencies and

disasters.

Pharmaceutical Care

1. To assure that patients are provided with safe and effective drugs, at reasonable costs.

2. To ensure the quality of pharmaceutical services provided.

3. To enhance the medication safety programs.

4. To accomplish rational drug use in all institutions.

Nursing Care:

1. To enhance quality performance of nursing and midwifery services.

2. To develop nursing and midwifery services in primary health care and community

health.

3. To develop systems of nursing and midwifery practice so as to protect the recipient

from irresponsible nursing practices.

4. To develop human resources in the field of nursing and midwifery through focusing on

nursing leadership, continuous education and providing safe and effective working

environment.

Laboratories:

1. To support and develop laboratories in all health institutions.

2. To reinforce Laboratory Bio-safety and Bio-security measures.

3. To insure and improve laboratory quality controls.

14

Blood Services:

1. To increase the number of voluntary blood donors.

2. Optimal use of blood and blood products.

3. To improve and develop the quality of blood transfusion services at the national level.

Radiology Service

1. To enhance the radiology services in the health institutions and improve its quality

assurance.

2. To improve the performance of workers in the field of radiology

Rehabilitation Services:

1. Development of rehabilitation services in all Ministry of Health institutions.

Quality Assurance / Improvement and Patient Safety:

1. To establish and develop quality management and accreditation systems in health care

facilities.

2. To establish patient safety system in health care facilities.

3. To build the qualified national capacity in quality assurance / improvement and patient

safety systems.

Communicable Diseases:

1. Strengthening and maintaining the national capacity for infectious disease, detection

and response through achieving effective preparedness, surveillance and response

system that meet the IHR requirements.

2. Reduction of health care associated infections (HAIs) rates.

3. Maintaining the lowest rates of vaccine-preventable diseases.

4. Achieving the lowest possible rates for other communicable disease.

HIV/AIDS and Sexually Transmitted Infection (STI)

1. To control the spread of HIV/AIDS and STIs in the community in general and in the

most vulnerable groups in particular and stabilizing the current rates of these diseases.

2. To improve health and psychological conditions of patients with HIV/AIDS, reduce the

complications of the disease; reduce mortalities due to opportunistic infections

associated with AIDS, and management of STI as a Syndromic Case Management

Approach (SCMA) with provision of essential medicines in primary health care

institutions.

3. Promotion and support of NGOs who are working with Most At Risk Populations/

those with high risk behavior and People Living With HIV (PLHIV).

15

Malaria Eradication

1. To maintain the incidence of indigenous malaria cases at zero.

2. Prevention of epidemics due to vector borne diseases.

Non- Communicable Diseases:

1. To reduce the risk factors for non-communicable diseases (diabetes, cardiovascular disease,

chronic renal disease, asthma, cancer) associated life style and reduce the steady increase in it.

2. Early diagnosis of non-communicable diseases (diabetes, hypertension, high lipid, chronic renal

disease, stroke, obesity, cancer).

3. Good control of non –communicable disease and reduce complications.

4. To promote researches and studies in the field of non-communicable disease.

Eye Health

1. To control factors leading to blindness in all age groups.

2. To Maintain Trachoma prevalence below WHO recommended standards for elimination of

blinding trachoma.

3. Reorganization of eye care services at all eye care levels specially the secondary and tertiary

levels to improve preventive, curative and rehabilitative eye health services.

Ear Health

1. Prevention of Hearing loss among all Omani population.

2. Treatment and rehabilitation of patients with hearing loss.

Oral and Dental Health

1. Improving Oral and Dental Health services provided to priority groups in the community.

Mental Health

1. To improve the quality of mental health services provided to adults for some of the prevailing

psychiatric disorders (schizophrenia, anxiety, and depression).

2. To improve the quality of mental health services for psychological, behavioral, and learning

disorders of children and adolescents.

3. To reduce the incidence of substance dependence and its harmful consequences.

Genetic Diseases

1. Provision of effective preventive measures and developing Molecular Genetic technology

expertise capable of supporting local effective prevention programs.

2. Improving the quality of the services provided in the field of genetic health.

3. Provision & expanding of premarital examination to reduce the prevalence of genetic diseases

and congenital malformation.

4. To raise the public awareness of genomic technology and its benefits. To continue genomics

education, capacity building and training in new technologies;

16

Environmental and Occupational Health

1. To reduce the environmental and occupational health morbidity and mortality.

Accidents and Injuries

1. To decrease morbidity and mortality and disability resulting from the accidents and medical and

public health emergencies.

Woman Health

1. Expansion in the provision of Reproductive Health services package in the Ministry of Health'

Facilities.

2. Improving Reproductive practices in the community.

Child Health

1. To reduce childhood mortality and morbidity rates with focus on neonates, infants and

children less than 5 years of age.

2. To improve quality of health services provided to children with a focus on:

Children with special needs.

Children with chronic illnesses.

Children victims of maltreatment.

3. To enhance coordination between different domains related to child health at a central

level.

Elderlies Care

1. To promote elderlies care service for elderlies population who can reach to PHC institutions and

those who cannot reach to improve their quality of life.

2. To empower PHC institutions to provide elderlies care services.

3. To raise the awareness of the community about the importance of elderlies care service to

encourage their contribution in this service.

Health Education and Communication

1. Developing and improving the health education services.

2. Developing the skills and building the capacity of MOH staff working in the field of health

education.

3. Increasing health awareness, targeted at changing unhealthy attitudes and practices and

promoting healthy lifestyles and behaviors in the community.

Adolescent and Youth Health

1. To promote the role of primary health care in providing services appropriate for adolescents and

youth in all regions of the Sultanate.

2. To increase awareness about adolescents and youth issues in order to promote healthy lifestyles

in all regions of the Sultanate.

17

School and College Health

1. To promote healthy lifestyles among all categories of the school community in all regions of the

Sultanate.

2. Development and expansion of efficient, high quality, and comprehensive health services to

all school community in all regions of the Sultanate.

3. To promote the health of students in higher educational institutions in all regions of the

Sultanate.

Nutrition

1. Promotion of food and nutrition policies and strategies.

2. Promotion and management of infant and young child nutrition.

3. Control of micronutrients deficiency among the whole population.

4. Improve nutrition and dietetics services in all health institutes.

5. Support of food safety systems in coordination with other sectors.

Community Participation

1. Implementation of health promotion strategy.

2. Improve the mechanisms of community participation.

Health Management

1. Improvement & activation of performance practices within the health care system.

2. Activation of decentralization.

3. Equal/Balanced distribution of Human and material resources.

Health Information and Statistic

1. Provide comprehensive data and information to meet the needs of the health system.

2. Improve the quality of the health information system outputs.

3. Ensure optimal use of the health information by health workers.

Health Research and Studies

1. Provision of data and information that are required by health system through conducting

researches and studies by the domains.

2. To develop technical capabilities and skills of Health Research Teams on research

design, methodology and other skills.

3. To develop and improve the capacity of research users at different levels to utilize

information as a tool for evidence-based planning and management.

4. To develop and strengthen the infrastructure of Health Research System (HRS) and

ensure its high quality.

18

Information Technology

1. To expand the digital infrastructure in various administrative and health institutes and

consolidate ALSHIFA system among various health institutions.

2. To support IT staff.

3. To activate the electronic communication within the health system.

4. To provide e-services through the website of the Ministry.

5. Access to unified national electronic health records for the patient.

Human Resources Development and Omanization in the Health Field

1. To provide adequate and equitable numbers of trained manpower to all MoH institutions.

2. Accelerate the process of manpower appointing and recruitment.

3. Reduce the number of resignations in all job categories especially in medical and Para-

medical job categories.

4. To train Omani health cadres in various health fields.

5. To Develop Continuing Education further in MoH.

6. Development of the learning resources infrastructure.

Health Educational Institutions in Ministry of Health

1. To improve and implement the Quality Assurance schemes in the Health Educational

Institutions.

2. To improve the academic programs to conform with the national frames, standards and

trends of higher education and professional practice.

3. To improve the infrastructure of the Health Educational Institutions, so that it meets the

demands of higher education.

4. To continue developing the capabilities and skills of the teaching staff and the

administrative staff and retain qualified staff.

5. To enhance the capabilities and skills of the teaching staff and students on approach and

methodology of scientific research.

6. To promote the academic and the student relationships with other universities and

colleges, nationally and internationally.

Health Services for the Private Health Sector

1. Strengthen and enforcing the legislation and laws governing the work of the private

health sector.

2. Developing the inspection and monitoring system of private health establishments.

The following chapters represent the National Strategic Plan of the 8th

Five-Year Plan for Health Development of Sultanate of Oman for the Year

2011 to 2015.

19

Chapter four

Domains of the Eighth

5-Year Plan for Health Development

(2011 – 2015)

20

Delivery of High Standards of Health Care

to the Community

Vision One

21

Domain One

Primary Health Care

22

Vision: Delivery of High Standards of Health Care to The Community

Goal: Developing Pillars of The Health System

Domain: Primary Health Care

INTRODUCTION:

Primary health care is the first entrance for all levels of health care (secondary and

advanced) and establishes a link between community and health care providers. After Alma

Ata Declaration in 1979, Ministry of Health in the Sultanate committed itself that the primary

health care is the strategy to achieve the goal of health for all and improve the health

indicators which are vital to the Omani society. And also the primary health care services

provided through health centers, polyclinics and local hospitals is the essential foundation for

health care which is an integral part of comprehensive health system, which aims to assist in

the social and economic development of the individuals and society as a whole.

A major development in the infrastructure of primary health care institutions in the

Sultanate during the last five-year plans, where the number of primary health care institutions

by the end of 2010 were 207. Of which (154) health centers and (22) extended health centres

and (31) local hospitals. Out of the ministry's keenness to facilitate access for the individual

and society to provide health care with ease, the ministry adopted through the five-year

plans the establishment of health centers and polyclinics in order to reach, a health center per

10,000 population, and attract these institutions about 85% of the total OPD attendance of the

health system in the Sultanate, reaching visits to primary health care institutions, about 12

million visits during 2010. It has been supported by the existing institutions with the latest

equipment and medical devices and the provision of medical staff, technical, and

administrative requirements to suit the healthy development while providing opportunities for

internal and external training and continuing education for them. As a result of the presence

of various integrated health programs in the primary health care to serve the community has

enhanced the development of quantitative and qualitative primary health care services. The

increase of primary health care institutions with easy access and the implementation of

programs have great impact on the citizens.

With a change in the pattern of disease the method of providing service in these centers

has changed where, it became eligible to provide a comprehensive service for chronic

diseases through the integration of specialist clinics for diseases such as diabetes, blood

pressure, kidney disease and mental health into primary health care services, taking into

account the training of doctors to deal with these diseases.

OBJECTIVES:

1. To strengthen the PHC infrastructure.

2. To provide high quality PHC services to the community.

23

OBJECTIVE’S INDICATORS:

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To strengthen PHC infrastructure

1. Rate of health centers per 10000

population.* 0.68 0.75 0.84

2. Rate of PHC doctors per 10000

population.* 4 6 8

3. Rate of family physician per 10000

population*. 0.2 0.35 1

4. Rate of PHC nurses per 10000

population.* 7.9 9 12

5. Rate of PHC dentists per 10000

population.* 0.48 0.6 1

6. Rate of PHC assistants pharmacists per

10000 population.* 1.57 2.2 3

7. Rate of PHC lab. Technicians per

10000 population.* 0.99 2.0 3

8. Rate of PHC radiographers per 10000

population.* 0.5 1 1

9. Rate of PHC dietitians per 10000

population*. 0.28 0.35 0.75

10. Rate of PHC health educators per

10000 population*. 0.52 0.6 2

Second Objective’s Indicators: To provide high quality PHC services to the Community

1.

Percentage of PHC institutions that

implement PHC SOP for general

layout.

NA 15% 60%

2.


implement PHC SOP for furniture&

equipments.

NA 15% 60%

3.


have network connection to upper

health care level.

NA 22.8% 40%

4. Percentage of PHC institutions that

have network education services. 0 0 50%

5.


have clinical SOP for the management

of emergencies.

NA NA 60%


implement staff norms guideline. NA 15% 60%

7.


implement quality assurance

programme.

20% 75% 90%

8. Percentage of doctors that have ACLS. NA 2% 20%

24

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015


implement elderlies care programme.

NA 4.6% 55%

10. Percentage of doctors enrolled in the

GP training programme.

NA 5% 50%


conduct patient satisfaction surveys. 10% 15% 50%


conduct staff satisfaction survey. 7% 30% 60%

* MoH institutions only.

* PHC institutions include: health centers, polyclinics and local hospitals.

STRATEGIES:

Strategies to Achieve 1st Objective: To strengthen PHC infrastructure.

1.1 Completion & strengthen PHC services coverage.

Expected results:

Increase in the number of health centers and service users‟ attendance.

1.2 Improve and develop PHC institutions (equipment, laboratory service).

Expected results:

Standard PHC services.

1.3 Determine the catchments’ area for all PHC.

Expected results:

Determination of all catchments‟ area for all PHC institutions.

1.4 Strengthen PHC institute with the required manpower.

Expected results:

PHC institutions covered with the required staff as per (staff Norms).

1.5 Continuing to introduce preventive programmes and early detection of cases (including

chronic diseases) in PHC services.

Expected results:

Proper follow-up of the cases.

Early detection of chronic diseases cases.

Comprehensive and continuous care.

Reducing the expenses of the higher level of care.

1.6 Providing a proper elderlies health care system that meets their health need.

Expected results:

Reduction of the morbidity rates among the elderlies age group.

Early detection of elderlies and senile diseases and their complications.

25

Strategies to Achieve 2nd Objective: To provide high quality PHC services to the

community.

2.1 Revising PHC SOP.

Expected results:

Revised SOPs.

2.2 Reviewing standards of PHC institutes structure & layout.

Expected results:

Specific standards for the PHC structures.

2.3 Revising the standards for the manpower.

Expected results:

Revised Standards for staff norms.

2.4 Revising the standards for the equipments and furniture.

Expected results:

Revised standard list of equipment.

2.5 Implementing effective network connection with the upper health care level.

Expected results:

Easy transfer of data between the two levels.

Smooth referral and feedback.

2.6 Training of PHC physicians on family medicine.

Expected results:

Improved patients‟ satisfaction.

Enhanced clinical knowledge for PHC physicians.

Reduces the number of referred cases to upper health care level.

Reduced re-visits.

2.7 Promoting leadership and administrative skills for all technical staff at PHC institutions.

Expected results:

PHC staff with leadership and management skills.

Effective Leaders at the Wilayate and PHC centers level.

2.8 Training PHC staff on communication skills.

Expected results:

Health care team equipped with communication skills.

2.9 Training of PHC physicians on ACLS.

Expected results:

Competent PHC physicians.

Reduced mortality due to cardiac causes at PHC.

Reduced complication.

26

2.10 Introduce e-learning in primary health care institutes.

Expected results:

Up-to-date guidelines and evidence based in the computer system.

2.11 Conduct patients & staff satisfaction surveys.

Expected results:

Know level of satisfaction.

STRATEGIE’S INDICATORS:

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

Indicators of Strategies of the 1st Objective

1.1a Rate of Health Centers per 10000 population.* Annually 0.75 0.84

1.2a Percentage of the PHC institutes that have

renewed their equipments. Annually 25 % 50 %

1.3a Percentage of Health Centers with active

catchments‟ areas system. Annually 30 % 60%

1.4a Percentage of PHC institutes with complete

manpower according to staff norms. Annually NA 60%

1.5a

Percentage of PHC institutes that covered 80%

from the total target for the chronic diseases

screening programme (above 40 years)

Annually 37% 70%

1.6a Percentage of PHC institutions providing

elderlies care services. Annually 4.6% 60 %

1.7a Percentage of PHC institutions that have

completed the equipment and devices. Annually Nil 100%

Indicators of Strategies of the 2nd Objective


updated clinical SOP according to standards. Annually NA 40%

2.2a Percentage of PHC institutions that follow PHC

standard for the general layout. Annually 15% 60%


standard for the equipment. Annually 20% 60%

27

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.3b Percentage of PHC institutions that follow PHC

standard for the furniture. Annually 20% 55%


standard for the staff norms. Annually NA 60%

2.5a Percentage of PHC institutions with

computerized system. Annually 83% 96%

2.5b Percentage of PHC institutions connected by a

network with higher level of care. Annually 22.8% 40 %

2.6a Percentage of health centers implementing

family folder. Annually 15% 50%

2.7a Percentage of PHC staff trained on leadership

and management. Annually 20% 60 %

2.7b Percentage of health workers covered by

Continuous Medical Education (CME). Annually 30 % 60%

2.8a Percentage of PHC staff trained on

communication skills. Annually 30% 60 %

2.9a Percentage of physicians trained on ACLS. Annually 5% 20 %

2.9b Percentage of physicians trained on SOP for

emergency cases& injury management. Annually 2% 20 %


network education services. Annually Nil 20%

2.11a Percentage of the Wilayate that conducted

patient satisfaction survey. Annually 40% 60%

2.11b Percentage of the Wilayate that conducted staff

satisfaction survey. Annually 30% 60%

* MoH PHC institutions only

28

Domain Two

Secondary and Tertiary Health Care

29



Domain: Secondary and Tertiary Health Care

INTRODUCTION:

Ministry of Health has exercised all its efforts to achieve the set objectives of previous

years, through developing and establishing health care plans for curative and preventive

programs, and further developing human resources in the health sector. To achieve its main

objective of provision of optimum level of health care, the Ministry has committed itself and

worked to ensure the appropriate distribution of health facilities for easy / fast access and

respond to its citizens‟ expectations and their health and health related requirements.

Hospitals constitute the critical component of health care delivery system in Oman

and provide secondary and tertiary care services; in addition they also contribute substantially

to primary health care services, either directly or indirectly, with an access to these services.

The health care services have developed considerably over recent years, in 1970 there were

only two small hospitals with 12 inpatient beds, and in 2010 it increased to 50 hospitals with

4692 beds. MoH may adopt new methods and tools in the management of health facilities

with a focus to improve the standards and quality of health services offered in the hospitals,

to keep in pace with the continuous development of health care management and the

provision of health care services. In this context the Ministry of Health launched national

programs to support the hospitals with an aim to reinforce delivery or quality of health

services provided by MoH hospitals, and to facilitate optimum utilization of available

resources of financial, human, information by applying improved management techniques

and tools in planning, organizing, directing and monitoring.

The Ministry also initiated Hospital Autonomy to some of the regional hospitals to

enhance and improve quality in provision of health care services. After years of overall

development and ongoing work and laying the stepping stones on health systems in Sultanate,

it is very obvious that there is a need to assess and evaluate the networking of the specialized

care services and to consider expansion of hospital services to keep in pace with the medical

and technological advancements, and also the increasing population and the growing needs of

the community.

During last few years the Sultanate experienced severe climatic changes, and events

associated with these, affected the infrastructure of health facilities. All efforts to be

exercised to develop, improve and enhance readiness of the Secondary and Tertiary care

health facilities in providing the services seamlessly during such emergencies and crisis and

ensure continuity of provision of health care.

OBJECTIVES:

1. To develop the infrastructure of the hospitals.

2. To Improve and expand secondary and tertiary health care services.

3. To develop and improve the readiness of hospitals to respond to emergencies and

disasters.

30


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To develop the infrastructure for hospitals.

1.

Number of secondary health care

hospitals established during the years

of the plan. (Muscat General H.,

Suwaiq H.).

NA NA 2

2.

Number of secondary and tertiary

hospitals refurbished / expanded

(Khoula H., Samail H., Khasab H.).

NA NA 3

3.

3- Number of secondary care hospitals

(Willayat Hosp.), replaced during the

years of the plan.

NA NA 3

Second Objective’s Indicators: To improve and expand secondary and tertiary health care.

Services

1. Number of Regional hospitals with the

availability of tertiary care services. NA 2 4

2.

Number of hospitals in which the

computer systems are upgraded to Al

Shifa 3+.

NA 1 11

3. Availability of accreditation system in

secondary and tertiary care hospitals. NA NA

System

available

4. Number of Regional hospitals linked

with tertiary care hospitals. NA 4 8

Third Objective’s Indicators: To develop and improve the readiness of hospitals to respond

to emergencies and disasters.

1. Number of hospitals with updated plan

for emergencies and disasters response 0 8 19

2. Availability of a national plan for

emergency and disaster response. NA NA

Plan

Available

3.

Number of hospitals (Wilayat) in which

emergency departments have been

refurbished (Khoula H., Sinaw H.,

Saham H., Sumail H., Khasab H.).

0 0 5

31

STRATEGIES:

Strategies to Achieve 1st Objective: To develop the infrastructure of the hospitals

1.1 To establish secondary health care hospitals to cope with the increased demand for

secondary and tertiary care services.

Expected results:

Increase in the number of secondary health care hospitals (Wilayats).

1.2 To refurbish secondary health care hospitals in Wilayats.

Expected results:

Provide good standard health care services in safe and healthy environment.

1.3 To study on the bed occupancy rate in various departments of the hospital.

Expected results:

Identify services for expansion at priority.

1.4 To increase the number of beds in critical care units (ICU, PCU, CCU, SCBU)

Expected results:

Provide better services for patients in critical care areas.

1.5 To conduct an evidenced based study to assess the actual needs for the specialized

health professionals.

Expected results:

Availability of adequate number of specialized health professionals to ensure continuation of

medical services and reduce the work pressure on existing staff.

Identify deficiencies in the distribution of medical staff to hospitals.

1.6 To develop a plan for each hospital to replace or acquire the medical equipment.

Expected results:

Speed up the process of replacing / acquiring medical equipment.

Ensure continuation of medical services requiring the use of medical equipment.

1.7 To provide equipment as per the priorities determined by each hospital.

Expected results:

Availability of resources as per hospital needs.

Delivery of better health care services to patients.

Strategies to Achieve 2nd Objective: To develop and expand health care services secondary

and tertiary.

2.1 To establish National clinical teams / committee for various specialties.

Expected results:

Availability of a reference for various medical specialties.

32

2.2 To provide adequate financial budget for training and education to enhance the skills of

the medical staff in management of patients.

Expected results:

Availability of medical staff with enhanced skills in delivery of quality health care.

Improved and enhanced health care services provided to the clientele.

2.3 To expand health care services as per the evidence based by the secondary and tertiary

care hospitals.

Expected results:

Fast / easy access to the specialized health care in secondary and tertiary care health

facilities.

Increased satisfaction of the clientele in the specialized services provided by the secondary

and tertiary care referral hospitals.

Reduce the workload on tertiary health care hospitals.

2.4 To provide telemedicine in the regional hospitals.

Expected results:

Optimal use of available resources in hospitals.

Use modern technology to enhance delivery of health care services in hospitals.

2.5 Number of wilayat hosptials linked completely with tertiary care hospitals.

Expected results:

Optimal utilization of available resources.

Speed up and facilitate transfer of patients and information between hospitals.

Improve referral feedback between hospitals.

2.6 To develop national standards for patient safety in hospitals.

Expected results:

Improved patient safety standards in hospitals.

Improved satisfaction of the patients with the services provided by the hospitals.

Reduce morbidity related to patient safety in hospitals.

2.7 To launch a campaign targeting community / health workers to build trust / confidence

in the health care services provided by the hospitals.

Expected results:

High level of satisfaction of patients on health care services provided by the hospitals.

Improved confidence of community on the capabilities of the medical staff providing health

care services.

Improved channels of communication with the community.

2.8 Training of Administrative Leaders in hospitals in the area of strategic management and

planning and resource management. Expected results:

Improved management process in hospitals.

Availability of expert trained and qualified administrators in the basics of hospitals

management and administrative skills.

33

2.9 Training doctors and nurses on the basics of principles of patient safety.

Expected results:

Availability of medical staff with expertise in principles of patient safety.

Strategies to Achieve 3th Objective: To develop and improve the readiness of hospitals for

emergency and disaster

3.1 To develop a health plan at national level to respond to emergencies and disasters.

Expected results:

Availability of a national plan to respond to medical emergencies and disasters.

3.2 To develop a plan to respond to emergencies and disasters at the level of secondary and

tertiary care hospitals.

Expected results:

Availability of a hospital plan to respond to emergencies and disasters.

3.3 Training of medical staff in emergency and other departments on cardio pulmonary

resuscitation (ACLS).

Expected results:

Availability of medical staff in emergency and other departments to manage cardiac patients

efficiently and effectively.

Better services to cater cardiac patients.

3.4 Training of medical staff in emergency and surgical departments on the management

of Trauma cases (ATLS).

Expected results:

Availability of medical staff in emergency and surgical departments to manage patients with

trauma and accidents efficiently and effectively.

Availability of medical staff acquired with management of accidents and injuries.

Better services for the management of accidents and injuries.

3.5 Training health workers on crisis and disaster management programs.

Expected results:

Availability of qualified staff in hospitals to manage crises and disasters.

3.6 To provide required equipment to respond to emergencies and crisis.

Expected results:

Enable hospitals to respond effectively and efficiently to emergencies and crisis.

3.7 To establish command centre with provision of all required tools during emergencies

and disasters.

Expected results:

Availability of command centre to manage and liaise with concerned health facilities to

manage emergencies and disasters efficiently and effectively.

34

3.8 To create centralized health information data base to respond during emergencies and

disasters. Expected results:

Provide basic information to respond to emergencies and crises.

3.9 To establish trauma centers in priority areas.

Expected results:

Provide better services for the management of injuries and accidents.


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Availability of study on Bed occupancy rate in

specialty departments. Annually NA

Study

available

1.2a

Number of hospitals being renovated during the

plan.

By the

end of the

current

Plan

NA 25% of the

hospitals

1.3a Availability of study to assess the actual need of

the hospitals for medical professionals.

Annually NA Study

available

1.4a Number of critical bed added in (ICU, CCU,

PCU, and SCBU).

Annually NA 25% of the

hospitals

1.5a Availability of study to assess the actual need of

the hospitals for medical staff.

Annually NA

Study

available

1.6a

Availability of a plan for each hospital to

replace / upgrade or acquire medical equipment.

Annually NA Availability

of plan for

all hospitals

1.6b Percentage of condemned equipment replaced

with new equipment.

Annually NA 100%


2.1a Availability of clinical teams / committees of

various specialties in hospitals.

Annually

1

Availability

of clinical

teams /

committees

2.2a Availability of adequate financial allocation for

training.

Annually Not

adequate

Adequate

budget

35

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.3a Number of hospitals with laparoscopic services. Annually 2 8

2.3b Number of hospitals providing cardiac

catheterization.

Annually 0 2

2.3c The number of hospitals with day-care services

devices.

Annually 3

All regional

hospitals

2.3d Number of hospital services providing Pediatric

Surgery.

Annually 2 4

2.4a The number of hospitals with the provision of

telemedicine.

Annually 0 8

2.5a Number of regionals / wilayat hospitals linked

with tertiary care hospitals.

Annually

4

All regional

and Wilayat

hospitals

2.5b

Number of Secondary and Tertiary Care

hospitals linked with the primary health care

facilities in the regions.

Annually

2 All Regional

hospitals.

2.6a Availability of national standards for patient

safety in hospitals.

Annually

NA

Availability

of patient

safety

standards

2.7a Availability of a plan to build trust / confidence

in community on the services in hospitals.

Annually NA

Availability

of a plan

2.8a Percentage of administrative leaders trained in strategic management, leadership.

Annually 13% 80%

2.9b Percentage of doctors and nurses trained in the basic

principles of patient safety.

Annually NA 25%

Indicators of Strategies of the 3rd Objective

3.1a Percentage of staff trained in the management of

crises and disasters.

Annually 1.5% 04%

3.2a Availability of health Plan at all regional hospitals to

respond to emergencies and disasters.

Annually

NA

Availability of

the Plan at all

regional

hospitals

3.3a Percentage of staff trained on CPR programs

(ACLS). (Doctors and nursing staff of emergency

departments and the first on call doctors in other

departments).

Annually

17% 50%

36

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

3.4a

Percentage of staff trained on management of

trauma and injuries (ATLS)

(Doctors and nursing staff of emergency

departments, Surgical departments and first on call

doctors in other departments).

Annually

< 1% 25%

3.5a Number of staff trained in disaster management.

Annually NA 200

3.6a Availability of National command center for crisis

management operations and disaster equipped with

the required tools.

Annually

NA Availability of

the Center

3.7a Availability of command centre in all regional and

tertiary care hospitals equipped with required tools

to manage emergencies and crisis.

Annually

NA Availability of

the Center

3.8a Availability of health information data base for

emergency response and crisis management.

Annually

NA

Availability of

the

information

base

3.9a Availability of trauma centers in priority areas.

Annually

NA

Availability

of the Center

(2)

37

Domain Three

Pharmaceutical Care

38



Domain: Pharmaceutical Care

INTRODUCTION:

Pharmaceutical care is a responsible provision of drug therapy to all patients for the

purpose of achieving definite outcomes that improve a patients quality of life, through curing

disease or eliminating / reduction of patient‟s symptoms / arresting or slowing a disease

progression or preventing a disease or symptoms, this will normally be done through setting

and implementing curative & and preventive plans, and monitoring the medication use

outcomes, in order to achieve the set goals, and improve patients quality of life through

rational & cost-effective use of medicines. And to ascertain drug use related problems.

In view of the Sultanate achievements in different health care sectors which make it

important for the pharmacy practice to accompany such development and work in line with

the health system requirements that compliant with changes in methods of providing health

care, which needs qualifying of pharmacists for acquiring the fundamental pharmaceutical

care standards, and caring for patients therapy outcomes and safety, this can be reflected by

provide the patients with safe and effective medications that comply with standard quality &

specification.

In pursuit of Ministry‟s policy towards caring & developing the pharmaceutical care

services the ministry adopted the pharmaceutical care program within the six fifth year health

development plan programs (2001-2005) as pharmaceutical care is considered an essential

and integral element in health care.

One of the positive indicators that show the commitment of the state to make the

financial resources available to meet this vital element is allocation of about 20% of the total

MoH budget towards medicinal expenditure, due to the importance of making available

effective and safe medicines for patients‟ health. With this end in view, MoH has

successfully implemented the procurement system for drugs through, open international and

local tenders and also by participating efficiently in GCC joint tenders. The Executive Board

of GCC Health Ministers Council too has approved certain set of guidelines for drug

procurement policy from generic companies, which helps acquisition of drugs at competitive

rates within the acceptable quality specifications. Another area of consideration was the

establishment of standard warehouses for storage of drugs, in accordance with the required

good storage conditions.

In respect of increased drugs treatment costs and increased number of specialised

medications, which make the participation of pharmacist within the medical team is of vital

importance, for introducing the pharmaceutical care concepts which will assure the quality of

services provided and maintain patient safety through rational utilization of the available

resources, keeping in mind the success of pharmaceutical care program will be reflected

positively on all health care programmes within the five-year plan since the drugs are

considered as a common element in all health and therapy programmes.

Accordingly the support of pharmaceutical manpower in primary care level, as per

service requirements and in secondary & tertiary level, on bed capacity basis, is considered as

the fundamental element to provide an integral and comprehensive pharmaceutical care. This

39

should be reflected positively on all health Programmes within the five-year plan since the

drugs are considered a vital & common element in all these Programmes.

OBJECTIVES:

1. To assure that patients are provided with safe and effective drugs, at reasonable costs.

2. To ensure the quality of pharmaceutical services provided.

3. To enhance the medication safety programs.

4. To accomplish rational drug use in all institutions.

OBJECTIVES’ INDICATORS:

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To assure that patients are provided with safe and effective

drugs, at reasonable costs

1. Number of the negative reports on

drug quality. 27 20 >10

2.

Number of health institutions with

insufficient storage space and that does

not comply with required

specifications.

52 42 zero

3. Number of drug batches analyzed by

the central Quality Control Laboratory

for MOH governmental institutions.

NA 1075 1200

4. Number of drug batches analyzed by

the central Quality Control Laboratory

for private institutions.

NA 62 400

Second Objective’s Indicators: To Ensure the quality of pharmaceutical services provided

1.

Percentage of referral hospitals that

have established Drug Information

System.

NA 10% 100 %

2.

Percentage of Government Health

institutions that apply medications

counseling system.

NA 11% 5 0 %

3.

Percentage of the private/community

pharmacy that apply medications

counseling system.

NA NA 20 %

4.

Average number of clinical pharmacy

in hospitals with respect to bed

capacity.

1:4542 1:244 1:50

5.

Average Number of Pharmacists in

hospitals with respect to the total

Number of patients.

NA 1:109 1:60

6.

Average number of pharmacists in

primary healthcare institutions with

respect to the Number of patients.

1:1300 1:600 1:150

40

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

7.

Average number of Assistant

pharmacists in primary healthcare

institutions with respect to the Number

of patients.

1:120 1:50 1:30

8.

Percentage of hospitals applying

quality assurance standards in

pharmaceutical care.

NA NA 100%

9.

Percentage of MOH Health institutions

having a comprehensive electronic

system for medicine management,

which covers (prescribing, dispensing,

issuing, and material management

processes).

73% 80% 100%

10.

Percentage of asthmatic patients who

given medication counseling on their

inhalation devices techniques, prior

leaving their health facility.

NA NA 50 %

11. Number of field visits for each private

pharmacy per year. Unrecorded 1.2 2

Third Objective’s Indicators: To enhance the medication safety programs

1.

Percentage of health institutions where

medication safety programs are

applied.

NA NA 50 %

2. Number of ADRs reports. 320 653 1000

3.

Number of referral hospitals having

guidelines manual, for safe handling of

dangerous drugs (cytotoxic & radiated

isomers).

NA NA All referral

hospitals

Fourth Objective’s Indicators: to accomplish rational drug use in all institutions (All

indicators are set to Primary Health Care level)

1. Average number of drugs per

prescription. 2.7 < 2.5 < 2.5

2. Percentage of prescription consists of

Antibiotics. 46% < 30% < 30%

3. Percentage of drugs dispensed out of

the prescribed ones. 97% 98% 98%

4.

Percentage of patients who understand

the instruction for the use of their

medications while leaving the

pharmacy.

Unrecorded 72% 85%

5. Average time for dispensing a

prescription in minutes. NA 2.23 5

41

STRATEGIES:

Strategies to Achieve 1st Objective: To assure that patients are provided with safe and

effective drugs, at reasonable costs

1.1 Organizing acquainting symposiums for all health professionals with regard to the

drugs quality monitoring programs.

Expected results:

Ensure quality and efficiency of medicines.

1.2 Training of pharmaceutical manpower to follow scientific methods in forecasting the

requirements, and for inventory control.

Expected results:

Ensure medicines availability continuously in sufficient quantities at the appropriate timings.

Minimize overstocking and expiration of drugs.

1.3 Supports drug procurement policy from generic companies as per the required quality

specifications.

Expected results:

Ensure optimum utilization of available financial resources.

1.4 Determine the designs spaces & specification of pharmacies and drug stores at all

health institutions according to the good storage conditions requirements.

Expected results:

Storage of drugs within the required storage conditions to maintain efficacy during the entire

shelf life.

1.5 To make available of all instruments and equipment required for storing medicines

and medical items according to the good storing conditions standards.

Expected results:

Follow-up and monitoring the stored medicines and medical items at all Health institutions to

ensure preserving their efficacy throughout their storing time.

1.6 Linking the central medical stores with the medical stores at health Units via

computerized system and expansion of electronic prescribing.

Expected results:

Efficient inventory control.

1.7 Establishment of DGMS sub stores at the remaining regions.

Expected results:

To ensure close availability of medical supplies to all health institutions.

1.8 Set up a national plan for importing biological products.

Expected results:

Ensure procurement of safe and high quality products.

42

Strategies to Achieve 2nd Objective: To ensure the quality of pharmaceutical services

provided

2.1 To setup standards for pharmacy staff requirements at different levels of health

Institution.

Expected results:

Ensure the provision of comprehensive pharmaceutical care services for all targeted

categories.

2.2 Setup an approved training and qualification programs for pharmacy staff in different

pharmaceutical care domains.

Expected results:

Improved quality of pharmaceutical services provided.

2.3 Establishment and development of drug information services in all referral Hospitals.

Expected results:

Accessible up-to-date efficient drug information for all medical professionals & patients.

2.4 Set up roles & guidelines for drug promotion.

Expected results:

Provision of all medical professionals with unbiased medicine information, which help in

achieving the optimum therapeutic outcomes.

2.5 Prepares and update written manuals, for standard operating procedures for various

issues in pharmacy practices.

Expected results:

Standardization of operating procedures in all health units.

Offering a high quality pharmaceutical service.

2.6 Providing medicine-counseling places in pharmacy departments at secondary &

tertiary healthcare levels institutions.

Expected results:

Increase the percentage level of patients acquainted with proper knowledge to use the

prescribed drugs.

Minimizing the drug related problems for this patient‟s category.

2.7 Determine the hospital pharmaceutical care quality standards.

Expected results:

Identify the quality of pharmaceutical care provided in health institutions.

Ensure the quality of pharmaceutical care provided.

43

2.8 Updating the policies and procedures for dealing with narcotics and controlled drugs at

all healthcare levels.

Expected results:

To ensure safe utilization and disposal for narcotics and controlled drugs.

Exactitude the control of Narcotics other controlled drugs, through monitoring the

implementation of policies and procedures in dealing with this group of drugs & to minimize

their misuse.

2.9 To establish an evaluation standards for profession competencies in pharmacy

practice.

Expected results:

Existence of pharmaceutical manpower with high profession competencies standards at both

government & private sectors.

Existence of unified standards for the evaluation of professional competencies in pharmacy

practice.

2.10 To Qualify and train pharmacists in the field of pharmaceutical care quality

standards.

Expected results:

Enhance the concepts quality in pharmaceutical care.

Presence of qualified pharmaceutical manpower in the field of quality.

Ensure the quality of pharmaceutical care services provided.

2.11 To Qualify and train pharmacists in the field of patient counseling for the targeted

groups of chronic patients.

Expected results:

Improve drug therapy outcomes.

Establish pharmaceutical care concepts awareness among public & Health professional.

2.12 To Qualify and train pharmacists in the field of drug information.

Expected results:

Existence of qualified pharmaceutical manpower for provision of drug information.

Accessible up to date efficient drug information for all medical professionals & patients.

2.13 Determine quality standards for assessment of pharmaceutical services quality in

private pharmacies.

Expected results:

Existence of quality standards for assessment of pharmaceutical services quality in private

pharmacies.

2.14 Conduct study to evaluate the performance of pharmaceutical services in the private

pharmaceutical sector by the concern authorities.

Expected results

Strengthen the role of the private pharmaceutical sector in the provision of pharmaceutical

care.

44

Strategies to Achieve 3rd Objective: To enhance the medication safety programs.

3.1 Assessment of the current medication safety situation at health institutions.

Expected results:

Ascertain the aspects of deficiencies in medication safety functional systems.

Existence of quality standards for assessment of medication safety in health institutions.

3.2 Establishing the aims and strategies for medication safety programs.

Expected results:

Minimization of medication errors.

Promotion of patient medication safety programs.

3.3 Conduct symposiums & orientation meetings about Pharmacovigilance.

Expected results:

Complete awareness of pharmacy staff with concepts of medication safety &

Pharmacovigilance.

3.4 Formation of Medication safety committees at hospitals & regions level.

Expected results:

Implementation of Medication safety proactive & interactive programs.

3.5 Setup approved standards to ensure the safety of sterile & non-sterile pharmaceutical

preparation.

Expected results:

Assurance of the quality and safety for sterile & non-sterile pharmaceutical preparation.

3.6 Set a program for monitoring and documenting the medication errors and categorizing

them according to the level of risk.

Expected results:

Enumeration of medication errors and determination the level of risk.

Control the incidences of medication errors.

3.7 Organization of training courses in the medication safety scope.

Expected results:

Boos up the medication safety programs.

3.8 To Qualify and train pharmacists in the field of medication safety.

Expected results:

Acquisitioning the pharmacy staff with the knowledge and skills required for implementing

the medication safety programs.

45

3.9 Reviewing & analyzing the ADRs reports and set up the necessary recommendations to

minimize the adverse effects.

Expected results:

Reduction of adverse effects complications.

Increase the health professional awareness about the importance of monitoring & reporting

ADRs.

3.10 Conducting studies and research in the field of drug use evaluations.

Expected results:

Establish a pharmaceutical research system for conducting research and study in the field of

drug use evaluations.

Updated therapeutic manuals and protocols.

Strategies to Achieve 4th Objective: To accomplish rational drug use in all institutions

4.1 Training all health care providers in the field of rational drug use.

Expected results:

Enhancement of the rational drug use concepts.

Rational prescribing of drugs.

Acquainting the health professionals with required skills to conduct studies in the field of

rational use of drugs.

4.2 Compile and implement strategies and Programs for public health education

concerning the rational drugs use.

Expected results:

Improve the public awareness about the risks of drug misuse.

Boosting the positive behavior of public towards the rational use of drugs.

4.3 Preparation of guidelines and advices on medication use to be handed over to patients.

Expected results:

Acquaintance of patients with guidelines and advices related to medication use.

Enhance patients‟ compliance to medication use.

4.4 Establishing a system for monitoring the patterns of prescribing in health institution.

Expected results:

Reduction of medication errors.

46

STRATEGIES’ INDICATORS:

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a

Number of orientation sessions in quality

reporting program for health care

providers.

Annually 1 10

1.2a

Number of training sessions for

pharmaceutical manpower to follow

scientific method in forecasting and

inventory control.

Annually 2 15

1.3a Percentage of drugs value purchased from generic companies compared to that purchased from patent companies

Annually 43% 55%

1.4a

Number of Health units with insufficient

storage space, or with storage area that

not comply with the good storage

specifications, for storing medicine and

medical items.

Annually 42 Zero

1.5a Existence of a guideline manual for

storing medicines according to good

storage specifications.

End of

year 2012

Manual

available but not

approved

Manual

available and

approved

1.6a Percentage of Health units with

electronic-link to the central stores. Annually 50% 100%

1.7a Existence of sub stores at regions &

districts. Annually 2 4

1.8a Existence of a national plan to regulate

importing of biological products. End of

year 2012 Plan NA

Existence of

implemented

plan

Indicators of Strategies of the 2nd

Objective

2.1a Existence of standards for determining

staff requirement at all health care levels.

End of

year 2012

Standards

NA

Existence of

approved

Standards

2.2a

Number of education and training

Pharmaceutical sessions conducted for

pharmaceutical manpower in

governmental sector.

Annually 2 10

2.2b

Number of education and training

Pharmaceutical sessions conducted for

pharmaceutical manpower in private

sector.

Annually 4 7

47

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.3a Number of Referral Hospitals providing

drug information service. Annually 2

All referral

Hospitals

2.4a

Existence of rules regulating the delivery

of drug information and organizing drug

promotion activities.

End of

year 2012 NA

Existence of

approved rules

& regulations

2.5a

Percentage of referral Hospitals having

implemented Unit Dose system for

inpatients.

Annually 50% 80%.

2.5b

Presence of pharmacy practice Manuals

for different policies and procedures. End of

year 2012

Available but

not completed

Existence of

approved

manuals

2.5c

Percentage of referral Hospitals having

their own drug formulary out of the

approved drug formulary.

Annually 22% 100%.

2.6a

Percentage of Health units offering drug-

counselling service for patients at

designated areas.

Annually 71% 100%.

2.7a

Existence of approved assessment tools

for assessing the quality of

pharmaceutical care at referral hospitals.

End of

year 2012

Not

implemented

Existence of

approved

standards

2.8a

Existence of updated Standard Operating

policies & procedures with regard to

handling Narcotics and Controlled Drugs

at all healthcare levels.

End of

year 2012

Available not

updated

Existence of

updated SOP at

all levels

2.9a

Presence of assessment standards to

evaluate the professional competencies in

pharmacy practice.

Annually Standards

NA

Existence of

approved

Standards

2.10a


pharmaceutical manpower in the field of

quality assurance.

Annually 1 10

2.10b

Percentage of pharmaceutical manpower

trained in the field of Quality. in

pharmaceutical services.

Annually NA 20%

2.11a



medication counseling.

Annually 3 10

48

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.11b

Percentage of pharmaceutical manpower

trained in the field of medication

counseling.

Annually 4% 20%

2.12a Percentage of pharmaceutical manpower

trained in the field of drug information. Annually 2% 20%

2.13a

Existence of approved standards to

evaluate the pharmaceutical services

quality in private sector.

End of

year 2012 NA

Existence of

approved

standards

2.14a

Conduct study to evaluate the

performance of pharmaceutical services

in the private pharmaceutical sector.

By the

end of the

current

plan

NA Existence of

study

Indicators of Strategies of the 3rd

Objective

3.1a

Number of health care institution where

medication safety practices have been

evaluated.

End of

year 2013 NA

One study for

each institution

3.2a Existence of Medication safety manual.

Annually NA Existence of

Manual

3.3a

Number of orientation sessions

conducted in the field of

pharmacovigilance for pharmaceutical

manpower.

Annually 3 25

3.4a Percentage of Referral Hospitals having

Medication safety committees. Annually NA 80%

3.5a

Presence of Manual for sterile & non-

sterile pharmaceutical preparation. End of

year 2012

Not

comprehensive

Existence of

comprehensive

Manual

3.6a

Presence of registers (Forms) for

monitoring and documenting the

medication errors.

Annually NA Existence of

Registers

3.6b Number of documented pharmaceutical

interventions in treatment therapy. Annually 426 5000

49

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

3.7a

Existence of manual for safe handling &

disposing of Dangerous Drugs

(Cytotoxic-radiated Isomers).

End of

year 2012 NA

Existence of

Manual

3.7b Number of training session in the field of

Medication Safety. Annually zero 15

3.8a Percentage of pharmaceutical manpower

trained in field of Medication Safety. Annually zero 30%

3.9a Presence of Medication use evaluation

studies. Annually NA 2

Indicators of Strategies of the 4th Objective

4.1a



rational use of medicines.

Annually (5) At center

(5) At regions

(30) At center

(100) At regions

4.2a Number of education session for publics

in the field of rational use of medicines. Annually (2) At center

(98) At regions

(20) At center

(250) At regions

4.3a Number of medicines that have written

advices and use guidelines for patients. Annually NA 50

4.4a

Existence of system for reviewing the

prescribing pattern of drugs at health care

institutions.

Annually NA

Existence of

drug reviewing

system

50

Domain Four

Nursing Care

51



Domain: Nursing Care

INTRODUCTION:

Nursing and Midwifery profession occupies prominent place in the heart of the work of

health institutions therefore Ministry of Health has paid the greatest attention to this

profession in terms of the preparation of national cadres and follow-up and development of

their performance. Health services have witnessed a remarkable development in this

profession during the last decade of the reign of the Sultanate so keep up with modern

developments in the country and meeting the needs of the health system of qualified nursing

staff.

The beginnings were humble in the fifties, where it was relying on the preparation of nurses

through training on the job and on the help of some foreign organizations which had been

present at that time in the Sultanate. The situation continues as it is until the dawn of the

Renaissance when the first School of Nursing was opened at Al-Rahma Hospital in 1970

where a limited number of nurses and nurses aides graduated. Then the nursing program

moved to the Institute of Health Sciences in 1982 and continued until the opening of the

Muscat Nursing Institute in 1993.

In order to speed up development processes, the Ministry has expanded in the establishment

of colleges of nursing in the various governorates and regions to a total of (12) Nursing

Institutes that graduate (7703) nurses up to the year 2010. Thus, the ratio of Omanization

cadres had reached 66% in 2010, but exceeded 95% in some areas. For the sake of the

ministry to continue to develop its human resources, it provides internal or external

scholarships to some of the nursing staff to get diplomas specialist or bachelor's degree or master's in order to achieve the vision of the ministry and the needs of the required qualified

staff.

Ministry of Health believe in providing better nursing services to those in need regardless

of where they are, consequently it has adopted a home-based care project "palliative" for

patients with cancer and the elderlies with chronic diseases and this program is currently

applied in the governorate of Muscat and some states in other regions. The Ministry has also

adopted the infection control program for the year 2009 with the capacity of accommodating

(25) nurses per academic year.

Moreover, the Ministry has established the Oman Nursing and Midwifery Council under

the Ministerial Decree 67/2001, to perform the functions of regulating the profession of

nursing and midwifery. The Council proceeded to develop a plan of being able to perform all

activities effectively and efficiently.

52

OBJECTIVES:

1. To enhance quality performance of nursing and midwifery services.

2. To develop nursing and midwifery services in primary health care and community

health.

3. To develop systems of nursing and midwifery practice so as to protect the recipient

from irresponsible nursing practices.

4. To develop human resources in the field of nursing and midwifery through focusing

on nursing leadership, continuous education and providing safe and effective working

environment.


Indicators Past situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To enhance quality performance of nursing and midwifery

services.

1.

Availability of new guidelines

for nursing & midwifery

practices.

Available but not

updated

Available but

not updated

Available &

Updated

2.

Availability of indicators for

measuring performance of

nursing practices. NA

Started

developing

indicators with

e-reports

Available &

effective

3.

Availability of safety

guidelines for patients and

staff.

Available but not

updated

Available but

not updated

Available &

Updated

4. Number of clinical studies &

researches. NA

3 (at central

level)

5 (at central

level)

5.

Availability of continues

audits on nursing and

midwifery practices.

Continuous Continuous

All tools updated

and distributed

to all regions

6.

Number of new programs in

nursing extended role in

critical specialties. 6 specialized

programs and 4 on-

job training

programs

Infection control

program, New

on-job training

programs have

been started in

medical-surgical

nursing.

Start new

programs on

advance nursing

practice and

decentralize

current on-job

programs to

regional

53


2005

Current

situation

2010

Targeted

situation

2015

New programs

in mental health,

primary health

care, school

health, and BSN

in primary health

care will start in

September 2011.

autonomous

institutions.

Second Objective’s Indicators: To develop nursing and midwifery services in primary health

care and community health.

1.

Number of regions applying

home visits to follow up cases

referred by secondary and

tertiary health institutions.

3 3 11

2.

Number of specialized BSN

nurses in primary health care/

community health.

None None 100 specialized

BSN graduates

3.

Availability of guidelines for

nursing services in primary

health care and community

health.

Available but not

updated

Available but

not updated Available &

Updated

4.

Availability of a new

program in advanced nursing

practitioners in:

- Primary Health Care.

-Advanced Midwifery

Practice.

- None

- Available

- Program

Developme

nt in

progress.

- Available

-Available

- Available

5.

Number of on-job training

graduates in community

health. 28 graduate form on

job training

- 28 graduate

from on job

training

- None graduates

from specialized

diploma

program.

100 graduates

from BSN

program.

6.

The number of graduates in a

specialized program in

community health. None None

100 post basic

diploma

graduates will be

available

Third Objective’s Indicators: To develop systems of nursing and midwifery practice so as to

protect the recipient from irresponsible nursing practices.

1.

Availability of an updated

system for practicing nursing

and midwifery

Available but not

updated

Available but

not updated

Available &

Updated

54


2005

Current

situation

2010

Targeted

situation

2015

2.

The proportion of Nurses and

Midwives who obtained a

license from the nursing and

Midwifery Council to practice

the profession.

100% 100% 100%

Fourth Objective’s Indicators: To Develop Human Resources in the Field of Nursing and

Midwifery through Focusing on Nursing Leaderships and Continuous Education and Providing

Safe and Effective Working Environment.

1.

Number of Nurses (in the

Ministry of Health) per 10000

of population.

30.9 30.7 31.5

2.

Number of

Omani directors of nursing

and midwifery and heads of

nursing holding masters

degrees in nursing.

Administration

2 8 26

3.


developing nursing leadership

according to career structure

in MOH

Available but not

updated

Available but

not updated

Available &

Updated

4.

Number of hours approved

by the Omani Medical

Specialty Board for Nursing

and Midwifery.

None None

At least 30 hours

for each

specialty.

5.

Availability of criterion

applied for development and

career progression

Available but not

updated

Available but

not updated

Available &

Updated

6.

Availability of an up-to-date

job descriptions for all nursing

categories

Available but not

updated

Available but

not updated

Available &

Updated

7. Availability of a law for

nursing staff safety in practice None None

Available and

effective

8.

Availability of a tool for

calculating human resources

needs

None

A committee has

been formed in

the ministry

level in Jan 2011

and will be

finishing its

tasks in Oct 2011

Available and

effective

9.

Availability of a strategy for

motivating and retaining

nursing and midwifery

workforce

None None Available

55


2005

Current

situation

2010

Targeted

situation

2015

10.

Availability of a study

revealing impact of irregular

leaves on nursing

performance

None

Considering a

field study

covering all

health

institutions

4

11.

Number of Omani nurses

qualified with:

Masters

Bachelor

Post basic specialty Diploma

5

10

850

22

145

1700

56

252

2500

STRATEGIES:

Strategies to Achieve 1st Objective: To enhance quality performance of nursing and midwifery

services.

1.1 Determining indicators of effectiveness of nursing and midwifery performance

through:

Listing all the indicators associated with the nursing and midwifery practices.

Developing a system to collect data related to indicators.

Conduct studies to determine the level of efficiency in nursing performance.

Raise awareness among all categories of nursing and midwifery of the importance

of monitoring the indicators of the efficiency of services.

Expected Results:

Existence of Indicators used to assess the efficiency of nursing and midwifery services.

Existence of a system for collecting data related to indicators.

1.2 Promoting awareness among nursing staff on the importance of quality performance

through:

Promoting a culture of quality performance through lectures and workshops.

Involving all nursing and midwifery categories in promoting quality performance.

Expected Results:

Increase awareness among nursing staff on the importance of quality performance.

56

1.3 Promoting awareness on the importance of researches and its impact on clinical

practices through:

The existence of a working group to identify research priorities for clinical nursing

and midwifery and coordination with the concerned authorities.

Encouraging nursing and midwifery employees to conduct and publish researches.

Preparing nursing and midwifery staff and equipping them to conduct researches

through workshops.

Developing a system for archiving and publishing researches.

Expected Results:

Increase in the number of staff able to conduct researches.

Existence of a system for archiving and publishing researches.

1.4 Strengthening nursing fundamentals in daily practice through:

Promoting awareness among recipients about their rights.

Giving lectures for nursing staff about nursing fundamentals.

Make the subject of a priority in the nursing action plan.

Expected Results:

Improved nursing performance and patient care.

Strategies to Achieve 2nd Objective: To develop nursing and midwifery services in primary

health care and community health.

2.1 Strengthening nursing services in the area of primary health care and community

health through:

Setting up training programs to promote the performance level of nurses working

in primary health care.

Applying bachelor program in Community Health.

Expected Results:

Increasing efficiency of nurses working in primary health care and community health.

2.2 Promoting awareness on the importance of the role of nursing and primary health care

in the community through:

Establish awareness programs aimed at raising the importance of the role of nursing

and primary health care among members of the community.

Expected Results:

Promoting awareness in the community on the importance of the role of nursing and primary

health care.

The existence of community-based awareness initiatives in partnership between service

providers and recipients.

57

2.3 Introducing a Specialized Advanced Nursing Program and creating a suitable

mechanism to apply the program in primary health care.

Expected Results:

Existence of Advanced Nursing Practice Program.

Strategies to Achieve 3rd Objective: To Develop Systems for Nursing and Midwifery Practice

so as to Protect the Recipient from Nursing Malpractices.

3.1 Promoting awareness on the importance of Oman Nursing and Midwifery Council in

regulating the practice through:

Activating the role of the Council in coordination with the concerned authorities.

Developing systems to regulate the practice of the profession of nursing and

midwifery.

Expected Results:

Promoting awareness among nursing staff of the Council‟s role.

3.2 Activating the practicing license for nursing and midwifery profession through:

Developing a mechanism to issue and renew licenses to practice the profession of

nursing and midwifery.

Establishing a mechanism to deal with expired licenses.

Expected Results:

All staff in the field of nursing and midwifery encompasses their own licenses from

Oman Nursing and Midwifery Council. 3.3 Having information exchanged among the Gulf states about the validity of the licenses

granted to nursing staff through:

Establishing a mechanism to exchange information among the Gulf States on

expired licenses.

Expected Results:

Benefiting from the exchanged information.

Avoiding contracting with those who committed professional misconduct.

Strategies to Achieve 4th Objective: To Develop Human Resources in the Field of Nursing and

Midwifery through Focusing on Nursing Leadership and Continuous Education and Providing

Safe and Effective Working Environment

4.1 Enhancing the efficiency and capability of Omani nursing leaders through:

Equipping leaders with various scientific and suitable degrees

Enhancing communication between nursing leaders in all regions to exchange

experiences

58

Activating the criterion for selecting leaders in various nursing positions.

Involving leaders in international nursing organizations.

Expected Results:

Omani nursing leaders scientifically qualified with sufficient expertise.

Having a system for exchange information among nursing leaders in Oman and universally.

4.2 Upgrading the knowledge and skills of nursing and midwifery workforce through:

Following up the implementation of the on-the-job training and specialized

programs and setting up new programs based on actual needs.

Increasing the number of programs approved by the Oman Medical Specialties

Board and based on the actual needs of services.

Expected Results:

Nursing staff appropriately qualified, as needed.

All the implemented programs are based on actual needs.

4.3 Developing Plans on scientific bases to identify the needs of nursing departments

through:

Finding a tool to determine the numbers of nurses needed for the health

institutions.

Finding a mechanism to determine the required diversity (Skill Mix) in each

section of the hospitals and health centers to ensure patient’s safety.

Expected results:

Availability of a tool to determine the number of nurses required.

Existence of a mechanism to determine the required diversity in each section of the hospitals

and health centers.

4.4 Developing strategies to assess the unplanned leaves (sick, emergency, maternity)

through:

Availability of a mechanism to assess the magnitude of the impact of unplanned

leaves on nursing performance and workflow.

Expected Results:

Availability of a mechanism to deal with sick leave and its impact on workflow.

4.5 Promoting the efficiency of newly appointed nursing staff by:

Giving a sufficient period of time to allow the new graduates to acquire the skill and

experience necessary to enable them to perform their jobs appropriately Working on

improving the mechanism of replacement so as to give the trainee enough time to gain

sufficient experience.

Expected Results:

Availability of an effective mechanism to provide new graduates with the necessary

expertise.

59


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Availability of indicators used for assessing

efficiency of nursing and midwifery services. Annually None

Available

and activated

1.1b Availability of a system to collect data related

to indicators.

End of the

current

plan

Being

prepared

Available

and

Activated

1.2a

The number of courses held in nursing

quality of performance.

Annually None

Available

and

periodical for

all regions in

a national

level.

1.3a

Existence of a national committee on the

development of strategies and their

application in the field of research.

End of

2012 None Available

1.3b

Number of qualified nursing staff in

conducting researches.

Annually 26 200

1.3c Availability of a system for research archiving

and publishing.

End of

2012 None

Available

and activated


2.1a

The percentage of nurses trained in PHC.

Annually 20%

50% +

availability of

OJT Program

2.2a The number of governorates that give lectures

to community about importance of PHC. Annually

none All region

2.3a Availability of an Advanced Nursing Practice

Program. Annually Being

prepared Available


3.1a

Number of governorates that are deliver lectures

to introduce the importance of the role of the

Oman Nursing and Midwifery Council in the

organization of practicing the profession.

Annually

Lectures are

been

conducted at

many

Governorates

Available

and carried

out on

annual basis

at

governorate

and at

national

level.

60

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

3.2a

The percentage of nursing and midwifery staff

working in the Ministry of Health and obtained

licenses from the Oman Nursing and Midwifery

Council.

Annually 100% 100%

3.3a

Availability of information exchanged between

the Gulf states about the validity of the licenses

granted to nursing staff.

Annually Available Available


4.1a Percentage of nursing leaders with masters‟

degree. Annually

23 56

4.2a Number of continue education programs

accredited by Oman Medical Specialty Board. Annually

100 1000

4.3a

Availability of a mechanism for identifying

number of needed nursing staff.

End of

2012

A committee

has been

formed in the

ministry level

in Jan 2011

and will be

finished in Oct

2011

Available

and effective

4.3b

Availability of a mechanism for identifying

the diversity wanted in each department in all

hospitals and health centers.

Annually

A committee

has been

formed in the

ministry level

in Jan 2011

and will be

finished in Oct

2011

Available

and effective

4.4a

Availability of a mechanism for managing

sick leave and addressing their impact on

workflow. Annually

A

comprehensive

survey is

being

conducted in

all health

institutions

Available

4.5a Availability of a mechanism for equipping

graduates with sufficient experience. Annually

Available Available

61

Domain Five

Laboratories

62



Domain: Laboratories

INTRODUCTION:

Before 1974, the numbers of laboratories was small, with limited facilities and

capabilities and were mainly confined to the hospitals. Later on, a Central Public Health

Laboratory was established in Muscat with microbiological and chemical analysis

facilities, followed by the establishment of laboratories in Samail, Nizwa, Salalah, Saham

and Sur polyclinics. In the late 1980s, Regional Public Health Laboratories and Central

Laboratory for Drug Analysis were established. Realizing the importance of the

laboratories, the MoH went further and established high quality laboratories in the

primary, secondary and tertiary health care levels.

In 1994, the Department of Laboratories was restructured to include Microbiology,

Virology, Parasitology, chemical analysis and diagnostic sections. In 2000, QAP section

was established as a part of re-structuring of the department.

In addition to the above, laboratories play a major role in helping to design health care

policies through the provision of vital data in terms of statistics, results and reports.

It is therefore very important that laboratories are supported with highly qualified and

trained human resources (both technical and administrative), as well as equipped with

advanced instruments of good quality and performance, necessary reagents and purpose

built laboratory buildings.

OBJECTIVES: 1. To support and develop laboratories in all health institutions.

2. To reinforce Laboratory Bio-safety and Bio-security measures.

3. To insure and improve laboratory quality controls.

63


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To support and develop laboratories in all health institutions

1.

Number of Laboratories in the ministry

of Health Institutes. 169 206

Laboratories

available in

all Health

facilities

2. Availability of a Central Active Body

within MOH to control laboratories. NA NA Available

3. Presence of a specialized committee for the

selection of laboratory equipment. NA NA Available

4. Number of Lab tests added to CPHL. 10 0 15

5. Percentage of Labs with network

systems on the central level. None None 60%

6. Percentage of Labs using the National

SOP Manuals.

No National

SOP 0% 100%

Second Objective’s Indicators: To reinforce Laboratory Bio-safety and biosecurity measures

1. Percentage of Lab. technician vaccinated

against Hep. B. 90% 100% 100%

2. Number of Labs accidents registered

throughout the year. 7 0 0

3. Presence of a central committee to follow up

on bio-safety and bio-security within the laboratory.

NA NA Available

4. Availability of legislations and regulations governing the possession, handling, storage

and transportation of hazardous micro-

organisms and substances in the Sultanate.

NA NA Available

5. Number of biosafety officers in the regional

hospitals. 0 0 11

6. Percentage of Labs. following safety

Manual procedures. 70% 90% 100%

Third Objective’s Indicators: To insure and improve laboratory quality controls.

1. Availability of specialized department to

ensure laboratory quality assurance. NA NA Available

2. Availability of Laboratory Quality

Assurance Manual and SOP. NA NA Available

3. Number of staff trained in laboratory quality

management. 0 0 12

4.

Percentage of errors in the results of

Heamatology according to the quality

assurance program.

N\A 0 0

5. Percentage of errors in the results of

microbiology. 33% 0 0

64

STRATEGIES:

Strategies to Achieve 1st Objective: To support and develop laboratories in all health

institutions

1.1 Establishment of a Centralized Laboratory Authority.

Expected results:

Ease monitoring and evaluating of laboratory services and quality assurance.

1.2 Construction of Central Public Health Laboratory.

Expected results:

Provision of a specialist reference laboratory at the national level.

More accurate and faster results.

To serve as an appropriate environment for training and research for all OMSB doctors and

other Medical assistant specialties.

1.3 Training of laboratory technicians in reference hospitals on cell tissue examinations.

Expected results:

Provision of qualified national manpower for cell tissue examinations.

Reduction of time taken before the release of results.

1.4 Increase the financial incentives for laboratory personnel.

Expected results:

Higher staff satisfaction.

1.5 Enhance Number and Quality of staff in the labs.

Expected results:

Provision of specialties as needed.

Reduce possibilities of technical errors.

1.6 Provision of modern equipment and instruments to perform the required lab. tests.

Expected results:

Quick and accurate results and performance.

Reduced costs over the long term.

Reduced chances of human errors.

Strategies to Achieve 2nd Objective: To reinforce Laboratory Bio-safety and Bio-security

measures

2.1 Prepare Bio-safety programme inside laboratories.

Expected results:

Provision of safety tools and procedures inside the lab (Fire extinguishers, Lab. coats, eye

washer, first-aid kits).

Protection of staff.

Reducing lab. accidents.

Making sure that lab. tests are performed in a safe environment.

65

2.2 To prepare a laboratory waste manual and follow-up implementation.

Expected results:

To increase the quality of services provided.

To increase staff knowledge on how to get rid of lab. waste products.

2.3 Training laboratory personnel on safety procedures and waste disposal.

Expected results:

Increase the efficiency of workers.

Strategies to Achieve 3rd Objective: To insure and improve laboratory quality controls.

3.1 To prepare a National Manual for laboratory quality assurance and management.

Expected results:

To increase the quality of services provided.

3.2 Conduct training courses in laboratory quality assurance for lab workers.

Expected results:

Increase the efficiency of workers.

Reduce errors.

3.3 Sending some laboratory workers for scholarships on Laboratory quality management.

Expected results:

Increase the efficiency and capability of workers.

66


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a

Presence of a Central Active Body within

MOH to control laboratories.

End of the

current

plan

NA Available

1.2a Presence of Central Lab. building up to the

standard with all the required specialties. Annually Old building &

inconvenient new complex

1.3a

Number of referral hospitals with at least one

technician performing cell tissue

examination.

Annually 0 All referral

hospitals

1.4a Availability of incentives for lab workers. Annually NA Available

1.5a Number of scholarships for lab technician. Annually 8 12

1.5b

Number of abroad training courses.

- MSc level

- PhD level

Annually

6

0

12

4

1.5c Number of local training courses. Annually 35 50

1.6a Percentage of modern equipment and

instruments in the lab. (Less than 10 years). Annually 50% 90%

1.6b Presence of instruments maintenance

contracts. Annually

For some

instruments

For all

instruments


2.1a Presence of Lab. safety manual in the lab.

Annually Available but

not updated

Available &

updated

2.1b Percentage of Labs that uses the manual. Annually 90% 100%

2.2a Presence of Lab. waste manual. Annually None Available

2.2b Percentage of laboratories disposing and

transporting their waste safely Annually 10% 100%

2.3a Number of training courses on how gets rid

of Lab. waste products. Annually None Twice a Year

67

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


3.1a Presence of National Laboratory Quality

management Manual. Annually None Available

3.1b Number of Laboratories that implement the

national quality manual. Annually None 100%

3.2a Number of training courses on Quality

Assurance, Control and Management. Annually None Twice a Year

3.3a Number of scholarships on quality

Assurance. Annually 0 2

68

Domain Six

Blood Services

69



Domain: Blood Services

INTRODUCTION:

Blood Services in Oman has remained outstanding in provision of safe, efficacious and

high quality blood, blood products and related transfusion services for the benefit of nation

that is sustainable through the generosity of volunteer donors.

The health care services in the Sultanate are ever expanding and to keep the pace with

development there must be proportionate expansion of the blood bank and transfusion

services.

One of the indicators of previous five year health plan that has been achieved successfully

is the increase in the number of blood donors because of the awareness, health education and

initiative from the members of various communities to work for this noble humanitarian

cause.

According to the report of the WHO blood safety there are between 5% - 10% of cases of

HIV infection worldwide that has occurred through the transfusion of contaminated blood

and blood products. In addition, there are many recipients of blood infected with other

viruses such as Hepatitis B and C, and other diseases transmitted through blood transfusion

such as Syphilis and malaria.

Therefore, there is need to activate the policies, programs and plans developed by the

Department of Blood Services to increase the safety of the blood and reduce the probability

of the incidence of these diseases through blood transfusion.

OBJECTIVES:

1. To increase the number of voluntary blood donors.

2. Optimal use of blood and blood products.

3. To improve and develop the quality of blood transfusion services at the national level.

70


Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective’s Indicators: To increase the number of voluntary blood donors

95% (MOH)

78 %

(MOH)

67% (MOH) Percentage of voluntary donors among

the total number of the donors. 1.

50 % 35% 47% Percentage of New donors. 2.

At least one in

each blood

bank

0 1

Number of staff trained to work in

Donor Affairs Section at the Department

of Blood Services and Regional Blood

Banks.

3.

Second Objective’s Indicators: Optimal use of Blood and Blood Products

To be

formulated in

each regional

blood banks

Royal &

Khoula

Hospitals

Royal Hospital

only

Existence of Hospital Blood Utilization

Committees. 1.

Number of

units issued

should be

proportional

to the actual

requirement

for each

hospital

53058 NA

Number of blood units requested by the

regional referral hospitals.

2.

Cross-match

transfusion

ratio must be

proportionate

28922

NA

Number of Blood units gone through

Cross match process. 3.

Number of

units

transfused

must be

proportionate

to the number

of units cross-

matched.

22805 NA

Number of blood units transfused to the

patients.

4.

Third Objective’s Indicators: To improve and develop the Quality of Blood Transfusion

Services at the National Level

100% 20% 40%

Percentage of blood banks that have

implemented quality assurance

programme.

1.

Two in each

blood bank zero 1

Number of staff trained to perform

quality assurance in Department of

Blood Services and Regional blood

banks.

2.

71

Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

4 zero Zero

The number of regional blood banks

with specialized laboratory to perform

Nuclear testing for early detection of

disease.

3.

50% zero 10% Percentage of leucodepleted blood units. 4.

50% zero Zero

Percentage of regional Blood Banks

linked with Central Blood bank through

computer network.

5.

STARATEGIES:

Strategies to Achieve 1st Objective: Increase in number of voluntary blood donors

1.1 Develop a plan with community members on the importance of sustainable blood

donations.

Expected results:

Increase awareness about the importance of safe blood donation.

Increase the number of blood volunteers and new safe blood donors.

1.2 Train and Employ competent Omani staff at Donor Affairs section in the Dept. of Blood

Services and Regional Blood Banks.

Expected results:

The presence of Trained Oman Staff.

Strategies to Achieve 2nd

Objective: Optimal Use of Blood and Blood Products

2.1 Formulation of Hospital Blood Utilization Committee in every regional Blood Bank.

Expected results:

Patients receiving proper treatment through optimal use of blood and blood products.

Rationalization of financial resources.

Strategies to Achieve 3rd Objective: Improve and develop the quality of blood transfusion

services at the national level

3.1 Regional Blood Banks must be separated from the Diagnostic laboratories and should

have separate premises for their function.

Expected results:

Improve the quality of blood transfusion services at the regional level.

3.2 The Administrative offices at the Dept. of Blood Services must be separated from the

Central Blood Bank laboratories.

Expected results:

Increase quality and safety of blood and blood products.

72

3.3 Provision of Nucleic Acid Testing (NAT) on all blood units.

Expected results:

Greater security and safety of blood and its components.

3.4 Provision of blood bags with in-line filters for leucodepletion pre-processing once all the

necessary, required tests has been performed or provision of laboratory leucodepletion

filters to hospital for leucodepletion before the unit issued to the ward.

Expected results:

Reduction in the number of reactions related to White Blood Cells in donated blood.

Reduction in the transmission of viral diseases such as CMV and other viral diseases.

3.5 Coordination with the Directorate General of Information Technology to implement

Blood Bank Information Management System at the central level that to be integrated as a

network with all the regional blood banks.

Expected results:

Access to all activities related to blood banking and transfusion services at national level.

Effective transportation of blood and blood component.


Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators


In all regions In some

regions

Annually

Presence of a Plan with community members

on the importance of sustainable blood

donations.

1.1a

5 2 Annually

Number of health education programs that

have a key role in raising the level of

community knowledge of the importance of

blood donation (at the national level).

1.1b

16 At the

national level

1 Annually

Number of qualified staff for specialized

executive services at Dept. of Blood Services

and the regions. 1.2a


0% NA Annually

Proportion of errors in laboratory blood tests. 2.1a

0% NA Annually The proportion of donors who had reactions

during the donation process. 2.1b

0% NA Annually The proportion of patients who develop

transfusion reactions. 2.1c

All the

hospitals

with blood

banks

4 Hospitals Annually

The number of hospitals that have hospital

blood utilization committee. 2.1d

73

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

100% 20% Annually Percentage of trained competent staff in their

field of work. 2.1e


Objective

50% 9% Annually Percentage of regions having specialized

premises for blood bank services. 3.1a

Available NA

Annually

Administrative offices at the Department of

Blood Services those are separate from the

Central Blood Bank.

3.2a

4 Zero Annually Number of regional blood banks equipped with

Nucleic Acid Testing. 3.3a

80% Zero Annually Percentage of the usage of in-line filters for

pre-storage leucodepletion. 3.4a

100% Zero Annually Percentage of regional blood banks linked to

Central blood bank via network services. 3.5a

74

Domain Seven

Radiology Service

75



Domain: Radiology Service

INTRODUCTION:

During the development of the pillars of the health system for health care, the Ministry

of Health has paid a special attention to five years plans of all the fields of the health care

and radiology is no exception. The field of radiology has participated in the five years

strategy planning for the second time and proven its interest in improving the provided

services in terms of horizontal expansion as well as vertical.

In this arena, the Ministry has paid attention to the Omanization of the human recourse

by locally training the radiographers to a diploma level. For the purpose of improving the

services, the Ministry of Health also initiated a post graduate scheme to upgrade those

diploma holders to BSc. and Msc.

According to statistics the omanization in the radiology departments in Ministry of

Health institutions has reaches to 63%. In addition, a great number of candidates has been

specialized on MRI, CT scan and other specialized modalities.

In terms of the expansion of radiology services, the number of institutions that provide

services for radiology and\or radiography is reaches to 121 divide among tertiary are five,

secondary seven and the balance is primary health service. The offered services by these

institutions are ranged between normal imaging to advanced imaging such as CT, MRI,

etc.

The ministry has paid a special attention to upgrade the old x-ray equipment which

constitutes a significant economic burden on the budget as the life-span of radiology

equipment by default is seven to ten years. Thus continuing to use old equipment requires

intensive service to avoid frequent breakdowns that occur as a result of heavy use and

sometimes needs spear parts that are no longer available. Thus increase the value of the

actual cost of the equipment.

OBJECTIVES:

1. To enhance the radiology services in the health institutions and improve its quality

assurance.

2. To improve the performance of workers in the field of radiology.

76


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To enhance the radiology services in the health institutions and

improve its quality assurance

1. The proportion of recipients‟

satisfaction from x rays services. NA NA 90%

2. The number of x-rays done per

radiographer (in primary health care

institutions) per day.

NA 9.2 12

3. The number of x-rays done per

radiographer (in secondary and wilayat

hospitals) per day.

8.4 9.8 12

4.

Average number of waiting days for specialized radiological examinations:

CT scan NA 75 11

MRI scan NA 235 23

Ultrasound NA 75 11

Mammography NA 75 11

Radionuclide Imaging NA NA 23

5. Percentage of repeated x-rays. 12% 12% 5%

6.

Number of secondary and tertiary

hospitals with digital radiology

departments.

3 3 12

7. Number of departments with safety

guide booklet.

0 0 All health

institutions

8. Number of departments with operation

protocol.

0 0 All health

institutions

Second Objective’s Indicators: To improves the performance of workers in the radiology

services.

1. Number of radiologists with

qualifications or training in specialize

imaging.

6 7 24

2.

Number of radiographers with higher qualifications or training in specialize imaging:

CT scan 1 1 12

MRI scan 2 2 6

Mammography) 3 3 23

77

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

3.

Number of patients per radiographer per day:

primary health care institutions NA NA 12

Secondary and tertiary hospitals NA NA 16

4. Number of local training courses per

year. 2 2 5

5.

Number of trainees in specialized radiography in local courses:

Ultrasound 20 20 50

Mammography 2 3 20

CT scan 9 12 36

MRI scan 2 2 8

STRATEGIES:

Strategies to Achieve 1st Objective: To enhance the radiology services in the health institutions

and improve its quality assurance.

1.1 Upgrade the radiology departments in line with the volume of services provided through it.

Expected results:

Faster completion of tests.

Reduced waiting time for auditors in the Department of Radiology.

Accurate results and better diagnosis.

1.2 The provision of MRI services in regional hospital.

Expected results:

Reduced pressure on existing centres (Royal & Khaulah Hospitals).

Reduced waiting days and therefore faster diagnosis and better service.

1.3 Establish training programs in CT scan and Sonography.

Expected results:

Low proportion of cases transferred to Muscat CT scan centres.

Better utilization of the radiographers in the primary health centres by training them on

obstetric sonography and reduces the patients waiting time.

High levels of occupational safety.

1.4 Train radiographers in the regional hospital on mammography.

Expected results:

Reduced the number of human errors for mammography and the risk.

78

1.5 Implements quality programs in all radiology departments.

Expected results:

Low rate of repeated radiograph thus lower radiation dose to patients, staff.

Reduced running costs of radiology department.

1.6 Replace conventional radiography with digital radiography and PACS in proportion to

the volume of provided services.

Expected results:

High performance and faster transmission of images.

Longer storage periods at low cost while maintaining image quality.

More accurate results with low dose to the patient.

1.7 Standardize the radiology procedures in all departments by establishing (1) standard

protocol for imaging procedures (2) occupational safety.

Expected results:

Enhance safety measures for the risks of radiation and chemicals.

Provide adequate protection for patients and society from the hazards of radiation.


Objective: To improve the performance of workers in the field of

radiology

2.1 Provides sufficient numbers of radiologists and radiographers who are well qualified in

radiology imaging in the regional hospitals.

Expected results:

Reduced the number of patients waiting days for advanced radiology tests such as CT and

ultrasound.

High quality of service provided.

2.2 Conduct analytical studies to determine the amount of work for radiographer at

different levels of health care.

Expected results:

Identify the volume of work to setup a mechanism for the distribution of radiographers based

on workload.

2.3 Conduct training programmes (CPD) to Enhance the local radiographers\radiologists.

Expected results:

Reduced the number of overseas scholarships.

Enhanced the quality of work.

79


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Number of primary health institutions with

digital radiology departments. Annually NA

60% of all

hospitals

1.1b Number of secondary and tertiary hospitals

with digital radiology departments. Annually 4 All hospitals

1.2a Number of MRI units in the Secondary and

tertiary hospitals Annually 2 6

1.3a Percentage of radiographers with higher

qualifications or training in specialize imaging. Annually 14% 90%

1.4a Number of mammographer in the regional

hospitals. Annually 2 20

1.5a Availability of QA programmes in all

radiology departments. Annually

No standard

Protocol

standard

Protocol

1.6a Number of departments which have digital

radiographer systems instead of analogue. Annually NA

All health

institutions

1.7a Availability of occupational safety guideline.

Annually NA Provision of

guideline

1.8a Availability of standard operational protocol.

Annually NA Provision of

protocol


2.1a Number of radiologists in the radiology

services in regional hospitals. Annually 55 80

2.1b Number of radiographers in the radiology

services. Annually 0 114

2.2a Analytical studies to determine the amount of

work for radiographer at primary health care. Annually NA

availability of

the study

2.2b

Analytical studies to determine the workload

per radiographer at secondary and tertiary

health care.

Annually NA availability of

the study

2.3a Number of local training programmes to

upgrade\update the radiographers. Annually 0 4

80

Domain Eight

Rehabilitation Services

81



Domain: Rehabilitation Services

INTRODUCTION:

Health care as a civil service cannot be considered as a complete entity without including

rehabilitation services with all its branches as an important keystone element.

Rehabilitation considered as a young domain here is Oman which has been introduced

recently in our healthcare system providing facilities to secondary and tertiary patient care,

and since rehabilitation effect the patient life style directly to physically, functionally,

socially and mentally, we can sense the need of this service.

Rehabilitation is one of supporting specialty in the medical field which includes a number

of subspecialties which aims toward prevention and compensation of functional lost of a

body part or general health improvement and social integration for the patients in the shortest

possible periods with maximum independence.

Different rehabilitation treatments are used for the aim of providing a high standard of

specialised services including physiotherapy, occupational therapy, language and speech

therapy, orthotics and prosthetics, podiatry, medical social work, rehabilitation nursing as

well as psychotherapy.

Rehabilitation service is considered to be a forefront in prevention, improve patient life

style and functional abilities. There is strong clear evidence for growing demand of

rehabilitation services in the Sultanate of Oman to due improved primary and secondary

health care and surgical techniques that results in improve and prolong average life

expectancy of patients. This is in addition of growing the number of patients who live with

unhealthy lifestyle that can lead to medical conditions such as obesity, ischemic heart disease

or diabetes. Further, it is obvious increased number of road traffic accidents that lead in

serious disabling chronic conditions that sometimes are lives threatening.

In addition of the above, rehabilitation service can not be overlooked and if it is not

adequately provided it will have negative impact on patient physically, psychologically,

functionally and economically and in many situations it increases the burden on government

expenditures as it raises the budget in which the Ministry of Health reflected in increased bed

occupancy with prolonged admissions and complication related to inadequate rehabilitation

services. This includes in increased social security expenditures for depended family

members.

Currently, the Ministry of Health provides acute short term rehabilitation services in some

major tertiary hospitals whereas long term comprehensive rehabilitation services particularly

for chronic disabled patient do almost not exist. Community Based Rehabilitation services is

at large NA in the majority of regions.

Moreover, there is an evident of shortage of human resources within the field of the

rehabilitation services physiotherapy speciality to cover the entire MOH organization, while

specialities such as occupational therapy, speech and language therapy, orthotics and

prosthetics, medical social workers and others are extremely limited in numbers.

82

Regardless of the above mentioned facts, following strategic plans and expert

recommendations from central and the peripheral representative members of different fields

of rehabilitation services should open the door for discussions and exchange of new ideas and

support strategies which will help and succeed the upcoming the ministry's 8th five year plan.

This will be a continuation of what has been achieved during the previous 7th five year

Rehabilitation Service plan.

OBJECTIVES:

1. Development of rehabilitation services in all Ministry of Health institutions.


Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective’s Indicators: Development of rehabilitation services in all MoH institutions

250 174 122 Numbers of Physiotherapists. 1.

40 8 2 Numbers of Occupational therapist. 2.

10 3 2 Numbers of Orthotic & Prosthetic

specialists. 3.

35 14 10 Numbers of Orthotic & Prosthetic

technicians. 4.

30 7 5 Number of Speech therapists. 5.

10 5 0 Number of social workers. 6.

5 days Data NA Data NA

Average number of days waiting for the

first appointment in Rehabilitation clinics

(Physiotherapy).

7.




(Occupational therapy).

8.

30 days 9 months Data NA



(Prosthetics & Orthotics) Artificial lower

limb.

9.

1 day Data NA Data NA



(Speech & Language therapy).

10.



follow up appointment in Rehabilitation

clinics (Physiotherapy).

11.

1 day Data NA Data NA



clinics (Occupational Therapy).

12.

30 days 12 months Data NA



clinics (Prosthetics & Orthotics) Artificial

lower limb.

13.

83

Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

5days Data NA Data NA



clinics (Speech & Language therapy) .

14.

70% Data NA Data NA Patient satisfaction in Rehabilitation

Services (Physiotherapy). 15.


Services (Occupational Therapy). 16.


Services (Prosthetics & Orthotics). 17.


Services (Speech and Language Therapy). 18.

STRATEGIES:

Strategies to Achieve 1st Objective: Development of rehabilitation services in all MoH

institutions.

1.1 Create an integrated structure for career development of rehabilitation Staff.

Expected results:

Staff job satisfaction level elevated.

High level of efficiency and performance in the Rehabilitation services.

1.2 Expansion of the rehabilitation services to include referral hospitals.

Expected results:

Adequate coverage within the Ministry of Health for Rehabilitation Services.

Delivering high quality of Rehabilitation Services to all patients.

Elevated patient‟s satisfaction level in rehabilitation services.

1.3 Continuation of Rehabilitation training programmes nationally and internationally to

optimize national staff coverage in Ministry of Health institutions.

Expected results:

Increase number of Omani trainees and scholarships for all rehabilitation staff.

Raising the level of competence of professionals in the field of rehabilitation.

1.4 Establishment of free standing Rehabilitation Services for long term patients who

require treatment.

Expected results:

Provision of long term care and treatment for patients with special needs.

Minimizing hospital bed occupancy for long term patients.

1.5 Establishment of community-based rehabilitation services to long term patients after

hospital discharge.

Expected results:

Involvement of the community in the rehabilitation services.

84

Increase of independency of individuals.

Easing the burden of hospitalization and long term stay for Ministry of Health.

1.6 Establishment of National Rehabilitation Centre for patients who require long term

Rehabilitation Centre in Muscat Region.

Expected results:

Increased of standard and high quality of Rehabilitation Services for chronic patients.

Reduce number of patients travelling abroad for Rehabilitation Services.


Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators


existing of

career

structure

Not existing By the end

of 2012

Implementation of career structure for all

rehabilitation professionals. 1.1a

80% 15% Annually

Percentage of secondary and tertiary health

care institutions providing rehabilitation

services.

1.2a

15

specialized

cadres

9 Annually

Number of specialized Omani rehabilitation

professionals graduates with Bachelors Degree. 1.3a

15 8 Annually Number of specialized Omani rehabilitation

professionals graduates with Master Degree. 1.3b

2

Within the

Plan

0 Annually

Number of specialized Omani rehabilitation

professionals graduates with Doctorate Degree. 1.3c

Existing of

C.B.R team Not existing

By the end

of the plan

Existing comprehensive Community Based

Rehabilitation (CBR) team. 1.4a

Existing of

C.B.R

programme

Not existing By the end

of the plan

Existing Community Based Rehabilitation

(CBR) programme.

1.5a

85

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

1 training

programs

annually for

each hospital

Not existing Annually

Number of training programs for long term

patients with chronic disability after hospital

discharge. 1.5b

Existing of

Rehab.

Centre

Not existing Annually

Presence of Rehabilitation Centre in Muscat.

1.6a

86

Quality Assurance of Health Services

and Patient Safety

Vision Two

87

Domain Nine

Quality Assurance & Improvement

and Patient Safety

88

Vision: Quality Assurance of Health Services and Patient Safety

Goal: Provision of High Quality Health Services

Domain: Quality Assurance / Improvement and Patient Safety

INTRODUCTION:

The success of the strategy of implementing quality and accreditation systems at health care

institutions requires a clear vision and integrated strategy; ongoing top leadership support for

the strategy to overcome the difficulties facing implementation; developing and carrying out

comprehensive training plans; continued technical support in all phases of implementation;

building and investing in national capacity to ensure continuity and quick execution;

commitment of all employees at all levels to cooperate and actively participate in all activities

and events, in addition to a system of continuous assessment of the strategy to ensure

effectiveness and efficiency of implementation.

The health care delivery system in the Sultanate of Oman has the advantage of solid

infrastructure, well established standards; policies and plans, effective community

participation, availability of sound information network as well as highly committed and

supportive organizational structures and leaderships. All these potentials are considered the

main successful factors for establishing and developing quality and accreditation systems in

health services in the Sultanate.

Safety is one of the fundamental healthcare principles and a vital component of quality

management. Maintaining the citizens` safety and wellness is the main objective of

healthcare. However, medical interventions, combining the technical operations, the use of

complex medical technology and human interactions that shape the delivery of healthcare

system, could inevitably lead to potential medical risks that might do harm to patients and

health care workers.

Patient safety principle draws the full attention of the Ministry of Health. Therefore,

"patient safety" comes on the top priorities of the Ministry agenda. Patient and staff safety

system has been integrated as an essential component within the scope and domains of the

8th strategic plan for Health Development (2011-2015).

The Ministry`s strategic plan includes many activities and operational procedures, that aim

to improve the quality of performance, and to dedicate and apply concepts of patient safety

accredited by the World Health Organization and the World Alliance for Patient Safety in all

health care facilities of the Ministry.

OBJECTIVES:

1. To establish and develop quality management and accreditation systems in health care

facilities.

2. To establish patient safety system in health care facilities.

3. To build the qualified national capacity in quality assurance / improvement and patient

safety systems.

89


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective Indicators: To establish and develop quality management and accreditation

systems in health care facilities

(Calculated separately for primary/secondary/and tertiary care levels)

1.

Number of health care facilities

implementing quality assurance /

improvement system.

64 (PHC) , 5

regional

hospitals

118 (PHC) ,

10 regional

hospitals

More than 90%

(PHC) , 12

regional

hospital

2.

Number of trained health care workers on

basics, concepts and applications of

quality assurance and improvement

programme.

2200 (PHC) ,

400 regional

hospitals

7574 (PHC) ,

4159 regional

hospitals

More than 80%

of total health

care workers

3. Number of trained health care workers on

communication skills and teamwork. 300 5733

More than 60%

of total health

care workers

4.

Number of qualified auditors to conduct

audit activities on quality systems and

programmes in health care facilities.

240 655 1100

5. Number of quality improvement projects. None 22 65

6. Number of written user complaints (and

their relatives) NA

309 (PHC) ,

182 (statistics

of 7 regional

hospitals)

Decrease by

25% (total) at

end of 2015

7. Percentage of patients‟ complaints that

have been resolved. NA 73% More than 90%

8. User satisfaction rate.

75% (PHC,

average of

statistics of 4

regions) ,

79% (PHC) ,

61.5%

(average

statistics of 2

regional

hospitals)

More than 75%

(PHC) , more

than 65%

(regional

hospitals)

9. Staff satisfaction rate None

56.5%

(average

statistics of one

region and one

regional

hospital)

More than 75%

90

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

10. Existence of approved, documented

motivation system to health care staff. None

4 regions,

4 regional

hospitals

Approval and

implementation

of the system

11.

Number of health care facilities that are

preparing for accreditation according to

the National Accreditation System.

None None

5 regional

hospitals (at

least)

Second Objective Indicators: To establish patient safety system in health care facilities.

(Calculated separately for primary/secondary/and tertiary care levels)

1. Number of health care workers trained on

basics and concepts of patient safety. None 1600

More than 50%

of total health

care workers

2. Number of adverse events reports in

health care facilities. NA NA

Decrease by

25% (total) at

end of 2015

3.

Number of written user (and their

relatives) complaints related to patient

safety.

NA NA

Decrease by

25% (total) at

end of 2015

4.

Percentage of patients complaints related

to patient safety that have been resolved

according to approved protocols.

NA NA More than 90%

Third Objective Indicators: To build the qualified national capacity in quality assurance /

improvement and patient safety systems.

1.

Number of Omani heath care providers

participated in national training

Programme or Specialized Diploma

degree in quality assurance /

improvement and patient safety in health

care.

None 21 100

2.

Number of national cadres has higher

degree in quality assurance /

improvement in health care. (Local or

international).

6 15 25

91

STRATEGIES:

Strategies to Achieve 1st Objective: To establish and develop quality management and

accreditation systems in health care facilities

1.1 Formulation of the organizational structure for the quality system on the central and

regional levels as well as health care facilities.

Expected results:

Facilitating of implementation of the quality assurance / improvement and patient safety systems

in health care facilities.

1.2 Accomplishing quality management systems in all health care facilities through:

Developing annual quality improvement objectives in health care facilities.

Setting standards and indicators to measure performance in health care facilities.

Implementing quality control/monitoring system.

Implementing quality improvement projects.

Expected results:

Establishing an effective quality control/monitoring system.

Establishing effective approaches to perform follow up and reform the quality system at all

levels.

1.3 Developing skills of health care workers in quality assurance / improvement programme

through:

Executing training programmes for health care workers to build quality culture in

health care facilities.

Executing training programmes for health care workers to develop their

communication skills.

Preparing and training audit teams.

Executing training programmes for health care workers to develop quality

improvement projects.

Expected results:

Raising awareness of health care workers about basics, principles and applications of quality in

health care.

Health care workers shall acquire knowledge and skills that are necessary to improve their

performance.

Qualified and well trained audit teams.

Qualified and well trained teams on quality improvement projects.

1.4 Conducting periodical surveys to assess user's satisfaction.

Expected results:

Provision of the necessary data about user's satisfaction of health care services.

Identifying the weaknesses and strengths and implementing the necessary interventions.

92

Strategies to Achieve 2nd Objective: To establish patient safety system in health care facilities.

2.1 Executing training programmes in patient safety for health care workers.

Expected results:

Raising awareness of health care workers regarding patient safety concepts and principles.

2.2 Executing training programs on root cause analysis for health care workers.

Expected results:

Staff skilled on conducting root causes analysis for sentinel events.

2.3 Establishing a system that ensures patients’ safety of and through:

Setting operational manual of patient safety standards.

Setting standards of patient's rights that take into account the social, ethical and

professional aspects.

1.5 Conducting periodical surveys to evaluate the level of staff satisfaction in health care

facilities.

Expected results:

Provision of the necessary data about the level of staff satisfaction.

Identifying the weaknesses and strengths and implementing the necessary interventions.

1.6 Setting and implementing mechanisms to enforce community participation in quality

improvement activities and projects.

Expected results:

Disseminating quality culture in the community.

Creating effective community participation that supports the quality system.

1.7 Establishing staff motivation system.

Expected results:

Improving staff performance.

Achieving job stability.

1.8 Establishing a National Accreditation System for health care facilities through:

Preparing the manual of national accreditation standard.

Conducting training courses to certify national surveyors for the accreditation system.

Setting and implementing systematic plans to prepare health care facilities to comply

with accreditation standards.

Initiating the formulation of the National Accreditation Council (independent body).

Expected results:

Health care facilities are preparing for accreditation according to the National Accreditation

System.

93

Establishing a system for patient complaints (and their relatives).

Expected results:

Approval and implementing the operational manual of patient safety policies and procedures in

health care facilities.

Issuing the document of patients' rights.

A reduction in the number of written complaints from patients and their relatives.

2.4 Establishing a standardized system for reporting adverse events.

Expected results:

Increased rates of reported adverse events.

2.5 Implementing patient safety goals/solutions in health care facilities.

Expected results:

Reduced rates of medical errors in health care facilities.

Strategies to Achieve 3rd Objective: To build the qualified national capacity in quality assurance

/ improvement and patient safety systems.

3.1 Developing skills of national cadres in the field of quality and patient safety through:

Conducting central training programmes/ Specialized Diploma to qualify Omani

cadres on quality and patient safety in health care.

Integrating quality and patient safety in the training curricula of health institutions

(belonging to Ministry of Health).

Sending abroad a number of properly selected and distinguished health care workers

to get a higher degree in the field of quality and patient safety.

Expected results:

Qualified and specialized national professionals in total quality management systems to lead

quality assurance/improvement and patient safety systems in their regions.

94


Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators


Documented

organizational

structure

Available

but not

documented

Annually Presence of documented organizational structure

for quality system at central level. 1.1.a

11 regions / all

hospitals

9 regions /

12 regional

hospital

Annually Number of regions/hospitals with documented

organizational structure for quality system. 1.1.b

More than 70%

118 (PHC)/ 2

regional

hospitals

Annually Number of organizations that have annual quality

improvement objectives.

a

1.2.a

More than 75% NA Annually Percentage of organizations implementing

approved key performance indicators. 1.2.b

11 regions , all

regional

hospitals

6 regions Annually Number of regions/hospitals that implement

quality audit / monitoring system. 1.2.c

45 wilayat/ , all

regional

hospitals

15 wilayat/ ,

one regional

hospital

Annually Number of wilayat/ hospitals implementing

quality improvement projects. 1.2.d

11 regions/ 5

regional

hospitals

5 regions/ 2

regional

hospitals

Annually

Number of regions/hospitals that conduct the

annual top management reviews for quality

systems. 1.2.e

10 workshops

(at least) for

each region/

hospital during

the plan

320 Annually

Number of workshops to train health workers

on quality assurance / improvement principles,

concepts and applications. 1.3.a

10 workshops

(at least) for

each region/

hospital during

the plan

174 Annually Number of workshops to train health workers on

communication skills and teamwork. 1.3.b

35 18 Annually Number of training courses to certify quality

auditors. 1.3.c

95

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

20 5 Annually Number of workshops to train health workers on

the tools and approaches of quality improvement. 1.3.d

More than 70%

118 (PHC)/ 7

regional

hospitals

Annually

Number of health care facilities that implement

customer satisfaction survey (in primary,

secondary and tertiary care).

1.4

11 regions/ all

regional

hospitals

4 regions/ 4

regional

hospitals

Annually Number of regions/hospitals that implement staff

satisfaction survey. 1.5

5 workshops

for each region

during the plan

25 Annually

Number of workshops to train community

support groups in quality assurance and

improvement.

1.6

Approved

documented

system

None Annually Availability of an approved documented

motivation system for health care workers. 1.7

Approved

documented

manual

None End of

2013

Availability of an approved documented manual

of national accreditation standards 1.8.a

One central

training course

and one course

for each

hospital

applying the

system

None Annually Number of training courses to train surveyors for

the National Accreditation System. 1.8.b

5 regional

hospitals (at

least)

None 2013 -

2015

Number of organizations that are preparing for

accreditation according to the National

Accreditation System.

1.8.c

Fulfillment of

procedures for

formulation of

the council

None End of

2013

Availability of preparatory steps for the

formulation of a National Accreditation Council

(an independent national body).

1.8.d


5 workshops (at

least) for each

region/ hospital

during the plan

43 Annually

Number of workshops to train health care

workers on principles and concepts of patient

safety.

2.1a

96

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

One workshops

for each

regional

hospital

None Annually Number of workshops to train hospital staff on

root cause analysis of sentinel events. 2.2a

Documented

manual Draft 2013

Availability of operational manual of patients‟

safety standards. 2.3.a

Approved

document None 2013

Availability of approved document regarding

patient‟s right in different levels of health care. 2.3.b

All regions Available in

some regions 2012

Availability of an approved system for patients‟

complaints. 2.3.c

More than 50%

(PHC) , all

regional

hospitals

NA Annually

Number of organizations that implement the

approved standardized adverse event reporting

system. 2.4a

More than 20%

(PHC) , 50%

regional

hospitals

NA Annually Number of organizations that implement patient

safety solutions. 2.5a


4 1 Annually

Number of central specialized training

programmes/diploma to qualify Omani

professionals in the field of quality and patient

safety.

3.1a

Not less than

30% of

educational

programmes

3 Annually

Number of educational programmes (in MoH

institutions) that have integrated quality and

patient safety topics in its curriculum. 3.2a

25 15 Biennially

Number of national cadres who got a

postgraduate degree in quality management in

heath care. 3.3a

97

Alleviation of Risks Threatening The Public

Health

Vision Three

98

Domain Ten

Communicable Diseases

99

Vision: Alleviation of Risks Threatening The Public Health

Goal: Reduction of Mortality and Morbidity Rates of Diseases and

Accidents to the Lowest International Levels

Domain: Communicable Diseases

INTRODUCTION:

Infectious diseases continue to pose a threat to humans despite great progress in their

control and management. Morbidity, disability and mortality attributed to communicable

diseases still constitute a huge burden and challenges worldwide. It is needless to say that

prevention and control of such diseases have got the utmost attention of our wise government,

the Law of Prevention and Control of Communicable Diseases was issued by the Royal

Decree No. 73/92, which regulates the surveillance and control of communicable diseases and

specifies the role of the concerned health organizations in implementing measures and

procedures required to protect the community from communicable diseases. Ministry of

Health (MOH) has adopted policies, strategies and plans to prevent and control communicable

diseases, based on evidence-based science and up-to-date technology. This is also based on

the in-depth analysis and interpretation of epidemiological data generated by the Disease

Surveillance System. These efforts are in line with the initiatives and recommendations of the

concerned international organizations.

Globally, demographic, social and economical changes facilitates the emergence of

new diseases (e.g. AIDS, SARS, Avian Influenza), or emergence of some diseases which

were eradicated (or thought to have been eradicated) or those which were on decline (e.g.

Tuberculosis, West Nile Fever and Dengue Fever). Spread of such diseases has serious

economical, political and health implications. Therefore, the presence of a reliable, effective

and highly sensitive “Disease Surveillance System” is considered an essential prerequisite for

generating the information required for planning and decision making within the (Integrated

Disease Control) framework. In addition, this system functions as an early alert system to

predict outbreaks and epidemics. The “Epidemic Preparedness”, provides the logical basis for

the interventions by Health Authorities.

The Sultanate of Oman has achieved a lot in early diction and prompt treatment of

communicable diseases in the country. The presence of an effective and highly efficient EPI

program enabled Oman to accomplish very high rates of coverage (> 99%) for more than 15

years. The EPI has contributed in reducing the incidence rates of vaccine-preventable

diseases, and averted morbidity and mortality associated with those infections to the lowest

levels, especially in children under five years. MOH is continuously searching for the

adoption most up-to-date technologies in the field of prevention and control of communicable

diseases.

Health care has outstandingly improved over time. This has helped in saving lives and

has brought remarkable benefits to generations of patients and their families. However,

progress in health care delivery is associated with risks. The treatment and care of millions of

100

patients worldwide is complicated by infections acquired during health care. HealthCare-

associated infection is a growing as a public health problem. Patients are becoming more

susceptible to infections because of more serious underlying illnesses. Advances in medicine;

new procedures, new treatments, organ transplantation and intensive care are associated with

an increased risk of infection. Moreover, microorganisms become more resistant to treatment

with anti-microbial drugs. Shortage of trained health care workers and increased bed

occupancy rates are among the additional factors that facilitates the spread of these infections

in healthcare settings.

Patient‟s safety is one of the important health priorities for the Ministry of Health of

the Sultanate of Oman. Every patient has the right to receive a clean and safe care. The

ministry of health adapts the evidenced-bases and cost-effective strategies to reduce the

burden of healthcare-associated infection in its plans.

OBJECTIVES:

1. Strengthening and maintaining the national capacity for infectious disease, detection

and response through achieving effective preparedness, surveillance and response

system that meet the IHR requirements.

2. Reduction of health care associated infections (HAIs) rates.

3. Maintaining the lowest rates of vaccine-preventable diseases.

4. Achieving the lowest possible rates for other communicable disease.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: Strengthening and maintaining the national capacity for infectious

disease detection and response through achieving effective preparedness, surveillance and

response system that meet the IHR requirements.

1. Number of Borders*that implements the

IHR requirements. Nil Nil 5

2.

Availability of updated national work

plan which is able to report and respond

to any events that could be a risk to the

public health.

N/A N/A Updated plan

3.

Availability of updated national

Committees which is able to report and

respond to any events that could be a

risk to the public health.

N/A Available Available

4.

Percentage of the regions that have

developed Epidemic Preparedness Plans

yearly.

80% 90% 100%

101

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

5.

Percentage of the regional Hospital that

have developed Epidemic Preparedness

Plans.

0% 10% 100%

6. Number of governorate which deal

effectively with e-surveillance. 6 7 11

Second Objective’s Indicators: Reduction of health care associated infections (HAIs) rates.

1.

Incidence rate of reported blood/body

fluid exposure among healthcare

workers.

N/A N/A

25%

decrease of

the baseline

2.

Percentage of Resisting antimicrobial

isolates (MRSA) among the detected

(Staph).

N/A N/A

25%

decrease of

the baseline

3.

Percentage of resisting antimicrobial

isolates (MDRO) among the detected

(Acinetobacter).

N/A N/A

25%

decrease of

the baseline

Third Objective’s Indicators: Maintaining the lowest rates of vaccine-preventable diseases

1.

Percentage Coverage:

OPV / IPV

HBV

Diphtheria

Pertussis

Tetanus

Measles

Rubella

Mumps

Hib

BCG

Pneumococcal Vaccine (PCV)

Varecilla

>99%

>99%

>99%

>99%

>99%

>98%

>98%

>98%

>99%

>99%

N/A

N/A

>98% >98%

2. Incidence rate of AFP per 100,000

children below 15 years. 3,9 2,54 More than 2

3. Number of +ve polio cases. Zero Zero

Maintaining

Zero

reporting

status

102

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

4. Number of Diphtheria cases notified. Zero Zero

Maintaining

Zero

reporting

status

5. Incidence Rate of Neo-Natal Tetanus per

1,000 live births. Zero Zero

Maintaining

Zero

reporting

status

6. Number of Non Neo-Natal Tetanus

cases notified. 6 2 Zero

7.

Incidence rate of Measles per 1000,000

populations (EMRO initiative of

Measles Elimination by 2010).

0.8 0.9 0.1

8.

Incidence rate of Rubella per 1000,000

populations (EMRO initiative of Rubella

Elimination by 2010).

0.4 0.9 Zero

9.

Number of Congenital Rubella

Syndrome due to Rubella infection per

1,000 live births.

0.0004 Zero Zero

10. Incidence rate of Mumps per 100,000

populations. 35 20 10

11. Incidence rate of H. influenza type b

(Hib) infection per 100,000 of children

<5 years.

0.04 0.37 Zero

12. Number of deaths due to complications

of infection by H. influenza type b. Zero Zero Zero

13. Incidence rate of pneumococcal diseases

per 100,000 populations. 3.9 1,2 1


of infection by pneumococcal disease in

children <5 years.

N/A Zero Zero

Fourth Objective’s Indicators: Achieving the lowest possible rates for other communicable

disease

1.

Incidence rate of sputum smear positive

(active pulmonary TB) per 100,000

populations.

5.21 4.86 1.0

2. Percentage of Cure rate of sputum smear

positive (active pulmonary TB). 93% 94% 95%

3.

Number of new sputum smear positive

(active pulmonary TB) with Multi Drug

Resistance (MDR).

0 4 < 5

103

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

4.

Number of new sputum smear positive

(active pulmonary TB) with X Drug

Resistance.

0 0 0

5.

Incidence rate of Leprosy per 10,000

populations (Leprosy elimination

initiative).

0.2 0.1 0.1

6.

Incidence rate of Rotavirus infection per

100,000 of children under 5 years. (In

Regional Referral Hospital).

N/A 260 50

7. Percentage of Severe dehydration

among all diarrheal. 0.2 0.2 0.1


of Diarrheal diseases. 0 0 0

9. Percentage of Severe ARI (among all

ARI cases in children < 5 years). 0.3 0.2 0.2


of ARI diseases. 2 2 1

11. Incidence rate of Brucellosis per

100,000 of Dhofar population. 41.8 31.3 20

12. Incidence rate of Brucellosis per

100,000 of All population. 4.5 3.9 2

13. Incidence rate of Schistosomiasis per

100,000 of Dhofar population. 0.6 0.32 0

14. Incidence rate of acute viral hepatitis A

per 100,000 populations. 24.2 13.4 10

104

STRATEGIES:

Strategies to Achieve 1st Objective: Strengthening and maintaining the national capacity for

infectious disease detection and response through achieving effective preparedness,

surveillance and response system that meet the IHR requirements.

1.1 Strengthening and maintaining the national capacity for infectious disease detection

and response through achieving effective preparedness, surveillance and response system

that meet the IHR requirements through:

Upgrading the surveillance capacity of the country’s points of entry.

Increasing the capacity of the Public Health Laboratory to appropriately detect

infectious disease.

Finalizing the mapping of potential health risks areas (e.g. vector breeding areas,

animal farms, and industrial zones, petrochemicals and radio-nuclear hazards).

Updating the regional and hospital committees plans for communication,

notification and response to Public Health Event of International Concern

(PHEIC).

Updating the IHR related laws and regulations.

Building the human resources capacities for preparedness, notifications, and

response to public health events of international concerns.

Updating the epidemic preparedness plans.

Implementing simulation & response exercises.

Expected results:

Entry Points are ready to implement IHR standards.

Availability of specific reagent in the Public Health lab for early detection of

emerging/epidemic-prone infections.

Availability Heath Risk Maps (e.g. vector breeding areas, animal farms, and industrial zones,

petrochemical and radio nuclear hazards).

Availability of updated the regional and hospital committees and plans for communication,

notification and response to Public Health Event of International Concern (PHEIC).

Availability of updated IHR-related laws and regulations.

Trained staffs are available to detect, assess and respond to epidemics and reduced the

consequence of severe epidemics.

Availability of updated regional and hospital epidemic preparedness plans and implemented

simulation & response exercises.

Strategies to Achieve 2ndObjective: Reduction of health care associated infections (HAIs)

rates.

2.1 Restructuring the infection prevention & control program through:

Expanding the central infection prevention & control.

Restructure and revitalization of the role of the hospital infection control

committees.

Reporting of the infection control team to the executive director of the hospital.

105

Establishing infection control committee at the regional level.

Appointment of a focal point at the regional level.

Expected results:

Improving efficiency and effectiveness of the structure of the infection control program

2.2 Updating Infection Prevention & Control SOPs & Manuals.

Expected results:

Updated infection prevention & control is available

2.3 Building the capacity& the career of Infection preventionists through:

Continuation of the Infection prevention & control post-basic nursing diploma.

Enrolling post-basic diploma graduates in the Bachelor degree studies.

Granting scholarships for master degree in infection prevention & control for

infection preventionists (nurses).

Granting scholarships for master degree in infection prevention & control for

doctors.

Continually organizing training workshops in infection control.

Expected results:

Updated Infection prevention & control is available

2.4 Promoting Infection Prevention & Control Principles and Practices among healthcare

workers (HCWs) and in the community through:

Implementing national campaign to promote essential practices of infection

prevention and control, e.g.: Hand hygiene, Injection safety.

Conducting continual training of HCWs on the basic principles and best practice of

infection prevention and control.

Promoting Infection Prevention & Control Principles and Practices among

healthcare workers (HCWs) in the private sector.

Introducing Infection Prevention & Control Principles and Practices among the

community.

Expected results:

Understanding and knowledge of basic principles of infection prevention and control among

healthcare HCWs.

Improvement of Infection prevention and control practices.

Orientation of the community about healthcare associated infections and their prevention.

106

2.5 Improving instruments’ Disinfection & Sterilization processes in healthcare facilities

through:

Building the capacity of staff working in instruments sterilization through

education and continual education.

Developing instruments sterilization manual & SOP.

Proving appropriate sterilization techniques and devices for medical instruments

and equipments.

Expected results:

Improvement of the knowledge and practices of staff working in instruments‟ Disinfection &

Sterilization.

Availability of national standards and procedures on instruments‟ Disinfection &

Sterilization processes.

2.6 providing medical instruments and supplies that have infection prevention and control

features through:

Involving infection prevention and control committees and teams in medical

instrument and equipments evaluation and purchasing decisions.

Expected results:

Availability of medical instruments and supplies that have infection prevention and control

features.

2.7 preventing and controlling infections among health care workers (HCWs) through:

Providing essential HCWs vaccinations (e.g. Hep B, seasonal Influenza, Varicella

and MMR).

Pre employment screening of HCWs against infectious diseases.

Training HCWs on safe practices.

Providing safety-engineered medical instruments to HCWs.

Improving blood/body fluid exposure reporting and follow up system.

Collaboration with agencies involved in occupational health.

Expected results:

Improving vaccination coverage among HCWs.

Reducing rates of HCWs occupational infections.

Follow up of exposed cases.

2.8 Strengthening the surveillance system of healthcare associated infections through:

Updating the surveillance manual related to health services.

Updating the reporting system between different levels of health services.

Establishing electronic database system.

Expected results:

Availability of accurate information on rates and trends of Healthcare associated infections.

107

2.9 Establishing Supervision and monitoring system for infection prevention and control

through:

Establishing national standards for infection prevention and control.

Developing national and facility level indicators.

Developing infection prevention and control audit system.

Expected results:

Availability of national standards and indicators on infection prevention and control

Strategies to Achieve 3rd Objective: Maintaining the lowest rates of vaccine-preventable

diseases

3.1 Upgrading vaccines and updating vaccines target groups in the EPI Program through:

Adding Varicella vaccine to EPI to be given to targeted children starting Jan 2011

for children born in Jan 2010 and after.

Adding Rota vaccine to targeted children

Adding Hexa-valent vaccine (that includes Hib, Hep B, DTP & IPV) to the EPI

program

Providing seasonal influenza vaccine to children > 6 month.

Mass campaign to vaccinate children between 2-5 years with PCV those who didn’t

receive vaccine.

Expected results:

Protecting children against vaccine preventable diseases.

Expanding vaccination coverage to children.

3.2 Upgrading vaccines and updating vaccines target groups among adults through:

Expanding seasonal influenza vaccine coverage among adults.

Providing Hep B vaccine to adults >30 years of age.

Providing pneumococcal vaccine to high risk groups, e.g. >65 years.

Expected results:

Protecting adults against vaccine preventable diseases.

Expanding vaccination coverage among adults.

3.3 Upgrading vaccines and updating vaccines target groups among Healthcare workers

(HCWs) in collaboration with Infection Prevention and control Section through:

Continuation of providing Hep B vaccine to HCWs.

Continuation of providing IPV vaccine to HCWs.

Expanding seasonal influenza vaccine coverage among HCWs.

Providing Varicella vaccines to HCWs.

Providing MMR vaccine to HCWs with no evidence of immunity.

Expected results:

Protecting HCWs against vaccine preventable diseases.

Expanding vaccination coverage among HCWs.

108

3.4 Maintaining the quality of the EPI program performance and the high coverage

percentage through:

Maintaining the efficacy of vaccines in the cold-chain (central / governorate).

Improving the surveillance of adverse effects following immunization (AEFI).

Continuing the vaccine’s defaulter’s retrieval system in the target age group.

Continuing the training and CME activities for all health workers involved in the

implementation of the Programme in the regions.

Continuing the health education activities to the community on the EPI schedule

and diseases targeted by these vaccines.

Improving supervision and monitoring of EPI activities.

Expected results:

continuation of the quality of the EPI program

Strategies to Achieve 4th Objective: Achieving the lowest possible rates for other

communicable disease.

4.1 Strengthening the epidemiological surveillance and intervention plans for elimination,

control , and eradication of the communicable diseases not targeted by EPI through:

Updating the current SOPs (Leprosy-Tuberculosis-Aids-Communicable Diseases).

Strengthening, upgrading, and updating the disease e-notification system including

web-based surveillance).

Establishing Hepatitis B national registry.

Utilizing the (GIS) applications in communicable diseases.

Improving early warning systems for communicable diseases (.e.g. Severe Acute

Respiratory Illness; SARI).

Upgrading regional surveillance units and providing recourses particularly trained

cadres to them.

Analyzing the current situation of some significant diseases (e.g. HPV, Rota, & Q

fever).

Expected results:

Early detection of communicable diseases other than the vaccine-targeted diseases.

Reduction in the incidence rates of these diseases.

Keeping incidence rates on minimum levels.

Established web-based notification system for communicable disease.

GIS system applied in communicable diseases for central and peripheral level.

Fully prepared regional surveillance units and prepare trained staff for these units.

109

4.2 Strengthening the National TB Program through:

Establishing electronic national reporting system (ENRS).

Strengthening surveillance of anti-microbial resistance of TB.

Improving TB infection prevention and control practices in healthcare facilities.

Continuing to provide DOTS strategy.

Expected results:

Early detection and management of TB cases.

Reduction in the incidence rates of TB particularly among case-close contacts.


Indicators Follow up

timing

Current

situation

2010

Targeted

situation

2015


1.1a

Existence of maps up to date on the sources of

risk to public health Risk Mapping, such as

places where the vectors and animal farms and

factories, petrochemical and radio nuclear.

Annually NA Available

1.1b Number of meetings held by Epidemic

Preparedness committee. Annually

Twice for

each

governorate

Twice for

each

governorate

1.1c Number of staff trained to deal with outbreaks

of a class (public health specialist) annually. Annually 2 11

1.1d Number of the epidemic preparedness plans

approved and updated annually by the regions. Annually 6 11

1.1e

Percentage of regions / provinces and hospitals

that have implemented a simulation of the

implementation of preparedness and response

plan.

Annually 20% 100%

1.1g

Number of regions / provinces in which the

joint committee up to date with relevant

government agencies.

Annually 7 11


2.1a Number of Employees in infection control

section. Annually 1 5

2.1b

Number of infection control dept established

that reports directly to the Director General/

Hospital Executive Director of hospitals.

Annually 1 All hospitals

2.1c

Number of regions / provinces with a

committee for the prevention of infections

associated with health care.

Annually 0 11

110


timing

Current

situation

2010

Targeted

situation

2015

2.1d

Number of regions / provinces with a focal

point at the regional level for the prevention of

infections associated with health care.

Annually 2 11

2.2a

The existence of Updated National guidelines

for the prevention of infections associated with

health care.

The end of

the current

plan

N/A Available &

Updated

2.3a Continuation of the Post- basic Diploma

course during the years of the plan. Annually Continued Continued

2.3b Number of Infection control practitioner study

Bachelor Degree. Annually 0 25

2.3c

Number of Infection control practitioner sent

to study for a Master Degree in prevention of

infections associated with health care.

Annually 0 10

2.3d

Number of Doctors sent abroad for a Master

Degree in prevention of infections associated

with health care.

Annually 3 13

2.4a Number of Hand Hygiene audits conducted in

every healthcare facility.

Annually At least one At least one

2.5a The existence of guidelines for policies and

procedures for sterilization.

The end of

the current

plan

N/A Available

2.6a

The existence of Infection control responsible

in evaluation and purchase committee of tools

and supplies (Infection control equipments).

Annually N/A Available

2.7a Percentage of vaccinated HCWs against Viral

Hepatitis type B in every healthcare facility.

Annually 65% At least 90%

2.7b

The existence of reporting system and

documentation of exposures to blood and body

fluids and acupuncture with sharp tools at

every healthcare facility.

The end of

the current

plan

N/A Available

2.8a

The existence of reporting system and

documentation of infections associated with

health care at every regional and referral

hospital.

Annually

N/A Available

2.9a

The existence of standards for practices,

procedures and prevention and control health

care associated infections at every healthcare

facility.

Annually

N/A Available


3.1a Coverage of varicella vaccine among target

children. Annually NA >98%

111


timing

Current

situation

2010

Targeted

situation

2015

3.1b Availability of Rota Virus Vaccine (severe

diarrhea). Annually NA available

3.1c Availability of Hexvalent vaccine. Annually NA available

3.1d Availability of Seasonal Influenza vaccine for

children more than 6 months. Annually NA available

3.1e Coverage of PCV vaccine among children 2-5

years for those who did not receive vaccine. Annually NA 90%

3.2a Coverage of Seasonal Influenza vaccine

among adult, more than 50 yrs. Annually NA 40%

3.2b Coverage of Hep B vaccine among adult more

than 30 yrs. Annually NA 60%

3.2c Coverage of PCV vaccine among adult – more

than 60 yrs. Annually NA 60%

3.3a Coverage of Influenza vaccine among HCW. Annually 20% 40%

3.3b

Coverage of varicella vaccine among HCW

those not vaccinated or not exposed by

disease.

Annually NA 50%

3.3c Coverage of MMR vaccine among HCW those

not vaccinated or not exposed by disease. Annually NA 40%

3.4a Coverage of vaccine wastage due to cold chain

failure. Annually <1% <1%

3.4b Rate of Health education sessions per child per

visit. Annually Every visit 100%

3.4c Coverage of defaulters due to vaccination. Annually >99% >99%

3.4d Coverage of trainees who‟s responsible of EPI

program. Annually 100% 100%

Indicators of Strategies of 4th Objective

4.1a The existence of updated manuals for

communicable diseases.

End of the

current plan

Available but

needs update

Updating the

3rd edition

112


timing

Current

situation

2010

Targeted

situation

2015

4.1b

Percentage of Health Care Institutions that

have a monitoring system and electronic

reporting (Web Based Surveillance) of

infectious diseases in each region.

Annually

Available in

65% of

Muscat

Governorate

50% of health

institutions of

each region

4.1c The existence of National Registry for chronic

viral hepatitis (B and C) at the central level. Annually Zero Available

4.1d

Number of regions / provinces that have a

geographic information system (GIS) for

priority communicable diseases.

Annually Zero 8

4.1e

Number of regions / provinces that have

trained units of integrated epidemiological

surveillance (epidemiologist, Health

Inspectors and data entry).

Annually 1 (Dhofar)

To be

Available

In all

Governorates

4.2a

The proportion of health centers which have

trained 100% of lab technicians on the use of

the Electronic Reporting System (ENRS) for

TB patient.

Annually NA 70%

4.2b

The proportion of centers for the examination

of immigrant labour, which have trained at

least 50% of lab technicians on the use of the

Electronic Reporting System (ENRS) for TB

patient.

Annually 50% 100%

4.2c

The proportion of tertiary care hospitals,

which have trained at least 50% of lab

technicians on the use of the Electronic

Reporting System (ENRS) for TB patient.

Annually 20% 100%

4.2d

Number of of regions / provinces that have 4

master trainers on Electronic Reporting

System (ENRS).

Annually NA 11

4.2e

Percentage of Health Care Institutions that

have one master trainer on Electronic

Reporting System (ENRS).

Annually NA 50%

4.2g

The rate of sputum conversion from positive to

negative within 2 to 3 months from the date of

commencement of treatment / all sputum

positive TB patients.

Annually 94% 95%

4.2h

The proportion of people with latent TB

(house hold contacts of TB patients) who

completed treatment for 9 months.

Annually NA At least

80%

4.2i

The proportion of health institutions that

implement Electronic Reporting System

(ENRS) for TB patient.

Annually NA 70%

113


timing

Current

situation

2010

Targeted

situation

2015

4.2j



(ENRS) for TB suspect.

Annually NA 70%

4.2k



(ENRS) in laboratory for TB patients.

Annually NA 100%

4.2l

The proportion of patients with HIV/AIDS co-

infection and receive treatment for both

diseases.

Annually 100% 100%

4.2m

The proportion of TB patients with positive

sputum who are isolated during their

admission till their sputum is converted from

positive to negative.

Annually 90% 100%

114

Domain Eleven

HIV/AIDS and Sexually Transmitted

Infection (STI)

115




Domain: HIV/AIDS and Sexually Transmitted Infection (STI)

INTRODUCTION:

Acquired Immune Deficiency Syndrome (AIDS) caused by Human

Immunodeficiency Virus (HIV) is a major health concern facing our world today. Not a

single country in the world is free from HIV/AIDS, and in many countries the epidemic has

escalated and in some it is out of control. The number of people living with HIV / AIDS in

the world at the end of 2009 was estimated to be approximately 33.4 million people, and

around 28 million persons died due to HIV/AIDS in the world during 2009.It is estimated that

the number of people infected with Sexually Transmitted Infections (STIs) each year is

approximately 340 million people in the world.

HIV/AIDS is a major cause of death among young people, especially in the

developing countries where more than 90% of the cases exist. The most affected regions are

Africa, and South East Asia. Oman is located between the two regions and has strong

historical ties with countries in those regions, which increases the need to take certain

precautionary measures to curb the spread of this epidemic, given the rapid social and

economic changes associated with the demographic and epidemiological changes in the

Sultanate.

Although the prevalence rate in Oman remains low, In less than 25 years, the overall

at the end of 2009 cumulative number of reported cases amongst Omanis is 2000 cases, with

total number of people who have died till the end of 2009 is 30% of the total. High-risk

sexual behavior- extramarital relationships and injecting drug use is responsible for more than

90% of all reported cases in Oman, especially in the past 10 years, making it fundamental to

address the issue in a culturally sensitive and pragmatic ways and take all necessary

precautions to halt the spread of the disease further.

There are major factors contributing towards the increase of HIV in Oman; migration

from rural villages to more urban cities in search for jobs and continuing higher education,

the growth of tourism both internal and external, high number of young people who are

seeking jobs. Stigma and discrimination linked with the disease, in addition to its association

with high risk behaviors within the society, also contribute to its increase.

Ever since the reporting of cases in Oman initiated, the Ministry of Health has taken

various measures to face this pandemic, keeping in consideration the importance of the

involvement of all relevant sectors in the fight against HIV/AIDS. A technical committee for

AIDS was established in 1987, which includes representatives from various governmental

health institutions, and aim to develop the regulations and guidelines in the area of diagnosis

and treatment, as well as other technical matters related to HIV/AIDS. It was followed by the

establishment of the National Educational Committee for AIDS in 1990, which was expanded

in 2002 to include a number of representatives from other ministries and relevant

organizations, in addition to the Ministry of Health. The HIV/AIDS control section was

established in 1987 at the Directorate-General of Health Affairs, Ministry of Health in order

to plan, implement and evaluate the prevention and control activities against the disease at

various levels with objectives a) Prevention of HIV transmission including transmission by

way of blood, sexual, injection and perinatal transmission b) Reduction of morbidity and

116

mortality associated with HIV infection and AIDS c) Reduction of the impact of HIV

infection and AIDS on individuals and their families and communities. In 1996, Sexually

Transmitted Infection (STI) was also integrated into the National AIDS Programme (NAP).

In 2007, the National Strategy for HIV/AIDS (2008-2011) was launched with involvement

of thirteen ministries and sectors for the formation of plan of action and development of

strategies to counter HIV/AIDS in Oman. The strategy involved setting clear objectives

where the goal of each sector was to set aside a budget from their respective 5 year plans or

from a special budget specifically for the strategy from the Ministry of Finance. In line with

the initiation of the strategy, the „Lets Talk AIDS‟ Campaign 2009-2010 was launched, with

the goal of increasing awareness among young adults on the prevention of HIV and related

services and to advocate for acceptance and rights of people living with HIV. The campaign

had a strong impact amongst youth in Oman. Moreover, an expansion of the HIV/AIDS/STI

Section took place, increasing its capacity in order to implement its activities to achieve the

goals and follow the policies set out by the Ministry of Health towards combating HIV/AIDS.

OBJECTIVES: 1. To control the spread of HIV/AIDS and STIs in the community in general and in the

most vulnerable groups in particular and stabilizing the current rates of these diseases.

2. To improve health and psychological conditions of patients with HIV/AIDS, reduce the

complications of the disease; reduce mortalities due to opportunistic infections

associated with AIDS, and management of STI as a Syndromic Case Management

Approach (SCMA) with provision of essential medicines in primary health care

institutions.

3. Promotion and support of NGOs who are working with Most At Risk Populations/

those with high risk behavior and People Living With HIV (PLHIV).


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To control the spread of HIV/AIDS and STIs in the

community in general and in the most vulnerable groups in particular and stabilizing the

current rates of these diseases.

1. Prevalence rate of HIV per 100,000

populations. 51 62 86

2. Prevalence rate of HIV per 100,000 in

age group 15 – 49 years. 80 90 105

3.

Prevalence rate of STI detected by

laboratory examination per 100,000

populations.

67 24 67

4. Prevalence rate of STI syndrome per

100,000 populations. 344 151 344

117

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

5.

Number of cases of HIV, Syphilis,

Hepatitis B&C infected through blood

transfusion.

0 0 0

6.

Number of newly diagnosed children

infected with HIV through their

mothers.

4 5 0

Second Objective’s Indicators: To improve health and psychological conditions of patients

with HIV/AIDS, reduce the complications of the disease; reduce mortalities due to

opportunistic infections associated with AIDS, and management of STI as a Syndromic

Case Management Approach (SCMA) with provision of essential medicines in primary

health care institutions.

1. Number of cases receiving ART. 273 481

1000

2.

Percentage of PLHIV receiving

treatment from total of those who are

eligible for treatment (as per the HIV

Management Guidelines).

80% NA 100%

3. Number of trained counselors. 85 129 140

4. Number of Patients receiving Social

Assistance/ welfare. 25 49 500

5. Number of PLHIV trained as

volunteers work with the NAP. 6 15 19

6. Annual mortality rate due to AIDS. 4.4% 2.5% 2.5%

Third Objective’s Indicators: Promotion and support of NGOs who are working with Most

At Risk Populations/ those with high risk behaviour and People Living With HIV (PLHIV).

1. Number of projects supported by

Government. 0 0 2-3 annually

2.

Financial support provided to NGOs.

NA NA

RO 2000-

5000

annually

STRATEGIES:

Strategies to Achieve 1st objective: To control the spread of HIV/AIDS and STIs in the

community in general and in most at risk population (MARPS) in particular, and

stabilizing the current rates of these diseases

1.1 Expansion of voluntary counseling and testing (VCT) through:

Promotion of VCT particularly for MARPS- injecting drug users (IDUs), men

who have Sex with men (MSM), female sex workers (FSW) and their clients &

STI Patients.

Training of health care workers at primary Health Care (PHC) Levels on VCT.

118

Expected Results:

Raise awareness on prevention methods on HIV.

Address stigma and Discrimination against PLHIV.

Raise awareness of PLHIV and the community at large by enabling them to receive

accurate information on HIV at all times.

Early detection of a larger number of cases affected by HIV and management of such

cases.

1.2 Elimination of mother to child transmission through screening of all pregnant

women for HIV and taking all preventative measures to avoid vertical transmission.

Expected Results:

Protection of children born from infected mothers.

Reduction in incidence rates among children of infected women.

Detect new cases in the community through screening of contacts of infected pregnant

woman.

1.3 Raise awareness of the community on HIV/AIDS and STI through:

Carry out annual national campaigns to raise the awareness of the community

on risky behaviours associated to HIV, and address the social stigma and

discrimination associated with it.

Support and promote awareness activities directed to young people and women

through the promotion of peer education programmes in collaboration with

ministries, agencies and relevant sectors and institutions.

Address stigma and Discrimination against PLHIV.

Expected Results:

Raise awareness in the community in general and MARPS in particular on HIV and STIs.

Increase participation of government institutions and NGOs in health education on HIV

Involvement of other sectors in peer education programme; Ministry of Education,

Ministry of Higher education, private schools and institutes and Women‟s Associations.

Eliminate stigma and discrimination against HIV.

1.4 Provision of post-exposure prophylaxis (PEP)to exposed health care workers and

capacity building on management of PEP.

Expected Results:

Raise knowledge and behavior of health care workers on prevention methods.

Prevention of health care workers from exposure to HIV.

1.5 Strengthen epidemiological surveillance system to monitor and control the spread of

HIV/AIDS and STI and document future directions for infection and disease.

Expected Results:

Understand in magnitude of problem better so corrective action can be done according to

requirement.

Raise efficiency of health care workers in laboratories and blood banks in order to create

„Qualified Health Care Workers, Better Services‟.

119

Strategies to Achieve 2nd Objective: To improve health and psychological conditions of

patients with HIV/AIDS, reduce the complications of the disease, reduce mortalities due to

opportunistic infections associated with AIDS, and management of STI as a Syndromic

Case Management Approach (SCMA) with provision of essential medicines in primary

health care institutions.

2.1 Care of HIV/AIDS/STI Patients and provision of treatment including anti retroviral

triple therapy, opportunistic infections, preventative treatment and follow up medically

including laboratory monitoring and counseling.

Expected Results:

Improve the health status of those infected with HIV/AIDS/STI and their caregivers.

Reduce numbers of visits of PLHIV to health institutions especially admission in

hospitals.

2.2 Strengthen training of health care workers skills in counseling, management and

care of PLHIV through:

Continuous training of physicians and nurses working in the hospitals and the

counselors through periodic and regular refresher training courses

Strengthen the central unit (National Technical Committee) to supervise the

treatment, follow up and counseling of patients.

Strengthen the regional HIV teams in all treatment facilities/ referral hospitals

(physician, nurse, pharmacist, lab technician) to follow up on treatment and

provide regular refresher training courses for them.

Expected Results:

Enhance skills of health care workers in management and care of HIV patients.

Improve follow up of HIV infected patients.

2.3 Management of STI as syndromic case management approach with provision of

treatment in primary health care institutions and training of health care workers in

PHC on treatment of STIs.

Expected Results:

Early and effective treatment.

Reduction in incidence rates of these infections.

Reduction in patient drops out especially during the referral process.

Offer and provide treatment for partners.

Provision of condoms.

Strategies to Achieve 3rd objective: Promotion and support of NGOs who are working for

Most At Risk Populations and People Living With HIV (PLHIV)

3.1 Promote and provide financial support to NGOs/ civil society working in the area of

substance abuse and care of those who are substance dependent and those who are HIV

infected and support them in their awareness raising campaigns addressing MARPS.

Expected Results:

Improve NGO and CSOs.

Control the spread of HIV/AIDS.

Raise awareness of MARPS on high risk behavior.

120


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Number of Government health institutions

offering voluntary counseling and Testing

(VCT) for HIV with referral system

Annually 0 30

1.1b Number of Private health institutions offering

VCT for HIV with referral system. Annually 0 10

1.1c Percentage of people tested for HIV and knows

their results. Annually NA 100%

1.1d Percentage of completely filled out counseling

forms and sent to NAP. Annually

10%

80%

1.1e Percentage of Omanis who have had at least one

WB after ELISA +. Annually 100% 100%

1.1f Percentage of expatriates who have had at least

one WB after ELISA +. Annually 100% 100%

1.2a Percentage of Pregnant women tested for HIV

from total numbers registered in ANC. Annually 99.8% 100%

1.2b

Percentage of HIV infected pregnant women

who have been followed up during pregnancy

and delivery and receive ART to prevent mother

to child transmission.

Annually 99% 100%

1.2c

Percentage of children born to infected mothers

and receiving preventive treatment

(Antiretroviral Prophylaxis) for at least 6 weeks

after delivery.

Annually

NA 100%

1.2d Percentage of children born to infected mothers

and received Co-Trimoxazole CTX within 2

months of being born.

Annually NA 100%

1.2e Percentage of children born to infected mothers

and tested for antibody or virological tests

within 2 months of being born.

Annually 100% 100%

1.2f Percentage of HIV infected Pregnant women

who are counseled on artificial feeding.

Annually 100% 100%

1.2g Percentage of children born to infected mothers

at 18 months who are diagnosed positive for

HIV.

Annually 3% 2%

1.2h Number of deliveries during which intra-natal

ARV was not administered. Annually None

None

1.2i Percentage of infants born to infected mothers‟

breastfed at DPT 3 visit. Annually

NA 0%

1.2k Percentage of children born to infected mothers

is tested by ELISA at 18 months. Annually NA 100%

1.3a Number of health education activities during

World AIDS Day. Annually 1129 1312

1.3b Number of hits to OmanAIDS website. Annually NA 50,000

121

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

1.3c Number of injecting drug users (IDUs) tested

for HIV and knows their results. Annually NA 3000

1.3d Number of injecting drug users (IDUs) tested

for Hepatitis B, C and knows their results. Annually NA 3000

1.3e Number of persons trained to work with

MARPS. Annually 13 25

1.3f Percentage of government schools

implementing the peer education project. Annually NA 40%

1.3g Percentage of private schools implementing the

peer education project. Annually

NA 10%

1.3h Percentage of government schools that have

HIV integrated within their curriculum starting

from Grade 7.

Annually NA

80%

1.3i Percentage of private schools that have HIV

integrated within their curriculum starting from

Grade 7.

Annually NA

30%

1.3j Percentage of governmental colleges/ institutes

implementing the peer education project. Annually

NA 40%

1.3k Percentage of Private colleges/ institutes

implementing the peer education project. Annually

NA 10%

1.3l

Number of people age group 15-24 who

completed questionnaire on mode of

transmission and misconceptions on HIV (5 UN

standardized questions).

Annually NA

5000

1.3m Percentage of young people age group 15-24

correctly answers all 5 UN standardized

questions on HIV.

Annually NA

70%

1.3n Number of condoms distributed in STI clinics,

HIV clinics, ANC clinics for prevention of HIV

and other clinics.

Annually NA

100,000

1.4a

Percentage of government health institutions

that provide post exposure prophylaxis (PEP) or

have a referral system in place with other health

institutions.

Annually 75% 100%

1.4b Number of cases received PEP after exposure

with HIV source.

Annually NA 25

1.4c Number of reported cases of occupational

exposure to HIV source who are evaluated for

PEP according to national guidelines.

Annually NA

40

1.4d Percentage of private health institutions that

provide PEP or have a referral system in place

with other health institutions.

Annually NA

100%

1.5a Percentage of government health institutions

having at least one trained doctor for STI

Syndromic treatment and provide treatment.

Annually NA

80%

122

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

1.5b Percentage of Omani PLHIV given their

Western Blot reconfirmed test results within

two week of being tested.

Annually NA

95%

1.5c Percentage of non- Omani PLHIV who were

given their Western Blot results. Annually NA 95%

1.5d Number of units of donated blood tested for

HIV under external quality assurance. Annually 100% 100%

1.5e Number of units of donated blood tested for

HBsAg under external quality assurance. Annually 100% 100%

1.5f Number of units of donated blood tested for

Anti-HBc under external quality assurance. Annually 100% 100%

1.5g Number of units of donated blood tested for

HCV under external quality assurance. Annually 100% 100%

1.5h Number of units of donated blood tested for

TPHA under external quality assurance. Annually 100% 100%

1.5i Number of studies targeting (MARPS).

End of the

current

plan

0 3

1.5j Number of programmes and interventions

targeting MARPS.

Annually 1 4

1.5k Number of syringes distributed among injecting

drug users.

Annually NA 150,000

1.5l Number of condoms distributed among

MARPS.

Annually NA 300,000


2.1a Number of health institutions providing ART

for PLHIV. Annually 15 18

2.1b Number of health institutions providing follow

up for PLHIV on treatment. Annually 15 18

2.1c Percentage of PLHIV testing CD4 at least once

a year. Annually 45% 100%

2.1d Percentage of PLHIV receiving treatment from

total of those who are eligible for treatment. Annually 95% 100%

2.1e Percentage of infected children under 15 who

are on treatment. Annually 100% 100%

2.1f Percentage of health institutions that had a stock

out during the last year. Annually NA 0

2.1g Percentage of TB patients who are HIV + and

on ART treatment. Annually 100% 100%

2.1h Number of PLHIV on INH treatment for

prevention from TB. Annually NA

All cases as per

the National

Guidelines

2.1i Number of PLHIV on TMP-SMX treatment for

prevention from some communicable diseases. Annually NA

All cases as per

the National

Guidelines

123

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.1j Percentage of PLHIV of all groups known to be

on treatment 12 months after starting of ART. Annually

NA 90%

2.1k Percentage of PLHIV of all groups known to be

on treatment 24 months after starting of ART. Annually

NA 90%

2.1l Percentage of PLHIV of all groups known to be

on treatment 36 months after starting of ART.

Annually NA 90%

2.1m Percentage of PLHIV of all groups known to be


Annually NA 90%

2.1n Percentage of PLHIV of all groups known to be


Annually NA 90%

2.1o Percentage of PLHIV testing Viral Load at least

once a year.

Annually 45% 100%

2.2a Number of people trained who have attended at

least one training/ conference on counseling

PLHIV up to the end of 2010.

Annually 129 NA

2.2b Number of counselors who completed refresher

training course on counseling PLHIV.

Annually NA 120

2.2c Number of physicians trained on administration

of treatment for PLHIV.

Annually 29 45

2.2d Number of paediatricians trained on

administration of treatment.

Annually 9 15

2.2e Number of obstetricians/ gynaecologists trained

to deal with infected pregnant women.

Annually 10 30

2.2f Number of pharmacists trained on counseling

and treatment compliance.

Annually 11 30

2.2g Number of people tr who have completed at

least 5 days comprehensive training on HIV/STI

counseling during current 5 year plan.

End of the

current

plan

0 120

2.3a Percentage of PHC physicians trained on

treatment of STI as syndromic case

management approach.

Annually NA

70%

2.3b Percentage of government PHC institutions that

provide treatment of STI as syndromic case

management approach.

Annually NA

70%


3.1a Number of campaigns on HIV conducted in

partnership with substance abuse concerned

NGOs.

Annually 0 10

3.1b Number of studies conducted by NGOS that are

supported by Ministry of Health.

End of the

current

Plan

0 5

3.1c Financial support provided to NGOs.

End of the

current

Plan

NA Available

124

Domain Twelve

Malaria Eradication

125




Domain: Malaria Eradication

INTRODUCTION:

Malaria was one of the major public health problems in Oman. The endemicity reached

its peak in the seventies when about 300,000 clinical cases were recorded annually. Malaria

control strategies were adopted in Oman in eighties but the programme failed to fulfill its

objective to reduce the incidence of malaria therefore the ministry of health decided to

implement an eradication strategy with the main objective to interrupt malaria transmission

and deplete the reservoir of infection. The pilot programme started in Sharquiya governorate

and gradually extended to include all governorates. Excellent results were obtained, the last

indigenous cases were recorded in 1999, and interruption of malaria transmission was

achieved in 2004 and maintained till September 2007 when a focus of local transmission was

detected in Dakhiliya governorate. In 2008 another outbreak of local transmission occurred in

North Batinah governorate.

Presently the available expertise in vector-borne disease prevention and control is mainly

focused on malaria. In the event of future outbreaks of vector-borne diseases (not only

malaria, but also other vector-borne diseases, e.g., leishmaniasis, dengue or West Nile Virus),

it is very important to ensure that this expertise is not lost over the course of time, in order to

deliver a robust and technically sound vector control response to such outbreaks.

Despite of this successful achievement, still there are many challenges the large number of

internationally imported malaria cases from highly endemic countries is a major threat to the

program together with the increased Receptivity may result in resurgence of malaria

transmission in the Omani community whose population has lost their acquired immunity

against malaria. Epidemics of malaria transmission will have serious effects on the health,

economy, tourism and social life of the population.

The suggested strategies in this plan aims to maintain the above achievements in this field by

supporting all activities that lead to prevent malaria transmission.

OBJECTIVES:

1. To maintain the incidence of indigenous malaria cases at zero.

2. Prevention of epidemics due to vector borne diseases.

126


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To maintain the incidence of indigenous malaria cases at zero

1.

Proportion of indigenous cases from

total number of locally transmitted

cases.

0 0 0

2.

Proportion of introduced cases from the

total number of locally transmitted

cases.

0 0 0

3. Number of deaths due to malaria. 0 2 0

First Objective’s Indicators: Prevention of epidemics due to vector borne diseases.

1. Number of epidemics due to vector-

borne diseases. NA 0 0

STRATEGIES:

Strategies to Achieve 1st Objective: To maintain the incidence of indigenous malaria cases at

zero

1.1 The use of evidence-based planning through:

Introducing PCR for genotyping of strains, especially where cases occur in clusters

that may be linked to local transmission.

Conduction of studies and experimental field work for evaluation and plan

development.

Monitoring & evaluation of all field activities.

Expected results:

Detecting all cases and determining the source of infection of each case.

Early detection & appropriate management of outbreaks.

The availability of the information needed for planning.

1.2 Early detection and immediate& radical treatment for all the diagnosed cases through:

Activation of the governmental and private health institutions role in the early

detection of malaria cases.

127

Development of the lab technician’s skills in early detection of cases.

Availability of immediate treatment in government health institutions.

Expected results:

Increase the effectiveness of the early case detection strategy in governmental and private

health institutions.

Improvement in the accuracy of determining the source of infection.

Availability of treatment to all patients and prevention of the complication.

Strategies to Achieve 2n Objective: Prevention of epidemics due to vector borne diseases

2.1 Using Integrated Preventive measures:

Integrated Vector Control in the high risk areas.

National human resources development in the area of vector biology & control.

Continuous availability of chemoprophylaxis for travelers to highly endemic areas.

Expected results:

Reduction of the vectorial capacity of vector borne diseases.

Availability of qualified & trained national human resource in the area of vector biology &

control.

Protecting travelers to endemic areas from severe and complicated malaria.

2.2 Enhancement of the health awareness in the community through :

Increase health awareness in the community about the activities of the program

and the risk of ignoring their implementation.

Increase health awareness among the high risk population about the importance of

the early detection in prevention of disease’s complications.

Expected results:

Increase health awareness in the community about the disease, prevention methods and the

importance of early detection.

128


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Number of studies and experiments conducted. Annually 0 25

1.2a

Percentage of the slides examined in the

private health institutions to the total number

of slides examined.

Annually 21% 100%

1.2b Percentage of the slides diagnosed correctly to

the total number of slides. Annually 95% 95%

1.2c Number of travelers to high risk area who

received chemoprophylaxis. Annually 6130 25000


2.1a Number of epidemics due to vector-borne

diseases. Annually 0 0

2.1b Number of National staff qualified in

entomology and vector control. Annually 0 4

2.2a

Number of field visits conducted by the

directorate of malaria eradication for

monitoring and evaluation.

Annually 6 30

2.2b Number of awareness activities conducted. Annually 7 55

129

Domain Thirteen

Non- Communicable Diseases

130




Domain: Non- Communicable Diseases

INTRODUCTION:

Non-communicable diseases which are associated with patterns of lifestyle, such as

obesity, diabetes mellitus, hypertension, hyperlipidemia and metabolic syndromes represent a

challenge facing any regional or global health system.

Studies have shown a marked increase in diseases associated with unhealthy lifestyles over

the past ten years which represented by increase in the rate of smoking among males from

8.3% in 2000 to 14.7 in 2008. This reflected on the health sector in the form of an increase in

the prevalence of obesity and overweight, from 48% in 2000 to 52.9% in 2008, as well as an

increase in the prevalence of diabetes from 11.6% in 2000 to 12.3% in 2008. Also, the

prevalence of hypertension has increased from 33% in 2000 to 40.3% in 2008 while the

prevalence of hyperlipidemia has dropped from 40.6% in 2000 to 33.6%.

The complications of the above diseases represented a challenge to the health system, with

increased in the number of deaths due to heart disease during the Seventh Five Year health

Plan (2006-2010) to 220 deaths as well as the number of cases of chronic renal failure (end

stage) to 872 during the same period.

With regard to respiratory diseases bronchial asthma, has recorded the highest rates of

admissions, as well as obstructive airways disease was among the most common disease in

outpatient clinics. In addition, cancer represents the highest mortality rate among overall

mortality (about 250-300) deaths each year.

To face these challenges, the ministry adopted strategies and operational activities for the

prevention and treatment of chronic diseases in particular those associated with lifestyle. The

national strategy for Diet, physical activity and health, has been completed and will be

implement during Eighth Five Year Plan as well as different strategies to implement the

provisions of the Framework Convention for Tobacco Control, that signed by the Sultanate in

2005.

The implementation of early screening program for chronic diseases which was

implemented three years ago, in all primary health care units, is credited with the early

detection of pre-diabetes and hypertension, and subsequently early intervention aiming at

reduction of disease related complications.

The national screening programme has enhanced community awareness about these issues

which resulted in increase percentage of people that know there are diabetic to 63.8% and

high blood pressure to 24.3% in 2008 compared to 37% and 19% in 2000 respectively as well

as to the continued development of health services in the field of chronic diseases.

131

Targeted

situation

2015

Current

situation

2010

Past

situation

2005 Indicators

First Objective’s Indicators: To reduce the risk factors for non-communicable diseases

(diabetes, cardiovascular disease, chronic renal disease, asthma, cancer) associated life style and

reduce the steady increase in it

75% 52.8% 39.7%

Percentage of people over 20 years of

age doing regular physical activity

(more than 2.5 hours per week).

1.

10% 14.7% 8.7% Percentage of current smokers of

cigarettes (males only). 2.

40% 52.9% 48%

Prevalence of overweight and obesity in

the age group of more than 20 years.

3.

13% 12.3% 11.6% Prevalence of diabetes in the age group

of more 20 years. 4.

35% 40.3% 33% Prevalence of hypertension in the age

group of more than 20 years. 5.

30% 33.6% 40.6% Prevalence of high cholesterol in the age

group of more than 20 years. 6.

28% 38% NA

Prevalence of chronic kidney disease in

the age group of more than 40 years

according to the index of glomerular

filtration rate (eGFR) in the screening

progamme.

7.

The Ministry of Health has made great strides in the fight against tobacco use. The WHO

Framework Convention on Tobacco Control (FCTC), has ratified by the Sultanate and was

adopted by - Royal Decree No. 20 / 2005.This first application for it was to ban smoking in

enclosed public places since 1st April 2010.

OBJECTIVES:

1. To reduce the risk factors for non-communicable diseases (diabetes, cardiovascular

disease, chronic renal disease, asthma, cancer) associated life style and reduce the

steady increase in it.

2. Early diagnosis of non-communicable diseases (diabetes, hypertension, high lipid,

chronic renal disease, stroke, obesity, cancer).

3. Good control of non –communicable disease and reduce complications.

4. To promote researches and studies in the field of non-communicable disease.


132

Forth Objective’s indicators: To promote researches and studies in the field of non-

communicable disease

Available NA NA

The presence of an electronic database

for non- communicable diseases at the

national, the governorates and the

regional levels.

1.

3 1 0 Number of studies conducted in the area

of non-communicable diseases. 2.

Targeted

situation

2015

Current

situation

2010

Past

situation

2005 Indicators

Second Objective’s indicators: Early diagnosis of non-communicable diseases (diabetes,

hypertension, high lipid, chronic renal disease, stroke, obesity, cancer).

90% 63.8% 37%

Proportion of people who know that

they are diabetic in the age group of

more than 20 years.

1.

70% 24.3% 19%

Proportion of people who know that

they have high blood pressure, in the

age group of more than 20 years.

2.

0.25% 0.5% NA

Proportion of people with severely

deranged renal function test (eGFR <30)

among the screened in the national

screening programme.

3.

Third Objective’s indicators: Good control of non – communicable disease and reduce

complications

45% 36.1% 30% Proportion of diabetic patients with

good control of diabetes. 1.

55% 48% 42% Proportion of hypertensive patients with

good control of blood pressure. 2.

680 872 609 Number of patients with chronic renal

failure (end stage) on heamodialysis. 3.

100 22 NA

Number of patients with chronic renal

failure (end stage) on peritoneal

dialysis.

4.

12 14 15 Asthma admissions rate per 10000

populations. 5.

3 5 4 Stroke admission rate of per 10000

populations. 6.

5 12 30 Prevalence of Diabetic foot amputation

rate per 10000 patients. 7.

133

STRATEGIES:

Strategies to Achieve 1st Objective: To reduce the risk factors for non-communicable diseases

(diabetes, cardiovascular disease, chronic renal disease, asthma, cancer) associated life style

and reduce the steady increase in it

1.1 Implementation of the national strategy for diet, physical activity and health and

develop indicators to monitor and evaluate the activating of the Ministry of health in this

regards.

Expected results:

Reduce the proportion of non-communicable disease related to life style.

Increasing in the proportion of people doing regular physical activity.

1.2 Activating the Framework Convention for Tobacco Control.

Expected results:

Application of a national plan for tobacco control and work on legislation to reduce tobacco

use.

Reduction in the number of smokers.

Increased in trained staff to assist in smoking cessation.

1.3 Activate the national screening programme for non-communicable diseases.

Expected results:

Increased detection of cases in pre stage disease such as obesity, Pre-diabetes, pre-

hypertension.

Reduction in the incidence of chronic diseases associated with unhealthy lifestyle.

1.4 Increase manpower in nutrition and health education fields and to continue development

of their capacities.

Expected results:

• Increase health awareness in patients on non-communicable diseases.

• Improvement in quality of health care services provided for patients with non-communicable

diseases.

1.5 Expansion of well being clinics in primary health care to be 50 clinics by end of this plan.

Expected results:

Improve the quality of health services provided for diabetes and hypertension.

1.6 Expansion in Healthy Villages and Cities projects in collaboration with other sectors to

include at least one city and village, in each governorate or region.

Expected results:

• Increase number of people doing regular physical activity.

Strategies to achieve 2nd

Objective: Early diagnosis of non-communicable diseases (diabetes,

hypertension, high lipid, chronic renal disease, stroke, obesity, cancer).

134

2.1 Strengthens and activates the national non-communicable disease screening program, with

media coverage and solves the medical and administrative problems that prevent coverage of

the target groups and to start awareness campaigns, on the initial symptoms of stroke.

Expected results:

Achieve wider coverage of the target groups.

Increase in the number of chronic diseases detected.

Providing early appropriate treatment.

2.2 Start to include the age group of 30 to 40 years with high-risk factor for chronic diseases

(obesity, family history) within the national non-communicable disease screening program.

Expected results:

Increase the number of cases of chronic disease detected.

Providing early appropriate treatment.

Reducing the complications of these diseases.

Strategies to Achieve 3rd Objective: Good control of non –communicable disease and reduce

complications

3.1 Training and strengthening the manpower in the field of non-communicable diseases and

develop new jobs as medical assistance such as (Heamodialysis Technician ,Grader and

Retinal Photographer, Respiratory Therapist, Diabetes Nurse Specialist, Echocardiographic

Technician, Physiotherapist ,Speech Therapist.

Expected results:

Availability of qualified medical professionals for proper diagnosis and treatment in both

primary and secondary.

Availability of medical staff, to provide the best care for patients with non-communicable

diseases.

3.2 Expansion in specialty clinics by introducing new clinics in polyclinics and hospitals to

support the existing ones such as (Cardiology clinics – Transient Ischemic attack clinics –

asthma clinics – nephrology clinics – retinal clinics) conducted by specialists in the field.

Expected results:

Availability of better services at both primary and secondary levels.

Reduction in the number of cases transferred to hospitals.

Reduce the burden on the tertiary level.

Availability of clinics to follow up cases of Transient Ischemic Attack in the referral

hospitals

3.3 Consolidate health services for non-communicable diseases in polyclinics by providing

echocardiography machines, spriometry, digital camera for retina, and diagnostic

equipment to measure venous blood sugar, glycated hemoglobin and microalbuminuria.

Expected results:

Availability of better services at both primary and secondary levels.

Reduction in the number of cases transferred to hospitals.

Reduce the burden on the tertiary level.

135

3.4 Consolidate and expand the combined clinics that provide comprehensive medical

service to the patient, such as combined clinics for diabetes and pregnancy, diabetes,

nephrology clinics, hypertension and nephrology clinics.

Expected results:

Better care for high-risk patients.

Reducing the rate of complication among patients.

Providing optimal treatment for hypertensive patients, diabetes and chronic renal failure.

3.5 3.5Establish a medical team for diabetic foot surgery in Khoula Hospital and regional

hospitals.

Expected results:

Existence of an integrated medical team specialized in foot surgery.

3.6 Expansion in diabetic foot clinics to cover all health centers per 10000 populations.

Expected results:

Reduce the burden on referral hospitals

Reduction in the rate of foot amputation

Reduce the complications rate among patients

3.7Improve diabetic foot clinics so that to be able to perform the biomechanical of the foot and

nail surgery and establish four laboratories for diabetic foot in Sohar - Sur - Salalah – Nizwa.

Expected results:

* Reduction in the rate of foot amputation.

* Improve the quality of life for patients with diabetes

* Reduce the complications rate among patients

1.8 Prepare a national proposal for peritoneal dialysis services and assess the experience of

Sohar, Nizwa Hospital in this regard as a prelude to the adoption of the service at the

national level.

Expected results:

Adoption of peritoneal dialysis service at the national level.

Increase in cases of peritoneal dialysis for end stage renal disease.

3.9 Update the current practical manual and create new manual for the diagnosis and

treatment of non-communicable diseases.

Expected results:

Provide guidelines for medical professional for the diagnosis and treatment of non-

communicable diseases at the national level.

Strategies to Achieve 4th Objective: To promote researches and studies in the field of non-


4.1 Converting current paper records for non-communicable diseases to electronic records.

Expected results:

Provide detailed information about non-communicable diseases.

Provide optimum care based on the available data.

136


Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators


All regions 0 Annually Number of regions implemented the national

strategy for diet, physical activity and health. 1.1a

Available

1 NA Annually

Presence of a dietitian to follow the national

strategy for diet, physical activity and health. 1.1b

Available NA Annually Existence of legislation prohibiting the use

of trans fats in the Sultanate. 1.1c

Available NA Annually

Existence of legislation determining the

amount of absolute salt and the daily

requirement per person in processed foods.

1.1d

Available NA Annually Presence of a national law for the regulation of

tobacco use. 1.2a

5 1 Annually 1-2- b - Number of “quit smoking” clinics 1.2b

75% of box

value

33% of box

value Annually

percentage of the tax

rate on tobacco from retail sale price. 1.2c

70% 37% Annually Percentage of annual coverage of the target

group in the national screening program. 1.3a

70 40 Annually Number of Trained nutrition technicians on

the therapeutic feeding for chronic diseases. 1.4a

4.2 Create indicators to measure the quality of health services in non-communicable disease

such as quality indicators for dialysis - health education – nutrition - therapeutic

interventions for diabetic foot - curative and palliative services for cancer - emergency

services for myocardial infarction – Stroke.

Expected results:

Improve the quality of health services provided to patients.

4.3 Conduct researches to support medical practice in non- communicable disease with

evidence –based methodology.

Expected results:

Improvement of services in the area of non-communicable diseases.

Provide a database for decision-makers and planners.

137

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

50 15 Annually Number of well beings clinics in regions. 1.5a

8 4 Annually Number of Healthy Cities projects. 1.6a

Indicators of Strategies of 2nd Objective

70% 37% Annually

Percentage of annual coverage of the target

group in the national screening program in

group age of 40 years and above.

2.1a

50 NA

Annually

Number of campaigns and activities that have

been implemented to raise awareness for

early symptoms of strokes and patterns

of healthy life.

2.1b

1300 1093 Annually Number of new diabetic cases detected in the

age group 30-40. 2.2a

Indicators of Strategies of 3rd Objective


Availability of a uniform method for the

training of primary care and emergency

physicians to detect and diagnose patients with

stroke and early referral.

3.1a

150

30

22

120

35

11

11

0

0

0

0

0

0

0

Annually

Number of manpower:

- Heamodialysis Technician

- Grader and Retinal Photographer

- Respiratory Therapist

- Diabetes Nurse Specialist

- Echocardiographic Technician

-Physiotherapist

- Speech Therapist

3.1b

8 0 Annually Number of polyclinics that have cardiology

clinics. 3.2a

16 9 Annually Number of polyclinics that have asthma

clinics. 3.2b

138

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

12 6 Annually Number of polyclinics that have nephrology

clinics. 3.2c

20 13 Annually Number of polyclinics that have hypertension

clinics. 3.2d

All regional

hospitals 0 Annually

Number of regional hospital that have

transient ischemic attach (TIA) clinics. 3.2e

All regional

hospitals 1 Annually

Number of regional hospital that have stroke

treatment units. 3.2f

8 0 Annually Number of polyclinics that have retinal clinics

and using digital camera for retina. 3.2g

25

25

25

25

0

0

2

0

Annually

Equipment numbers:

- Echocardiography machines

- Spriometry

- Digital camera for retina

- Diagnostic equipment to measure venous

blood sugar, glycated hemoglobin and

microalbuminuria

3.3a

10 2 Annually Number of combined clinics for diabetes and

nephrology. 3.4a

4 0 Annually Number of hospitals that have medical team

for diabetic foot surgery. 3.5a

50 0 Annually Number of diabetic foot mini clinics in health

centers. 3.6a

4 0 Annually Number of advance diabetic foot clinics. 3.7a

100 25 Annually Number of patients treated with peritoneal

dialysis. 3.8a

10 6 Annually Number of practical manual of non-

communicable disease for primary health care. 3.9a

139

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

Indicators of Strategies of 4th Objective

1

1

1

0

0

0

Annually

Number of electronic register for non-


- Diabetes

- Chronic renal disease

- Stroke

4.1a

7 2 Annually Number of non-communicable disease

programs that have quality indicators. 4.2a

3 1 Annually

Number of researches based on evidence –

based methodology.

4.2b

140

Domain Fourteen

Eye Health

141




Domain: Eye Health

INTRODUCTION:

The bilateral blindness declined from 8.2% reported in 2005 to 5.6% in 2009 among 40

years and older Omani population. Elimination of blinding Trachoma is the reflection of

decline in the infectious eye diseases. Oman has applied in 2009 to World Health

Organization for certification that blinding trachoma is no more a public health problem. On

other hand low vision disabilities are rising in different age groups. This is due to changing

demography, epidemic of life style related health issues and high rate of birth defects.

The policy of the Ministry of Health for eye care is inspired by philosophy of VISION 2020

- The Right to the Sight. The health plans therefore aim to reduce the diseases leading to

blindness through early detection and appropriate interventions to reduce blinding

complications. It also favors improving preventive and curative services that are provided to

citizens at all health institutions. For this, developing human resources and modernizing

ophthalmic technologies for the diagnosis and treatment requires a reorganization of services

mainly at secondary and tertiary level of eye care centers.

OBJECTIVES:

1. To control factors leading to blindness in all age groups.

2. To Maintain Trachoma prevalence below WHO recommended standards for elimination of

blinding trachoma.

3. Reorganization of eye care services at all eye care levels specially the secondary and tertiary

levels to improve preventive, curative and rehabilitative eye health services.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To control factors leading to blindness in all age groups

1. Percentage of bilateral blindness

(<3/60) in 40 years and older citizen.

8.2%

5.6%

4%

2. Coverage rate of Refractive services for

school children (grade 1, 4, 7 & 10).

90%

95%

100%

142

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

3. Percentage of eye screening of patient

with diabetes.

80%

NA

100%

4. Percentage of glaucoma in the

population aged 40 years and above.

4.7%

NA

5%

Second Objective’s Indicators: Maintain active Trachoma prevalence below WHO recommended

level

1. Percentage of active Trachoma among

1st grade school children.

0.4%.

0.4%

Less then

0.4%

2.

Prevalence of Trachoma complications

among Omani population aged 15 years

and above.

4.1%

0.1%

0.1%

Third Objective’s Indicators: Reorganization of eye care services in all eye care levels specially

secondary and tertiary to improve preventive; curative and rehabilitative eye health services to

be compatible with VISION- 2020 THE RIGHT TO THE SIGHT.

1. Ratio of Ophthalmic Unit / 100,000

population.

1.6

2.0

2.0

2. Ratio of Ophthalmologists / 100,000

population.

4.8

5.0

5.0

3. Ratio of Refractionists and ophthalmic

nurses per 100,000 population.

2.7

3.0

3.8

4. Cataract Surgery Rate (/million

population/ year.) 2,210 1,400 3,000

5. Percentage of IOL implantation to total

cataract surgeries.

90%

95%

98%

6 Percentage of Diabetic patients with

STDR who underwent laser treatment. NA 50% 100%

7.

Percentage of children with low vision

who were provided low vision aid at

secondary/ tertiary care hospital.

NA

NA

100% of

cases

143

STRATEGIES:

Strategies to Achieve 1st Objective: To control factors leading to blindness in all age groups

1.1 To continue proactive eye examination of patients with chronic eye diseases and

diseases with priority in primary health care and to provide cadres (optometrist) capable

of early diagnosis to assess the vision and eye problems.

Expected results:

Early detection of the serious and blinding eye cases.

Reduction in incidence of diseases causing blindness.

Reduction in incidence of cases referred to central hospitals.

Reduction in rate of visual disability among children.

1.2 To co-operate with other ministries and private sector in order to reduce the incidence

of occupational and non occupational eye injuries.

Expected results:

Availability of data on rate of occupational & non occupational eye injuries in registration

under care of occupation health care directorate.

Improved awareness and preventive measures at work places with particular hazard to eye

among workers.

Existence of an international standard model for dealing with eye injuries and its reporting.

1.3 Introduce amblyopia (lazy eye) screening at age of 3-4 years of age.

Expected results:

Availability of complete data for the cases of lazy eye and poor vision.

Early intervention for the treatment of lazy eye if treatable.

Low percentage of children with congenital preventable blindness.

1.4 Comprehensive eye assessment of population aged 40 and above at eye units of

extended health centers for detection of glaucoma, entropion, dry eye, age related macular

degeneration, and cataracts.

Expected results:

Early detection of eye cases.

Early therapeutic and surgical intervention.

Reduction in rate of blinding complications associated with the disease detected.

1.5 To encourage community participating through different health committees and

supportive groups for eye health promotion and adoption of healthy lifestyle so as to

prevent eye diseases.

Expected results:

High sense of belonging and positive interaction of community with health service providers.

High level of community awareness and advocacy for adopting healthy lifestyles to prevent

eye diseases.

1.6 Annual eye examination for diabetic patients in all governorates, enhance documenting

diabetic retinopathy in all governorates and start the accountability system for retrieval of

DR cases causing blindness.

144

Expected results:

High proportion of DR cases detected.

Low proportion of cases of blindness due diabetes and retinal disorders.

Decline in cases of defaulters to follow-up for annual examination of the eye.

Decline in cases of defaulters to laser treatment of STDR and follow up.

1.7 To establish a system for co-operation between local and international health associations

and private sector.

Expected results:

Presence of a joint committee responsible for implementing a system for co-operation

between concerned authorities.

Joint efforts in the field of preventive ophthalmic care.

Increased participation of stakeholders to develop the eye health services.

1.8 To encourage private sector to provide eye health services by strengthening eye care

facilities.

Expected results:

Availability of efficient private sector with standard eye care services.

Reduction of workload on government health institutions for eye care.

Presence of collaboration between the two sectors for better delivery of eye care.

Strategies to Achieve 2nd Objective: Maintain active Trachoma prevalence below standard

level recognized by WHO

2.1 Continuation of early detection of cases of active trachoma among 1st grade students.

Expected results:

Maintain low levels of active trachoma transmission potential.

2.2 Continuation of addressing blinding trachoma through health services.

Expected results:

Maintain low levels of visual disabilities due to Trachomatous Trichiasis (TT).

Strategies to Achieve 3rd Objective: Reorganization of eye care services in all eye care levels

especially secondary and tertiary levels to improve the preventive, curative and rehabilitative

eye health services to be compatible with VISION- 2020 THE RIGHT TO THE SIGHT.

3.1 To provide latest diagnostic equipments, care facilities and surgical instruments to

governorate hospitals with special emphasis on sterilization system for micro surgical

instruments.

Expected results:

Improved resources for quality eye care in all governorates.

Rise in level of eye care and surgical techniques and modern methods of management and

quality of instruments.

Reduced cases transferred from other governorates to the tertiary eye care units at Muscat.

Increased life of instrument and equipment without damage due to faulty sterilization.

145

3.2 Strengthening and supporting eye health care services at the tertiary level by establishing

an eye bank for Corneal transplantation and a center for low vision.

Expected results:

Presence of a specialized and advanced eye care system in Oman.

Improved eye services at tertiary level.

Improved visual function and quality of life of low vision disabled.

3.3 Upgrading human resources at eye health care by continuous training and sending eye

doctors abroad for higher qualification/skills and active participation in international

conferences.

Expected results:

Improved services in all ophthalmic subspecialties in secondary/ tertiary eye centers.

Improved performance and access to the latest developments in the field of eye care.

3.4 Training and building capacity of eye health care staff:

(Optometrists, refractionists, ophthalmic nurses, ophthalmic assistants, eye surgery nurses,

specialist in low vision care, orthopticians, fundus photographers and graders, etc).

Expected results:

Availability of qualified Omani refractionists.

Highly efficient nursing staff at operation theaters, in-patient facilities and outpatient clinics.

Increase efficiency and productivity of eye specialists.

Early detection and intervention of refractive errors.

3.5 Expansion of ophthalmic services in institutions of secondary and tertiary care to increase

the surgical outcomes (quantitative and qualitative).

Expected results:

Comprehensive eye health care to citizens in different governorates.

Availability of high quality and skilled surgeries.

3.6 Provide technology needed for the comprehensive eye health care in the governorates by:

Provide a digital fundus camera in all eye units of the governorates and (OCT) to

one per governorate with the necessary facilities of electronic linkage to ‘centre for

diabetic retinopathy’ for review and evaluation.

Telemedicine and other facilities for evaluating eye diseases, especially diabetes,

glaucoma and other retinal disorders by providing labor force in all major areas

and link them with health care centers (the highest in the Muscat area).

Supply of consumables and IOLs of required types and adequate quantities to

governorates.

Establishment of laser unit for management of diabetic retinopathy in all

governorates.

Expected results:

Keeping pace with advances in eye health care.

Availability of state of art eye health services in all governorates.

Decreased work load on the tertiary eye care units.

146


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Rate of newly detected glaucoma cases. Annually 3.7% 5%

1.1b Number of newly detected Cataract cases. Annually 4,940 30,000

(6,000/year)

1.1c Prevalence of communicable eye diseases in

school children. Annually 0.1% >0.1%

1.2a

Presence of a plan and mechanism for

cooperation between the MOH and other

related sectors.

By end of

the current

plan

NA Available

1.2b Number of audio and visual messages about the

health of the eye. Annually 5/year 30

1.3a Number of cases of refractive defects of vision

and visual impairment among school students Annually 12,484 5,000/year

1.4a Number of newly detected glaucoma cases. Annually 2,790 4,000/year

1.4b Number of newly detected cataract cases. Annually 4,940 30,000

(6,000/year)

1.5a Availability of a joint committee for eye health.

By the end

of current

plan

Available Available

1.5b Number of wilayat with plans to raise

awareness about eye health. Annually 10 All wilayat

1.6a Number of newly detected cases of Diabetic

Retinopathy. Annually 2243 9000

1.7a Availability of a joint committee for eye health.

By the end

of current

plan

NA Available

1.7b Number of annual meetings between program

in-charge & private sector DG. Annually 0 5

1.8a Number of private eye clinics. Annually 25 35

147

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


Objective

2.1a Existence of a committee to follow and report

cases of trachoma. Annually

Available but

need to be

activated

Available and

active

2.2a Percentage of schools with active trachoma

cases in first grade. Annually 64% 100%

2.3b Percentage of health institutions to report cases

of active trachoma. Annually 90% 100%


Objective

3.1a Percentage of governorates having a well

equipped Ophthalmic Unit. Annually 70% 100%

3.2a Availability of Eye Bank.

by end of

the current

plan

NA

Eye bank

present &

functioning

3.2b Availability of Low vision care unit.

by end of

the current

plan

NA 1

3.3a Number of Omani trained in sub-specialties. Annually 3 10

3.3b

Number of Omani Ophthalmologists

participated with researches in International

Conferences.

Annually 3 15

3.3c Number of Omani Ophthalmologists

participated in International Conferences. Annually 10 50

3.3d Number of Omani doctors in Ophthalmology

residency program under OMSB. Annually 7 20

3.3e Number of Courses conducted in the field of

eye health Annually 7 20

3.4a Number of Omani trained as Optometrist or

refractionist. Annually 21 70

3.4b Number of Omani trained as mid level care in

eye services.

by end of

the current

plan

NA. 120

3.5a Number of governorate hospital with eye units. Annually N.A

All the

governorate

hospitals

148

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

3.6a Number of Wilayat hospitals with eye units &

surgical facilities. Annually 0 2

3.7a Number of extended health centers or

polyclinics with digital fundus camera. Annually 2

All the

centers

3.7b Number of governorates with laser facilities. Annually 8 All the

governorates

149

Domain Fifteen

Ear Health

150




Domain: Ear Health

INTRODUCTION:

The 8th- 5 year Health plan‟ aimed at preventing hearing loss (HL) and addressing

causes of hearing impairment. Hence MOH focused on strengthening health services so as

to provide health services of high standards to citizen of all ages. Hearing screening of

newborn had started in all governorates

MoH saved no effort in applying measures for prevention of ear diseases leading to

hearing loss by early detection and management of ear diseases to prevent complications.

This was achieved through improving preventive and therapeutic services in all MoH

institutes by keeping ENT medical specialties up to date and using the highest technology

medical equipments for diagnosis and treatment, and as a result, the surgical intervention

for middle ear diseases increased progressively.

It is also worth mentioning achievement, the start of cochlear implant surgeries for the

first time in sultanate by Omani surgeons with highest international surgical faculties and

re-habilitation of such cases after surgery by specialized Omani audiologists and speech

and language pathology.

OBJECTIVES:

1. Prevention of Hearing loss among all Omani population.

2. Treatment and rehabilitation of patients with hearing loss.

151


Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective’s Indicators: Prevention of Hearing loss among all Omani population

4.5% NA 5.5%

(1996 survey)

Prevalence survey for hearing loss in

the community. 1.

20% 24 27%

Percentage of hearing loss cases

registered at ENT out-patient

departments in MOH institutes.

2.

100% 98.7% 24.3

Percentage of newly born screened

babies for hearing loss to the total

newly born.

3.

0.3% 0.4% 0.5% Percentage of hearing loss cases among

newly born screened babies 4.

< 0.1% 0.2% 0.2% Percentage of hearing loss cases among

screened school children. 5.

3 NA 8 Rate of cases of OME per 1000

population. 6.

<1 NA 3 Rate of cases of CSOM per 1000

population. 7.

Second Objective’s Indicators: Treatment and rehabilitation of patients with hearing loss

50% NA 13.2%

Percentage of Middle ear surgeries for

restoration of hearing out of all ear

diseases.

1.

>90% 83% 70% Percentage of cases with improved

hearing after surgery. 2.

50% 30% 25% Percentage of cases successfully

rehabilitated out of all cases with HL. 3.

152

STRATEGIES:

Strategies to Achieve 1st Objective: Prevention of Hearing loss among all Omani population

1.1Newborn Screen for Hearing in all MoH hospitals and health institutions with

maternity beds.

Expected results:

Early detection of cases with Hearing loss.

1.2 Hearing assessment for all pre-school age children at primary health care centers.

Expected results:

Establishing Data base for hearing problems in this age group.

Early detection, treatment and rehabilitation of cases.

1.3 Ear care programme for Training of all Doctors working in primary health care

centers.

Expected results:

Early detection of ear diseases leading to hearing loss.

1.4 Health promotion about prevention and care of ear diseases through mass media.

Expected results:

Increased awareness among community regarding ear diseases and their prevention.

1.5 Issuing health education booklets and leaflets for ear diseases and prevention methods.

Expected results:

Improved health education material and increased awareness about ear diseases.


Objective: Treatment and rehabilitation of patients with hearing loss

2.1 Sending Omani Doctors for studying and training abroad in ENT specialty.

Expected results:

Availability of Omani ENT specialists.

Providing highly specialized medical services.

2.2 Training medical personnel from regional areas in audiology and speech disorders (8 in

Muscat, 4 from each category and 2 in every ENT set up, 1 from each category).

Expected results:

Providing services of audiology and speech and language disorders in all regions.

153


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Percentage of newly born babies screened for

HL in all hospitals and maternity centers. Annually 88% >95%

1.2a Percentage of school age children screened for

HL in all primary health centers every year.

Annually 98% 100%

1.3a Number of Workshops in ear care held for

doctors working in primary health centers.

Annually 2 10

1.4a Number of session on ear care in mass media. Annually 2 5

1.5a Number of distributed booklets copies of ear

diseases. Annually

3 3


2.1a Number of Omani doctors trained in ENT

specialty. Annually 3 15

2.2a Number of trained personnel from regions in

audiology and speech and language disorders. Annually 6 25

154

Domain Sixteen

Oral and Dental Health

155




Domain: Oral and Dental Health

INTRODUCTION:

Oral health is a state of well-being of the oral cavity. This means improving good

teeth and supportive tissues is integral to general health and essential for better health. It

implies being free of chronic oro-facial pain, oral and pharyngeal (throat) cancer, oral

tissue lesions, birth defects and other diseases and disorders that affect the oral, dental and

craniofacial tissues. It is a direct reflection of the health of the entire body and the

interrelationship between oral and general health is proven by evidence.

Dental caries is the most common disease in the world and this is due to the rapidly

changing socioeconomic and political conditions, shifting in nutrition behavior from

traditional towards more westernized diet high in sugars, coupled with ubiquity of

tobacco, inadequate application of preventive measures and an inappropriate establishment

of oral health care delivery systems.

Oral Health surveys have showed that 1 out of every 4 children in the age 5 – 6 years

had dental caries. This percentage rises to 90% in low socioeconomic countries. Dental

caries has a great impact on the child nutrition and performance in school. Children who

suffer from dental pain are 12 times more likely to be late or absent from school than

healthier children. Dental diseases reflect the nutritional and behavioral state of the

community.

In 1975 they were only 6 dentists providing oral health care in Oman. Now days there

have been a significant increase in the dentists in Oman. The 2010 reports showed the

number of dentists rise up to 654. In the past, the Oral health services were providing

curative treatments only and rarely directed towards the causes of the disease. This was

mainly due to the lack of oral health care workers. In the recent years, Ministry of Health

adopted a proper planning and strategies to fight the causes of oral and dental diseases and

preventing the diseases at an early age to avoid the high cost of treatments. These

strategies have developed to be provided within the primary oral health care.

The surveys conducted by Ministry of Health in 2009 have showed the percentage of

oral diseases were reached 88% for 6 years old children, with caries index average 4.4 in

primary dentition. Also the caries index average has shown huge decrease in oral diseases

around 51% in permanent teeth for 12 years old children and the mean of caries index

(DMFT) was 1.3 in 2006 comparing to 2001 in which the percent of oral diseases were

over 70% and the mean of caries index was 1.65.

156

This improvement in oral health indicators is another evident of good planning to

prevent the oral diseases at an early age, in order to reduce the high cost of advanced

treatments. This plan will move forward to reduce the percentage of dental caries to reach

world class standards. Therefore, this plan will give us great opportunity to ensure

providing the best dental care based on the latest scientific methods applied by Ministry of

health.

OBJECTIVES:

1. Improving Oral and Dental Health services provided to priority groups in the community.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: Improving Oral and Dental Health services provided to priority

groups in the community.

1. Ratio of Dental Surgeons per 10,000 of

Omani population. 0.97 0.76 1

2.

Caries Index – deft [decayed, extracted,

filled Primary teeth] for 6 years old

children.

5 4.4 4

3.

Average carious teeth among:

12 years old children.


1.5

2.8

1.1

1.7

1

1.5

4.

Average missing teeth among:



0.1

0.33

0.1

0.2

0.1

0.2

5.

Average filled teeth among:



0.1

0.11

0.1

0.1

0.2

0.2

157

STRATEGIES:

Strategies to Achieve 1st Objective: Improving Oral and Dental Health services provided to

priority groups in the community

1.1Provision of comprehensive primary health care to Omani population across the Sultanate

including (preventive & restorative treatments, extractions, periodontal therapy, oral

prophylaxis and single rooted canal treatments).

Expected results:

Improvements in the oral health status in the community.

Dental caries reduction.

Increase the restored tooth.

Decrease in the percentage of extracted teeth.

Improvements in the Oral cavity cleanliness.

1.2 Training of staff in extended programme of quality assurance and epidemiology in

directory of Dental and Oral Health Department-Ministry of Health.

Expected results:

Increase the quality of the provided services.

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

6.

Percentage of treatment needed for 12

years old children.

[Unmet Restorative Index = 100 -F/

(D+F) x 100].

93.8% 91.7% 87%

7. Percentage of care provided.

[Care Index = F/DMF x 100]. 6% 7.7% 9%

8.

Percentage of the children affected by dental caries at age of:

6 years 84.5% 88% 85%

12 years 70% 51% 45%

15 years 73.2% 60.5% 55%

9.

Percentage of children (6-7 years) at

High Risk of developing dental caries

[deft > 5].

45% 33% 30%

10.

Percentage of children (6-7 years)

receiving preventive oral health

treatment.

33% 94% 100%

158

1.3 Training of dentists specialized in oral and dental health in primary health care centers.

Expected results:

Increase dentists‟ skills and ensure providing advanced dental services.

1.4 Provide secondary services for OMFS and Orthodontics in referral hospitals.

Expected results:

Increase the level of provided dental care across the Sultanate.

1.5 Training of the Extended Programme for Immunization (EPI) nurses & Health educators

in primary health care centres to provide oral health promotion to mothers regarding child

dental health for 6 months-5 years of age.

Expected results:

Reduction of dental caries in primary teeth.

1.6 Regular inspection & monitoring of the fluoride level to ensure 0.5-0.8 p.p.m. of Fluoride

level in drinking water.

Expected results:

50% Reduction in the prevalence of dental caries in the fluoridated communities.

1.7 Provision of oral health care to special need groups.

Expected results:

Improvements in the oral health status of this group.

1.8 To continue the preventive school oral health programme directed to the grade one & Two

school children (Topical fluoride application twice a year for the medium & high risk children

and fissure sealant to the high risk children).

Expected results:

Protecting the permanent teeth from early carious lesions.

Oral health education to grade one & two schoolchildren.

1.9 Strengthening the tooth brushing drills for grade one schoolchildren.

Expected results:

Increased awareness of schoolchildren towards oral diseases.

1.10 Conducting annual Oral Health Promotion campaigns for schoolchildren and the

community.

Expected results:

Increasing health awareness, community involvement and the private sector to improve the oral

health.

159


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Ratio of Dental Units per 10,000 of the Omani

Population. Annually 0.67

0.8

1.2a

Number of Trained Dentists/Staff in Quality

assurance and Epidemiology in Directory of

Dental and Oral Health Department.

End of the

current

plan

0

1 Quality

Assurance and

1

Epidemiology

1.3a Percentage of specialized dentist in primary

health care. Annually 0

5%

1.4a Percentage of regions that have Orthodontic

and OMFS units. Annually 0

20%

1.5a Number of training courses for the EPI nurses

and health educators in primary health care

centres.

Annually 13 136

1.6a Percentage of population receiving fluoridated

water. Annually 24%

50%

1.7a Percentage of Special Care Needs Groups

receiving regular Dental Care. Annually 58%

70%

1.8a Percentage of schools receiving the preventive

school oral health programme. Annually 88%

100%

1.8b 1-8-b- Percentage of screened children in the

preventive school oral health programme. Annually 88%

100%

1.8c Percentage of sealant retention after one year

of placement.

Every two

years 38%

75%

1.8d Percentage of grade one & two schoolchildren

received fissure sealant. Annually 65%

80%

1.8e Percentage of grade one & two schoolchildren

received biannual topical fluoride application. Annually 94%

100%

1.9a Percentage of grade one & two schoolchildren

received toothbrushes and toothbrushes drills. Annually 100%

100%

1.10a Number of Oral Health Promotion Campaigns. Annually 30 170

160

Domain Seventeen

Mental Health

161




Domain: Mental Health

INTRODUCTION:

Mental health services in Oman are provided through the three levels of health care:

Primary, Secondary and Tertiary Care. This ensures the provision of adequate, effective and

good level mental health care for all citizens.

Primary psychiatric care is provided through all the primary health centers. Secondary

psychiatric care is provided through outpatient psychiatric clinics in all the regional hospitals

and Extended Health Centers. Ibn Sina hospital provides tertiary psychiatric care to all

referred cases from all parts of the Sultanate. It also provides secondary psychiatric care to the

population of the Governorate of Muscat. In addition, the Psychiatric Emergency Section of

Ibn -Sina hospital provides round the clock emergency psychiatric care.

The focus of the eighth Five-Year Plan for Health Development (2011-2015) is to

further improve the standard of care by providing more specialized care for the patients and to

address a number of common psychiatric problems that have been identified through analysis

of statistics and morbidity trends in the Arabian Gulf States and other neighboring Middle

Eastern countries.

An improved standard of care is ensured by the process of continued service upgrades

and continued technical training that is being done for all levels of health providers.

Implementation of the policy of decentralization and autonomy for all hospitals under the

Ministry of Health has led to the provision of health services at regional hospitals under local

regional control so there is a need to create a system for evaluating the quality of psychiatric

services provided in the autonomous regional hospitals. This would ensure the provision of an

equally high standard of care from every hospital. It would also be possible to then apply the

same indicators in the different regions in order to assess and compare the quality of

performance among them.

Ibn Sina Hospital is the only tertiary care psychiatric hospital that provides inpatient

care to the population of Oman. It has only 89 beds, and this is grossly inadequate for the

needs of the country. Establishing a new 245 beds psychiatric hospital is included as a priority

of this plan. With an adequate number of beds, specialized services, emphasis on

rehabilitation and staff training this hospital will provide the highest international standards of

psychiatric care to the patients in Oman.

162

OBJECTIVES:

1. To improve the quality of mental health services provided to adults for some of the prevailing

psychiatric disorders (schizophrenia, anxiety, and depression).

2. To improve the quality of mental health services for psychological, behavioral, and learning

disorders of children and adolescents.

3. To reduce the incidence of substance dependence and its harmful consequences.


Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective’s Indicators: To improve the quality of mental health services provided to adults

for some of the prevailing psychiatric disorders (schizophrenia, anxiety, and depression).

5% Not applicable Not applicable

Percentage of new patients with anxiety

disorders to the total number of new

patients attending the primary health

care centers.

1.

5% Not applicable Not applicable

Percentage of new patients with

depressive disorders to the total number

of new patients attending the primary

health care centers.

2.

20% 23% 36%

Percentage of new patients with anxiety

disorders to the total number of new

patients attending the psychiatric

clinics.

3.

20% 20% 30%


depressive disorders to the total number

of new patients attending the psychiatric

clinics.

4.

20% 11.8% 22%


schizophrenia to the total number of

new patients attending the psychiatric

clinics.

5.

20% 26% 12%

Percentage of patients with depressive

disorders admitted to central hospital to

the total number of patients admitted.

6.

163

Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

30% 28% 40%

Percentage of patients with

schizophrenia admitted to central

hospital to the total number of patients

admitted.

7.

Second Objective’s Indicators: To improve the quality of mental health services for

psychological, behavioral, and learning disorders of children and adolescents.

10% 8.6% 3%

Percentage of children new patients with

behavioral, mental, and learning

disorders to the total number of patients

attending Psychiatric Clinics.

1.

12% 10.7% 1%

Percentage of adolescent new patients

with behavioral and mental disorders to

the total number of patients attending

Psychiatric Clinics.

2.

Third Objective’s Indicators: To Reduce the incidence of substance dependence and its

harmful consequences

6% 1.17% 2%

Percentage of new patients with alcohol

dependence to the total number of new

patients attending the central hospital.

1.

10 % 3.2% 0.3%


dependence on substances other than

alcohol, to the total number of patients

attending the central hospital.

2.

100 Not applicable Not applicable

Number of addictive patients that

treated in rehabilitation departments of

the central hospital.

3.

100 Not applicable Not applicable Number of Opioid dependent patients

on replacement therapy. 4.

20% Not applicable Not applicable Percentage of patients who drop out

from replacement therapy. 5.

164

STRATEGIES:

Strategies to Achieve 1st Objective: To improve the quality of mental health services

provided to adults for some of the prevailing psychiatric disorders (schizophrenia,

anxiety, and depression).

1.1Mental Health Act legislation and put it under implementation.

Expected results:

The existence of clear definitions to the legal rights of patients, including the right of

authorizing the consent with respect to mental health and means of treatment.

A precise legal definition of the duties and rights of workers in the field of mental health.

A precise legal criterion for the treatment of patients and cases requiring compulsory

treatment.

1.2 Implementation of the program of integrating mental health in primary health care.

Expected results:

Accessibility to mental health services for the majority of patients in all parts of the

Sultanate.

Reducing the work load on health complexes and reference hospitals in the regions.

Reduction of the work load on the central psychiatric hospital.

Improve the communication between medical staff and patient's families to maintain

remission.

Reduce the impact of stigma on patients.

Decrease the frequency of exacerbations of mental illness.

1.3 Establish mental health departments in reference hospitals in some regions (North

Batna, Al-Dakhilya).

Expected results:

Accessibility to diagnostic and therapeutic services provided by specialist psychiatrists and

social workers and maintenance of adequate follow up of patients.

Ensure patient follow-up by the same medical staff after discharge from the hospital and this

has a great effect on the continuation of patient treatment and enhance patient's adherence to

treatment.

. Improve communication with families of patients to follow up the patient within his family

and social surroundings.

Decrease the burden of the patient's transfer to the central hospital and residence in.

Reduce the large number of patients and the length of waiting lists in the central hospital.

1.4 Open mental health clinics in all health complexes in the Willayets.

Expected results

Improve the quality of mental health services at secondary health care level.

Improve communication with patients and their families, and lessening the impact of social

stigma on patients.

165

1.5 Establishment of a new Psychiatric Hospital providing tertiary care services and highly

specialized mental health care services.

Expected results:

The provision of mental health service capable of accommodating patients from all over the

Sultanate.

Provision of psychiatric sub specialized services (forensic psychiatry, childhood and

adolescence psychiatry, old age psychiatry).

Improve rehabilitation services for the patients with mental illness.


Objective: To improve the quality of mental health services

for psychological, behavioral, and learning disorders of children and adolescents.

2.1 Training of primary health care physicians to diagnose and treat mental illnesses of

children and adolescents.

Expected results:

Early diagnosis and management of mental and behavioral disorders in children and

adolescents.

Reduction of the impact of mental and behavioral disorders in children and adolescents on

their social, educational functioning.

2.2 Training of primary health care nurses to care for children and adolescents with

mental and/or behavioral disorders.

Expected results:

Early and adequate management of mental and behavioral disorders in children and

adolescents.



2.3 Opening of Psychiatric and behavioral Clinics for children and adolescents in the

health complexes and reference hospitals.

Expected results:

Early diagnosis and management of mental and behavioral disorders in children and

adolescents.



2.4 Opening of a center for psychological counseling for children and adolescents in Al-

Dakhilya region.

Expected results:

Prevention of psychological, educational, social and behavioral problems among students.

Provision of support and counseling services to children, adolescents and their families.

2.5 Training of social workers in schools on how to identify mental and behavioral

disorders in students and how to manage them.

Expected results:

Increase the capacity and efficiency of social workers to deal with students who suffer from

mental disorders.

Expansion and development of mental health services for school students.

166

2.6 Training of school health physicians on diagnosis and management of mental,

behavioral and learning disorders among students.

Expected results:

Improve the ability of school health physicians to diagnose and manage mental, behavioral

and learning disorders among students.

2.7 Training of psychiatrists in secondary and tertiary care on child & adolescent

psychiatry.

Expected results:

Improvement of the scientific level and professionalism of psychiatrists in the field of

psychiatry and behavioral sciences related to children and adolescents.

Strategies to Achieve 3rd

Objective: To Reduce the incidence of substance dependence

and its harmful consequence

3.1 Implementation of the Program (prevention and treatment of drug dependence) in

some of the regions/governorates.

Expected results:

Reduction of the problem of addiction in society.

Reducing the rate of relapse cases & reduction of the rate of infectious diseases resulting

from the use of injectable drugs.

3.2 Initiating replacement therapy for patients dependent on opium or its derivatives

(central hospital).

Expected results:

Reduction of infectious diseases resulting from the use of contaminated heroin injections

(viral hepatitis. AIDS).

Reduction of mortalities resulting for heroin overdose.

3.3 Open sections for vocational rehabilitation, social and life skills training for alcohol and

drug dependents.

Expected results:

Rehabilitation of the addict and training on social, vocational and family activities for the

purpose of providing the social environment, which assists in the abandonment of addiction.

167


Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators


Available and

active NA Annually Presence of Mental Health act. 1.1a

100% 4% Annually

Percentage of primary health care physicians

trained on diagnosis and management of

mental disorders.

1.2a

50% 1% Annually

Percentage of primary health care nurses

trained on diagnosis and care provision for

patients with mental disorders.

1.2b

10% Not

applicable Annually

Percentage of cases with mental disorders

diagnosed and treated in primary health care

centres to the total number of cases.

1.2c

3 1 Annually

Number of reference hospitals at regions

/governorates with established mental health

sections.

1.3a

21 19 Annually Number of polyclinics that have mental health

clinics. 1.4a

50 28 Annually Number of psychiatrists working in

regions/governorates. 1.4b

300 157 Annually Number of psychiatric nurses in central

psychiatric hospital. 1.4c

50 29 Annually Number of psychiatric nurses in regions/

governorates. 1.4d

10 Nil Annually Number of social workers in psychiatric

clinics of regions/ governorates. 1.4e

Available NA Annually Establishment of new central psychiatric

hospital. 1.5a


Objective

100% 4% Annually

Percentage of primary health care physicians

trained on children and adolescents mental

health to the total number of primary health

care physicians.

2.1a

168

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

50% 1% Annually

Percentage of primary health care nurses

trained on children and adolescents mental

health to the total number of primary health

care nurses.

2.2a

10 2 Annually Number of children and adolescents

psychiatric clinics. 2.3a

1 0 Annually Number of psychological counseling centers

for children and adolescents. 2.4a

50%

5% Annually

Percentage of school social workers trained

on children and adolescents mental health. 2.5a

100%

4% Annually

Percentage of school health physicians trained

on children and adolescents mental health. 2.6a

100%

10% Annually

Percentage of general psychiatrists trained on

children and adolescents mental health. 2.7a


3 2 Annually

Number of regions/governorates that

implement the program for the prevention and

treatment of addiction.

3.1a

100 Not

applicable Annually

Total number of addictive patients treated by

drug replacement therapy. 3.2a

20% Not

applicable Annually

Percentage of patients who drop out from

drug replacement therapy. 3.2b

100 Not

applicable Annually

Number of addictive patients that had been

rehabilitated in rehabilitation centers (central

hospital).

3.3a

169

Domain Eighteen

Genetic Diseases

170




Domain: Genetic Diseases

INTRODUCTION:

As the knowledge of genetics expands with an increasing pace, the advances in Human

Genetics are translated into Disease Prevention and Health Promotion worldwide.

Genetic services are recognized as being important in maintaining high quality medical

service for the population and are an efficient tool to prevent genetic disease, reducing

mortality and handicap and saving national health and social resources.

Availability of the Genetic Service and Genomic Technologies increase chances of every

Omani family to have healthy children and ensure early and proper care for those affected by

adult onset disorders. Also each individual genetic disease is rare event, but overall

prevalence of inherited diseases is high due to extremely large variety. High prevalence of

genetic disease in Omani community makes it impossible to be managed by research

institutions and becomes an important service obligation.

The preventive measures that can reduce the risk of genetic diseases among high risk

people are available now, which can lead to a progress in the field of individual preventive

medicine. Laboratory tests and genetic examination are now used to anticipate individual‟s

predisposition to adult onset disorders and patient‟s response to medicines. As a result of all

these new developments, “Genetics” will occupy a central position in the practice of clinical

medicine and public health in the near future. Genetic conditions are found worldwide and a

common knowledge is that every human on Earth has few genetic imperfections.

Community based survey performed in 2010-2011 as needs assessment procedure for

congenital and multifactorial disorders in Omani community. The figures of morbidity and

mortality in newborns, infants and children reflect the situation in traditional Omani

community where communicable diseases were successfully controlled and prevention

measures for genetic disorders is in a preparation phase. Current study confirmed genetic and

congenital disorders being major contributors to morbidity, mortality in handicap (Figure 1).

Learning difficulties; 8%

Intellectual disability; 37%

Genetic Blood disorders; 15%

Inborn errors of metabolism and

rare disorders; 6%

Congenital anomalies; 13.30%

Congenital deafness and

blindness; 10.30%

Isolated physical disability; 44%

Other; 7%

171

The prevalence of handicapped children in Oman increases progressively due to presence of

comprehensive health care system and improvement in quality of life. The number of

surviving affected children increases alongside the annual birth cohort, causing a

considerable burden on the healthcare services.

PRIORITIES

1. Intellectual and physical disabilities due to various groups of disorders:

chromosomal rearrangements, congenital malformation syndromes, inborn errors of

metabolism, neurodegenerative diseases, congenital myopathies, skeletal

dysplasia‟s, dermatological conditions, congenital blindness and deafness. These

diseases have long-term impact on public health and community. Consequently,

necessary actions should be taken by public health to prevent these diseases as the

number of disabled people may increase 5 – 10 times in the next 50 years.

2. Genetic blood disorders: Around 10% of Omani people are carriers of gene of

sickle cell anemia and 3% are carriers of gene of Beta-thalassaemia. Approximately

120 children are born yearly with sickle cell anemia and 20 with Beta-Thalassaemia.

It is expected that through the next 10 years the number of the cases will increase

to be 1200 cases of sickle cell anemia and 200 cases of thalassaemia if the

preventive measures are not provided. The curative management of all these new

cases could cost about $17 million yearly while provision of preventive methods

cost about 10% of this sum. One case of Beta-Thalassaemia or two of sickle cell

anemia may save $ 500.000.

3. Care for affected by malignancies.

a. Familiar cancers: From 10 to 20% of cancer cases are familiar so more studies

and specific preventive approaches are needed. Breast Cancers and Colon Cancers

are common.

b. Hematological Cancers care

4. Adult onset disorders

Diabetes mellitus: About 20% of Omani population is suffering from diabetes

mellitus which means more studies are needed to identify the specific genetic

predisposing factors.

OBJECTIVES:

1. Provision of effective preventive measures and developing Molecular Genetic

technology expertise capable of supporting local effective prevention programs.

2. Improving the quality of the services provided in the field of genetic health.

3. Provision & expanding of premarital examination to reduce the prevalence of genetic

diseases and congenital malformation.

4. To raise the public awareness of genomic technology and its benefits. To continue

genomics education, capacity building and training in new technologies;

172


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: Provision of effective preventive measures and developing Molecular

Genetic technology expertise capable of supporting local effective prevention programs

1. Percentage of newborns with genetic

diseases or congenital malformation. 10% 10% 5%

2. Rate of cases of Sickle Cell Anemia /

1000 population. 2.4 2 1

3. Rate of Thalassaemia cases /1000

population. 0.4 0.3 0.1

4. Rate of Down syndrome / 1000

population. 2 2.3 1

5.

Percentage of moderate to severe

mental retardation cases among children

below 15 years.

5% 5% 2%

Second Objective’s Indicators Improving the quality of the services provided in the field of genetic

health.

1. Number of Scientists sent abroad for

studying genetic sciences. NA 2 5

2. Availability of Quality assurance

program in the field of genetic health. NA NA

Available

&applied

3. Availability of Tandem mass test. NA NA Available

&applied

Third Objective Indicators: Provision of premarital examination to reduce the prevalence of

genetic diseases and congenital malformation

1.

Percentage of primary health institutions

providing premarital examination

services.

10% 20% 50%

Fourth Objective Indicators: To raise the public awareness of genomic technology and its benefits.

To continue genomics education, capacity building and training in new technologies

1. Percentage of Secondary schools where

genetic education was introduced. 20% 40% 100%

2. Percentage of couples had been

counseled premarital. 1% 5% 50%

173

STRATEGIES:

Strategies to Achieve 1st Objective: Provision of effective preventive measures and developing

Molecular Genetic technology expertise capable of supporting local effective prevention

programs.

1.1 Establishing facilities in a National Genetic Center to provide Clinical and Laboratory

diagnostic services carry on Prevention Programs besides conducting training activities and

researches in the field of genetic health.

Expected results:

Availability of local diagnostic services and prevention programs of high quality.

Clinical Genetic Consultation provision in Regions.

1.2 Presenting base line data about genetic diseases and congenital malformations.

Expected results:

Hospital-based data is available. Population-based data is required.

Central notification of congenital and genetic disorders.

DNA storage facility.

1.3 Records of community prevalence of genetic diseases, congenital malformations and

handicap.

Expected results:

Monitoring birth prevalence of genetic diseases and cong anomalies in order to assess

efficiency of the prevention programmes.

1.4 Training Omani nationals in Clinical Genetics and Laboratory Genetic Technology.

Expected results:

Acquiring national expertise in Molecular Genetics and Health Biotechnology for disease

prevention and provision of high standard of Medical Care in Oman.

1.5 Draw National Policy regarding Genetic and Congenital Disorders in the Sultanate.

Expected results

Availability of National Policy regarding Genetic and Congenital Disorders

1.6 Coordination with other Health programms within Ministry of Health, other Ministries

and the Omani community in prevention of handicapping genetic disorders.

Expected results

Comprehensive national effort to prevent handicapping genetic disorders.


Objective: Improving the quality of the services provided in the field of

genetic health.

2.1 Development of external quality assessment scheme and accreditation scheme for genetic

laboratories.

Expected results:

Reach international standard capacity for diagnosis and carrier testing in families affected by

genetic disorders.

Reach the international quality standard of genetic tests.

Establishing quality control scheme in National Genetic Center.

174

2.2 Establish genetic laboratories and technologies of international quality in National

Genetic Center.

Expected results:

Availability of modern gene testing technology Satisfy requirements of Health Care in genetic

testing in: ( Haemoglobin disorders ,Tumor markers for Hematological Cancer patients, Mental

retardation, Breast Cancer, Colon Cance, Cardiogenetics, Neurogenetics, Immunogenetics,

Others).

2.3Continue education& professional training for Omani Nationals in Clinical and Laboratory

Genetics.

Expected results:

Availability on national manpower in Laboratory Genetics, Bioinformatics, Clinicalgenetics,

and Councelling to satisfy requirements of Oman Healthcare and maintain high standars of

Medical care in the Sultanate.

2.4 Conduct Research in genetics and epidemiology of handicapping genetic disorders, and adult

onset disorders of high impact.

Expected results:

Effective planning of genetic services and effective prevention strategies to improve health of

Omani population.


Objective: Provision & expanding of premarital examination to reduce

the prevalence of genetic diseases and congenital malformation

3.1 Training of the primary health care staff on premarital examination and counseling for

hemoglobin disorders and intellectual disability.

Expected results:

Presence of trained health staff in premarital counseling and Health Education in genetic health.

3.2 Establishment of special clinic in each region (in addition to 6 wilayat of Muscat) to provide

premarital examination services in order to prevent congenital and genetic disorders among

those planning for marriage.

Expected results:

The premarital examination services are available for all couples throughout the Sultanate.

3.3 Increase capacity (manpower, equipment and consumables) of laboratories at secondary

Care (Regional Hospitals) in premarital testing for Haemoglobin Disorders (HPLC for Sickle

Cell, Beta-Thalassaemia diagnostics) and G6PD deficiency.

Expected results:

Available manpower and equipment (HPLC equipment, lab technicians, councellors and

statistical registration), and consumables for Premarital testing for Sickle Cell and Beta

Thalassaemia.

3.4 Introduce Basic Genetics and Counseling skills in Institute of Health Science.

Expected results:

Graduates are familiar with basic genetics, health education and genetic counseling.

175

Strategies to Achieve 4th Objective: To raise the public and medical staff awareness of genomic

technology and its benefits. To continue genomics education, capacity building and training in

new technologies;

4.1 Study most efficient Methods of Health Education in Genetic Health.

Expected results:

Cost-effective and efficient health education in Genetic Health matters.

4.2 Developing specific educational package about genetic health matters taking in consideration

local traditions.

Expected results:

Increased community knowledge about Genetic Health.

4.3 Educate Omani population about the impact of Genetic diseases and the ways it can be

prevented.

Expected results:

Decrease in the rate of consanguineous marriage among families with past history of genetic

diseases.

4.4 Genetic Center provide update to medical professional about modern genetics, genetic

technologies available to their utilization:

To improve health.

Genetic disease management.

Prevention of genetic and adult onset disorders.

Expected results:

Health Care professionals of Ministry of Health are familiar with availability of new

technologies, advances of genetic testing and modern management of genetic and multifactorial

disorders with genetic component.

176


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Functions in National Genetic Center. Annually Not present

Expanding to

satisfy the

needs of Oman

health Care

1.1b

Number of laboratories with advanced

technology machines and equipment in

Genetic Center Laboratories.

Annually

One

laboratory

for

Karyotyping

and FISH

5 laboratories

1.1c

Number of man power working in the

national genetic center:

▪ Doctors

▪ Nurses (Counselors)

▪ Laboratory technicians

▪ Health educators

Annually

2

1

10

0.0

4

6

40

6

1.1d

Presence of national register/database for

genetic diseases and congenital

malformation.

Annually

There is

incomplete

registry

The registry is

present

1.1e Number of research studies conducted in the

field of genetic diseases. Annually 2

5 research

studies

1.1f Number of Omani staff trained on clinical

genetics and laboratory genetic technology. Annually 4 24

1.1g Existance of national Policy regards genetic

and congenital disorders.

Annually NA available

1.1h Number of meetings annually with related

governmental sectors.

Annually 0 4


Objective

2.1a

Presence of external quality assessment

scheme for genetic laboratories and

International Accreditation.

Annually Not present Present

2.1b Number of doctors trained in Clinical

genetics. Annually

2 4

2.1c Number of Laboratory Geneticist. Annually

20 100

2.1d Number of genetic Nurses. Annually

0 20

2.1e Health Educators updated in genetic

Councelling. Annually

10% 50%

2.1f

Number of sessions for Community Support

Groups updated in Genetic Councelling

&Genetic Ethics.

Annually 1 50

177

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.1g Number of workshops in Laboratory and

Clinical genetics. Annually

0 10

2.1h Number of laboratory geneticists with MD

and PhD. Annually

10 30

2.1i Number of research studies in genetic health. Annually

1 5


Objective

3.1a

Number of trained primary health care health

staff (doctors and nurses) about premarital

examination and counseling in the health

institutions / year.

Annually Not present 20 (2 from

each region)

3.2a Number of clinics providing premarital

examination services in PHC. Annually 1 10

3.2b

Percentage of attendance who are going to

marriage and received counseling and

premarital examination per year.

Annually 5% of the

targets

50% of the

targets

3.3a

Mean number of health education seminars

about importance of premarital examination

in secondary school.

Annually One seminar

/school/year

Two seminars

/school / year

and 2 national

seminars/ year

3.3b

Mean number of educational courses for

community support group members on

importance of premarital examination.

Annually The courses

are not

regular

One training

course for each

group / year

3.4a

Basic genetic and counseling skills

introduced in curriculum of institute of health

science.

Annually --

The curriculum

changed

Indicators of Strategies of the 4th

Objective

4.1a

Presence of study on the most efficient

methods of health education in genetic

health.

Annually Not present The study is

present

4.2a

Presence of specific educational package

about genetic health matters taking in

consideration local traditions.

Annually Not present

The

educational

package is

present

4.2b

Number of health education seminars in

omani community about impact of genetic

diseases and ways of prevention.

Annually 2national

seminars/year

2 seminars /

region/year and

2 national

seminars /year

178

Domain Nineteen

Environmental and Occupational Health

179




Domain: Environmental and Occupational Health

INTRODUCTION:

With the fast industrial and economical growth in Oman and the increase in the

number of national workforce, without doubt there will be environmental and occupational

exposures that will be reflect in the health safety of the surrounding environment and the

workers in different sectors. The recent published data indicates that the workers constitute 32

% of the general Omani population. The workers in different governmental and private

sectors, including the health care workers, are exposed to serious dangerous hazards in their

work environment, which can result in serious health effects such as injuries, diseases and

death. All these effects will dramatically affect the productivity and so affecting the national

economy and the sustainable development.

Nowadays, the air pollution problems and its related-health effect on the other hand

are one of the community concerning issues especially in the areas near the industrial

development. The issues of food safety, medical waste, environmental health impacts of the

developmental projects are all issues of focus that need attention and allocation of resources

to allow the health sector to perform its related responsibility and functions in these aspects.

As a result of all these developments, there is a need to develop a national

occupational disease surveillance system, new injuries-related disability assessment system,

national occupational health and safety program for health care workers especially the

radiation safety, exposure to chemicals and hazardous drugs. Capacity building in term of

human resources, infrastructure, analytical services and research is needed to allow the health

sector to monitor and evaluate the related health effects.

The research study indicates that the morbidity of respiratory disease and water borne

diseases are high in the waste dumping area. The methods for solid medical waste

management need further development. As a result the environmental health issues need to be

highlighted and promoted in this 5 year plan.

The following table indicates the national environmental standard maximum pollution

concentrations for the common air contaminants.

180

Table: National environmental standard maximum pollution concentrations 2011.

Contaminant

Threshold

Concentration

Averaging

period

Permissible excess

Carbon monoxide

(CO)

10 mg/m3

8 hour running mean

One 8 hour period in

any 12 month period

Nitrogen dioxide

(NO2) 200 μg/m3 1 hour mean

9 hours in any 12

month period

Ozone (O3) 150 μg/m3 1 hour mean Not to be exceeded

Particulate Matter

(PM10) 50 μg/m3 24 hour mean

One 24 hour period in

any 12 month

Sulphur dioxide

(SO2)

350 μg/m3

570 μg/m3

1 hour mean

1 hour mean

9 hours in any 12

month period

Not to be exceeded

OBJECTIVE:

1. To reduce the environmental and occupational health morbidity and mortality.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To reduce the environmental and occupational health morbidity and

mortality.

1.

National environmental standard maximum

pollution concentrations:

Carbon monoxide (CO)

Nitrogen dioxide (NO2)

Ozone (O3)

Particulate Matter (PM10)

Sulphur dioxide (SO2)

NA NA

See the above

table for the

Permissible

excess of

each

contaminants

2. Number of hospital admission due to

respiratory disease in main industrial cities. NA 32820

(number) 10

% reduction

from the

current

situation

181

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

3. Number of hospital admission due to asthma

in main industrial cities in Oman. NA 3555

(number) 10

% reduction

from the

current

situation

4.

Number of hospital admission due to

circulatory diseases in main industrial cities

in Oman.

NA 14832

(number) 10

% reduction

from the

current

situation

5. Incidence of ARI in main industrial cities in

Oman. NA 5.3

(rate) 10 %

reduction

from the

current

situation

6. Incidence of occupational injuries per 1000

workers. NA 2

(rate) 10 %

reduction

from the

current

7. Incidence of poisoning per 1000 population. 0.89 3.14 2

8. Incidence of water-borne disease per 1000

population (admitted/confirmed). 49.04 28 20

9. Percentage of biological contamination in

tested water sample. 29.6% 17% 10%

10. Number of health care workers with a

radiation dose > 20 m/sv/year. NA NA 0

11. Number of outbreak from water-borne

disease. NA 2 0

13.

Incidence of occupational injuries and

diseases in health care per 1000 health care

workers.

NA NA

(rate) 10 %

reduction

from the

current

14. Number of mortality due to environmental

and occupational exposure. NA 20 10

*main industrial cities in Oman: Cites with industrial state or heavy industrial establishment such as Muscat,

Sohar, Sur, Nizwa, Salalah and Al dqum

STRATEGIES:

Strategies to Achieve 1st Objective: Reduce the environmental and occupational health morbidity

and mortality.

1.1 Strengthening the infrastructure for environmental and occupational health by:

Increase the number of beneficiaries from environmental and occupational health

services -especially poisoning-related-by upgrading the analytical laboratory services for

environmental and occupational health centrally and in North Al-Batinah Region.

182

Implementation of the National Strategy for Occupational Safety and Health

(establishment of national OHS for health care workers, risk assessment, establishment

of medical surveillance and medical fitness program, establishment of disability

assessment System, provision of occupational medical service, reporting of occupational

injuries and diseases, healthy workplace).

Development of national guidelines for primary health care doctors and health

inspectors( national guidelines for occupational health in primary health care, OHS

guidelines for health inspectors, risk assessment guideline, updating the national

guideline for HIA).

Initiating the 2nd

phase of GIS (Geographical Information System).

Integration of health impacts assessment in the national policy by inter-sectoral

cooperation (representation of MOH in the Higher Committee for Town Planning,

national guidelines for HIA, health licensing for developmental projects).

Implementation of risk assessment and water safety plan with cooperation with

Authority for Electricity and Water.

Expanding the National Injuries Surveillance Program.

Implementation of chemical safety in laboratory and handling of hazardous drugs

programs.

Initiating/Implementation of the national plan for preventing occupational noise induced

hearing loss (ONIHL).

Establishment of the national program for medical waste management.

Conducting researches in environmental and occupational health with cooperation of

other sectors.

Expected results:

Provision of service related to prevention environmental and occupational hazards.

Improvement of environmental and occupational health services.

Protection of health care workers from occupational exposure.

Tracking/notification of occupational noise induced hearing loss (ONIHL).

Health licensing for developmental projects.

1.2 Development of human resources in environmental and occupational health by:

Increase the number of doctors specialized in occupational medicine and health.

Training of primary health care doctors through EOH Medicine Course in collaboration

with OMSB.

Introducing OH in medical school curriculum ( SQU and Oman Medical College).

Introducing the EOH subject in nursing curriculum and sending for post-graduate

study in occupational nursing.

183

Training of health inspectors in occupational hygiene (2 per region).

Training of doctors in disability assessment committee in national guidelines for

disability assessment.

Expected results:

Availability of trained national personnel in environmental and occupational medicine/health.

1.3 Increase awareness about environmental and occupational medicine/ health by:

Continue celebrating the World Day for Health and Safety at Work.

Increase the number of health education materials.

Increase awareness of school students about environmental and occupational health.

Further Improvement of DEOH website.

Conducting health education campaign regarding heat exposure, noise exposure and

chemical exposure.

Expected results:

Increase awareness among community and health care workers about environmental and

occupational health issues.


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Number of beneficiaries from Poison

Control Center. Annually 200 1000

1.1b Number of actions, programs implemented

from National Strategy for OHS. Annually 0 5

1.1c Number of national guidelines in EOH. Annually 1 6

1.1d Percentage of health programs which

implement GIS. Annually 0 100%

1.1e Number of developmental projects which

their health impacts have been assessed. Annually 0 100%

1.1f Number of cases which is assessed using

national guidelines for disability assessment. Annually 0 100%

1.1g Number of workers exposed to noise

>=85db for 8hrs/day in industrial state. Annually NA

(number) 20%

reduction from

the current

situation

184

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

1.1h Incidence of occupational noise induced

hearing loss in industrial state. Annually NA

(rate) 20%

reduction from

the current

situation

1.1i

Percentage of health institutions which

implement national program for medical

waste management.

Annually 0 100%

1.2j Number of researches and studies in EOH. Annually 3 5

1.2a Number of national qualified personnel in

EOH. Annually 6 20

1.2b Number of trainee in EOM course from

OMSB and primary health care workers. Annually 30 135

1.2c Number of health inspectors trained in

Industrial hygienist program.

Every two

years 0 6

1.2d Number of doctors trained by national

guideline for disability assessment. Annually 0

All members in

disability

assessment

committee

1.3a Number of health education materials in

EOH. Annually 10 20

1.2b Number of topics in curriculum. Annually 1 3

1.2c Number of awareness campaigns. Annually 4 15

185

Domain Twenty

Accidents and Injuries

186

Vision: Alleviation of Risks Threatening the Public Health



Domain: Accidents and Injuries

INTRODUCTION:

The intentional and environment-based injuries can either be prevented or mitigated

in terms of magnitude. This can be made possible if the underpinning causes delineated so

that the proper preventive measures to reduce public exposure. The surrounding environment

should be the first target to address these causes. The accident bear adverse economic, social

and health burden on the Sultanate since the latest statistics show that injuries are the leading

cause of morbidity among men and rank the sixth leading cause of morbidity among women.

The injuries account for 8 % of total mortality of hospitalized patients (Situational Analysis

of injuries in Oman 2008). The Ministry of Health plays a central role in prevention of

injuries and safety promotion in collaboration with other governmental sectors. The data had

been provided by the Ministry of Health were used in the national strategic planning aimed at

accidents prevention and safety promotion. The Ministry has been a faithful promoter of

accidents prevention and safety enhancement in order to priories these themes within the

government planning. The financial and human resources need to be identified in order to

prevent injuries and promote safety in the different levels of health care system.

After the misfortunate environmental calamities that took place in 2007 and 2010 and

the H1N1 swine flu epidemic the disaster preparedness and emergency response became a

focus of national interest. In response, the Ministry of Health paid a great attention to this

national issue in the eighth 5-year plan in order to meet the national, regional and

international requirements. The initial survey conducted by the Department of Environmental

and Occupational Health in collaboration with the World Health Organization and European

Union showed the real need for clear preparedness and response plan to medical and public

health emergencies and the definite shortage in the specialized personnel in disaster

management.

This plan will define the vision and the strategic goals for Ministry of Health in the

injuries prevention and safety promotion and the emergency preparedness and response for

medical and public health emergencies. It will also provide a guideline approach for creation

of safety culture and the priorities in medical and public health emergencies.

OBJECTIVES:

1. To decrease morbidity and mortality and disability resulting from the accidents and medical

and public health emergencies.

187


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To decrease morbidity , mortality & disability resulting from the

accidents and medical and public health emergencies

1. Incidence of Injuries per 10000 population. NA 86

(rate)

Reduction by

10% from the

current

situation

2. Deaths Rate of Injuries per 10000

population. NA 0.399

(rate)Reduction

by 5% from the

current

situation

3. Deaths rate of RTA per 10000 population. NA 0.316

(rate)

Reduction by

5% from the

current

situation

4. Number of Non-fatal injuries from RTA. NA 9709

(number)

Reduction by

5% from the

current

situation

5. Deaths rate from other non-RTA injuries per

10000 population. NA 0.183

(rate)

Reduction by

5% from

current

situation

6. Percentage of Disability due to injuries. NA 8%

(percentage)

Reduction by

5% from the

current

situation

7. Number of injuries and deaths related

disaster. Nil 24

x

(number)

Reduction by

5% from the

current

situation

x Deaths from 2010 environmental calamities

188

STRATEGIES:

Strategies to Achieve 1st Objective: To decrease morbidity , mortality & disability resulting from

the injuries and medical and public health emergencies.

1.1 Development of human resources and the basic infrastructure through:

Qualifying Omani-nationals to specialize in injuries prevention and safety promotion and

emergency preparedness and response.

Conduct specialized training courses in injuries prevention and safety promotion for the

medical personnel.

Incorporation of injuries prevention and safety promotion into the health curriculum of

medical schools, nursing schools and health inspection.

Conduct a simulation exercise to practice medical and public health emergencies.

Providing the basic infrastructure needed for the emergency preparedness and response

in the health care system.

Expected results:

Existence of qualified and specialized nationals in injuries prevention and safety promotion and

medical and public health emergencies.

Improvement in the quality of the services provided to prevent injuries and enhance safety.

1.2 Strengthening of injuries surveillance system and emergency data collection through:

Approval of injuries electronic surveillance system in all health institutions.

Training of health personnel in injuries electronic surveillance system.

Continuous update of medical and public health emergencies data.

Distribution of the collected data regarding the emergencies and injuries prevention

using the GIS.

Expected results:

Establishment of effective e-surveillance system.

Improvement in the quality of the data regarding injuries notification.

Deriving accurate data regarding injuries to support prevention program.

Provision of the necessary data to plan for public health and medical emergencies.

Pinpointing of hazards, risks and weakness in the health system.

1.3 Establishment of the national policies regarding injuries prevention and the preparedness

and response to the medical and public health emergencies through:

Formulate a national framework relaying on injuries prevention and safety promotion.

Establishment of a national committee to run the injuries prevention and safety

promotion program.

Involvement of the concerned parties of the government in the program of injuries

prevention and safety enhancement.

Formulation of national safety standards.

Expected results:

Formulation of national prevention plan for injuries prevention and safety promotion in

collaboration with other governmental sectors.

189


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Number of A/E staff trained to deal with

injuries. Annually 200

50% of A/E

Staff

1.1b Number of A/E staff trained in BLS &

ACLS. Annually

Total number of

trained staff in

all departments:

ACLS=900

BLS=1400

50% of A/E

Staff

1.1c Number of A/E Staff trained on ATLS. Annually

NA 50% of A/E

Staff

1.1d Number of A/E Staff trained on different

emergencies and crises. Annually

143 50% of A/E

Staff

1.1e

Number of A/E departments with

infrastructure to respond to emergency for

all hazards:

PPE for All hazards

Negative pressure isolation room

Decontamination room

back up communication system

Every two

years

Zero (not

complete)

All A/E

departments in

Referral

hospitals

1.1f Number of simulation drills in different

emergency themes. Biannual 13 20

1.2a Number of health institutions implementing

the injury e-surveillance. Annually

Zero All referral

hospitals

1.2b Number of trained staff in injury

surveillance. Annually

15 100

1.3a Number of injury prevention awareness

campaign. Annually

Zero 20

1.3b

Number of topics regarding accidents

prevention and safety promotion adopted by

the willayate health committees.

Annually Zero 20

1.3c

Number of community-based injuries

prevention and safety enhancement projects

done by Wilayat health committees.

Annually Zero 10

1.3d Number of hospitals with emergency plan

for all hazards. Annually

Zero

All referral and

regional

hospitals

1.3e Number of hospitals with hospital safety

index worked out (HSI). Annually

Zero

All referral and

regional

hospitals

1.3f

Number of A/E departments with chemical

information resources (MSDS/Chemical

Safety Database).

Annually Zero

All A/E

departments

1.3g Number of researches in the field. Annually

3 6

190

Promoting Woman and Child health and

maintaining the health of elderlies

Vision Four

191

Domain Twenty One

Woman Health

192

Vision: Promoting Woman and Child Health and Maintaining

The Health of Elderlies

Goal: Improving Health Care Provided to

Women and Children and Elderlies

Domain: Woman Health

INTRODUCTION:

Since the Renaissance, Ministry of Health has committed to promote the health and

development of the Omani citizens. Under this objective MoH has put the basis for basic and

specialized heath components in its place. Health services in Oman have developed

dramatically in quantity and as well as quality. Now, 98% of population has accessibility to

universal health care at primary health care level and specialized care at secondary and

advanced care at tertiary level. This is as a result of well-organized and integrated health care

system and further to decentralization of primary health care services and establishment of

autonomous hospitals.

Women represent half the community and are important human resource. God has

blessed women with special gift of giving birth to babies and ability to breast-feeding. In

addition, they are the institution of care and builder of the new generation who subsequently

will take the responsibility of building healthy and productive community.

As high as 28.83% of the total Omani population is females in the reproductive age

(15-49), Women being an important section of the population, Ministry of Health (MoH) pay

special attention to women‟s health. MoH has adopted a lot of polices and strategies to

promote women‟s health.

During the seventeenths and the eighteenths of last century the focus was to provide a

comprehensive health service for children and mothers during reproductive age, which

include providing antenatal, childbirth and postnatal cares. In the nineteen's two components

of reproductive health were introduced; birth spacing program and infertility program. After

ensuring stability and quality of these programs, the focus shifted at the beginning of the third

century to adolescent health and menopausal health.

Review of health indicators for the year 2009, pertaining to women‟s health have

shown a great improvement in the health services provided to mothers, like Ante-natal

coverage reaching to 99.4 % and birth attended by supervised medical attendants to 98 %. In

addition, the Maternal Mortality Ratio has dropped to 13.4 per 100,000 live births, which is

lower than many of the international and surrounding countries. This ratio reflects the

progress, development and improved quality of maternal health services. The health statistics

also show an increase in maternal outpatient Morbidity from 0.2% in 1996 to 0.7% in 2009.

At the same time the inpatient morbidity due to maternal causes increase from 9.4% in 1996

to 11.9% in 2009.

193

The Population Pyramid in 2009 shows that about 7 % of population is of females

beyond reproductive age. This percentage will increase, taking in account the current life

expectancy, which is around 75.7 years for females. This age group usually faces a lot of

medical problems most of which start by the end of the reproductive age. Post reproductive

problems in women affect the quality of life and necessitate providing special services for

them like, regular medical checkup for prevention and early detection of diseases such as

osteoporosis, breast and cervical cancer etc, that warrant conducting studies and providing

data on the causes and morbidity amongst this age group

For all above challenges and taking into the account the recommendation of international

conferences on reproductive health and Oman‟s obligation to international convention and its

principles to improve the woman health in all stages of her life, the objectives, goals and

strategies of the 8th five-year plan (2011-2015) have been put in place.

OBJECTIVES:

1. Expansion in the provision of Reproductive Health services package in the Ministry of Health'

Facilities.

2. Improving Reproductive practices in the community.


argeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective’s Indicators: Reduction of morbidity and mortality rates among women in the

reproductive age

10 13.4 (2009) 15.4 Maternal Mortality Rate (Per 100,000 live

births). 1.

8 8.8 (2009) 9.2 Still birth Rate (Per 1000 births). 2.

11 2 0 Number of regions that provide service of

screening for breast cancer. 3.

11 2 1 Number of regions that provide health

service for menopausal women. 4.

100% NA NA Percentage of children born for HIV mothers

with negative HIV result at age ≥18 months. 5.

Second Objective’s Indicators: Improving the healthy reproductive practice in the community

40% 37.7% 39.1% Percentage of women who have birth at

interval more than 3 years. 1.

3% 3.8% 4.14% Percentage of births to mother less than 20

years old. 2.

11% 12.7% 14.14% Percentage of births to mother more than 35

years old. 3.

30% 28.2%* NA

Prevalence of B.S method use (modern and

traditional) between women in reproductive

age.

4.

* world health survey 2008

194

STRATEGIES:

Strategies to Achieve 1st Objective: Expansion in the provision of Reproductive Health services

package in the Ministry of Health' Facilities

1.1 Adding service of screening for breast cancer to the package of woman health services at

primary health care level and training health care providers on clinical breast examination and

breast self examination.

Expected results:

Increase in the number of breast cancer cases detected at early stage.

1.2 Training of health care providers on counseling on screening for breast cancer.

Expected results:

Increase in the number of breast cancer cases detected at early stage.

1.3 Putting an annual advocacy plan for governorates to expand breast cancer screening

services.

Expected results:

Increase number of breast cancer cases detected at early stage.

Increase in the percentage of women who aware of the methods of screening and early detection

of breast cancer.

1.4 Training health care providers on pregnancy and childbirth management guidelines in

collaboration with other concerned sections, departments, primary health care facilities and

hospitals.

Expected results:

Improvement in the quality of health services provided to pregnant women.

Increase in the percentage of clients satisfied with the services.

1.5 Training health care providers on counseling in antenatal, delivery and postpartum issues.

Expected results:

Presence of high percentage of health care providers with counseling skills in Mother‟s Health

issues.

Reduction in maternal morbidity and mortality.

1.6 Strengthening health care providers' skills on dealing with obstetric emergencies through

introducing ALSO program.

Expected results:

Improvement in health care providers' skills on dealing with obstetric emergency.

1.7 Provision of counseling, testing and treatment services to reduce sexually transmitted

disease especially HIV in mothers.

Expected results:

Early detection of HIV in pregnant women.

Reduction in the number of children with HIV due to mother to child transmission.

195

1.8 Training health care providers on the guidelines on management of menopause with

collaboration with other concerned sections, departments, and primary health care centers and

hospitals.

Expected results:

Improvement in the quality of health services provided for menopausal woman.

Increase in the percentage of clients satisfied with the services.

1.9 Training health care providers on counseling in medical problems related to menopause.

Expected results:

Presence of high percentage of health providers with counseling skills on menopausal health

issues.

Strategies to Achieve 2nd objective: Improving community reproductive practice

2.1 Expanding birth spacing services through adding new contraceptive method to the

currently provided birth spacing methods and encouraging women to use long acting methods.

Expected results:

Increase in the number of clients benefited from the birth spacing services.

2.2 Continue training of health care providers on birth spacing services to strengthen their

skills.

Expected results:


Reduction in maternal morbidity.

Improvement in the services provided.

2.3 Continue training health care providers on counseling in birth spacing.

Expected results:

Reduction in maternal morbidity


2.4 Strengthen health education and media activities through conducting awareness campaigns

to reduce early, late and frequent pregnancies.

Expected results:


Reduction in percentage pregnancies in young age (less than 20 years).

Reduction in percentage pregnancies in old age ( more than 35 years)

Reduction in percentage frequent pregnancies (birth at interval less than 3 years).

196


Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators


All

governorate 2

Annually Number of regions that provide service of

screening for breast cancer. 1.1a

80% 15.27% Annually

Percentage of primary health care institutions

that provide service of screening for breast

cancer.

1.1b

70% 13.9% Annually

Percentage of trained doctors and nurses at

primary health care institutions on clinical

breast examination and breast self

examination.

1.2a

70% 8.8% Annually

Percentage of trained Arabic speakers doctors

and nurses on providing counseling on

screening for breast cancer issues.

1.2b

5000 703 Annually

Number of health education/ awareness

activities on importance of early detection of

breast cancer.

1.3a

80% 8.6% Annually

Percentage of trained doctors at primary health

care institutions on pregnancy and childbirth

management guidelines (level I).

1.4a

80% 9.5% Annually

Percentage of trained nurses and midwives at

primary health care institutions on pregnancy

and childbirth management guidelines (level

I).

1.4b

80% 32% Annually

Percentage of trained doctors at secondary

health care institutions on pregnancy and

childbirth management guidelines (level II).

1.4c

80% 11.2% Annually

Percentage of trained nurses and midwives at

secondary health care institutions on

pregnancy and childbirth management

guidelines (level II).

1.4d

60%

Training

curricula

will be

produce in

2012

Annually


and nurses at primary and secondary health

care institutions on providing counseling

pregnancy and childbirth issues.

1.5a

50% Not in place

yet Annually Percentage of trained doctors and midwives in

maternity wards on ALSO program. 1.6a

99% 98.6% Annually Percentage of deliveries occurring under

medical supervision. 1.6b

50% 14.5% Annually


and nurses at primary and secondary health

care institutions on providing counseling on

HIV in pregnancy.

1.7a

197

Targeted

situation

2015

Current

situation

2010

Follow

up

timing

Indicators

100% 97.4% Annually Percentage of registered pregnant women who

are screened for HIV. 1.7b

100% 77% Annually

Percentage of eligible HIV mothers who are

receiving treatment.

1.7c

96% NA Annually Percentage of children born for HIV mothers

with negative HIV result at age ≥18 months. 1.7d

100% NA Annually Percentage of HIV mothers who are using

birth spacing at 18 months after delivery. 1.7e

80% 7% Annually

Percentage of trained doctors and nurses at

primary and secondary (gynecology clinic)

health institutions on management of

menopause guidelines.

1.8a

60% 9.6% Annually


and nurses at primary health care and

secondary health care institutions on providing

counseling on menopausal health issues.

1.9a

Indicators of Strategies of 2nd

Objective

6 5 Annually Number of contraceptive methods that are

provided by Ministry of Health. 2.1a

60% 42.21% Annually Percentage of primary health care Institutions,

which provide the service of IUCD insertion. 2.2a

80% 41.89% Annually Percentage of PHC Institutions with a trained

male staff on BS counseling. 2.3a

20% 11% Annually Percentage of Primary Health Care institutions

with room specified for counseling. 2.3b

50 3

By the end

of current

plan

Number of health projects on Birth Spacing

Programme that are adopted by health

committees.

2.4a

80% NA

Every two

years Percentage of users of contraceptive methods

of during first year delivery. 2.4b

35% 24.2%

Every two

years Percentage of users of modern contraceptive

methods during first year after delivery. 2.4c

40% 37.7% Annually Percentage of women who have birth at

interval more than 3 years. 2.4d

3% 3.8% Annually Percentage of births to mother less than 20

years old. 2.4c

11% 12.7% Annually Percentage of births to mother more than 35

years old. 2.4e

198

Domain Twenty Two

Child Health

199





Domain: Child Health

INTRODUCTION: For over three decades, child health has been recognized as a priority in Oman. Investing

in children is investing in our future, healthy children have a greater chance of growing up

into strong, healthy, productive adults that can carry the society forwards. This commitment

was further strengthened in 1996 by the signatory on the Convention of the Rights of the

Child and joining the international arena in achieving the Millennium Developmental Goals;

Children under 18 makeup over one third of the population in Oman.

The ministry of Health has developed diverse strategies to improve health of children, to

cover a range of aspects, be it; infectious diseases, care of the newborn baby, promotion of

breast feeding, care of the sick child, safety and accident prevention, etc…

This commitment resulted in the remarkable advances in reducing child mortalities. As the

rate for under 5 year of age has reached 12/1000 live birth and the infant mortality was

9.6/1000 live birth in the year 2009.

However to further reduce child mortality, there is a need now to strengthen and integrate

existing programmes, upscale healthy services provided to children, raise levels of

competencies of health care providers, increases level of awareness among community and

families and introduce new strategies to cover emerging issues.

This cycle of planning aims to further reduce mortality of children and improve quality of

health care provided to them. Introduce health services to children with chronic illnesses, and

children victim of maltreatment. Strengthen health services at a community level. Coordinate

efforts of different stake holders involved in child health strategies.

OBJECTIVES: 1. To reduce childhood mortality and morbidity rates with focus on neonates, infants and

children less than 5 years of age.

2. To improve quality of health services provided to children with a focus on:




3. To enhance coordination between different domains related to child health at a central

level.

200


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To reduce childhood mortality and morbidity rates with focus on

neonates, infants and children less than 5 years of age.

1. Infant mortality rate/1000 LB. 10.3 (2004) 9.6 8.5

2. Perinatal mortality rate/1000 LB. 14.46 13.9 (2008) 12

3. Under 5years mortality rate/1000 LB. 11.05 12 10

4. Rate of children under 5 affected with

diarrhea /1000 child. 263 240 150

5. Percentage of severe diarrhea cases admitted

to the total number of cases. 0.2% 0.2% 0.1%

6. Number of deaths due to diarrhea. None None None

7. Rate of acute respiratory tract infections

/1000 children less than 5 years. 1500

1123

(2009) 1000

8.

Percentage of severe infections cases

admitted to total number of acute respiratory

infections cases.

0.3% 0.2% 0.2%

Second Objective’s Indicators: To improve quality of health services provided to children with a

focus on:




1.

Number of health centers with defined

service package for children with chronic

illnesses.

0 0

At least one

health facility

for every

region

2. Number of chronic illnesses included in the

package (Down Syndrome & Asthma). 0 0 2

Third Objective’s Indicators: To enhance coordination between different domain related to child

health at a central level.

1. Availability of Child Health Committee at a

central level. NA NA

Available at

central level

201

STRATIGIES:

Strategies to Achieve 1st Objective: To reduce childhood mortality and morbidity rates with focus

on neonates, infants and children less than 5 years of age

1.1 Train doctors & midwives working at delivery facilities on Neonatal Resuscitation.

Expected results:

Increase percentage of certified doctors and nurses on Neonatal Resuscitation Programme.

Improve skills of providers on dealing with critical care of newborns.

Reduce complications associated with deliveries and critically ill newborns.

1.2 Train doctor working at Pediatrics and Accident & Emergency departments on Pediatrics

Advanced Life Support.

Expected results:

Increase percentage of certified doctors on PALS.

Improve skills of doctors of dealing with emergency pediatrics.

Reduce child mortality.

1.3 Increase number of certified cites of training on NRP & PALS.

Expected results:

Optimize training requirements of regions.

1.4 Establish a trained transport team (pediatricians & nurses) for the transport of critical

cases to the referral hospitals and provision of the necessary equipment.

Expected results:

Decreased complications associated with transportation of ill children.

1.5 Complete equipments lists for neonatal care at all health facilities where deliveries are

being conducted.

Expected results:

Improved care for newborns.

Reduction of Perinatal mortality rates.

1.6 Complete equipment list needed for caring of children at pediatrics wards and emergency

departments.

Expected results:

Better care for children at emergency situations.

Reduce child mortality rates.

1.7 Analyze causes of perinatal and infant mortality in Oman.

Expected results:

Have a clear understanding of leading causes of perinatal and infant mortalities in Oman, as per

the regions.

Improve health services provided to newborns and infants.

202

1.8 Train doctors on care of the newborn guidelines level 1 and level 2.

Expected results:

Trained doctors on standardized care for newborns.

1.9 Expand coverage of Integrated Management of Childhood Illnesses strategy.

Expected results:

All Primary Health Care Facilities implementing the IMCI strategy.

1.10 Strengthen the community component of IMCI.

Expected results:

Increasing awareness level of the community in managing childhood illnesses.

1.11 Train medical and Nursing students on the IMCI strategy.

Expected results:

Implementing the pre service component of the IMCI Strategy.

Strategies to achieve 2nd objective: To improve quality of health services provided to children

with a focus on:




2.1 Conduct a study to determine the prevalence of inherited disorders in Oman.

Expected results:

Identify the most common inherited congenital disorders that can be screened for at birth.

2.2 Expanding neonatal screening tests performed to include hereditary blood disorders

(Sickle Cell Disease & Thalassemia) and some metabolic disorders in collaboration with the

Genetic Center.

Expected results:

Increasing number of disorders screened for.

Improving health status of children through early detection of inherited diseases.

2.3 Set up a follow up system for children with chronic illnesses at health facility level.

Expected results:

Up scaled health services provided to children with chronic illness.

2.4 Integrate home services to children through community nursing program.

Expected results:

Increase accessibility of health services to certain groups of children.

A data base for children requiring community nursing services.

203

2.5 Set up a follow up system for children victims of maltreatment.

Expected results:

Strengthen reporting system of child maltreatment.

Improved health service and psychological support to abused children.

2.6 Carry out a qualitative research on child maltreatment.

Expected results:

Have a better understanding of factors contributing to child maltreatment.

Strategies to achieve 3rd Objective: To enhance coordination between different domains related to

child health at a central level.

3.1 Establish a central committee for child health.

Expected results:

A better collaboration among child health programmes and strategies.


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a

Percentage of doctors & midwives working at

health establishments with delivery facilities

and are trained on Neonatal Resuscitation.

Annually

64% 95%

1.2a

Percentage of doctors working at pediatrics

wards and A&E departments who are trained on

Pediatric Advanced Life Support (PALS).

Annually

30% 95%

1.3a Number of training sites on NRP.

By the

end of the

current

plan

1 (Royal

Hospital) 5

1.3b Number of training sites for PALS

By the

end of the

current

plan

2 (Royal

Hospital&

Sohar

Hospital)

5

1.4a Availability of an online system that links

Intensive Care Units

By the

end of the

current

plan

NA Available

204

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

1.4b Number of specialized safe transport teams.

By the

end of the

current

plan

Zero

(as per new

guidelines)

At least one

team in each

Secondary

Hospital

1.5a

Number of secondary hospitals that have

fulfilled the central list for safe transport

equipments.

Annually

1 (Royal

Hospital)

All secondary

hospitals

1.5b

Percentage of health facilities with delivery

services that have completed the central list of

equipments.

Annually 58% 100%

1.6a

Percentage of pediatrics wards and A&E

departments with a complete list of pediatrics

equipments.

Annually 1 (Royal

Hospital) 100%

1.7a A national study to analyze causes of perinatal

and infant mortalities.

By the

end of the

current

plan

NA Study

conducted

1.8a Availability of training guidelines on Hospital

based child care.

By the

end of

2013

NA available

1.8b

Percentage of doctors working in pediatrics

wards that are trained on hospital based child

care.

Annually zero 30%

1.9a Percentage of primary health care facilities

implementing the IMCI strategy. Annually

80%

100%

1.9b Percentage of Primary Health Care (PHC)

doctors trained on the IMCI strategy. Annually 61% 90%

1.9c Percentage of nurses working at PHC that are

trained on the IMCI strategy. Annually 70% 90%

1.10a Percentage of health educators trained on the

IMCI strategy. Annually 70% 90%

1.10b Percentage of PHC implementing the

community component of IMCI strategy. Annually 10% 50%

1.10c Number of regions supporting the community

component of the IMCI. Annually 1 All regions

205

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

1.11a Percentage of health care providers trained on

the IMCI. Annually 60% 80%

1.11b Percentage of trained academics on IMCI. Annually 20% 70%

1.11c Percentage of Medical students at SQU &

Oman medical College trained on IMCI. Annually 10% 60%

1.11d Percentage of medical students who received

clinical training on the IMCI. Annually 5% 60%

1.11e Percentage of institutes and colleges that are

teaching the IMCI. Annually zero 50%


Objective

2.1a A national study to determine the 5 most

common hereditary disorders at birth.

By the

end of the

current

plan

NA available

2.2a Number of diseases screened for at birth.

By the

end of the

current

plan

2 5

2.2a

Number of health education activities in

relation to child safety inside and outside the

house.

Annually NA At least one per

month.

2.2b Percentage of screened newborns on the

congenital hypothyroidism. Annually 99.8 % 99%

2.2c

Percentage of secondary hospitals with delivery

facilities and are provided with an echo hearing

test.

Annually 70% 95 %

2.2d Percentage of screened newborns on the

hearing screening program. Annually 81.6% >95%

2.3a

Availability of guidelines on follow up for

children with chronic illnesses and

implementing it at hospital levels. (Down

Syndrome & Asthma).

By the

end of

2012

NA available

206

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.3b Percentage of doctors trained on chronic

illnesses guidelines.

By the

end of

2013

NA 30%

2.3c Percentage of health facilities implementing the

chronic illnesses guidelines.

By the

end of

2013

NA 30%

2.4a Categories of children included in the

community nursing program.

By the

end of

2013

NA 5

2.4b Percentage of children included in the

community nursing program. Annually NA

At least 30% of

children

2.5a Available guidelines for management and

follow up of maltreated children.

By the

end of

2013

NA available

2.6a Qualitative research on child maltreatment in

Oman.

By the

end of the

current

plan

NA available


3.1a Availability of a central committee for child

health

By the

end of the

current

plan

NA available

207

Domain: Twenty Three

Elderlies Care

208





Domain: Elderlies Care

INTRODUCTION:

Elderlies age group (60 years and above) is a growing group in Omani population, it

represents about 3.76% from the total population (according to 2009 med-year estimate), and

with the expectation of further growing in coming decades. This increase is attributed to the

impressive improvement in living status and the services provided for the individual and

community including health care, which as a result leads to remarkable decrease in mortality

rates and increase in expected age at birth.

Elderlies population divided to tow main groups: the first group including elderlies that are

functionally able. They can manage about the care of themselves without a support or

caregiver. The second group are totally or partially dependant or retarded. The latter group

needs most of the support and their dependency either due to senility process or neglect from

there caregiver, this lead to accumulation of senility effects and may lead to total dependency

and as a result very high cost of care.

Senility is continuous biological process all the biological system undergoing though it.

The effect of senility varies from individual to another and from community to another, but

with proper care can delay or minimize its effect or even prevent it. Many morbidities are in

relation with senility (osteoporosis, osteoarthritis, dementia, HTN, DM,…ect).

Morbidity as consequences of senility can create a very huge burden on the health care in all

levels and the community evenly. Elderlies care either institutional or community care (home

care) is very important, since it can relieve the burden on the health system, community and

the elderlies also. Therefore, Ministry of health and through the comprehensiveness of its

services to cover all groups of the population elderlies care programme is founded to shape

the care provided for this very important group of people.

OBJECTIVES: 1. To promote elderlies care service for elderlies population who can reach to PHC institutions

and those who cannot reach to improve their quality of life.

2. To empower PHC institutions to provide elderlies care services.

3. To raise the awareness of the community about the importance of elderlies care service to

encourage their contribution in this service.

209


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To promote elderlies care service for elderlies population either who

can reach or cann’t to PHC institutions to improve their quality of life.

1. Percentage of PHC institutions that provide

elderlies care service. zero 6.6% 80%

2. Percentage of elderlies who use elderlies

care service. zero 3.4% 80%

3.

Percentage of elderlies who can‟t reach

PHC institutions and involved in home care

service.

NA 3.2% 70%

4. Average number of visits for home care

group in all regions. NA < visit / month A visit / month

Second Objective’s Indicators: To empower PHC institutions to provide elderlies care services.

1. Number of regional coordinator for the

programme of elderlies care. zero zero 11

2. Average number of nurses working as

institutional coordinator for the programme. zero zero

One nurse /

institution

3. Average number of physiotherapist for each

sector*. zero zero

Physiotherapies

/sector

4. Average number of physiotherapy units for

each sector*. zero Zero Unit / sector

5. Average number vehicles for each sector*. zero zero Vehicle/ sector

6. Availability of elderlies care guideline in all

PHC institutions. NA NA available

7. Number of nurses trained to provide

elderlies care service. zero zero

A nurse/

institute (at

least)

8. Number of master trainer doctors. zero zero A doctor/

region

*(total number of sectors is 78 sector in all regions)

210

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Third Objective’s Indicators: To raise the awareness of the community about the importance of

elderlies care service to encourage their contribution in this service.

1. Number of community activities to raise

awareness about elderlies care. zero

2 / institution at

least*

2 / institution at

least

2.

Percentage of people in community who

know about the importance of elderlies

care.

NA NA 60%

This data was available from Al Dakhliya region for 2010.

STRATEGIES:

Strategies to Achieve 1st Objective: To promote elderlies care service for elderlies population either

who can reach or cann’t to PHC institutions to improve their quality of life.

1.1 Nominate a regional focal point and programme coordinator.

Expected results:

Better follow up and monitoring of the programme in the regions.

1.2 Implement proper elderlies care service mechanisms in PHC institutions.

Expected results:

Provide standard elderlies care services.

1.3 Determine a service pathway in PHC institution.

Expected results:

Easy flow of the elderlies in all stations of the service.

1.4 Create elderlies care service guideline for PHC institutions.

Expected results:

Availability of reference for provision of elderlies care service.

1.5 Implement home care service mechanism.

Expected results:

Provide standard home care service easily.

1.6 Determine home care service pathway and checklists.

Expected results:

Provide easy and standard home care service for elderlies.

211


objective: To empower PHC institutions to provide elderlies care services.

2.1 Support PHC institutions with necessary number of nurses.

Expected results:

Ensure continuity of elderlies care service.

2.2 Support PHC institutions with physiotherapists.

Expected results:

Provide physiotherapy service for elderlies in PHC setting.

2.3 Support PHC institutions with mobile physiotherapy units.

Expected results:

Provide physiotherapy service for elderlies in PHC setting.

2.4 Provide transportation for elderlies care team in PHC setting.

Expected results:

Ensure easy follow of service providing team in inter-institution and in the community.

2.5 Provide enough printed material for provision of service.

Expected results:

Easy provision of service.

2.6 Provide enough educational materials.

Expected results:

Raise the awareness and knowledge of the targeted group.

2.7 Train elderlies care service providers.

Expected results:

Provide a proper service with trained staff.

2.8 Train trainers in elderlies care.

Expected results:

Continuity of training of staff in all regions.

2.9 Coordinate with Ministry of social development about elderlies care.

Expected results:

Participation of social workers in the service and provision of comprehensive social service.


Objective: To raise the awareness of the community about the importance

of elderlies care service to encourage their contribution in this service.

3.1 Prepare community awareness package.

Expected results:

Easy community education process.

212

3.2 Training of health educators and community support groups about elderlies care education

package.

Expected results:

Availability of trained staff for the process of community awareness.

3.3 Conduct a community based study to measure community awareness.

Expected results:

Measuring community awareness about elderlies care service.


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Percentage of regions with elderlies care

programme focal point. Annually 100% 100%

1.1b Percentage of regions with elderlies care

programme coordinator. Annually 100% 100%

1.2a Percentage of Health institutions with

elderlies care guidelines. Annually zero 100%

1.3a Percentage of Health institutions with clear

elderlies service pathway. Annually zero 100%

1.4a Percentage of Health institutions with

elderlies care service manual. Annually zero 100 %

1.5a Percentage of PHC institutions with home

care package. Annually zero 100 %

1.6a Percentage of PHC institutions with home

care package checklists. Annually zero 100%


Objective

2.1a Percentage of PHC institutions with trained

nurses in elderlies care. Annually zero 80 %

2.2a Percentage of sectors with physiotherapist. Annually zero 60%

2.3a Percentage of sectors with physiotherapy

units Annually zero 60%

213

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.4a Percentage of sectors with vehicle. Annually zero 75%

2.5a Percentage of institutions with elderlies care

printed list. Annually zero 90%

2.6a Percentage of institutions with elderlies care

educational materials. Annually zero 90%

2.7a Percentage of regions with trained doctor. Annually zero 90%

2.8a Availability of training of trainers workshops. Annually zero Available

2.9a Percentage of sectors with social workers. Annually zero 60%


Objective

3.1a Percentage of PHC institutions with

community awareness package. Annually zero 100%

3.2a

Percentage of PHC institutions with (two)

staff trained on proper community education

about elderlies care.

Annually zero 75 %

3.3a

Number of field studies on community

awareness about the importance of elderlies

care.

Annually N.A 2

214

Dissemination of Healthy lifestyles in the

Community

Vision Five

215

Domain: Twenty Four

Health Education and Communication

216

Vision: Dissemination of Healthy Lifestyles in the Community

Goal: Increasing Health Awareness, Correcting Attitudes and Establishing

Healthy Behaviors and Practices in the Community

Domain: Health Education and Communication

INTRODUCTION:

Health education plays a prominent role not only at dissemination of health

information to the community but also in informing the citizens about the programs and

services offered by the Ministry in order for them to take advantage of these services. Health

Education is a joint responsibility of all health workers in different health institution and not

exclusively on health educators.

Health education is an important and integral part of all health services and programs

of the Ministry of Health and its various institutions that spread throughout community. The

Ministry of health therefore making considerable efforts in supporting health education

programmes towards the achievement of established goals and targets intended to sensitize.

In the past few decades, Oman has gone through unprecedented socioeconomic

development. Life expectancy has increased dramatically, major infectious diseases have

been controlled or eradicated and infant mortality rates have been reduced. The rapid

development of the country‟s physical infrastructure has facilitated easy access to and

availability of health and non-health facilities for all citizens. Economic growth has played an

important role in these achievements. Simultaneously, the country has begun to experience

the emergence of an increased rate in non communicable diseases such as diabetes, heart

disease, hypertension and cancer and behaviors related to unhealthy lifestyles.

The emergence and persistence of such practices and unhealthy behaviors, and the

consequent significant increase in morbidity indicators and other health problems, represents

a major challenge to the efforts of awareness-raising and education. It also form a heavy

burden on health care and treatment therefore there is an urgent need to introduce modern and

attractive strategies in health education. As well as building capacities of health care workers

in the field of health education and related subjects.

health education is a continuous process, it is necessary to develop a database on

different risky behaviors and practices in the community as well as conducting different

studies which assist in determining the priority issues in the community and therefore

planning different awareness raising programs.

Health education works with different community organizations and government

agencies. Aiming to help the community to identify its needs, draw upon its problem-solving

abilities, and mobilize its resources to develop, promote, implement and evaluate strategies to

improve its own health status.

OBJECTIVES:

1. Developing and improving the health education services.

2. Developing the skills and building the capacity of MOH staff working in the field of health

education.

3. Increasing health awareness, targeted at changing unhealthy attitudes and practices and

promoting healthy lifestyles and behaviors in the community.

217


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: Developing and improving the health education services

1. Rate of health educators per 10,000

population. NA

One health

educator for

20,000 of the

population

One health

educator for

10,000 of the

population

2. Presence of a health education strategy. NA Not completed A strategy

present

3.

Percentage of health institutions that meet

the standard prerequisites of health

education as per the quality auditing

form.

0% NA 80%

4. Percentage of the Willayat that have well

equipped health education rooms. 0% 5% 50%

5.

Number of educational packages produced in the following subjects:

Adolescents health NA

In preparation

One Package

for each subject Healthy lifestyles

NA NA

Elderlies care NA

NA

Second Objective’s Indicators: Developing the skills and building the capacity of MOH staff working

in the field of health education

1. Presence of continuing education

program for health educators. NA NA Existence of a

program

2. Number of training activities conducted

in the field of health education. 5

3 centrally

56 at regional

level

3 centrally

44 at regional

level

3.

Percentage of primary health care workers who have been trained in health education:

Health educators NA 50% 100%

Doctors 5% 27% 45%

Nurses 16% 28% 50%

Pharmacists & Assistant

Pharmacists 0% 27% 57%

medical orderlies 25% 51% 65%

218

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Third Objective’s Indicators: Increasing health awareness, targeted at changing unhealthy attitudes

and practices and promoting healthy lifestyles and behaviors in the community

1.

The proportion of citizens who have knowledge about :

Risks of Tobacco. 52%* 84.3%** 95%

Importance of moderate physical

activities. NA 70.2% 90%

Healthy nutritional habits. 66% 89% 90%

2.

The proportion of citizens who:

Practicing moderate physical

activity NA

33.4%*** 50%

Smoking NA

6.9%**** 3%

Obese NA

24.8%**** 10%

3.

Availability of baseline data regarding

knowledge, attitudes and practices of the

community of towards important health

issues.

NA NA available

4.

Percentage of the beneficiaries from health education activities in the :

Health institutions 10% 14% 50%

Community 15% 42% 50%

5.

The number of health educational activities and events that have been implemented to raise health

awareness in the community through:

Health campaigns

NA

5 at central

level

77 at regional

level

3central level

55 at regional

level annually

Health exhibitions 8

7 central level

202 at regional

level annually

3central level

100 at regional

level annually

IEC materials produced 45 95 500

219

STRATIGIES:

Strategies to Achieve 1st objective: Developing and improving the health education services

1.1 Adopting new methodologies and approaches in the field of health education.

Expected results:

Improve the quality of health education activities.

1.2 Expansion in the number of health educators.

Expected results:

Increase the number of health educators and improve services

1.3 Coordination with different five-year plan health programs to develop a joint communication

plans.

Expected results:

Improve the effectiveness of health education activities. Coordinated efforts in directing health messages to the targeted groups.

1.4 Establishing a national call center for the various health topics.

Expected results:

Increase awareness of various health problems. Monitor the important health problems and issues of concern to the community.

1.5 Review and update the curriculum for health educators.

Expected results:

Updated curriculum for health educators.

Strategies to achieve 2nd

Objective: Developing the skills and building the capacity of MOH staff

working in the field of health education

2.1 Developing a of continuing education program for health educators in education and health

communication.

Expected results:

Increase the efficiency and effectiveness of health educators.

2.2 Providing abroad qualification for the staff in the field of health education and communication,

media and social marketing.

Expected results: Qualified expertise staff to improve services.

2.3 Training health care workers on health education and communication, media, social marketing

and methodology of IEC materials production.

Expected results:

A well trained team.

220


Objective: Increasing health awareness, targeted at changing unhealthy

attitudes and practices and promoting healthy lifestyles and behaviors in the community

3.1 Establish a database on the knowledge, attitudes and practices of community towards different

health issues.

Expected results:

Identifying the knowledge, attitudes and practices prevailing in the society and its impact on health

to find appropriate interventions.

3.2 Production of attractive and advanced high quality IEC materials.

Expected results:

Provision of a variety of attractive IEC materials support healthy behviours.

3.3 Adapting new approaches to market and promote health in the media.

Expected results:

Efficient healthy messages in the media.

3.4 Unify health messages with the concerned programs and sectors.

Expected results:

Increase the effectiveness of health messages.

3.5 Conduct a study to evaluate the impact of health education activities in the community.

Expected results:

Improve health education activities according to the results of the evaluation of interventions

implemented.

STARATEGIES’ INDICATORS:

Indicators

Follow

up

timing

Current

Situation

2010

Targeted

Situation

2015


1.1a

Presence of an integrated health education

strategy.

By the

end of

2012

NA Strategy present

1.1b

The presence of an electronic record to

document the health education activities.

By the

end of

2012

NA Electronic record

present

1.1c

The presence of manual for health educators.

By the

end of

2012

NA Manual present

1.1d The presence of manual on methodology of

IEC materials production. Annually NA Manual present

221

Indicators

Follow

up

timing

Current

Situation

2010

Targeted

Situation

2015

1.1e The presence of manuals on communication

skills with the media.

By the

end of

2012

NA Manual present

1.2a Number of health educators enrolled in the

ministry annually. Annually 2 30 yearly

1.3a Number of communication plans for

programs that have implemented strategies. Annually NA

Communication Plan/

strategy implemented

1.4a

The establishment of a health national call

center.

By the

end of the

current

plan

NA Call center established

1.5a

The existence of an updated curriculum for

health education.

By the

end of the

current

plan

NA updated curriculum


2.1a The Existence of continuing education

program for health educators.

End of the

current

plan

NA program present

2.2

Number of training programs implemented in the area:

a. Health education and communication Annually NA 11

b. Media Annually NA 11

c. Social Marketing Annually NA 11

d. Production of IEC materials Annually 1 11

2.3a The number of qualified personnel in the

field of health communication, media and

social marketing.

Annually NA 3

2.4

Percentage of primary health care workers who have been trained in the field of:

a. Health education and communication Annually NA 30%

b. Health media Annually NA 20%

c. Social marketing Annually NA 20%

d. IEC materials production

Annually NA 30%

222

Indicators

Follow

up

timing

Current

Situation

2010

Targeted

Situation

2015


Objective

3.1a The availability of a database on knowledge,

attitudes and practices in the community

towards health issues.

By the

end of

2013

NA Baseline Date available

3.2

Number of educational materials have been produced according to the steps of scientific-based

educational material for the production of:

a. Printed: Annually 27 350(70 yearly)

b. Audio: Annually 0 25(5 yearly)

c. Audiovisual: Annually 0 25(5 yearly)

3.3a

The number of health messages broadcasted in the media:

a. Television Annually 60 100

b. Radio Annually NA 100

c. Press Annually 4 150

3.3b The number of health programs implemented in the media :

a. Television Annually 51 100

b. Radio Annually 99 150

3.3c The number of Media professionals who have

been trained on the health topics. Annually 170 50

3.4a The number of activities which was

characterized by a unified health messages. Annually 10 25

3.4b The number of health messages that have

been developed in collaboration with

different programs and other sectors.

Annually 27 50

3.4c

Number of IEC materials produced in

cooperation with the different programs and

other sectors.

Annually 55 70

3.5a The presence of a study evaluating the impact

of health education activities in the

community.

By the

end of the

current

plan

NA Study present

223

Domain Twenty Five

Adolescent and Youth Health

224




Domain: Adolescent and Youth Health

INTRODUCTION:

Adolescents and youth in the age group 10 to 24 years constitute a significant sector of Omani

society. They represent approximately 34% of the population as per the census 2003. They are

also considered the main investment in the future national development.

Adolescence is considered a transition stage in human being lives, as he/she gets physical,

biological, psychological and social changes which substantially shape his/her personality and

attitudes. However during this delicate phase of a lifetime, many sources can influence the

attitudes and behaviors of adolescent and youth such as peer pressure, media and

communication technology…etc. Adolescents and youth may be exposed to risky behaviors

such as sexual behaviors, tobacco and drugs addiction, exposure to psychological diseases

which may negatively affect their attitudes and practices.

Many studies conducted by Ministry of Health had shown that adolescents and youth are

vulnerable to many risk behaviors such as smoking and unsafe driving. Not only that, these

studies also revealed that adolescents have misconceptions about a lot of issues related to

reproductive and sexual health.

According to that , Ministry Of Health with other concerned ministries have implemented the

Information, Education and Communication strategy(IEC) for adolescents and youth health

emphasizing the main role of the health services provided for adolescents and youth . In

order to continue the hard work and to improve the health services provided for youth, a study

was conducted in 2006 to evaluate the health services provided for this group through the

schools and primary health care, and to know their opinions and attitudes towards their

reproductive and sexual health needs.

The study revealed many gaps associated with the health services provided for adolescents

and youth, of these:

Primary health care provides certain reproductive and sexual health services for

adolescents and youth through maternal and child clinics which provide only

antenatal care and health education on birth spacing for adults .

There is no health services specific for adolescents and youth such as counseling

The most important recommendations from this study are:

The importance of establishing adolescents and youth clinics in order to focus and

improve the quality of reproductive and sexual health services provided for this age

group which is suitable for the different developmental stages.

The importance of improving the health education programs to be more suitable and

appropriate with the information needs of adolescents and youth

225

The importance of provision of appropriate health educational materials for

adolescents and youth.

According to these recommendations, the objectives of this domain will focus on promotion

of adolescents and youth health.

OBJECTIVES:

1. To promote the role of primary health care in providing services appropriate for adolescents

and youth in all regions of the Sultanate.

2. To increase awareness about adolescents and youth issues in order to promote healthy lifestyles

in all regions of the Sultanate.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To promote the role of primary health care in providing services

appropriate for adolescents and youth in all regions of the Sultanate

1. The number of adolescents‟ clinics in the

primary health care. 0 11

61

(One clinic per

Wilayet)

2.

Number of added services provided for

adolescents and youth in the primary health

care institutes (counseling, investigations,

health education …).

Not applicable 1 At least 3

services

3.

Number of studies conducted to evaluate to

what extent the health services provided at

PHC institutes is adolescents and youth

friendly.

NA

1

(evaluation of

services in

2006)

2

4.

4-percentage of health educators who are

trained on advocacy for youth health

services.

NA Not applicable 80%

Second Objective’s Indicators: To increase awareness about adolescents and youth issues in order to

promote healthy lifestyles in all regions.

1.

Percentage of adolescents (15-19years)

who have good knowledge about

reproductive health.

50%

(2001) NA 90%

226

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

2.

Percentage of youth (19 - 24years old) who

know the symptoms of sexually transmitted

infections (STI).

NA 23.3% 70%

3.

Percentage of youth (19-24 years old) who

know that physical activity and dieting are

optimum measures to control overweight.

NA 70.2% 90%

4.

Number of studies conducted to know the

level of awareness among adolescents,

youth and their families about the

adolescents and youth health issues.

Adolescent‟s

survey 2001

University &

college survey

2010

2

STRATIGIES:

Strategies to Achieve 1st Objective: To promote the role of primary health care in providing services

appropriate for adolescents and youth.

1.1 Development of training manuals and clinical guidelines dealing with adolescents and youth

health issues.

Expected results:

Increase knowledge and skills of health workers in the primary health care institutions.

Improve the health services provided for adolescents and youth.

1.2 Training of health workers in primary health care institutions on dealing with adolescents and

youth health issues.

Expected results:

Improve the quality of health services provided for adolescents and youth.

Increase knowledge and skills of health workers in primary health care institutes on health issues of

adolescents and youth.

1.3 Provision of counseling service for adolescents and youth in the primary health care

institutions appropriate for their needs.

Expected results:

Solving adolescents and youth health problems especially related to reproductive health issues.

227

1.4 liaison /coordinate with IT and PHC Department to improve the computer/information system

to register and document the clients visiting the adolescents’ clinics.

Expected results:

Retrieve the data and indicators of adolescents and youth.


Objective: To increase awareness about adolescents and youth issues in

order to promote healthy lifestyles in all regions of the Sultanate

2.1 Development of educational package targeting adolescents, youth and their families in order to

change their knowledge, attitudes and behaviors in relation to issues like adolescence, tobacco,

sexually transmitted diseases, physical activity, reproductive health, mental health and nutrition

related problems…etc.

Expected results:

Increase the percentage of adolescents and youth who are aware about their health issues.

Reduce the percentage of adolescents and youth who exercise risky behaviors.

2.2 Increase the educational and media activities to advocate for the adolescents and youth health

services provided in the primary health care institutes in collaboration with Health Education

Directorate.

Expected results:

Increase awareness among adolescents, youth and their community about the health services

available for them.

Availability of the media support for proper utilization of adolescent‟s and youth‟s health services.

2.3 Collaboration and coordination between different sectors involved in the National Strategy of

Information, Education and Communication on adolescents’ and youth’s health.

Expected results:

Increase knowledge among adolescents and youth about their health related issues.

2.4 Strengthening the participation of health committees and community based initiatives to

support the educational activities targeting the adolescents and youth.

Expected results:

Increase the care of adolescents and youth health issues.

Adoption of the health committees and community based initiatives (at the Wilayats level) for the

educational activities about adolescents and youth health issues.

228



timing

Current

situation

2010

Targeted situation

2015


1.1a

Availability of clinical

guidelines on adolescents and

youth health.

By the end of the

current plan NA Available & Applied

1.1b

Availability of Training

manual on adolescents and

youth counseling.

By the end of the

current plan NA Available

1.2a

Number of health workers

(doctors &nurses) who are

trained on the clinical and

training guidelines.

Annually Not applicable 50-100 health workers

/region

1.2b

Number of training

workshops for health workers

on how to use the clinical and

training guidelines.

Annually Not applicable 1-2 workshops per region

annually

1.2c

Percentage of health

educators who are trained on

health education of

adolescents and youth health

issues.

Annually 8.9% 80%

1.3a

Percentage of health

institutions which provide

counseling for adolescents

and youth.

Annually 6.3% 80%

1.4a

Availability of improved data

system for adolescents and

youth health.

By the end of the

current plan NA available


2.1a

Number of educational

materials published by MOH

at the central level on

adolescents and youth health.

By the end of the

current plan 4 5-7 through the plan

229


timing

Current

situation

2010

Targeted situation

2015

2.1b


materials published by

regions on adolescents and

youth health.

By the end of the

current plan 0

1-2 per region through

the plan

2.2a


activities conducted at the

PHC on adolescent‟s health.

Annually 1-2 activity

/institution/annually

5-7 per

institution/annually

2.2b

Number of activities in the

community that advocate for

adolescents and youth health

services provided at PHC

institutes annually.

Annually NA 2-5 /region/annually

2.3a

Percentage of sectors that

have implemented the

National Strategy of

Information, Education and

Communication in

adolescent‟s health.

Annually 70% without

Muscat & Dhofar 100%

2.4a

Number of Wilayats that

incorporate the adolescents

and youth health in their

health activities.

Annually 50 All wilayats

230

Domain Twenty Six

School and college health

231




Domain: School and College Health

INTRODUCTION:

Education has witnessed a tremendous development in the Sultanate and has reached the

number of students based on estimates for 2008/2009 about 584401 students, out of them

43396 (7.4%) students in private schools.

The educational indicators point to high rates of gross enrollment and net per year as they

reach the total enrollment for the academic year 2008 / 2009 to 99.2% for grades 1-6, 101.7%

for grades 7-9, 91.3% for grades 10-12, while Net enrollment rates are of the same year,

91.4% for grades 1-6, 83.6% for grades 7-9, 71.6% for grades 10-12

The number of schools in the Sultanate is 1250, including a school in 1047 government

schools, 3 schools for Special Education and 200 private schools. The number of schools staff

is about 53487 people (46533 teachers and 6954 administrative)

Many studies conducted in the Ministry of Health had shown that the students are prone to

exercise a lot of negative behaviors. The MOH annual report showed that there is an increase

in the prevalence of overweight and obesity among school students, where in 2009 amounting

to about 2% for grade one, 9% for grade seven and 9.3% for grade ten.

In order to care for this category, school health services are currently available through the

Ministry of Health. It aim to provide comprehensive school health services for all students in

government schools and some services to private schools and care centers for people with

disabilities. The school community includes students as well as school staff and parents, who

are in need to enable them to improve their health and practice healthy behaviors that may

reflect on the behavior of students.

A comprehensive school health program includes eight core components which are

health education, school health services, a healthy safe and supportive environment, nutrition

promotion, encourage physical activity, mental health promotion as well as promotion of

school staff health and community participation. In 2008 the National School Health Strategy

was launched .It was developed by school health department in coordination with the sectors

concerned the health of school students and with technical support of WHO-EMRO.

In order to promote the health of students in universities, colleges and higher

educational institutions, the Ministry of Health in collaboration with the World Health

Organization in 2008 conducted a survey to measure their knowledge, attitudes and practices.

The results showed poor knowledge and practices, especially in the field of nutrition, physical

activity, tobacco use, alcohol, substances abuse, road safety, STI and HIV/AIDS. A multi-

sectoral action plan was developed in collaboration with universities and institutions of higher

232

education and other related government and non-governmental sectors concerned with health

of this category.

OBJECTIVES:

1. To promote healthy lifestyles among all categories of the school community in all regions of

the Sultanate.

2. Development and expansion of efficient, high quality, and comprehensive health services to all

school community in all regions of the Sultanate.

3. To promote the health of students in higher educational institutions in all regions of the

Sultanate.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective's Indicators: To promote healthy lifestyles among all categories of school community

in all regions of the Sultanate

1. Percentage of students in grade one who

suffer from underweight. 14.2% 12.7%* 8%

2. Percentage of students in grade one who

suffer from overweight and obesity. 1.1% 2.17%* 1%

3. Percentage of students in grade seven who


4. Percentage of students in grade ten who



are current smokers. NA

3.1%

(2007) 2%


currently use smokeless tobacco. NA

8.7%

(2007) 5%


currently use shisha. NA

5.4%

(2007) 3%

8. Percentage of students in grade ten who are

current smokers. NA 5.9% 3%


currently use smokeless tobacco. NA 6.1% 3%

233

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015


currently use shisha. NA 3.9% 1.5%

11.

Percentage of students in grade seven who

eat vegetables and fruits at least five times

per day.

10.8% NA**

100% increase

from current

situation

12.

Percentage of students in grade ten who eat

vegetables and fruits at least five times per

day.

8% 12.5% 60%

13.


walk for at least half an hour daily 5-7 days

per week.

18.2% NA**

100% increase

from current

situation

14.

Percentage of students in grade ten who

walk for at least half an hour daily 5-7 days

per week.

25.1% 21.3% 60%

15.


spend three hours or more in watching TV

or using computers and video games.

33.1% NA**

30% reduction

from the current

situation

16.


spend three hours or more in watching TV

or using computers and video games.

34.3% 33% 25%


always have breakfast in the past 30 days. 49.2% NA**

100% increase

from current

situation


always have breakfast in the past 30 days. 32% 30.5% 60%


eat fast foods 3 or more days per week. 11.8% NA**

30% reduction

from the current

situation

20. Percentage of students in grade ten who eat

fast foods 3 or more days per week. 8.2% 24.6% 15%


use seat belt in a car driven by another. 31.1% NA**

75% increase

from current

situation

22. Percentage of students in grade ten who use

seat belt in a car driven by another. 33.7% NA**

75% increase

from current

situation

234

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

23.


have been in a physical attack in last 12

months.

46.9% NA**

30% reduction

from the current

situation


have been in a physical fight in last 12

months.

47.6% NA** 30% reduction

from the current

situation


have been bullied in last 12 months. 33.2% NA**

30% reduction

from the current

situation

26.


have been in a physical attack in last 12

months.

29.4% 29.4% 20%

27.


have been in a physical fight in last 12

months.

34.5% 37.3% 25%


have been bullied in last 12 months. 39.2% 41.8% 30%

29. Percentage of school staff who use any

kind of tobacco. NA 14.1% 8%

30.

Percentage of school staff who eat

vegetables and fruits at least five times per

day.

NA NA***

50% increase

from current

situation

31. Percentage of school staff who walk for at

least half an hour daily 5-7 days per week. NA NA***

50% increase

from current

situation

*WHO-BMI for age curve was used in 2008/2009

** Data of physical screening of students in grades seven and ten for year 2011/2012 will be considered as

baseline of the current plan

*** A KAPB on lifestyles will be conducted in 2011 /2012 and could be considered the baseline of the

current plan

235

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Second Objective's Indicators: To expand the efficient, high quality, and comprehensive health

services to all school community in all regions of the Sultanate

1.

Percentage of public schools with

comprehensive school health services to

students.

100% 100% 100%

2.

Percentage of public schools where quality

assurance program for school health is

implemented.

NA 1% 50%

3.

Percentage of public schools with

comprehensive school health services to

school staff.

NA 20.3% 100%

4. Percentage of private schools with

comprehensive school health services. 30% 60% 100%

5. Percentage of centers of disabilities which

have comprehensive school health services. 50% 60% 100%

Third Objective's Indicators: To promote health of students in high educational institutions in all

regions of the Sultanate

1. Percentage of students in high educational

institutions who smoke cigarettes. NA 9.9% 5%


institutions who smoke shisha. NA 7.7% 5%


institutions who use chewable tobacco. NA 3.9% 2%

4.

Percentage of students in high educational

institutions who eat at least 5 servings from

vegetables and fruits.

NA 12.4% 60%

5.


institutions who walk at least half an hour

daily for 5-7 days per week.

NA 50.1% 75%

6.


institutions who spend three hours or more

in watching TV or using computers.

NA 28.7% 15%

236

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

7.


institutions who have breakfast daily in the

past 30 days.

NA 23.9% 60%

8.


institutions who eat fast foods 3 times or

more in the past 7 days.

NA 46% 25%


institutions who use seat belt while driving. NA 71.4% 90%

10. Percentage of high education institutions

which have health education programs. 1% 80% 100%

STRATEGIES:

Strategies to Achieve 1st Objective : To promote healthy lifestyles among all categories of school

community in all regions of the Sultanate

1.1 Expansion of the national health promoting schools network.

Expected results:

Raise awareness of school community towards healthy lifestyles.

1.2 Implementation of peer education strategy in all health issues among school community.

Expected results:

Raise awareness of school community.

1.3 Monitoring of high risk behaviors among school community.

Expected results:

Availability of indicators related to health behaviors of school community.

1.4 Provision of training and health education programs to school staff.

Expected results:

Increase health awareness of school staff.

1.5 Provision of health education programs to parents.

Expected results:

Increase health awareness of the parents.

1.6 Expand the benefits from Facts for Life book and the school health websites.

Expected results:

Increase health awareness of school community.

237

1.7 Ensure healthy safe school environment which support to learning and work.

Expected results:

Presence of healthy, safe and supportive school environment.


Objective : To develop and expand the efficient, high quality, and

comprehensive health services to all school community in all regions of the Sultanate

2.1 Continuous provision of efficient, high quality school health services to students and school

staff in public schools.

Expected results:

Increase the beneficiaries of school health services.

2.2 Encourage and support the provision of school health services in private schools and centers

for special needs.

Expected results:

Complete coverage of health services to students in educational institutions.

2.3 Strengthen the cadre of school health especially school health nurses as per one nurse for

each school.

Expected results:

Availability of adequate trained nurses to provide comprehensive effective school health services.

2.4 Strengthen the cadre of school health department and school health sections with nurses for

planning, supervision, training and monitoring the school health nurses in schools.

Expected results:

Availability of supervision, training and monitoring of school health nurses from central level.

2.5 Continuous implementation of the national school health strategy with other related sectors.

Expected results:

Coordination between different sectors concerned with students' health.

2.6 Strengthen the well equipped school health clinics in all schools.

Expected results:

Improve quality of services provided.

2.7 Availability of electronic database on students' health through e-portal of Ministry of

Education.

Expected results:

Availability of indicators to be used for improvement of the services.

2.8 Evaluation of the beneficiary satisfaction.

Expected results:

Availability of data on the beneficiary satisfaction.

238

Strategies to Achieve 3rd Objective : To promote health of students in high educational institutions

in all regions of the Sultanate

3.1 Strengthen the organizational structure of school health department and sections in the

regions to include a section in the department / unit in the sections for planning, supervising and

monitoring the health programs in the high education institutions.

Expected results:

Facilitation of monitoring and evaluation of school and collage health programs.

3.2 Advocacy and implementation of health promotion in the high educational institutions.

Expected results:

Raising students' awareness on health promotion.

3.3 Implementation of peer education approach in all issues related to healthy lifestyle in the

high educational institutions.

Expected results:

Raising high educational students' awareness towards healthy lifestyles.

3.4 Supervise the implementation of multisectoral plan of action on health promotion of high

educational students.

Expected results:

Coordination between all related sectors.

3.5 Monitoring of high risk behaviors among high education students.

Expected results:

Availability of indicators related to health behaviors of students in high institutions.


Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015


1.1a Percentage of schools joined the National

Health promoting Schools Network. Annually 20.3% 60%

1.2a

Percentage of school health nurses trained

on peer education approach from total

number of school health nurses.

Annually 13.5% 80%

239

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

1.2b Number of training courses on peer

education in all regions. Annually 46 165

1.2c Number of peer educators from schools

students trained in issues related to lifestyles. Annually 3036

5-10 students in

each school

1.2d Number of peer educators from school staff

trained in issues related to lifestyles. Annually

Not

applicable

2-5 staff in each

school

1.3a Number of studies conducted to monitor the

health behaviors among school staff.

By the end

of the

current

plan

1 2

1.3b Presence of periodic monitoring system for

risk factors among students.

By the end

of the

current

plan

Present but

incomplete

Present and

complete

1.4a

Number of health education sessions

conducted for school staff in different health

issues.

Annually

3 sessions in

20.3% of

schools

At least 3- 5

sessions in each

school annually

1.5a

Number of health education sessions

conducted for parents in different health

issues.

Annually

2 sessions in

20.3% of

schools

At least 2-4

sessions in each

school annually

1.6a Number of users of Facts For Life and

school health websites. Annually

Not

applicable 4000 annually

1.7a Percentage of schools with healthy, safe and

supportive environment. Annually 20.3%

60%


2.1a

Percentage of schools provides school

health services with quality assurance

program.

Annually 1% 50%

2.2a Percentage of private schools which have a

comprehensive school health services. Annually 60%

100%

240

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.2b

Percentage of centers of disabilities which

have a comprehensive school health

services.

Annually 60% 100%

2.3a Percentage of schools with full time school

health nurse. Annually 0 100%

2.3b Number of training courses/ workshops for

school health nurses. Annually

1 workshop

per region

annually

3-5 Courses/

workshops per

region annually

2.3c Percentage of school health nurses trained in

mental health promotion. Annually 1% 80%

2.3d Doctors (part time)/schools ratio. Annually

1doctor /7

schools

(Estimated)

1doctor/4 schools

2.3e Number of central courses for school health

nurses' trainers. Annually 0 5

2.4a Number of nurses working in school health

department.

End of the

current

plan

0 2

2.4b 2-4-B Number of nurses working in school

health section in the regions.

End of the

current

plan

3 11 ( 1 in each

region)

2.5a

Percentage of concerned sectors

implementing the national school health

strategy.

Annually 60% 100%

2.6a Percentage of schools which have equipped

school health clinic. Annually 80% 100%

2.7a 2-7-A Percentage of schools which have

electronic data base for students‟ health. Annually 10% 100%

241

Indicators

Follow

up

timing

Current

situation

2010

Targeted

situation

2015

2.8a Number of studies conducted to evaluate the

beneficiaries‟ satisfaction.

End of the

current

plan

0 1


3.1a

Percentage of regions where school health

section has a unit for higher education

institutions.

Annually 0 100%

3.2a Percentage of higher education institutions

that declared health promoting institution. Annually 0

25%

3.3a

Number of peer educators from students in

higher education institutions trained in issues

related to healthy lifestyles.

Annually

5-10 students

in some

institutions

5-10 students in

each institution

3.4a

Presence of coordination between the

concerned sectors in implementing the

multi-sectoral plan on health promotion.

End of the

current

plan

Not

Applicable Present

3.5a

Number of studies conducted to monitor

health behaviors among students of higher

education institutions.

End of the

current

plan

1

1

by the end of the

plan

242

Vision Six

Better Nutrition for All

243

Domain Twenty Seven

Nutrition

244

Vision: Better Nutrition for All

Goal: Improvement of the Nutritional Status of Omani Society

Domain: Nutrition

INTRODUCTION:

Studies and researches have indicated a prevalence of nutritional issues among different

groups of the society in the Sultanate of Oman, which rise concerns among health authorities

since malnutrition of different types affects negatively on immunity, and increase the chances

and durations of morbidity among children and childbearing and pregnant women.

Furthermore, it affects the capacity of individual productivity.

Since 8.6% of children under the age of five suffer from low weight, 44% of children

suffer from mild to moderate anemia at the age of 9 months and 45.5% at the age of 18

months in 2009. For school children, the percentage of anemia reached to around 48.9%

among boys and 52.7% among girls in 2004. The percentage of anemia among childbearing

women reached to 39.6% and 12% among males in 2004, and, the percentage of anemia

reached to 27.5% among pregnant women in 2009.

About iodine deficiency and vitamin A deficiency, it have been found in 2004 that about

34% of the Omani society do not use iodized table salt, which shows that the goal of full

coverage of the iodized table salt have not achieved, and this indicator raises concerns about

the probability of diseases associated with iodine deficiency. Also, there is a need to fortify

some of the food products with vitamin A and vitamin D, such as vegetable oils beside the

continuation to provide Vitamin A doses along with vaccines, which led to decrease in the

rate of retinol deficiency from 20.8% in 1994 to 5.2% in 1999.

It should be noted that there are no clear indicators about the nutritional status of school

children. However, studies showed that the rate of fat and meat consumption exceeded the

recommended amount by 25%, while the rate of consumption of carbohydrates, fruits and

vegetables, and dairy products decreased by 50%. The rate of obesity has been around 24.8%

in 2008 (Global Health Survey, WHO). And when comparing this percentage with

neighboring countries, it was found that the Sultanate of Oman is the only country where the

rate of obesity among males and females is equal. Moreover, this rate is double the rate of

obesity among males in the Kingdom of Bahrain and the United Arab Emirates, and more

than five times in Iran. As well as, there are no clear indicators to know the prevalence of

diseases associated with food contamination, but the food borne disease surveillance program

cleared that there was 255 observed cases of food poisoning for every 10000 of the population

during 2009, and this percentage compose about 1.4% of the total patients attending the OPD

in health institutions.

OBJECTIVES:

1. Promotion of food and nutrition policies and strategies.

2. Promotion and management of infant and young child nutrition.

3. Control of micronutrients deficiency among the whole population.

4. Improve nutrition and dietetics services in all health institutes.

5. Support of food safety systems in coordination with other sectors.

245


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective's Indicators: Promotion of food and nutrition policies and strategies.

1. Availability of updated National Food &

Nutrition Policy. NA NA

Available & updated

2.

Availability of a protocol determines the

nutrition components which exist in the

Diet, Physical activity, and Health Strategy

(DPAHS).

NA NA Available

3.

Availability of a protocol determines the

nutrition programs in the Healthy lifestyle

programs.

NA NA Available

4.

Availability of a protocol based on scientific

evidence to control overweight and obesity

among community.

NA NA Available

Second Objective’s Indicators: Promotion and Management of infant and young child nutrition.

1. Prevalence rate of underweight (weight-for-

age) in children less than 5 years of age. 17.9% 8.6 % < 5%

2. Prevalence rate of wasting (weight-for-

height) in children less than 5 years of age. 7% 7% < 5%

3. Prevalence rate of overweight in children

less than 5 years of age. NA 2.3 % 2.3 %

4. Prevalence rate of obesity in children less

than 5 years of age. NA 0.5 % 0.5 %

Third Objective's Indicators: Control of micronutrients deficiency among the whole population.

1. Prevalence of anemia in children at 9

months of age. NA 29% 18%

2. Prevalence of anemia in children at 18

months of age. NA 39.8% 18%

3. Prevalence of anemia in adolescent girls

(10th

grade). NA NA 38%

246

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

4. Prevalence of anemia in pregnant women. 42% 29.2% <25%

5. Percentage of household salt iodization

coverage. 68.5% 68.5% >90%

Fourth Objective’s Indicators: Improve nutrition and dietetics services in all health institutes.

1. Availability of approved standard guidelines

for the organization of dietetics practice. NA NA available

2.


with qualified dietitians according to the

standards.

0% 0% 20%

3. Percentage of secondary health institutions

with qualified dietitians. 0% 0% 10%

4. Percentage of tertiary health institutions

with qualified dietitians. 0% 0% 50%

5.


which are evaluated annually for nutrition

and dietetic services.

NA 50% 100%

6.


which provide the targeted quality of

nutrition and dietetic services.

0% 0% 10%

7. Percentage of institutions with nutrition

clinics equipped as per MOH standards. 0% 20% 50%

Fifth Objective’s Indicators: Support of food safety systems in coordination with other sectors

1. Incidence of food borne disease (Salmonella

cases) infections. NA 28 .0 Reduction by 10%

2. Number of food poisoning outbreak. NA 2 Reduction by 10%

3. Number of MoH hospitals applying

HACCP system. NA 0% 20%

STRATIGIES:

247

Strategies to Achieve 1st Objective: Promotion food and nutrition policies and strategies.

1.1 Establishment of a taskforce from different involved sectors.

Expected results:

Availability of approved national food & Nutrition Policy.

1.2 Implementation of nutrition components of DHPAS.

Expected results:

Availability of DHPAS applied nutrition components.

Implementation of 20% of nutrition activities outlined in DHPAS.

1.3 Incorporation of nutrition objectives in cooperation with healthy lifestyle projects.

Expected results:

Availability of document specifies nutrition-related projects to healthy lifestyles.

Availability of guidelines for the nutrition-related projects to healthy lifestyles.

1.4 Enact community measures for obesity prevention into national policies and procedures.

Expected results:

Reduction in overweight and obesity rate in the community.

1.5 Implementation of the communication strategy of the Omani Food-based Dietary

Guideline.

Expected results:

Increased awareness of school students regarding overweight and obesity.

Reduction in overweight and obesity rate among school students population.

Strategies to Achieve 2nd Objective: Promotion and management of infant and young child

nutrition.

2.1 Implementation of national IYCF policy according to WHO guidelines.

Expected Results:

Availability of a protocol to monitor and evaluate the national IYCF policy.

All health staff are trained on the IYCF policy.

All health institutions implement the national IYCF policy.

2.2 Development and implementation of Child Nutrition Manual.

Expected Results:

Availability of the manual.

Achievement of Optimal child nutrition guidelines.

2.3 Revitalize BFHI.

Expected Results:

Availability of BFHI manual.

248

Improvement of child health services in the hospitals.

100% of targeted health institutions are accredited as BFHI institution.

Strategies to Achieve 3rd Objective: Control of micronutrients deficiency among the whole

population.

3.1 Development and implementation of National strategy for IDA control and management.

Expected results:

Availability of national policy on control and management of IDA.

Availability of a protocol to evaluate the national strategy of IDA among children and women.

3.2 Implementation of International Guideline for Certification to achieve status of elimination

of IDD.

Expected results:

Certificate that Oman is free of IDD.

Strategies to Achieve 4th Objective: Improve nutrition and dietetics services in all health institutes.

4.1 Develop and implement Standard Guideline for Dietetics in Oman.

Expected results:

Availability of standard guidelines for dietetics practice to improve service.

4.2 Establishment of Registration Process in MOH for nutritionist and dietitians and diet

technicians.

Expected results:

Availability and implementation of accreditation system.

4.3 Collaborate with academic institution to accredit Dietetic program.

Expected results:

Availability of accreditation system of MoH institutions for dietetic training & its implementation

to improve service quality.

Strategies to Achieve 5th Objective: Support of food safety systems in coordination with other

sectors.

5.1 Conduct the Total Diet Study.

Expected results:

Availability of study to determine the levels of bacteriological and chemical contamination of

foods as well as pesticide residues in agricultural products.

5.2 Strengthen Surveillance of Communicable Food-Borne Diseases.

Expected results:

Availability of enhanced food-borne disease surveillance for planning and decision making.

249

5.3 Implementation of HACCP in all MOH institutions.

Expected results:

To determine the hazard analysis and critical points for food-borne disease.



timing

Current

situation

2010

Targeted

situation

2015


1.1a Availability of approved national

food & Nutrition Policy.

By the end of

the current plan NA Available

1.2a Availability of DHPAS applied

nutrition components.

By the end of


1.2b Percentage of implemented DHPAS

applied nutrition components. Annually Inapplicable 20%

1.3a

Availability of document

specifies nutrition-related

projects to healthy lifestyles.


1.3b


nutrition -related projects to healthy

lifestyles.

By the end of


1.4a

Availability of protocol for evidence-

based community measures to

prevent obesity.


1.5a

Percentage of governorate

implementing communication plan

for Omani food dietary guideline.

Annually NA 100%


Objective

2.1a

Availability of a protocol to monitor

and evaluate the national IYCF

policy.


2.1b Percentage of health staff who are

trained on the IYCF policy. Annually NA 100%

250


timing

Current

situation

2010

Targeted

situation

2015

2.1c

Percentage of health institutions

implements the national IYCF

policy.

Annually NA 100%

2.2a Availability of the child nutrition

manual.

By the end of


2.2b Percentage of health staff who are

trained on the manual. Annually Inapplicable 50%

2.2c Percentage of health institutions

which have the manual. Annually NA 100%

2.3a Availability of BFHI manual. By the end of


2.3b Availability of training tools for the

manual. Annually NA

Available

&implemented

2.3c Percentage of hospital certified as

BFHI. Annually Inapplicable 100%

2.3d Percentage of primary health centers

certified as BFI. Annually Inapplicable 100%


3.1a

Availability of a protocol to monitor

the National strategy for iron

deficiency anemia in women and

children.

By the end of

the current plan

NA

Available

3.1b Availability of an updated policy to

control and monitor IDA program.

By the end of


3.1c Percentage of the policy activities

which are implemented. Annually NA 20%

3.2a

Percentage of implementation of the

Universal Sustained Iodization (USI)

protocol.

By the end of

the current plan Inapplicable 80%

251


timing

Current

situation

2010

Targeted

situation

2015


4.1a Availability of a standard guideline

for dietetics practice.

By the end of


4.1b Number of clinical Dietetics as

trainers. Annually 0 2

4.2a Availability of accreditation system

to register dietitians and Diet Tech. Annually NA

Available &

implemented

4.3a

Availability of accreditation system

in health institutions to train

dietitians.

Annually NA Available &

implemented


Objective

5.1a Availability of implemented Total

Diet Study.

By the end of


5.2a Availability of a protocol for the food

borne disease surveillance.

By the end of


5.2b Percentage of health institutions

which implement the protocol. Annually

Unimplemente

d 20%

5.3a Number of auditing staff for HACCP. Annually NA 1

5.3b Availability of a training and

evaluation guideline for HACCP.

By the end of


5-3-c percentage of hospital dietetics

staff who trained on HACCP Annually 0 20%

5-3-d percentage of hospitals

implement HACCP Annually 0 100%

252

Joint Action for Better Community Health

Vision Seven

253

Domain Twenty Eight

Community Participation

254

Vision: Joint Action for Better Community Health

Goal: Mobilization of the Community and Health Related Sectors for

Health Promotion

Domain: Community Participation

INTRODUCTION:

Community participation is known in health sector as the process in which the

individuals are responsible for their own health, and wellbeing of their society.

Community participation can be achieved through participating actively in planning,

implementation and evaluation of community developmental initiatives.

Since, the participation of the Community -in various forms- is considered one of the

main pillars of the health care system, the Ministry of Health strives to achieve this by

connecting health institutions with local community to help diagnose health problems and

assimilate them, and also to improve the capacity of individuals in identifying their needs.

Therefore, service delivery, quality and outcome can be enhanced, and utilization of the

resources can be improved so these services can remain continuous and citizens can create

sense of ownership of the service provided by primary health care.

The formation of willayat health committees (WHCs) under the Ministerial Order

No.(33/1999 m) was developed to add a new feature in the health system in Oman which

is to engage the community and the government sectors -related to health- as a sponsor of

health projects and activities. These health committees have already contributed

effectively in the planning, implementing and tracking health issues in order to find best

solutions. This led the health committees to adapt community based-initiatives ( CBIs)

and healthy project in different states in Oman.

Community support groups (CSGs) were established in 1992 as one of mechanisms in

the community health development and showed a great example of community

participation in the progress of their own health. Since their establishment, these groups

work as a link between the health system and the community, and their presence created

an essential shift in concepts and perceptions among the public in promoting their health

Therefore, the Ministry of Health showed special attention and interest in these

volunteering groups, whose numbers reached (3076) volunteer by the end of 2009. The

ministry provided various mechanisms and methods to provide appropriate methods to

build their capacity. Thus, the ministry developed a accredited training curriculum that

contains six health topics related to healthy lifestyles, namely: (reproductive health,

nutrition, communication skills, tobacco, physical activity, accidents and first aid).

CBI approach includes community participation and building connections and

cooperation between different sectors to improve health, economic and environmental

assets of communities. Such intervention is created to strengthen the capacity of people to

interact with the health developmental process, and to strengthen the coordination between

sectors to support their own self-management to improve the health of their community.

Public‟s health is everyone's responsibility from government sectors, non-governmental

organizations, civil society to the media. . A good example of these achievements can be

seen in Nizwa healthy lifestyles project in 1999, Sur Healthy City 2002, Qalhat Healthy

Village in 2002, healthy villages and neighborhoods in Muscat 2004, Sohar Healthy City

in 2006, Salalah Healthy City in 2006.

255

In order to enjoy life and good health, individuals must have proper personal

resources and physical capacity to boost their health, therefore, health promotion is not

just about following healthy life style patterns, but many other factors overlap in order to

reach healthy life style. Hence, health is not the responsibility of the Ministry of Health

only, but the responsibility of many other ministries and bodies and organizations as well

as the public, all join their efforts to promote health.

Our goal is to promote community participation to access health through monitoring

and meeting the Eighth Five Year Plan activity and indicators. We hope that all efforts and

cooperation between various sectors to achieve the development of community

participation in health expansion and the application of health promotion strategy in the

Sultanate.

OBJECTIVES:

1. Implementation of health promotion strategy.

2. Improve the mechanisms of community participation.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective's Indicators: The implementation of health promotion strategy

1. The existence of a multisectoral plan of

action related to health promotion strategy. NA NA

Existence of a

plan of action

2. The proportion of sectors implementing the

action Plan. NA NA 45%

Second Objective's Indicators: To Improve the mechanisms of community participation in the health

1. The number of community-based initiatives

that have been implemented. 9 13 25

2.

The proportion of CBI sites that are

implementing components of CBI approved

by WHO.

NA 5% 80%

3. The proportion of CBIs that have completed

all the stages of implementation. NA

5 100%

4. The number of community support group

(CSG‟s). 4291 3075 5000

5. The proportion of (CSG‟s) trained in the

training curriculum. NA NA

30%

6. Participation rate of non-health sectors in

the meetings of WHCs. NA NA

80%

7.

The proportion of the implementing

recommendations of the WHCs of the total

recommendations.

NA NA 80%

8. Number of community based projects

project carried out by the WHCs. NA 35 60

256

STRATIGIES:

Strategies to Achieve 1st Objective: The implementation of health promotion strategy.

1.1 Approval of the organizational structure for health promotion (National Committee for Health

Promotion).

Expected results:

Facilitate following -up of health promotion activities. Organized work with relevant sectors in the field of health promotion.

1.2 Formation of a team from various sectors to implement the strategic action plan of health

promotion.

Expected results:

Facilitate following-up of health promotion activities. Organized work with relevant sectors in the field of health promotion.

1.3 Include health promotion short course in the curriculum of health educational institutions

(institutes of health, medical colleges, Oman Medical Specialty Board).

Expected results:

The presence of human resources in health promotion.

1.4 Capacity building of health workers in the field of health promotion.

Expected results:

The presence of trained health staff in the field of health promotion

Develop assessment and evaluation to assess the activities of the health promotion strategy.

Expected results:

Enhanced Performance.


Objective: Improve the mechanisms of community participation in health.

2.1 Capacity Building of health workers in CBI Management.

Expected results:

The presences of a trained staff manage CBI.

2.2 Application of self-monitoring tools for community-based initiatives.

Expected results:

Ease follow-up of sites in CBI.

2.3 Following up implementation of action plans in all initiatives.

Expected results:

Ease of monitoring and evaluation of CBI sites.

2.4 Establishment of community information centers in all healthy villages.

Expected results:

Existence of indicators at the village level.

2.5 Conducting of training workshops for CSGS on the training curriculum for CSGS.

Expected results:

Improve the knowledge and skills of community support groups on the training curriculum

topics of healthy lifestyle (Tobacco, nutrition, physical activity, accidents, first aid, and

reproductive health). The existence of volunteers trained to deliver health messages to the community in core

subjects.

2.6 Training members of WHCs to CBI Management.

Expected results:

The presence of trained WHCs members on management of Community based projects. Improve the level of community based health projects implemented.

257

2.7 Advocate for the role of community participation in health promotion.

Expected results:

Increasing awareness of the concept of community participation in health.

2.8 Adopting ways and means to motivate CSGs and members of WHCs.

Expected results:

To maintain a base of CSGs and ensure their continuity and to improve their performance.

More efficient members of the WHCs.



timing

Current

situation

2010

Targeted

situation

2015


1.1a The existence of an approved

organizational structure.

By the end of

2012 NA

Existence of

structure

1.2a

The number of sectors related to

health participating in the

implementation of health promotion

strategy.

Annually 0 6

1.3a

The proportion of educational

institutions that have included the

health promotion short course in

their curriculum.

Annually 0 20%

1.4a

Number of training activities that

have been implemented in the field

of health promotion.

Annually NA 5 (Rate of 1 /

Region) annually

1.4b

The number of trained people on the

training curriculum for health

promotion.

Annually NA 12

1.4c

The number of qualified personnel in

the field of health promotion.

Annually 0 3

1.5a

Percentage of activities carried out

from the health promotion strategy

action plan.

Annually NA 60%


Objective

2.1a The number of trainings targeted to

build capacities of CBI focal points. Annually 3

5 (Rate of 1 /

Region) annually

2.1b

The number of trained people on

management of community-based

initiatives.

Annually 20 50

2.1c

The percentage of participants

(members of the community ) in

training activities,

Annually NA 20%

258


timing

Current

situation

2010

Targeted

situation

2015

2.2a The proportion of CBI sites that are

applying the self Monitoring tools. Annually NA 100%

2.3a

The proportion of healthy villages

that are applying the cluster

representative‟s approach.

Annually 6% All healthy villages

2.4a The number of villages that have

Community Information Centre.

By the end of

the current Plan 4

25 (Rate of 1 /

Region) annually

2.5a Number of workshops conducted for

CSGs, in the training curriculum. Annually NA 22

2.5b

The proportion of CSGs members

who are trained on the training

curriculum.

Annually 0 25%

2.6a

Number of training activities

conducted in the management of

Community based projects for

members of WHCs.

Annually 3 65

2.6b

Proportion of members of WHC‟s

who have been trained on the

management of community-based

projects.

Annually 11% 60%

2.7a Participation rate of other relevant

sectors in the meetings of WHCs. Annually NA 80%

2.7b

The number of private sectors that

contribute in financing of community

activities.

By the end of

the current Plan 25 170

2.7c Number of Community Based

projects.

By the end of

the current

Plan

35 60

2.8a

The proportion of the members of

the CSG‟s who have received any

kind of incentives (honor, training,

overseas visits ... etc) at the central

level.

By the end of

the current

Plan

30% 50%

2.8b

The proportion of members of WHC

who received the reward of any kind

(incentives, training, overseas visits

... etc) at the central level.

By the end of

the current

Plan

11% 60%

259

Reaching to Distinction in Administrative Practices

Vision Eight

260

Domain Twenty Nine

Health Management

261

Vision: Reaching to Distinction in Administrative Practices

Goal: Development of Health Administration upon all levels

Domain: Health Management

INTRODUCTION:

The development of health services in Sultanate of Oman is considered one of the

distinctive markers which demonstrate the Economical and Social Development. That under

the wise leadership of His Majesty Sultan Qaboos bin Said .has been achieved these

fundamental and measurable changes in the quality and size of health service delivery. Has

raised its stature in developing countries

The Health care system in the Sultanate of Oman is based on sound fundamental

principles, one of which is the development of Health Administration. Each level of health

care services has an Administration or Department to ensure the efficiency of Human and

other resource. The five fundamental Administrative functions are „Planning, Organization,

Recruitment, Supervision, & Follow-up.

However, one of the main strategic directions in the8th Five year health plan is the

enhancement of the communications, techniques and strengthening of decentralization

through the application of a suitable model at different levels of the health care system

Attaining distinction in administrative practices will be achieved through training and

equal distribution of human resources, increase of technical expertise and proper resource

management.

OBJECTIVES:

1. Improvement & activation of performance practices within the health care system.

2. Activation of decentralization.

3. Equal/Balanced distribution of Human and material resources.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective's Indicators: Improvement & activation of performance practices within the health

care system.

1. Availability of manual \ policy of

documentation sections. NA NA Available

2. Percentage of health institutions that apply

computer system. 57.7% 57% 100%

3.

Percentage of health administrative

departments connected to the integrated

communications network (MPLS).

NA 75% 100%

4.

Percentage of health institutions connected

to integrated communications network

(MPLS).

NA 22% 100%

262

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

5. Presentage of occupations that have job

descriptions. NA

60% 100%

6. The existence of comprehensive

administrative manuals. NA Available but

not complete

Available and

complete

Second Objective's Indicators: Activation of decentralization system

1. Number of Wilayats that has a

decentralized health administration section. 9 55 61

2.

Existence of study proposal for extent of

availability & given authorization for all

leadership (First lines).

NA NA Available

3. The existence of a legal affair in the

governorates. NA NA

Available

Third Objective's Indicators: Equal/Balanced distribution of different resources.

1.

Percentage of the health institutions that are

covered with human resources according

to the measurable criteria.

33% 44% 100%

2.

Percentage of management that are covered

with human resources according to the

measurable criteria.

40% 50% 100%

3.

Percentage of health institutions that are

covered with equipments and tools

according to the measurable criteria.

46% 66% 100%

STRATIGIES:

Strategies to Achieve 1st Objective: Improvement & activation of performance practices within the

health care system.

1.1 Support communication between the health systems at all levels.

Expected results :

Easiness of procedures.

Saving time and effort in different treatments.

1.2 Activation of documentation in the Directorate.

Expected results :

Easiness of follow up of procedures.

1.3 Introduction of information technology system in human resources.

Expected results :

Completion of transactions on time and with accuracy.

263


Objective: Activation of decentralization system.

2.1 Specification of budget for the activities of Directorate of Health Services.

Expected results :

Activated and reinforced activities in the Directorate of Health Services.

2.2 Prepare a proposal for administrative leaderships (First lines).

Expected results :

Easiness of procedures.

Saving time.

2.3 Formulate a guideline for activation mechanism between Directorates & Autonomous

hospitals.

Expected results :

Complete health services delivery.

Distribution of representing health services in a systematic manner.


Objective: Equal/Balanced distribution of different resources

3.1 To develop mechanisms to reward the administrative staff.

Expected results :

Raise staff satisfaction.

3.2 Efficient use of human resources.

Expected results :

Enhancement of service levels of delivery & performance quality.

Increase and speed of productivity.



timing

Current

situation

2010

Targeted

situation

2015


1.1a Availability of standardized

administrative work manual. Annually

Available and

not authorized

Available and

authorized

1.1b

Percentage of electronic

correspondence to all correspondence

(on the institutions and all regional

level).

Annually NA 50%

1.2a Number of Directorates that has

documentation sections.

By the end of

the current plan NA

All directorate

1.3a Percentage of trained electronic

system to all workers. Annually

NA 80%

264


timing

Current

situation

2010

Targeted

situation

2015

1.4a Number of Directorates that has legal

affairs sections.

By the end of

the current plan NA

All directorate


Objective

2.1a

Percentage of Directorate of health

service that has specified budget for

its activities.

Annually 0% 100%

2.2a

Existence of proposal for the

availability and authorizations for

administrative leaderships (1st line).

Annually NA

Available and

activated

2.3a

Percentage of administrative

authorities at Directorate General

levels.

By the end of

the current plan NA 100%


3.1a Percentage of staff rewarded. Annually

NA 5%

3.1b Percentage of staff satisfaction

among the administrative. Annually

53% 70%

3.2a

Existence of National criteria for

distribution of resources between

health institutions.


3.2b Presence of work guide for human

resources.

By the end of

the current plan NA

Available

3.2c Existence of employment guide.

By the end of

the current plan NA

Available

265

An Efficient Health Information and Research

System to Meet the Needs of Health System

Vision Nine

266

Domain Thirty

Health Information and Statistic

267

Vision: An Efficient Health Information and Research System to

Meet the Needs of Health System

Goal: Strengthening the System of Statistics,

Health Information and Research

Domain: Health Information and Statistic

INTRODUCTION:

Health information is a major pillar of the health system. It is an essential tool and an

important reference for decision makers and development planners to set the health plans in a

scientific manner, and contribute to the development of the health services that will reflect in

the improvement of the health of individuals and population.

The main objective of health information is to provide data and information that are valid,

comprehensive, recent and updated and affordable at the appropriate time and place. Health

information should be useful for planning, follow-up and evaluation of the various activities

and programs of health. It should also, contribute to the process of decision making at

administrative and technical levels.

In spite of developments in the health information system at the Ministry of Health, there is

still scope for further development by addressing some of the problems that have been

identified during assessment of the health information system which can be summarized as

follows:

Information technology systems don‟t cover all health institutions, may not satisfy all

needs of health information system as regards the raw data.

Shortage of some data, such as the health economics, data on environmental health,

occupational health and elderlies health.

These problems led to the emergence of some shortcomings in terms of providing the

necessary information, such as:

Absence of some important data necessary for planning and follow-up.

Weak coordination between the Information technology and the health information

system.

There is a need to develop the abilities and skills of users of health information

(administrators, professionals and design makers).

OBJECTIVES:

1. Provide comprehensive data and information to meet the needs of the health system.

2. Improve the quality of the health information system outputs.

3. Ensure optimal use of the health information by health workers.

268


Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective's Indicators: Providing comprehensive data and information to meet the needs of the

health system

Health

Economic Data

Private Inst.

Statistics

- Data that was made available on a

regular basis (qualitative indicator). 1.

Environmental

and

occupational

health Data

Births &

Deaths Data

Health

prescriptions

Data

Mental Health

Data

Second Objective’s Indicators: Improve the quality of the health information system outputs.

The application of criteria for evaluating information system and health indicators

1.

04% 76% - Data collection

methods

00% 60% - Timeliness of data

00% 67% - Periodicity of data

60% 76% - Consistency and

completeness of data

Representatives of

data

Data desegregation

Third Objective's Indicators: Ensure the optimal use of health information by health workers.

%85 %77 -

The Percentage of health institutions

covered by the electronic information

system of total health institutions.

1.

269

STRATIGIES:

Strategies to Achieve 1st Objective: Provide comprehensive data and information to cover the needs

of the health system

1.1 Increase Coordination among data and information producers within the Ministry of Health.

Expected results:

Make available data produced outside HIS.

1.2 Increase coordination among data and information producers outside the Ministry of Health.

Expected results:

Make available data produced outside Ministry Of Health.

1.3 Support infrastructure for information and statistics system.

Expected results:

Enough number of statisticians to deal with data made availability.

Provide computer and databases to deal with data made availability.

Strategies to Achieve 2nd Objective: Developing the outcome quality of Health Information Officer

2.1 Training statisticians on data analysis and interpretation of results.

Expected results:

More efficient statisticians.

Statisticians trained in analyzing data.

2.2 Provide manuals to unify definitions in the health information system.

Expected results:

Manuals of definitions made available.

2.3 Develop tools to measure the quality of statistics and health information.

Expected results:

Tools to measure health information made available.

Assurance of decision makers about quality of the data and health indicators.

2.4 Modify data collection tools.

Expected results:

Valid data made available.

Save time spent in data collection.


Objective: Ensure the optimal use of the health information by health

workers

3.1 Training health workers in understanding and optimally use health indicators.

Expected results:

Evidence based decisions.

3.2 Diversity in the methods of presentation and dissemination the information and health data.

Expected results:

Data and health indicators available at appropriate time to decision makers.

270


Targeted

situation

2015

Current

situation

2010

Follow up

timing Indicators


Departments within the Ministry of Health, that provide data periodically (qualitative indicator).

1.1a

Available NA Annually Communicable disease

department

Available NA Annually Non- communicable

disease department

Available NA Annually Environmental and

Occupational Health

Available NA Annually Financial planning

Agencies outside the Ministry of Health, that provides data periodically.

1.2a

Monthly details

data

Annual data not

details Annually Medical Services in

Armed forces

Monthly details

data

Annual data not

details Annually Medical Services in

R.O.P.

Monthly details

data

Annual data not

details Annually Medical services at the

Diwan of Royal Court

80% 59% Annually

The percentage of the private health

sector which are sending monthly

statistics.

1.2b

101 83 Annually Number of Statisticians. 1.3a

90% 67% Annually Omanization among statisticians 1.3b


10 2 Annually Statisticians with master degree in health

statistics (cumulative). 2.1a

10 ( 2 in a year) 1 Annually Workshops in health statistics and

applied epidemiology. 2.1b

271

Targeted

situation

2015

Current

situation

2010

Follow up

timing Indicators

25 per workshop 25 Annually

Number of statisticians attending health

statistics and applied epidemiology

workshops.

2.1c

Available &

updates Available Annually Manuals of definitions and terms. 2.2a

2 1 Every two

years

Use HMN tool to evaluate health

system. 2.3a

Age

Sex

Address

Distribute

inpatient

statistics as

week days

… etc

Age

Sex Annually

Levels of data desegregation

(descriptive) 2.4a


5 0 Annually Number of workshops in optimal use of

information for health workers. 3.1a

200 0 Annually Number of health workers attending

workshops in optimal use of information. 3.1b

The availability of a variety of methods to disseminate health information.

3.2a

Continue Done Annually Books and health facts.

Continue Done Annually Electronic CD.

Continue Done Annually Publishing in website.

Continue Done Annually Publishing in

advertisements boards.

Continue Done Annually Publishing in newspaper

& magazines to raise

health awareness.

272

Domain Thirty One

Health Research and Studies

273

Vision: An Efficient Health Information and Research System to

Meet the Needs of Health System

Goal: Strengthening the System of Statistics,

Health Information and Research

Domain: Health Research and Studies

INTRODUCTION:

Health research is an investment for development and health improvement. It is an

essential source of evidence- based information that cannot be provided through routine

sources that are required for the process of planning; implementation; monitoring and

evaluation. Research is an essential tool for formulation of solid information system and

database.

Therefore, the Ministry of Health (MoH) had established the Department of Research and

Studies under the Directorate General of Planning since 1991 which draws the research

policy and sets the research priorities from the "fifth 5-Year Plan for Health Development,

1996-2000” and onward. The research policy aims at spreading of research culture;

promotion of the scientific approach; development of research skills & infrastructures at

different levels of health sectors and utilization of research findings in planning and

improving the effectiveness and efficiency of health system and decision making.

In this respect, the Research and Studies department, during this eight 5 year plan,

focuses on the availability of well-trained and competent researchers at the central and

regional levels who are capable to conduct researches and training.

To have accurate and reliable data, there should be a commitment to the standard

regulations of scientific methods & ethical considerations of researches. Hence, ethical

approval should be obtained from the Ethical and Review Committee as to yield good quality

of research and good output.

In addition to have high quality of researches, it is also important to get use of the

available data and information from the previous researches and surveys as these researches

provide evidence base for the health policy and decisions makers in their implementation

plans. Furthermore, It is also important to narrow the gap between the “knowledge and

action” through appropriate communication and interactions between the decision makers

and the researchers as this will lead to appropriate use of evidences from the researches for

policies formulation.

However, the success of any research should not only be measured by the number of

researchers or number of published papers, but also by implementation and appropriate

utilization of research findings.

Conducting researches require collaboration between different sectors and

institutions, as this Multidisciplinary approach will lead to study the problem from different

aspects; mobilization of resources and solutions, which are beyond the single sector.

Furthermore, links are important between researchers (supply side), research users (demand

side) and funding agencies in addition to partnerships with the community, NGOs and the

private sector.

Worldwide, less than 10% of health research budget each year is devoted to the health

problems of 90% of the world population. The so called “10/90 gap” leads to many

international conferences which recommended helping correct or narrowing the gap and

274

focusing research effort on the research priorities, improving the allocation of the research

funds and by facilitating collaboration between partners.

The general aim of the Eight "5- year Plan for Health Development" is to achieve

more development & progression in researches & studies by managing the problems &

obstacles that identified through analyzing the health situation. These obstacles are:

The available qualified manpower and financial resources cannot meet the demands

of the researches.

There are no enough trained persons to train others for research methods and ethics

and for statistical analysis, especially in the regions.

Poor verification of researches and studies priorities at regional levels.

Poor obligation and commitment to the planned priority proposals/researches and

this causes deficiency in the needed data and information for planning and

monitoring processes at the levels of both the centre and the regions

Poor documentation and follow up to the steps of some researches that affects the

utilization of research findings for planning, policy formulation and decision

making..

Lack of obligation of some researchers with regard to submission of their proposals

to the Research and Ethical Review Committee at the central or regional levels. This

led to execution of research by unqualified researchers and to duplication of

researches in many times.

Lack of longitudinal; projection; interventional and evaluative studies and

inadequate secondary/advanced analysis of available data.

OBJECTIVES:

1. Provision of data and information that are required by health system through

conducting researches and studies by the domains.

2. To develop technical capabilities and skills of Health Research Teams on research

design, methodology and other skills.

3. To develop and improve the capacity of research users at different levels to utilize

information as a tool for evidence-based planning and management.

4. To develop and strengthen the infrastructure of Health Research System (HRS) and

ensure its high quality.

275


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: Provision of data and information that are required by health system

through conducting researches and studies.

1.

Percentage of health and health related

domains in the eight 5 - Year Plan for

Health Development which conducted

research to provide required information for

the process of monitoring and evaluation.

50% 70% 85%

2. Percentage of conducted researches to the

total number of the targeted researches. 50% 65% 75%

Second Objective’s Indicators: To develop technical capabilities and skills of Health Research

Teams on research design, methodology and other skills.

1.

Percentage of researches that been approved

by MoH Research & Ethics committee, to

the total number of the conducted

researches.

NA 65% 80%

2.

Percentage of trainees who conducted

researches to the total trainees on research

design and methodology.

NA NA 50%

Third Objective’s Indicators: To develop and improve the capacity of research users at different

levels to utilize information as a tool for evidence-based planning and management.

1.

Percentage of researches utilized for

planning and improving health services to

the total researches.

NA 60% 80%

Fourth Objective’s Indicators: To develop and strengthen the infrastructure of Health Research

System (HRS) and ensure its high quality

1. Availability of updated and well established

research data base. NA NA Available

2.

Percentage and number of published

researches to the conducted researches

(Scientific conferences & workshops –

Local, regional or international Journal).

NA NA 60%

276

STRATIGIES:

Strategies to Achieve 1st Objective: Provision of data and information that are required by

health system through conducting researches and studies by the domains

1.1 Identification of the research priorities and direct the researches towards the priority

health problems, towards vulnerable groups and health system problems.

Expected results:

Provision of enough data on priority health problems aiming at decreasing of morbidity and

mortality; improving the quality of life; better utilization of resources, assuring health care

equality; understanding reasons of diseases spreading and performing appropriate

intervention.

Provision of detailed information to meet the needs of health planning and policy making.

2.1 Introducing "Package of Periodic Training" on research that supporting the domains

and the different health programmes.

Expected results:

Improvement of quality of writing research proposal as this will facilitate the approval of

Research and Ethics committee.

Availability of appropriately conducted researches according to the plan, which are adherent

to the scientific standards of the research.

1.3 Involvement of private sector, NGOs and community in different stages of research.

Expected results:

Availability of researches that are directed to accommodate the community needs.

Ensure different resources of finance.

1.4 Coordination among research stakeholders inside and outside the Ministry of Health

and international organizations.

Expected results:

Availability of "memorandum of understanding" between the concerned research

authorities agreed and signed by all of them , such as ( academics; scientific research council

of Oman; other ministries and international organizations ) and the Ministry of Health in

order to be adherent to research priorities which should be an area for collaboration and

support to each others.

Availability of high quality joint researches from the domains to be used for planning.


Objective: To develop technical capabilities and skills of Health

Research Teams on research design, methodology and other research skills

2.1 Training for developing the skills in research methods, research ethics, in addition to

the other skills of research.

Expected results:

Empowerment of the researchers' capabilities as to conduct high standard researches. This

277

includes research ethics; follow up of research conduction; statistical analysis; appropriate

research writing for publication in scientific journals, and utilization of results for evidence-

based policies and decisions making.

Promotion of research culture and increase trust on quality research results as this will

encourage the users to utilize the findings.

Developing and improving the capacity of Research and Ethics Review Committees.

Avoid wastage of resources allocated for studies conducted on unscientific basis.

Encouragement of the researchers to cooperate together and to be adherent to the research

ethics, publications and authorship credits.

2.2 Availability of trained & qualified research staff who are capable to train others on

research methods and ethics.

Expected results:

Availability of trained researchers at the central and regional levels who capable to conduct

researches and studies in accordance with the research standards.

Improvement of quality and efficiency of the Research and Ethics committees in the regions.


Objective: To develop and improve the capacity of research users at

different levels to utilize information as a tool for evidence-based planning and management.

3.1 Training of the health planners and decision makers on how to use the research results.

Expected results:

Capacity development of the directors, policy makers and health care providers on use of

research findings for planning and improvement of health services.

Implementation of the research findings and formulation of polices.

Enhancement of the process of planning and decisions making based on knowledge and

evidence.

Encouragement of the second line leaders to use the evidence-based knowledge on their

practices.

3.2 Promotion of evidence- based medicine for clinical research and health management.

Expected results:

Clinical practices of health care providers, managers and researchers based on evidence.

Improvement of the health care services.

Strategies to Achieve 4th

Objective: To develop and strengthen the infrastructure of Health

Research System (HRS) and ensure its high quality

4.1 Formulation of plans for recruiting of adequate number of qualified staff for the

Department of Research and Studies through coordination with Human Resources

Department.

Expected results:

Provision of adequate number of research specialists, statisticians and information

technology specialists and coordinator to carry out the health research plan activities in order

to achieve the objectives of the plan.

To send a number of research specialists abroad to have higher studies in research methods

and ethics as to be able train the others.

278

4.2 Establishing Data Base for research activities, results and research necessary for

planning and decision making.

Expected results:

Avoidance of double and repetitive researches.

Dependence on evidence based knowledge when making decisions.

4.3 Facilitation for the MoH researchers to have access to scientific references through

subscriptions to medical periodicals.

Expected results:

Available information from different sources.

Availability of full text published papers of other countries and in Oman.

Easy and in depth analysis of data and its interpretation.

Facilitate decisions making based on evidence from the research.

4.4 Revision and expansion of the functions of the "Research & Ethical Review

Committee" centrally and activating the committees in the health regions.

Expected results:

To have an upgraded rules for reviewing and approval of research proposals and revision of

the final reports.

Coordination with other sectors, ministries, research and academic institutes, and

international organizations.

High quality researches that following the scientific research guidelines; avoiding repetition

or duplication and with highly reliable findings that can be used for planning, decisions

making and polices formulation.

4.5 Encouragement of publications of the researches results through:

Creating electronic websites.

Training in how to formulate polices that based on evidences, and training in

scientific writing of articles and publication.

Expected results:

Increase of interactions between decision makers and managers from one side and the

researches from the other side for the purpose of decision and policies formulation based on

knowledge and evidences that obtained through the research.

279



timing

Current

situation

2010

Targeted

situation

2015


1.1a

Availability of priority list of

research (central and in every

region).

Annually

Central &

Regional

priority list

Updated Central

& regional

priority lists

1.1b

Percentage of research &

studies conducted to total

targeted research in the 5 y.

plan.

Annually 65% 75%

1.2a

Number of trainings including

the periodic training package

(after meeting with the focal

pionts of the different domains

at central and regional levels.)

Annually Not applied 4 trainings

1.2b

Number of trained persons in

the training package of the

research.

Annually Not applied

25 trainees /

workshop ( 100 in

the plan)

1.2c

Number of protocols that been

applied to and approved by the

Research & Ethics

Committee.

Annually NA 15 protocol per

year

1.3a

Percentage of researches that

conducted by MoH in

collaboration with and

participation of private

sectors, NGOs or community.

Annually 10% 30%

1.4a

Number of meetings between

the concerned people of the

research after signing the

memorandum of

understanding.

Annually Not applied 4 meetings ( once

per year)


Objective

2.1a

Number of training workshops

held for developing research

capabilities and skills.

Annually Two workshops

annually

One workshop

annually ( in total

5 in the 8th

plan)

280


timing

Current

situation

2010

Targeted

situation

2015

2.1b

Number of trainees for

developing research

capabilities and skills.

Annually 60 trainees

annually

30 trainees

annually

2.1c

Number of trainees sent

abroad to study research

methodology and ethics.

Annually Not applied 5

2.2a

Number of training workshops

held to qualify researchers in

order to be capable to train

others (TOT) (2-3 months).

Annually Not applied

(new indicator)

Two trainings

workshops per the

8th

plan

2.2b

Number of trainees who are

capable to train others (2-3

months).

Annually NA

(new indicator)

25 trainees per

workshop

( 50 persons

during the whole

8th

plan)


3.1a

Number of workshops held to

train in how to implement the

researches findings and use

them for policies formulation

and decision making.

Annually One workshop Two workshops/

the 8th

plan

3.1b Number of trainees on the

above mentioned workshops. Annually 40 trainees

30

trainees/workshop

( 60 in total/plan)

3.2a

Number of workshops held in

favor of Evidence-based

Medicine.

Annually 1 Once per year

3.2b

Number of trainees in

Evidence-based Medicine- in

the fields of clinical practice

and health management and

administration.

Annually 30 trainees

annually

30 trainees

annually

281


timing

Current

situation

2010

Targeted

situation

2015


Objective

4.1a

Presence of central plan for

sanctioning the required

manpower/human resources.

Annually Presence of

central plan

Presence of

updated central

plan

4.1b

Number of research

specialists/experts in the

Department of Research and

Studies.

Annually 3 5

4.1c

Number of statisticians in the

Department of Research and

Studies.

Annually 3 5

4.1d

Presence of supporting

manpower (information

technology persons,

coordinators etc-.)

Annually NA 2

4.2a

Presence of well established &

updated database for different

research activities.


4.2b

Number of subscriptions in

websites and/or electronic

journals.

Annually NA 2 websites

4.3a

Numbers of regions that have

active research committees

(conduct at least 3

meetings/year.)

Annually 4 All regions

4.3b

Presence of annual timed

work plan for research

activities at the beginning of

each year in each region.

Annual

Presence of

annual work

plan for every

region

Presence of

annual work plan

for every region

4.3c

Presence of periodic reports

from Research Committee

/Research Coordinator in each

region about their annual

achievements.

Annually

Presence of

annual report

for every region

Presence of

annual report for

every region

282


timing

Current

situation

2010

Targeted

situation

2015

4.3d

Percentage of reviewed

studies by Research & Ethics

Review Committee to the total

number of conducted studies.

Annually 60% 90%

4.4a

Percentage of published

studies to the total number of

the conducted studies.

Annually NA 60%

4.4b

Conduct a study to assess the

performance of the Health

Research System in Oman.

By the end

of the

current plan

NA Presence of the

study

283

Achieving Integrated Digital Environment

Vision Ten

284

Domain: Thirty Two


285

Vision: Achieving Integrated Digital Environment

Goal: Facilitate and speed the access to electronic system data

Domain: Information Technology

INTRODUCTION:

Information Technology (IT) is one of the most important pillars that underpin the

development plans of the Ministry of Health. The importance of IT is in linking all the health

and administrative institutions to various computer systems to achieve integrated digital

environment. Because of this importance it has been included within the Eighth Five Years

Plan of the Ministry of Health (2011-2015) to meet the Ministry's policy aimed to develop all

disciplines.

The Ministry of Health has introduced technology which includes various systems and

programs into most of its institutions. An integral example is the implementation of health

information system (ALSHIFA) which is implemented in 248 health institutes in various

provinces of the Sultanate. This program won two awards in 2010; The Sultan Qaboos Award

for Excellence in eGovernment in eProject category and United Nations Public Service

Award (UNPSA) in Advancing Knowledge Management in Government category. In order to

facilitate the extraction and the accuracy of health data, the directorate of IT implemented

Nabd ALSHIFA (HIMS Pulse), a program that collects and analyzes data on the national

level. Given the importance of electronic connectivity, the ministry sought to link various

health institutions to the ministry headquarters, where it linked about 75% of health

institutions and 22% of its administrative institutions via MPLS. It also implemented

electronic referral to all patients from different provinces of the Sultanate. To better control

and track infectious cases, IT applied an electronic notification system among many health

institutions linking them to the ministry main campus for updated decision-making and

follow up.

Despite these achievements, there are numerous difficulties and challenges that the ministry

is facing on implementing its objectives and vision, the most prominent of these challenges

and difficulties are the following:

The availability of adequate infrastructure to link the various health institutions in the

Sultanate.

Attain unified national electronic health record for the patient, where this step it

requires availability and speedy telecommunication, standardize coding for

investigations and procedures and other administrative issues.

Lack of specialized human resources staff turnover for workers in the field of

information technology because of the great competition by many of the private

sectors.

Ensure the security and confidentiality of information.

OBJECTIVES:

1. To expand the digital infrastructure in various administrative and health institutes and

consolidate ALSHIFA system among various health institutions.

2. To support IT staff.

3. To activate the electronic communication within the health system.

4. To provide e-services through the website of the Ministry.

5. Access to unified national electronic health records for the patient.

286


Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

First Objective’s Indicators: To expand the digital infrastructure in various administrative and

health institutes and consolidate ALSHIFA system among various health institutions.

100% 75% 60% Percentage of health institutions that

applies information technology systems. 1.

100% 75% 0% Percentage of administrative institutions

connected to the integrated

communication network (MPLS).

2.

100% 22% 0% Percentage of health institutions



3.

100% 0% 0% Percentage of education institutions



4.

75% Less than 1% 0% The percentage of Health institutions

using the latest version of ALSHIFA

system.

5.

90% NA NA Percentage of ALSHIFA Users

satisfaction. 6.

Available NA NA Availability of Data protection policy. 7.

100% 100% 100% The percentage of uptime during the year. 8.

0 2% 2% The percentage of health institutes that

experience suspension of work due to

electronic health system.

9.

100% 20% 0% The percentage of Government health

institutions not under Ministry of Health

linked to the Ministry of Health.

10.

50% 0% 0% The percentage of private institutions

linked to the Ministry. 11.

Second Objective’s Indicators: To Support IT Staff

1 for 3

Health

Centers

1 for 8 Health

Centers

1 for 10 Health

Centers

Number of IT technicians for each Health

Center. 1.

1 for each

Poly Clinic 0 0

Number of IT technicians for each poly

clinic. 2.

287

Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

1 for each

hospital

1 for two

hospitals 0

Number of IT technicians for each

province hospital or local hospital. 3.

3 for each

institute 2 2

Number of IT technicians for each

secondary care institute. 4.

5 for each

institute 4 3

Number of IT technicians for each tertiary

care institute. 5.

Third Objective’s Indicators: To activate the electronic communication within the health system

100% 28.8% 0% The percentage of feedback to the number

for referral. 1.

100% 27% 0% The percentage of electronic notification

to the requests. 2.

100% 30% 0% The percentage of health institutes own

email facility. 3.

100% 100% 0% The percentage of Administration

institutes own email facility. 4.

50% 22.1% 0% The percentage of electronic

communication to the entire

communication.

5.

50% 0% 0% The percentage of electronic archive

communication. 6.

100% NA NA

The percentage of staffs having the

International Computer Driving License

(Information Technology Authority staff

training project).

7.

90% NA NA The percentage of beneficiaries‟

satisfaction from active methods

communications.

8.

Fourth Objective’s Indicators: To provide e-services through the website of the Ministry

10 5 0 The number of e-services provided in the

ministry website for the staff and the

citizens.

1.

10 NA 0 The number of e-services provided in

eoman portal. 2.

Available NA NA The existence of digital network

protection policy. 3.

0 2 NA The number of network hacks. 4.

288

Targeted

situation

2015

Current

situation

2010

Past

situation

2005

Indicators

Fifth Objective’s Indicators: Access to unified national electronic health records for the patient

Available NA NA The existence of a policy for unified

national electronic health record. 1.

Available

and active

Available and

not active N.A

The existence of a system to standardize

the data according to the international

standards.

2.

13%

10%

8%

NA

NA

NA

NA

NA

NA

The percentage of ID used in the health

electronic:

Health Centers

Poly clinics

Hospitals

3.

Available NA NA The presence of Central Database. 4.

50% 0% 0% The percentage of health institutes linked

to the central database. 5.

50% 0% 0% The percentage of health institutes not

under Ministry of Health umbrella linked

to the central database.

6.

289

STRATEGIES:

Strategies to Achieve 1st Objective: To expand the digital infrastructure in various

administrative and health institutes and consolidate ALSHIFA system among various health

institutions.

1.1 Completing the introduction of information technology in the health institutes and

connecting them to an integrated network between regions and central level.

Expected results:

Improve the healthcare and administration transaction.

Time availability on transferring data and correspondence response.

1.2 Preamble the computer rooms at Health institutes to meet Information Technology

Authority standards.

Expected results:

Availability of suitable environment for the staff.

1.3 Upgrade internal hardware and software in the administrative and health institutes.

Expected results:

Obtain faster time to complete tasks.

Reduce work downtime because of hardware or software failure.

1.4 Conducting analytical study on the real problems of Health Information Management

System (ALSHIFA).

Expected results:

Knowing the percentage of ALSHIFA users‟ satisfaction.

Rise to the best level in the ALSHIFA system efficiency.

1.5 Seeking to gain an international classification in the field of information security such

as ISO (17 799) and ISO (27 033) or (HIPPA).

Expected results:

Secure network and free of problems.

Runs longer period.

Gain the users confidence and services beneficiaries.

1.6 Raise digital awareness for the electronic health system users.

Expected results:

Reduce data manipulation and systems misuse.

1.7 Develop data protection policy.

Expected results:


Reduce systems misuse.

1.8 Regular development to protect data via upgrading programs and its security devices.

Expected results:

Secured data

290


Objective: To support IT staff

2.1 Train the trainee in the regions and governance on ALSHIFA system.

Expected results:

Increase the number of the trainee on ALSHIFA system.

Easy to deal with ALSHIFA system and enhance the service.

2.2 Train and qualify IT staff.

Expected results:

Pursue the development.

More efficient on solving problems.

Upgrade IT staff level to work more effectively.

2.3 Develop a physical and moral stimulation mechanism for the IT staff.

Expected results:

Increase the staff performance.

Increase staff retention rate.


Objective: To activate the electronic communication within the health

system.

3.1 Cover the electronic communication between the health systems at all levels.

Expected results:

Experience and exchange administrative, health and medical information to provide better

services in the regions.

Activate referrals, feedback and electronic notification.

3.2 Develop a supportive policy for electronic correspondence.

Expected results:

Better use of electronic correspondence system.

Easy to follow-up electronic correspondence.

3.3 Activate electronic Archive.

Expected results:

Reduce the traditional storage spaces.

Easy search for documents.

Possibility to save for long period.

3.4 Find mechanisms to raise the level of knowledge in information technology between the

staff in the ministry.

Expected results:

Increase the staff awareness on electronic culture.

Easy for the staff to deal with new systems.

291


Objective: To provide e-services through the website of the Ministry.

4.1 Insert important enhancements into the ministry website to provide electronic services.

Expected results:

Save time of beneficiaries.

Publishing the information in a good manner.

Pursue Oman Digital Society initiative.

4.2 Appointing specialized team to manage the website and its database.

Expected results:

High efficiency e-services.

Secured environment for the electronic transaction on the Intranet.

4.3 Develop a policy to protect the digital network.

Expected results:


4.4 Regular development to protect data via upgrading programs and its security devices.

Expected results:

Secured data.


Objective: Access to unified national electronic health records for the

patient.

5.1 Coordinate with other actors (Government and Private) who provide health services

for unifying data exchange.

Expected results:

Ease of data collection.

Connect other actors with central database.

Quick and effective transactions and data exchange between stakeholders.

5.2 Establishing a national technical committee for unifying the medical file.

Expected results:

Having decisions that serve the connection with other actors.

Availability of criteria to standardize the database within the electronic health system.

5.3 Adopt and apply the international criteria to unify the database and patient file.

Expected results:

Easy to manage the health database.

Easy to communicate electronically.

5.4 Create a central database.

Expected results:

Available central database contains all patients‟ information.

Easy access to integrate data about the patient from any location in the Sultanate.

292


Targeted

situation

2015

Current

situation

2010

Follow up

timing Indicators


100% 57% Annually Percentage of institutes having

electronic connection. 1.1a

100% 60% Annually

Percentage of computer rooms in

the health and administrative

institutes meeting the


Authority requirements.

1.2a

0% 2% Biannual

Percentage of stopped work due

to hardware or systems

malfunction.

1.3a

Available NA

By the end

of the

current plan

Availability of analytical study

on real problems relates to

ALSHIFA system.

1.4a

90% NA

By the end

of the

current plan

Rate of ALSHIFA users‟

satisfaction. 1.4b

Available NA Every two

years

Availability of application for

international classification in

information security.

1.5a

90% NA Annually

Percentage of digital awareness

for the health electronic system

users.

1.6a

Available NA Every two

years

Availability of data protection

policy. 1.7a

80% 10% Every two

years

Percentage of upgrade programs

and devices of information

security.

1.8a


Objective

100% 40% Annually Percentage of ALSHIFA system

trainee. 2.1a

293

Targeted

situation

2015

Current

situation

2010

Follow up

timing Indicators

60 12 Annually

Number of Internal IT training

provided by Directorate General

of IT.

2.2a

90% 70% Annually Percentage of IT staff retention. 2.3a


Objective

80% 27% Annually

Percentage of electronic

communication coverage

between the health systems.

3.1a

Available and

Active NA Annually

Availability of active policy

about electronic correspondence

use.

3.2a

70% 10% Annually Percentage of electronic

correspondence activation. 3.2b

50% 0% Annually Percentage of electronic archive

activation. 3.3a

100% 40% Annually

Presence of knowledge level in

information technology between

the staff in the ministry.

3.4a


Objective

80% 30% Annually Percentage of the ministry

website enhancements. 4.1a

6 2 Annually Number of specialized team in

managing the website. 4.2a

Available and

Active NA Annually

Availability of active policy to

protect the digital network. 4.3a

60% 10% Annually

Percentage of upgrade software

and devices of information

security.

4.4a


Objective

50% 0% Annually

Percentage of ministry of health

hospitals connected to the central

database.

5.1a

294

Targeted

situation

2015

Current

situation

2010

Follow up

timing Indicators

30% 0% Annually

Percentage of government

hospitals not under ministry of

health connected to the central

database.

5.1b

Available NA

By the end

of the

current plan

Availability of national technical

committee for notifying the

medical file.

5.2a


Availability of criteria to

standardize the database within

the national electronic health

records.

5.3a

Available NA

By the end

of the

current plan

Availability of central database. 5.4a

295

Availability of Qualified Human Resources to

Work in Health Institutions

Vision Eleven

296

Domain: Thirty Three

Human Resources Development and

Omanization in the Health

297

Vision: Availability of Qualified Human Resources in Suitable

Numbers to Work in Health Institutions

Goal: Ensuring the Availability of Adequate Numbers of Suitably

Qualified, Trained and Efficient Workforce

Domain: Human Resources Development and

Omanization in the Health Field

INTRODUCTION:

Human resources development is considered one of the main pillars for health care systems

planning. Hence, MOH Inaugurates its 8th five year plan with evaluating the Human

Resources Development and Omanization as one of its main priorities.

The Ministry of Health attaches significant importance to human resources development as a

strategy for achieving effective health services development in the Sultanate of Oman. Not

only, MoH spends about two third of its recurrent budget on human resources, but also MOH

ensures that most ,if not all, high skilled specialties are available with modern and advanced

medical equipments, beside providing controlled and guaranteed qualitative health services.

The Ministry of Health has developed a plan for Education & Training in the basic

educational programmes for health professions by establishing a chain of educational

institutes in most of the governorates in the Sultanate. The number of graduates from these

institutions from 2006 to 2010 reached 3,299 graduates of whom 2,479 graduates were in the

General Nursing area.

MoH also focused on post-basic specialized programmes, by allowing number of the MOH

Omani staff to join the needed specialized nursing programmes such as: Renal Dialysis

nursing, SCABU, Midwifery, Nursing Management, adult ICU nursing, psychiatry health

nursing, Physiotherapy and health education, also in the field of health administration. The

number of post-basic specialized programmes graduates from 2006 to 2009 reached 750

graduates. The field of medical continuing education was also facilitated by number of

programs and activities implemented on both central and regional level and accredited from

Omani Medical Specialty Board.

Every year number of medical doctors are being sent to developed countries for specializing

in medical and allied health fields. Also, the Omani Medical Specialty Board (OMSB) plays

an active role in training and qualifying Omani doctors by introducing a group of

programmes that enables the omani doctors to pass regional and international exams and gain

certificates that are identified internationally, also, the OMSB helps the omani doctors to

continue their learning in more specialized fields in various worldwide countries that are

connected professionally and scientifically with the sultanate. In 2010, OMSB enrolled 341

doctors in different specialties. The Omanization level in physician category has increased.

The Omani physician percentage has increased from 27% in the year 2005 to 32 % in the

year 2010. Also the Specialist/ Consultant percentage has increased from 23% to 27% in the

same period. This increase in the doctors omanization ratio in spite the fact that there were a

big expansions during that period in health services which required more Non-Omani doctors

to cover these expansions.

298

OBJECTIVES:

1. To provide adequate and equitable numbers of trained manpower to all MoH

institutions.

2. Accelerate the process of manpower appointing and recruitment.

3. Reduce the number of resignations in all job categories especially in medical and Para-

medical job categories.

4. To train Omani health cadres in various health fields.

5. To Develop Continuing Education further in MoH.

6. Development of the learning resources infrastructure.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective’s Indicators: To provide adequate and equitable numbers of trained manpower to all

MoH institutions

Category Total

No.

%

Omani

Total

No.

%

Omani

Total

No.

%

Omani

1. Health Administrators 129 95% 139 98% 153 100%

2. Physicians 2981 27% 4123 32% 5185 38%

2.1 Med. Specialists 1094 23% 1678 27% 1996 32%

2.2 Medical Administrators 47 57% 61 72% 83 93%

2.3 Medical Officers 1840 29% 2384 35% 3106 40%

3 Dentists 168 41% 259 53% 372 55%

4. Pharmacists 154 49% 279 66% 323 78%

5. Nurses 7909 59% 10059 67% 11802 74%

6. Physiotherapists 123 64% 174 64% 375 64%

7. Sanitarians 168 86% 211 81% 289 84%

8. 8- Radiographers 401 60% 579 63% 669 66%

9. Lab. Technicians 873 52% 1259 60% 1467 65%

299

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

10. Asst. Pharmacists 690 69% 1049 63% 1272 65%

11. Medical Orderlies 2184 100% 2781 100% 3326 100%

12. Other Paramedical Staff 831 86% 1093 88% 1335 92%

12.1 Dental Technicians 137 99% 219 100% 276 99%

12.2 Dieticians 98 97% 139 99% 175 100%

12.3 Health Educators 124 100% 128 100% 183 100%

12.4 Misc. Paramedic Staff 472 76% 607 79% 701 81%

13. Other Technical Staff 179 56% 247 65% 266 64%

13.1 Scientists / Engineers 102 43% 109 48% 98 35%

13.2 Technicians 77 73% 138 79% 168 73%

14. Other Support Staff 3374 96% 4039 98% 4898 98%

14.1 White Collars 2285 94% 2927 97% 3586 98%

14.2 Skilled Labours 676 99% 855 100% 1001 100%

14.3 Unskilled Labours 413 100% 257 100% 311 100%

15. Teachers/ Tutors 268 26% 299 47% 214 74%

Grand Total 20432 66% 26592 70% 31946 72%

300

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Second Objective’s Indicators: Accelerate the process of manpower appointing and recruitment

1.

Existence of internal procedures in both

MOH and other related ministries to

accelerate omanization and appointing

process for all jobs.

NA NA Available and

active

Third Objective’s Indicators: Reduce the number of resignations in all job categories specially in

medical and Para-medical categories

1. Percentage (No.) of Resigned doctors in

different speciality. NA

7.3% (285)

Year: 2009 5%

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Fourth Objective’s Indicators: To train Omani health cadres in various health fields

Category Inside Outside Inside Outside Inside Outside

1.

Number of Employees trained and qualified in different specialties:

- Post Graduate NA NA 6 266 22* 329*

- University degree NA NA 40 245 29* 270*

- No. of different training courses NA NA NA NA 600 90

- No. of trainees NA 235 4285 171 5999** 239**

2. No of doctors enrolled at OMSB. 296 404 370

3. Finding a technique to connect training with

employment. NA NA Available

Assumption: To Increase Training Activities: * 10% ** 40%

301

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Fifth Objective’s Indicators: To Develop Continuing Education further in MoH

1.

Continuing education programmes:

- No. of continuing education programmes

performed on central level for different

categories.

NA

51

(Programmes

and

Workshops)

14

(Programmes

and

Workshops)

- No. of continuing education programmes

performed on regional level for different

categories

NA 6144 8050

- No. of participants in continuing education

activities on central level NA 1805 726

- No. of participants in continuing education

activities on regional level NA 106463 120950

- Percentage of continuing education

programmes accredited by OMSB NA 50% 80%

2. No. of scientific studies conducted to study the

effect of continuing education programmes. NA 1 2

3. Existence of job careers for staff development

coordinators and medical librarians. NA NA Available

No. of continuing education programmes on central level during the 8th

five year plan (2011-

2015) are expected to be less than before to concentrate more on increasing the No. of

continuing education programmes conducted on regional level

** Percentage of continuing education programmes conducted on regional level is expected to be

less than before to concentrate more on the “How will the quality of the programmes?” not

“How many programmes conducted?” . The training and professional development units will

facilitate the quality studies to include any programme with the continuing education

programmes plan

302

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Sixth Objective’s Indicators: Development of learning resources infrastructure

1. Existence of a study to establish learning

resources center. NA NA

Available

2. Existence of an organizational structure for

learning resources center. NA NA Available

3. No. of central scientific databases

(membership in publications and e-books). 0 0

5

STRATEGIES:

Strategies to Achieve 1st Objective: To provide adequate and equitable numbers of trained

manpower to all MoH institutions

1.1 The human resources distribution’s standards on all levels of health institution sorted

according to priorities.

Expected results:

Availability of manpower distributed on health institutions according to standards.

1.2 Stability of professional staff in their technical specialty with clear job description and

limitation of transfer to other job categories.

Expected results:

Immovability of professional staff and performing their job according to job description.

Elimination of human resources shortage.

1.3 Conducting a study to identify specialties with omanization ratios to be increased.

Expected results:

Availability of solid plans of manpower production in different categories.


Objective: Accelerate the process of manpower appointing and

recruitment.

2.1 Shorten the MOH internal appointment process by setting a time frame and a responsible

person for each process.

Expected results:

Satisfaction among appointed staff.

Faster recruitment process for needed staff.

2.2 Coordination with other involved organizations to accelerate their related process of

recruitment.

Expected results:

Abridge the related process of recruitment from the involved organizations side.

Faster enrollment of new staff.

303

2.3 Using modern communications techniques in communication with nominees (E-

Communication).

Expected results:

Saving time in transfer of nominees‟ information.

2.4 Searching for additional sources to attract medical cadres from different countries.

Expected results:

More job applicants.


Objective: Reduce the number of resignations in all job categories

specially in medical and Para-medical job categories.

3.1 Payment of motivating Special allowances for rare specialties.

Expected results:

Lower number of resignations among rare special cadres.

Improved Quality of services provided.

3.2 Activate the bonus and special allowances mechanism to encourage energetic staff, with the

assignment of an annual financial item for that purpose.

Expected results:

High performance among staff.

3.3 Annual rewarding system for staff with high performance whom contributed in rising the

work performance rates.

Expected results:

High satisfaction and performance among staff.

3.4 Introducing opportunities for active administrative staff to continue their education in

different fields needed by the MOH.

Expected results:

Availability of adequate number of trained and qualified administrative staff that can cover

different fields required by MOH.


Objective: To train Omani health cadres in various health fields

4.1 Training and qualifying Omani staff in different specialties (inside and outside the

Sultanate).

Expected results:

Increase in the efficiency of Omani employees in various specialties.

4.2 Continuing performing training courses inside the Sultanate for various categories in the

MOH health institutions and match the training and development with the actual needs.

Expected results:

Benefit of large number of employees in various fields.

Improvement in the quality of performance in the training courses.

Improvement in the quality of performance of staff as a result of training.

304


Objective: To Develop Continuing Education further in MoH

5.1 Develop health cadres capabilities by:

Activate Continuing Education Programmes for different health specialties at central

level.

Activate Continuing Education Programmes for different health specialties at regional

level.

Strengthen and encouraging planning for professional development programmes

accredited by OMSB.

Strengthen the evidence-based practices and conducting scientific studies to measure the

effect of implementing the continuing education programmes.

Setting job careers for staff development coordinators and medical librarians.

Expected results:

Increase in the efficiency of professional health employees and quality improvement of health

services.


Objective: Development of the learning resources infrastructure

6.1 Strengthen the infrastructure of learning resources by:

Preparing a study to identify the need to develop the learning resources infrastructure.

Introducing an evaluation study about the effect of developing the learning resources

infrastructure on upgrading the capabilities of health workers through central activities

and programmes.

Activate the membership of central scientific databases (publications and e-books).

Establish a time frame plan for the development of learning resources infrastructure.

Expected results:

Development of health categories in line with the MOH needs.

Availability of modern learning resources with most recent technology to serve all health regions.

305



timing

Current

situation

2010

Targeted

situation

2015


1.1a Availability of updated list of

Manpower in health institutes. Annually

Available but not

updated

Updated List

Available

1.2a

No. of Students expected to join in

Basic Diploma.* 2011 2012 2013 2014 2015 Total

sOuOela dneG 434 469 469 469 469 2310

cONeMla blL lOMiueMn 50 50 50 50 50 250

slNepaeloiOeG 30 30 30 30 30 150

Physiotherapists 20 20 20 20 20 100

tOuDla sneaOeg uGGeGDluD 16 16 16 16 16 80

cONeMla sOMpeN lOMiueMelu 15 15 15 15 15 75

Assistant Pharmacist 50 50 50 50 50 250

latoT 615 650 650 650 650 3215

*Expected Number enrolled from 2011 to 2015 based on the assumption of unchanged intake during

the year 2010.

1.2b

No. of Students Enrolled and

Expected to graduate with Post-

Basic Specialized Diploma*,**.

2011 2012 2013 2014 2015 Total

Renal Dialysis 23 23 23 23 23 115

Midwifery 63 63 63 63 63 315

SCBU/Nursery 21 21 21 21 21 105

Nursing Administration 27 27 27 27 27 135

Intensive Care (Adult) Nursing 27 27 27 27 27 135

Psychiatric Nursing 18 18 18 18 18 90

Infection Control 24 24 24 24 24 120

Nursing Bsc 27 27 27 27 27 135

latoT 230 230 230 230 230 1150

Remarkes:

* Assumption is that the number of Graduates is equal to the number enrolled because the period of

study of specialized diploma is one year.

** Estimation of graduates for the years 2011 –2015 is based on the assumption that the same intake

level as of 2010 will be maintained till 2015.

$ Distribution of students of Midwifery: 26 in Institute of Specialized Nursing, 14 in North Al Batinah

Institute, 15 in Ad Dakhliyah Institute and 8 at Adh Dhahirah Institute.

306


timing

Current

situation

2010

Targeted

situation

2015

1.3a

Availability of a study to identify

specialties with omanization ratios

to be increased.

By the end

of the

current plan

NA Available


Objective

2.1a Presence of faster process of

appointment and recruitment. Annually

Available but not

Active

Available and

Active

2.2a

Presence of coordination with other

related organization to accelerate

appointing process.

Annually Available Available and

more Active

2.3a Presence of modern communication

techniques with nominees. Annually NA Available


Objective

3.1a Presence of special allowances to

motivate rare specialties. Annually NA Available

3.1b Percentage of Medical and para-

medical cadres resignations. Annually

7.3%

(Year: 2009) 5%

3.2a

Presence of active mechanism for

granting bonus and allowances for

active employees.

By the end

of the

current plan

NA Available

3.3a Presence Annual rewarding system. Annually NA Available


Objective

4.1a

Presence of Training and qualifying

plan for Omani staff in different

specialties.


Continued

4.2a

Existence of a mechanism to

identify actual needs of training in

different specialties.

Annually Available but not

accurate

Available and

accurate

4.2b Reviewing of annually trained

numbers. Annually NA Available

4.2c

Identifying job description for each

job category to connect the training

course with the job career.


4.2d Presence of Scientific Technique to

measure the outcome of training. Annually

Available but not

Active

Available and

Active


Objective

5.1a

Presence of a plan for continuing

education programmes

development on central level.

Annually Available

Available with

service results

focused

5.1b

Number of continuing education

programmes for different

specialties on central level.

Annually 51 14

307


timing

Current

situation

2010

Targeted

situation

2015

5.1c

Number of continuing education

programmes for different

specialties on regional level.

Annually 6144 8050

5.1d Percentage of accredited continuing

education programmes. Annually 30% 80%

5.1e

Presence of job career for staff

development coordinators and

medical librarians.

Every 4

months NA Available


Objective

6.1a

Presence of a study to identify the

need for a developed center for

education and learning resources.


active

6.1b

Number of central scientific

databases (publications and e-

books).

Annually 0 5

6.1c

Presence of a time frame for

establishing a developed center for

education and learning resources.


6.1d

Presence of a developed center for

education and learning resources

for MOH health institutions in

Wattaya.


308

Domain: Thirty Four

Health Educational Institutions in Ministry

of Health

309

Vision: Availability of Qualified Human Resources in Suitable Numbers to

Work in Health Institutions

Goal: Ensuring the Availability of Adequate Numbers of Suitably

Qualified, Trained and Efficient Workforce

Domain: Health Educational Institutions in Ministry of Health

INTRODUCTION:

The Ministry of Health has established Health Educational Institutions aiming at the

preparation of suitably qualified nurses and allied medical workforce, who can work

efficiently according to the standards of practice, based on proof and evidence, and who are

able to positively interact with the other members of the health team.

The great accomplishments that the ministry has achieved correspond to the country's

general vision of the development of manpower in the last four decades. Hence the MoH has

spread out the health education umbrella over the regions since 1991. As a result, the number

of educational institutions reached up to 16 institutions which hold 17 programs; 7 basic

programs, 8 specialized programs and 2 BSN programs.

The Ministry efforts during earlier plans concentrated on extending educational

opportunities in health professions, through basic and specialized programs. That was to meet

the increasing needs of the health care services with more staff of these professions due to the

expansion in the health sector. However, the MoH decided to shift the focus to the expansion

of constituting specialized programs, such as Infection Control Program. Furthermore,

undergraduate programs, BSN and physiotherapy have been started in collaboration with

international universities.

The ministry also recognizes the importance of educational curriculum review and

development for all its programs, so that these reach international standards in the field. This

was to make sure that the programs meet the new developments in education so that the

students have the chance to enroll in advanced studies in the future.

The ministry believes that the quality of performance and outcome of the educational

institutions is far-fetched without periodical review of the basic components of the of these

institutions, the operations and procedures they implement, improving and updating them so

that they meet the changes in higher education, in general, and health education in particular.

Therefore, core domains, relating to improving the basic structure of the Health Educational

Institutions and improving their curricula, abilities and capabilities have been introduced in

this plan. Consequently, this will contribute to the preparation of these institutions for quality

audit by the Oman Academic Accreditation Authority, which will take place in 2013, as a

first phase for Academic Accreditation. This phase is just to ascertain the effectiveness of the

operations and procedures of these institutions in accomplishing their goals and objectives, in

preparation for the institutional accreditation process and the accreditation of the educational

programs, as a second phase.

OBJECTIVES:

1. To improve and implement the Quality Assurance schemes in the Health Educational

Institutions.

2. To improve the academic programs to conform with the national frames, standards and

trends of higher education and professional practice.

310

3. To improve the infrastructure of the Health Educational Institutions, so that it meets the

demands of higher education.

4. To continue developing the capabilities and skills of the teaching staff and the

administrative staff and retain qualified staff.

5. To enhance the capabilities and skills of the teaching staff and students on approach

and methodology of scientific research.

6. To promote the academic and the student relationships with other universities and

colleges, nationally and internationally.


Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

First Objective's Indicators: To improve and implement the Quality Assurance schemes in the

Health Educational Institutions.

1. Percentage of Health Educational Institutions

which implement the Total Quality Systems. NA NA 100%

2. Number of qualified auditors to implement

audit and review activities according to the

educational institutions' quality systems.

0 8 15

Second Objective's Indicators: To improve the academic programs to conform with the national

frames, standards and trends of higher education and professional practice.

1. Percentage of curricula complying with the

national standards of higher education to the

total curriculum revised.

NA 30% 70%

2.

Number of multi-phase transitional,

educational programs – Diploma and then

Bachelor's Degree.

0 1(Physiothera

py)

4 (General

Nursing P,

Physiotherapy

P, medical

imaging P,

Medical

Laboratory P)

3.

Percentage of the enhanced Programs Oman

Nursing Institute complying with the

national standards of higher education and

future vision of health development.

0 NA 100%

311

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Third Objective's Indicators: To improve the infrastructure of the Health Educational Institutions,

so that it meets the demands of teaching and training.

1.

Presence of organizational structures of the

proposed academic institutions (College of

Nursing & Health Sciences and its regional

branches, and Higher Institute for Health

Specialties).

NA NA

Presence of

approved

organizational

structures

2.

Presence of an integrated information

system and website for the proposed

academic institutions.

Different and

non-integrated

systems are

available

Different and

non-

integrated

systems are

available

Presence of an

integrated and

a unified

information

and knowledge

system

3. Availability of an electronic scientific library

that includes the latest journals/periodicals. NA NA

Availability of

an electronic

scientific

library

4. Percentage of subscribed electronic

journals/periodicals. NA 12.2%

30% of

periodicals to

subscribe to

(Total

subscribed

journals are 82

periodical)

which cover all

the educational

programs

5. Percentage of educational programs

connected to the electronic library. 0 0 50%

6. Number of digital simulators. NA 3 20

312

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Fourth Objective's Indicators: To continue developing the capabilities and skills of the teaching staff

and the administrative staff and retain qualified staff.

1. Percentage of staff trained in the field of

active teaching. 18% 43.8% 85%

2.

Percentage of staff trained in the field of

clinical assessment methodologies. 25% 55.6% 85%

3.

Percentage of administrative and

professional leadership in the field of

administration to the total number.

10% 26% 50%

4. Number of Omani staff sponsored to obtain

PhD degree. 0 12 20

Fifth Objective's Indicators: To enhance the capabilities and skills of the teaching staff and students

on approach and methodology of scientific research.

1.

Percentage of trainees who conducted

research to the total trainees on research

design and methodology.

1% 2% 10%

2.

Percentage of research utilized for planning

and improving teaching and the related

activities.

NA NA 50%

3. 3. Number of published research in scientific

conference / scientific journals. NA NA 4

4. Availability of data-base for research. NA NA Availability of

this data base

313

Indicators

Past

situation

2005

Current

situation

2010

Targeted

situation

2015

Sixth Objective's Indicators: To promote the academic and the student relationships with other

universities and colleges, nationally and internationally

1.

Number of ratified agreements with national

and international universities and colleges

that includes academic & student

relationship, curriculum development, and

using electronic teaching learning resources.

3 3 6

STRATEGIES:

Strategies to Achieve 1st Objective: To improve and implement the Quality Assurance schemes in

the Health Educational Institutions.

1.1 Establishing a Quality Assurance Section in the proposed academic institutions (College of

Nursing and Health Sciences, and Higher Institute for Health Specialties.).

Expected Results:

Availability of a Quality Assurance Unit in the Directorate General of Education and Training.

Availability of effective collecting data mechanisms to review the followed plans and mechanisms

and to put and implement plans for improvement.

Availability of work operational guides for quality.

Facilitating the implementation of the Quality Assurance activities in the Health Educational

Institutions.

1.2 Continuing to enhance the skills of both the teaching staff and the administrative staff in

terms of assuring and improving the quality of performance in the educational institutions

through:

Implementing training programs for the staff of the Health Educational institutions on

the concepts of quality in higher education institutions.

Exchanging experience, nationally and internationally.

Expected Results:

Raising the teaching staff's potentiality in the field of the higher educational institutions quality.

Raising the confidence among the teaching staff to implement ADRI model to analyse the scopes

of the activities and the teaching and training processes which are included in the Quality Audit

Manual, released by the Omani for Academic Accreditation Authority (OAAA) to determine the

accomplishments, the weakness and improvement mechanisms.

Enhancing quality of education and training in the Health Educational Institutions.

Availability of selected teaching staff capable of training in the field of quality.

Availability of personnel capable of running the Quality Assurance and enhancement programs in

the Health Educational Institutions.

314

1.3 Developing Quality Assurance guides in the Health Educational Institutions.

Expected Results:

Availability of effective mechanisms to collect data about the activities of the Health Educational

Institutions and related indicators.

Facilitating the implementation of the Quality Assurance activities and plans for improvement in

the health educational institutions.

Enhancing quality of education and training in the Health Educational Institutions.

1.4 Implementing the Quality Assurance schemes and enhancement plans in the Health

Educational Institutions.

Expected Results:

Quality of the administrative and professional processes in the Health Educational Institutions.

1.5 Preparing the Health Educational Institutions for the external audit by Oman Academic

Accreditation Authority (OAAA).

Expected Results:

Being aware of the strengths and weakness and the interventions needed.

Teaching and administrative staff and students acquisition of the self-assessment related

information and the skills required for improvement.

Raising other stakeholders' awareness of the self-assessment portfolio content.


Objective: To improve the academic programs to conform with the

national frames and standards, the higher education modern trends and professional practice

2.1 To prepare guidelines for the curriculum reviewing committees to prepare, follow up

implementation, evaluates and improve curriculum.

Expected Results:

Availability of effective mechanisms to implement, follow up, evaluation of curriculum at all

levels.

Experience exchange in the field of reviewing, implementation, follow up, and improving

curriculum.

2.2 To review curriculum and implement related plans for improvement.

Expected Results:

A unified foundation period for the students of the Basic Diploma Programs.

Availability of common, unified core courses for the Basic Diploma Program.

Facilitating a student's transfer from one program into another.

Facilitating a student's transfer from one phase (educational level) into another within the program

he/she is enrolled in.

Curriculum which meets the national framework of higher education.

New curricula that meet the health system needs for health Professionals.


Objective: : To improve the infrastructure of the Health Educational

Institutions so that it meets the demands of teaching and training

3.1 To prepare a study on the actual situation of the educational institutions and to provide a

comprehensive suggestion for the need of merging them into one college.

315

Expected Results:

Getting the utmost benefit of resources, lessening expenditure and shared utilization.

Facilitating a student's transfer from one program into another.

Facilitating the implementation of various programs of academic plans.

Availability of opportunities for students to improve their academic performance.

3.2 To establish a unified database for the student information.

Expected Results:

Availability of information, relating to the Health Education Institutions, for staff, students,

parents and others.

3.3 Renovating the buildings of the Educational Institutions to fit the requirements of the

variant educational programs.

Expected Results:

Sufficient areas for teaching and training activities.

Active learning which is applicable through team work and small group discussions.

Granted teaching of certain courses to a large number of students.

3.4 Modernizing teaching and learning resources.

Expected Results:

Plentifulness of scientific references and electronic periodicals/journals.

Subscription of the Health Educational Institutes in the websites of the periodicals that are related to the various educational programs.

Simplicity of obtaining latest information from periodicals/journals and international scientific resources.

Consolidating process of active learning and training, using virtual tools/simulators, training manikins/models and electronic panels/boards.


Objective: To continue to developing the capabilities and skills of the

teaching staff and the administrative staff and reserve qualified staff

4.1 Updating the knowledge and the skills of the teaching staff in the field of the teaching

strategies to continuously reinforce active learning and the assessment approach.

Expected Results:

Enhancing the performance of the teaching staff in using teaching tools and strategies to reinforce

active learning.

Enhancing the performance of the teaching staff in using various methodologies to assess student

learning in the theoretical and practical aspects.

Enhancing the students‟ ability of reflective thinking of their educational experiences and to utilize

these experiences to improve the learning standards.

Enhancing the students‟ ability to interact during the educational activities.

4.2 Activating incentive’s mechanism for the employees to reinforce job stability.

Expected Results:

Granting job stability for the employees.

Enhancing work incentives output rates.

316

4.3 To continue to enhance the capabilities of the administrative staff.

Expected Results:

Enhancing the performance of the administrative staff in all administrative fields.

Providing Omani administrative staff capable of running the Health Education Institutions.

Availability of a plan for administrative succession.

Availability of administrative processes and procedures.

4.4 Qualifying Omani staff at the Ph.D. level in the specializations required.

Expected Results:

Availability of a plan to qualify Omani staff at the Ph.D. level in the specializations required.

Qualified Omani staff at the Ph.D. level for the various educational programs.

Increased number of staff who holds the Ph.D. Degree.


Objective: To enhance the capabilities and skills of the teaching staff and

students on approach and methodology of scientific research

5.1 Training to enhance the skills in the field of the research and studies approach.

Expected Results:

Enhancing the performance of the teaching staff in the field of conducting studies and research to

conduct research scientifically.

The quality of research complies with the scientific methodology which makes research results

trustworthy hence, encouraging the use of these results in planning and executing these plans.

Students‟ gain the basic research skills to conduct primary research scientifically.

Availability of selected teaching staff capable of training in the field of conducting studies and

research.

5.2 Continue to train in the field of evidence-based practice in teaching and other professional

practices.

Expected Results:

Enhancing the performance of the teaching staff in the field of teaching and evidence-based

practice.

Evidence-based education and practice is carried out by the teaching staff.

Students acquire the basic concepts of the evidence based practice.

5.3 Procuring scientific references for the teaching staff researchers.

Expected Results:

Teaching staff researchers access scientific references easily.

Plenty of information from various resources.

Availability of full research studies conducted in the Sultanate and in the other countries.

5.4 Cooperation with other sectors affiliated with the stages of conducting research.

Expected Results:

Directed research for the related professional and social needs.

Community projects to health based on actual needs.

Availability of channels for communication and cooperation with professional organizations and

community based institutions.

317


Objective: To promote the academic and the student relationships with

other universities and colleges, nationally and internationally.

6.1 Arranging student visits to national and international universities and colleges of mutual

academic and professional relationships.

Expected Results:

Opportunities provided for students to gain learning and training experiences which are NA in the

Health Education Institutions run by the MoH.

6.2 Doing mutual teaching staff visits with universities and colleges.

Expected Results:

Opportunities provided for a bigger number of the teaching staff to learn about educational and

training systems, programs and experiences which are not granted by the Health Education

Institutions run by the MoH.

6.3 Obtaining a license which grants access to the learning and teaching electronic sites of

universities and colleges.

Expected Results:

Making use of the teaching and learning resources of universities and colleges.

6.4 Reviewing curriculum by specialists from universities and colleges.

Expected Results:

Curriculum conforms to modern trends in health and education.



timing

Current

situation

2010

Targeted

situation

2015


1.1a

Availability of a Quality Assurance

Section in the proposed academic

institutions (College of Nursing and

Health Sciences, and Higher Institute

for Health Specialties.).

By the end of

2012

Availability of

unapproved

organizational

structure

Availability of

approved

organizational

structures

1.2a The number of workshops to train

employees on the concepts Quality

Assurance.

Annually 32

4 at the central

level and 64 at the

Institutional level

1.2b

Percentage of staff participated in

national and regional conferences

and workshops in the field of higher

education institutions.

Annually 40% 85%

1.2c Number of quality auditors in the

educational institutions who were

trained by OAAC.

Annually 8 15

318


timing

Current

situation

2010

Targeted

situation

2015

1.2d Number of staff capable of leading

Quality Assurance programs in the


Annually 9 20

1.3a Availability of guidelines for total

quality of the mechanisms in the


Every two

years

Guidelines under

development

Comprehensive

guide available

1.4a Number of Health Educational

Institutions which implemented the

quality enhancement projects.

Annually 2 14

1.4b

Number of annual meetings held to

follow up and review the quality

systems in the Health Educational

Institutions, at the central level.

Annually Periodic but not

annual meetings 5

1.5a Availability of an approved portfolio

for self-evaluation.

Mid of the

year 2012 NA

Approved

portfolio for self-

evaluation

1.5b

Number of scopes where quality is

implemented, according to the

quality moderation guidelines issued

by the OAAC.

End of the

year 2012 NA All scopes (9)


Objective

2.1a Availability of guidelines for

reviewing curriculum.

By the of

2012

Disintegrated

guidelines

available

Unified guidelines

for reviewing

curriculum

available

2.2a

Availability of a unified foundation

program for the basic programs

students which compiles to the

Omani higher education standards.

Mid of the

year 2011

Un unified

foundation

program is

available

Available unified

foundation

programs (English

Language, Maths,

Learning Skills,

IT)

2.2b

Number of core courses and the

shared ones among the educational

programs.

By the end of

2013

NA for basic

programs (1),

specialised

programs (applied

research)

4 (Anatomy and

Physiology,

Introduction to

Research,

Introduction to

Health,

Biochemistry)

2.2c Number of implemented programs

after being improved.

By the end of

2012

7 (Nursing,

Physiotherapy, X-

ray, Labs, Mouth

& Dental Health,

Adult and

Paediatric ICU

14

319


timing

Current

situation

2010

Targeted

situation

2015


Objective

3.1a

A proposal for merging the

educational institutions into one

college is on the table.

By the end of

2011

First draft of a

plan is available

A proposal for

merging the

educational

institutions into

one college is on

the table along

with other

recommendations

3.1b

Availability of approved

organizational structures of the

proposed academic institutions

(College of Nursing and Health

Sciences, and Higher Institute for

Health Specialties.).

By the end of

2012

A proposed

organisational

structure is

available

Approved

organisational

structures are

available

3.2a

Availability of a unified database of

students information- Student

Management System (SMS).

By the end of

2014

Disjointed various

systems are

available

A unified student

management

system is available

3.3a

Number of halls that can hold at

least 100 students.

By the end of

2013 3 11

3.4a Number of digital simulators. Annually

3 20

3.4b

Number of institutes which possess

electronic panels/boards for active

learning and through electronic sites.

Annually 1 14

3.4c

Availability of an educational portal

for the Health Educational

Institutions.

Annually NA Availability of an

educational portal

3.4d

Number of computers to:

- Students

- Teachers

Annually

* One computer

per 5 students

* One computer

per each teacher

* One computer

per 3 students

* One computer

per each teacher


Objective

4.1a

Percentage of teaching staff trained

in the field of teaching strategies to

reinforce active learning (Student

Centered Learning).

Annually 43.8% 85%

4.1b Percentage of teaching staff trained

in assessment techniques. Annually

43.8% 85%

4.2a Percentage of employees granted

incentives. Annually

0 50% in every year

320


timing

Current

situation

2010

Targeted

situation

2015

4.2b

Availability of a study to assess the

current situation of the teaching staff

and job satisfaction.

By the end

of the current

plan

NA Job satisfaction

study available

4.3a Number of Omani staff trained in the

field of administration. Annually 29 50

4.3b Availability of work guide for

administrative procedures.

By the end of

2012

Comprehensive

guide unavailable

Administrative

work guide

available

4.4a Number of Omani staff sponsored to

be PhD qualified. Annually 12 20


Objective

5.1a

Availability of a study to evaluate

the current situation of the research

system.

By the end of

2011

Primary study

conducted

A study of the

current situation

available

5.1b Availability of database of research

activities and researchers. Annually NA

Database of

research activities

and researchers

available

5.1c Number of researcher capable of

conducting research training. Annually 5 10

5.1d

Number of workshops conducted

centrally in the field of improving

research skills and capabilities.

Annually 0 4

5.1e Percentage of employees trained in

scientific research methodologies. Annually 15% 45%

5.1f Number of trainees who conducted

research and studies. Annually 11 22

5.1g

Number of educational programs

which trained students to conduct

primary research systematically.

By the end of

2011 12 14

5.2a Number of workshops in the field of

evidence-based practice. Annually

12

64 workshops at

the institutional

level

5.2b

Percentage of trainees in the field of

evidence-based practice compared to

staff total number.

Annually 34% 85%

5.3a Number of subscribed electronic

sites and periodicals. Annually 10 36

5.4a Number of health community

projects. Annually 6

14 projects at the

institutional level

321


timing

Current

situation

2010

Targeted

situation

2015


Objective

6.1a Percentage of ratified agreements

that includes mutual students visits. Annually

0 100%

6.1b

Number of students who visited

national and international

universities and colleges of ratified

agreements.

Annually 0

15 per program

encompassed in

the agreement

6.2a

Number of teaching staff who visited

national and international

universities and colleges of ratified

agreements.

Annually 7

10 per each

program

encompassed in

the agreement

6.3a

Number of users of the electronic

teaching and learning resources

available in the universities and

colleges of ratified agreements.

Annually 40 (OSNI) 27

(IHS)

All students of the

programs

encompassed in

the agreement

6.4a

Number of curriculum developed in

cooperation with universities and

colleges of ratified agreements.

Annually 3

All programs

encompassed in

the agreement

322

Improving the health services provided by the

private health sector according to a health

system that is based on excellence, quality and

the scientific and practical efficiency; and to

ensure the rights of patients and their safety.

Vision Twelve

323

Domain: Thirty Five

Health services for the Private Health

Sector

324

Vision: Improving the Health Services Provided by the Private Health

Sector According to a Health System that is Based on Excellence,

Quality and the Scientific and Practical Efficiency;

and to Ensure the Rights of Patients and their Safety.

Goal: To Support the Private Health Sector in Order to Provide

Preventive, Curative and Promotive Health Services to All Members of

Community According to International Quality Standards and Licensing.

And to Supervise the Private Health Establishments as per the National

Legislation and Regulations in Order to Ensure the Efficiency of Health

Services Provided and their Consistency with Government Health Services

to Fulfill the Needs of Community Members.

Domain: Health Services for the Private Health Sector

INTRODUCTION:

The health services provided by the private health sector are considered to be one of

the reliable sectors worldwide because of its importance in achieving a solidarity health

community. Private health establishments are the main supporter of the government health

services. In the Sultanate, the private health establishments have a wide range of diversity in

terms of type and complexity of health service as well as their distribution over the country in

order to meet the urgent need to support the government health sector and to enrich the health

services provided to the community in many specialized services. Furthermore, the private

health sector would help in raising the quality, efficiency and effectiveness of these services

and to reduce the shortage of medical staff in our health institutions.

During the past ten years the growth of private health sector has gone up throughout

the Sultanate; and the governorate of Muscat had the lion's share because of the density of

population and increasing demand for various specialties. There are more than thousand

health institutions are now registered with the Department of private health establishments,

which vary between hospital, specialist and general clinic. These institutions cover all kind of

major and minor specialties as well as diagnostic laboratory and radiology services.

With this diversity in private sector, it is mandatory to get solid legislations and laws

to control the work of those institutions that have become one of the main stakeholders of

health system in the country. Thus, strengthening of legislation for those institutions and their

development have become the main concern of health authority in order to govern their

works, protect patient and his family's safety and to raise the efficiency of professional staff

to deliver good quality of health services. Therefore, this would not possible to take place

unless there are modern standards and legislation in place that are able to accommodate the

accredited patient safety and health quality protocols.

One of the strategic objectives for the private health sector is to incorporate its

services with the government health sector to form an integrated health system in order to

meet the growing needs for health services and to achieve this strategy, the private health

sector needs to get solid infrastructure of accurate data and statistics upon which to build

strategic plans with the existence channels of communication between private and

government health institutions. Also referral system protocol that govern referral of patients

to and from various institutions needs further development to ensure receiving high quality

health services which have become the ABCs of any health system.

325

Among the most prominent challenges facing the private health sector in the Sultanate

is the lack of adequate legislation and laws to legalize and organize the work of those

institutions in order to ensure the provision of health service quality and safety of patients.

The second challenge that to be focused on is the inadequacy of trained inspector among the

technical and administrative personals who are holding the legitimate authority.

Therefore, the rationale behind inclusion of private health services among other healthcare

domains is mainly to improve their strategic planning in order to achieving the future vision

and goals of private health sector in the country.

OBJECTIVES:

1. Strengthen and enforcing the legislation and laws governing the work of the private

health sector.

2. Developing the inspection and monitoring system of private health establishments.


INDICATORS

PAST

SITUATION

2005

CURRENT

SITUATION

2010

TARGETED

SITUATION

2015

First Objective’s Indicators: Strengthen and enforcing the legislation and laws governing the work

of the private health sector

1.

Existence of updated and enabled human

medical& dental practicing regulation for

private health sector.

Available Available

Not-Updated

Updated and

Enabled

Regulation

2. Existence of Updated requirements guideline

for licensing of private health establishments.

Available –

not-updated

Available –

not-updated

Updated

Guideline

3. Existence of updated requirement guideline

for licensing health professionals.

Available –

not-updated

Available –

not-updated

Updated

Guideline

4.

Percentage of private health establishments

that apply human medical & dental practicing

regulation.

60% 70% 100%

5.

Percentage of private health establishments

that apply the requirements guideline for

licensing of private health establishments.

60% 70% 100%

6. Existence of Complementary and Alternative

Medicine Law. NA NA Available

7. Existence of patients‟ referral protocol to and

from private health establishments. NA NA Available

326

INDICATORS

PAST

SITUATION

2005

CURRENT

SITUATION

2010

TARGETED

SITUATION

2015

8. Existence of dress code policy for health

professional personals. NA NA Available

9. Existence of list of legal penalties for private

health establishments. NA NA Available

10 Existence of issuing sick leave policy. NA NA Available

11 Existence of drugs prescription policy. NA NA Available

12 Existence of clinical privilege for all medical

and surgical specialities. NA NA Available

13 Existence of IVF (in vitro fertilization) Law. NA NA Available

Second Objective’s Indicators: Developing the inspection and monitoring system of private health

establishments

1. Rate of technical and administrator personals

who got legitimate authority. NA

Available for

few personals

but not

enabled

One per 10

health

establishments

2.

Existence of unified and approved mechanism

for inspection for all over Sultanate's regions

and governorates.

Un-unified

mechanisms

Un-unified

mechanisms

Unified

mechanism

3. Rate of technical and administrator personals

who are trained on inspection and monitoring. Zero Zero 100%

327

STRATIGIES:

Strategies to Achieve 1st objective: Strengthen and enforcing the legislation and laws governing the

work of the private health sector

1.1 Provide and enable the human medical & dental practicing regulations and policies that govern

the work of private health establishments and supervise their implementation of these legislation by:

Make sure that all private health establishments have got these regulations and policies.

Conduct workshops and seminars to all private health establishments to explain and clarify

these regulations and policies.

Train the technical and administrators (the In-charge of private sector) Staff on how to

monitor the abidance of private health establishments of these regulations during inspection

visits.

Expected results:

All private health establishments are well informed and be aware of all regulations that

oversee the work and practice of private health sector.

Decrease the number of the administrative and technical breaches committed by private

health establishments.


Objective: Developing the inspection and monitoring system of private

health establishments

2.1 Make sure that all private health institutions are inspected and monitored according to well

established inspection system through which:

Standardize the mechanism of inspection and monitoring.

Training of inspection teams.

Well documentation of field visits (central and regional) by proper written reports.

Auditing the quality of inspection reports that are submitted by the inspection teams.

Expected results:

There is a uniform mechanism of inspection and monitoring for all regions.

The members of inspection team are well trained on how to inspect the private health

establishments.

Increase the number of field visits to these establishments by the inspection team.

328



timing

Current

situation

2010

Targeted

situation

2015


1.1a

Number of workshops that are carried out

to demonstrate the current regulations for

private health establishments.

Annually 1 5

1.1b

The percentage of inspection teams'

members who are trained on how to

perform inspection's procedures.

Annually Zero 50%

1.1c Number of private health establishments

that are provided with copy of regulations. Annually NA

All private

health

establishments

1.1d

Number of private health establishments

that had been withdrawn their licenses due

to breach of regulations.

Annually Zero Zero

1.1e

Number of private health establishments

that had been stopped temporarily from

work due to breach of regulations.

Annually 5 Zero

1.1f

Number of workshops and meetings that

were held to demonstrate the regulations

to private health establishments.

Annually Once a year at

central level

At least once a

year in each

region


Objective

2.1a

Availability of a standardized form of

inspection and monitoring of private

health establishments.

Annually Available but

not standardized

Standardized

form is available

2.1b

Percentage of private health

establishments that had been inspected by

the regional inspection teams on average

of three times more per year.

Annually 60% 100%

2.1c

Percentage of private health

establishments that had been inspected by

the central inspection team on average of

once or more per year.

Annually 10% 100%

2.1d

Percentage of inspection reports that were

submitted by the inspection teams are

upon the best required quality of

documentation.

Annually 40% ≥ 90%

the 8th five - year plan for health developmentthe 8th five-year plan for health development covers...

Documents