Country profiles

Kuwait

Overview

Kuwait has a surface area of 17 818 km². The greatest distance between the northern and southern borders of the country is 200 km, while the greatest distance between the eastern and western borders is 170 km. Kuwait’s population was estimated at 1.8 million in 1997, of which 41% were Kuwaiti citizens. The crude birth rate was estimated at 23.7 per 1000 population in 1997. The Kuwaiti population is relatively young: 26% are under the age of 15 years (1997), while the corresponding figure among non-Kuwaitis is 16%. The population of people above 65 years of age was estimated at 1.3% in 1997 [footnote: The population above 65 years of age was obtained from EMRO statistics].^* Life expectancy at birth is 74.8 years (1996). The literacy rates are high: about 88% of the adult population (1997) and about 86% of the female adult population (1997). The crude death rate in Kuwait is among the lowest in the Eastern Mediterranean Region; it was estimated at 2.2 per 1000 population for 1996. The infant mortality rate is 13 per 1000 live births (1997). The maternal mortality rate was 0.9 per 10 000 live births in 1996. The percentage of deaths of children under age 5 is 27 (1984). In 1997, the under-5 mortality rate was estimated at 16 per 1000 live births.^*

Kuwait has a very sophisticated health information system, and all data regarding morbidity and mortality, as well as vital health statistics, are accurate and reliable. The leading causes of mortality in the total population, in 1997, were the following: diseases of the circulatory system (38.4%), accidents (16.1%), neoplasms (10.7%), perinatal morbidity (5.3%), and diseases of the respiratory system (5%). The per capita GNP in 1996 was US$19 800.

Ever since its independence in 1961, the leaders of Kuwait planned for it to become a welfare state, and in effect Kuwaiti citizens enjoyed one of the most comprehensive welfare systems in the world. Articles 9,10, 11, and 15 of the Constitution clearly affirm the responsibility of the State for provision of health care to all sectors of the population, with special emphasis on vulnerable groups such as the handicapped, the deprived, children, mothers and the elderly. The health plan, as part of the total socioeconomic development plan and health policy, is based on three principles: maintenance and promotion of health in the people; improvement of physical, mental and social well-being of the people; and reducing morbidity, disability and mortality as much as possible. In this respect, health goals have been defined as long-term and medium or short-term.

The health system is based on three levels of health care delivery: primary, secondary and tertiary health care. Primary health care is delivered through a series of health centres, with general or family health clinics, maternal and child care clinics, diabetic clinics, dental clinics, and preventive care clinics, school health services, ambulance services and police health services are also available.

Secondary health care is provided through six general hospitals, each serving about 300 000 people. Tertiary health care is provided through a number of national specialized hospitals and clinics.

The regionalization of the health care delivery system is now complete so that each of the six general hospitals, along with a number of health centres which refer to it, constitutes a health region. This new health region system has allowed better community involvement and better planning through identification of local health problems. It has also allowed for better management and more efficient use of resources. The regionalization of the health system, which covers six health regions, has also resulted in more efficient delivery of health services. Regional directors of health are involved in the planning process as well as in itemization of the budget and recruiting of human resources. They are responsible for annually reporting on the activities of their regions.

In 1997, there were 3756 physicians in Kuwait, only 335 of whom were in the private sector. The overall rate of physicians per 10 000 population was 21 and the overall rate of nurses per 10 000 population was 47.5. Non-Kuwaiti nurses represent 86% of all nurses.

In terms of physical resources, in 1997, there were 70 health centres with 70 general health or family health clinics, 24 maternal clinics, 70 child care clinics, 18 diabetic clinics, 65 dental clinics and 56 preventive care clinics. There were also 667 school health clinics, 22 government hospitals (6 general and 16 specialized) with a total of 4449 beds. In addition, there were 8 private or company hospitals with 548 beds giving a total of 4997 beds or 27.6 beds per 10 000 population.

The patterns of mortality by far, resemble that of developed countries, with a high percentage of mortality due to chronic rather than acute illnesses. Health facilities are in close proximity to beneficiaries.

The implementation of health strategies has had an effective impact on the health status of the population, as can be seen from the decrease in mortality indicators and the increase in life expectancy, as well as the decline in incidence of infectious diseases. Kuwait has, in fact, become the welfare state it was designed to be, as it overcame successfully, through its planning after liberation, the negative impacts of the Gulf War on health facilities, health status and environment.

MENTAL HEALTH

Mental health care in Kuwait can be considered to fall into three distinct phases. Until the late 1980s mental health care was strongly centralized in the large Psychiatric Hospital. This situation existed until alternatives were considered as part of developing a national programme of mental health. Iraqi occupation defined the next phase. The events of 1990-91 not only disrupted the new development stream of mental health care, but also brought to the forefront a new set of needs due to the period of occupation. The large numbers of the general population affected with post-traumatic stress disorder have been the major focus of mental health care during recent years. A special unit, a REGGIE centre, has been set up with extensive human resources for care and systemic research relating to post-traumatic stress disorder. The third phase relates to the emerging period of reorganization of mental health care in the country.

The major centre of psychiatric care is the Psychiatric Hospital with 480 beds. This hospital, which had the features of a conventional psychiatric hospital, has been renovated, except for two wards, which were going to be phased out. Two new blocks have been built, each with four wards and a capacity of 94 beds. The hospital facility has 24 wards, 3 of which are for treatment of addiction, separate from the main hospital building, with 58 beds. The rest of the wards cater for acute, short-term, long-term, geriatric and forensic patients in addition to an occupational therapy centre and a day centre. There is a new hospital under construction with an additional 260 beds along with a day centre for 150 clients. Both of these were expected to be completed by 1996. There are also plans to open a pilot halfway house to cater for 30 patients, in one of the regions. The addiction service has 58 beds, of which 14 are for detoxification, 24 for rehabilitation and 20 for long stay. This unit admits male patients only.

Outpatient clinics are conducted both at the Psychiatric Hospital as well as at the five regional hospitals (Jahra, Farwaniyya, Addan, Emiri and Mubarak). Psychiatric clinics are also conducted at various other centres such as prisons, special schools and centres where psychiatric assistance is required (14 centres).

Child psychiatric clinics are carried out in the paediatric departments in Sabah, Emiri, Mubarak and REGGIE centres. Liaison consultations are carried out in the General, Maternity Hospital and Geriatric Department, Ministry of Social Affairs.

Presently, there are no community mental health facilities such as halfway houses, group homes, day centres or sheltered workshops.

For occupational activities in the psychiatric hospital there is a workshop which offers art, woodwork, sewing, embroidery and domestic science. A social, leisure and recreational programme also exists, with outings and visits to various facilities in the country. The available facilities are not adequate.

A very important new outpatient psychiatric service has been the REGGIE centre, which has been working for the past seven years. This is for care of those suffering from post-traumatic stress disorder and provides services for those affected by Iraqi occupation, such as prisoners, the injured and families of those killed, injured or missing. This centre also carries out public education and research activities.

There are 48 psychiatrists, 17 psychologists, 8 social workers, 294 psychiatric nurses and 182 non-medical staff working in the Psychiatric Hospital. About 45% of the psychiatrists and 80% of the rest of the staff are expatriates.

Undergraduate medical education in psychiatry consists of 130 hours, of which 100 hours are for practical training.

The official mental health policy favours the regionalization of services and the integration of mental health into primary health care. Training of primary health care workers in mental health issues is a recognized priority. At present, training includes a five-week clinical attachment for medical students and appropriate courses for nurses. For primary care physicians, attempts are being made to increase awareness of psychiatric disorders and to improve detection, referral practice and treatment of less severe disorders. Primary care physicians are attached to specialist mental health services for a four-week period. Each course is attended by between two and four physicians depending on interest, background and availability. Family doctors are attached for eight weeks of postgraduate training.