Country profiles

Oman

Overview

Oman, with a surface area of 309 500 km², occupies the south-eastern corner of the Arabian Peninsula. Most of Oman consists of desert, semi-arid plains and mountains. Northern Oman, which contains most of the resources and population, is separated from the southern province of Dhofar by 700 km of desert. . The total population was 2.3 million in 1998, with about 73% locals. 74% of the population were urban in 1998 . The population below 15 years of age and above 60 years of age, in 1998, was 34.6% and 4.6%, respectively. In 1995, 80% of the total adult population was literate and in the same year, the percentage of adult literate females was estimated at 75.5%. The per capita gross domestic product in 1997 was US$ 6715. The majority of the population is Muslim.

Additionally, according to the most recent statistics, the crude birth rate per 1000 population was 29 in 1997. In the same year, it was estimated that the total life expectancy at birth was 72 years. Also in the same year, infant mortality rate was 18 per 1000 live births and the under-5 mortality rate[Footnote: The under-5 mortality rate was obtained from EMRO statistics.]^* was calculated to be 27.5 per 1000 live births. The maternal mortality rate was estimated at 2.1 per 10 000 live births in 1996.

Health for all has been endorsed as national policy at the highest official level. The principal thrusts of the national health policies are that health care is the right of every individual; improving the quality of health services in general and basic health services in particular; integration of curative, preventive and promotive services at local and regional levels; use of appropriate modern technology for the diagnosis and treatment of chronic diseases; reduction of mortality, particularly infant mortality (to reach 20 per 1000 by the end of the fourth five-year plan; reduction of the incidence of communicable diseases to such low levels as not to be public health problems; improvement in the fields of environmental health and community development; health education of the public through the mass media on health problems and ways to deal with them; development of human resources with a view to gradually replacing expatriates by national health personnel.

The Ministry of Health is the main provider of health care in the country. There are three other governmental organizations concerned, namely the Ministry of Defence, the Royal Oman Police, and Petroleum Development of Oman, which provide medical care only to their employees and dependents. The University Hospital was inaugurated in 1990 and at present caters for the primary health care needs of university students and staff. Only two private hospitals exist in Oman. During 1989, the health system was regionalized and the provision of health services in each of the eight health regions became the responsibility of the regional directorates general. Health services, at the first-contact level, are provided through health centres, each headed by a resident physician. The services provided by these facilities are basically curative, with a number of preventive and promotive services such as MCH services. The outpatient departments of small local hospitals (with 4-49 beds) are also accessible to the people as a first line of contact and thus contribute, to a large extent, in the delivery of primary health care. Attached to both health centres and hospitals are 66 public health units manned either by one or more physicians or, in the case of the smaller ones, by sanitarians. In rural areas, health services are based on a combination of static as well as mobile health units to serve both the rural and the nomadic populations. At the local and regional levels, the curative services are provided by local hospitals with 50 to 60 beds and regional hospitals with 200 or more beds. These hospitals have extensive inpatient and outpatient services including specialized services in medicine; surgery; paediatrics; gynaecology; ear; nose and throat; ophthalmology; dental surgery; dermatology and psychiatry. At the central level, three major hospitals in Muscat provide tertiary care and act as national referral hospitals. In addition, there is one psychiatric hospital.

Community involvement has remained marginal.. Nongovernmental organizations, such as the Oman Women’s Association, cooperate in the Ministry of Health’s expanded programme on immunization, maternal and child health services, and health education programmes.

The Ministry of Health’s total budget represented 8.5% of the total government budget while recurrent Ministry of Health expenditures represented 10.7% of the government’s recurrent expenditures. The per capita health expenditure in 1997 was thus US$ 147 compared with US$ 166 in 1985.

The Faculty of Medicine in Sultan Qaboos University started functioning in 1986. Total enrolment in 1989-90 was 238 medical students (in addition to 99 studying medicine overseas). The Institute of Health Sciences has increased its training facilities for paramedical staff and is now producing nursing personnel, medical laboratory technicians, physiotherapists and radiography technicians. In addition, regional training centres are being established to train Omani secondary school graduates as health workers. At the end of 1997, there were 2815 physicians working in the country; 68% of these were employed by the Ministry of Health and 25% were private physicians. There were also 6822 nurses and 182 dentists; 48% of the dentists were in the private sector. The overall rate of physicians, nurses and dentists per 10 000 population was 12.0, 29.0 and 0.7, respectively, in 1995.

MENTAL HEALTH

The first psychiatric facility for the care of mentally ill patients in Oman was started with one psychiatrist at Al Rahma Hospital in 1975. Initially, the Psychiatric Unit consisted of an outpatient clinic in a makeshift three-room block and a small ward having five beds. Almost at the same time, the psychiatrist at Al Rahma Hospital started monthly visits to Sultan Qaboos Hospital in Salalah where he would conduct an outpatient clinic for three days. In April 1976, a 30-bed ward was started for male patients, initially to accommodate 16 patients from Jalali Fort. In January 1979, a psychiatrist was permanently posted at Sultan Qaboos Hospital, Salalah, in charge of the outpatient clinic and five beds for acute psychiatric cases. In view of the progressive increase in the number of patients seeking psychiatric care (in 1980, there were 656 new cases, 6209 total registered attendance) the need for a special hospital had become obvious. A 120-bed hospital was planned but the number of beds was reduced to 60 during the construction phase by the medical planners, considering the revised bed-strength as adequate enough to cope with the situation. The 60-bed facility was named Ibn Sina Hospital and inaugurated in November 1983. It is a well equipped modern facility for adequate psychiatric treatment and patient care.

The mental health care facilities consist of the central psychiatric hospital, Ibn Sina Hospital, near Muscat, psychiatrists at regional referral hospitals, the Department of Behavioural Sciences at Sultan Qaboos University Medical School, and the primary care physicians trained in mental health care.

Ibn Sina Hospital is the main psychiatric facility. It is located 25 km west of Muscat. It is a 60-bed facility with two male wards and one female ward which house acute as well as chronic psychiatric patients and a number of seriously mentally retarded children and adolescents. It is staffed by two senior consultants, two specialists, two junior specialists and five medical officers in psychiatry, nursing staff and three social workers. The hospital is equipped with an electroencephalogram, X-ray, laboratory and two small occupational therapy units for male and female patients. Being the only inpatient facility in the country, this hospital is under heavy demand.

Psychiatrists are stationed in seven regional referral hospitals in Salalah, Sohar, Nizwa, Ibri, Rustaq, Ibra, Sur, Musandam and Buraimi. Each of these psychiatrists has access to four beds in the local general hospital for the hospitalization of their patients, except in Salalah where 10 beds are available .

The Sultan Qaboos University Medical School has a Department of Behavioural Sciences with about 15 psychiatric beds in the university hospital. These are exclusively training beds, and the facility functions outside the regular health system.

A referral system exists between the first, second and third levels of care.

There is a small 15-bed facility for the mentally retarded under the Ministry of Social Affairs.

There has been a growing awareness of the drug abuse problem since 1972. The main drug of abuse, initially, was charas (hashish). Between 1974 and 1980, the use of opiates, alcohol and psychotropic drugs was also seen. From 1982, there have been some cases of heroin addiction. Cases of cologne drinking, glue sniffing and shoe polish sniffing have been reported.

50 students every year graduate from Sultan Qaboos University Medical School. Students are taught behavioural sciences in the first year of training and subsequently receive clinical training in psychiatry.

Nursing training has only theoretical classes and very little practical training. A joint postgraduate psychiatric residency programme (Sultan Qaboos University and Ibn Sina) is also available for the training of doctors.

The national mental health programme of Oman was discussed and finalized in a national workshop in March 1990 with participation of professionals and planners from a wide variety of disciplines and sectors. The objectives of the national mental health programme are: provision of mental health care for all, taking into account measures for prevention, treatment and rehabilitation; and promotion of mental health and quality of life by adapting culturally sound and relevant psychosocial and behavioural principles at work, in family life and in the community.

The main strategies identified are: integration of mental health services in general health care; development of an administrative structure for mental health; a school mental health programme; involvement of religious teachers; services for the mentally retarded; programmes for substance abusers; training of professionals; mental health education for the community; and operational research.

The national mental health programme has been actively implemented in Oman. The integration of mental health with general health care has been achieved by the following steps: preparation of a manual for medical officers on mental health care ; standard operating procedures for the primary management of psychiatric cases (in print;) biannual training programmes for primary health physicians-these three-week training programmes emphasize knowledge, skills and positive attitudes; a review workshop in October every year to assess the progress of the national mental health programme and development of community-based psychiatric care in Oman; development of a referral system linking the different levels of care; regional workshops in psychiatry, which are regularly held for the training of primary health care staff from every region of the country for primary management of psychiatric cases.

Educational administrators, schoolteachers and schoolchildren constitute a large portion of the literate population, particularly in the rural areas, and hence, exert tremendous influence on community attitudes and behaviour patterns, including popular ideas and beliefs on health and disease. This resource can be exploited in school mental health programmes, by inculcating a positive attitude towards mental health and illness among the community by using the school system as a social tool of change. Teachers and selected students are given basic training courses using lectures, debates, discussions and essay competitions. Children are taught simple educative slogans aimed at modifying their attitude and level of education. Such slogans are also propagated among the community through banners, posters, advertisements in newspapers and magazines, stickers and stamps printed on school homework notebooks. School health workers and selected teachers are given special training in workshops to attain the skills so that they can recognize and help those in need of special education and parents and teachers who need counselling in dealing with children.

Research studies using routine hospital data have been carried out. A study conducted in 1995 showed that poor compliance and irregularity in taking medicines were the main causes of relapses in chronic psychiatric cases in Oman. Hospitalization was required in the majority of cases where frequent and repeated relapses occurred. Distance from hospitals also contributed to poor attendance record and poor compliance with treatment. The conclusion of this study was that strengthening of the primary health care services near patients’ homes was essential.

.*All the statistics here are the figures provided by the authorities in the Ministry of Health of Oman, and are based on the most recent EMRO statistics.