Self-management of primary health centers

Primary health care is considered the cornerstone of healthcare services in the Kingdom of Bahrain, serving as the first point of contact for individuals seeking healthcare. It encompasses a range of services including promoting healthy behaviors, early disease detection, diagnostic and therapeutic services, and rehabilitation.

The Kingdom of Bahrain adopted the Universal Declaration of Almaty in 1978, followed by the Astana Declaration in 2018 to achieve comprehensive health coverage initiative, which indicates that primary health care is the key to achieving health for all through a global strategy, and highlights the need for everyone in the world to have access to health in order to be productive members of society. Therefore, the Ministry is committed to implementing Article 8 of the Kingdom's Constitution in the field of health care, which states:

Every citizen has the right to health care, and the state is responsible for public health, providing means of prevention and treatment through the creation of various types of hospitals and health institutions.
An individual or entity may establish a hospital or clinic under the supervision of the state, according to the law.

The Kingdom provides its primary health services through 26 health centers and one health clinic distributed across five health areas in all regions of the Kingdom. These centers provide therapeutic, preventive, and rehabilitation services for families and communities. All citizens and residents are registered in health centers affiliated with their residential areas for treatment, and a referral system is in place for secondary care when necessary.

Major Achievements

Therapeutic services.
Preventive services that include maternal and child health, such as prenatal care, regular child check-ups, vaccination, postnatal or abortion services, family planning services, regular women's check-ups, pre-marriage check-ups, and ultrasound for pregnant women.
Oral and dental health services, such as a dental health program, fluoride application, educational activities, dental care for mothers and children, care for diabetic patients, the elderly, and clients with special needs.
Rehabilitation services provided by the Natural Therapy department at the health area level.

Registered beneficiaries (Bahraini and Bahraini family)	Health Center	Health zone
20,771	National Bank of Bahrain Health Center - Arad	The first health zone
35,330	BBK Center - Hidd
6,243	Sheikh Salman Health Center
20,984	Muharraq Health Centre
17,609	National Bank of Bahrain Health Center - Al-Dair
19,028	Bu Maher Case Center
7,412	Al-Naeem Health Center	The second health zone
3,749	Ibn Sina Health Center
13,041	Hoora Health Center
16,791	Sheikh Sabah Al-Salem Health Center
30,375	Bilad Al Qadeem Health Center
7,412	Jidhafs Health Centre
43,415	Yusuf Abdul Rahman Engineer Health Center	The Third health zone
28,121	Isa Town Health Centre
40,866	Sheikh Jaber Al-Ahmad Al-Sabah Health Center
29,356	Budaiya Health Center
6,747	Budaiya Coastal Clinic
27,476	Sitra Health Centre	The Fourth health zone
20,135	Ahmed Ali Kanoo Health Center
38,533	Hamad Kanoo Health Centre
30,481	Sheikh Abdullah bin Khalid Al Khalifa Health Center
26,318	A'ali Health Center
35,482	Hamad Town Health Centre	The Fifth health zone
40,008	Kuwait Health Center
42,940	Mohammed Jassim Kanoo Health Center
5,099	Zallaq Health Center
3,934	Khalifa City Health Centre

With the self-management project, a separation process was carried out between the administrative and financial functions of primary health care centers and the Ministry of Health and government hospitals. As a result, primary health care centers became an independent government system with its own board of trustees and a separate chief executive officer to oversee them. Wide authorities will be granted for their management without centralization, as the administrative and operational power will be in the hands of decision makers in the field, based on the specificities and needs of each individual health center, in line with the Health Insurance (Sehati) program.

The key outcomes are:

A national work team was formed in the first quarter of 2021 to work on the self-management project.
The team, in cooperation with the consulting company, conducted an analytical study of the health centers' situation after the COVID-19 pandemic and identified appropriate solutions to the existing challenges based on the self-management strategy adopted by the Supreme Health Council.
After developing the operational model and implementation plan for primary health care centers, the trial application of the project was started in a comprehensive manner in the first health area (Al-Mahraq governorate) as it met all criteria set by the national team in collaboration with the consulting company.
Under the self-management project for primary health care, several programs are included, the most prominent of which are:

Choose Your Doctor

Project connects every individual with a family doctor of their choice to enhance the quality of primary healthcare services.
The medical and nursing staff are re-distributed among health centers to match the population count.
Doctors are grouped into "group practices" and are linked with a nurse.

Health Card

A health card is currently being issued and distributed to the beneficiaries registered in the "Choose Your Doctor" project after they have selected their family doctor.

Emergency Care Service

The services provided in "emergency care" are separate from the services provided by "choose your doctor" in health centers that operate 24/7.
Activation of the Canadian Triage and Acuity Scale (CTAS) system and training of staff on its use.

Immediate handling of emergency cases according to their classification to ensure that patients receive appropriate treatment at the appropriate time within the scope of primary health care.

Central Laboratory

Transferring routine tests to the Salmaniya Central Laboratory.
Extending the blood draw and sample reception period in all laboratory centers in Al Muharraq Governorate to include the evening hours during official work days.
Receiving samples from referring health centers as well as transferred samples from government hospitals and non-insured institutions under the Ministry of Health.

Development of oral and dental health services

Implement a system for appointment booking and activate the pre-booking appointment service for oral and dental health services.
Reallocate human resources to clinics according to need and population density.

Funding and payment model

Study and analyze the current cost of variable family physician salaries.
Prepare a proposal that includes rules and calculation methodology for individual share.
Determine the individual share percentage based on the proposed model and compare it to the current salary calculation system.
Prepare and send the required financial information to the information and human resource systems.
Work with the information and physician team to verify the accuracy of the data related to the "Choose Your Doctor" program for calculating salaries in the pilot phase.

The most important next steps are:

Gradually implement the national project based on the readiness of remaining primary healthcare centers.