Vision 2030 and Sustainable Development: State Capacity to Revitalize the Healthcare System in Saudi Arabia

Abstract

Vision 2030 is a social and economic strategic program by the Kingdom of Saudi Arabia (KSA) aimed at diversifying the nation’s economy and stimulating numerous changes in its social and economic sectors, including in healthcare. Sustainable Development (SD) 2030 is a global consensual agreement among nation-states to build a sustainable, desirable and progressively interrelated world. The Saudi government highlighted Vision 2030 to improve population health and the world body reiterated that SD 2030 will contribute to “healthy lives and promote well-being for all at all ages.” This article analyzes the state capacity in revitalizing the healthcare system in Saudi Arabia with the context of Vision 2030 and SD 2030. Scoping reviews and thematic data analysis techniques were used as a method of this study. The realization of Vision 2030 is essential for the fulfilment of the SD Goals 2030. The government has realigned its national programs, plans and strategies with global development targets, indicators, and goals to achieve the SD Goals. Achieving SD 2030 is seen as the main component of development for health. Prudent reforms should be taken to accommodate the goals and objectives of Vision 2030 and SD 2030. These measures will help strengthen governance and state capacity so as to ultimately revitalize the Saudi healthcare system and improve population health. Saudi Arabia’s Vision 2030 encourages the state to play a renewed role in development in light of the UN’s declaration of the “right to development.” While pursuing SD Goals, the state must create the necessary environment for sustaining capacity, need to improve service delivery by building cooperation and coordination among providers and interactions among groups to realize constructive roles and functions in maintaining state affairs, which ultimately enhances state capacity to revitalize healthcare system of Saudi Arabia.

What do we already know about this topic?

Since the announcement of Vision 2030 in 2016, several sectoral studies (education, tourism, knowledge economy, health, energy, etc.) have been conducted. While Vision 2030 is projected to be a catalyst of health sector reformation that would bring benefits to the Saudi economy and development of the health sector, it is also debated that the initiative is flawed due to its unrealistic nature.

How does your research contribute to the field?

This article explores the state capacity and the role of Vision 2030 and SD 2030 in revitalizing the healthcare system of Saudi Arabia. This paper also discusses policy measures that would lead to the development of the Saudi healthcare system and their impact on the sector.

What are your research’s implications toward theory, practice, or policy?

This manuscript explores state capacity linkage to development. It examines the tripartite links among Vision 2030, Sustainable Development 2030, and development.

Introduction

The Saudi constitution signifies health as one of the fundamental rights of every citizen. As noted in Article 31, “The state takes care of health issues and provides healthcare for each citizen.” The development of population health is one of the priorities of the government which is mentioned in the subsequent national development plans, and international commitments and agreements. Since the establishment in the 1900s, the Saudi government has been trying to provide the best possible healthcare to its citizens. Vision 2030 was announced in 2016 to revitalize the economy and promote the private sector as an engine of growth. ¹ Sustainable Development Goals (SDGs) 2030 was declared by the global community in 2015 to transform the world toward sustainability and development. This study examines state capacity and the role of Vision 2030 and SD 2030 in revitalizing healthcare systems in Saudi Arabia.

Methods

Different search engines and databases including Google (g), Google Scholar(GS), PubMed Central (PMC), Web of Science (WoB), Current Contents (CC), Directory of Open Access Journals (DOAJ), and Scopus have been used. The Boolean operators AND, OR and NOT were used in synthesizing the search. Relevant keywords such as “Saudi Arabia” “health” “healthcare” “health sector” “state capacity” “development” “Vision 2030” and “Sustainable Development 2030,” [“development” AND “Vision 2030”], [“health” OR “health sector” AND “Sustainable Development 2030”], [“healthcare” AND “Sustainable Development 2030” NOT “development”] were used. This search helped to find 559 articles from different search engines and databases. With help of Prisma approach, after scanning and screening, 38 articles were finally selected (Figure 1). References of each publication were also scanned. This article also uses relevant reports and discussion papers of the World Health Organization (WHO), World Bank, United Nations, and International Monetary Fund (IMF). The timeframe of the articles and documents used in this research spans between 2000 and 2019, as this period is the most relevant in grasping the growth of private healthcare in Saudi Arabia. The review also excluded non-English documents. Scoping reviews and thematic data analysis techniques were used as a method of this study. The analysis is focused on the agreement of thematic contents in the available sources of text or data ² and it has helped triangulate these agreements. ³

Figure 1.

Prisma approach utilized to select appropriate articles.

The Conceptual Framework

Vision 2030

Since the foundation of Saudi Arabia in 1932, the visionary leadership planned for change toward growth and development. Different regimes have taken initiative to diversify the economy and prioritized to prepare 5-year plans to uplift the economic conditions of the country but the outcome was not completely successful due to abnormal fluctuations in oil prices, or other national and international factors.^4,5 Between 1980 and 2017, there were 13 budget surplus years of between 1% and 32% and 22 budget deficit years of between 2% and 25%. ⁶ Evidently, the country could not maintain feasible budgets in the last few decades. The country faced a budget deficit of SAR367 billion in 2015 and SAR297 billion in 2016. Similarly, oil revenues in the national budget decreased from US$277 billion, USD$163 billion, and US$141 billion in 2014, 2015, and 2016 respectively. ⁷ In addition, the country faced challenges due to population growth and fiscal deficits. This financial deficit, socio-cultural change and increased health knowledge has contributed to increase demand on public sector healthcare. The government expected to overcome these problems by reducing dependence on oil and prudent management of the economy. ⁸

The government unveiled a determined program of development in April 2016 as “Vision 2030” to transform the economy by 2030, ⁹ and the National Transformation Program (NTP) 2020 was subsequently announced to achieve the goals. ¹⁰ In announcing Vision 2030, the government focused on its geographical location, the nature of its society, highlighted privatization and the need to maximize the contribution of the private sector to administer effective governance. ⁹ It was suggested that Vision 2030 would contribute to doubling the gross domestic product (GDP) from its current figure. The creation of 6 million additional jobs for Saudi nationals and additional investment of US$4 trillion in the non-oil economy by the private sector, will be expected to bring in a 60% increase in Saudi household income and a rise of GDP to US$8 billion. ⁸ The government’s target of Vision 2030 had prior focus to take the economy forward—from its current position to among the first 15 countries in the world. The intention was to increase private sector contributions from 40% to 65% of GDP and foreign direct investments from 3.8% to 5.7% of GDP. Finally, there would be an increase in Saudi-ization in the oil and gas sectors (from 40% to 75%) and the Public Investment Fund’s assets (from SAR600 billion to more than SAR7 trillion). ¹¹ The government highlighted the danger of “oil addiction” and advised overcoming and building a self-reliant economy. In enunciating Vision 2030, the government reiterated, “We have developed a case of oil addiction in Saudi Arabia.” The government further reaffirmed that in the future, the country would not like to be at the mercy of external markets. The Vision, along with promoting the private sector as the main engine for social and economic development, also wants extensive revolution in transforming the economy toward multidimensional growth with minimal oil dependency. ¹¹

The government has always been supportive of the vision for the advancement of the nation. To ensure the implementation of Vision 2030, the government also streamlined process output to measure achievable goals. The government also emphasized on the necessity of accountability, transparency, flow of communication and public engagement toward modernizing and uplifting the nation to a higher level.

Sustainable Development 2030

In 1986, United Nations declared the ”right to development” and advised nation states to work toward overall development in every aspect of human life, while ensuring equal opportunities for all. ¹² This can be achieved by provision of access for all to basic resources such as health, education, nutrition and housing, employment and fair income distribution. All states should try worthwhile options to realize development. The constitution of the World Health Organization’s (WHO) definition of health reiterates the need for the development of health. The Alma-Ata declaration in 1978 further consolidated the development of minimum health for everyone. ¹³ The Ottawa Charter for Health Promotion in 1986 emphasized health development, and the Millennium Development Goals in 2000 highlighted the need to attain Universal Health Coverage (UHC) for development. The WHO Commission on Social Determinants of Health in 2000 and WHO Commission on Macroeconomics and Health in 2001, both placed health at the center of development. It is well-established that economic growth contributes to health development and better health in turn contributes to economic growth.^14,15

In late 2012, the United Nations System Chief Executives Board for Coordination (CEB), and World Bank Group agreed to strengthen their efforts to align their strengths and capacities for better cross-sectoral and cross-institutional thinking, coherence and coordination. This brought 2 world bodies together. In the meantime, the United Nations Conference on Sustainable Development was held in Rio de Janeiro in 2012. At the same time, civil society and non-governmental organizations formed People’s Health Movements (PHMs) and advocated for the right to health. PHM organized a few health assemblies worldwide and published an alternative health report from the WHO. People’s Health Assembly and People’s Charters for Health voiced the need for rights to health in 2000. The interactions between United Nations and World Bank along with advocacy and civil society’s campaign for a sustainable world helped give birth to SD 2030.

The UN General Assembly established Sustainable Development Goals (SDGs) 2030 in September 2015 with 17 universal goals to be achieved by 2030 for fostering a better world that is transforming toward sustainability and development. ¹⁶ While highlighting the links between peace, development and human rights, SD 2030 constitutes an integrated and universal rights-based agenda for SD. It aims to balance economic growth along with social justice and environmental stewardship. ¹⁷ SD 2030 is an extraordinary action of global consensus to build a sustainable, desirable and progressively-interrelated world. ¹⁸ Health is included as a central agenda in the SDG3 that aims to “ensure healthy lives and promote well-being for all at all ages” ¹⁶ and focuses on the necessity to the strengthen sustainability of health systems. Here, sustainability means resource mobilization together with allocative and technical efficiency improvements and politically acceptable development of organizational capacity of the health system. ¹⁹ Since setting global health goals has a positive impact on overall development, ²⁰ SD 2030 provides an opportunity to build political commitment for a common agenda toward strengthening the health system. ²¹ In 2016, the WHO put in place the International Health Partnership (IHP) for UHC to bring together government and development partners for improved coordination of health system strengthening that will further help strengthen the UHC. ²¹

Development

Development leads to progress toward positive change in human life and contributes to growth, quality of life and welfare. Internationally, development as an issue came to the forefront in the second half of the twentieth century. Development is linked not only to economic growth, but also to socio-economic and political factors of a country. Amartya Sen developed the “capability approach,” which has been used as parameter of the human development index. The 1986 UN declaration of the “right to development” encouraged the state to play a key role in development, while pursuing goals that help bring in the right and provide equal opportunity for all. ¹² The state has been entrusted with the responsibility of ensuring and guaranteeing individual access to basic resources for a dignified standard of living such as health, education, nutrition, housing, employment, and fair distribution of income.

The path to SD started in the 1970s but the Brundtland Report highlighted it at the United Nations level in 1987 and linked it to the needs of present and future generations as a direction to development. ²² In realizing development, the state must maintain its capacity to maintain its affairs. ²³ State capacity is also linked to good governance.^24,25 It can be largely improved if the state develops an institutional environment to maintain necessary political support, capability and resources, and cooperation between groups. ²⁶ Moreover, the state capacity is linked to the political will^27,28 of the government. It includes the government capability to manage information, logistics, communication networks, and human resources, all of which help achieve better performance outcomes. ²³

Tripartite Relation of Vision 2030, Sustainable Development 2030, and Development

Saudi’s Vision 2030 and National Transformation Program (NTP) 2020 aims to transform the country into a sustainable one. Here, sustainability refers to its meaning in the context of development. The government took various steps to fulfil development goals. Vision 2030 is comprehensively linked with sustainability. The government wants to bring in a revolutionary transformation in the economy and gear it toward multidimensional growth and minimal oil dependence, building an affluent and sustainable economic development based on the country’s strength and policies. The Sustainable Society Foundation developed the Sustainable Society Index (SSI). This index is based on social, economic and environmental factors ²⁹ that lead to sustainable development. Here SD was focused on as a multidimensional interpretation of development. ²⁹ Vision 2030 is aligned to SD indices, which have been pronounced to reflect the wishes, ambitions and situation of Saudi Arabia. ²⁹

“Sustainable Development is a transformation process in which the exploitation of resources, direction of investments, orientation of technological development and institutional change are reconciled and reinforces present and future potential, in order to attend to needs and future aspirations (. . .) it is that which attends to present needs without compromising the possibility of future generations attending their own needs (p. 49).” ³⁰

Development indices are also linked to social, economic, political, and environmental factors. The United Nations Conference in the 1990s on Environment and Development (Eco-92) focused on development more comprehensively and subsequently. Agenda 21 was launched as the global agenda of SD. ²² Development is denoted as “a state, process, well-being, progress, economic and human growth or ecological balance” (p. 11). ³¹

From the above analyses, we can conclude that both Vision 2030 and the SD 2030 are development-oriented (Figure 2). The government recognizes SD 2030 as “incorporated into the government’s detailed action plans and programs that are being developed and refined under the Vision 2030 framework” (p. 16). ³² This indicates that the government is committed to implementing SD by linking it with the implementation of Vision 2030.

Figure 2.

Interrelation of vision 2030, sustainable development 2030, state capacity and healthcare system.

Result

Role of Vision 2030 in Re-Vitalizing Health Sector

The Saudi public health system and the Ministry of Health were founded in 1925 and 1950, respectively. Since the 1970s, the health sector was given priority in the National Development Plans that helped revolutionize this sector and resulted in enormous developments in the health status of the population. ³³ Along with the Ministry of Health, the private sector and non-government agencies have also contributed in improving the health status of the population. As is the case elsewhere, KSA is facing the challenge of rising expenditures in healthcare. The health and social sector was allocated 14% of the total budget, totaling SAR120 (US$32) billion. ³⁴ In 2014, overall health expenditure as a percentage of GDP was 4.68%, and the per capita expenditure was US$1,147. ³⁵

The government is making an effort to overcome economic uncertainty by 2020 with the help of methods such as broadening the economy, creating job opportunities for Saudi nationals in the private sector, and reducing expenses of the state. ¹⁰ Additionally, recently, the Ministry of Health has started new reforms according to the National Transformation Program (NTP) 2020 and the Saudi Vision 2030, focusing on the development of the health system and improving the finance system, bringing about competency along with success in service delivery.^9,10 The state has been entrusted with providing healthcare services, while ensuring its quality and affordability to complement social needs and fulfill consumer desires. Under the NTP, the government will strive to enhance infrastructure, manage health facilities, and maintain safety and quality standards. ¹⁰ The government is in the process of developing many medical cities (of 6200 beds) across the country with investments of up to US$4.3 billion intending to provide specialist healthcare services. The government has also undertaken the job of covering the geographical area. The plan is to build 38 new health centers with 9100 beds and 23 new hospitals with 4250 beds. ³⁶ By 2020, the government is assumed to have built 264 hospitals with 70,694 beds, 2750 Primary Health Centers (PHC), and 27 specialist medical centers. ³⁶ A recent initiative indicates the Ministry of Health is establishing a corporation under which 6 regional corporations will be created to accelerate privatization. However, only 3 regions will come under the implementation phase, including the East, Makkah and Riyadh regions, due to higher consumer presence and demand for healthcare in these regions. ³⁷

Vision 2030 highlighted that the public sector would engage in the promotion of preventive care, reduction of infectious diseases and advising people to utilize primary healthcare. This will broaden partnership and assimilation between health and social care. The public sector is entrusted with the involvement of planning, monitoring and supervising the delivery of healthcare. The government intends to work as public corporations to enhance privatization which would improve quality in the provision of healthcare. The government also intends to reduce the waiting time for appointments with specialists and consultants. Physicians will be trained to look after patients with modern diseases.^9,32

Vision 2030 has prioritized the private sector and therefore the government is expecting and anticipating more investments here. With the help of various programs and changes in the economic field, the state is strengthening the private sector. It plans to improve the management system and generate standards for healthcare. The NTP intends to expand the functions of the private sector by concentrating on privatization and Public-Private Partnerships (PPPs), improving the business environment, developing local markets, encouraging Foreign Direct Investments (FDI), and supporting Small and Medium Enterprises (SMEs). ¹⁰ It is considered that the expenses in the private sector would increase from 25% to 35% of GDP, generating a revenue jump to SAR4 billion from SAR300 million. It also foresees a spending of SAR23 billion by the Ministry of Health in the next 5 years, bringing about changes in primary healthcare, public-private partnership, and privatization of one of the medical cities. ¹⁰ By 2020, the government intends to privatize 2259 PHCs and 295 hospitals. It wants to keep the planning, supervision, and ownership of these institutes, but be managed by the private sector. ¹⁰

The government has also developed a national investment vision to increase investments, resulting in an additional SAR2.3 trillion in investments in the economy. ¹⁰ The vision targeted health sector privatization and projected an increase in revenue of the current US$3 billion to US$4 billion. It is also expected that by 2020, total private investment in the health sector will reach US$100 billion (SAR375 billion), adding 12,500 new beds every year. The privatization move was aimed at increasing private sector participation in the healthcare sector from 25% to 35% in line with the requirements of Vision 2030, which seeks to provide free and quality healthcare to 20 million Saudi citizens.^37,38 The government is undertaking different reform initiatives to boost the healthcare sector. The privatization of the health sector is one of the focal points of government economic diversification activities to minimize public sector expenditures and reduce dependence on it. In 2015, more than US$20.8 billion alone was contributed by the health sector to the country’s GDP. It is expected that this sector will grow by 13.7% by 2025. The government also planned to privatize all public hospitals and build Public-Private Partnerships (PPPs). At present, the public sector holds 80% of bed capacity, which will be expected to add 73,768 beds in 2020 and the private sector is expected to bring 26,000 beds by 2020. It is reported that a private group of investors is building 8 130-bedded hospitals, 60 outpatient clinics, and other necessary amenities in a medical village in Riyadh. The government is also constructing 36 new hospitals with 8950 beds and 2 medical cities. Moreover, the government is planning to build another 18 hospitals with 9904 beds over the next 2 years. In April 2018, Saudi Arabia announced an ambitious privatization plan, which includes 14 PPP investments to be completed across 10 sectors, including healthcare by 2020. In July 2018, the government signed an agreement with the private sector for SAR407 million loans to establish hospitals and medical facilities in Abha, Abu Arish, Buraydah, Dammam, Jeddah, and Riyadh. ³⁷

Role of Sustainable Development 2030 in Re-Vitalizing Health Sector

SDGs have 17 universal goals and 169 targets that are intertwined. For example, the achievement of SDG2 means a country is secure and confident in the availability and accessibility to food, SDG8 is a micro-economic policy, SDG10 is to minimize inequality, and SDG13 is building resilience for climate change. All of the above are essential to accomplish SDG1, which is ending poverty. ³⁹ This, in turn, contributes to SDG3 aimed at health and wellbeing, indicating a country must necessitate multidimensional and multisectoral policy interventions to achieve SD. ⁴⁰ SDG3 is related to 16 other SDGs that are also linked to the social determinants of health (includes poverty, hunger, education, gender equality, water and sanitation, energy, economic growth, inclusive and sustainable industrialization and innovation, inequality, safe cities, sustainable consumption and production, climate change, sustainable use of water reservoirs, environmental protection, peace and justice, and partnerships). The development of health is dependent on its determinants. Population health will benefit from development in each of the determinants. ⁴¹

Target SDG3.8 focused on achieving Universal Health Coverage (UHC; including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all), emphasizing quality health services where all people and communities have easy access. ¹⁶ Strengthening the health system means advancement toward UHC. ²¹ A functional health system always works to support people, institutions and resources to improve, maintain or restore the health of the population. Health system strengthening allows an improvement of the system’s performance ⁴² by maintaining and achieving quality, equity, efficiency, accountability, resilience, and sustainability. ²¹ According to Kieny et al. strengthening the health system supports UHC and vice-versa. ²¹ These have been helping to achieve SD.

Kieny et al. suggested that UHC can help achieve sustainability goals through investments in the health sector while providing improved health outcomes for the whole population and contributing to SDG1. ²¹ Investments in the health sector to promote UHC will lead to enhanced economic development in line with SDG8. Investment in health leads to good health, which ultimately contributes to better educational outcomes that fulfil SDG4. Equitable engagement in the workforce leads to SDG5. Investment in health contributes to strengthening the health system which can provide impartial, responsible and amicable health services to the population that are linked to SDG16. ²¹ Numerous health promotion and prevention actions are required beyond the health sector ⁴³ and economically, it is estimated that US$371 billion per annum is required to achieve targets for SDG3 only to “ensure healthy lives and promote well-being.” ⁴⁴ Therefore, it can be concluded that the implementation of SD will enhance and revitalize the health system.

Discussion

The Saudi Ministry of Health indicates that it has a strong commitment to fulfilling Vision 2030 and engages the private sector in economic growth and sustainable development. ⁴⁵ The private sector will have to work with the public sector to improve the overall quality of healthcare services delivered, boost patient satisfaction, reduce financial risks and promote sustainable growth in attaining the goals mentioned in Vision 2030.^1,45 The10th development plan of the government gave importance to strengthening SD. ⁴⁶ The government also invited foreign investors and assured them 100% ownership for their investment in the healthcare sector. ⁴⁷ Investment alliances between national and global capital forged in the leadership of World Bank Group member International Finance Corporation (IFC) have critically contributed to the expansion of the global for-profit healthcare sector. Moreover, increased interest in the healthcare and social sectors as potential growth areas has seen the global healthcare industry as a crucial target of private equity investments over the past decade. ⁴⁸

While the government will continue its development and modernization of health infrastructure and services, some programs and schedules have been revised to ensure the achievement of the intended objectives of Vision 2030. These measures were taken to safeguard the alliance with the global capital and promote the global healthcare industry. ⁴⁹ Reiterating the government’s clear vision and specific plans, the Crown Prince of Saudi Arabia has stated that the country is working toward achieving laid-out goals and toward attaining economic stability, which in itself is a pillar of SD. ⁴⁹ Budget 2020 comes at a time of global economic challenges and protectionist policies that call for increased flexibility in the management of public finances and steps toward improving the economy’s ability to overcome these hurdles. By taking advantage of the progress already achieved through various programs and building on the same, Saudi Arabia aims to strike a balance between pace of economic growth and the need for sustainable financial stability that ensures support for such growth. The private sector also becomes an engine of SD by linking the public and private sectors. ⁴⁵

Saudi Arabia aims to take the following action by linking SD and Vision 2030 (Relevance of SDG 1 to Vision 2030):

1. Making healthcare easily accessible, based on geographical proximity, affordability and availability.

2. Empowering citizens through the welfare system.

3. Improve the living conditions of the expatriate community.

4. Improve the value of healthcare services in terms of quality of outcomes, experience, and cost.

5. Strengthening the prevention program against health threats (public health system and health crisis management).

6. Better effectiveness and efficiency of the social services system (p. 36). ³²

A close analysis outlines the importance of SDG3 in Vision 2030’s strategic objectives and related initiatives, as follows:

Making healthcare services easily accessible; promoting the value of healthcare services; promoting sports activities in society; improving quality of services provided in Saudi cities; substantially reducing air, noise, water and soil pollution; enhancing the nation’s immunity towards drug abuse; promoting traffic safety; safeguarding the environment from natural threats; enhancing family involvement in preparing for their children’s future; empowering citizens through the welfare system.

As per the goals of Vision 2030, Saudi Arabia has laid out a patient-based National Healthcare Model (NHM). ³² The features of NHM are as follows:

Strengthen healthcare services provided over the hotline; enhance services of the Saudi Center for Disease Control and Prevention; building comprehensive health polyclinics; provision of antenatal care services; establishing national referral network; setting up pre-marriage medical examination; provision of better home-based healthcare services; develop health research programs; developing school-based education programs; implementing safety programs at school (p. 46). ³² Saudi Arabia offers educational programs “Al Afia” on traffic safety to build community awareness. ³² Other ministries and government agencies took several initiatives to achieve SDG4 (sustainable educational development), SDG5 (gender equity), SDG8 (economic growth) and SDG12 (reduce pollution) that are aligned with Vision 2030. Vision 2030 incorporates several SDs into its agenda with key priorities in the three dimensions of social, economic and environmental sustainability. Continued political support from the highest level, a conducive policy environment, streamlined institutional systems and the ability to build on the experience gained have all had positive impacts on the implementation of Agenda 2030 (p. 29). ³² The frameworks of SD 2030 and Vision 2030, and the development trajectory so far have a significant degree of alignment.

Challenges facing the government are also enormous. Although the Saudi state was formed with a constitution in 1932 and the power base of the country is monarchical with Islamic values, the state is yet to build on governance in maintaining state affairs. The administrative system and institutional capacity of the state can be characterized as unduly complex due to over-centralization, nepotism, limited accountability, undue formality and intransigence, and heavy workloads. These issues are compounded by the overlap of functions, bureaucratic corruption, the ubiquity of rules and procedures, fragile implementation and monitoring capacity, the inefficient flow of information, and lack of information to make decisions. Moreover, insufficient inter-agency consultation or coordination, oversight of regulations, inadequate delegation of authority, and complexities and delays in decision-making affected policy and the performance of the administration. This, in turn, affected the functioning of the state and limited its capacity ^50,51 The Saudi government has the financial resources but does not have the sufficient trained health professionals. ⁵² The government sustained economic conditions, and has the potential capacity to raise resources from their own sources. Saudi Arabia has a mix of formal and informal elements in the state’s management. ⁵³ More recently, several factors such as changes in demography, life expectancy, disease patterns, lifestyles, consumer expectation, costs of healthcare, and delivery of services have made it challenging for the state to continue providing health services at no cost.^5,54 Poor quality of services and greater health literacy renewed the demand for better healthcare. Although the government is capable of assigning resources to the health sector, it is stressed due to the ever-increasing expenditure and demands and stagnant resources. During the implementation of goals and objectives, there seems to be an absence of markers that could gauge and calculate its success. The economic impact of Covid-19 and fluctuations in the price of oil in the global market have ramifications on Vision 2030, and it will be increasingly difficult to achieve these goals. Therefore, it can be said that the state will face many challenges in realizing Vision 2030 and SD Goals in the Saudi context. This will limit its impact on revitalizing the Saudi healthcare system.

Conclusion

Saudi Arabia prepared Vision 2030 to outline promises to the nation, to uplift its economy and to overcome the challenges faced by the country. The government highlighted targeted goals to gain admiration and support from vast population groups that are young and dreaming of better lives and livelihoods. The government emphasized the economic development and advancement of the nation by diversifying from an oil-dependent economy into a non-oil product and services economy. Though the government has made significant improvement in the health sector, it needs to readjust policies and programs with changing disease patterns and financial conditions of the country. Overall, the government should improve the governance of the health sector and extend the same to other sectors that will enhance state capacity. There is a need to improve service delivery by building cooperation and coordination of different services providers and other stakeholders. The government needs to strengthen healthcare through health human resources development, building partnerships between the public and private sectors, good management practices and efficient use of resources.

While the Saudi government is working to achieve SD Goals 2030, it is also interested in engaging with other nations to share knowledge and experiences regarding global progress on the same. The government is enthusiastic to improve collaboration among relevant government services (such as the Ministry of Health, National Guard, Armed Forces, Security Forces, Saudi Aramco, Royal Commission for Jubail and Yanbu and university hospitals) and non-government actors (private sector healthcare and insurance). It also aims to strengthening the institutional framework in place to support the fulfilment of SD 2030. By setting aside substantial financial resources for the sectors, significant improvements have been made in the country’s health and education outcomes. By chalking out a strategy to transform the Saudi economy and society, Vision 2030 has laid the foundation for achieving SD 2030 while reiterating the government’s commitment to do so. The realization of Vision 2030 is now also essential for the fulfilment of SD. The government has adapted SD 2030 to the realities of the country by further realigning its national programs, plans and strategies with global development targets, indicators, and goals. Sustainable development and collaboration among public, private, and non-profit stakeholders would likely be at the heart of all policy making and implementation if better collaboration among actors and strengthened institutional frameworks around Vision 2030 are achieved. Involved parties would have a better sense of ownership and commitment if they have a direct engagement with the pursuit of SD 2030. Prudent reforms should be undertaken to accommodate the goals and objectives of Vision 2030 and SD 2030. Such measures will also help strengthen governance and state capacity to ultimately revitalize the Saudi healthcare system and improve population health.