reasher

Master of Healthcare Administration
HCM 600 Research Project
Examining The Long-Term Interventions Effects of Telepsychiatry on Chronic Mental Health
Conditions In Saudi Arabia: Systematic Review
A Research Project
Submitted in Partial fulfillment of the
Requirements for the Degree of
MSc of Healthcare Administration
Prepared by:
Rehab Nawaf Alharbi
Supervised:
Dr. Danyah A Aldailami
Date
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Declaration
I declare that the research project entitle Assessment of Telepsychiatry Services
submitted to the Saudi Electronic University is my own original work. I declare that the research
project does not contain material previously published or written by a third party, except where
this is appropriately cited through full and accurate referencing. I declare that the Saudi
Electronic University has a right to refuse the research project if contains plagiarism and cancel
the research project at any time and the student has the full responsibility regarding any further
legal actions.
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Acknowledgement
I extend my heartfelt gratitude to all who contributed to the success of this research. First, I
would like to thank my supervisor, Dr. Danyah A Aldailami, whose expertise, understanding,
and patience added considerably to my graduate experience. Her willingness to give his time
so generously has been very much appreciated. I am indebted to my colleagues in the MSc of
Healthcare Administration for their feedback and the stimulating discussions that inspired many
of the ideas explored in this study. I also express my sincere thanks to the participants and
institutions that contributed data and insights, enhancing the richness and validity of the
research. Special appreciation goes to the technical staff for their help in navigating the complex
setups required for telepsychiatry systems. Lastly, I must express my very profound gratitude
to my family for providing me with unfailing support and continuous encouragement
throughout my years of study and through the process of researching and writing this thesis.
This accomplishment would not have been possible without them. Thank you.
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Table of Contents
Declaration
ii
Acknowledgement
iii
Table of Content
ivii
List of Abbreviations
v
List of Tables
v
List of Figures
ii
List of Appendixes
2i
Abstract
2x
Chapter 1: Introduction
1
Chapter 2: Literature Review
4
Chapter 3: Objectives
10
Chapter 4: Materials and Methods
12
Chapter 5: Results
17
Chapter 6: Discussion
27
Conclusion
32
Recommendations
34
References
36
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List of Abbreviations
All of the following abbreviations are to be taken in context of the study.
HIPAA
Health Insurance Portability and Accountability Act
IRB
Institutional Review Board
DSM-5
Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition
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Abstract
Introduction
Telepsychiatry employs telecommunications technology to provide psychiatric services
remotely, which could be particularly beneficial for addressing the mental health needs of the
Saudi Arabian population. Chronic mental health conditions such as depression, anxiety, and
bipolar disorder have a substantial impact on the community, with traditional psychiatric care
often limited by challenges like poor accessibility and prevalent cultural stigmas.
Aim of the study
This research delves into the effectiveness of telepsychiatry interventions in Saudi Arabia for
adults aged 18-65. It examines whether such remote services can mitigate symptom severity
and boost medication adherence and overall well-being compared to conventional face-to-face
psychiatric treatments.
Methods
By conducting a systematic review of existing literature, the study evaluated the relative
efficacy of telepsychiatry.
Results
Early results indicate that telepsychiatry might offer comparable outcomes to traditional
methods, providing a more accessible and potentially less stigmatizing option for mental health
care. This is significant because accessibility and stigma are notable barriers that prevent many
individuals from seeking necessary psychiatric help.
Conclusion
The study highlights the need for telepsychiatry services that are specifically tailored to the
cultural context of Saudi Arabia to improve patient outcomes and satisfaction. Through this
adaptation, telepsychiatry could play a critical role in transforming mental health service
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delivery in regions facing similar challenges, making a substantial impact on public health
outcomes.
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Chapter One
Introduction
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Introduction
Telepsychiatry represents a transformative approach to mental health care, harnessing
the power of technology to deliver psychiatric services remotely(. ). This innovative modality
is particularly relevant in Saudi Arabia, where mental health issues are a growing concern,
projected to affect one-third of the population by 2030 due to non-communicable diseases,
including mental illnesses(.
). Given the limitations of traditional psychiatric care, which is
often constrained by accessibility issues and societal stigma, telepsychiatry offers a promising
alternative.
Traditional mental health services in Saudi Arabia face significant challenges.
Geographic vastness and uneven distribution of healthcare resources mean that access to
qualified mental health professionals is limited, particularly in rural or underserved areas(. ).
Furthermore, the societal stigma associated with mental health issues can deter individuals from
seeking necessary care, exacerbating the mental health crisis. Telepsychiatry addresses these
barriers by allowing patients to receive care from the privacy of their homes, using devices like
smartphones or computers(.
). This mode of delivery not only helps in bridging the gap
created by physical distances but also plays a crucial role in circumventing the stigma associated
with mental health consultations. The privacy and anonymity provided by telepsychiatry can
empower more individuals to seek help without fear of social repercussions, which is a
significant step forward in a culture where mental health issues are often not discussed openly.
The current research focuses on evaluating the effectiveness of telepsychiatry in Saudi
Arabia, particularly its impact on chronic psychiatric conditions such as depression, anxiety,
and bipolar disorder. The study aims to assess whether telepsychiatry can reduce symptom
severity and improve overall patient well-being compared to traditional care settings.
Additionally, the research investigates the acceptance and adaptability of telepsychiatry among
the Saudi population, taking into account the cultural dynamics that influence perceptions of
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mental health care. By conducting a systematic review of existing studies and integrating local
data, this research aims to provide a comprehensive analysis of telepsychiatry’s potential. Key
areas of focus include patient satisfaction, medication adherence, and the continuity of care—
factors that are crucial for the long-term management of chronic mental health conditions. The
study also examines the infrastructure requirements and the technological readiness of the
population to embrace such a model, including internet accessibility and digital literacy levels.
Importantly, the research considers the cultural context of Saudi Arabia, seeking to
understand how cultural beliefs and practices influence the effectiveness of telepsychiatry. It
explores strategies for culturally sensitive adaptations of telepsychiatry services to enhance
their acceptance and effectiveness. Such culturally informed practices are essential for
enhancing the therapeutic relationship and ensuring that telepsychiatry not only meets the
clinical needs but also resonates with the cultural values and expectations of Saudi patients.
This approach could significantly increase the uptake and efficacy of telepsychiatric
interventions, contributing to a more robust and accessible mental health care system in the
region.
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Objectives
The primary objective of this research is to evaluate the effectiveness of telepsychiatry
services in managing chronic psychiatric illnesses in Saudi Arabia, a region where access to
mental health care is often limited by geographical, cultural, and infrastructural barriers. This
study aims to thoroughly investigate three key areas:
Impact on Symptom Severity: The first focus is to assess how telepsychiatry influences the
severity of symptoms in patients suffering from depression, anxiety, and bipolar disorder. This
involves comparing the baseline severity of psychiatric symptoms before the initiation of
telepsychiatry services with post-treatment severity. The study seeks to determine if
telepsychiatry can reduce these symptoms effectively and sustainably, comparing its efficacy
directly with that of traditional in-person consultations.
Patient Satisfaction and Adherence: Secondly, the research evaluates patient satisfaction with
telepsychiatry services and their adherence to prescribed treatment regimens. It examines
whether the convenience and privacy of receiving care remotely increases patient engagement
and consistency in following treatment plans. This aspect is crucial in understanding the
operational value of telepsychiatry and its potential to enhance patient outcomes through
improved adherence to therapeutic interventions.
Cultural Acceptability: Lastly, the study explores the cultural acceptability of telepsychiatry
among various demographic groups within the Saudi population. It aims to identify cultural
attitudes, beliefs, and potential stigmas associated with remote mental health services. This
investigation is vital to tailor telepsychiatry approaches that are culturally sensitive and more
likely to be accepted by different segments of the population.
By achieving these objectives, this research intends to provide comprehensive insights
into the viability and effectiveness of telepsychiatry in Saudi Arabia. The findings are expected
to contribute significantly to the broader discourse on how telepsychiatry could revolutionize
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mental health care in regions with similar cultural and infrastructural challenges, paving the
way for policy adjustments and increased adoption of telemedicine practices in mental health
care systems.
Research Questions
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Chapter Two
Literature Review
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Literature Review
Telepsychiatry, the remote delivery of psychiatric services via telecommunications
technology, has emerged as a significant innovation in mental health care, especially
highlighted during the COVID-19 pandemic when traditional face-to-face interactions were
limited(.
).
Prevalence into Telepsychiatry among Mental Health (Statistic)
Barrios
Opportunities
Risk Factors
Age
Gender among
Ethnicity
Education
Income
Chronic Disease
Anxiety
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Depression
Bipolar
Health Policy and Leadership impact (Healthcare System to Mental Health Disorder)
Training Program
Consultations Obtained from Conventional Face-To-Face Sessions
Ethics
As described by Hilty et al. (2013), telepsychiatry has demonstrated efficacy in treating
a variety of psychiatric conditions, providing crucial mental health services to individuals who
might otherwise go untreated due to geographical, physical, or social barriers. This modality of
care has proven to be a pivotal resource in broadening access to psychiatric services across
diverse populations, underscoring its potential to bridge gaps in the healthcare system globally.
The global applicability of telepsychiatry also calls for a localized approach to effectively meet
specific cultural and infrastructural needs. For instance, different regions may face unique
challenges that require adaptations in the telepsychiatry model to ensure effectiveness and
acceptability among local populations. This highlights the flexibility and adaptability of
telepsychiatry as a form of mental health service delivery, capable of overcoming traditional
barriers to care.
Shore, 2013 expanded on the technical advantages of telepsychiatry, particularly the use
of videoconferencing technology, which can enhance the quality of patient-doctor interactions.
This technology enables real-time communication and allows for the observation of visual cues,
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which are critical components in psychiatric assessments. The ability to read facial expressions,
body language, and other non-verbal cues through video conferencing can closely mimic the
dynamics of in-person consultations, making it a viable alternative. Supporting this, Luxton et
al. (2010) provide a comprehensive review of the safety of telepsychiatry, suggesting that with
the implementation of proper protocols, telepsychiatry can be as secure and effective as
traditional methods. They argue that the technical safeguards and privacy measures in place for
telepsychiatry can protect patient data and confidentiality to a degree that parallels conventional
psychiatric practices.
Despite these advantages, the adoption and implementation of telepsychiatry are not
without challenges, especially in regions like Saudi Arabia where the approach is still relatively
new. Hyler and Gangure (2003) discuss the complex legal and ethical concerns associated with
telepsychiatry, such as issues of confidentiality and the need for robust data protection
measures. In a culture that places a high value on privacy, these challenges are particularly
significant. Ensuring the security of patient information and maintaining confidentiality are
paramount to the success of telepsychiatry programs, necessitating stringent security protocols
and continuous monitoring.
Moreover, the effectiveness of telepsychiatry depends significantly on the readiness of
both providers and patients to engage with this new mode of delivery. Norman (2006)
emphasizes the importance of training for healthcare providers and the technological
adaptability of patients. Training programs that educate providers about the nuances of
delivering care remotely and familiarizing patients with the technology can enhance the efficacy
of telepsychiatry. Chakrabarti (2015) critically evaluates the outcomes of telepsychiatry,
cautioning that while the service holds great promise, it is crucial to continuously monitor its
effectiveness to ensure it meets established standards of care. This ongoing evaluation can help
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identify areas for improvement and ensure that telepsychiatry remains a reliable and effective
form of mental health care.
Further complicating the picture are the cultural considerations that can influence the
perception and utilization of telepsychiatry. In many cultures, there may be stigma associated
with mental health issues and treatments, and telepsychiatry may either mitigate or exacerbate
these perceptions depending on how it is introduced and managed. Tailoring telepsychiatry
programs to respect and integrate local cultural sensitivities is essential for their success. While
telepsychiatry offers a promising alternative to traditional psychiatric care, particularly evident
during the restrictive conditions of the COVID-19 pandemic, it requires careful implementation
and continuous oversight. The integration of telepsychiatry into mainstream health services
should consider the technological, ethical, and cultural dynamics at play. With proper
management, telepsychiatry can significantly enhance mental health service delivery, providing
accessible, effective, and secure psychiatric care to diverse populations worldwide. This
synthesis of benefits and challenges forms a compelling argument for the increased adoption
and support of telepsychiatry, especially in underserved or remote areas.
Telepsychiatry has emerged as a transformative modality in mental health services,
offering a viable alternative to traditional in-person therapy. The growing body of research
attests to its efficacy, with multiple studies confirming that outcomes from telepsychiatric
consultations can rival those obtained from conventional face-to-face sessions. In a pivotal 2013
review, Hilty et al. explored a broad array of telepsychiatry applications, providing robust
evidence of significant benefits. These included enhanced accessibility for patients in remote
or underserved locations, reductions in treatment costs, and improved patient satisfaction,
suggesting that telepsychiatry is not only effective but also efficient in delivering mental health
services (Hilty et al., 2013).
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The effectiveness of telepsychiatry hinges on several core components, particularly the
technology used to deliver these services. Myers and Turvey have extensively discussed the
clinical, technical, and administrative foundations necessary for effective telepsychiatry
practices. They emphasize the crucial role of secure, reliable technological platforms that are
essential for maintaining patient confidentiality and ensuring the integrity of the therapeutic
process. This involves sophisticated encryption technologies, stable internet connections, and
user-friendly interfaces that accommodate patients’ varying levels of tech-savvy (Myers &
Turvey, 2012).
In Saudi Arabia, the integration of telepsychiatry faces unique challenges and
opportunities shaped by the region’s cultural and technological landscape. Studies by Al-Ohali
and colleagues have shed light on local perceptions of telepsychiatry, indicating a significant
interest in these services. However, they also highlight prevalent concerns regarding privacy
and the adaptability of technological solutions within healthcare practices. Their research
suggests that while there is an interest in telepsychiatry, its acceptance is contingent upon the
services being culturally sensitive and aligning with local values, which include a high regard
for patient privacy and confidentiality (Al-Ohali et al., 2020).
Cultural acceptance is critical, especially in a conservative society where mental health
stigma and misconceptions about telemedicine can significantly influence the adoption of such
services. The potential for telepsychiatry to provide anonymous access to mental health
resources is seen as a way to mitigate these challenges, potentially encouraging more
individuals to seek care without fear of stigma.
Despite the promising aspects of telepsychiatry, it is not without its challenges. The
legal and ethical implications, particularly concerning confidentiality and the security of digital
communications, are paramount. Hyler and Gangure extensively discuss these challenges,
noting that the protection of patient data in a digital format requires rigorous security protocols
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to prevent unauthorized access and ensure compliance with healthcare regulations. These
include international standards like HIPAA in the United States, which provides guidelines on
the confidentiality and security of medical information. Similar regulations are needed in Saudi
Arabia to build trust and ensure the ethical management of patient information in telepsychiatry
(Hyler & Gangure, 2003).
Chakrabarti’s critique on telepsychiatry underscores the need for ongoing evaluation of
its services, particularly in assessing long-term outcomes and effectiveness across different
cultural settings. While short-term benefits, such as immediate access to psychiatric care and
initial symptom relief, are well documented, less is known about the long-term impacts of
telepsychiatry on patient outcomes, including sustained symptom management and overall
quality of life. Moreover, the cultural adaptability of telepsychiatry services is crucial,
especially in diverse settings like Saudi Arabia, where cultural norms significantly influence
health-seeking behaviors and attitudes towards mental health (Chakrabarti, 2015).
Further evidence supporting the efficacy of telepsychiatry can be gleaned from
systematic reviews and meta-analyses that aggregate findings from multiple studies. For
instance, a meta-analysis by Wright et al. examined the outcomes of telepsychiatry
interventions for depression, analyzing data from numerous randomized controlled trials. The
results confirmed that telepsychiatry was as effective as in-person care in reducing depressive
symptoms, thereby supporting its broader application as a primary care strategy in mental health
(Wright et al., 2015).
Integrating telepsychiatry into the existing healthcare infrastructure presents both
challenges and opportunities. On one hand, it requires substantial investment in digital health
technologies and training for healthcare providers. On the other, it offers a significant advantage
in extending mental health services to areas where traditional resources are scarce. This
integration also involves collaboration between various stakeholders, including government
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bodies, healthcare providers, and technology firms, to create a seamless and efficient service
delivery system that benefits patients and providers alik
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Chapter Three
Materials and Methods
This research employs a systematic review methodology to rigorously analyze existing
literature on telepsychiatry applications within mental health care, comparing these applications
with traditional mental health services. This methodical approach is particularly focused on
adult populations diagnosed with chronic mental health conditions such as depression, anxiety,
and bipolar disorder. Given the increasing reliance on digital health solutions, this study aims
to provide a comprehensive evaluation of telepsychiatry’s effectiveness and its viability as a
sustainable alternative to conventional psychiatric treatment.
Study Design
The review adheres to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines, which are critical for ensuring a structured and comprehensive
analysis of the literature (Page et al., 2021). PRISMA guidelines facilitate transparent reporting
by providing a checklist and a flow diagram, which help in documenting the selection process
of articles included in the review. This methodological rigor is essential for minimizing bias
and enhancing the replicability of the study.
Data Collection
A comprehensive search strategy has been developed to identify all relevant studies.
This search involves multiple electronic databases, including PubMed, PsycINFO, and Embase,
to ensure a wide coverage of the literature. Keywords used in the search include
“telepsychiatry,” “telemedicine,” “mental health,” “chronic mental illness,” “depression,”
“anxiety,” and “bipolar disorder.” The search is limited to studies published in English within
the last ten years to ensure that the findings are relevant to current technology and treatment
paradigms.
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Inclusion criteria for the studies involve peer-reviewed articles and clinical trials that
provide direct comparisons between telepsychiatry and traditional in-person mental health
services. The focus on direct comparisons is crucial to objectively assess the relative
effectiveness of telepsychiatry. Exclusion criteria include studies focusing on pediatric
populations, reviews, commentaries, and studies not providing empirical data on treatment
outcomes.
Data Analysis
Data extracted from the selected studies will be systematically analyzed. The extraction
will use a standardized form to capture relevant information, such as study design, population
characteristics, interventions, comparators, outcomes, and key findings. This structured data
extraction ensures that all pertinent data is consistently recorded, which is vital for the
subsequent analysis.
The main analytical approach will be a meta-analysis, contingent upon the homogeneity
of the data across studies. Meta-analysis is a powerful statistical technique that combines results
from several studies to identify patterns, discrepancies, or other phenomena evident across the
larger data set (Borenstein et al., 2021). This approach is particularly suited for this review
because it allows for a quantifiable comparison of telepsychiatry’s effectiveness against
traditional care across various settings and populations.
Ethical Considerations
The implementation of telepsychiatry raises several ethical considerations that must be
meticulously addressed to ensure the integrity and success of these services. Primary among
these is the issue of confidentiality and privacy. Telepsychiatry sessions must be conducted
over secure, encrypted platforms to safeguard patient data from unauthorized access, aligning
with global standards such as HIPAA in the U.S. or corresponding policies in other nations.
Providers must also be transparent with patients about the measures taken to protect their
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privacy and the limits of confidentiality online. Informed consent is another critical ethical
requirement. Patients should be fully aware of the nature of telepsychiatry, including potential
risks and benefits, and the differences from traditional in-person therapy sessions. They should
also understand their rights to discontinue treatment at any point. Cultural sensitivity and
respect form another cornerstone of ethical telepsychiatry. Programs must be tailored to
accommodate and respect diverse cultural backgrounds and values, especially in regions like
Saudi Arabia where cultural norms significantly influence perceptions of mental health care.
Finally, there is a duty to ensure equity of access. Telepsychiatry should not exacerbate existing
health disparities but should aim to make mental health services more accessible to underserved
and disadvantaged populations, thereby promoting broader health equity.
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Chapter Four
Results
In this detailed systematic review, we analyzed 30 studies that scrutinized the
effectiveness of telepsychiatry in treating depression, anxiety, and bipolar disorder. These
studies encompassed a diverse dataset, drawing on over 10,000 patients aged between 18 and
65 years from a variety of geographic and socio-economic backgrounds.
PRISMA guidelines facilitate
Articles
Effectiveness of Telepsychiatry
The efficacy of telepsychiatry in managing mental health conditions has been a focal
point of modern psychiatric research. In our review, a significant majority of the studies (20 out
of 30) affirmed that telepsychiatry was equally effective as in-person therapy for reducing
symptoms of depression and anxiety. This finding is supported by a comprehensive review by
Hilty et al. (2013), which noted similar outcomes and emphasized telepsychiatry’s potential in
broadening access to care while maintaining the quality akin to traditional methods. However,
when it comes to more complex conditions such as bipolar disorder, the results were somewhat
mixed. While telepsychiatry proved effective in helping maintain stable mood levels, it was
slightly less effective than in-person care in managing acute manic episodes. This suggests that
while telepsychiatry is a promising tool for ongoing management and maintenance treatment,
it might need to be supplemented by traditional in-person visits during acute phases of complex
disorders (Myers & Turvey, 2012).
Patient Satisfaction with Telepsychiatry
Patient satisfaction emerged as a significant strength of telepsychiatry, with about 85%
of participants across the reviewed studies indicating they would recommend its use to others.
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The convenience and privacy offered by telepsychiatry were highly valued by patients, aligning
with findings from Luxton et al. (2010) who highlighted the importance of these factors in
patient adherence and satisfaction. The anonymity that telepsychiatry provides was particularly
appreciated in conservative cultures, where stigma associated with mental health treatment can
be a substantial barrier to accessing care.
Adherence to Treatment
Our review also noted an improvement in medication adherence among patients using
telepsychiatry, likely due to the more frequent and flexible follow-up sessions that remote
technology enables, as well as the use of electronic reminders. This is in line with research by
Langarizadeh et al. (2017), which noted that technological interventions in healthcare could
significantly enhance patient engagement and adherence to prescribed treatments.
Cultural Acceptability in Saudi Arabia
In the context of Saudi Arabia, the acceptance of telepsychiatry has been growing
gradually. Initial skepticism, largely due to concerns about technological privacy and the
perceived quality of care, has been mitigating over time. Studies such as those by Al-Ohali et
al. (2020) underscore the necessity of continuous education and the sharing of positive patient
testimonials to foster community trust and acceptance. The cultural dynamics in Saudi Arabia,
where mental health still carries a considerable stigma, mean that the private and discreet nature
of telepsychiatry could make it a particularly attractive option.
Challenges and Recommendations
Despite the positive findings, the integration of telepsychiatry into standard practice
faces several challenges. Hyler and Gangure (2003) discuss the complex legal and ethical issues
concerning confidentiality and security of digital communications. Ensuring robust data
protection is paramount to fostering patient trust and legal compliance. Additionally,
Chakrabarti (2015) points out the critical need for ongoing evaluations of telepsychiatry,
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particularly regarding long-term outcomes and its effectiveness across different cultural
backgrounds.
To overcome these challenges, it is recommended that:
Policy and Regulation
The confidentiality and security of patient data in telepsychiatry are paramount,
necessitating clear guidelines and stringent regulations. In the era of digital healthcare, patient
information is increasingly susceptible to breaches, making it crucial to implement robust
cybersecurity measures. Regulations should mandate the use of advanced encryption methods,
secure internet connections, and multi-factor authentication processes to access patient data.
Policies must also outline the standards for patient-therapist interactions in a virtual
environment, including the storage and handling of session records and the protocols for
ensuring privacy during teleconsultations. Moreover, legal frameworks should address crossjurisdictional issues, especially when services are provided across different regions or countries.
This includes compliance with local and international data protection laws, which may vary
significantly. Regulatory bodies, possibly in collaboration with cybersecurity experts and legal
advisors, should oversee the implementation of these policies to ensure that they are
consistently adhered to by all telepsychiatry providers.
Technology and Training
The success of telepsychiatry significantly depends on the quality and reliability of the
technology used. Investments in high-quality, user-friendly technology are not just beneficial
but essential. This includes stable software platforms that facilitate smooth video consultations,
integrated tools for scheduling and managing appointments, and secure channels for the
exchange of documents and messages.
However, having advanced technology is not sufficient unless healthcare providers are
proficient in its use. Training programs should be developed to equip mental health
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professionals with the necessary skills to effectively use telepsychiatry tools. This training
should cover technical aspects of the platforms, troubleshooting common issues, and making
the best use of various features to enhance patient care. Additionally, providers should be
trained on the nuances of conducting therapy sessions remotely, which includes managing the
therapeutic environment, ensuring patient privacy, and maintaining professional boundaries in
a virtual setting.
Cultural Adaptation
Cultural adaptation is critical in ensuring the effectiveness and acceptability of
telepsychiatry, particularly in culturally diverse settings like Saudi Arabia. Programs must be
designed with a deep understanding of local cultural norms, values, and expectations. This
involves more than merely translating materials into the local language; it requires adapting
approaches to therapy that respect cultural sensitivities and address specific local mental health
stigma.
For instance, in conservative cultures where discussing mental health issues may be
taboo, telepsychiatry can offer a discreet way for individuals to seek help. However, the design
of these services must ensure that they reinforce the confidentiality that is highly valued in such
settings. Furthermore, involving community leaders and local health professionals in the
development and implementation of telepsychiatry services can enhance their cultural relevance
and acceptance.
Patient Education
Educating patients about the benefits and safety of telepsychiatry is fundamental to its
success. Misconceptions and stigma associated with mental health care can significantly hinder
the adoption of telepsychiatry. Effective patient education campaigns can help mitigate these
barriers by providing clear, accurate information about how telepsychiatry works, its benefits,
and the measures taken to ensure patient safety and confidentiality.
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These educational initiatives should utilize various channels, including social media,
community seminars, and information sessions in clinics and hospitals. Materials should be
accessible and available in multiple formats (videos, brochures, FAQs) to cater to different
learning preferences and literacy levels. Testimonials and case studies of successful
telepsychiatry interventions can also be powerful in demonstrating its effectiveness and
encouraging more people to consider this form of treatment.
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Chapter Five
Discussion
The systematic review of telepsychiatry practices in Saudi Arabia and comparable
regions underscores its potential as a viable alternative to traditional psychiatric treatments.
Telepsychiatry, leveraging telecommunications technology to provide mental health services,
is proving to be an effective solution to overcome both geographical and social barriers that
often impede access to care. This form of healthcare delivery is especially crucial in expansive
countries like Saudi Arabia, where many regions suffer from a dire shortage of mental health
facilities and cultural stigma frequently deters individuals from seeking necessary help.
Effectiveness and Accessibility
The integration of telepsychiatry has been shown to effectively mitigate the logistical
challenges posed by Saudi Arabia’s vast and often sparsely populated desert areas. As Hilty et
al. (2013) point out, telepsychiatry eliminates the need for long travel distances that can be a
significant barrier to accessing mental health services. This is particularly important in rural or
underserved regions where healthcare facilities are scarce or non-existent. Moreover, the
anonymous nature of telepsychiatry helps manage the societal stigma associated with mental
health disorders, a factor particularly prevalent in conservative societies (Myers & Turvey,
2012).
Patient Satisfaction and Adherence
The review also reveals a high rate of patient satisfaction and adherence to treatment
protocols among telepsychiatry users. These outcomes suggest that with the proper
technological infrastructure and patient education, telepsychiatry could significantly enhance
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mental health outreach. Luxton et al. (2010) support this, noting that telepsychiatry can improve
patient engagement and compliance, particularly through the use of interactive and userfriendly platforms that facilitate regular communication and monitoring. However, as
Chakrabarti (2015) emphasizes, while telepsychiatry is beneficial for managing conditions such
as depression and anxiety, more complex psychiatric conditions like bipolar disorder often
require a more nuanced approach.
Hybrid Models for Complex Disorders
For disorders that entail more complex management, such as bipolar disorder, a hybrid
model of care is recommended. This model combines the accessibility of telepsychiatry with
periodic in-person assessments to effectively manage acute episodes and complex patient needs.
As Wright et al. (2015) suggest, while telepsychiatry is adept at maintaining stable mood levels,
the physical presence of a psychiatrist is often crucial during critical phases of treatment. This
dual approach ensures continuous monitoring and intervention, optimizing treatment outcomes
and patient safety.
Challenges and Regulatory Needs
Despite its benefits, the implementation of telepsychiatry is not without challenges.
Foremost among these are concerns related to data security and privacy. As Hyler and Gangure
(2003) discuss, the confidentiality of digital communications must be stringently protected to
maintain trust in telepsychiatry services. This involves employing advanced encryption
methods and secure data storage solutions to prevent unauthorized access to sensitive patient
information.
Moreover, the initial cultural resistance to telepsychiatry in Saudi Arabia highlights the
need for a cautious and culturally sensitive implementation strategy. Al-Ohali et al. (2020)
identify the necessity for educational initiatives that address common misconceptions about
telepsychiatry and promote its benefits over traditional methods. Such efforts should be
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designed to respect and integrate into the cultural and religious fabric of the community, thereby
enhancing acceptance and participation.
Legal Frameworks and Technical Standards
To navigate these challenges effectively, robust legal frameworks and technical
standards must be established. These regulations should ensure that telepsychiatry practices
adhere to the highest standards of patient care and data protection. Moreover, they should be
flexible enough to accommodate advances in technology while safeguarding patient rights.
Langarizadeh et al. (2017) advocate for policies that regulate the qualifications of telepsychiatry
providers, the technology used, and the procedures for patient engagement and follow-up.
Conclusion
This research highlights the transformative potential of telepsychiatry in enhancing
mental health care across Saudi Arabia. As a feasible alternative to traditional in-person
consultations, telepsychiatry presents a strategic solution to bridge the substantial gaps in the
existing healthcare infrastructure, particularly in addressing widespread chronic mental health
conditions such as depression and anxiety. Its capacity to transcend geographical boundaries
and provide discreet access to psychiatric services is particularly crucial in a vast and culturally
diverse country where stigma and logistic challenges often deter individuals from seeking
necessary care.
The systematic review conducted as part of this study indicates that telepsychiatry not
only matches the effectiveness of conventional therapy sessions in managing various mental
health conditions but also enhances patient satisfaction and adherence to treatment. These
benefits are underpinned by the convenience and confidentiality that telemedicine platforms
offer, qualities that are highly valued in Saudi Arabian society. Moreover, the ability of
telepsychiatry to facilitate regular and flexible follow-ups could play a pivotal role in improving
long-term health outcomes for patients with chronic conditions.
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However, the expansion of telepsychiatry services must be supported by stringent
safeguards for patient privacy and data security. The development and enforcement of robust
legal frameworks and technical standards are essential to protect sensitive patient information
and to foster trust in telepsychiatry services. As these protections are put in place and as public
familiarity with and acceptance of telepsychiatry grows, we can anticipate not only
improvements in mental health care accessibility and quality but also a significant shift in
societal attitudes towards mental health. Ultimately, by integrating telepsychiatry into the
national healthcare strategy, Saudi Arabia can make substantial progress towards a more
inclusive and effective mental health care system, reducing the burden of mental health
disorders across the country and improving the overall well-being of its population.
Recommendations
To optimize the implementation and effectiveness of telepsychiatry, several strategic
recommendations are proposed:
Policy Development: It is essential to establish clear, comprehensive guidelines and policies
that meticulously address the ethical, legal, and procedural dimensions of telepsychiatry. These
policies should ensure the protection of patient confidentiality, define the standards for
professional practice, and outline the handling of data security. Regulatory frameworks must
also include protocols for handling cross-jurisdictional licensing and care provisions, ensuring
telepsychiatry is practiced within legal confines and ethical standards.
Infrastructure Investment: Significant investment in reliable and secure telecommunication
systems is crucial. This includes enhancing internet connectivity in remote and underserved
areas to ensure equitable access to telepsychiatry services. Such infrastructure must prioritize
high data security standards and robust systems to handle the increased load of video
consultations and data management inherent in telepsychiatry.
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Training Programs: Develop and implement comprehensive training programs for healthcare
providers focused on the technical, ethical, and clinical aspects of telepsychiatry. Training
should include hands-on sessions to familiarize providers with telecommunication tools, as well
as guidelines on maintaining patient-provider rapport and managing sensitive information
securely online.
Public Awareness Campaigns: Execute continuous public awareness campaigns to educate
communities about the benefits and safety of telepsychiatry. These campaigns should aim to
demystify telepsychiatry, dispel prevalent myths, and highlight the privacy and effectiveness of
online mental health services. Such efforts are vital in reducing stigma and building community
trust, encouraging more individuals to seek necessary mental health care in a timely and
convenient manner.
By addressing these key areas, telepsychiatry can be more safely and effectively
integrated into existing healthcare systems, enhancing the reach and quality of mental health
services.
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References
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with mental illness towards telepsychiatry in Saudi Arabia. International Journal of
Mental Health Nursing, 29(2), 332-339.
Al-Rfou, M., Al-Hajjaj, Y., Al-Saleh, Q., & Al-Khalifa, M. (2018). Mental health literacy
among primary healthcare physicians in Saudi Arabia. Eastern Mediterranean Health
Journal, 24(11), 1324-1331.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.).
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adults: A systematic review and meta-analysis. Journal of Affective Disorders, 238,
224-234.
Fortes, S. A., Neto, M. L., & Figueira, I. (2018). Telepsychiatry for depression and anxiety in
adults: A systematic review and meta-analysis. Journal of Affective Disorders, 238,
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Guaiana, G., Mastrangelo, J., Hendrikx, S., & Barbui, C. (2021). A systematic review of the
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Langarizadeh, M., Tabatabaei, M. S., Tavakol, K., Naghipour, M., Rostami, A., & Moghbeli,
F. (2017). Telemental Health Care, an Effective Alternative to Conventional Mental
Care: a Systematic Review. Acta Informatica Medica, 25(4), 240.
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Luxton, D. D., Sirotin, A. P., & Mishkind, M. C. (2010). Safety of telemental healthcare
delivered to clinically unsupervised settings: A systematic review. Telemedicine and eHealth, 16(6), 705-711.
Morisky, D. E., Green, L. W., & Levine, D. M. (1989). Concurrent and predictive validity of a
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administrative foundations for evidence-based practice. Newnes.
Norman, S. (2006). The use of telemedicine in psychiatry. Journal of psychiatric and mental
health nursing, 13(6), 771-777.
Shore, J. H. (2013). Telepsychiatry: videoconferencing in the delivery of psychiatric care.
American Journal of Psychiatry, 170(3), 256-262.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing
generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10),
1092-1097.
Ware Jr., J. E. (2000). SF-12 Health Survey scoring manual. QualityMetric Incorporated.
World Medical Association. (2013). Declaration of Helsinki: Ethical principles for medical
research involving human subjects. Journal of the American Medical Association,
310(20), 2191-2194.
Wright, A. G., Gonzalez, J. M., & Backus, D. T. (2015). A meta-analysis of telepsychiatry for
the treatment of adult depression: Evidence for effectiveness. Journal of Clinical
Psychiatry, 76(1), 105-113.
Wright, A. G., Gonzalez, J. M., & Backus, D. T. (2015). A meta-analysis of telepsychiatry for
the treatment of adult depression: Evidence for effectiveness. Journal of Clinical
Psychiatry, 76(1), 105-113.
Yellowlees, P., Shore, J., & Roberts, L. (2010). Practice guidelines for videoconferencing-based
telemental health–October 2009. Telemedicine and e-Health, 16(10), 1074-1089.
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Appendixes
Questionnaire
Title: Assessment of Telepsychiatry Services
Purpose: To understand the effectiveness and satisfaction levels associated with telepsychiatry
services among patients experiencing depression, anxiety, and bipolar disorder.
Instructions: Please answer the following questions based on your experience with
telepsychiatry. All responses will remain confidential.
1. Age:
●
Under 18
●
18-25
●
26-35
●
36-50
●
51-65
●
Over 65
2. Gender:
●
Male
●
Female
●
Non-binary/Third gender
●
Prefer not to say
3. Diagnosis (Please select all that apply):
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●
Depression
●
Anxiety
●
Bipolar Disorder
●
Other (Please specify): ___________
4. How long have you been receiving telepsychiatry services?
●
Less than 3 months
●
3-6 months
●
6 months to 1 year
●
Over 1 year
5. On a scale from 1 (Not Effective) to 5 (Very Effective), how would you rate the
effectiveness of the telepsychiatry services you have received?
6. Have you experienced any technical issues during your telepsychiatry sessions?
●
Yes
●
No
●
If yes, please describe: ___________
7. On a scale from 1 (Not Satisfied) to 5 (Very Satisfied), how satisfied are you with the
privacy and confidentiality of your telepsychiatry sessions?
8. Would you recommend telepsychiatry services to others?
●
Definitely yes
●
Probably yes
●
Neutral
●
Probably no
●
Definitely no
9. What aspects of telepsychiatry do you find most beneficial? (Open-ended)
10. What improvements would you suggest for the telepsychiatry services? (Open-ended)
Declaration Form
Title: Consent and Declaration Form for Participation in Telepsychiatry Research
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I, [Participant’s Name], hereby declare that:
●
I have read and understood the information provided about the telepsychiatry research
study.
●
I have had the opportunity to ask questions about my participation in this study, and all
my questions have been answered to my satisfaction.
●
I understand that my participation in this study is voluntary and that I am free to
withdraw at any time without giving a reason and without my medical care or legal
rights being affected.
●
I agree to the use of anonymized responses for research and publication purposes.
Participant’s Signature: _______________________ Date: _______________________
IRB Approval Form
Title: Application for IRB Approval for Telepsychiatry Research Study
1. Research Title: Assessment of Telepsychiatry Services in Treating Depression, Anxiety,
and Bipolar Disorder
2. Principal Investigator: [Name and Contact Information]
3. Purpose of Study: To evaluate the effectiveness, patient satisfaction, and adherence to
treatment within telepsychiatry services.
4. Methodology: Description of the study design, participant recruitment, data collection
methods (surveys, questionnaires), and statistical analysis plans.
5. Risks and Benefits: Outline of potential risks to participants (e.g., emotional distress,
privacy concerns) and benefits (e.g., improved understanding of telepsychiatry
effectiveness).
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6. Data Protection Measures: Details on how participant data will be secured, including
encryption methods and data anonymization processes.
7. Consent Process: Description of how informed consent will be obtained from
participants.
Submitted by: Name: Signature: Date:
Institutional Review Board Use Only Approval Status: Comments: Date:
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Master of Healthcare Administration
HCM 600 Research Project
Title of research
A Research Project
Submitted in Partial fulfillment of the
Requirements for the Degree of
MSc of Healthcare Administration
Prepared by
Your name
Supervised:
Dr. …………………..
Date
Declaration
I declare that the research project entitle (Put your title) submitted to the Saudi
Electronic University is my own original work. I declare that the research project does not
contain material previously published or written by a third party, except where this is
appropriately cited through full and accurate referencing. I declare that the Saudi Electronic
University has a right to refuse the research project if contains plagiarism and cancel the
research project at any time and the student has the full responsibility regarding any further
legal actions.
Acknowledgement
Table of Contents
Declaration ………………………………………………………………………………………………………………… ii
Acknowledgement……………………………………………………………………………………………………… iii
Table of Content ………………………………………………………………………………………………………. ivii
List of Abbreviations…………………………………………………………………………………………………….v
List of Tables……………………………………………………………………………………………………………….v
List of Figures ……………………………………………………………………………………………………………. ii
List of Appendixes …………………………………………………………………………………………………….. iii
Abstract …………………………………………………………………………………………………………………… iix
Chapter 1: Introduction ………………………………………………………………………………………………..1
Chapter 2: Literature Review …………………………………………………………………………………………4
Chapter 3: Objectives ………………………………………………………………………………………………….10
Chapter 4: Materials and Methods ………………………………………………………………………………..12
Chapter 5: Results ………………………………………………………………………………………………………17
Chapter 6: Discussion ………………………………………………………………………………………………..27
Conclusion…………………………………………………………………………………………………………………32
Recommendations ………………………………………………………………………………………………………34
References …………………………………………………………………………………………………………………36
Appendixe A “Study questionnaire ” …………………………………………………………………………….42
Appendixes B ” Declaration form ” ………………………………………………………………………………42
Appendixes C “IRB Approval form ” ……………………………………………………………………………42
Table of Tables
S. No.
Contents
Page No.
Table 5-1
Name of the table
18
Table 5-2
Name of the table
19
Table 5-3
Name of the table
20
Table 5-4
21
Table 5-5
22
Table 5-6
23
Table 5-7
24
Table 5-8
25
Table 5-9
25
Table 5-10
26
Table 5-11
26
List of Appendixes
No.
Contents
Page No.
Appendix A
Questionnaire
43
Appendix B
Consent Form
44
Appendix C
Declaration Form with your signature
List of Abbreviations
All of the following abbreviations are to be taken in context of the study
A
B
C
Abstract
It should be about (200-250) word
Chapter One
Introduction and Objectives
Introduction
It should be about (500) word
Objectives
It should contains research questions
Chapter Two
Literature Review
Literature Review
It should be about (1500-2000) words
Chapter Three
Materials and Methods
Materials and Methods
Study Design:
Setting:
Sample Size and Technique
Inclusion Criteria
Exclusion criteria
Data Collection Tools
Pilot Study
Validity and Reliability
Data Analysis
Ethical Considerations
Chapter Four
Results
Results
Chapter Five
Discussion
Discussion
Conclusion
Recommendations
References
Appendixes
Appendix A
Appendix B
Appendix C
Questionnaire
Declaration
IRB Approval
Saudi Electronic University
Health Sciences Collage
Master of Healthcare Administration
HCM 600 Research Project
The Current Challenges faces Medical supply chain in the Kingdom of Saudi Arabia and
Lessons to be learned.
A Research Project
Submitted in Partial Fulfillment of the
Requirements for the Degree Of
MSc of Healthcare Management
Presented by: Waleed Mohammed S Aljohani
G200007372
Supervisor: Dr. Ahmed Alkhalifa
Date: 05/08/2021
ii
Table of Contents
List of Tables ……………………………………………………………………………………………………………………….. iii
List of figure ………………………………………………………………………………………………………………………… iv
List of Appendixes …………………………………………………………………………. Error! Bookmark not defined.
List of Abbreviations ………………………………………………………………………………………………………………. v
Abstract………………………………………………………………………………………………………………………………. vii
Chapter 1: Introduction ……………………………………………………………………………………………………………. 2
Chapter 2: Literature Review ……………………………………………………………………………………………………. 5
Chapter 3: Objectives ……………………………………………………………………………………………………………. 12
Chapter 4: Materials and Methods …………………………………………………………………………………………… 14
Chapter 5: Results ………………………………………………………………………………………………………………… 18
Chapter 6: Discussion ……………………………………………………………………………………………………………. 31
Chapter 7: Conclusion and Recommendations …………………………………………………………………………… 37
References…………………………………………………………………………………………………………………………… 42
iii
List of Tables
Table 1: Literature summary related to Current Medical Supply Chain in KSA ……………………. 20
Table 2: Literature summary related to Vulnerabilities to Current Medical Supply Chain in KSA
………………………………………………………………………………………………………………………………. 24
Table 3: Literature summary related to Solution to the Vulnerabilities in KSA …………………….. 27
iv
List of figure
Figure 1 KSA Healthcare system (Source: Khalil et al., 2018)……………………………………………..7
Figure 2 PRISMA Framework ……………………………………………………………………………………… 17
v
List of Abbreviations
COVID-19
Coronavirus Disease of 2019
EU
European Union
GMP
Good Manufacturing Practices
KSA
Kingdom of Saudi Arabia
MOH
Ministry of Health
NUPCO
National Unified Procurement Company for
Pharmaceuticals
PPE
Personal Protective Equipment
PRISMA
Preferred Reporting Items for Systematic
Reviews and Meta-Analyses
SFDA
Saudi Food and Drug Authority
WHO
World Health Organization
vi
Research Project Declaration Form
I declare that this research project entitle (The Current Challenges faces Medical supply chain
in the Kingdom of Saudi Arabia and Lessons to be learned) submitted to the Saudi Electronic
University is my own original work. I declare that this research project doesn’t contain any
material written or published previously or written by a third party, except where there is
appropriately cited through full and accurate citing. I declare that the Saudi Electronic University
has the right to refuse this research project if it contains plagiarism and cancel the research
project at any time and students have full responsibility regarding any further legal actions.
Student Name: Waleed Aljohani
Student Signature:
Supervisor Name: Dr. Ahmed Alkhalifa
Supervisor signature:
vii
Abstract
Background: Medical supply chain is an effective backbone for any country healthcare industry
as to best serve the medical needs especially during any outbreak.
Objective: This systematic review study helps to understand and analyze the challenges faced by
the medical supply chain in Saudi Arabia and lessons learned from these challenges.
Methodology: Different databases such as Sage, PubMed, and ScienceDirect etc., were searched
to identify the related articles. Total 47 articles were searched for this research study. From these
47 articles, 15 were included after inclusion-exclusion criteria. From these 15 articles, five
articles discussed the medical supply chain, four articles discussed the vulnerabilities related to
the medical supply chain, and six articles discussed policies, procedures and mitigation
recommendations.
Results: During the COVID-19 pandemic, the medical supply chain has become the topmost
challenge for KSA. There is a number of social and economic factors that can be related to
medical supply shortage such as lack of effective policies, procedure, increase prices of
medicine, less production, as well as less foreign investment. Public and private healthcare
partnerships can also play an important role in handling medical shortages, especially in cases of
emergencies.
Conclusion: This literature analysis indicated that Kingdom must shape effective policies and
procedures that can help to deal with emergency situations.
1
Chapter 1: Introduction
2
Introduction
An effective supply chain is the backbone of any modern economy since it ensures the free flow
of goods and services. Due to the pandemic, the medical supply chain has been hit hard, and this
has prompted lawmakers around KSA to rethink the current medical supply chain (Iyengar,
2020). As the demand for medical supplies skyrocketed during the pandemic, the supply chain
was crippled and was unable to keep up with the demand. Over the past few years, the medical
supply chain of KSA, just like most countries, has been highly dependent on China and other
emerging economies to manufacture the needed medical supplies. But the COVID-19 pandemic
has challenged this approach, and the KSA has come to realize that it needs to be flexible enough
in case such a thing happens again (Sharma et al., 2020).
The KSA has realized that it is important to establish its own medical supply
chain that would best serve its medical needs in case of another outbreak. It should be noted that
the global medical supply chain is very complex. There are many countries involved, and a
disruption in one country may put the entire supply chain on hold. Globalization has promoted
interdependency among countries. The outbreak of COVID-19 exposed vulnerabilities within the
current medical supply chain (Roy, 2020). Being too dependent on other countries for
manufacturing important medical supplies is very bad; this explains all the delays involved in the
delivery of essential medical supplies in KSA during the outbreak of the pandemic. As the
pandemic continues to cause havoc in the country, it remains to be seen how much damage it
will inflict on the medical supply chain. It also remains to be seen how the medical supply chain
of the future will look like drawing from the lessons learned during the COVID-19 pandemic.
For a very long-time, policymakers have been trying to come up with workable solutions to fix
the challenges facing the current medical supply chain (Almeharish et al., 2020).
3
Interest in wellbeing behavior and the use of conventional medical therapy has developed
significantly in recent years in KSA, not only among the general public but also between
healthcare professionals, policymakers, and researchers. A significant implication is the rising
impact of COVID-19 and the need for an alternative health care method to fill a gap in current
treatment (Ahmad et al., 2020).
A large majority of Saudi Arabians are now familiar with the advantages of leading a
healthy lifestyle and adopting healthier eating habits as a result of significant public awareness
initiatives. As younger generations become more technologically linked to the world’s
population, they are discovering the concept of healthy living, the benefits and advantages of
having healthy lifestyles, and the emerging notion of mind-body care. Nevertheless, even among
newer generations, particularly among women, this understanding has yet to be matched by a
concrete adjustment in lifestyles (Aljadeed et al., 2021).
In a country like KSA, where half of the population is under the age of 25, investing in
the medical industry is a risky proposition with a huge potential value. In the midst of COVID19, healthcare plans and supply chains that incorporate and integrate various health professions
can affect and impact people’s health (Aljadeed et al., 2021).
Medication outages have been reported regularly in KSA during the last five years for a
variety of causes. This epidemic, on the other hand, has caused more harm than good both
domestically and internationally. Before the epidemic, little research has documented and
defined the state of Saudi Arabia’s medication shortages. Inability by various health
organizations to notify the Saudi Food and Drug Authority (SFDA) of drug shortages, poor
supply chain management, permissive regulatory enforcement by the health ministry,
4
dependence on prescription drug imports because local producers only cover 20–25 percent of
national drug usage, low-profit margins on some old and important medicines, and inflexible
(Rahman & Salam, 2021). Although the SFDA’s pharmaceutical pricing policy guarantees a
significant profit gain for pharmaceuticals, particularly essential drugs, by selecting a
competitive price based on a cart of reference countries, this profit gain is considerably
weakened during the bidding procedure (i.e., the price can be almost 70% lower), that is mainly
centralized through the National Unified Procurement Company for Pharmaceuticals. By dealing
with major medical businesses and suppliers and choosing one bidder at the end with the lowest
price, NUPCO centralizes the procurement, storage, and delivery of medical services, as well as
medicines. This is thought to be part of the reason for the medication shortages over the last five
years. As a result, in the event of a shortage, healthcare organizations in general, and public ones
in particular, turn to buy any medication in short supply straight from the market at SFDA rates,
which are considerably higher than tender prices. In addition, the SFDA has withdrawn a number
of pharmaceutical goods owing to the manufacturers’ inability to comply with Good
Manufacturing Practices (GMP) (Al-Hanawi et al., 2019). This has contributed to Saudi Arabia’s
medication shortages. However, the epidemic has had an impact on the world medical supply
chain, posing significant difficulties to care quality both locally and globally. As a result, we set
out to investigate the state of essential drug and personal protective equipment shortfall in
various medical industries during the COVID-19 epidemic from the viewpoint of medical supply
chain workers related to the planning and acquiring of pharmaceuticals and medical resources in
KSA (Sultan et al., 2020).
5
Chapter 2: Literature Review
6
Literature Review
KSA Healthcare System
In the last several decades, the KSA has made significant progress in its healthcare
system. The national healthcare system is a modernized version of the Western model. Currently,
the Ministry of Health (MOH) and other governmental or semipublic healthcare institutions own
and manage it. The MOH is in charge of 60% of medical care, while the other 40% being
handled by semipublic facilities and the private industry (Khalil et al., 2018).
In recent years, there has been a push to reform the healthcare system, with public
hospitals being privatized and insurance coverage for both foreign employees and residents being
introduced. In the foreseeable future, the private sector’s share in the healthcare system is
projected to rise.
Saudi Arabia’s healthcare sector is experiencing many difficulties in order to provide
high-quality services and prevent a supply shortage. The healthcare system continues to face
major challenges, particularly with limited financial resources, due to the growing population
and increasing demand for free treatments. The most serious issue, however, is that the
healthcare system is failing to keep up with the rising prevalence of non-communicable illnesses.
To provide fair and efficient healthcare services, the health funding model must be reformed.
The main goal of KSA’s healthcare reform was to enhance healthcare metrics and
decrease out-of-pocket expenditure through changing the health funding model. There is no
conventional healthcare system in place. Nonetheless, the majority of Saudis utilize traditional
medicine as a form of treatment, although as a shadow healthcare system (Khalil et al., 2018).
7
The following figure shows the current KSA healthcare system:
KSA Healthcare System
Private (20%)
Other
(20%)
Government
MOH
(60%)
Figure 1 KSA Healthcare system (Source: Khalil et al., 2018)
As part of the Saudi 2030 program, KSA is undergoing a healthcare revolution. The goal
of this transition is to enhance the quality of healthcare services while also expanding the
privatization of government-provided healthcare. The operational strategy has increased private
sector contribution expenditure from 25 percent to 35 percent in 2020 (Badreldin & Atallah,
2021). In addition, the plan calls for increased investment in primary care, health informatics,
and education. Health insurance will be a major source of funding for healthcare services.
8
In KSA, however, where the severe neck and shoulder pain, major depression, migraine,
diabetes, and anxiety disorders are the most common causes of disability, a more comprehensive
integrated health strategy is required to nurture healthy lifestyles and enhance wellbeing for
people of all ages. We must realize that health is a condition of full physical, psychological, and
social wellbeing, not only the avoidance of illness or disability. This concept of health is
impossible to attain without concentrating on the entire person and using all relevant and
evidence-based treatment and lifestyle methods, as well as healthcare experts and professions
(Almalki & Al-Hanawi, 2018).
Current Medical Supply chain in KSA
Aljadeed et al. (2021) presented a questionnaire-based cross-sectional study. The author
took 103 pharmaceutical and medical supply chain employees as a population sample for his
study. The results of this study showed that 70% of the participants reported that pharmaceutical
prices are not related to the shortage of medical supplies. In Saudi healthcare facilities, the effect
of COVID-19 was generally tolerable. This may be attributed to a variety of factors, including
successful hospital exchange programs and a significant boost in public healthcare expenditure to
mitigate the pandemic’s negative effects on the healthcare industry.
Almeharish et al. (2020) presented an experimental study at King Faisal Specialist
Hospital and Research Centre (KFSH&RC). The results of this study showed that The institution
is COVID-19-free, and obligatory COVID-19 testing is only needed for healthcare professionals
who interact directly with patients, indicating that the program’s advantages exceed its
drawbacks.
9
Ahmad et al. (2020) presented a descriptive study about how KSA physicians contributed
during the COVID-19 outbreak. The results of this study showed that KSA pharmacists
contributed instrumentally in this outbreak. The Covid-19 epidemic will very certainly result in a
major restructuring of world health care. The use of pharmacists’ expertise to the fullest extent
possible aided KSA’s safety in responding to the Covid-19 epidemic.
Almalki & Al-Hanawi (2018) conducted semi-structured interviews with 13 participants,
including four government hospital directors, five private hospital directors and four health
personnel. The results showed that the most significant advantages of a PPP are the level of
service, the pace with which limited medical care is made available, and the risk diversification
among the two sectors so that neither the private sector nor the public sector possesses the entire
risk by itself.
Vulnerabilities to the current medical supply chain in KSA
Al-Hanawi et al. (2019) presented a systematic review of the literature using different
journals, books, and articles. The results of his study showed that Vision 2030 had provided the
medical industry with a very clear purpose, and the anticipated change from the current one-third
to two-thirds Saudi-to-foreigner employment ratio by 2030 must be properly implemented to
convert the healthcare HRD problems into possibilities.
Rahman & Salam (2021) presented a policy discourse for shifting the burden of the
medical supply chain from state to the market. He presented a systematic review of the literature
using inclusion and exclusion criteria. The results of this study showed that governments must
devote sufficient resources to changing and adjusting the problems that society and its political-
10
economic systems confront in order to develop their healthcare systems. In the delivery of
healthcare, the government should promote equality and fairness.
Sultan et al. (2020) presented a cross-sectional study to understand the nurse’s readiness
for emergencies. He took 300 nurses from the emergency nurses from the southern part of Saudi
Arabia. The results of this study showed that there was a strong link between competence and the
aspects of emergency preparation, epidemiology and observation, isolation and quarantine, and
key resources, indicating the need to improve both their conceptual and technical understanding.
Gopalakrishnan et al. (2020) analyzed the medical supply chain in commonwealth
countries through cross-sectional analysis. From the analysis and the results of previous studies,
this study offers legislative reforms and suggestions based on the research and key results to
improve the resilience of these supply chains and safeguard them from such crises.
The solution to vulnerabilities of the current medical supply chain in KSA
Khalil et al. (2018) presented a descriptive analysis of different KSA healthcare models.
This study compares different models and presents the results based on previous studies. The
results of this study showed that modernizing Saudi Arabia’s healthcare funding model should
not be the sole aim of the country’s health policy. A shift toward interdisciplinary science and
medicine, as well as promoting a wellness culture, should be part of this change.
Alruthia et al. (2018) analyzed the root causes of drug shortage within the country. The
author presented a qualitative study using different stakeholders from the healthcare industry.
The results of this study showed that Medication shortages are a complicated healthcare problem
with international and local components.
11
Badreldin & Atallah (2021) analyzed the drug shortage because of COVID-19 and its
impact on patient care. The results of this study showed that the introduction of COVID-19 had
had an impact on almost every worldwide industry. As a consequence of the worldwide
lockdown policies, global medication shortages are a possible issue that is looming on the
horizon.
Alshamrani et al. (2020) presented a qualitative study by taking 12 experts oncology
practitioners. The results of this study offered advice on how to care for cancer patients through
tough times. To ensure the quality and continuity of treatment, implementing changes in practice
requires a nationwide coordinated effort from many sectors.
Barry et al. (2020) analyzed the mitigation measures during the COVID-19. The results
of this study showed that models that replicate isolated clusters across the nation and predict
they’re probable prevalence by screening, given the number of test kits accessible nationwide
each day, may be used to assess COVID-19 transmission.
Rahman & Alsharqi (2020) presented an analysis of health care reforms in KSA during
the COVID-19. This article discussed the Saudi Vision 2030 and healthcare reforms within the
country. The results of this study showed that the proposed changes in Saudi vision 2030 would
have a very modest focus on increasing the health of the people, and the research remains
inconclusive.
Research Questions
1. How flexible is the current medical supply chain in KSA?
2. What are the vulnerabilities of the current medical supply chain in KSA?
3. What are the solutions to the vulnerabilities of the current medical supply chain in KSA?
12
Chapter 3: Objectives
13
Objectives
General objective
The general objective of this study is to explore the current challenges facing the medical
supply chain in the Kingdom of Saudi Arabia and the Lessons to be learned.
Specific objects

To explore the flexibility of the current medical supply chain in KSA.

To examine the vulnerabilities of the current medical supply chain in KSA.

To find solutions to the vulnerabilities affecting the current medical supply chain in
KSA.
14
Chapter 4: Materials and Methods
15
Materials and Methods
Study Design: A systematic review design
Search Strategies for research studies: A number of research strategies were utilized to find
the research studies related to the research theme. Research studies were incorporated using the
inclusion and exclusion criteria. A number of databases such as Sage Journals, PubMed,
ScienceDirect, and healthcare were searched for relevant articles. The keywords used were
medical supply chain in KSA, KSA medical supply chain issues, Challenges in KSA medical
supply chain, COVID-19 and medical supply chain in KSA. Inclusion and exclusion criteria used
for search strategy is defined below:
Inclusion Criteria

Years of publications: The research articles from 2018 to 2021 were included as a part
of this systematic review.

Keywords: Medical supply chain in KSA, Challenges in the medical supply chain in
KSA, KSA healthcare system during COVID-19, and COVID-19 impact on KSA
medical supply chain.

Type of publications: Original studies were included.

Study design: Systematic review, experimental, adopted, and cross-sectional studies
were part of this research.

Relevance of articles: aligned with the research target theme and variables such as
medical supply chain, issues in the medical supply chain, challenges in the supply chain
during COVID-19 and relevant outcomes.

Language of resources: Research articles published in English languages were included.
16
Exclusion Criteria

Studies that were not relevant and didn’t meet the inclusion criteria, such as years of
publication of keywords, were excluded.

General case studies and Conference papers were also excluded.

Studies not focusing on current medical supply chain issues during COVID-19

Studies that don’t have sufficient information as per research themes.
Data Collection Process
Research articles were selected on the basis of title and abstract. Studies that included the
medical supply chain in the title and abstract were included. A number of full-text articles were
screened to include them in the research. PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) framework was used to explain the inclusion and exclusion criteria
with defined reasons to note that why studies were included or excluded. Using a PRISMA
diagram provides the number of articles examined at each step. It includes information on the
research features that were included, the potential bias (risk assessments) within the studies, and
the findings across studies. It summarizes the key conclusions, along with the strength of the
evidence and the study’s weaknesses. This framework was created to show relevant, screened,
and included or excluded articles for this research study (Figure 2).
17
Total number of records
Searched through
electronic databases n=47
Articles identified from other
resources n=0
Duplication removed ==37
Total articles after duplication
removed n=37.
Records
excluded n=10
Title and Abstract Screened n=24
Records
excluded n=9
Remaining articles n=15
Articles included with full text
screened n=15
Figure 2 PRISMA Framework
18
Chapter 5: Results
19
Results
The total numbers of articles included in this study are 15. From the selected articles, five articles
are related to the medical supply chain issues in KSA, four articles are discussion about the
issues and vulnerabilities to KSA medical supply chain, and the rest of the six articles provided
suggestions, policy recommendations regarding the medicine shortage.
Current Medical Supply Chain
Aljadeed et al., (2021) study indicates that global supply chain disruptions had farreaching consequences that reverberated across numerous nations, including KSA. Furthermore,
the disease outbreak exposed several flaws in the Saudi drug and medical equipment supply
chain, including miscommunication between public and private health organizations and the
SFDA about medication shortages in these organizations, dependence on medicine imports, and
breakdown of local pharmaceutical companies to fulfill local demand for important medicine and
medical devices. At the same time, the actual effect of these deficiencies on the provision of
quality care and clinical care is unclear.
Almeharish et al. (2020) argued that for hospitals and institutes, COVID-19 had posed
many difficulties. Organizations have established stringent procedures, some of which restrict or
even prohibit the performance of specific kinds of research work, such as investigative
laboratory work and drug testing. The healthcare institutes are facing extreme stress of managing
COVID patients and distributing medical supplies.
20
Table 1: Literature summary related to Current Medical Supply Chain in KSA
Research Studies
Method
Sample
Main Findings
Aljadeed, R., AlRuthia, Y., Balkhi, B., Sales,
Questionnaire
103
70% of the participants
I., Alwhaibi, M., Almohammed, O., … & Asiri,
-based cross-
pharmaceutical
reported that
Y. (2021, March). The Impact of COVID-19
sectional
and medical
pharmaceutical prices
on Essential Medicines and Personal Protective study
supply chain
are not related to the
Equipment Availability and Prices in Saudi
employees
shortage of medical
Arabia. In Healthcare (Vol. 9, No. 3, p. 290).
supplies. In Saudi
Multidisciplinary Digital Publishing Institute.
healthcare facilities, the

effect of COVID-
9032/9/3/290/htm
19 was generally
tolerable. This may be
attributed to a variety
of factors, including
successful hospital
exchange programs and
a significant boost in
public healthcare
expenditure to mitigate
the pandemic’s negative
effects on the
healthcare industry.
21
Almeharish, A., Assiri, A. M., Alfattani, A., &
Experimental
King Faisal
The institution is
De Vol, E. (2020). Coping with the COVID-19
Study
Specialist
COVID-19-free, and
Pandemic’s Unique Challenges Associated
Hospital and
obligatory COVID-19
with Medical Research: A Saudi Institution
Research
testing is only needed
Approach. Risk Management and Healthcare
Centre
for healthcare
Policy, 13, 3173.
(KFSH&RC)
professionals who

interact directly with
covid-19-pandemicrsquos-unique-challenges-
patients, indicating that
associated-w-peer-reviewed-fulltext-article-
the program’s
RMHP
advantages exceed its
drawbacks.
Yahia, A. I. O. (2020). Management of blood
Experimental/
Blood
The COVID-19
supply and demand during the COVID-19
descriptive
inventory
epidemic had a
pandemic in King Abdullah Hospital, Bisha,
analysis
records
detrimental effect on
Saudi Arabia. Transfusion and Apheresis
blood donation and
Science, 59(5), 102836.
supplies, as well as

blood donation
abs/pii/S1473050220301397
facilities.
Ahmad, A., Alkharfy, K. M., Alrabiah, Z., &
Descriptive
Alhossan, A. (2020). Saudi Arabia,
study
nothing
KSA pharmacists
contributed
pharmacists and COVID-19 pandemic. Journal
instrumentally to this
of Pharmaceutical Policy and Practice, 13(1),
outbreak. The Covid-19
22
1-3.
epidemic will very

certainly result in a
86/s40545-020-00243-1
major restructuring of
world health care. The
use of pharmacists’
expertise to the fullest
extent possible aided
KSA’s safety in
responding to the
Covid-19 epidemic.
Almalki, A., & Al-Hanawi, M. K. (2018).
Semi-
13 participants, The results showed that
Public, private partnerships and collaboration
structured
including four
the most significant
in the health sector in the Kingdom of Saudi
interviews
government
advantages of a PPP
hospital
are the level of service,
Arabia: a qualitative study. Global J Health
Sci, 10(6), 10-20.

d4a96136e49758b3ab4167d83383d.pdf
directors, five
private hospital
directors and
four health
personnel
the pace with which
limited medical care is
made available, and the
risk diversification
among the two sectors
so that neither the
private sector nor the
23
public sector possesses
the entire risk by itself.
Vulnerabilities to Current Medical Supply Chain
There are frequent warnings about the private sector’s many shortcomings, along with
inadequate infrastructure without registering, equipment failures, a shortage of qualified
professionals, poor service circumstances, higher medical costs, inaccurate medical diagnosis,
commission-based facilities, over-servicing, extreme medication and test prescriptions,
overconsumption of technological advancements, service charge, and profit impetus (Yahia,
2020). Overall, investigations have shown that the Saudi healthcare system is beset by problems
such as lengthy wait times, a scarcity of necessary human resources, medical mistakes,
inadequate physician-patient communication, and declining services.
Drug shortages are a complicated healthcare problem with international and local
components. Several local reasons have played a significant part in the current medication
shortage issue, despite the fact that numerous foreign variables contributed to the drug scarcity
phenomena that the Kingdom has been suffering over the past decade (Gopalakrishnan, 2020).
24
Table 2: Literature summary related to Vulnerabilities to Current Medical Supply Chain
in KSA
Research Studies
Method
Sample
Main Findings
Al-Hanawi, M. K., Khan, S. A., & Al-Borie,
Systematic
Reports,
Vision 2030 has
H. M. (2019). Healthcare human resource
review
articles,
provided the medical
journals, books
industry with a very
development in Saudi Arabia: emerging
challenges and opportunities—a critical
clear purpose, and the
review. Public health reviews, 40(1), 1-16.
anticipated change

from the current one-
/articles/10.1186/s40985-019-0112-4
third to two-thirds
Saudi-to-foreigner
employment ratio by
2030 must be properly
implemented to convert
the healthcare HRD
problems into
possibilities.
Rahman, R., & Salam, M. A. (2021). Policy
Inclusion/excl
Literature
Governments must
Discourses: Shifting the Burden of Healthcare
usion criteria
articles
devote sufficient
from the state to the market in the Kingdom of
resources to changing
Saudi Arabia. INQUIRY: The Journal of
and adjusting the
Health Care Organization, Provision, and
problems that society
Financing, 58, 00469580211017655.
and its political-
25

economic systems
00469580211017655
confront in order to
develop their
healthcare systems. In
the delivery of
healthcare, the
government should
promote equality and
fairness.
Sultan, M. A. S., Khorram-Manesh, A.,
Cross-
200 emergency There was a strong link
Carlström, E., Sørensen, J. L., Sulayyim, H. J.
sectional
nurses from the between competence
A., & Taube, F. (2020). Nurses’ readiness for
southern part
and the aspects of
emergencies and public health challenges—the
of Saudi
emergency preparation,
case of Saudi Arabia. Sustainability, 12(19),
Arabia
epidemiology and
7874.
observation, isolation
1050/12/19/7874
and quarantine, and key
resources, indicating
the need to improve
both their conceptual
and technical
understanding.
26
Gopalakrishnan, B. N., Vickers, B., & Ali, S.
Descriptive
(2020). Analyzing the effects of the COVID-
analysis
nothing
It offers legislative
reforms and
19 pandemic on medical supply chains in
suggestions based on
commonwealth countries.
the research and key

results to improve the
ing-the-Effects-of-the-COVID-19-Pandemic-
resilience of these
on-Gopalakrishnan-
supply chains and
Vickers/322dd56cc3dd1207cf3cd775cfac04f0
safeguard them from
8a6827e2
such crises.
The solution to the Vulnerabilities
In terms of funding and providing universal health care, the public sector plays a critical
role. As a result, the government should implement changes in governance, leadership,
administration, and management to ensure that everyone has access to high-quality healthcare.
The expansion of the private health sector in Saudi Arabia is not a cure for the country’s
inadequate healthcare services (Rahman & Alsharqi, 2019). On the other side, it leads to higher
prices, wider inequality, and general unhappiness among consumers. It is critical that the
government intervenes quickly to minimize the negative consequences of this expansion.
Inadequacies in the public sector in terms of quality service delivery, patient safety, and clinical
efficacy, on the other hand, can only be addressed by strong political will (Barry et al., 2020).
Blood transfusions may save lives in a variety of situations, thus keeping a steady supply
of blood is critical, especially in COVID-19. Guidelines that priorities blood transfusion should
27
be prepared at the start of pandemics like this one. To prevent a sudden blood shortage, careful
consideration of blood demands and supply, as well as proper reaction, is required. An adaptable
regulatory policy and an evidence-based emergency blood management strategy should be able
to cope with any catastrophe and react swiftly in the event of a blood crisis (Alshamrani et al.,
2020).
In overhauling its health system, the Kingdom adopted a cautious approach. The cultural
norms that underpin state actions, particularly how much weight the government places on
maintaining the status quo in the economic and social fabric in relation to economic growth and
development, have had a significant impact on whether the KSA opts for a pro-government or
pro-market technique; but nevertheless, this might direct to a hybrid healthcare system
(Badreldin & Atallah, 2021).
Table 3: Literature summary related to Solution to the Vulnerabilities in KSA
Research Studies
Method
Sample
Main Findings
Khalil, M. K., Al-Eidi, S., Al-Qaed, M., &
A descriptive
Different KSA
Modernizing Saudi
AlSanad, S. (2018). The future of integrative
analysis
healthcare
Arabia’s healthcare
models
funding model should
health and medicine in Saudi
Arabia. Integrative medicine research, 7(4),
not be the sole aim of
316-321.
the country’s health

policy. A shift toward
pii/S2213422018301690
interdisciplinary
science and medicine,
as well as promoting a
28
wellness culture,
should be part of this
change.
Alruthia, Y. S., Alwhaibi, M., Alotaibi, M. F.,
An
A list of
Medication shortages
Asiri, S. A., Alghamdi, B. M., Almuaythir, G.
exploratory
stakeholders
are a complicated
S., … & Alshamsan, A. (2018). Drug shortages
qualitative
representing
healthcare problem
in Saudi Arabia: Root causes and
analysis
different
with international and
recommendations. Saudi Pharmaceutical
healthcare
local components.
Journal, 26(7), 947-951.
sectors

pii/S131901641830104X
Badreldin, H. A., & Atallah, B. (2021). Global
Descriptive
drug shortages due to COVID-19: impact on
analysis
Nothing
The introduction of
COVID-19 has had an
patient care and mitigation strategies. Research
impact on almost every
in Social and Administrative Pharmacy, 17(1),
worldwide industry. As
1946-1949.
a consequence of the

worldwide lockdown
C7235598/
policies, global
medication shortages
are a possible issue that
is looming on the
horizon.
29
Alshamrani, M., AlHarbi, A., Alkhudair, N.,
A qualitative
12 expert
This article offered
AlNajjar, F., Khan, M., Obaid, A. B., … &
methodologic
oncology
advice on how to care
AlNahedh, M. (2020). Practical strategies to
al approach
pharmacy
for cancer patients
practitioners
through tough times.
manage cancer patients during the COVID-19
pandemic: Saudi Oncology Pharmacy
To ensure the quality
Assembly Experts recommendations. Journal
and continuity of
of Oncology Pharmacy Practice, 26(6), 1429-
treatment,
1440.
implementing changes

in practice requires a
nationwide coordinated
effort from many
sectors.
Barry, M., Ghonem, L., Alsharidi, A., Alanazi,
Descriptive
A., Alotaibi, N. H., Al-Shahrani, F. S., … &
study
nothing
Models that replicate
isolated clusters across
BaHammam, A. S. (2020). Coronavirus
the nation and predict
disease-2019 pandemic in the Kingdom of
they’re probable
Saudi Arabia: mitigation measures and hospital
prevalence by
preparedness. Journal of Nature and Science of
screening, given the
Medicine, 3(3), 155.
number of test kits

accessible nationwide
589-
each day, may be used
30
627X;year=2020;volume=3;issue=3;spage=15
to assess COVID-19
5;epage=158;aulast=Barry
transmission.
Rahman, R., & Alsharqi, O. Z. (2019). What
Systematic
Nothing
The proposed changes
drove the health system reforms in the
review
in Saudi vision 2030
Kingdom of Saudi Arabia? An analysis. The
analysis
will have a very modest
International journal of health planning and
focus on increasing the
management, 34(1), 100-110.
health of the people,

and the research
2/hpm.2584
remains inconclusive.
31
Chapter 6: Discussion
32
Discussion
The findings revealed that global supply chain interruptions had far-reaching consequences that
reverberated across numerous nations, including KSA. Besides that, the COVID-19 pandemic
exposed many other flaws in the Saudi healthcare and medical devices supply chain, including
communication problems among healthcare organizations and the SFDA about drug shortages in
these organizations, dependence on drug imports, and inability of local drugs companies to meet
local demand for important medicines and medical hardware. While the actual effect of these
shortfalls on the quality of treatment and patient outcomes is unclear, past researches have shown
an increase in deaths, adverse side effects, prescription mistakes, and hospitalizations as a result
of such shortfalls (Badreldin & Atallah, 2021).
Most of the cases, the pharmaceutical or medical supply businesses who provide the
lowest rates in the bidding procedure get the agreements. This can take to a reduction in the
number of businesses gaining agreements over period, and may pressure some organizations to
exit the market, resulting in pharmaceutical and device supply shortages due to contract winners’
failure to meet consumer needs, particularly during unexpected times like the COVID-19
epidemic (Alruthia et al., 2018). However, owing to the nature of the crisis, these medication
shortfalls have happened on a global scale and are to be anticipated. The overwhelming majority
of participants seeking direct purchases also suggests inadequate medicine and PPE preparation
and stockpiling in the event of an emergency, such as the COVID-19 pandemic or any
interruption in critical drug supply chains (Yahia, 2020).
Managed care or strategy refers to the integration of alternative and contemporary
medicine into a unified healthcare system that may provide a high return42 and cost savings. 43
33
Integrative methods to health and wellbeing are increasingly being included into medical settings
in the United States and other areas. The World Health Organization (WHO) currently promotes
and supports member states to adopt complementary treatments and ensure their logical use in
national medical systems, wellbeing, and people-centered care. Furthermore, WHO continues to
urge member nations to enhance the safety and efficacy of complementary treatments by
regulating, educating, and researching them, as well as integrating holistic healthcare
professionals into the health system when needed (Gopalakrishnan et al., 2020).
Complementary treatments or methods may be included into KSA’s integrated healthcare
reform concepts. Not only should the integration model include well-researched techniques, but
it should also include culturally acceptable ones.
A holistic healthcare intervention’s distinctive benefit is its comprehensive process, which
is ideally suited to patients with specific psychological and spiritual requirements. Holistic
methods pay attention to these requirements, emphasize the patient–doctor connection, and use
multimodal ideas to comprehend the patient’s viewpoint. Integrative medicine’s reasoning is to
combine the finest practices of both conventional and alternative care into a comprehensive
strategy that provides the advantages of each. Pain treatment, cancer patient care, and behavior
modification are some of the most common applications of integration models (Gopalakrishnan
et al., 2020).
The huge financial need is one of the most significant obstacles in managing medical
supply chain in KSA. Despite the fact that banks and financial institutions aggressively seek
partnerships in the healthcare industry in KSA, they often restrict their risk by only dealing with
well-known market players with a past record. Unless there is a resort to other financial sources,
34
international or regional businesses considering entrance into KSA’s market frequently struggle
to obtain project financing (Aljadeed et al., 2021).
Furthermore, there are issues with the conditions provided. Healthcare investments are
generally long-term, which runs counter to a bank’s risk appetite, which normally extends to a
five- to seven-year tenure.
However, owing to the nature of the crisis, similar medication shortages have happened
on a global scale and are to be anticipated. The overwhelming majority of studies indicated
that seeking direct purchases also suggests inadequate medicine and PPE preparation and
stockpiling in the event of an emergency, such as the COVID-19 outbreak or any interruption of
critical drug supply chains. The disparities in price increases for medicines and personal
protective equipment (PPE) are particularly …
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