Healthcare Opportunities for U.S. Business

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2017 Edition

Healthcare Opportunities for U.S. Business

Gulf Cooperation Council (GCC)

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

Embassy of the United States of America

With a combined GDP of $1.6 trillion and per capita income of $33,000, the Gulf Cooperation Council (GCC) offers excellent export opportunities for American business in general and the healthcare market in particular. As a trading bloc, the GCC is America’s #5 export market. The GCC healthcare sector will surge to $70 billion in 2018, from $38 billion in 2013. Doubtless, healthcare is a strategic sector for American commercial interests in the Gulf. Through our extensive networks of public and private sector contacts and industry expertise, the U.S. Commercial Service in the Gulf helps American companies identify multi-market opportunities and protect their business interests across the region. We assist in navigating government policies, regulations, and standards, as well as in screening and assessing potential partners and end users. Why? To create jobs, growth and prosperity both at home and abroad. I encourage you to review the healthcare overviews in this booklet and contact our sector specialists to seize on these opportunities. We look forward to advancing your business goals in the Gulf and beyond.

Sincerely,

Dao M. Le Regional Senior Commercial Officer for the Gulf

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TABLE OF CONTENTS Bahrain .................................................................................... 4 Kuwait ..................................................................................... 8 Oman ...................................................................................... 14 Qatar ....................................................................................... 18 Saudi Arabia ........................................................................... 22 United Arab Emirates .............................................................. 28 Take Your Next Steps ............................................................. 34

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BAHRAIN

Contact

Christiaan De Luigi Commercial Officer +973 1724 2931 deluigice@state.gov 4

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OVERVIEW

Population: 1.378 million Age Structure: 0-14 years: 19 % 15-24 years: 16 % 25-54 years: 56 % 55-64 years: 6 % 65 years and over: 2 % Population Growth Rate: 2.33% Ethnic Groups: Bahraini 46%, Asian 45.5%, other Arab 4.7%, African 1.6%, European 1%, other 1.2% (2010 Est.) Religions: Muslim 70.3%, Christian 14.5%, Hindu 9.8%, Buddhist 2.5%, Jewish 0.6%, folk religion <.1, unaffiliated 1.9%, other 0.2% (2010 Est.) Languages: Arabic (official), English widely spoken Border Countries: Bahrain is an archipelago, linked via causeway to the Kingdom of Saudi Arabia Currency: Bahraini Dinar 0.377 BHD = $1.00 GDP: $30.41 billion (2015 Est.) GDP Per Capita: $22,068 (2014 Est.) GDP Real Growth Rate: 3.2% (2015 Est.) Consumer Price Inflation: 1.8% (2015 Est.) Principal Exports: Refined oil, aluminum, petrochemicals Main Imports: Crude oil, food, construction materials, machinery, vehicles and parts Transparency Rank: 50 of 168 (2015)*

*Source: Transparency International U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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MARKET OVERVIEW The Government of Bahrain (GOB) has prioritized developing the healthcare sector, including attracting foreign direct investment to improve the quality of healthcare services provided. The GOB forecasted capital expenditures for Bahrain’s Ministry of Health would reach BD 7 million in 2016 (roughly $18.5 million). In 2013, the Ministry of Health announced $716 million would be allocated from GCC Stabilization Fund monies to Bahrain’s Ministry of Health over a ten-year period, adding the funding would be used for eight major infrastructure projects, including construction of new hospitals and clinics, upgrading medical equipment at hospitals, and the construction of a genetic disease research center. The public sector dominates the supply of health care services in Bahrain and accounts for the majority of health care expenditures. Public health sector spending represents roughly eight percent of total government spending. All Bahrainis receive free, state-funded healthcare, while most companies offer their expatriate workers healthcare coverage, either through insurance companies or through arrangements with one or more local private hospitals. In 2015, a compulsory health insurance fee was implemented requiring all employers who wished to renew work permits for their employees to pay $191 for health insurance for one year and $383 for two years, which increased the private sector‘s contribution to the Bahraini healthcare system. The Pharmacy and Drug Control Directorate within the Ministry of Health monitors and controls the import and distribution of medical devices and pharmaceuticals. The Bahraini pharmaceutical market is highly dependent on imported drugs. Before the approval of any medication for sale domestically, two other GCC countries – one of which must be the Kingdom of Saudi Arabia – must approve it.

CHALLENGES Despite the entry into force of the U.S.-Bahrain Free Trade Agreement (FTA) in 2006, difficulties remain for duty-free access of select goods. Customs authorities

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occasionally attempt to collect customs duties on some items, and there have been reports that goods which are not individually labeled “Made in the USA” do not receive the preferential treatment they should be accorded under the FTA.

OPPORTUNITIES

Bahrain offers one hundred percent foreign ownership of companies in the healthcare arena. It is advisable for U.S. companies to designate a local agent/ representative to conduct business in Bahrain, though it is not always necessary. It is also advisable that companies work with local legal counsel when drawing up a contractual agreement and establish a presence in the country when bidding on government tenders. Due to the Free Trade Agreement (FTA), there is no customs duty on any U.S. imported equipment. Morbidity and mortality statistics indicate major diseases in Bahrain include: diabetes, respiratory infections, genetic diseases (sickle cell and thalassemia), and cardiovascular disease. Recent trends also reflect an increasing rate of oncology patients, particularly those with breast cancer. - Over 60 percent of the population is classified as overweight. - Almost 20 percent of the population is diabetic. - More than 20 percent of the population smokes regularly.

REGISTRATION INFORMATION The National Heath Regulatory Authority is the relevant organization in Bahrain to inquire about importing medical equipment and pharmaceuticals; however there is no standard registration process.

BEST PROSPECTS        

Pharmaceuticals, including drug packaging and distribution Health support services and resorts Health education and training Medical research centers Information technology (E-health program) Biotechnology Creating a national strategic storage facility to house an emergency supply of drugs and medicines Procuring an IT system that links public sector hospitals with their private sector counterparts

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KUWAIT

Contact

Yousif Almahdi Commercial Specialist +965 2259 1487 Yousif.Almahdi@trade.gov 8

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OVERVIEW Kuwait, officially the State of Kuwait, is a country in Western Asia. Situated in the northern edge of Eastern Arabia at the tip of the Persian Gulf, it shares borders with Iraq and Saudi Arabia. Kuwait is a constitutional emirate with a high income economy backed by the world’s sixth largest oil reserves. Population: 4.2 million, with immigrants accounting more than 69% (2015) Age Structure: 0-14 years: 25.18 % 15-24 years: 15.16 % 25-54 years: 52.28 % 55-64 years: 4.95 % 65 years and over: 2.43 % Population Growth Rate: 1.53 % Ethnic Groups: Kuwaiti 31.3%, other Arab 27.9%, Asian 37.8%, African 1.9%, other 1.1% (includes European, North American, South American, and Australian) (2013 Est.) Religions: Muslim (official) 76.7%, Christian 17.3%, other and unspecified 5.9% Note: Represents the total population; about 69% of the population consists of immigrants Languages: Arabic (official), English widely spoken Border Countries: Iraq, Saudi Arabia Currency: 0.3009 KWD = $1.00 (2015 Est.) GDP: $120.7 billion (2015 Est.) GDP Per Capita: $70,200 (2015 Est.) GDP Real Growth Rate: 1.3% (2014 Est.) Consumer Price Inflation: 3.3% (2015 Est.) Principal Exports: $55.32 billion (2015 Est.) Main Imports: Food, construction materials, vehicles and parts, clothing Transparency Rank: 55 of 168 (2015)* *Source: Transparency International

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MARKET OVERVIEW

In 2015, the Kuwait government has agreed to spend $115 billion on development projects over the next five years (2015-2020) as part of Kuwait’s National Development Plan, stretching from 2010 to 2035, based on a series of five 5-year plans, with an aim to convert Kuwait into a trade and financial hub of the region. The plan introduces ideas and laws to fund the development projects and to provide support to various sectors, including building a stronger healthcare system through the promotion of healthy lifestyles and behavior and enhancing the healthcare infrastructure. Kuwait’s public healthcare sector accounts for more than 80% of the healthcare spending in the country. Currently, Kuwait’s Ministry of Health is the owner, operator, regulator, and financer of the vast majority of healthcare services rendered, pharmaceuticals purchased, and medical equipment acquired in the country. The Government of Kuwait is currently operating 15 general and specialized hospitals with the private sector expected to grow moderately in the coming years. Private companies are estimated to take a share of 15-20% of healthcare spending. Between 1995 and 2013, Kuwait’s Ministry of Health operating budget has increased from USD 895 million (KD 253 million) to USD 4.5 billion (KD 1,294 million). In addition, during the same period, the Ministry of Health per capita expenditure has increased from USD 456 (KD 129) to USD 1,175 (KD 332). Approximately 50% of Kuwait’s Ministry of Health operating budget is geared towards salaries and benefits. If the Compounded Annual Growth Rate (CAGR) stabilized at 7%, Kuwait’s Ministry of Health operating budget would reach about USD 18 billion (KD 5 billion), by 2030. Currently, Kuwait has two hospital beds per 1,000 people, an undersupply of serious concern given the population growth and the growing disease burden. In 2012, the Ministry of Health and the Ministry of Public Works announced a USD 4.42 billion (KD 1.250 billion) project to replace and/or expand nine operating hospitals (five general hospitals and four specialized hospitals), which will add an additional 5,400 beds, 150 operating rooms, and 500 outpatient clinics. In 10

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addition, the USD 1.1 billion (KD 304 million) Sheikh Jaber Al-Ahmed Al-Sabah Hospital, which is expected to be completed by mid-2016, will add another 1,200 beds. Currently the Ministry of Health hospital bed capacity stands at nearly 6,000 hospital beds. Although the population is young on average, the World Health Organization (WHO) indicated that Kuwait is ranked13th in the world for obesity and 7th for diabetes. In addition, WHO’s metabolic risk factor for both male and female Kuwaiti nationals indicates that 78.8% suffer from overweight, 42% suffer from obesity, and 54% suffer from raised cholesterol. In 2012, the Ministry of Health and the Ministry of Public Works announced a USD 4.42 billion (KD 1.250 billion) project to replace and/or expand nine operating hospitals (five general hospitals and four specialized hospitals), which will add an additional 5,400 beds, 150 operating rooms, and 500 outpatient clinics. In addition, the USD 1.1 billion (KD 304 million) Sheikh Jaber Al-Ahmed Al-Sabah Hospital, which is expected to be completed by mid-2016, will add another 1,200 beds. Currently the Ministry of Health hospital bed capacity stands at nearly 6,000 hospital beds. Although the population is young on average, the World Health Organization (WHO) indicated that Kuwait is ranked13th in the world for obesity and 7th for diabetes. In addition, WHO’s metabolic risk factor for both male and female Kuwaiti nationals indicates that 78.8% suffer from overweight, 42% suffer from obesity, and 54% suffer from raised cholesterol.

CHALLENGES

The need for a Kuwaiti agent, distributor, or partner tends to add to the cost of selling goods in Kuwait. Imports to Kuwait require three certified and legal copies of the commercial invoice, three copies of the transport documents and two copies of the certificate of origin. The certificate of origin must describe the place of origin of the goods, the full name of the manufacturing plant or producer and the full name of the freight forwarder. It must also show gross and net weight, the trademark shown U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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in the manifest, value, type of packaging and means of transport. The certificate must be certified by the Chamber of Commerce in the exporter country and most of the time by Kuwait Embassy or any one of the GCC states mission in the absence of a Kuwaiti mission. Kuwait Customs is strict and most of the Kuwaiti importers/companies know the best ways to get the imported items faster to the country. Trade Events

OPPORTUNITIES

The healthcare sector is moving toward becoming a regulated market sector through reform initiatives that are being implemented. The privatization initiative involves broadening public-private partnerships and giving the private sector a growing role in the provision of healthcare services. Recently, public healthcare centers began referring patients to private medical care providers for services like IVF treatment and physiotherapy. Such soaring healthcare spending reflects the GOK’s priority to improve the quality of life for both citizens and expatriates and to treat more Kuwaiti patient’s in-country.

REGISTRATION INFORMATION

Kuwait Ministry of Health requires the following for product registration:  Free Sale Certificate from the concern health authority of origin to be legalized by Kuwait Embassy. This certificate should mention the trade name of the product, its volumes or weight, and it should state the product is allowed to be sold freely in the country of origin.  Certificate of composition (exact percentages) signed and sealed by the manufacturer.  Certificate of analysis signed and stamped by manufacturer.  As well samples of each product to be tested.  Should have a Kuwaiti importer

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BEST PROSPECTS

There is large potential in Kuwait’s healthcare industry for U.S. companies offering medical-dental-lab equipment, general hospital supplies, pharmaceutical products and specialized systems and applications. Additionally, there is demand for unique products and new technologies, such as laser-treatment, nanotechnology and molecular medicine. Laboratory testing is also a growing segment and will require testing equipment and disposable tests. Surgical instruments are in high demand, as well as diagnostic or laboratory equipment in the fields of orthopedics, trauma care, ophthalmology, cardiology, oncology, radiology or radiotherapy and healthcare information. Medical services such as project management, health care consulting, human resource development, hospital administration, and technology transfers are and will continue to be in demand.

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OMAN

Contact

Raji Daniel Commercial Assistant +968 2464 3784 DanielR@state.gov 14

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OVERVIEW

Population: 4.5 million (Nov. 2016) Age Structure: 0-14 year 30.14 % 15-64 66.40 % Above 65 3.40 % Population Growth Rate: 1.05 % (Est.) Ethnic Groups: Oman’s population primarily consists of Omanis (54.1%) and Expatriates (45.9%) comprising of South Asian (Indian, Pakistani, Sri Lankan, Bangladeshi), African and western nationals Religions: Islam (official) Languages: Arabic, English Border Countries: UAE, KSA, Yemen Currency: Omani Riyal GDP: USD 69.7 billion (2014) GDP Per capita: USD 16,791 (2014 Est.) GDP Real Growth Rate: -13.8 % Consumer Price Inflation: 2.04 % (Oct. 2016-2015) Principal Exports: Petroleum, re-exports, fish, metals, and textiles Main Imports: Machinery, transport equipment, manufactured goods, food, livestock, and lubricants Transparency Rank: 60 of 168 (2015)*

*Source: Transparency International U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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MARKET OVERVIEW

 The country’s healthcare infrastructure now boasts around 65 modern hospitals with almost 6,000 beds, a ratio of 2.1 beds for every 1,000 citizens in addition to more than 242 health centers and close to 1,000 private clinics throughout the Sultanate.  The healthcare market in Oman was expected to be worth $2 billion by the end of 2015 as a result of population growth, rising levels of lifestyle-related diseases, and increased health insurance, according to a report by the corporate advisory company Alpen Capital.  Stating that the market in the Sultanate is “in the developing stage,” the report adds that the market was expected to grow at a compound annual growth rate of 9.3% between 2010 and 2015 from the 2009 market value of US$1.2billion. In addition, the number of hospital beds required to meet this demand was anticipated to rise from an estimated 5,722 to 6,300 by the end of 2015.  Oman’s 2016 budget had allocated USD 1.6 billion (OMR 627.6 million) to health expenditure, which accounts for 13.6% percent of the total state budget and is consistent with the commitment to continue investment in the country’s healthcare system.

CHALLENGES

 Tedious and time consuming registration processes for new pharmaceutical products and price regulation of medicines by the Ministry of Health.  Bureaucratic obstacles – Omanization, clearances for visas for foreign workers, lack of coordination of investment promotion agencies.  Authenticated certificates of origin/shipping documents are at times still requested by Omani authorities despite not being required under the FTA. Duties are continuing to be charged on American goods transshipped by road via Dubai.  The continuing pressure on state budgets due to the depressed oil prices has seen many projects being cancelled, delayed or “on hold” and the government tenders have become extremely price-sensitive.

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OPPORTUNITIES

 The Omani market offers solid prospects for U.S. health care products. Oman is focused on upgrading its facilities and diagnostic capabilities.  New hospitals and health centers are being planned across the governorates of Oman.  The MOH has outlined other requirements including a full-fledged Emergency Medical Services/ambulance system, innovative health insurance solutions for the expat population, customized patient catering plans, healthcare information management technologies to standardize regional operations, and help with recruitment and training to address Oman’s severe shortage of doctors.  The Ministry of Health is also spearheading the development of the Medical City — a RO 300 million initiative envisioning a cluster of world-class tertiary care hospitals, medical college and R&D facilities. The government is exploring the Public-Private-Partnership (PPP) route for the implementation of this venture.

REGISTRATION INFORMATION

In Oman, medical products and services are regulated by the Ministry of Health (MOH). Products, whether they are manufactured in Oman or imported into Oman, must be registered with the MOH. The registration procedure is conducted by submitting an application form and other relevant documentation through a local Omani representative. www.moh.gov.om/en/web/dgpadc/resources

BEST PROSPECTS

Sub-Sector Best Prospects: Pharmaceuticals, medical equipment and supplies, X-ray and MRIs, ultrasound devices, surgical equipment, management information systems, tele-medicine, fellowships, residencies, specialized short courses, and healthcare administrator training.

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QATAR

Contact

Anissa Lahreche Commercial Specialist +974 4496 6040 / +974 5586 1786 anissa.lahreche@trade.gov 18

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OVERVIEW

Population: 2.312 million (2016) Age Structure: 0-14 years:Â 12.57 % (male 143,859 / female 140,027) 15-24 years: 12.02 % (male 206,775 / female 78,271) 25-54 years: 70.45 % (male 1,321,973 / female 269,072) 55-64 years: 3.41% (male 59,418 / female 17,578) 65 years and over: 0.94% (male 13,610 / female 7,700) (2016 Est.) Population Growth Rate: 2.64% (2016 Est.) Ethnic Groups: Arab 40%, Indian 18%, Pakistani 18%, Iranian 10%, other 14% Religions: Islam is the main religion of Qatar (Muslim 77.5%, Christian 8.5%, other (includes mainly Hindu and other Indian religions) 14% (2004 Est.) Languages: Arabic (official), English commonly used as a second language Border Countries: Saudi Arabia, Bahrain Currency: Qatar Riyal $185.4 billion (2015 Est.) GDP: GDP Per Capita: $132,100 (2015 Est.) GDP Real Growth Rate: 3.3% (2015 Est.) Consumer Price Inflation: 1.7% (2015 Est.) Principal Exports: Liquefied natural gas (LNG), petroleum products, fertilizers, steel Main Imports: Machinery and transport equipment, food, chemicals Transparency Rank: 22 of 168 (2015)* *Source: Transparency International U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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MARKET OVERVIEW

 In its 2016 budget, Qatar allocated $5.7 billion to private and public healthcare projects. This was up from $5.2 billion in 2015 and $4.8 billion in 2014.  In the past few decades, the Qatari government has heavily invested in developing an integrated healthcare system that offers high-quality services. As a result, the Qatari healthcare industry has displayed unprecedented growth.  The growth and development of the healthcare system is centrally controlled by the Qatari government through the Hamad Medical Corporation, a nonprofit organization that is the premier healthcare provider in the country.  The healthcare system in Qatar is also comprised of the Primary Heath Care Corporation and several privately owned hospitals.  The Ministry of Public Health has launched the “Qatar Health Facilities Master Plan” to foster competition between state and private health providers. Qatar’s long-term development strategy has been articulated in the Qatar National Vision 2030 and healthcare is one key aspect of the Human Development pillar.  Development in the healthcare system was expedited in the mid-1990s and the healthcare sector in Qatar now features highly-advanced medical equipment.  The Qatari Government is developing an integrated system of healthcare that will meet the needs of the existing and future generations and provide for an increasingly healthy life for all citizens.  There is a sharp rise of lifestyle-related diseases such as obesity, diabetes, high blood pressure, nutritional disorders, cardiovascular diseases, cancer, and endocrine diseases in Qatar according to Supreme Council of Health’s (SCH) ‘Qatar Health Report 2013’.

CHALLENGES

 All Qatari citizens are entitled to receive medical treatment abroad, if they so wish. Thus, there are high costs associated with medical treatment as overseas treatments for Qataris cost the government some $329.6 million in 2011.  The healthcare sector is dependent on foreign medical professionals as 69 percent of doctors and 92 percent of nurses in Qatar are recruited from abroad.

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OPPORTUNITIES

 Qatar’s healthcare system is expected to outperform its GCC neighbors within the next five years.  According to some estimates, Qatar’s healthcare market is expected to reach $8.8 billion in 2020 (the outpatient market is projected at $5.9 billion by 2020 and inpatient market at $2.9 billion.  Other reports forecast Qatar’s health spending by 2024 to reach $12 billion, a 360% growth compared with 2010 numbers.  Under the Qatar Health Facilities Master Plan, 48 healthcare projects are expected to be completed by 2020 and this includes 48 healthcare projects, 31 health centers, two long term care facilities and five hospital expansion plans  Due to the sharp rise of lifestyle-related diseases in Qatar, there are great opportunities for public-private partnerships (PPP) as well as job prospects for skilled medical professionals of all levels, who are in constant demand. Additionally, there is potential for the pharmaceutical industry especially those specializing is treating lifestyle related diseases.  Global healthcare organizations are invited to partner in opening new facilities. Finally, participation of the private sector is expected to rise in the healthcare industry.

REGISTRATION INFORMATION

 Foreign company registration requires a Qatari National/agent, registered with the Qatar Chamber of Commerce. The local authorized representative is then required to obtain an import permit. The Ministry of Economy and Commerce processes the application for medical devices and the application process requires an agent to communicate with the regulatory body.  This process may be time consuming and requires detailed attention and follow up.

BEST PROSPECTS

 E-medicine Technologies  Training & Training Equipment  Research & Development  Healthcare Education Materials  Medical Equipment  Medical Management/Consultancy Services

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SAUDI ARABIA

Contact

Maher Siblini Senior Commercial Specialist +966 11 488 3800 (Ext. 4302) maher.siblini@trade.gov 22

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OVERVIEW

Population: 32.3 million (2016 Est.) Age Structure: N/A Population Growth Rate: 2.3 % Ethnic Groups: 90% Arab, 10% Afro-Asian Religion: Islam Languages: Arabic Border Countries: Iraq, Jordan, Kuwait, Oman, Qatar, UAE, Yemen Currency: Saudi Riyal GDP: $687.1 billion (2016 Est.) GDP Per Capita: $21,813 (2016 Est.) GDP Real Growth Rate: 1.4 % Consumer Price Inflation: 3.4 % Principal Exports: Petroleum and refined products, petrochemicals, transportation equipment Main Imports: Machinery and electrical equipment, motor vehicles, metals, Gems, pharmaceuticals, Transparency Rank: 48 of 168 (2015)*

*Source: Transparency International U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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MARKET OVERVIEW  The 2017 Saudi budget indicates the government’s commitment to diversifying the economy.  Projected rise in oil prices will ease the austerity drive but will continue with the government’s vision to overhaul its policies and regulations.  The 2017 budget expenditures stand at $237.3 billion, 6 percent more than in 2016 - signaling the government’s commitment to support the economy.  For the first time since 1998, actual total spending came at $220 billion in 2016, 1.82 percent lower than the budgeted figure.  Education and healthcare remain key sectors in the budget representing over 36 percent of total allocations.  Adamant to streamline spending and ensure fiscal sustainability, annual spending on healthcare will slow down and grow by an average annual growth rate of 6 percent over the next 4 years.  Government allocations for the Health and Social Development sector is projected at $32.1 billion in 2017, 15 percent more than the 2016 budget.  New projects include replacement of equipment at various MOH hospitals, completion of 38 new hospitals and two medical cities.

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CHALLENGES

 Saudi Arabia like other countries in the Gulf continue to exhibit life style change trends within its morbidity statistics  Non-communicable diseases such as cancer and cardiovascular disease have become the main causes of death  The latest WHO figures estimate that 33.7% of Saudi adults are obese and 68.2 % are overweight  Type-2 diabetes is prevalent with 14.4% affected and the World Health Organization (WHO) predicts that there will be 2.5 million diabetics by 2030  Based on WHO data, Saudi Arabia has the world’s highest traffic fatality rate  The latest MOH figures reveal that, among the Saudi population: - More than 6.5% had high blood pressure - More than 3.7% had high cholesterol levels

OPPORTUNITIES

 The Saudi health care market is still the largest in the Near East and Africa  Annual spending was estimated to have contracted by almost 19 percent in 2016 to $22.4 billion, mainly due to the government’s rationalization efforts to control waste, streamline operating expenses and contain allowances  The private sector, however, is aggressively taking over from the public sector in the provision of health care services, with total investments expected to reach almost $15 billion  Similarly, the Saudi government, especially the Ministry of Health, is restructuring its role from being a provider of services to more of a regulator in line with Vision 2030 and the NTP 2020, including: - The provision of soft loans and increasing the credit limits for the construction of private hospitals and clinics

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- Expanding health insurance coverage - Supporting public-private partnership programs  There are already a number of private health care facilities being planned or in the pipeline, while others are on the drawing board  Major companies that are boosting their health care investments include, Dallah Healthcare Holding Company, Magrabi Hospitals and Clinics, National Medical Care Company, Dr. Sulaiman Al Habib Medical Group, Middle East Healthcare Company, Olayan Financial Company, Al-Hammadi Medical Group, Al Mouwasat Medical Services, Specialized Medical Center Hospitals, Clemenceau Medical Centers, and Saudi German Hospitals Group, among others

REGISTRATION INFORMATION

 The Saudi Food and Drug Authority (SFDA) monitors and controls the import and distribution of medical devices, pharmaceuticals, cosmetics and food products  The SFDA will usually accept, register and authorize the marketing and sale of any device that complies with applicable provisions of the SFDA’s Interim regulations and relevant regulatory requirements applicable in one or more of the countries of the Global Harmonization Task Force (GHTF), which includes Australia, Canada, Japan, USA, and EU/EFTA  U.S. companies need to appoint an “Authorized Representative” for any and all their dealings with the SFDA  U.S. companies are advised to appoint a local company to act as the American company’s distributor/agent in Saudi Arabia  Medical equipment is usually charged a 5% customs duty; in some instances, it gets exempted if the shipment is bound for a government entity or project

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BEST PROSPECTS

The following sectors and sub-sectors provide excellent potential for U.S. companies:  Patient beds  Monitoring equipment  Hospital disposables  Operating-theater instruments  Oxygen generators and related components  Rehabilitation equipment and accessories  Diagnostic equipment and components  Electro-medical equipment  Medical X-ray equipment  Optical microscopes and related components  Dental equipment and devices  Therapeutic appliances/Orthopedic appliances/Artificial body parts  Glucometers and blood-pressure devices  Medical laboratory equipment  Surgical instruments are also in high demand

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UNITED ARAB EMIRATES (U.A.E.)

Contact

ABU DHABI Manal El Masry Commercial Specialist +971 2 414 2217 Manal.elmasry@trade.gov 28

DUBAI Dilek Kelly Commercial Specialist +971 4 309 4176 Dilek.kelly@trade.gov

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OVERVIEW

Population: 9.9 million Age Structure: 0-14 years: 20.94 % 15-24 years: 13.53 % 25-54 years: 61.27 % 55-64 years: 3.23 % 65 years and over: 1.04%(2014 Est.) Population Growth Rate: 9.3% Ethnic Groups: Emirati 19%, other Arab and Iranian 23%, South Asian 50%, other expatriates (includes Westerners and East Asians) 8% Religions: Islam (official 76%), Christian (9%), Other (15% -Hindu’s and Buddhists) Languages: Arabic (Official), Persian, English, Hindi, Urdu Border Countries: Oman, Saudi Arabia Currency: Dirham (AED) – USD 1.00 = AED 3.67 GDP: USD 375 billion GDP Per Capita ($): 38,050 GDP Real Growth Rate: 2.3% (2016 Consumer Price Inflation: 2.3% (2014 Est.) Principal Exports: Crude oil, natural gas, re-exports, dried fish, dates, and aluminum Main Imports: Manufactured goods, machinery, foodstuffs, and transportation equipment Transparency Rank: 23 of 168 (2015)**

*Source: Meed (Yearbook 2017); CIA World Factbook; ** Transparency Internation U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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MARKET OVERVIEW

The United Arab Emirates (U.A.E.) healthcare sector is divided between public and private healthcare providers. Public healthcare services are managed and regulated by federal and emirate-level government entities, such as the Ministry of Health (MoH), Dubai Health Authority (DHA), Health Authority Abu Dhabi (HAAD) and Abu Dhabi Health Services Company (SEHA). The U.A.E. is among the top 40 largest medical device markets in the world and ranks fourth in the Middle East & Africa (MEA) region. Manufacturing capability is limited, therefore the market will continue to rely on imported medical devices. Population growth, a growing medical tourism industry, continuous healthcare infrastructure developments, expanding health insurance and increasing health expenditure are all factors contributing to market growth. Healthcare expenditure as percentage of GDP represented an estimated 3.9 percent in 2015, a value of AED 54.56 billion ($14.85 billion), equating to $1, 622 per capita. Overall healthcare spending is expected to account for 3.82 percent of the country’s GDP by 2020, down slightly from 3.90 percent in 2015. Effective January 1, 2018, the U.A.E. will start implementing a value added tax (VAT), according to the U.A.E. Minister of State for Financial Affairs. As of today, the U.A.E. is a zero-tax country, with excellent transportation, logistics infrastructure and is geographically well positioned to be the commercial hub in the region.

CHALLENGES

 Different healthcare regulators  Reliance on expat medical practitioners  Growing diseases, such as cardiovascular, respiratory, cancer, and diabetes  High percentage of obesity  Lack of transparency in Government tendering

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U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

OPPORTUNITIES

 Substantial investment in the healthcare sector, new medical infrastructure  Rising demand for medical tourism  Expo 2020  Increasing health expenditure  Increasing demand for premium hospital facilities  Increasing demand for medical professionals  Growth of mall-based medical centers  Adoption of new technologies  Reliance on medical device importation

REGISTRATION INFORMATION

All medical devices must be approved by the U.A.E. Ministry of Health Drug Registration and Control Department. Imported medical devices will not be cleared by Customs unless a pre-approval for importation of the consignment is issued by the MoH. If the exporter company/manufacturer has no legal presence in the U.A.E., it will have to appoint a local representative to act on its behalf to register the devices. The local representative must be appointed by written contract stating the appointment of the local authorized representative by the company. The local representative should be licensed by the MoH.

BEST PROSPECTS

The following sectors and sub-sectors have potential for U.S. companies:  Medical equipment  Mobile medical devices  Diagnostic imaging  Pre-hospital equipment ventilation and resuscitation equipment  Glucose monitoring devices, insulin pens and syringes  Hospital supplies  E-Health patient programs / Educational programs  Medical management / Consultancy services

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

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TAKE YOUR NEXT STEPS

What can the U.S. Commercial Service do for you?

The U.S. Commercial Service (CS) is the export promotion arm of the U.S. Department of Commerce’s International Trade Administration. Our global network of more than 1400 trade professionals is located throughout the United States and in U.S. Embassies and Consulates in more than 70 countries. Whether you are looking to make your first international sale or expand to additional markets, we offer the expertise you need to connect with lucrative opportunities to increase your bottom line.

OUR SERVICES

Our trade specialists work to address issues and trade opportunities, to ensure you have the information you need to grow your business. This resource guide is just one of the ways we can provide the information you need to set priorities and plan for business growth. To learn more about how we can help you, as well as information about individual industries, please visit: export.gov/industry

BUSINESS MATCHMAKING  Connect with pre-screened potential partners.  Promote your product or service to prospective buyers at trade events worldwide.  Meet with international industry and government decision makers in your target market(s). COMMERCIAL DIPLOMACY  Overcome trade obstacles to successfully enter international markets.  Benefit from coordinated U.S. government engagement with foreign governments to protect U.S. business interests.  Access U.S. government trade advocacy for your foreign government procurement bids. MARKET INTELLIGENCE  Analyze market potential & foreign competitors.  Obtain useful information on best prospects, financing, laws and cultural issues.  Conduct background checks on potential buyers and distributors. TRADE COUNSELING  Develop effective market entry and sales strategies.  Understand export documentation requirements and import regulations of foreign markets.  Navigate U.S. government export controls, compliance and trade financing options. 32

U.S. Department of Commerce | International Trade Administration | U.S. Commercial Service

export.gov U.S. Department of Commerce | International Trade Administration U.S. Commercial U.S. Department of Commerce | International Trade Administration | U.S. |Commercial ServiceService

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