d. Health

the Sultanate — envisions the procurement of 3,050 megawatts (MW) of renewables-based capacity by 2025, representing 16% of total electricity output by this timeframe. This compares with a minimum 10% share for renewables set by the Omani government by the 2025 milestone. Indeed, by 2030, renewable energy projects may account for roughly 30% of generation capacity in the Sultanate34 . Diam, the state-owned Public Authority for Electricity and Water, takes responsibility to study potential usage of renewable energy in generating electricity so that the government will reduce reliance on oil resources. In coordination with international consultants, the Authority for Electricity Regulation has supervised a comprehensive study to measure the level of renewable energy in Oman. The level of solar energy density in Oman being one of the highest in the world, the government seeks to take advantage of it by utilizing the renewable energy source in collaboration with other organizations, companies and consulting firms. There is significant scope for developing solar energy resources throughout Oman and solar energy has the potential to provide sufficient electricity to meet all of Oman’s domestic electricity requirements and provide some electricity for export. Also, the study has recommended implementing pilot projects in rural areas to ensure efficiency of renewable energy technologies35 .

d� Health

The Sultanate has succeeded in creating a modern healthcare system over the five decades after the Renaissance, represented by the percentage and speedy reduction in mortality, especially infants, and the control of communicable diseases. When the late His Majesty Sultan Qaboos rose to power in 1970, there were only two hospitals and an average life expectancy of just over 50 years. According to the ministry’s Annual Health Book, there were 261 health institutions at the end of 2019, including 50 hospitals accounting for 5,049 beds, 22 polyclinics and 189 health centres distributed across the Sultanate’s governorates and wilayats. In addition to this, the ministry has opened many super specialised clinics at referral hospitals in the governorates, providing a significant complement to the advancement of quality health services. The total number of workers in the health sector stood at 39,413 employees in 2019 compared to 39,506 in 201636. The total number of physicians increased by approximately 4%. The number of dentists increased by about 3% in this

34 Oman Daily Observer. (2020, January 7). 35 https://www.diam.om/Our-role-in-Oman/Renewable-energy

36 Ministry of Health Annual Report 2019. https://www.health.govt.nz/publication/annualreport-year-ended-30-june-2019

period. The biggest increase was in the pharmacists’ category, as it increased by more than 40% in this period. The number of Omani health workers increased by 5% in 2019 compared to 2016. The average life expectancy has now risen to more than 77 years, above the MENA average and just two years below the average for OECD members. Other key healthcare indicators such as infant mortality rates and deaths from cancer, diabetes, and cardiac disease have all likewise improved dramatically in recent years to place Oman above regional averages and on par with some of the world’s more developed countries.

The government has been involved in updating a major long-term health policy, known as Health Vision 2050, the document for which was first completed in 2012. Among the principles established in the document is the need to provide quality services, to focus on measurable outcomes, to emphasise disease prevention, to be patient-focused, and to keep up with emerging technologies. It has given rise to 28 visions and 142 strategic measures aimed at improving health sector performance in the future37. The formulation of Health Vision 2050 went hand in hand with the development of a health atlas that covers forecasts, future population projections, and future needs in terms of health services and medical equipment, in addition to forecasts of the amount of use for these services and the health human cadres required to develop the healthcare system at national and governorate levels. The said projections, forecasts, and needs are displayed in maps through a geographic health information system illustrating the evolution of needs over the years preceding 2050. All the visions and information presented in Health Vision 2050, as well as in its relevant working papers and strategic studies and the health atlas, lay down the foundation that guides the elaboration of five-year plans for health development. The ministry revises the Health Vision 2050 on a regular basis to assess the validity of proposed visions and strategies,subsequently build on new evidence to evaluate and update it. Furthermore, considerable efforts are being exerted by concerned authorities to inventory persons with disabilities and collect important data, inter alia on demographic aspects, disability type, and medical condition, to help the Sultanate adopt measures to overcome potential difficulties. A premarital medical examination service was initiated for any one intending to marry in order to identify if they carry or suffer from any genetic disease and give choices and alternatives to prospective couples, allowing them to plan a healthy family. This examination helps curb the transmission of recessive hereditary diseases to children such as sickle cell anemia and thalassemia and protect children from hereditary diseases and other congenital malformations. Health indicators attest to its comprehensive and well-developed standards.

37 First Voluntary National Review of The Sultanate of Oman 2019.

Health Vision 2050 milestones

Initiation of the process Vision Conference Launching of the Vision Five-year Strategic Plans First-term evaluation Second-term evaluation

STOP

2011 2012 2014

Source: Ministry of Health, Oman

2015 2020 Third-term evaluation

STOP

Impact evaluation

2030 2040 2050

At the same time, the government’s determination to provide all its citizens with free basic health care, along with treating persistent diabetes and cardiovascular disease, means that health-related expenditures are growing. Oman has been pushing for the implementation of modern technological solutions to boost efficiency in the healthcare sector and ultimately keep costs down and cut waiting times38. This has been notable in the digitization of the country’s medical records, with 86% of all government hospital and health care facilities having been linked electronically to a central database by the beginning of 2015. In early January 2017, the Ministry of Health began implementing a cashless transaction system at public health care centres, with both primary clinics and government hospitals now accepting card payments. Fitch Ratings, the American credit rating agency, in a report in November 2020, reaffirmed that the healthcare sector in the Sultanate is expanding and growing despite the challenges the national economy faces on account of the developments of COVID-19 pandemic and the decrease in oil prices39 . Although new public hospitals are under development, Oman’s private health care sector is also undergoing rapid expansion, bolstered by population

38 mediworldme.com/oman-adds-hi-tech-facilities-to-its-healthcare-sector 39 Oman News Agency.

growth, capacity constraints at existing public facilities and rising demand for specialty care. While health care is provided to all Omani citizens free of charge, a dearth of critical care options has prompted the government to fund overseas treatment for some patients, funds which could be used to build up domestic capacity and prevent an outflow of medical revenues. Recognising this, the government is now working with the private sector to establish two international medical cities in Salalah and Muscat, while recent statements from the Ministry of Health (MoH) demonstrate that these cities are the first of many opportunities for private investment in the Sultanate’s health sector. While government investment is set to bring a raft of new hospitals and clinics online, increased private sector participation is also helping Oman meet its health care goals. In October 2019, the Ministry announced that the Sultanate will develop its first medical city with an investment of RO 479 million40 . A further RO 159.5 million will be set aside each year as operating costs. Spanning over an area of 5 million square metres, the Oman Medical City will be developed in four different phases. While the first two phases will focus on commercial operations, private medical facilities, and residential projects, the other phases will be allocated for government use. It will be constructed in the Barka region in northern Oman. The medical city in Oman is a part of Oman’s Tanfeedh programme for economic expansion, which aims to reduce the Sultanate’s dependence on oil and gas as its primary source of income. In this regard, the government emphasizes the need to increase the role for private investments. As a result, an increasingly important role for the private sector has been encouraged, taking advantage of both mandatory insurance reforms and government incentives. The introduction of the mandatory health insurance law in March 2019 is expected to have major effects on care provision in Oman. The government also expressed its plan to open the health sector to greater private investment, with stakeholders looking to expand the use of Public Private Partnerships (PPPs). In July 2019 the government released widely anticipated PPP and privatisation laws to open key economic sectors – including health care – to private sector investment. As per the first stages of the law, the private sector is being invited to design, build and maintain state clinics, with management remaining under the remit of the Ministry of Health. Among private health providers in Oman, Muscat Private Hospital is one of the largest facilities and was the first facility in the country to be accredited by Joint Commission International. Badr Al Samaa Group is another major private sector player in Oman, operating six hospitals and polyclinics in the somewhat underserved regions of Suhar, Salalah, Al Khoud, Barka, Sur and

40 omanobserver.om/health-fund-mooted-to-finance-omans-medical-city

Nizwa. Additional facilities include the NMC Specialty Hospital, the Starcare network of hospitals, Apollo Hospital, KIMS Hospital, Burjeel and Al Raffa, to name a few.

With local production accounting for 7% of total market demand, Oman has historically relied on private sector importers and distributors to supply the country’s pharmaceutical needs. In 2018 it was reported that Oman spent around US$ 311m annually on pharmaceutical imports and another US$ 300 million on medical supplies. The segment remains dominated by local private companies such as Muscat Pharmacy and Stores, which imports pharmaceuticals and medical equipment from over 200 global suppliers. However, Oman’s Health Vision 2050 outlines an ambitious programme to establish local drug manufacturing operations and thereby reduce the country’s reliance on pharmaceutical imports. The government wants to raise local production of pharmaceuticals and medical equipment to 20-30% of total consumption through encouraging further foreign investment. In the beginning of 2019, there were three local pharmaceutical manufacturers operating in Oman and one manufacturer of surgical consumables41. Together, they account for 3.3% of registered manufactured medical products. The industry has some encouraging projects in the pipeline, including a US$ 365 million pharmaceuticals plant in the Salalah Free Zone which will produce over 100 pharmaceutical products upon completion in 2021. The Republic of India and the Sultanate of Oman continue to cooperate in various fields in the health sector. Both countries hold meetings on a regular basis as part of the endeavour to promote cooperation, as there is huge potential for Indian and Omani companies to explore the formation of joint ventures and establish operations in Oman, as well to facilitate Omani nationals to visit India for medical tourism. Healthcare in India comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players. The hospital industry in India accounts for 80% of the total healthcare market in India, and in the last five years has seen huge investor demand – from both global as well as domestic investors42. By 2022, India’s hospital industry is expected to reach US$ 132.84 billion, growing at a compound annual growth rate (CAGR) of 16% to 17%. The Indian medical tourism market, meanwhile, is growing at 18% percent year on year to reach US$ 9 billion by 2020. The government also plans to increase budget allocation for public health

41 Oxfordbusinessgroup.com/overview/ 42 india-briefing.com/news/indias-healthcare-investment-outlook

spending to 2.5% of the country’s GDP by 2025. There are several factors that make India the perfect destination for medical tourism: world class facilities at affordable costs, almost non-existent waiting time for surgeries, world class services and care system, and the availability of therapies such as Ayurveda, naturopathy and yoga. Indian system of medicine is beneficial in many ways, especially the traditional Ayurvedic therapy and the herbal medicines. Omani people look forward to traditional therapy and herbs which help them in muscle skeletal diseases, neurological diseases and skin diseases. As Dr. Dhanya Umanath of Kottakkal Aryavaidyasala in Muscat puts it, “Omanis believe in traditional medicine, and Ayurveda is widely accepted in Oman. Many Omani nationals have been travelling to the South Indian state of Kerala for Ayurvedic treatment. Since last 30 years citizens from Oman have been travelling to different Ayurveda centres for various treatments including paralysis, arthritis and other ailments. Approximately 10% to 15% of total Omanis travelling to Kerala for medical purposes are for alternative treatments”43. India is the world’s 2nd largest exporter of Ayurvedic and alternative medicine44. The wellness sector includes segments such as alternative therapies, beauty, fitness and nutrition, among others. Of these, rejuvenation services such as spas, alternative therapies, Ayurveda treatments and beauty services are expected to grow at around 30%, while the fitness sector which includes gyms and slimming centres is expected to grow by more than 25%.

According to the Indian embassy in Oman, nearly 2.5 times more e-medical visas from Oman to India were issued in just eight months of 2018, as compared to all of 201745. Moreover, people have been continuing to apply for regular medical visas as well. Some 2,635 e-medical visas were issued in 2017 and 6,579 e-medical visas have been issued up to August 2018. In 2017, the embassy issued 24,575 medical visas, while 11,450 medical visas have been issued up to August 2018. The hospital industry in India has attracted massive investments to fund healthcare delivery, advance technology and medical care, and expand market reach. This is further facilitated by the poor coverage of credible public healthcare institutions and services. Key drivers of investment growth include growing interest from private equity (PE) investors, increasing private capital from existing global and local hospital chains, business conglomerates, entrepreneurs, and international strategic players. As of April 2019, there were 38 Joint Commission International (JCI) accredited hospitals in India46 .

43 personal interview. 44 https://www.fdi.finance/sectors/healthcare 45 Press release, Embassy of India in Oman. 46 India Briefing. (2020, October 22). ‘India’s healthcare investment outlook: A brief profile’.

As of July 18, 2020, there are 708 National Accreditation Board for Hospitals and Healthcare Providers (NABH) accredited hospitals in India. Leading multispecialty corporate hospital chains in India include Apollo Hospitals, Fortis Healthcare, Narayana Health, Manipal Hospitals, Parkway Pantai Gleneagles Global Hospitals, Max Group, and Sahyadri Hospitals.

e� Mining

The growth of the mining sector in Oman is in line with Oman’s economic diversification plans, and the sector enjoys distinct advantages over other developing markets. The mineral-rich country has some of the richest and most diverse mineral deposits in the world, ranging from metallic – Copper, Chromite, and Laterite, and non-metallic – Gypsum, Limestone, Gabbro, Marble, Kaolin, Quartz, Clay, Basalt, Potash, and Dolomite – deposits. The discovery of these essential mineral resources has triggered an array of largescale exploration, mining, and extraction projects. The Omani mining sector is seeking exploration expertise, industrial mineral processing technology, as well as equipment, and companies experienced in developing mineral-based manufacturing. It is also looking to train and upskill in engineering consultancy, drilling and chemical testing, while also developing equipment manufacturing to fill supply chain gaps across the mining lifecycle. Of late, this sector has attracted increasing interest from both foreign and local operators. To safeguard its resources from wrongful exploitation, the Sultanate has several measures in place. In 2014, the government established the Public Authority for Mining to regulate the sector, and two years later it established Minerals Development Oman, a state-owned conglomeration of four Omani sovereign wealth funds and government investment entities, as a new holding company to serve as the executive arm. In August 2020, through a royal decree, the PAM was dissolved and its powers were transferred to the newly created Ministry of Energy and Minerals, as part of the government’s efforts to increase transparency and competitiveness in Oman’s mining sector47 .

In March 2019, the government rolled out the new mining law, bringing in hopes of attracting new investment and revitalising its mining industry. The new law stipulates that all mineral resources within Oman’s territory, which includes exclusive economic free zones, are the property of the state. According to the new law, investors can acquire mining permits under a more transparent legal framework. They will also be able to enjoy shorter approval times and fair royalty rates. Additionally, mining permits for projects that

47 export. gov. (2018, November 19). ‘Oman: Mining and Materials’. https://www.export. gov/apex/article2?id=Oman-Mining-and-Materials

2019 - Minerals Exports from Oman to India

Name of the Minerals Quantity in Metric Tons Value in US$ million Remarks

Gypsum Gypsum Calcined Limestone

Limestone Calcined

Stone boulders

Dolomite

Chrome ore

Marble Slabs

TOTAL

1,797,416

36,478

2,776,174

236,098

27,890

22,202

11,124

4,240

4,911,622

Source: Zawawi Minerals

36.96 Expected to grow on yearly basis 1.94 Expected to grow on yearly basis 52.93 Expected to grow on yearly basis 22.05 Expected to grow on yearly basis 0.62

0.34

1.46

2.57

118�87

span an area of under 5 sq. km will see an extension from one year to five years, and those that cover an area of more than 5 sq. km will be awarded an extension from 20 to 30 years. Industry analysts estimate Oman has more than one billion metric tonnes of gypsum and multi-billion metric tonnes of limestone. The country is in a secure position to meet the raising future demand for these commodities in India/and other Asian countries. The world’s largest gypsum exporter, Oman has recorded gypsum exports of 9 million metric tonnes in 2019, the volume having grown 30-fold over past 9 years. The major recipients include India, other Asian countries and South/East African countries. Oman controlled over 40% of imported gypsum market in these regions. Omani gypsum exports surpassed 1 million metric tonnes (MT) per month for the first time in July 202048. Exports from the Port of Salalah, the principal outlet for exports of locally mined gypsum, surged to 1.14 million metric tonnes in July and 1.15 million metric tonnes in October 2020. The corresponding figure for July 2019 was 0.885 million metric tonnes and October 2019 was 0.888 million metric tonnes49 .

Oman’s gypsum export through the Port of Salalah have already grown at a phenomenal pace. The Sultanate outperformed Thailand – long the leading exporter of gypsum globally – which saw its tally slump to 6.40 million tonnes in 2019. Iran, with exports of 5.31 million tonnes, was the next big player, while Pakistan, Bhutan, Australia, and Mexico accounted for around 0.99 million tonnes between themselves.

48 Oman Daily Observer. (2020, August 26). 49 Oman Daily Observer. (2020, July 5).

Analysts estimate that Oman’s majority reserves of limestone (used for steel manufacturing) and gypsum (used for cement and gypsum board manufacturing) are still untapped. But with demand soaring from Asia and South/East African countries for gypsum – a key raw material in cement production as well as gypsum plasterboard – the Sultanate is well-placed to capitalise on this demand growth by harnessing its prodigious deposits of this industrial mineral. And India is the world’s largest importers of Steel grade Limestone and Gypsum. Ramachandran, Chief Executive Officer, Zawawi Minerals, a leading Omani exporter of gypsum, says:

The Sultanate of Oman is Asia’s preeminent source of gypsum supplier to India, other Asian and South-East African countries and steel grade limestone to India. This can add value to the country’s non-oil exports revenue and the Sultanate can enhance non-oil export revenue growth from this promising mineral industry.50 India is the second largest cement producer in the world and accounts for nearly 10% of the global installed capacity and cement production reached nearly 335 MT in 2020. The housing sector accounts for around 65%-70 % of India’s cement consumption, followed by infrastructure (20%-23 %) with the rest accounted for by commercial and industrial capital expenditure. Due to the increasing demand in these sectors, cement demand is expected to reach nearly 500 million MT per annum by the year 2025. According to the data released by Indian Department for Promotion of Industry and Internal Trade (DPIIT) of India, cement and gypsum products industries attracted Foreign Direct Investment (FDI) worth US$ 5.28 billion between April 2000 and March 202051. Indian cement and gypsum board industries together imported around 5.30 million MT tonnes (30% of the overall consumption) gypsum in 2019, mainly from Oman and Iran. Gypsum plays a very important role in controlling the rate of hardening of the cement. During the cement manufacturing process, gypsum is added to control the setting of cement. If not added, the cement will set immediately after mixing of water leaving no time for concrete placing. India, which still has scarcity of local gypsum supply deficit in the domestic market, is facing an increased dependence on imports to meet demands in coming years — 40-50% of the annual consumption will be depending on imports. There is presently no substitute for gypsum in the production of cement and gypsum wallboard. Producers have to compete for raw gypsum material with a

50 Personal interview. 51 India Brand Equity Foundation. (2020, December 4). ‘Indian cement industry analysis’.

considerably larger and rapidly growing industry. In this context, Ramachandran foresees that the Sultanate will continue to be one of the major suppliers of gypsum to Indian cement and gypsum board industries. India surpassed Japan to become the world’s second largest steel producer in 2019 with crude steel production of 111.2 million MT and the crude steel production is expected to reach 255 million MT by 2030. India’s per capita consumption of steel grew at a CAGR of 4.43% from 46 kgs in 2008 to 74.10 kgs in 2019. The Government’s National Steel Policy 2017 aims to increase the per capita steel consumption to 160 kgs by 2030. Indian Government has taken various steps to boost the sector including the introduction of National Steel Policy 2017 and allowing 100% Foreign Direct Investment (FDI) in the steel sector under the automatic route. According to DPIIT, Indian metallurgical industries attracted Foreign Direct Investment (FDI) to the tune of US$ 13.40 billion between April 2000 and March 2020. However, the Indian steel sector is disadvantaged due to limited local availability of steel grade limestone and India is significantly dependent on import of limestone from Oman and United Arab Emirates. Indian steel industries imported around 25 million MT of steel grade limestone in 2019, mainly from Oman and United Arab Emirates. The main uses of limestone in steel industry are as a fluxing material. To produce 1 million MT of crude steel, around 0.15 – 0.20 million MT of limestone is required. The majority of the steel grade limestone resources in India are available in Rajasthan and the Himalayan regions. Environment concerns constrain Himalayan limestone exploitation and logistics constraints Rajasthan limestone excavation as high transportation costs are prohibitive for the majority of steel producers located in the east coast of the country. In this scenario, adds Ramachandran, “the Sultanate of Oman will continue to be one of the suppliers of steel grade limestone to Indian steel industries”52 . An abundance of limestone in the hinterland of Duqm unleashes opportunities for investment in a wide array of industrial activities, says Lee Chee Khian, ex-CEO of SEZ Authority at Duqm (SEZAD)53. High-purity limestone (99%) is perfectly suited for use in steel manufacturing, water treatment, desulphurisation of fuel gas for coal power plants. A slightly inferior grade (85%-97% purity) can be used in cement manufacturing and for agricultural purposes. Lower grades of limestone can be used in the production of aggregate for building and construction purposes.

52 Personal interview. 53 Duqm one. (2020). ‘Duqm SEZ Oman’s next economic growth engine’. https://www. duqm1.com/2020/01/duqm-sez-omans-next-economic-growth.html