– Lazhar Bounafa, Director General – Algeria
The Director General for the newly created National Agency for Healthcare Equipment and Management of Health Infrastructures (AREES) speaks out about the institution and plans for new University Hospitals and Anti-Cancer Centres
Can you present the agency, Arees, and priorities to our readers?
The National Agency for health equipment and management of health infrastructures (Arees), created by Executive Decree No. 13/220 of the 18th of June 2013, is an industrial and commercial public establishment (EPIC) with legal attribution and financial autonomy. The agency has two essential missions.
First, the agency is designated as delegate project manager to manage, on behalf of the state or at the request of a public or private legal institutions, transactions or services contributing to the realization of investment projects in the field of health, and secondly, to perform on behalf of the Ministry of Health, Population and Hospital Reform, acquisition of health equipment based on a list established by the Minister of Health.
To accomplish these tasks, it is necessary to use qualified human resources; in this context the agency plans training in the related fields, primarily in hospital engineering, biomedical, etc.
In the 1980s, the pattern in terms of equipment was based on “national medical equipment agency”; after its dissolution, it was up to the Directors of Health and Population of each Wilaya (country department) to acquire equipment for the local health facilities. This organization had shortcomings, which led the Minister of Health, Population and Hospital Reform to take measures to regulate the market and become directly involved in the quality of patient care. Qualification and specialization in equipment are therefore now required and the agency today plays a critical role in the regulation of the equipment market for hospitals.
That being said, there are also other means and institutions that will ensure the operation and regulation of the equipment market, such as the creation of a guarantee fund, an institution in charge of standardization, certification and quality control. All these supervisory bodies will provide support to the agency’s mission.
As for the project management, the first step involves taking care of the creation of the ten new university hospital centers (CHUs that will reinforce the existing 14 CHUs. These latter should align with the quality of the new university hospitals, thus the need for restructuring and upgrading. Regarding the ten new CHUs, the Ministry of Housing, Planning and of the City launched a national and international call for the study, implementation, equipment and management, based on a short list with ten consortiums from five countries.
Currently five CHUs were assigned, namely the Algiers CHU to the group Rizzani Eccher / Ospidale San Raffaele, the CHU of Tizi-Ouzou to Daewoo Engineering & Construction neck / Heerim architects and planners, the CHU of Constantine given to Bouygues International / Vamed / APH Paris, the Wargla CHU to Hyundai engineering & Construction co / Baum architect inc / Seoul national university / Sun and finally the CHU of Tlemcen Hospital given to International Hospitals Group.
Algeria now has an average of 1.6 beds per 1,000 inhabitants, where the world’s average is around three. Would the new CHU provide solutions to this issue?
It is true that the WHO standard is three beds per thousand inhabitants, while the Algerian average is around 1.6 to 1.8. We are currently building an additional 28,000 beds, which will total to 80,000 beds in the country and reach the average of 3.2 beds per thousand people by 2019. However, it should be noted that even today, the bed occupancy rate does not exceed 50 percent and the capital Algiers takes care of up to 60 percent of the nation’s patients. For this reason, we felt it appropriate to consider a mutual bed management system to improve performance. The current organization of services should disappear in the new CHUs, in favor of an organization driven by a technical platform that will be managed as a business. In this new organization, hospitalized patients will be assigned a bed by the administration, and their doctor will organize their stay carefully through the technical platform.
What do you plan to do to balance the traffic between the existing CHus of Algiers and the rest of the territory in order to restore the confidence of patients who voluntarily come to the capital to be taken care of?
Of the 14 existing CHUs, four are attached to the city of Algiers. There are therefore ten CHUs spread in the other wilayas (departments), leaving almost two-thirds of them without hospitals. This is what causes the flow to Algiers. But the current country health map, even if it is organized around the 14 CHUs, provides each of the 1541 municipalities with a clinic or a community hospital with 60, 120 or 240 beds, despite the lack of CHUs. Ouargla, as well as the wilaya of Bechar, will soon be equipped with university hospital centers, which will help complete the coverage of the national territory in terms of CHUs.
Of course, with the commissioning of these new modern facilities in co-management with foreign companies, as noted above, the existing 14 CHUs will need to be restored to avoid having a difference in the level of care. By 2019 we will have 24 CHUs, including 10 newly built. The message to be conveyed is that healthcare is now the priority project in Algeria in terms of investment.
This fourth five-year presidency term focuses on infrastructure and healthcare investments, along with the development of industry and the port system. In summary, the restructuring of the existing CHUs (20,000 beds), the creation of prefabricated hospitals (7500 beds) in addition to the achievement of ten new centers, is a definite market opportunity in terms of hospital engineering for the next five years.
How do you ensure that the willingness of the government and institutions to ensure state of the art equipment matches the human resources capabilities and training? What are the efforts of staff qualifications to be considered?
This is one of the main missions of the agency. The ministry is aware of the human resource needs required by 2019. The development and training of medical and paramedical staff is a constant concern for which the Ministry of Health will propose a training plan for the 2015-2019 period. As for equipment, it is the agency that will offer training starting in 2015 to allow the staff to familiarize themselves with the new technologies at the front line.
In terms of equipment, Algeria will have around 60 accelerators supplied by the two global providers, VarianMedicalSystems and Elekta, which represents 10 percent of the global acquisitions of accelerators in the world. The coverage of the national territory in terms of cancer care, with the opening of ACCs (Anti- Cancer Centers) Batna, Setif, of Annaba, Tizi Ouzou, Tlemcen and Bechar Bejaia will leverage and multiply oncology services throughout the 48 provinces.
Indeed, the willingness of public authorities to fight cancer, as seen in the cancer plan, developed under the authority of Professor Messaoud Zitouni, approved by the president of the People’s Democratic Republic of Algeria, is an ambitious plan that made Algeria an emerging player in the fight against this disease. The plan revolves around 26 points, including the establishment of 19 Anti-Cancer Centers (ACCs) and five functional radiotherapy centers in addition to five private centers.
Can you tell us about the current status of the progress of various plans and programs regarding the UHCs, old and new anti-cancer centers?
Regarding the assigned UHCs, which have been cited above, the work will start in November of this year (2014). This leaves 48 months to train the staff, with the assistance of foreign companies. Thus the CHU Constantine will be managed for five years by APH Paris / Vamed, the Tizi Ouzou CHU will be supervised by the hospitals of Seoul, the Algiers UHC from Ospidale San Raffaele (Rome) etc.
Indeed, the consortiums in their proposals, integrated a management plan and training, some of them will take place in Algeria others abroad so that at the opening of the CHUs, they will have the appropriate and qualified personnel.
However, it is to be noted that the Anti-Cancer Centers suffer from a lack of medical and clinical physicians because of the deficit in some professions. Aware of these shortcomings, the government has worked on this issue involving the Ministry of Higher Education and Scientific Research to further develop this training by increasing the number of departments offering the specialty in question and holding continuous training to meet the demand for new ACC.
The budget allocated to the ACCs is of 4.5 billion dinars (43 million euros) for each anti-cancer center. The Algerian company Sonatrach is also involved substantially in the fight against cancer by agreeing to fund four radiotherapy units to help support the treatment of patients.
How were selected these groups/consortium and companies that are part of them? Have you tried to include Algerian companies, or were you looking at only foreign companies?
First, all local hospitals with 60, 120 and 240 beds have been built through national competences. However, it is clear that the complexity of the specification for the CHUs, in addition to the requirement to work with companies that have already built CHUs in the past, which also had the technical capacity for this type of construction, quickly left the door open to renowned multinational companies.
Earlier, you said that the main issue with the existing hospitals was management. What do you define as part of the management itself, and what are you planning to implement in the new and old CHUs?
These institutions (the new CHUs) will be governed under the status of public enterprises with administrative character: they will be subject to legal requirements for public institutions. However, the status, and without interfering with the lesson learnt, it is appropriate to improve the quality of management, develop reliable management tools, indicators of cost management, dashboards, and real management tools able to guarantee performance, cost control, profitability, pooling of resources and a national evaluation .
A new private hospital has received a construction agreement: do you believe in the management of public hospitals under the private model?
We will necessarily see a public-private mix, as in either case, the key concern lies in patient satisfaction and treatment of diseases. There is little difference between the two denominations, except that the private hospital may be better controlling its costs and equipment. Personally, I do not see a real difference between the two sectors in healthcare.
In your opinion, do you think that Algeria has what it takes to become a regional champion? What are its strengths and what is left to do for it to really take this position?
Algeria represents a real potential market in healthcare and in hospital equipment in particular, before becoming a regional leader in the field of health investment. Today, the Ministry of Health launched large investment projects, covering all aspects, whether the treatment of cancers with results expected in 2015, the restructuring of CHUs, the construction of new ones, in addition to more work on emergencies, resuscitation, geriatrics, pediatrics.
The presence of multinational accompanies and reinforces these large investments undertaken. This is what makes me say that the role of regional leader is perfect for our country. We have the capacity, the skills and market breadth. Algeria is really starting to shine on the regional level, individual competence is not lacking in Algeria, although collective responsibility needs to be developed.