Thursday, October 25, 2012

A Glimpse into Kuwaiti Primary Care in the Early 1980s

As recently as 1982, the Kuwaiti primary care system was based on local clinics and polyclinics, most of which had separate facilities for male and female patients. The local clinics provided primary care services for a few thousand people. They were staffed by so-called general practitioners, who were perhaps more appropriately described as clinic doctors. They received little or no specific training in the field of primary care or general practice. Reportedly, many of them would have preferred to be hospital specialists and were too eager to leave primary care when a hospital post became available. The clinic doctors' turnover rate was typically high.

Most of the primary care service was provided by the larger and more comprehensive polyclinics. These clinics, which had catchment areas of 30,000-90,000 individual, offered primary care services as well as services like community obstetricians and gynecologists, basic laboratory and x-ray services. Polyclinics had dedicated clinics for diabetes, pediatrics, ophthalmology, and dermatology that were run by doctors working full-time in these specialties without being fully-qualified to work as such—so called specialoids.

Primary care clinics were, then, open at 0730 until midnight. After that, patients had to go to the hospital. Care was provided by around 600 physicians working in the primary care sector, none of whom was a Kuwaiti citizen! At the time, primary care had a low status in the eyes of patients, hospital specialists, and many of the clinic doctors themselves. The system was fragmented and lacked continuity and coordination. Many patients 'shopped around' between clinics and hospitals, and have often received multiple prescriptions from multiple doctors for the same condition. Care was generally characterized by overprescribing and the clinical standards were unsatisfactory.

A decision was made by the Kuwaiti ministry of health, in 1983, to reform the whole primary care system. Details on the 1980s primary care reform in Kuwait will be covered in a future blog post.

Further reading:
• Fraser R (1995). Developing Family Practice in Kuwait. BJGP. 45(391): 102–106.

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