Hemodialysis Center
King Abdullah bin Abdul-Aziz Foundation for International Humanitarian Activities

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The number of renal failure patients in Saudi Arabia is increasing. The public sector does not have enough facilities where they can be treated. Mostly, private hospitals or clinics are the only one available, however, these are costly and non-affordable by some of the patients. As per the survey conducted by Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia.1 They surveyed its 130 active hemodialysis (HD) centers using a questionnaire about their manpower, hemodialysis equipment, as well as, peritoneal dialysis and transplant patients at the end of the year 2000. Almost all the dialysis centers were on hospital campus but of variable sizes with an average ratio of 14.8 dialysis machines per center (range 2-113 machines per center). The distribution of the dialysis centers according to the geographical regions of Saudi Arabia included 18(14%) in the northern, 25(19%) in the southern, 13(10%) in the eastern, 35(27%) in the western and 39(30%) in the central region. There was a total of 6,694 dialysis patients served on 1,918 hemodialysis machines. There were 1,793(93%) HD machines capable of performing bicarbonate dialysis. There was an average ratio of 3.5 patients per one HD machine. In addition to the hemodialysis, there were 28(22%) centers engaged in peritoneal dialysis (PD) and 56(43%) centers in the follow-up of post transplant patients. The total number of the nephrologists, regardless of their expertise was 212 of whom 180(84%) spoke Arabic; the average ratio was 32 patients per nephrologist (range of 14-58). There were 1320 hemodialysis nurses of whom only 465(35%) spoke Arabic. The average ratio of patients to nurses was five patients per nurse (range of 4-6). There were 72(55%) social workers and 70(54%)dietitians with average patients ratios to these supporting services of 1:93 patients (range of 1:58-137) and 1:96 patients (range of 1:53-137), respectively. Of the hemodialysis patients, 1,815(27%) were diabetics.1 Saudi Center for Organ Transplantation data, on end-stage renal disease patients conducted on the end of the year 2012, revealed that the number of patients treated with dialysis in 2012 reached 12844 patients, which indicates an increase in the prevalence of End Stage Renal Disease (499 cases per million annually). The total of new patients treated with blood purification in the same year reached 3666 patients and is expected to increase by the year 2014 to reach 15,000 patients. The number of renal failure patients treated with blood purification in the kingdom between 1993 and 2012 marked a significant increase as the number has risen from 3000 to 13000 patients. There are several risk factors of renal failure including blood-pressure, diabetes, obesity, smoking, urinary tracts blockage due to stones etc. It is worth mentioning that diabetic renal complications occur in 50% of patients with type I diabetes compared to only 10% in patients with type II diabetes.2 Reference: https://www.ncbi.nlm.nih.gov/pubmed/18209376 1 Souqiyyeh MZ, Al-Attar MB, Zakaria H, Shaheen FA. Saudi J Kidney Dis Transpl. 2001 Jul-Sep;12(3):293-304. 2 King Abdullah bin Abdulaziz International Foundation for Charity and Humanitarian works Page 29 - Statistics of Patient with Renal Failure

B. Strategic Approach

 2. What was the solution?
In order to meet the needs of patients with renal failure across the kingdom; The Custodian of the Two Holy Mosques, King Abdullah bin Abdulaziz International Foundation for Charity and Humanitarian Activities Project was established. With the initiative of H.E. Dr. Bandar Al Knawy, Chief Executive Officer, Ministry of National Guard Health Affairs (MNG-HA), the operational and supervisory support of MNG-HA, the team assigned to set up these humanitarian projects has accomplished its mission in a timely manner after being provided with well-trained national medical staff to be able to accommodate the increasing numbers of dialysis patients, in addition to the specialized administrative and consulting support provided by MNG-HA to such significant national project. The inception on August 2013 of King Abdullah bin Abdulaziz International Foundation for Humanitarian Activities, Hemodialysis Project help renal failure patients in Saudi Arabia, various Specialized Dialysis Centers was opened in different locations throughout the Kingdom, accessible dialysis clinics that provides high quality dialysis and rehabilitative services for patients with acute and chronic renal failure with quality care and assist the patient to progress toward a level of optimal health.

 3. How did the initiative solve the problem and improve people’s lives?
The renal failure patients were able to take advantage of the accessible dialysis centers across the Kingdom of Saudi Arabia. A new emphasis on the priority of the patient’s Health. These humanitarian projects which have been ordered by the Custodian of The Two Holy Mosques, come to interpret his vision which emphasizes the people’ rights to reach various services. His long-term vision anticipated the increase in numbers of renal failure cases which was revealed by the official statistics, the matter that called for speeding-up establishment of such centers, taking into consideration the highest level of quality and patient safety. To ensure that services provided to patients with renal failure are of high quality and meet internationally-approved standards in terms of dialysis efficiency, the center has been supported with highly qualified medical and supervisory staff with long experience in treatment of renal failure cases taken into consideration the following: anemia treatment efficiency, vascular access efficiency, parathyroid gland therapy efficiency, nutrition efficiency in addition to full commitment to the international medical standards of infection control. The centers have been provided with thousands of devices with the state of the art dialysis machine and latest technology in dialysis, where 207 assigned for Jeddah (Western Region) and 198 in Riyadh (Central Region). The second phase launched other centers in Makkah Al Mokarramh with 100 dialysis machines, 48 assigned to Al Madinah Al Monawrah and 38 dialysis machines in Hail. While the third phase will provide 295 devices with the launching of other centers. It is planned to provide dialysis for 5000 patients gradually in seven (7) years and the expenses will be covered by King Abdullah bin Abdul-Aziz Foundation for International Humanitarian Activities. The patient lives greatly enhance without worrying for the cost of dialysis as it is funded by King Abdullah bin Abdulaziz International Foundation for Humanitarian Activities, Hemodialysis Project. This important humanitarian project has acquired a high national value at both social and health levels, being a charity project at the expense of the Custodian of The Two Holy Mosques, in continuation to his keenness in serving his country and people.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Massive centers in different locations in six months since its inception. The project includes 1000 hemodialysis machines and equipment, dialysis centers buildings, medical/non-medical logistics, support services contracts, support services buildings, maintenance of centers, transportation means and machinery. The centers will serve 5000 patients free of charge across different regions of the kingdom. With the highest quality standards in establishment of buildings as to space, site-vitality, and easy access to services; contracts have been signed with companies experienced in construction of specialized health facilities to equip and secure these buildings with the latest systems raising quality level of services such as Reverse Osmosis equipment, provides sterilized water through thermal sterilization; Electric system, ensures continuous current with stand-by generators for patients’ safety; Medical gases stations with backup systems; High quality A/Cs equipped with negative pressure systems for isolated patients. Agreements with international companies for the supply of cutting-edge medical/non-medical equipment, etc. Contracts on disposal of medical waste with quality and safety regulation. Contracted specialized company that provides advanced communications and information technology services for the transfer of patients between the centers. Provides service cars to transfer patients in need and with special needs to and from the centers.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
H.E. Dr. Bandar Al Knawy, Chief Executive Officer, Ministry of National Guard Health Affairs initiated the hemodialysis centers and headed its’ operation, all throughout the Kingdom of Saudi Arabia under the patronage of the Custodian of the Two Holy Mosques King Abdullah bin Abdul-Aziz Al Saud, His Royal Highness Prince Muqrin bin Abdul-Aziz Al Saud, Second Deputy of the Prime Minister and Counsel of the Special Representative of the Custodian of the Two Holy Mosques, launched the King Abdullah bin Abdul-Aziz Foundation for International Humanitarian Activities, Hemodialysis Project to extend care for renal failure patients on 15th of January 2014. The organization headed by Dr. Bandar Al Knawy as the Chief Executive Officer with 616 number of employees all throughout the different centers as follows: Riyadh Dialysis North Center – 145; Riyadh Dialysis South Center – 94; Hail Dialysis Center – 46; Makkah Dialysis Center – 66; Jeddah Dialysis Center – 175; Al Madinah Dialysis Center – 56; Dialysis Center Corporate Office – 34. Following the establishment of different centers across the kingdom a total of 3,354 number of patients had been treated and/or had sessions: (Riyadh Dialysis North Center: 969 patients, Riyadh Dialysis South Center: 649 patients, Jeddah Dialysis Center: 973 patients, Makkah Dialysis Center: 309 patients, Al Madina Dialysis Center: 316 patients, Hail Dialysis Center: 90 patients)
 6. How was the strategy implemented and what resources were mobilized?
The action plan is to open the Hemodialysis centers all over the Kingdom of Saudi Arabia in the most needed areas based on the statistics of population. Two (2) dialysis centers in Riyadh (North and South) with 198 stations and Jeddah with 207 stations have been launched within the first phase of this humanitarian project which followed by the launching of other centers cities across the Kingdom. The second phase of the project launched the centers in Makkah with 100 stations, Madinah with 48 stations and Hail with 38 stations which will include a total of 230 dialysis machines for patients in need. The third phase entails 295 dialysis machines where Rafha Dialysis center is included and other nominated cities in the future. The plan is to gradually reach a capacity to provide dialysis to 5,000 patients free of charge across different regions in the Kingdom over a period of seven (7) years. The foundation has taken into such as patients monitoring, radiology equipment, etc. Contracted with other pioneering operation companies to provide housekeeping, catering, laundry and environment protection services. Agreements with medical companies to provide high quality medical items to ensure patients safety. The Foundation does not only strive to provide patients with means of comfort but is also keen to increase employees’ satisfaction through providing them with fully equipped residential units where all services are available. Also, with communication and transportation services to ensure the continuation of the operational process in the centers. As well as securing featured warehouses equipped with cooling units to store medical supplies and medications for the project’s full operation to achieve the project’s humanitarian objectives. The project cost and/or commissioning cost is about SAR400 million (USD$106.6 million) while the operational cost including manpower is SAR230 million (USD$61.3 million) annually. This important humanitarian project has acquired a high national value at both social and health levels, being a charity project at the expense of the Custodian of The Two Holy Mosques, King Abdullah bin Abdulaziz Al-Saud in continuation to his keenness in serving his country and people.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders involved are the following: Dr. Bandar Al Knawy, Chief Executive Officer, Ministry of National Guard Health Affairs, King Abdullah bin Abdul-Aziz Foundation for International Humanitarian Activities funded and supported under the patronage of the Custodian of the Two Holy Mosques King Abdullah bin Abdul-Aziz Al Saud.

 8. What were the most successful outputs and why was the initiative effective?
Acknowledging the fact that human needs are given priority in the Kingdom and emphasizing the values of their life, specialized health care is being considered an integral part of the process of development of Kingdom of Saudi Arabia. The launching of various dialysis centers in different location affiliated to the Custodian of the Two Holy Mosques Foundation for Charity and Humanitarian Activities, the public have accessible centers to treat patients with a goal of optimum health care progress. Public were served in their dialysis needs delivering quality care and high quality equipment around the kingdom. Such facilities promote a humanitarian value and focus directly on the provision of dialysis care to the patients by highly qualified specialists to contribute to the development and strengthening of health services rendered in the kingdom. MNG-HA, a national healthcare institution, through providing support and experience to such humanitarian projects, has contributed to the accomplishment of such remarkable national project, which helps, in meeting the growing health needs of patients with renal failure, utilizing the highly advanced technical systems at the highest standards, and are overseen by competent doctors specialized in this area. A total of 3,354 patients from different dialysis centers gain these benefits and treatments.

 9. What were the main obstacles encountered and how were they overcome?
During the planning stage, one of the obstacle in achieving accessible dialysis centers for the public is finding a good location and building. The task force strategize in finding an existing building and medical construction company was contracted. Sourcing for the equipment for dialysis is another obstacle but were able to overcome. We were able to source out good quality equipment from Germany and other supply vendors of MNG-HA. A contract has been signed with Fresenius Medical Care, the German world’s leading provider of dialysis services for over 100 countries worldwide. The company provided the latest dialysis technologies capable of advanced dialysis treatment that improves patients’ outcomes through a number of clinical features including hemodiafiltration. The renovation of the building was fast track though quality measures is in place in order to comply with the quality and patient safety. One of the most important components of hemodialysis is the availability of very pure water through establishment of Reverse Osmosis unit. Upon setting up the project, the availability of high-tech advanced water treatment systems has been taken into consideration. Therefore, the foundation has contracted with Gambro, a world leading Sweden Company to supply water treatment systems for hemodialysis units. All the treated water distribution pipes are made of approved polyethylene (PIX) that prevents the formation of Biofilm and resists high temperatures, up to 90°C. Manpower is another issue as we need specialize consultants, physicians, nurses and other health care provider for dialysis. The task force communicated with different resources including direct head hunting and through our accredited international recruitment agencies to provide suitable qualified candidates for the dialysis centers. Currently the centers are operated by highly qualified specialized manpower team. Patients are treated with quality care and assist patient to progress toward a level of optimal health.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The public benefited with the accessible dialysis centers across the different regions in the Kingdom. The patient even up to the poorest people of the Kingdom benefited from the free services of transportation, meals, supply of medications and the patient lives greatly enhance without worrying for the cost of dialysis as the dialysis centers are funded by King Abdullah bin Abdulaziz International Foundation for Humanitarian Activities, Hemodialysis Project. This important humanitarian project has acquired a high national value at both social and health levels, being a charity project at the expense of the Custodian of The Two Holy Mosques, in continuation to his keenness in serving his country and people. Diverse quality devices and equipment with a total of 1,000 state of the art hemodialysis dialysis machines and equipment, dialysis centers buildings, medical/non-medical items, support services contracts, medications, medical supplies, support services buildings, maintenance of centers the affiliated facilities, transportation means and machinery. As of today, the Dialysis centers have a total of 3,354 patients from different locations.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The dialysis centers were opened and operational with the goal to serve the public with their dialysis needs giving the people the full commitment to the international medical standards and highly qualified medical and supervisory staff with long experience in treatment of renal failure cases. This is part of the integrity of the King Abdullah International Foundation For Humanitarian Activities to provide health services to renal failure patients with the highest quality of care with equality in treatment among people of the Kingdom. King Abdullah International Foundation For Humanitarian Activities is a non-profit organization with limited budget and resources but it provides excellent service compared with existing public projects which have unlimited resources and budget. By providing high quality service for renal failure patients in King Abdullah International Foundation For Humanitarian Activities project, it raises awareness among other public projects to meet the same high level of quality.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Yes, special measures is in place to ensure that women and girls and even both gender equality benefits from the dialysis center. In fact, we have more than 300 female employees across the various centers in order to serve the big portion of female patients. Both genders are treated equally, individualized care by all nursing staff, physicians and consultants that such care should incorporate physical, emotional and spiritual needs.

Contact Information

Institution Name:   King Abdullah bin Abdul-Aziz Foundation for International Humanitarian Activities
Institution Type:   Other  
Contact Person:   Abdulaziz Al Awad
Title:   Deputy Executive Director, Administrative Affairs  
Telephone/ Fax:   +966118043580
Institution's / Project's Website:  
E-mail:   awada@ngha.med.sa  
Address:   KAMC-MNGHA PO Box 22490
Postal Code:   11426
City:   Riyadh
State/Province:   Riyadh
Country:  

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