Toward the indigenization of the nursing workforce in Saudi Arabia comaparative study of three ...

298 Pages·2016·18.33 MB·English

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Al-Thowini, Kasem; (2009) Toward the indigenization of the nursing workforce in Saudi Arabia coma-
parative study of three gulf states Saudi Arabia, bahrain and Oman. PhD thesis, London School of
Hygiene & Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.00682428
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DOI: https://doi.org/10.17037/PUBS.00682428
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honline.lshtm.ac.ukhttps://researc
Toward the indigenization of the nursing workforce in Saudi
Arabia
Comparative study of three Gulf states: Saudi Arabia,
Bahrain and Oman
Thesis submitted by
Kasem AI-Thowini
BSc, MSc
F or the degree of
DOCTOR OF PHILOSOPHY
In the
Faculty of Health Services Research Unit
University of London
Department of Public Health and Policy
London School of Hygiene and Tropical Medicine
University of London
2009
Abstract
For the last three decades, the Gulf Cooperation Council (GCC) states, comprising
Bahrain, Kuwait, Sultanate of Oman, Qatar, Saudi Arabia and the United Arab
Emirates (UAE) have relied heavily on doctors, nurses and allied health professionals
recruited from other countries. Globally, there is a persistent shortage of doctors and
nurses and the GCC countries are no longer able to meet their human resource
requirements through international recruitment. They have thus pursued policies that
aim to increase the supply of qualified indigenous health-care professionals -
indigenization.
This study aims to understand and examine why and how an indigenization policy has
been formulated and implemented in a purposively selected sample of three Gulf
States. Saudi Arabia, Bahrain and Oman have many commonalities and the structures
of their health-care services, labour force and indigenization policies confront similar
broad issues and challenges. However, they were selected to represent different social,
cultural and policy environments in the region and different levels of success in
creating an indigenous nursing workforce.
This study employs a qualitative research approach to generate an in-depth
understanding of the factors that facilitate or inhibit the implementation of
indigenization policies in nursing. This includes semi-structured interviews with 78
stakeholders comprising current and former policy-makers, human resource
managers, religious leaders and nursing officials living and working in one of the
three Gulf States. Document analysis provided the historical and technical
background for understanding the mechanism of the indigenization policy process and
practices. Findings reveal that cultural, economic and political issues play important
roles, as do society's views on education, the role of women and the image of nursing.
The recommendations to address these issues, particularly in respect of increasing
women's participation in the workforce, may contribute to the development of nursing
in the Gulf.
2
Index of contents
Abstract 2
Index of contents
3
Dedication
8
Acknowledgments 9
Chapter 1. Gulf states: introduction and historical background 10
l.1 Introduction 10
l.2 Transformation of the Gulf 11
1.2.1 Background 11
1.2.2 Demographic characteristics 12
1.2.3 Transformation of Gulf society 14
l.3 The Gulf Cooperation Council (GeC) 17
1.4 Summary 18
l.5 Religion 18
l.5.1 Islam 18
l.5.2 Impact on health workers 19
l.6 Bahrain 20
l.6.1 Geography 20
l.6.2 Demographic and social characteristics 21
1.6.3 Health service and the Ministry of Health 23
1.6.4 Education 24
l.7 Oman 25
l.7.1 Geography 25
l.7.2 Demographic and social characteristics 26
l.7.3 Health service and the Ministry of Health 27
l.7.4 Education 28
l.8 Kingdom of Saudi Arabia 29
l.8.1 Geography 29
l.8.2 Demographic and social characteristics 30
1.8.3 Health service and the Ministry of Health 32
1.8.4 Education 34
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1.9 Chapter summary 35
Chapter 2. Literature review 37
2.1 Introduction 37
2.2 Limitations 38
2.3 Nursing shortages 39
2.3.1 Factors contributing to global shortage of nurses 40
2.3.2 Consequences of nurse migration 41
2.4 Nursing shortages in the Gulf 42
2.4.1 Background 42
2.4.2 Recruitment and retention of indigenous nurses 44
2.4.3 Recruitment of foreign nurses 45
2.4.4 Factors influencing nurse shortages in the Gulf 46
2.4.5 Importance of an indigenous nursing workforce 48
2.4.6 Summary 48
2.5 Human resources for health in the Gulf 49
2.5.1 Shortage of indigenous human resources the 50
In
heal th servi ce
2.6 Women's participation in the Gulf workforce 52
2.6.1 Women's participation in the three Gulf states 54
2.6.2 Why is Saudi Arabia different? 54
2.6.3 Summary 56
2.7 Human resources in the Gulf 57
2.7.1 Characteristics of human resources in the Gulf 57
2.8 Labour markets in the three Gulf states 59
2.8.1 Labour market in Saudi Arabia 60
2.8.2 Labour market in Oman 63
2.8.3 Labour market in Bahrain 65
2.8.4 Foreign labour in the Gulf 67
2.9 Policy-making in the Gulf 70
2.9.1 Background 70
2.9.2 Public policy-making process in the three Gulf states 71
2.9.3 Indigenization as a public policy 73
2.9.4 Bahrainizati on 76
4
2.9.5 Omanization 77
2.9.6 Saudization 78
2.9.7 Indigenization and the role of education and training 84
2.9.8 Indigenization policies and culture in the Gulf 86
2.10 Chapter summary 88
Chapter 3. Research process and methodology 91
3.1 Introduction 91
3.2 The researcher and the research 92
3.3 Practical difficulties and implications of lack of 95
data
3.4 Evolution of research questions 96
3.5 Framework for understanding indigenization 97
policies
3.6 Research approach 98
3.7 Research design 101
3.7.1 Case studies 101
3.8. Data collection process 103
3.8.1 Selection of case studies 104
3.8.2 Selection of participants 105
3.8.3 Sampling strategies 107
3.8.4 Access to research setting 110
3.9 Data collection methods III
3.9.1 Interviews 112
3.9.2 Documentary analysis 116
3.10 Data analysis of interviews and documents 117
3.10.1 What is stakeholder analysis? 120
3.10.2 Cross-national comparison 123
124
3.10.3 Open coding
3.10.4 Theoretical coding 125
3.11 Ethical considerations 125
3.12 Strategies for enhancing rigour of the research 126
3.13 Chapter summary 129
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Chapter 4. Indigenization - regional policy, multiple voices 131
4.1 Introduction 131
4.2 Policy development and structure 132
4.2.1 One concept, different perspectives 132
4.2.2 Changing concept of indigenization policies 134
4.3 Bahrainization and Omanization 138
4.4 Implementation of the indigenization policy 140
4.4.1 Implementation in the public sector 140
4.4.2 Implementation in the private sector 146
4.4.3 Incentives and penalties for implementing 152
indigenization policies
4.5 Indigenization in the health service 154
4.5.1 Global competition 155
4.5.2 Strategy for development of indigenous health-care 155
workers
4.6 Indigenization in nursing: where is the indigenous 160
nurse?
4.6.1 Indigenization strategies in nursing 162
4.6.2 Nursing education 164
4.7 Recruitment and retention 169
4.7.1 Factors inhibiting recruitment and retention 171
4.8 Implementation of indigenization policy in 173
nursing: what and where are the problems?
4.8.1 Contextual factors 174
4.8.2 Organizational factors 191
4.8.3 Situational factors 194
4.9 Chapter summary 198
Chapter 5. Image of nursing in the Gulf: "What is an indigenous 200
woman like you doing working as a nurse"?
5.1 Introduction 201
5.2 Economic issues 203
5.3 Social attitudes 208
5.3.1 Role of the family 214
218
5.3.2 Knowledge
219
5.4 Religion
5.5 Gender relations in the Gulf 223
5.6 Media influence 227
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5.7 Role models 228
5.8 Chapter summary 230
Chapter 6. Discussion and conclusion: fate of the indigenous nursing 233
workforce in the Gulf
6.1 Introduction 233
6.2 Empirical research literature 234
6.3 Key findings 236
6.3.1 Image of nursing is key to improving indigenization 236
of the nursing workforce
6.3.2 Human resource practices inhibit career progression 239
for indigenous nurses
6.3.3 Local cultures and religions: impact on 240
indigenization of nursing
6.3.4 Indigenous female nurses and multidimensional 241
di scriminati on
6.4 Is there a GCC policy process? 243
6.5 Implementation of indigenization policies: 243
challenges and constraints
6.5.1 Slow policy response 244
6.5.2 Recruitment and retention strategies 244
6.5.3 Indigenous workers lack skills and experience: myth 245
or fact?
6.6 Gulf education and training systems cannot meet 246
the needs of the labour market
6.7 International recruitment can be beneficial 247
6.8 Availability, accessibility and transparency of 247
data in human resources for health
6.9 Conclusion and recommendations 248
6.10 Future research 254
Appendices 256
References 272
7
Dedication
This dissertation is dedicated to my grandfather Abdullah, my father Mohammed and
my mother Latifa who have shared with me their knowledge and experience and
encouraged me to be always a student of knowledgeable and experienced people.
I also dedicate this dissertation to all the health-care professionals, especially those in
the nursing profession in all three Gulf countries, who desired to provide meaningful
information to help me complete this research.
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Acknowledgements
I want to express my heartfelt thanks to all the participants - the indigenous nurses
and students~ national and local stakeholders~ and those who assisted in organizing
access to the research sites and willingly shared their thoughts, opinions and
experiences. This research would not have been possible without them. I also want to
express my great and deepest appreciation to my supervisors Anne-Marie Rafferty,
Jill Maben and Elizabeth West for their support and encouragement.
I must express my special appreciation and gratitude to my day-to-day supervisor Jill
Maben who also played the role of mentor, providing counsel and guidance
throughout this research. She believed in and helped me, especially in those times
when I really needed a friend and a supporter. I was so lucky to have someone like Jill
as a friend and supervisor.
In addition, I want to thank my supervisory committee members, especially Professor
Charles Tripp from the School of Oriental and Mrican Studies. He was always very
helpful and his input is very much appreciated. I also want to thank all the people and
friends who supported me throughout this research especially Gill Walt, John Cairns,
Karen Clark, Avril McAllister and all those who work in the health service and policy
research units and computer department. My appreciation also goes to Professor Pam
Smith (University of Surrey) and Dr. John Carrier (LSE) for their contribution and
recommendations as examiners. Finally, I want to express my indebtedness to my
wife Zubaida and my children Mohammed, Sara, Abdullah, Khalid and my newly
born son Talal for their continuous support, encouragement and patience. Without
them this research would not have been possible.
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