A Community Health Assessment is a systematic approach to the collection and analysis of health data used to identify and describe outstanding community health needs, inequities in health and access to services, and to determine priorities for the most effective use of resources to address identified needs.

The HSE team has completed a comprehensive, data-informed Community Health Needs Assessment (CNA), in which THE COMPANY population played a key role in identifying the top health problems and priorities.

Health data include information on risk factors, quality of life, social determinants of health, determinants of inequity, mortality, morbidity, community assets, forces of change, and information on how well the public health system provides essential services.

This report provides a sample and overview of findings from a community health needs assessment conducted in Qatar, in order to assess health needs in the healthcare service areas served by the Health and safety of The company. 

 

  CNA Goal and Objectives

The ultimate goal of CNA is to improve the THE COMPANY community health status and quality of life.

1. Objectives:
   develop a comprehensive profile of health status, and care management indicators to better understanding of the community health.
2. Identify the priority health needs (primary health care) within the THE COMPANY community in all locations.
3. Serve as a foundation for developing subsequent recommendations to inform strategic, operational, and service planning within HSE.

 

 Health Care Facilities and Resources

 

The Health and safety (HSE) is withstand the day-to-day corporate health challenges and offers high-quality primary care and emergency care to around 165,800 people in various industrial locations.

HSE is committed to serving the business interests of THE COMPANY.

 

Primary Health provides continuing and comprehensive healthcare for individuals and families across all ages, sexes, and diseases, covering a range of family medicine and EMS services:

• Routine care for acute, short term illnesses
• Chronic disease management,
• Health promotion preventive medical care
• Enhanced primary care services
• Emergency Medical Services
• Administrative services

 

 Service Area

Primary health services are provided to THE COMPANY employees and other eligible beneficiaries.

The served population can be categorized into four groups.

1. THE COMPANY Employees and their dependents
2. JVC’s employees covered under private insurance agreement
3. Contractors covered under private insurance agreement
4. Local community in remote industrial areas where HSE is the only primary care provider.

 

 Data Sources

CNA project seek to identify priority health status and access issues for THE COMPANY populations. Conducting a health needs assessment requires the collection of both quantitative and qualitative data about the population’s health and the factors that affect it.

The most current data available was used to determine the health needs of the community.  Accordingly, the following data are assessed:

1. Demographics: from the THE COMPANY human resources annual statistics report
2. HSE electronic medical records: common health conditions, risk factors and health indicators
3. Qualitative data: interviews, focus group meetings
4. National health data: Ministry of Health annual reports.

 

Demographics

The primary population served by HSE centers is THE COMPANY employees and their families’ counts 39801, this cluster is well defined and the main target of service, THE COMPANY’s human resources are able to provide detailed demographics information on this group regularly and precisely.

on the other hand, JV’s employee groups are not full defined,  some of them are only covered partially by HSE clinics, the have high turnover rates, some of contractors work for A Short period up to 3 months so no accurate demographic are available on these groups.

 

Age Distribution

THE COMPANY, people are generally younger than in the rest of the state, it is primarily a working group with few elderlies.  The highest percentage of THE COMPANY’s population is 25-44 years old, whereas most of Qatar residents are 45 to 64 years old.  In addition, 47 percent of THE COMPANY population is under 20 years of age, compared to 22.60 percent in Qatar as a whole.  Only 10% are over 50 and 1 % over 60.

 

 

Job level

THE COMPANY employees are divided into 2 job levels, juniors and senior staff, although the first group received better allowance packages, both groups are  well paid and supported by the company.

Socioeconomics

Qatar, according to International Monetary Fund, is considered one of the highest income countries with a per capita GDP (PPP) of over 105 thousand dollars USD (IMF 2014).

The company is recognized as a one of best employer in Qatar. Provides a highly competitive benefits package for all employees working in the company with medical insurance, transportation, and educational assistance to their dependents. In addition, the company offers

Employees with competitive salary and compensation packages. Benefits include:

• retirement, savings and insurance plans,
• Paid annual vacation and company holidays.

Education: The THE COMPANY employees has a high level of educational attainment, with at least a high school diploma, in addition the company offer scholarship program and grants opportunity to young Qatari employees under training, and educational assistant to all employees’ dependents.

National Health Data

National health statistics data was used to help guide the process of prioritization and the health needs part of this report.

Analyzing these data gives insight to the key health problems, resources and burdens in THE COMPANY community, and help in benchmarking the health indictors of our community with national ones, the source of data were, SCH reports and international sources such as WHO and UNDP reports as well as other sources such as the national adults smoking survey. Chronic non-communicable diseases (NCDs), such as cardiovascular diseases hypertension and diabetes, have been established as the cause for a major burden and threat to the Qatari community (Haj Bakri 2013).

NCDs constitute more than half of the deaths registered per annum and with many more suffering of one or more of these diseases.

 

Chronic diseases

Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death globally, representing 30 percent of all deaths (WHO 2013).

Most CVD can be prevented by addressing risk factors. These risk factors include raised blood pressure, and raised blood cholesterol.

 

Stepwise Survey found a 32.9 percent prevalence of raised blood pressure among respondents (Haj Bakri 2013).

 

The prevalence was higher among females, at 37.7 percent, than males, at 28 percent.

The Qatar Stepwise Survey found a 21.9 percent prevalence of raised total cholesterol among respondents (SCH 2013)

The prevalence was higher among females, at 24.6 percent, than males, at 19.1 percent.

The share of registered deaths related to CVD in 2012 was 12.1 percent. This represents minimal change since 2011(SCH 2013).

.

Diabetes

Diabetes is one of the most common NCDs, with type 2 diabetes comprising 90 percent of all cases (SCH 2012).

The Qatar Stepwise Survey provides the prevalence rate of raised blood glucose, as a measure of diabetes, for the Qatari population aged 18–64.

In 2012, the Qatar Stepwise Survey found a 16.7 percent prevalence of raised blood glucose among respondents (Haj Bakri 2013).

The prevalence was higher among males, at 17.6 percent, than females, at 15.9 percent.

 

 Cancer

Cancer is a leading cause of death globally, with the incidence predicted to rise 37 percent by 2025 (WHO 2013).

In 2012, Qatar’s cancer incidence was 7.1 cases per 10,000 population. This represents a 22 percent increase since 2011, (SCH 2014).

 

 The cancer incidence was 10.8 cases per 10,000 population for the Qatari population, and 6.5 for the non-Qatari population. The incidence was higher for females than males in the Qatari population, at 12.5 compared to 9.1, respectively, and the non-Qatari populations, at 12.8 and 4.8, respectively.

The five most common cancers in Qatar were breast cancer (18.9 percent), bone marrow cancer (8 percent), colon cancer (7.3 percent), and skin cancer (6.9 percent).

 

 

National risk factors:

The major behavioral risk factors in Qatar are (Haj Bakri 2013):

• Currently daily smokers
• less than 5 serving of fruits and vegetables per day
• low level of activity (<600 MET-minutes)
• overweight or obese (BMI ≥ 25 kg/m2)
• raised BP(SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

Respondents with low risk factors

As such, based on the aforementioned, the overall prevalence of respondents with low risk factors (0 risk factors) was 0.8% being higher among men than women (1.3% vs. 0.3%). See table 3.46.

 

Respondents with high risk factors

The overall prevalence of respondents with high risk factors (3-5 risk factors) was 50.6%. The difference in prevalence between men andwomen were very little.

 Smoking Status

20.2% of men, 3.1% of women, and 12.1% overall (51 thousand adults) currently smoked tobacco. Among Qatari, 21.3% of men, 0.6% of women, and 10.5% overall (16 thousand adults) currently smoked tobacco. Among Non- Qatari, 19.6% of men, 4.6% of women, and 12.9% overall (35 thousand adults) currently smoked tobacco (GATS 2013).

 

 Mortality rate

In Qatar, the crude death rate declined from 1.88 per 1000 to 1.15 per

1000, between 2001 and 2010 (Haj Bakri 2013).  In 2011, the adult mortality rate* was 52 for women and 74 for men ( per 1000) according to the Human Development Report (UNDP 2014).

The total life expectancy at birth increased from 74.4 in 2001 to 78.4 in 2013 (UNDP 2014).

 

*Adult mortality rate: Probability that a 15-year-old will die before reaching age 60, expressed per 1,000 people

 

Cause of death

Over time in Qatar, the mortality contributions from non-communicable diseases rise, and contributions from communicable diseases and external causes decline (UN 2012).

 

According to Qatar health report (SCH 2014), the top five causes of classified death were:

• Diseases of the circulatory system
• Neoplasms
• Endocrine, nutritional and metabolic diseases
• Diseases of the respiratory system.

Perinatal death

 

Road traffic accidents

Road traffic accidents (RTAs) are a major cause of death and disability globally; High rates of serious RTAs have been reported for several Arabian Gulf countries. Qatar’s rate of road traffic deaths is almost 25 percent higher than the global average(WHO 2012).

According to stepwise survey in2012 (Haj Bakri 2013) The results illustrate that 14.9% of the respondents have been involved in a road traffic crash as a passenger, driver or pedestrian in the last 12 months prior to the interview. The proportion was higher in men than that in women (16.9% vs. 12.9%). 

Qatar’s estimated road traffic death rate is 23.7 deaths per 100,000 population; the estimated global average is 19.4 deaths per 100,000 population; Qatar’s world rank: 58/178 (WHO 2012)

Secondary Data Assessment (clinical data form EMR)

 HSE adopted an Electronic Medical Records to document clinical activities and to provide access all clinic data, annual statistics reports created annually to calculate indicators and measure the performance of the organization.

 

 

 Most common health conditions

34,477 patients visited HSE because of upper respiratory tracts infections (URTI); it is the most common diagnosis 2014.

12.30% of visits were due to URTI, cough or common cold.

The table below is extracted from the 2014 EMR report shows the top 10 diagnosis in 2014

Diagnosis	Clinic visits
Infection;upper resp tract	34477
HTN	20221
Diabetes	19995
Deficiency;vitamin D	10212
Dyslipidaemia	8870
Cough	4640
Hypothyroidism	4907
Common cold	4584
Well Baby clnic visit	4485
Dental Exam	4307

Top 10 diagnosis

 

8.2- Top five chronic diseases

Hypertension (HTN) and diabetes mellitus were the top 2 diseases in THE COMPANY community in 2014. 2750 hypertensive patients visited the clinic 20221 times and 2556 diabetics visited 3546 times, these numbers go inline with the national statistics.

The table below shows the most common chronic disease according to number of visits and to unique patient’s numbers.

Diagnosis	No. of visits	No. of patients	visit per patient
HTN	20221	2750	7.4
Diabetes	19995	2546	7.9
Vit D Deficiency	10212	1903	5.4
Dyslipidemia	8870	948	9.4
Hypothyroidism	4907	634	7.7

 Top 5 chronic diseases

 

 

 Obesity

Obesity is a major public health problem worldwide; Qatar is one of the highest county in terms of obesity rates.

According to the WHO, the prevalence of overweight in high-income and upper-middle income countries was more than double of that in low and lower-middle income countries (WHO 2011).

 

 

 

The prevalence rate of overweight, which means the prevalence of THE COMPANY employees with BMI ≥ 25 kg/m2 was 65% and the prevalence of obesity was 26.6%.

It is lower than the national rates, though, higher than the international rates.

The national data; the overall prevalence rate of overweight is 70.1%. and 41.4% of The respondents were obese, (Stepwise Qatar 2012)

Worldwide, 39% of adults aged 18 years and over were overweight in 2014, and 13% were obese (WHO 2014).

 

 Current smoking Status

The overall prevalence of smoking was 11% among THE COMPANY population. It is lower than the national level of 12.1% (GATS 2013) in addition; it is lower than the global smoking rate of 22% (World health statistics 2013).

 

Health needs Survey - Customer satisfaction

HSE are conducting an analysis of the health needs of THE COMPANY population.  Along with gathering data about how the population is satisfied about the services provided, 

The survey used gather information from all locations regarding their perceptions about their health and health services provision.

Online survey conducted in 2014, sent to all THE COMPANY employees, as the company provide internet access to its entire staff. The survey results provide insight into THE COMPANY community health.

   

HSE selected Health indicators

 

The National health services indicators

 

These indicators are mandatory required by the government (SCH) from all healthcare providers in Qatar.

THE COMPANY HSE calculates and provides these indicators regularly to SCH.

The purpose is to enable providers to use a common framework for measurement and assessment for the accurate and regular collection of data and to improve the quality of healthcare services, monitor and measure the overall performance of the health system.

Which would help achieve the ultimate outcome of enhanced health status for the population of Qatar.

2014 HSE indicators:

1. % Diabetics aged 18-75 years who received an Hemoglobin A1c (77.5%)
2. % Diabetics with HbA1c<9% the indicator in THE COMPANY population is 64.9%, it means that 35.1% of DM patients are in poor control, this is a relatively high rate; in comparison with the US National Health and Nutrition Examination Survey, the prevalence of poor controlled DM is 12.9%. (Ali MK 2012)

 

3. % Hypertensive patients with BP 140/90 or less; in THE COMPANY population it was, it is almost similar to the national figure, according to the Qatar stepwise survey, the percentage of respondents with blood pressure with BP 140/90 or less was 67.1 % (Haj Bakri 2013).

 

Adults who are obese

Obesity is a known risk factor for chronic diseases such as diabetes and cardiovascular disease. 

The prevalence rate of obesity was 26.6%. It is lower than the national rates, though, higher than the international rates. (Stepwise Qatar 2012)

Worldwide, 13% of adults aged 18 years and over were obese (WHO 2014).

 

Self-reported health status

Self-reported health status is a good predictor of future disability, hospitalization and mortality.

 Data from the HSE patient satisfaction survey in 2014 shows that majority of THE COMPANY employees rating themselves as being in very good or good health.

 

A commonly asked question relates to self--perceived health status, of the type: How is your health in general? Despite the subjective nature of this question, indicators of perceived general health have been found to be a good predictor of people’s future health care use and mortality (DeSalvo, 2005).

In total, 69% answered that their health is above average (very good or excellent) and 4% poor health, male 69%, 6% female 64% and 5% respectfully. It is comparable to the international rates, in the OECD countries, 69% answered that their health is good, 71% in male and 64% in females (OECD 2013).

 

Workforce Density

HSE primacy care workforce

HSE family division comprises 398 employees, the bulk of which constitute nursing staff (272), medical officers (74) and pharmacists and assistants (26) operating out of four main geographic areas covering the State of Qatar.  HSE also relies on the support of 48 receptionists, 13 administrative assistants, 4 regional administrators and 1 driver. 

 

 

Workforce by Density

Health workforce by density measures the number of key health personnel per 10,000 population, and the ratios of key health personnel.

 These are used as indicators of the availability and composition of the health workforce.

In 2012, the health workforce density in Qatar was 58.1 nurses, 25.3 physicians, 6.3 pharmacists and assistants, and 9.7 dentists per 10,000 population.

In 2012, the ratio of physicians per pharmacist was 4.02. This represents a 57 percent increase since 2011.

Qatar’s health workforce densities were higher than the GCC averages, and lower than the OECD averages.

Qatar’s ratio of physicians to pharmacists was higher than the GCC and OECD averages.

 

THE COMPANY HSE model population

68292 patients have visited HSE clinics in 2014,The over all population served by HSE count around 165800, however many of them have access to other primary health care providers, to calculate a accurate number of client that relay exclusively on HSE primary care, we used a mathematical calculation to estimate the model population. Using the factor of 82%; the fraction of the population that visit a doctor at least once per year (Blackwell 2014). The Model population is 85,365

THE COMPANY health workforce density

In comparison with the national rates, THE COMPANY has by far a lower level of healthcare workforce density. With 17 nurses and 4.6 per 10,000 population.

 

 Workforce density

 

 

Density (per 10,000)	OECD	GCC	Qatar	THE COMPANY
Nurses	86.8	40.9	58.1	17
Physician	30.2	17.7	25.3	4.6
Pharmacists and Assistants	9	5.2	6.3	1.6

 

 Health professional density, THE COMPANY, Qatar, GCC and OECD

OECD: Organisation for Economic Co-operation and Development

 

 

Adjusted workforce density

Buy using the adjusted model population of 85365, the density indicators will rise to 32 and 8.7 per 10,000.

 Adjusted workforce density

 

Density (per 10,000)	OECD	GCC	Qatar	THE COMPANY
Nurses	86.8	40.9	58.1	32
Physician	30.2	17.7	25.3	8.7
Pharmacists and Assistants	9	5.2	6.3	3

 

 Adjusted density, THE COMPANY, Qatar, GCC and OECD

 

 

Average Annual Number of Physician Visits per Capita

HSE clinics noticed 365000 clinical episodes in 20014, 68292 patients and overall population of 165000.

This represents an average of approximately 30,000 visits per month over this period.

The average visit per capita is 2.2; it is relatively low rate in comparison with national and international figures, (Qatar Health Report 2012) by using the adjusted model population, the rate will be 4.3 visit per capita per year.

 

Region	Visit per capita
UK	5
USA	4.1
OECD	6.4
Qatar	3.8
THE COMPANY	2.2
THE COMPANY adjusted	4.3

 no. of visits per physician

 

Average Annual Number of Physician Visits per Capita (Qatar Health Report 2012)

 

Mental Health Care Capacity

Mentally healthy workforce is linked to lower medical costs, as well as less absenteeism and better productivity. Stress has become a common and costly problem in the workplace. ‘One-fourth of employees view their jobs as the number one stressor in their lives.’(NIOSH 2014)

HSE mental health clinic offers different types of services and treatments for depression anxiety and other conditions. Run by a Psychiatrists and mental health nurse practitioner.

In 2013, HSE conducted an online stress assessment survey using the Perceived Stress Scale PSS10. 564 employees responded to the survey. The stress level was divided into low, moderate and high based on cut of point that has been used by

Out of 564 respondents, 67.4 % perceived they have some form of stress at either moderate level (58.7%) or high level (8.7%).  The low level of stress was perceived by 32.6 % of the respondent the mean stress score of the respondents was 16,8 which is higher than, Scores around 13 are considered average,( Cohen 1988).

 

 

                     Vulnerable group

Elderlies: the company’s population is young and only 1% of them are over 60 years of old, and only 1% of patients visited HSE clinics in 2014 are over 65 years of age.

Language barrier: The official language of the company is English, and all staff join work are tested for language proficiency. However, few number of local retiree may have some communication difficulty due to language barrier.

Al HSE clinics provide a bilingual receptionist to assist those patients in appointment booking and accessing health services.

 

 

 Prioritized Health Needs - Areas of Health Concern

 

The analysis of all of the information gathered was completed in a number of stages. Analysis of the quantitative data identified indicators of particular importance to the community, these indicators compared with national and international indictors in order to identify priorities. Inadditoin, Qualitative data collected from clients feed baqck, interviews,  andfocus group meetings.

Results of the information gathered from each source was compared to determine if the various sources of data were giving us the same health issues. When a health issue were presented as priority in more than one data source, we were provided with validation of the results.

The list below shows the health issues that presented in one or more of the data set as a health priority to THE COMPANY community:

The needs listed below summarized the health issues identified by the assessment as priority needs across the entire THE COMPANY community served by the HSE clinics. 

• Diabetes mellitus
• Hypertension
• vitamin D  Deficiency
• Dyslipidemia
• Children's Health 
• Obesity
• Access to healthcare
• Health Professional Shortage Area
• Mental health services provision
• Hypothyroidism
• Tobacco Use

 

Based on their expertise and existing resources, HSE team has selected the below five priority categories of concern:

• Chronic Diseases: Diabetes high blood pressure and CHD
• Lifestyle/Health Behavior Concerns: Obesity, healthy eating/nutrition, and lack of places to participate in physical activities in workplace.
• Vitamin D deficiency
• Access to service, appointments, Shortage of healthcare professionals and parking.
• Children's Health services provision.

 

 

 

Information gap and limitations   

Inaccessibility of consistent and current data caused some information gaps. Some statistics are not current indicators of the current health status, for example the national health report is dated 2012.

 

The main limitation of the survey was that the primary data was collected through self-reported online questionnaire.

Respondents might have recalled inadequately the duration of their morbidity.

 

Employees are able to receive PHC services from other private or public healthcare providers, this make data collection more difficult.

Not clearly defined population segments; THE COMPANY staff, dependent, JVs and contractors.

 

 

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