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8/22/2019 Colliers International - Qatar Healthcare Education Overview May 2013
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Accelerating success.
Qatar
HEALTHCARE & EDUCATION OVERVIEW
Q2 2013
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
For further information please contact:
Mansoor Ahmed MAS, MSc
Director | Development SolutionsHealthcare | Education | [email protected]. Box 71591 | Dubai | UAEMain: +971 4 453 7400Mobile: +971 55 899 6091
Duncan GrayDirector [email protected]. Box 71591 | Dubai | UAEMain: +971 4 453 7400Mobile: +971 55 720 0707
ntroduction482 offices in
62 countries on
6 continents
United States: 140
Canada: 42
Latin America: 20
Asia Pacific: 195EMEA: 85
• $2.0 billion in revenue• More than 13,500 employees• 5,100 brokers• $71 billion in transaction volume across more than
78,000 sale and lease transactions• 1.1 billion square feet under management
SERVICES OFFERED BY COLLIERS INTERNATIONAL
• Strategic & Business Planning
• Economic Impact Studies
• Market & Competitive Studies
• Highest & Best Use (HBU) Studies
• Market & Financial Feasibility Studies
• Financial Modelling
• Mergers & Acquisitions Assistance
• Buy side Advisory/Sell side Advisory
• Sale and Leaseback’ Advisory
• Public Private Partnership (PPP) & Privatisation
• Operator Search & Selection and Contract Negotiation
• Land, Property and Business Valuation
• Asset & Performance Management
• Site Selection & Land / Property Acquisition
• Performance Management and Industry BenchmarkSurveys
As healthcare and education markets in the MENA region and aroundthe world continue to evolve, the real estate and operational needs of providers and operators become increasingly complex. Trends andindustry changes require investors and operators of healthcare and
education facilities to make challenging decisions. Over the years,despite improvements in social infrastructure processes and systemsacross the region, these sectors still offer significant opportunities for investors / operators on the back of the following factors:
o High population growth rates. The MENA population increased fromaround 100 million in 1950 to 500 million in 2010. Current projectionsanticipate the population will reach 800 million by 2050, withapproximately 33% under the age of 15.
o Poor government provision in both volume and quality. Due to theincome divide in the region, the expenditure on healthcare andeducation is half of what it is in Europe and the US.
o Introduction of compulsory health insurance (by a number of regionalgovernments). After compulsory health insurance was introduced in
Abu Dhabi, the revenues of a number of private hospitals doubled inone year.
o High returns on healthcare and education investments.
o Healthcare Market
- There is a heavy reliance on imported medicine and medicalequipment. This increases the cost of establishing healthcarefacilities. There are a number of medical equipment suppliers either
providing medical equipment on long-term leases, or even byequity investment.
- Continued growth of regional medical tourism. Most governmentsin the region are encouraging medical tourism, with Jordan,Lebanon and Dubai leading the way.
o Education Market
- The government’s increasing focus on education by means of expenditure and education reforms, along with a high demand for quality education, specially from expatriate white collar families,has emphasised demand for quality branded schools.
- Compulsory education guidelines set by SEC (primary andpreparatory). The government has plans in setting secondaryeducation compulsory as well.
With an estimated population of 1.9 million residents with an annualgrowth rate of 6%, Qatar’s healthcare and education sectors cater to arapidly growing population and the concurrent increasing demand onhospitals and schools.
Overall, the supply of healthcare and education facilities makes aconsiderable effort to keep pace with the burgeoning population, asituation recognised by the government which has recently introduced
initiatives including increased budget allocations and reforms to supportthe market.
Coll iers Internation al Healthcare & Education Overview provides a
br ief snapshot of the key factors impact ing the Qatar market and
the future out look of the sectors.
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
1.1 ECONOMIC PERFORMANCE
• Qatar’s economy has become one of the fastest growing economies in theworld, driven by sustained production and rapidly expanding natural gasexport, the main component of the GDP (Refer to Exhibit 1).
• Qatar’s economy is forecasted to continue to enjoy high GDP growth over the next few years (Refer to Exhibit 2), underpinned by large capitalexpenditure programs in energy and real estate, with sustained domesticdemand. Although most of this growth can be attributed to Qatar’s coreeconomic engine, the hydrocarbons sector and the non-oil and gas sector also enjoy double-digit growth.
• Revenue generated by the hydrocarbon sector, coupled with a determinedeconomic diversification programme on the part of the government hasenabled the country to emerge as one of the wealthiest countries in the
world in terms of GDP per capita (Refer to Exhibits 3 & 4)
• Qatar’s per capita income is, though, projected to grow at a relatively slower pace after 2011, according to IMF estimates, the estimated per capitaincome in 2016 is expected to reach $113,040.
• Global hydrocarbon demand is expected to rise in 2013 as a result of continued growth in emerging markets, primarily Asia. This represents apositive indication for Qatar’s economic growth, which is highly dependenton hydrocarbon revenues.
• The global economic downturn in 2009 resulted in a low GDP (constantprices) growth rate of 8.6% compared to 25.4% in 2008, a figure which isexpected to grow by a CAGR of approximately 5% during 2013-2016.
• Impact on Healthcare & Education: Overall, Qatar’s economy has beenperforming well which translates positively towards the healthcare andeducation industries. Anticipated increases in hydrocarbon prices and
strong GDP growth forecasts will help to strengthen the market andencourage private sector investment in both sectors from Qatari nationalsand expatriates in the coming years. The following sections examine thehealthcare & education sectors of Qatar in more detail.
ource: IMF2012, Colliers International 2013
xhibit 2: Qatar GDP, constant prices
xhibit 1: GDP at Constant Prices Contribution byconomic Sectors
ource: Qatar Statistics Authority, 2010 ,Colliers International 2013
1. Economic & Demographic Overview of Qatar
3 4 . 0 7
4 0 . 4 1
5 1 . 2 3
6 4 . 2 5
6 9 . 8 0
8 0 . 9 5
9 5 . 9 9
1 0 4 . 9 2
1 0 9 . 8 0
1 1 5 . 1 4
1 2 1 . 0 3
0
20
40
60
80
100
120
140
2 0 0 5
2 0 0 6
2 0 0 7
2 0 0 8
2 0 0 9
2 0 1 0
2 0 1 1
2 0 1 2 E
2 0 1 3 E
2 0 1 4 E
2 0 1 5 E
US$Billions
Oil & GasSector 50%
Manufacturing5%
Electricity &Water
1%
Building &Const
7%
Trade, Rest,Hotels
7%
Transport &Communication
9%
Fin, Ins, & RealEstate
9%
Other Services12%
Source: Arab Human Development Report 2011 (UNDP); Colliers International 2013
Exhibit 3: GCC Countries Per Capita Income & Population Distribution
Highest Per CapitaIncome, however 2nd Lowest Population
Base in GCC
Bahrain, 1,324,27,433
Kuwait, 2,818,54,283
Oman, 2,846,28,684
Qatar, 1,840,88,314
Saudi Arabia,28,083, 24,268
UAE, 7,891,47,893
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
0 5,000 10,000 15,000 20,000 25,000 30,000 35,000
P e r C a p i t a l I n c o
m e ( U S $ )
Population (000)
Bahrain Kuwait Oman Qatar Saudi Arabia UAE
hibit 4: Arab World Income & Population Distribution
ource: Arab Human Development Report 2011 (UNDP)
Country Population
(mil l ions)
Per Capital
Income
(US$)
Population
(%) GDP (%)
Bahrain 1,324 27,433 0.38% 0.08%
Kuwait 2,818 54,283 0.80% 4.91%
Oman 2,846 28,684 0.81% 2.62%
Qatar 1,840 88,314 0.53% 5.31%
Saudi Arabia 28,083 24,268 8.02% 21.89%
UAE 7,891 47,893 2.25% 12.14%
GCC 44,801 33,322 12.79% 46.95%
Algeria 35,980 5,920 10.27% 6.84%
Egypt 82,537 6,831 23.57% 18.11%
Iraq 32,665 3,864 9.33% 4.05%
Jordan 6,330 5,966 1.81% 1.21%
Lebanon 4,259 14,609 1.22% 2.00%
Libya 6,423 16,897 1.83% 3.49%
Morocco 32,273 4,952 9.22% 5.13%
Palestine 4,152 2,465 1.19% 0.33%
Sudan 44,632 2,325 12.74% 3.33%
Syria 20,766 5,252 5.93% 3.50%
Tunisia 10,594 9,351 3.03% 3.18%
Yemen 24,800 2,333 7.08% 1.86%
Others 305,412 5,407 87.21% 53.05%
Total 350,213 8,978 100.00% 100.00%
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
1.2 DEMOGRAPHIC ANALYSIS
• Qatar’s population has more than doubled in the past decade, fromapproximately 700,000 in 2004 to almost 1.84 million in 2012 (Refer to Exhibit5).
• The rapid increase in the population over the last few years is attributed to thestrong performance of the economy, which has resulted in a large number of projects coming online, thereby leading to the influx of professionals, serviceworkers and contracting sector staff.
• Taking into consideration the current large-scale construction projects as wellas Qatar winning to host the 2022 FIFA World Cup, the population is estimated,by Colliers, to reach approximately over 2.2 million by 2016, and over 3 millionby 2020, according to IMF.
• However, due to the large expatriate population in Qatar, the number of residents above the age of 55 is limited (Refer to Exhibit 6)
• One of the major consequences of population growth is the distribution betweenQatari nationals and expatriates. Qatari nationals account for approximately25% of the country’s population, with the remaining composed of foreignexpatriate workers. From an ethnic perspective, Indians and Pakistanis are thenext largest groups at 18% each. Other Arabs account for 15%, Iranians 10%and other ethnic groups combined, total 14% of the population.
• Gender distribution in Qatar is skewed towards males, constituting 74% of thetotal population. The majority of males are within 25 - 45 years of age, acategory between Generation X (1965-1980) and Generation Y (1981 andthereafter).
1. Economic & Demographic Overview of theQatar (continued)
Exhibit 6: Distribution of Population in Qatar
The Raise of Generation X, Y & Z and
its Impact on Healthcare Demand
Lifestyle diseases (also sometimes called diseases
of longevity or diseases of civilization
nterchangeably) are diseases that appear to
ncrease in frequency as countries become more
ndustrialized and people live longer. They can
nclude Alzheimer's disease, atherosclerosis,
asthma, some kinds of cancer, chronic liver disease
or cirrhosis, Chronic Obstructive Pulmonary
Disease, Type 2 diabetes, heart disease, metabolic
syndrome, chronic renal failure, osteoporosis,
stroke, depression and obesity.
Some commenters maintain a distinction between
diseases of longevity and diseases of civilization.Certain diseases, such as diabetes, dental caries or
asthma appear at greater rates in young
populations living in the "western" way; their
ncreased incidence is not related to age, so the
terms cannot accurately be used interchangeably
for all diseases.
As a result of urbanisation and rising disposable
ncome majority of the GCC population including
Qatar, have adopted a sedentary lifestyle
characterised by an aversion to exercise and
consumption of processed foods leading to
ncreased chronic diseases (such as diabetes,
coronary problems and other obesity-related
llnesses) previously uncommon to the region. For
example, in recent years the rate of diabetes-
related illnesses have witnessed an unprecedented
ncrease in the GCC which is expected to increase
from 1.5 million cases in 2000 to 4.5 million by
2030.
Source: Wikipedia 2012; Colliers International 2013
250 200 150 100 50 0 50 100 150
0-4 yrs.
5-9 yrs.
10-14 yrs.
15-19 yrs.
20-24 yrs
25-29 yrs
30-34 yrs.
35-39 yrs.
40-44 yrs.
45-49 yrs.
50-54 yrs.
55-59 yrs.
60-64 yrs.
65-69 yrs.
70-74 yrs.
75+ yrs.
in Thousands
Male
Female
Source: Qatar Statistics Authority (QSA); Colliers International 2013
1 . 6 4
1 . 7 0
1 . 7 7
1 . 8 4
1 . 9 1
1 . 9 9
2 . 0 7
2 . 1 5
0
5
1
5
2
5
2009 2010 2011 2012 2013 2014 2015 2016
xhibit 5: Qatar Population (million)
ource: IMF2012, Colliers International 2013
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Qatar
HEALTHCARE & EDUCATION OVERVIEW
Q2 2013
Qatar
HEALTHCARE OVERVIEW
Q2 2013
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
2. Healthcare Sector OverviewExhibit 7: Distribution of Hospital Beds
2.1 INTRODUCTION
Qatar’s healthcare sector has witnessed rapid development over the past fewyears. Despite the global economic slowdown in late 2008, Qatar’s healthcaremarket continues to grow given the influx of expatriate population.
2.2 KEY PLAYERS
The Qatar healthcare sector is composed of both public and private hospitals.Qatar’s Supreme Council of Health (SCH) regulates the medical market, where itdoes not provide clinical services. The SCH delegates the responsibility for careto public institutions, such as Hamad Medical Corporation (HMC), and privatehealthcare providers (Refer to Exhibits 7& 8).
• Supreme Council of Health (SCH): The Supreme Council of Health (SCH)oversees and regulates the medical marketplace (both private and public),which is run under the Minister of Health and Secretary General, HisExcellency Abdulla bin Khalid Al-Qahtani.
• Hamad Medical Corporation (HMC) –
Public Hospitals: Hamad MedicalCorporation (HMC) is the country’s main tertiary care provider, with eighthospitals covering the country as well as a national ambulance service and ahome healthcare service.
• Private Hospitals: The private sector comprises 4 hospitals; namely, Al Ahli, Al Emadi, American, and Doha Clinics Hospitals.
• Primary Healthcare Corporation (PHCC): The main primary healthcareprovider in Qatar is the Primary Healthcare Corporation (PHCC), which wasestablished in the 1950s to deliver quality care in the first instance to thepopulation of Qatar.
2.3 BUDGET ALLOCATION• Qatar’s public healthcare budget witnessed a rapid increase during 2012. The
approved budget for financial year 2012/2013 was 47% higher than that of the previous year.
• The SCH made equally determined efforts. By 31 December 2012, the SCHGeneral Secretariat (GS) had utilised 98.6% of the approved budget for financial year 2012/2013 on applying plans for the future model of care (Refer to Exhibit 9).
• Average healthcare spending in GCC is 3% of GDP per annum. Despiteincreased budget allocations, healthcare spending in Qatar (1.9% of GDP),continues to remain behind GCC and many developed markets. Healthcare
spending in Qatar is only one-fourth in markets such as UK (9.3% GDP) andUSA (17.9%). (Refer to Exhibit 10).
ource: Qatar Supreme Council of Health 2009, Colliersternational 2013
xhibit 10: Healthcare Spending as a % of GDP
ource: Colliers International 2013
Exhibit 9: Growth in Approved Budget and Actual Expenditure
Source: SCH Annual Report 2012, Colliers International 2013
17.9%
12.0%
11.6%
11.2%
11.1%
9.3%
3.7%
3.8%
2.7%
2.3%
1.9%
3.3%
0.0% 5.0% 10.0% 15.0% 20.0%
USA
therlands
France
Canada
Germany
UK
KSA
Bahrain
Kuwait
Oman
Qatar
UAE
Supreme Council of Health
amad Medicalporation (HMC)
Private HospitalsPrimary Healthcare
Corporation(PHCC)
Exhibit 8: Key Healthcare Entities
HamadGeneralHospital
25%
RumallahHospital
17%Women’sHospital
14% Al Khor Hospital
5%
Al AmalHospital
2%
Heartospital5%
hebanpital%
rivateospitals16%
Al WakrahHospital
13%
5,782 5,586
7,197
5,355
7,1087,912
9,149
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
ApprovedBudget
ActualExpenditure
ApprovedBudget
ActualExpenditure
ApprovedBudget
ActualExpenditure
ApprovedBudget
FY 2009/2010 FY 2010/2011 FY 2011/12 FY 2012/13
Q R M i l l i o n s
HMC PHCC GS Total
ource: UNDP 2012, Colliers International 2013
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
2. Healthcare Sector Overview (continued)2.4 KEY HEALTHCARE INDICATORS
• Comparing the healthcare indicators of Qatar to other GCC markets anddeveloped countries such as the US, UK and Germany, the local marketdemonstrates a shortage of resources. The shortage is prevalent across all
GCC countries; however, undersupply in Qatar is further intensified as themarket is represented by the lowest number of beds per population evenwithin the GCC (Refer to Exhibit 11).
• Healthcare expenditure represents 1.9% of GDP. Given the lower populationbase and high GDP, Qatar currently has the highest per capita healthcareexpenditure in GCC at US$1,715 (Refer to Exhibit 13).
• With the bed ratio per 1,000 population in Qatar falling within the lowest rangecompared to both the GCC and developed countries, the market offers scopeof more hospitals in the country.
• Given the limited healthcare resources, especially within the secondary andtertiary services, the SCH sends many patients for treatment overseas.Typical destinations include Germany, the United States, and the UnitedKingdom.
• In order to address the rapidly increasing demand for healthcare services, theSCH opened 3 new facilities in 2012 - 2 new hospitals, 1 newresearch/diagnosis facility; totalling to 297 hospital beds.
- January: Cuban Hospital, in Dukhan, 87 beds.
- April: a positron emission tomography – computed tomography (PET-CT)facility, in Doha. This is Qatar ’s sole integrated cancer diagnosis andtreatment facility.
- December: Al Wakra Hospital, in Al Wakra, 210 beds, and provides a fullrange of specialties, such as general medicine and surgery.
Exhibit 11: Qatar Key Healthcare Indicators (per 1,000 people)
Source: World Development Indicators (2005-2011), Colliers International 2013
3 . 0
0 4 . 7
0 6 . 6
0
3 . 2
0
8 . 3
0
3 . 0
0
2 . 2
0
1 . 8
0
2 . 0
0
1 . 8
0
1
. 2 0
1 . 9
0
9 . 8
0 1
3 . 4
0
9 . 3
0
9 . 9
0 1
1 . 4
0
9 . 5
0
2 . 1
0 3 . 9
0
4 . 6
0
4 . 5
0 7 . 4
0
4 . 1
0
2 . 4
0
2 . 9
0
3 . 4
0
2 . 1
0 3 . 7
0
2 . 8
0
0 . 9
0
1
. 5 0
1 . 8
0
2 . 0
0
2 . 8
0
1 . 9
0
-
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
U S A
N e t h e r l a n d s
F r a n c e
C a n a d a
G e r m a n y
U K
K S A
B a h r a i n
K u w a i t
O m a n
Q a t a r
U A E
Beds Nurses Physicians
Developed Nations Qatar GCC
Hospital BedsGCC Average : 1.85 per 1,000 pop
Qatar: 1.2
Health Expenditure (public)GCC Average : US$ 895
Qatar: US$ 1,715
Life Expectancy at BirthGCC Average : 76 years
Qatar: 78 years
Exhibit 13: Qatar ’s Ranking within Global and Regional Healthcare Parameters
Source: World Bank Database, Colliers International 2013
xhibit 12: Top 5 Leading Causes of Death
ading Causes of Death in Qatar
Unclassified symptoms, external causes, and
diseases of the circulatory system, which was the
third highest cause of deaths accounting for almost
17 in every 100,000 residents.
Neoplasms, which was a common cause of death
among women, was identified as the cause of death
for every 12 persons per 100,000, indicating an
increase of cancer related deaths (Refer to Exhibit
12).
3 3 . 9
2 6 . 5
1 6 . 7
1 2 . 1
9 . 0
-
5.0
10.0
15.0
20.0
25.0
30.035.0
U n c l a s s i f i e d S y m p t o m s ,
s i g n s a
n d a b n o r m a l
f i n d i n g s
E x t e
r n a l C a u s e s o f
M o r t a l i t y
D i s e a s e s o f
t h e C i r c u l a t o r y
S y
s t e m N
e o p l a s m s
E n d o c r i n e ,
N u t r i t i o n a l a n d
M e t a b o l
i c D i s e a s e s
urce: Qatar Supreme Council of Health 2009, Colliers
rnational 2013
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
2. Healthcare Sector Overview (continued)2.5 HOSPITALS & BED CAPACITY
• Analysis of bed capacity at hospitals in Qatar reveals (Refer to Exhibit 14):
- There are currently 12 hospitals in Qatar, with a capacity of over 2,200
hospital beds, both within the public and private sectors.
- The public sector dominates the market, representing 8 hospitals, and 80%of total hospital beds, with an average of 275 beds per hospital.
- The private sector accounts for 4 hospitals, but given the limited bedcapacity, is represented by only 20% of total hospital beds in Qatar, with anaverage of 148 beds per hospital (Refer to Exhibit 15).
- Overall, the average bed capacity per hospital across the public and privatesectors, stands at 223 beds.
• Hospital beds in Qatar ’s public sector witnessed a CAGR of 5% since 2006,while the private sector witnessed 8% during the same period.
• Private hospitals continue to represent a minor stake in the market. Althoughthere are only 4 private hospitals in the country, there are more than 200private individual clinics and polyclinics in the market. These clinics arehowever small in size and offer limited facilities.
• Plans are underway for 31 further facilities (including 9 secondary and tertiaryfacilities) between 2013 and 2021 (Refer to Exhibit 16).
2.6 INPATIENTS AND OUTPATIENTS:
• The volume of outpatients is considerably higher than inpatients. This is in linewith the nature of outpatient treatments, usually consisting only of consultations,and treatments.
• Based on the latest data available (SCH Annual Report 2012), out of a totalvolume of 2.2 million encounters in HMC, approximately 42% were outpatientvisits in 2012 (Refer to Exhibit 17).
• Analysing patient volumes by type, the majority of encounters after outpatients,were ED (Emergency Department) visits, PEC (Physical Education Cards)activity and ambulance calls.
• Growing demand for healthcare facilities is further justified by the increasingutilisation/occupancy rates experienced in both public and private hospitals in
Qatar. According to the latest statistics available, average bed occupancyreached 80% in 2009.
xhibit 17: Patient Activity Analysis - SCH, HMC
d PHCC
rce: SCH Annual Report, 2012, Colliers International 2013
xhibit 14: Growth in Public Hospital Beds
rce: SCH Annual Report, 2012, Colliers International 2013
xhibit 15: Growth in Private Hospital Beds
rce: SCH Annual Report, 2012, Colliers International 2013
ct iv i ty 2011 2012 Grow th (%)
CH 182,468 219,505 20.3
HC Visits 179,811 215,774 20
C Examinations 2,657 3,731 40.4
MC 2,068,339 2,288,586 10.65
patient
missions64,722 70,444 8.84
utpatient Visits 793,737 966,139 21.72
D Visits 675,582 726,467 7.53
ay Case
rgeries12,671 12,814 1.13
ome Healthcare
sits17,560 19,767 12.57
rths 17,624 18,814 6.75
EC Activity 486,443 474,141 -2.53
mbulance Calls 69,231 110,645 22.77
HCC 3,641,336 3,817,356 4.83
sits 3,641,336 3,817,356 4.83
tal 5,892,143 6,325,447 7.35
1,641 1,623
2,208
-
500
1,000
1,500
2,000
2,500
2006 2009 2012
383426
595
0
100
200
300
400
500
600
700
2006 2009 2012
Exhibit 16: Construction Plans for SCH and HMC Secondary/Tertiary Care Facilities, 2012-2021
Source: SCH Annual Report, 2012, Colliers International 2013
Expected Opening
2014 2015 2018 2021
HMC New Women’s
Hospital
HMC Communicable
Disease Hospital
HMC New Cancer
Hospital
HMC Mass Casualty
Trauma Hospital
HMC Ambulatory and
Minimally Invasive
Surgery Hospital
HMC Translational
Research Institute
HMC Physical
Medicine and
Rehabilitation Hospital
3 SCH Hospitals
Neurosciences Institute
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
• The demand for healthcare facilities in Qatar is expected to increase rapidly given that Qatar has one of the fastest growing populations, with high life expectancy at birth and low infantmortality rates.
•Non-communicable diseases (NCDs), also known as lifestyle diseases, are also increasingat an alarming rate in Qatar as a result of increasing prosperity and the socio-economictransformation. The epidemiological profile of the market and the region includes highincidences of obesity, hypertension and diabetes mellitus, particularly Type-2, which is theleading cause of cardiovascular disease, kidney failures and amputations. The complicationscaused by these diseases will increase long-term costs, further burdening an already over-stretched healthcare system.
• Plans are underway to implement compulsory health insurance in Qatar by the end of 2014.Regional insurance players have also identified Qatar as a growing market and have alreadyestablished themselves in the country. On the back of a growing population and high incomelevels, Qatar’s healthcare market offers opportunity for expansion.
• At present the healthcare market is dominated by the government sector (Hamad Medical
Corporation) and there is a supply gap for good quality tertiary healthcare facilities in theprivate sector.
• Despite positive government measures being implemented to meet the demand for hospitalbed capacity in the country, it remains challenging to deliver new hospitals or expandexisting facilities to overcome the prevailing undersupply.
• Moreover, it is Colliers’ understanding that most of the private hospitals are family ownedand operated by doctors, with limited healthcare operators having substantial managementexperience locally, regionally and internationally.
• Given the present undersupplied market, and attractive returns offers by the healthcaresector in Qatar, Colliers sees a possibility of foreign investors taking a role in meeting thesupply gap, especially in terms of branded regional or international operators.
• Overall, the demand for health services in Qatar is expected to increase gradually, especiallyrelating to chronic diseases, such as diabetes, is expected with larger volume increases inoutpatient settings. Moreover, it is also expected that there will be aggressive growth ininpatient services relating to both maternity and childcare, and diabetes.
3. Conclusion
High Population Growth Rate
Increasing Income levels
Raising Healthcare Expenditure
Plans underway for Compulsory Health
Insurance
Positive returns on Healthcare Investment
Continued growth of Regional Medical
Tourism
s i t i
a c t
r s
e g a t i v e F a c t o r s
Unorganised Regulatory Environment comparedto Mature International Markets
Heavy Reliance on Imported Medicine and
Medical Equipment
High Transient Population
Exhibit 18: Challenges and Opportunities in Qatar Healthcare Sector
Source: Colliers International 2013
ey Observations
Urbanisation and changing
lifestyle throughout the GCC has
resulted in an increase in chronic
diseases previously uncommon
to the region, such as diabetes,
coronary problems and other
obesity-related illnesses.
Low mortality and high fertility
rates are expected to gradually
change the demographic
structure of the region over the
next 20 years and at the current
growth rate of 5% a year, the
GCC ’ s 35 million population is
expected to double over the next
two decades.
80% of a person’ s healthcare
requirements typically occur after
the age of 40-50 years. In the
next 20-30 years, when most of the current young population of
the GCC countries age, there is
likely to be a sharp rise in
healthcare demand from older
people.
Compared to these challenges,
the healthcare indicators do not
reflect the income level enjoyed
by the majority of the population
in the region. This requires heavy
investment over the medium to
long-term.
The GCC healthcare sector is
going through a rapid change and most of the governments in the
region are encouraging private
sector investment in this sector,
either direct investment or
through Public Private
Partnership (PPP).
All these shortfalls provide an
opportunity for healthcare
providers to enter into a market
which offers enormous potential
for growth.
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
COLLIERS HEALTHCARE SERVICES - SNAPSHOT
Key Projects:
300 bed Hospital in Riyadh
200 bed Hospital in Abu Dhabi 80 bed Hospital in Abu Dhabi
100 bed Hospital in Dubai
200 bed Hospital in Sharjah
100 bed Hospital in Fujairah
100 bed Hospital in Amman
2 Healthcare Parks in Jeddah
1 Healthcare Park in Riyadh
1 Healthcare Park in Cairo
Conducted Studies for the
Following Specialities (2010-2012)
• General Hospital (20+ Hospitals)
• Maternity & Childcare (10+ Hospitals)
• Polyclinics (5+ Centres)
• Day-care Centre (5+ Centres)
• Trauma & Rehabilitation (5+Hospitals)
• Cardiac (2 Hospitals)
• Paediatric (2 Hospitals)
• Oncology / Cancer (1 Hospital)
• Orthopaedic (1 Hospital)
• Medical College (1 Institution)
• Nursing College (1 Institution)
Feasibility Studies; Due Diligence;Investment Memorandums (IM)
- Conducted over 50 Feasibility Studies, InvestmentMemorandums & Due Diligence for ; new projects,
Financing & Refinancing, Merger & Acquisitions:
- Countries: UAE, KSA, Qatar, Egypt, and Ecuador
- Total Number of Beds (2010-2012): 5,000 plus
- Mixed Use Healthcare Parks (2010-2012): 5 with a totalBUA of 5+ million sqft
- Total BUA of All Healthcare Projects (2010-2012):10+
million sqft
Land; Property; Business Valuation
- Conducted over 20 Hospital Valuations for ; end of year
Audit, Financing & Refinancing, Merger & Acquisition:
- Countries: UAE, KSA, Qatar, Egypt, and Oman
- Total Number of Beds Valued(2010-2012): 1,200 plusbeds
- Mixed Use Healthcare Parks (2010-2012): 5 with a total
BUA of 5+ million sqft
- Total BUA of All Healthcare Projects Valued (2010-
2012): 10+ million sqft
Operator Search & Selection and ContractNegotiation
- Countries: UAE, KSA, Qatar and Egypt
- Total Number of Beds (2010-2012): 1,000 plus
- Total BUA of All Healthcare Projects (2010-2012): 5+ million sqft
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Qatar
HEALTHCARE & EDUCATION OVERVIEW
Q2 2013
Qatar
EDUCATION OVERVIEW
Q2 2013
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
4. Education Sector OverviewExhibit 19: Total Number of Schools in Qatar 4.1 KEY PLAYERS
• Supreme Education Council (SEC): The Supreme Education Councilestablished in 2002, directs education policy and plays a vital role indeveloping and implementing the National Strategy guidelines, “Education for
A New Era” reforms.
• Independent Schools: All former Ministry of Education schools wereapproved as fully Independent schools at the start of school year 2010/2011.Each independent school has a board of trustees, a parent association and astudent parliament. Independent schools form the majority of the educationsector in Qatar, with a 58% share (Refer to Exhibit 19).
• Private Sector: Private schools are expanding in line with growing populationfor both Qatari and Expatriate Students, currently total private schoolsconstitutes remaining 42% of the schools in Qatar.
- Improved standards in private schools and the increasing number of expatriate population are the main drivers for growth in the number of school-going children in the private schools.
- Qatari parents are increasingly spending more to send their children tointernational private schools.
• The average number of students across different types of schools variessubstantially in Qatar (Refer to Exhibit 20).
4.2 BUDGET ALLOCATION
• The Qatari government has highlighted its intentions to improve the quality of education, with its decision to allocate US$ 6.04 billion for the educationbudget during the 2012/2013 fiscal year.
• According to the latest data from the World Bank, public expenditure oneducation in the region stands at 18.6% of the total government spendingcompared to the world average of 14.2%.
• Despite increased budget allocations, education spending as % of total GDPin Qatar continues to remain behind many developed markets. Educationspending in Qatar (3.3% of GDP) is almost half compared to what is allocatedin markets such as South Africa (6.0% GDP), Netherlands (5.9% GDP) andthe United Kingdom (5.6% GDP). (Refer to Exhibit 21).
ource: Supreme Council of Education, Qatar Statistics Centre.olliers International 2013
Exhibit 20: Average Number of Students per
School
Exhibit 21: Education Spending as % of GDP
Source: UNDP 2012, Colliers International 2013
58%
8%
26%
8%
Independent Private Arabic
International Community
3.3%
3.3%
4.6%
4.8%
5.4%
5.4%
5.6%
5.9%
6.0%
6.3%
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%
Singapore
Qatar
Germany
Canada
USA
Switzerland
United Kingdom
Netherlands
South Africa
Tunisia
505
330
896 877
190
-100200300400500600700800900
1,000
I n d e p e n
d e n t
S c h o o l s
P r i v a t e A r a b i c
S c h o o
l s
I n t e r n a t
i o n a l
S c h o o l s
C o m m u n i t y S c
h o o l
O t h e r s
N o . o f S t u d e n t s
ource: Supreme Council of Education, Qatar Statistics Centre.
olliers International 2013
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
4. Education Sector Overview (continued)4.3 EDUCATION REFORMS
• “Education for A New Era” reforms. At the heart of these reforms areincreased variety and choice in education provision through a well regulatedprivate sector alongside government-funded independent schools;
internationally benchmarked curriculum standards in Arabic, English,mathematics and science; and continuous performance monitoring of schools.
• In its effort to achieve world-class standards, Qatar has made significantinvestments to improve its entire education system. Despite these continuousefforts, education performance in Qatar, as measured through internationalexamination results, are gradually showing progress.
• Qatar offers a school voucher program for its citizens at selected schools,based on demand. The programme is expected to overcome financialchallenges faced by children from relatively disadvantaged households toaccess a selected group of private schools that meet strict quality criteria; theSupreme Education Council continues to review the voucher system to
determine the feasibility of extending it to a broader group of students.Exhibit 22: Key Milestones in Qatar's Education Sector
Source: General Secretariat for Development Planning, Colliers International Research 2013
4.4 SCHOOLS AND STUDENTS BY EDUCATION CYCLE
• Qatar ’s education system entails six years of primary schooling (commencingat age 6), followed by three years at the preparatory stage and three years of
secondary schooling; the first nine years are compulsory. After secondaryschool, several pathways are available for post-secondary education. (Refer to Exhibit 23).
• Despite the fact that the number of pre-primary establishments has exceededthe number of primary schools, it must be noted that kindergartens aresmaller in size and comprise of fewer class rooms and less students thanregular schools. With regards to Qatari children, as well as for children of non-Qataris working in the public sector, primary and secondary education isfree, and thus they make up the majority of the composition of students atpublic schools.
• In addition to compulsory schooling, there has been a rapid growth in pre-primary kindergarten education in support of early childhood development;
the uptrend in kindergarten education has been driven by private providers,which in 2010/2011 accounted for 81% of total enrolments (Refer to Exhibit24).
• Overall, the education sector in Qatar witnessed a significant rise in thenumber of students across all education cycles due to the increase in nationalpopulation growth, and the influx of expatriate workers.
xhibit 23: Schools Breakdown, by level of
ducation
ource: Qatar Statistics Authority, Colliers International 2013
xhibit 24: Classes Breakdown, by level of
ducation
1949, the first"modern‟school wasopened byHamad ibn Abd Allah – its one
teacher taught fiftyboys
1956, the firstschool for girlswas formallyestablished
The governmentestablished theDepartment of Education, later called theMinistry of Education
1973, opening
of Qatar University whichevolved fromteacher-trainingcolleges – separate for men andwomen
1995, TheQatar Foundation for Education,Science andCommunityDevelopmentwas set up
2002,Implementationof theindependent
school reformbegan inSeptember 2002and iscontinuing
33%
30%
19%
17%
Pre-Primary Primary
Preparatory General Secondary
16%
47%
20%
17%
Pre-Primary Primary
Preparatory General Secondary
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4. Education Sector Overview (continued)4.5 STUDENTS
• Analysis of student population by gender in each of the education cyclesshows both male and female students have increased by almost the sameCAGR over the last five years in Qatar.
• Free education in government funded schools have encouraged theeducation of more female residents. Therefore resulting in an increase of female students in government schools weighed against males, as opposedto private schools where parents are more likely to spend on education for males (Refer to Exhibit 25) .
• During the academic year 2010/11, 60% of the total student population wasdominated by non-Qataris (Refer to Exhibit 26). Further analysis by schooltype reveals that while independent schools are primarily made up of Qatarinationals, they represent less than 20% of total student population in privateschools.
• The education sector in Qatar has witnessed a considerable decline in thenumber of students as they progress upwards from 5 years, and a drasticreduction after 15 years, having completed compulsory education. Althoughthe government has plans to make secondary education mandatory, atpresent, given the data analysed, the majority of demand is for primary andpreparatory education (Refer to Exhibit 27). Another reason for this decline isthat expatriate student’s parents prefer to send their children back home totheir country for higher education.
4.6 TEACHERS:
• According to the Supreme Council of Education, 78% of the private schoolstaff are non-Qatari females. Only 9% of the total teachers employed in theprivate sector are within secondary education. The comparatively low
allocation of staff in the secondary cycle is in line with enrolment drops after the end of compulsory schooling.
• Further analysis of teachers by type of school reveals that the averagenumber of teachers per school is the highest in international schools followedby community schools. While English is used to teach mathematics andscience from Grade 1 of primary school, according to the General Secretariatof Development and Planning, not all primary school teachers are fluent inEnglish, and only a few are adequately qualified.
• The minimum qualification for teachers at private schools is Bachelor ’sdegree with prior experience in the curriculum. For Grades 6 – 12/13, someschools require a specified degree in Education and considerable teachingexperience.
• The General Secretariat of Development and Planning revealed that there arelimited incentives for teachers to improve their overall performance, as thereis no clear link from evaluation, professional development in teaching skills tofinancial or non-financial incentives.
• The teacher/student ratio across different types of schools variessubstantially in Qatar (Refer to Exhibit 28).
xhibit 27: No. of Students by Age Group in
atar – 2010/11
Exhibit 25: Gender-wise Breakdown of
Student Population in Qatar - 2010/11
ource: Supreme Council of Education, Qatar Statistics
uthority, Colliers International 2013
Exhibit 28: Average Number of Students
per Teacher by Type of School
51%49%
Males Females
Source: Qatar Statistics Authority, Colliers International 2013
Source: Supreme Council of Education, Qatar Statistics Authority, Colliers International 2013
Exhibit 26: Breakdown of Students by Nationality
0 5,000 10,000 15,000 20,000
<334567
89
10111213141516171819202122
No. of Students
Ages
Source: Qatar Statistics Authority, Colliers International 2013
DecreasingStudent Volume
with AgeIndependent (Govt.) School Students Private School Students
Qatari students represent the majority of the population in independent schools(Govt.) mainly due to free education
10
13 13
15
6
0
2
4
6
8
10
12
14
16
I n d e p e n d e n t
S c h o o l
P r i v a t e A r a b i c
S c h o o l
I n t e r n a t i o n a l
S c h o o l
C o m m u n i t i e s
S c h o o l
O t h e r s
p
Qatari65%
Non-Qatari35%
Qatari18%
Non-Qatari82%
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• An increasing population base (due to increased economic activities as a result of increased income growth and the World Cup), together with the proposed introduction of compulsory secondary education, the education market sector in Qatar is set to grow in theshort to medium term.
• Even though the government has undertaken some active measures to meet the demandfor education staff, it remains a challenge for the education sector to deliver a student toteacher ratio that meets international standards.
• Addressing the significant undersupply in the education market, the government hasintroduced initiatives to encourage the private sector to match the shortfall and benefit fromthis potentially lucrative sector.
• Qatar, having one of the highest per capita income in world, and given the increasedeconomic activities as a result of the World Cup 2020, it is only likely that the volume of expatriates migrating to Qatar will increase. The demographics will have a predisposition tobe selective in regards to the quality of education provided to their children.
• The majority of staff employed within the private education sector in Qatar is mainlyconsisting of non-Qatari females.
• Qatar ’s optimistic plans to invest over 18% of the governmental spending in education,reflects an increased appreciation of the value and commitment towards the sector.
• The undersupplied market along with attractive returns offered by the education sector inthe private sector in Qatar, highlights significant potential for foreign investors to fill thissupply gap.
• Given the market fundamentals, it is expected that the primary key success factor for anyeducational development in the existing market is the presence of a branded regional and/international operator.
• The increasing levels of income have positively influenced the enrolment rate throughoutthe compulsory cycles, thus indicating an increased level of awareness amongst the localpopulation.
• In order to attract experienced educational staff to the country, the Qatari governmentneeds to establish a clear reward program for teachers, that is linked to professionaldevelopment, in order to provide an incentive to migrate to Qatar, as opposed to other regional markets.
• With the existing supply unable to meet an increasing demand base, and high potential for niche markets, Qatar offers a number of opportunities for educational operators in anenvironment which provides high returns and vast potential for growth.
5. Conclusion
High Existing and Expected (Due to the
World Cup) Population Growth Rate
Expected Introduction of Compulsory
Secondary Education
High returns on Education Investment in
the Private Sector
Continued Growth in Local Demand for
Quality International Schools
Low Student to Teacher Ratio
s i t i
a
c t
r s
e g a t i v e F a c t o r s
High Reliance on Non-Qatari Teaching Staff
Law Freezing Tuition Fees
Exhibit 30: Challenges and Opportunities in Qatar Education Sector
Source: Colliers International 2013
ey Observations
The education sector in Qatar
has experienced a period of
reforms since the 1990 ’s.
Attracting good teachers in Qatar
is relatively difficult compared to
other parts of the GCC.
Therefore, an aggressively and in
time recruitment policy must be in
place to ensure the hiring of
quality teachers.
Compared to the market demand,
the education indicators do not
reflect the income level enjoyed
by the majority of the population
in the country. This requires
heavy investment over the
medium to long-term.
The GCC education sector has
witnessed multiple M&A
transactions over the past two
years, signalling the high interest
from investors, and confidence in
the sector.
All these shortfalls provide an
opportunity for school operators
to enter into a market which
offers enormous potential for
growth.
Established school operators with
facilities in their home country or
in the region in the GCC are likely
to be more competitive.
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COLLIERS EDUCATION SERVICES - SNAPSHOT
Key Projects: 2,000 Student British School Dubai
1,600 Student British School Dubai
2,000 Student British School Dubai
800 Student Girls Finishing SchoolDubai
1,600 Student Girls School Dubai
2,000 Student British Day &Boarding School Abu Dhabi
2,000 Student British School Doha 1,200 Student American School
Dubai
2,000 Student Indian School AbuDhabi
Conducted Studies for the
Following (2010-2012)
• Nurseries & Kindergartens (10+)
• British Schools (20+ Schools)
• International Baccalaureate (IB)Schools (10+ Schools)
• American Schools (5+ Schools)
• French School (2+ School)
• Indian School (2+ Schools)
• German School (1 School)
• Universities (5+ Universities)
• Medical College (1 Institution)
• Nursing College (1 Institution)
Feasibility Studies; Due Diligence;Investment Memorandums (IM)
- Conducted over 30 Feasibility Studies, InvestmentMemorandums & Due Diligence for ; new projects,
Financing & Refinancing, Merger & Acquisitions:
- Countries: UAE, KSA, Qatar, Egypt, and Ecuador
- Total Number of Students (2010-2012): 50,000 plus
- Mixed Use Education Parks (2010-2012): 3 with a totalBUA of 5+ million sqft
- Total BUA of All Education Projects (2010-2012):10+
million sqft
Land; Property; Business Valuation
- Conducted over 20 Schools / Universities Valuations for
end of year Audit, Financing & Refinancing, Merger &
Acquisition:
- Countries: UAE, KSA, Qatar, Egypt, and Oman
- Total Number of Schools Valued (2010-2012): 10,000plus schools
- Mixed Use Education Parks (2010-2012): 5 with a total
BUA of 5+ million sqft
- Total BUA of All Education Projects Valued (2010-
2012): 10+ million sqft
Operator Search & Selection and ContractNegotiation
- Countries: UAE, KSA, Qatar and Egypt
- Total Number of Students (2010-2012): 10,000 plus
- Total BUA of All Education Projects (2010-2012): 5+ million sqft
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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013
482 offices in
62 countries on
6 continents
United States: 140
Canada: 42
Latin America: 20Asia Pacific: 195
EMEA: 85
• $2.0 billion in revenue
• More than 13,500 employees
• 5,100 brokers
• $71 billion in transaction volumeacross more than 78,000 sale andlease transactions
• 1.1 billion square feet under management
SERVICES OFFERED BY COLLIERS
INTERNATIONAL
• Brokerage Sales and Leasing
• Corporate Solutions
• Development Solutions
• Hotel Services
• Healthcare and Education Services
• Investment Services
• Project Management Services• Real Estate Property Management
Services
• Research Services
• Retail Advisory Services
• Valuation and Advisory Services
SERVICES BY PROPERTY TYPE
• Office
• Retail
• Hospitals/Medical Clinics
• Mixed-Use
• Industrial• Hotels
• Residential
COLLIERS INTERNATIONAL
Colliers International is a leading global real estate services organisation defined by our spirit of
enterprise. Our 13,500 professionals in 482 offices worldwide are dedicated to creating strategic
partnerships with our clients, providing customised services that transform real estate into a
competitive advantage.
COLLIERS INTERNATIONAL MIDDLE EAST
Colliers International has been providing leading advisory services in the Middle East and North
Africa region since 1996 and in Saudi Arabia since 2004. Regarded as the largest and most
experienced firm in the region, Colliers International’s expertise covers Hospitality, Residential,
Commercial, Retail, Healthcare, Education and PPP sectors together with master planning
solutions, serviced from the five regional offices, i .e., Abu Dhabi, Dubai, Riyadh, Jeddah & Cairo.
Colliers Research Services Group is recognised as a knowledge leader in the industry, providing
clients with valuable market intelligence to support business decisions. Colliers research analysts
provide multi-level support across all property and business types, ranging from data collection to
comprehensive market and competition analysis.
OUR SPECIALISATIONS
The information contained in this document (the “Report”) has been obtained from sources deemed reliable. While every reasonable effort
has been made to ensure its accuracy, we cannot guarantee it. No responsibility is assumed for any inaccuracies. Readers are encouragedto consult their professional advisors prior to acting on any of the material contained in this report.
Colliers International makes no warranty, representation or undertaking whether expressed or implied, nor does it assume any legal liability,whether direct or indirect, or responsibility for the accuracy, completeness, or usefulness of any information contained in the Report. It is notthe intention of the Report to be used or deemed as recommendation, option or advice for any action(s) that may take place in the future.
Unless otherwise stated, all information contained in this Report shall not be reproduced, in whole or in part, without the specific writtenpermission of Colliers International.
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Director | Development Solutions
Healthcare | Education | Public Private Partnership (PPP)
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