Saudi Arabia has committed vast resources (US$16.4 billion in the years 1985 to 1990) to improving medical care for its citizens, with the ultimate goal of providing free medical care for everyone in the kingdom. In 1990 the number of hospitals operated by the government and the private sector together stood at 258, with a capacity of 36,099 beds. Of these hospitals, 163 were run by the Ministry of Health and sixty-four by the private sector. In addition, other government agencies, such as the national guard, the Ministry of Interior, and the Ministry of Defense and Aviation, operated hospitals and clinics for their staffs and families. There were also thirty-one teaching hospitals attached to the medical faculties of universities in the kingdom (see table 3, Appendix).

King Fahd Medical City outside Riyadh was a US$534 million project. It was to include five hospitals of different specializations, with a capacity of 1,400 beds in addition to outpatient clinics, and was expected to be completed in the early 1990s. To provide personnel for the expanding medical facilities, which in 1992 were staffed largely by foreign physicians, nurses, technicians, and administrators, the government has encouraged medical education in the kingdom and has financed medical training abroad. Four of the kingdom's seven universities offered medical degrees and operated well-equipped hospitals. Saudi universities also had colleges of nursing, pharmacology, and other fields related to the delivery of medical care.

One objective of medical planning was to sponsor cutting-edge research in the kingdom. There were some reported successes. The King Saud University College of Pharmacology developed a drug effective in stabilizing blood sugar in diabetics, and heart surgeons at the Armed Forces Hospital Heart Center in Riyadh performed innovative open-heart surgery on an infant. At the College of Sciences of King Saud University, scientists have used radioactive isotopes to determine the effect of antibiotics on body functions. The King Khalid Eye Specialist Hospital, staffed by foreign doctors, was a world center for the treatment of eye disorders.

Whereas advanced medical research and some of the most sophisticated medical care available anywhere in the world were concentrated in Riyadh and a few major cities, medical care at the most basic level was limited in the countryside. In the early 1990s, a key objective of the Ministry of Health was to facilitate the delivery of primary care to rural areas by establishing primary health-care centers that provided basic services and dispensed medicines. For every four or five primary centers, which numbered 1,668 in 1990, there was to be one diagnostic and maternity center (there were ninety-eight centers in 1990). The large specialist hospitals located in cities were intended as referral hospitals for sophisticated medical treatment such as transplants, cancer treatment, surgery, and complicated diagnoses.

For the primary centers to be effective, health education has had to become an essential par 10cc rt of the centers' mission. In some areas, basic hygiene was unknown, as was the principle of contagion. The rural population and others who had had little or no exposure to observable benefits of modern medicine tended to view preventive measures and medicines with caution. According to a common traditional view, illness was not related to human behavior, such as poor sanitation habits, but was caused by spiritual agents, such as the jinn, the evil eye, or the will of God. Prevention and treatment of disease, therefore, lay in appealing to the spiritual agent responsible, using means such as prayer to God, votive offerings, or amulets to ward off the evil eye.

Before the introduction of modern medicine, local practitioners specialized in a variety of treatments, such as exorcism for mental illness, setting of broken bones, herbal remedies for many ailments, and cauterization. Cauterization involved heating a stick or nail until it was red-hot and then applying it to the area believed to be affected this procedure was used to treat almost any affliction, from coughs to abscesses to convulsions. Recourse to local healers was declining as access to more effective health care and health education became available.

Infant mortality rates for the kingdom remained high in the early 1980s, with an estimated 118 deaths per 1,000 live births. By contrast, based only on deliveries of infants in hospitals of the Ministry of Health, the infant mortality rate (children stillborn or died during birth) was low, declining in 1990 to 21 per 1,000 in 1990 from 25 per 1,000 in 1986. Death rates have declined as well, from 20 per 1,000 in 1965, to 10.7 per 1,000 between 1975 and 1980, down to 7.6 per 1,000 between 1985 and 1990.

In 1990 the World Health Organization certified that Saudi Arabia was free from the quarantine diseases of cholera, plague, and yellow fever. Compulsory immunization of infants and young children and the introduction in 1986 of an epidemic control system to facilitate communication on outbreaks of communicable diseases have contributed to the successful eradication of these diseases. Poliomyelitis, however, has persisted, and the Ministry of Health has set a target date of the year 2000 to eliminate the disease.

Malaria remained a problem in the Tihamah southern coastal plain, especially in Jizan, Asir, and Al Qunfudhah, which was on the coast in northern Asir. In 1988 the disease affected 1.6 percent of the total population, down from the 4.2 percent recorded eight years earlier. This drop was attributed mainly to measures taken to eliminate breeding grounds for mosquitoes and spraying with insecticides. Bilharzia was a continuing problem in Jizan, Al Bahah, Asir, Najran, Medina, Al Jawf, Hail, and At Taif. The incidence of the disease was lowered from 8.4 percent in 1980 to 1.9 percent in 1988, but efforts to eliminate infestations of the bilharzia parasite and to prevent reinfestation were a continuing challenge. Cases of leishmaniasis have occurred in almost every province with the expansion of agricultural lands, which provide breeding grounds for diseasecarrying flies. In 1988 the reported number of cases (under 15,000) was small, but the disease was being studied to prevent its spread. Trachoma was considered one of the main causes of blindness in the kingdom despite programs designed to combat the disease.

Data as of December 1992