Oman’s Successful Child-Spacing Program Elevates National Health Standards Generally

by Richard H. Curtiss

Omani Minister of Health Dr. A. Moosa is both a grave and genial medical doctor who can effortlessly spin off statistics to answer any question about the astonishingly rapid development of his country’s medical facilities. They were nearly non-existent outside the capital in 1970 when Omani Sultan Qaboos took over the rule from his father. Today there is virtually total coverage, both in all parts of the country and for all of its citizens, regardless of economic status.

However Dr. Moosa, whose medical degrees are from Egypt and Britain, is ready to discuss much more than medical care and technology. A fascinating conversationalist, he can explain clearly exactly how his ministry’s programs dovetail with and lend synergy to Oman’s overall development goals, and how they compare with medical care in European and other Arab countries.

Most surprising of all are his keen insights into contemporary U.S. politics and the philosophical underpinnings of American democracy. He has reached his conclusions during annual summer stays of a month or two to the United States to visit his son, a Georgetown University graduate who now is working with a Wall Street firm in New York, and his daughter, who recently graduated from Georgetown and has returned to Oman. Dr. Moosa hopes to continue his first-hand acquaintance with all things American if his other daughter—his third and last child—also is accepted at Georgetown.

American readers may be heartened to learn that Oman-born Dr. Moosa, who understands clearly the domestic political pressures behind self- defeating U.S. policies in the Middle East, has more faith in the overall resilience of American civilization than do many Americans. He believes that U.S. immigration policies, which he describes as the most enlightened in the world, constantly renew and reinvigorate the American people, from the country’s political, scientific and technical elites to its hewers of wood and drawers of water.

North Americans, he believes, have found the way to beat the cycle of the rise and fall of civilizations that, since the eras of the Egyptians, Persians, Greeks, Romans, Arabs and Ottoman Turks, has ordained that the rise of every culture and empire to the pinnacle of world influence is followed by an ignominious collapse.

The view is startling to hear from a leader in a region which has turned, in less than 50 years, from the belief that Americans were more efficient and altruistic than the other Westerners who have been pouring into the Arab world ever since the Napoleonic invasion of Egypt, to a belief that all U.S. Middle East policies are doomed to failure because they are devised in Israel with the sole purpose of holding back and dividing the peoples of the Islamic world, and exploiting their natural resources.

If Dr. Moosa is idealistic in assessing the future of North America, he is pragmatic in defining his country’s health problems and addressing them. An example is his leadership in carrying out a child-spacing program, with the strong support of Oman’s Sultan Qaboos, after concluding that the country’s former extremely high birthrate was at the root of most of the health problems that once plagued Oman.

The country’s health officials reached this conclusion after a careful survey of existing data. “We noted the high percentage of low- weight births,” Dr. Moosa explains. “We also noted that maternal mortality, 21 per 1,000 births, was not as bad as in the Third World, but not as good as in the West. And we noted that infant mortality, though it was dropping because of the general improvement of standards, was not dropping as rapidly as it should have been. Nine percent of infants born were underweight. And 25 percent of children below the age of five were malnourished. We concluded that the main problem was that mothers were becoming pregnant every year, and that there should be a program of child spacing.”

To do something about this the Omani government in 1994 invited specialists from Johns Hopkins University in Baltimore to come to Oman to conduct a survey of public awareness of contraception methods, and its attitude toward them. At the same time the Ministry of Health began an education program to make both men and women aware of the health benefits of child spacing.

An Egyptian-American author and authority on the Qur’an, Dr. Abdul Rahim Omran, was invited to speak to Omani leaders about “Family Planning and the Legacy of Islam.” In his talks Dr. Omran cited the Qur’anic encouragement of child spacing as a health measure.

In addition, for each of three years 30 young women were started on a two-year course of basic health education and then assigned to health centers and clinics all over Oman. “Now we have 90 messengers all over the country explaining the benefits of birth spacing,” Dr. Moosa says.

The subject also was included in the syllabus of Oman’s nursing institute. Further, Oman’s education authorities included a section on child spacing in a booklet published for use by all 11th grade students that also covers such health problems as tobacco use, AIDS and prevention of diarrhea.

The inclusion of this booklet in the secondary school curriculum was accompanied by essay contests. These competitions invited students to provide in-depth essays on all of these subjects to compete for prizes for the best submissions on the school-wide, wilaya (province), and national levels.

Tangible results of the birth-spacing campaign appeared immediately. In 1995, one year after the program began, the country had 2,500 fewer births than in 1994. In 1996 another drop of 1,500 births was recorded, and this happened again in 1997.

“We were amazed at the number of people who were practicing birth spacing, and at first did not believe it,” Dr. Moosa confesses. “But we double-checked by counting the number of infants who were given vaccinations and other services in government health centers, and all of these exercises confirmed the drop in births.”

Meanwhile public opinion polls confirmed that, in the short time the educational campaign had been in operation, the number of Omanis who believed birth spacing was beneficial had risen from 64 to 94 percent of the public.

“All this is because we are moving with history,” Dr. Moosa explains. “More girls go to school, and female enrollment in the university is almost the same as male enrollment. And more ladies are working. All of these factors point us in the right direction. And meanwhile maternal mortality has dropped, as have underweight births and malnourished children.”

“So in 1997 we met again with all the sheikhs (traditional leaders) and walis (provincial governors) to show that all of these improvements in public health are due to birth spacing. And we also have issued certificates of gratitude to those who have helped.”

At present the Ministry of Health is using the media to make its findings known. It has filmed 19 public service spots for television, and prepared similar material for the radio and print media.

Since birth spacing is one of its newest programs, it is not surprising that other Ministry of Health programs with a longer history show even more dramatic results. Ninety-nine percent of children born in Oman now receive vaccinations against measles, diphtheria, polio, whooping cough, hepatitis B, rubella, and mumps. The result is that in 1993, the most recent year for which comprehensive statistics have been completed, there were no cases of polio or diphtheria, 7 of rubella, and 12 of measles contracted locally (although 127 cases contracted outside Oman were reported, mostly among families of expatriate workers). Infant mortality had dropped dramatically and life expectancy had risen to 71.4 years for men and 74.4 for women, figures comparable to First World countries.

These health improvements, Dr. Moosa explains, were achieved as the result of the Omani government’s heavy spending on social development. “Schooling is free, housing ownership is 86 percent due to subsidized home ownership loans, and the remotest villages now are accessible by road and have electricity and are served by a clinic.”

Meanwhile, although Oman’s petroleum reserves now are estimated to be sufficient for the next 50 years, the drop in world oil prices to their lowest levels since 1986 and the high cost of oil extraction in Oman compared to other Gulf states means that there now are fewer oil revenues available for the Omani government to spend on social services.

“Now the emphasis is changing from social welfare to producing jobs through economic development to enable people to help themselves,” Dr. Moosa explains, noting that Oman’s changing economic situation also impacts its child-spacing program.

Because of the high infant mortality rates of the past, he says, people had many children in hopes that some would survive to support them when they no longer could support themselves. “Also, because we were an agricultural society, children were able to make a contribution to the family income.” Now nearly all children survive, and in a largely urban society they become an economic burden rather than an asset. The result of all these factors has been an increase in the population from half a million in 1970 to today’s 2.2 million, and to a drop in the birthrate to 2.9 percent.

Dr. Moosa is upbeat in his assessment of Oman’s ability to make the transition to a 21st century society, even if the crutch of abundant petroleum revenues is removed.

“In Oman, the work ethic was always there,” he explains. “We are different than the other Gulf countries. Our people worked in agriculture, fishing, and as shepherds. Now, because as a nation that faces the sea with a long tradition of interaction with the peoples of Africa and Asia, we are open to the outside world and to learning new skills and accepting new ideas.

“For example, where other Arabian Gulf countries have had trouble producing nurses within their own borders, we analyzed the problem and concluded that the shortage was caused by the low financial and social status accorded nurses. So we raised the standards for our nursing schools, admitting only those who had graduated from secondary school with high marks. Then we started paying them well, almost what university graduates earn.

“Now we graduate 500 nurses every year and our 11 nursing institutes receive up to 10 times more applicants than they can admit.”

Oman’s 11 nursing institutes now follow American curricula, and a nursing diploma is recognized as the equivalent of a U.S. A.A. degree. Last year, 20 nursing graduates were sent to Villanova University in Pennsylvania for B.S. degrees, and a number of Omani B.S. holders who have been selected to be university instructors in Oman are attending George Mason University in northern Virginia to obtain M.A. degrees.

“Developing human resources is one of our primary concerns in the ministry,” Dr. Moosa explains. “Nine percent of our medical doctors are Omanis and we are graduating between 70 and 80 medical doctors every year from Sultan Qaboos University in Oman and from universities abroad, both at government and private expense.”

Assessing Oman’s current health situation, Dr. Moosa turns philosophical. “What has happened far exceeds the expectations, even the dreams, of my generation. But now we are at a crucial point and once again we have to adjust. More and more the government has to transfer some of the responsibility to the private sector, and we have to achieve some economies to live within our means.”

To illustrate, he points out that until recently treatment in government medical facilities was free, and the government could not keep up with demand. Then the government imposed a fee of 200 baisas (about 60 U.S. cents) for treatment in any government medical facility, and usage dropped by 25 percent. This shows, he says, that Oman’s superb network of medical facilities was being misused.

The system itself is carefully structured to provide medical care to the most remote and isolated villages. People so thinly scattered that they do not even live in permanent settlements are served by mobile health teams that bring vaccination and maternal care to them. At the village level basic services are provided by 108 health centers, 50 percent of which include maternal delivery facilities.

In turn, health centers can refer patients to one of six polyclinics where specialists are available. They, in turn, can refer patients to local hospitals which may elect to send patients to the district hospitals present in every province.

Cases requiring even more specialized care are referred to regional hospitals, which have all medical amenities, or to national hospitals with highly specialized facilities. Altogether, Oman has 47 hospitals. Thanks to such a carefully structured medical care system, 92 percent of total child deliveries in Oman are in government health facilities, rather than at home as in the recent past. It is just one more of Dr. Moosa’s statistics, illustrating his country’s remarkable rise in only 28 years from Third World status to a level of medical services and accomplishments comparable to any nation in the industrialized world.

Richard Curtiss is the executive editor of the Washington Report on Middle East Affairs.