The Healthcare Law Review: United Arab Emirates
The United Arab Emirates (UAE) is a confederation of seven emirates. The most well-known are Dubai and Abu Dhabi. The other emirates are Sharjah, Ajman, Fujairah, Umm al-Qaiwain and Ras al-Khaimah, often collectively referred to as the 'Northern Emirates'. At the federal level, the UAE operates within a constitutional framework, which makes provision for the health and welfare of the population in that 'the community shall provide all the citizens with medical care and means of prevention and treatment from diseases and epidemics and shall promote the establishment of public and private hospitals, clinics, and treatment houses'.2
The Federal Ministry of Health and Prevention (MOHAP) oversees the implementation of federal government policy in relation to the provision of comprehensive healthcare for all UAE citizens and residents, and works in collaboration with all health authorities to ensure that all public and private hospitals are accredited according to clear national and international quality standards of medical services and staff.
The emirates of Abu Dhabi, Dubai and Sharjah have established their own health authorities, the Department of Health (DOH), the Dubai Health Authority (DHA) and the Sharjah Health Authority respectively, and have the most developed rules and regulations among the seven emirates with respect to healthcare matters. The emirates of Dubai and Sharjah have also made provision for healthcare investment by establishing healthcare sector free zones, such as the Dubai Healthcare City (DHCC) and the Sharjah Healthcare City. The remaining Northern Emirates rely on the MOHAP to act as their regulator to oversee delivery of healthcare services.
The UAE has always looked to other jurisdictions for inspiration in creating a legal framework for the healthcare sector. The priorities are to ensure adherence with international best practice and to support delivery of high-quality medical care to the population. The drive to achieve continuing improvements in healthcare services throughout the UAE is intended to reduce the need for people to travel abroad for specialised treatment, encourage medical tourism, and is a key driver in widening the scope of services provided and building a healthcare sector that is supported by private sector and insurance investment.
In 2020 the healthcare sector was hit very hard by the arrival of the covid-19 pandemic. The health regulators issued numerous instructions to public and private sector operators on the handling of the situation and as we now emerge into the post-covid-19 environment we examine how some of those measures have accelerated the transformation of the health sector into the digital era. A number of these measures are discussed in this chapter, but this is not an exhaustive account of the collective effort to fight covid-19.
The healthcare economy
The status of the healthcare economy in the UAE is inextricably linked to the general economy and the government's policy of diversification away from the oil and gas sector. The indications for the general economy predicted by the IMF in April 2021 are that the UAE will grow 3.1 per cent in 2021. The National Agenda 2021 includes the objective of making the UAE a world-class healthcare system. Currently ranked 42 in the Healthcare Quality Index, a range of measures are currently under discussion to achieve this objective, and improve basic health outcomes, health infrastructure and preventative care, and physical and mental health satisfaction.3
ii The role of health insurance
The Insurance Authority established under Federal Law No. 6 of 2007 (as amended) introduced mandatory health insurance across the UAE.4 The UAE national Emirati population (and those of similar status) are covered by a government-insured scheme named 'Thiqa', which is administered by the UAE national insurance company, Daman, and provides for a comprehensive range of health insurance cover.
Abu Dhabi was the first emirate to fully implement mandatory health insurance for the expatriate population by Law No. 23 of 2005,5 which provides a basic level of cover for all employees and their families. A similar scheme is currently being implemented in Dubai pursuant to Law No. 11 of 2013,6 implemented from February 2014 over three phases according to employer workforce size, with the final phase completed in June 2016. Mandatory health insurance for expatriates has yet to reach every emirate in the UAE.
As the government reduces financial commitment to publicly funded services, which are largely accessed only by the Emirati population, the role of health insurance is critical to the ability of the remaining expatriate population to afford and access private medical services and medicines.
iii Funding and payment for specific services
Health insurance does not cover all healthcare needs. While the Thiqa cover for the Emirati population is reasonably comprehensive, recent cutbacks in spending have meant that access to certain Thiqa services has been withdrawn, and similarly, the expatriate population who benefit only from a basic level of cover must pay themselves for many services that are excluded from most policies. The extensive list of uninsured services means that expatriate patients must pay themselves, and in some cases, access services abroad, where they can be significantly cheaper.
Primary/family medicine, hospitals and social care
i Primary/family medicine
UAE patients can directly access medical specialist consultants without first transitioning through a primary care service. Direct access to specialist services is responsible for pushing up the costs of healthcare for both the government and insurers, with patients 'shopping' for services and seeking advice from a number of specialists for the same complaint.
Direct access is now being curtailed, with primary care becoming an increasing focus for healthcare regulators, with a view to improving the coordination of treatment throughout a continuum of care. The goal is the delivery of healthcare throughout the entire life cycle, in a process extending from the initial visit to a primary care physician, through the referral process, to the completion of treatment. Initiatives such as these should produce developments in the use of the expertise of primary care professionals through care pathways, and coordinated care between primary, secondary and tertiary healthcare services.
The DOH identified the need for primary care gateways as part of the emirate's master plan for delivery of healthcare services, and recently issued a standard for primary healthcare services in 2016.7 Similarly, the DHA has approved licences for 20 healthcare centres and clinics around the emirate providing primary healthcare services.
Insurers are increasingly taking the lead on adjusting health insurance policy terms and conditions to require patients to access primary care services and to have appropriate referrals from primary gateway providers before approving fees. In terms of future developments, as the UAE rolls out licensing for telehealth services, we also expect the ability of patients to access teleconsultation pathways.8, 9
The main public sector institutions that oversee delivery of healthcare services and quality are the DHA (with its subsidiaries the Healthcare Corporation and the Dubai Healthcare Insurance Corporation (DHIC)), the Abu Dhabi Health Services Company (SEHA) and the MOHAP. Within the scope of secondary care services provided by public hospitals are trauma facilities, obstetrics and gynaecology, orthopaedic, surgical services and the treatment of lifestyle diseases. The policy aim is to overlay these with more specialised services.
The DHA operates Dubai's public healthcare facilities, including Dubai Hospital, Rashid Hospital, Latifa Hospital and Hatta Hospital. It is currently building new facilities and expanding the range of services, including gastroenterology, a kidney transplant centre and specialist paediatric services.
SEHA is an independent public joint stock company that owns and operates all public hospitals and clinics across Abu Dhabi, consisting of 12 hospitals, 46 primary healthcare clinics, 10 disease prevention and screening centres, along with mobile clinics, a school clinic, blood banks, dental centres and a vaccination centre.10
Mubadala Healthcare, a division of the Abu Dhabi government investment vehicle Mubadala Development Company, has also played a prominent role in the provision of public healthcare services, also catering for privately insured or high net worth self-paying patients. Projects include the Cleveland Clinic-Abu Dhabi, Healthpoint Hospital, the Imperial College London Diabetes Centre and the Abu Dhabi Telemedicine Centre.
The MOHAP manages public healthcare services in the Northern Emirates, overseeing 16 hospitals and over 60 clinics. While historically servicing the Emirati population, MOHAP will soon extend services to all residents, such as through Ras al-Khaimah's flagship Sheikh Khalifa Specialist Hospital under the management of Seoul National University Hospital, and which now offers specialist cancer services.
The expansion of the private sector is well advanced and expected to play a significant role in the provision of healthcare in the future, with recent amendments to Federal Law No. 4 of 2015 (on Private Health Facilities), and Law No. 22 of 2015 Regulating Partnership between the Public Sector and the Private Sector in the Emirate of Dubai. For further details pertaining to private-sector hospitals, see Section IV.11
iii Social care
The Ministry of Community Development was created to oversee social care in the UAE,12 and largely focuses on development projects for Emirati families and persons with special needs. Since social care laws were first introduced in the 1970s, the concept of social care has remained immature. There has been very little focus on geriatric or dementia care services, resulting in an underdeveloped network supporting the transition of elderly or vulnerable patients from hospital care to home care with appropriate social care support. This burden was typically left to families to bear, but they will now benefit from additional support being made available through new initiatives by this Ministry and through the establishment of a Community Development Authority in Dubai, and a Department of Community Development in Abu Dhabi. There are now a number of initiatives in place that support transition to home care, such as a collaboration in Abu Dhabi to transition patients from Cleveland Clinic Abu Dhabi to Amana Home Care services, enabling good quality home care.
iv Data and patient health information
The UAE does not have a comprehensive data protection law. Privacy obligations stem from legal duties under the Penal Code as to the use or disclosure of 'secrets' without the consent of the person to whom the secret relates.13 However, there have been developments regarding new provisions that apply specifically in a healthcare context.
Federal Law No. 2 of 2019 (with implementing regulations), concerning the Use of Information and Communications Technology in Health Fields, regulates the use of information and communication technology in the areas of health in the country.14 The Law aims to achieve (among other things) the following objectives:
- require health authorities to set standards for the confidentiality and control of electronic patient records;
- create a central health record storage system; and
- restrict the transfer of patient health data outside the country without permission granted by the health authority, or in an exempt category.
The following laws also make provision for patient confidentiality, and remain in place alongside the new law.
Federal Law No. 5 of 2019 (concerning the Practice of Human Medicine Profession), which governs doctors licensed in the UAE, provides that in the absence of the patient's consent, no doctor has the right to divulge a private secret, either if the patient has directly confided it to him or her, or if he or she has come to know it by himself or herself in the course of his or her work.
The MOHAP Code of Conduct 1988 governing medical practitioners, pharmacists and other healthcare professionals licensed in the UAE requires complete confidentiality of information related to patients (including medical records and personal information related to the patient) and prohibits disclosure without the patient's prior informed consent.
DHCC Regulation No. 7 of 2013 (on Health Data) regulates the use and disclosure of Patient Health Information (including personal information and medical information relating to a patient's physical or mental health) by entities licensed in the DHCC.
The DOH Data Standard 2008 requires that healthcare providers in the emirate of Abu Dhabi develop and institute policies and procedures relating to confidential health information, which includes information that can be used to identify a patient. Policies developed pursuant to the Data Standard must ensure that only the minimum necessary personnel have access to confidential health information, and such information must be kept from unauthorised access.
The DHA introduced the Salama Electronic Medical Record System in 2017. This is a unified electronic medical record system currently connecting the government hospitals. In the long term, this scheme will be rolled out to all hospitals in the emirate of Dubai. The DOH has completed the implementation of a centralised electronic medical record central database, MALAFFI, mandating that all licensed health facilities in Abu Dhabi join the system and upload patient health information to the system.
The licensing of healthcare providers and professionals
Ministry of Health and Prevention
The MOHAP is the federal authority focused on creating a unified set of healthcare policies across the emirates. The MOHAP also plays the role of the primary health regulator for the Northern Emirates. In general, the MOHAP's activities include licensing and monitoring healthcare providers and healthcare professionals, administering health prevention and awareness training programmes, and regulating the registration and control of pharmaceuticals and medical devices.
Dubai Health Authority
The DHA was established pursuant to Dubai Law No. 13 of 2007 (on Establishing the Dubai Health Authority) and is the health authority regulating healthcare services, healthcare providers and healthcare insurance in the emirate of Dubai, and certain free zones. Included under the purview of the DHA is regulation of medical education and research.
While the DHA owns and manages public healthcare facilities in Dubai, it is the primary regulator for facilities licensing to the private sector. Facility licence categories include hospitals, day surgical centres, outpatient care facilities (which includes polyclinics, general clinics, dental clinics and speciality clinics), clinical laboratories, diagnostic imaging centres, home healthcare facilities, dental laboratories, school clinics, community pharmacies, optical centres, and complementary and alternative medicine centres.
There are two subsidiaries of the DHA that assist in the management of healthcare in the emirate of Dubai. Created in accordance to Dubai Decree by Law No. 17 of 2018, the Healthcare Corporation and DHIC support the DHA in managing public health facilities in Dubai and overseeing health insurance services respectively. These two sub-units, along with the new changes created under Dubai Law No. 8 of 2018, create a more comprehensive healthcare system for the residents of Dubai.
Dubai Healthcare City Authority
The DHCC free zone is regulated by Dubai Healthcare City Authority (DHCA),15 which is a public corporation established to promote the status of the emirate as an international medical and healthcare hub and which regulates healthcare establishments in the free zone by developing policies and procedures, granting licences and with power to enforce sanctions against violations of the law.
The Dubai Healthcare City Authority – Regulatory (DHCR) is an independent regulatory arm of the DHCA, and is responsible for healthcare facility licensing and healthcare professionals licensing.
Department of Health (Abu Dhabi)
The DOH was established pursuant to Abu Dhabi Law No. 10 of 2018 (on Establishing the Department of Health – Abu Dhabi). The DOH owns and operates public healthcare services and is the primary regulator for the private sector, granting facility licences, regulating health insurance providers and healthcare professionals.
Sharjah Health Authority
The Sharjah Health Authority was established by Sharjah Emiri Decree No. 12 of 2010 (amended by Emiri Decree No. 33 of 2016) and regulates Sharjah's healthcare system.
ii Institutional healthcare providers
In this section, we focus on the licensing and approval regime for private healthcare facilities. All private healthcare facilities must operate under a licence granted either by their governing regulator, typically the DHA through the Healthcare Corporation, the DHCA or the DOH, or by the MOHAP (as delegated to the local emirate municipality) in the case of the Northern Emirates.
Federal Law No. 4 of 2015 (on Private Health Facilities) (as amended) regulates the licensing of private healthcare facilities (except in the DHCC, which operates its own licensing system). The procedure for obtaining a licence entails making an online application to the regulator providing basic information to obtain an initial approval.
It is a requirement of the law that the facility licence be issued in the name of a UAE national person rather than a corporate entity, although this requirement may be relaxed in the case of a facility that comprises both local and foreign ownership. The application process then dives into further detail, with the applicant having to follow and conform to hospital or clinic planning, design and commissioning requirements applicable to the emirate and ensure the facility is constructed to approved local standards.
The applicant must choose from a range of permitted activities, such as hospital, clinic, dental clinic and rehabilitation clinic. The activity categories can vary slightly in each emirate.
The application will be subject to stringent scrutiny with a number of physical inspections of the facility while under development (or refurbishment) before the grant of the final licence. Time frames can vary significantly depending on the complexity of the project.
The process of appealing against the refusal to grant a licensing application entails issuing an appeal in writing to the Minister of Health or the head of the health authority within 30 days of the date of notification of the denial decision. A further grievance may be appealed to a competent court.
There are no exceptions to the requirement to obtain a facility licence. The licence must then be renewed periodically; the renewal period can vary and can be from one to five years. A breach of the licence conditions empowers the regulator to take disciplinary action, which usually takes the form of additional conditions being placed on a licence, suspension or revocation of the licence.
A penalty may also be applied against a general manager of a private facility, with potential sanctions including imprisonment for a period of no less than six months and a fine of no less than 100,000 dirhams.
iii Healthcare professionals
No person may practise as a healthcare professional in the UAE without first being licensed by the applicable health authority. A healthcare professional's licence is directly linked to a healthcare facility. All practising health professionals must have a designated facility sponsor whose name appears on their health professional licence. Thus, healthcare professionals who are not affiliated with a facility may apply for licensure at the relevant authority and receive a letter of eligibility while seeking employment, but may not practise the profession until a final licence is issued in connection with an employing healthcare facility.
If an individual is discovered to be practising as a health professional without the appropriate licence from the appropriate authority, civil and criminal penalties may be issued to the individual and the facility where the individual is carrying out the activities.
In the emirate of Dubai, the DHCR and the DHA have purview to regulate healthcare professionals in the emirate. The DHA is the sole authority authorised to issue a licence to practise medicine and other healthcare professionals operating in Dubai, outside the DHCC. Within the DHCC, the DHCR is responsible for regulating the facilities and professionals operating therein. Each authority, the DHCR and the DHA, has the charge to supervise, regulate and discipline healthcare professionals operating in its jurisdiction. Overseas visiting healthcare professionals are also required to obtain a DHA licence to practise their profession in the emirate of Dubai.
The DOH regulates healthcare professionals practising in the emirate of Abu Dhabi and maintains a similar online portal and applications process to the DHA. The MOHAP regulates health professionals practising in the Northern Emirates and in certain facilities regulated by the MOHAP.
Unified qualification requirements
The framework for healthcare professional licensure has been brought under a unified process by virtue of the Healthcare Professionals Qualification Requirements 2014 (PQR), jointly issued by the MOHAP, the DHA and the DOH to standardise healthcare professional requirements across the emirates. While the PQR has been adopted across the authorities, each authority still maintains its individual regulatory purview to approve and issue licences in its particular emirate. Consequently, the PQR acts as a baseline for the authorities to assess the documents submitted by healthcare professionals within their geographical jurisdiction, but does not unify the licensing approvals. Thus, if a healthcare professional practising in Abu Dhabi with a DOH licence moves to Dubai, an application will need to be made to the DHA for transfer of the licence, or granting of a new licence, by the DHA.
With regard to foreign licences, healthcare professionals who successfully complete one of the international examinations listed in the PQR, or hold an active registration or licence to practise with certain regulatory bodies, will be exempt from the assessment required to obtain the professional licence. A valid certificate of current status confirming good standing registration of the applicant issued by the registration or licensing authority at the time of application will be required. The other requirements will also still apply, however, including credentialling, experience and primary source verification. If there is a gap of more than two years in a healthcare professional's practice, the assessment exemption policy will not apply.
The UAE is a civil law jurisdiction with statutory codes governing most areas of substantive law.16 The Constitution provides that all laws in the UAE are subject to the overlay of the shariah (principles of Islamic law).17 Judicial authority is vested in its courts. A federal judiciary is based in Abu Dhabi and administered by the Ministry of Justice. The emirates of Abu Dhabi, Dubai and Ras al-Khaimah have each elected to maintain their own local judicial systems. The courts follow the Civil Procedure Code, which provides very broad grounds for the courts' jurisdiction. All cases are tried before judges. Civil matters are dealt with by way of written submissions. There is no full trial with oral testimony.
The courts can (and often do) refer cases that involve technical issues or complex fact situations to court-appointed experts. These experts conduct investigations and provide reports to the courts on the issues within their scope of work.
The official language of the UAE (and the courts) is Arabic, and all documentation brought before the courts in respect of any dispute must be in Arabic or accompanied by certified Arabic translations.
Patient rights and responsibilities
Health services in the United Arab Emirates have been steadily developed to provide health care of the highest quality while ensuring the highest level of patient satisfaction. A Charter has been drawn up in the belief that the patients have rights and should be enabled and engaged in any matter that would support and improve the services provided to them. As per Ministerial Resolution No. 14 of 2021, concerning the Charter of Patients' Rights and Responsibilities, this Charter includes all rights enjoyed by patients while receiving health services, in addition to their responsibilities towards health facilities, since rights in their modern concept cannot be realised, understood or activated without being combined with the responsibilities associated with them, which assist in embodying these rights in a delicate balance between rights and responsibilities, which ultimately has positive outcomes for all in terms of the type and quality of the health services provided.
Liability of healthcare providers
There are a number of ways in which healthcare providers are exposed to liability, potential legal claims and regulatory actions.
A patient is entitled to lodge a complaint with his or her regulator regarding the conduct of healthcare practitioners or providers. A complaint is investigated in accordance with the established procedure in the emirate in which the patient received healthcare services. There is variation in the process and approach in each emirate. The regulator may take disciplinary action against a provider or practitioner, with conditions imposed on a provider or professional licence, including suspension or revocation. In cases where there is sufficient evidence of malpractice, the regulator has further power to refer the matter to a medical liability committee convened under law, and ultimately to the courts.
The Medical Liability Law
The Federal Law No. 4 of 2016 (on Medical Liability) along with implementing regulations has brought several changes to the previous law, Federal Law No. 10 of 2008, which has been repealed.
The Medical Liability Law requires all medical malpractice claims to be referred to a new Medical Liability Committee before they are reviewed by the judicial authorities. It also affords protection and relief to doctors in criminal proceedings by prohibiting their arrest, imprisonment, and investigation before the authorities until the Medical Liability Committee issues a final report. The Medical Liability Law also introduces stringent penalties against medical practitioners who commit gross medical errors.
Cabinet Resolution No. 40 of 2019 prohibits the practice of medicine in the absence of insurance against civil liability for medical malpractice. The insurance policy must be provided by an insurance company duly licensed in the UAE. A licensed health facility must provide insurance for practising professionals.
Civil court claims
Subject to the restrictions imposed upon pursuing a civil claim under the Medical Liability Law, a patient can take a medical complaint before the civil courts to claim monetary compensation against healthcare providers and professionals for material, moral and psychological damage.
The legal burden of proof requires that the patient must establish that the healthcare professional was at fault. When assessing damages, the court will examine the harm suffered by the patient, the healthcare professional's actions or omissions, and the causal link. The criterion for the entitlement of an aggrieved party to compensation is that the damage should have been suffered as a direct result of the causal fault.18
When awarding compensation for damage or harm, the guiding principle in accordance with the Civil Code is that compensation should be equal to the harm suffered. Damages are the remedy used to restore the victim to the position the victim was in prior to the harm suffered. Direct damages, loss of profit, loss of opportunity, consequential damages and moral damages are types of damages recognised under UAE law.
ii Notable cases
The UAE is a civil code jurisdiction where the concept of legal precedent does not apply. Judges are under no obligation to take previous court decisions into consideration in an action before them, although prior rulings of the appellate courts have persuasive authority and are routinely cited by litigants in their pleadings and by the courts in their judgments.
Ownership of healthcare businesses
Statutory restrictions are in place that prevent foreign companies establishing wholly owned healthcare businesses, and require local partner involvement for most projects.19 Each company established in the UAE must have one or more UAE national partners who holds at least 51 per cent of the company's capital. A recent law allowing 100 per cent foreign ownership of companies allows foreign investors to create a foreign wholly owned legal entity to establish a healthcare facility provided that the investor meets certain share capital and other investment financial thresholds. At present, only the Emirate of Dubai has put a process in place enabling 100 per cent onshore ownership of healthcare facilities and only a few licences have been granted. Some of these have been to existing providers who have transitioned over from the traditional ownership structure and parted company with their local partners. Companies established in free zones are exempt from the 51 per cent requirement if the relevant free zone has special provisions regulating the company, in which case, where the services are established in a healthcare free zone, this would permit 100 per cent foreign ownership.
The UAE Federal Law No. 4 of 2012 (regulating competition) regulates anticompetitive practices, prohibiting: restrictive agreements, dominant position (market share of the establishment exceeds 40 per cent of the total transactions in the relevant market), and economic concentrations (application for approval should be submitted to a committee prior to concluding the relevant contract and applies to share acquisitions, transfers of assets and liabilities and should be made where the market share of the parties exceeds 40 per cent of the total transactions undertaken in the relevant market).20
Commissioning and procurement
The commissioning of healthcare services is government-led in terms of the policy position.21 The MOHAP, Dubai and Abu Dhabi health authorities dictate policy, identify what services are required, and determine whether these should be provided by public or private sector investment.
The DHA has upgraded services at the government-owned Rashid Hospital and has also completed the development of a medical university, the University of Sheikh Mohammed bin Rashid for Medicine and Health Sciences, along with establishing 40 primary healthcare centres and three new hospitals, as well as three new medical colleges and five nursing schools by 2025. The DHA now expects the private sector to either step in with operation and management agreements to run the existing facilities or proposals to develop the new facilities through public–private partnership.
In Abu Dhabi, the DOH has updated its master capacity plan, analysing a vast amount of population, demographic and healthcare data across the emirate to identify gaps in the provision of services and to prioritise what services will be required in future years. The private sector is expected to take a leading role in developing new services or recommissioning existing provision, with international brands committing to significant investment in large healthcare infrastructure projects, such as the 364-bed Cleveland Clinic in Abu Dhabi (a Mubadala project), which also supports the public sector through a long-standing relationship with the government hospital, Sheikh Khalifa Medical City.
Marketing and promotion of services
All advertising must comply with the MOHAP Healthcare Advertising Regulation.22 The Healthcare Advertising Regulation contains a comprehensive list of matters that are relevant to healthcare advertising.
The MOHAP must formally approve all advertising content by way of an application and approval process, which leads to the MOHAP giving a reference number that must be cited on all advertising material.
The MOHAP will take into account prohibitions on advertisements in poor taste, misleading statements of a medical nature, misleading statements of a comparative nature, and misleading statements of a general nature, as well as on sales incentives directed to certain persons. The prohibitions of advertisements that breach good taste are basically couched in terms of prejudice to public morals, and violation of the customs and traditions of UAE society or Islamic values.
Future outlook and new opportunities
The future outlook and opportunities listed in this chapter are subject to overcoming the immediate covid-19 pandemic crisis, which has inevitably impacted the priority of services but has also identified new opportunities for the health sector.
i Covid-19 – how the UAE is managing the crisis
The UAE declared an emergency response to the covid-19 pandemic during the period between 1 April 2020 and 31 July 2021.23
The MOHAP introduced then frequently updated the National Guidelines for the management of covid-19 patients by health facilities, which also included specific instructions regarding covid-19 testing, taking central control of the type of testing that could be undertaken (based on World Health Organization guidelines). The local health authorities then issued local circulars and resolutions to put the National Guidelines into effect.
In both Abu Dhabi and Dubai, samples can only be analysed by approved laboratories. Initially, these were government-owned laboratories, but to be able to cope with increased demand, some private-sector laboratories received approval to perform analysis. The Abu Dhabi government in collaboration with a Chinese company established a joint venture to build a covid-19 testing centre (initially for PCR testing), which was built in approximately 10 days and when operational by March 2020 became the largest covid-19 testing centre in the world outside China. Plans were immediately agreed to further extend the facility to include antibody testing on a large scale. More recently, the Abu Dhabi government and Chinese biotech company China National Biotech Group have announced plans to develop a covid-19 Sinopharm manufacturing facility in the emirate of Abu Dhabi.
In Dubai, suspected or confirmed cases are reported through the DHA's 'Hasana' portal by the healthcare facility.24 In Abu Dhabi, the DOH has mandated that healthcare facilities where covid-19 samples were collected, should notify only confirmed covid-19 PCR results to the DOH's Abu Dhabi Public Health Centre using the infectious diseases notification system (IDN) immediately after receiving the result from the laboratory.25 Hospitals in the Northern Emirates report results to MOHAP directly. There are no 'care homes' as such in the UAE, thus all reported cases are those that are tracked though hospital facilities.
Federal Law No. 14 of 2014 on Communicable Disease Control was updated further to Federal MOHAP Resolution No. 223 of 2020 to include covid-19. Doctors, pharmacists, pharmacy technicians and medical practitioners are obligated to report any known or suspected cases of covid-19 within 24 hours. Breach of the law is punishable by imprisonment or a fine, or both.26
By June 2021 the UAE had delivered 13.3 million doses of covid-19 vaccines to the majority of the population, and is among the world leaders in terms of population vaccine management. This initiative is expected to enable the UAE to reach expected economic recovery in the shortest possible time. Other notable statistics confirm that 51.7 million PCR tests have been carried out, 583,000 citizens have been diagnosed with covid-19 and there have been 1,699 deaths as a result of it.
ii Medical technology and innovation
In the enduring and post-covid-19 environment, the greatest opportunities will come from the medical technology, life sciences and biotechnology sector, bringing a choice of vaccines, and a plethora of medical products and devices that will protect the population from the virus and similar attacks on population health. The MOHAP has put in place a less formal and faster route to medical device approvals and for clinical research. A covid-19 device or application can be assessed and approved very quickly. The MOHAP is engaging more actively with international companies and procuring goods and services more quickly while managing to have regard to local procurement laws (that have not yet been amended). Meanwhile, the MOHAP and health authorities have approved much wider use of telemedicine services, e-prescriptions and the delivery of medicines to patients in their homes.
iii Public–private partnerships
With Law No. 22 of 2015, the emirate of Dubai was the first to promulgate a law to govern public–private partnership (PPP) projects. This Law was aimed at a wide range of PPP projects, but its application has been slow because of the absence of detailed procedures; these procedures are expected to be issued by the government soon.
Notwithstanding the absence of regulatory guidance, the DHA has begun to discuss how to promote the introduction of more PPPs into the healthcare system. The DHA has created an investment strategy promoting Dubai as a viable and competitive hub for investment in healthcare that addresses the needs of the emirate, while providing future opportunities and the best service for investors to enable development of a sustainable public–private model in Dubai.27
More recently, the emirate of Abu Dhabi28 has followed suit with the issuance of Law No. 1 of 2019 regulating PPP projects to encourage the private sector to participate in development projects and to maximise investment in the various relevant fields in a way that helps economic and social development in the emirate of Abu Dhabi. This Law is still very newly enacted and has yet to be put into practice.
Following the impact of covid-19, it is expected that the UAE government will increase efforts to attract private sector investment through PPP legal frameworks but also in parallel with other regulatory changes to make inward investment more attractive. Presently, the government has made a number of announcements of incentives to be offered by way of low-cost finance, and either waiving or heavily discounting fees payable by corporate establishments.
As the UAE emerges into a post-covid-19 environment, the healthcare sector is expected to expand rapidly through a combination of public and private investment and a realignment of some of the larger groups. The year 2021 is already seeing significant restructuring, along with merger and acquisition activity. Opportunities within the wider healthcare sector, such as life sciences and medical technology, are expected to grow exponentially. Regulators have adopted a series of long-term initiatives to create a healthcare sector that will be fit for purpose and guide the sustainable growth of this sector, supported by a legal framework created with reference to equivalent laws in other international jurisdictions and creating an environment where private and foreign investment can thrive.
1 Andrea Tithecott is a partner at Al Tamimi & Company.
2 Article 19 UAE Constitution of 1971, as amended.
4 Federal Decree by Law No. (24) of 2020 Amending Certain Provisions of Federal Law No. 6 of 2007 On the Establishment of the Insurance Authority and the Regulation of its Operations.
5 Law No. 23 of 2005 concerning Health Insurance in the Emirate of Abu Dhabi and the Implementing Regulation.
6 Law No. 11 of 2013 regarding Health Insurance in the Emirate of Dubai.
7 DOH Standard for Primary Health Care in Emirate of Abu Dhabi HAAD/PHC/SD/0.9.
8 Dubai Regulation No. 30 of 2017 regulating telehealth; DOH Standards on teleconsultation, TC/SD/0 2014.
9 Rules & Conditions for Providing Telehealth services (Cabinet Resolution No. 40 of 2019 Concerning the Executive Regulations of the Federal Decree Law No. 4 of 2016 on Medical Liability).
10 Established by Abu Dhabi Emiri Decree No. 10 of 2007.
11 Cabinet Resolution No. 29 of 2020 on the Executive Regulations of Federal Law No. 4 of 2015 Concerning Private Health Facilities.
12 Federal Decree Law No. 1 of 1972 concerning the Competence of the Ministries, as amended.
13 Article 379 Penal Code Law No. 3 of 1987.
14 Cabinet Resolution No. 32 of 2020.
15 Dubai Law No. 9 of 2011 (concerning Dubai Healthcare City).
16 The Federal Law No. 5 of 1985 (Civil Code).
17 Article 7 UAE Constitution 1971, as amended.
18 Articles 282, 292, 389 Federal Law No. 5 of 1985 (Civil Code).
19 Federal Law No. 2 of 2015 regulating Commercial Companies.
20 Executive Regulations (Council of Ministers' Resolution No. 37 of 2014) Cabinet Resolutions (Resolutions No. 13 and No. 22 of 2016).
21 Emirates Vision 2021.
22 Cabinet Resolution No. 7 of 2007 (regarding Health Advertisements Regulation).
23 Cabinet Resolution No. 5 of 2021 concerning the Emergency Financial Crisis.
24 DHA Circular 1142 dated 3 April 2020.
25 DOH Circular 21 of 2020.
26 Cabinet Resolution No. 17 of 2020 Concerning Issuing the Regulation for Controlling Violations of Precautionary Measures, Instructions, and Duties Imposed to Reduce Corona Virus (Covid 19) Outbreak.
27 DHA, 'Dubai Health Strategy 2016–2021'.
28 Administrative Resolution No. (179) of 2020 On regulating the Public Private Partnerships (PPP) Chairman of The Department of Economic Development.