INTRODUCTION: Non-communicable diseases (NCDs) burden has increased significantly over the past decade in Saudi Arabia (SA). Disparities of NCDs disease prevalence have been documented; however, little is known regarding inequities in NCDs health services access and delivery especially at the primary health care (PHC) level. Moreover, equity considerations have not explicitly been part of allocative financial decision-making criteria. The goal of this study is to assess equity-related challenges in accessing NCDs services as well as the current NCDs priority setting and financial resources allocation process to support the ongoing health system transformation efforts. METHODS: This study used a mixed methods approach. The quantitative data was obtained from existing secondary data of 10,000 households’ surveys, The Kingdom of SA World Health Survey, 2019. The primary collected qualitative data consist of 33 in-depth interviews (IDIs) with public officials from national and regional level using an interview guide supported by documents review. A multiple logistic regression and thematic analysis were used for the analysis. RESULTS: More than 35% of people with diagnosed diabetes, hypertension or dyslipidemia have an unmet need of primary care services. Only 20% of surveyed women had a cervical cancer screening during their last pelvic exam while only 18% of eligible women ever had a mammogram. Significant factors affecting primary care services utilization were region of residence, population density, wealth, income and education. Findings from the interviews revealed that NCDs and PHC are top priorities of the Saudi health reform with strong political commitment and major investments. However, there is no clear strategic direction to improve NCDs services given the highly centralized financial system with suboptimal resources allocation towards PHC and where increasing efficiency focuses mainly on higher level care. Governance-related challenges include accountability and power struggle, partly due to financial and human resources variations across the region. DISCUSSION: Improving budget formulation for primary care and NCDs programs, and harmonizing NCDs programs funding across sectors apart from the health sector while defining what equity and allocative efficiency mean for the Saudi health system transformation are priorities to achieve the health system transformation goals. / 2025-12-11T00:00:00Z

The expectations of patients have dramatically changed since the introduction of the first public health services more than a decade ago, as have the surrounding conditions a health system has to tackle. The grown health systems of the industrialised countries counter the challenges of an ageing society, technological advancement and chronic disease by a state of constant reform, which has been present for the last few years, without the abolition of the basic principles of affordability, accessibility and solidarity. One solution to answer all these expectations and requirements is so-called "integrated care", a patient-centred model, which propagates better processes, coordination and cooperation between the different service providers and sectors in health care. Based on a comprehensive discussion of the existing theories on health systems analysis, decision making and performance measurement in health as well as the trade-offs emerging therefrom, the first part of this thesis examines the changing conditions and expectations as well as problem areas of organisation and restructuring in health care systems. This analysis serves as a foundation for the introduction of the integrated care concept, an international expert questionnaire on the decision making in integrated care and conclusions on priority setting of decision makers in health. The analysis of the results demonstrates the high value that is placed on a clear political framework and incentives for the promotion of integrated care, as well as the substantive demand for improved communication, coordination and information structures. (author's abstract)