Shaping Oman's Child Health Future by 2040: Key projections for population and workforce in developmental-behavioural paediatrics

1. Introduction

The United Nations Development Program's Human Development Index has recognised Oman as the Arab nation exhibiting the most significant progress, owing largely to substantial advancements in social development and living standards.1 In conjunction with these human development achievements, Oman has made remarkable improvements in its health sector by providing universal and cost-free healthcare to all citizens. Consequently, skilled healthcare professionals attend over 98% of births, with more than 98% of infants receiving complete immunisation coverage. These developments have substantially improved population health indicators, as evidenced by an increase in life expectancy from below 60 years in the 1970s to approximately 74 years at present, alongside a notable 94% reduction in under-5 mortality rates.2 It was shown in previous studies that Oman's healthcare sector demonstrates strong leadership commitment and a clear understanding of value and target populations.3 In a recent survey, both patients and healthcare professionals provided assessments that reflected a high level of satisfaction, designating the quality of care and patient safety as excellent.4 Despite these advancements, Oman's health sector continues to face considerable challenges due to rapid population growth. The country ranks 48^th out of 230 nations in population growth rate and is experiencing a marked ‘youth bulge’, with over half of its population below the age of 25 years.2 In response to this demographic shift and in alignment with the strategic goals of Oman Vision 2040, the National Centre for Statistics and Information has published population projections to support informed policy planning. According to these projections, the total population of Oman is anticipated to rise significantly from the current 5 million to approximately 8 million by 2040. Notably, the population of children under 14 is expected to reach approximately 1.5 million, underscoring the urgent need for proactive planning and resource allocation to meet future demands on health and social services.5

1.1. The role of developmental-behavioural paediatrician and interactions with other subspecialities

Developmental-behavioural paediatrics (DBP) is a subspecialty concerned with the assessment and management of children with complex developmental and behavioural disorders guided by the “eco-bio-developmental model”.6

A multicentre survey conducted between 2013 and 2014 across 12 academic DBP programmes (n = 50 paediatricians) documented clinical practice across 29 distinct outpatient settings, ranging from autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder clinics to services addressing genetic syndromes (e.g., trisomy 21), chronic neurodevelopmental conditions (e.g., cerebral palsy) and medically fragile populations (e.g., infants born prematurely), thus highlighting the multifactorial and overlapping nature of DBP care.7 Similarly, a 2018 retrospective review of 800 patient referrals demonstrated a mean of three co-occurring concerns per child, underscoring the clinical complexity managed within DBP settings.8

Given limited workforce capacity and prolonged waitlists, the scope of DBP involvement varies across institutions from providing diagnostic evaluations and initial management plans to delivering ongoing interdisciplinary care. Core competencies of DBP practice include diagnostic formulation, etiologic workup, psychopharmacologic management, caregiver counselling and individualised intervention planning for neurodevelopmental disorders such as ASD, intellectual disability and specific learning or communication disorders.6

Furthermore, DBP roles intersect with other disciplines including child and adolescent psychiatry (CAP) and paediatric neurology. CAPs primarily manage severe psychiatric disorders such as mood dysregulation, suicidality and psychosis, while neurologists focus on abnormal neurologic findings such as seizures or headaches. Children with neurodevelopmental disorders often present with comorbidities across these domains, highlighting the complementary yet distinct contributions of DBPs in providing integrative, family-centred care.9

1.2. Global, regional and local statistics of developmental disabilities

Global and regional estimates of developmental disabilities indicate a prevalence range between 14% and 27.5%, according to global and regional estimates.10 Although precise data on the prevalence of developmental disabilities in Oman is currently lacking, the country is currently relying on national census data to estimate the prevalence of disability. Based on a report from the National Centre for Statistics & Information published in 2021, disabled people in Oman represent 1.55% of the Omani population.11 Interestingly, the same report highlighted that almost 74.7% of disabilities are congenital and present at birth. The highest proportion of reported disability cases was observed in North Al Batinah Governorate, accounting for 22%, followed by Muscat with 15.9% and Al Dakhliyah with 14%.11

A striking example of the rapidly increasing demand for DBP services in Oman is the substantial rise in autism prevalence within the nation, which has grown approximately 15-fold within a period of just 7 years.12 This surge has been accompanied by a parallel increase in the need for rehabilitation as well as educational and supportive services.12 Strategic health workforce planning is essential to ensuring the efficient allocation of healthcare resources in response to evolving population needs. This editorial highlights the critical and escalating demand for DBP services within Oman's paediatric population. It specifically examines the projected geographic distribution of children aged 0–14 years by the year 2040 and employs international workforce benchmarks to estimate the requisite DBP capacity. In this context, this editorial aligns its projections with the Delphi-based health workforce forecasting methodology endorsed by the Ministry of Health, reinforcing the importance of evidence-based policy development in addressing future paediatric subspecialty demands.13

1.3. Workforce benchmarking and the urgent need for DBP expansion in Oman

In 2024, a collaborative article addressing paediatric subspecialty workforce allocation in the United States indicated a benchmark availability of approximately 1.0 DBP subspecialists per 100,000 children.14 This analysis was based on children up to age 17 and assumed a retirement age of 70. In contrast, Oman employs different demographic parameters, calculating based on children up to age 14 and a retirement age of 65.15 Given Oman's notably younger demographic profile, this benchmark will serve as a reference to estimate the required DBP workforce to adequately meet national paediatric demands. Moreover, projections indicate that by 2040, Oman must train over 13,000 additional physicians to meet its broader healthcare target of 28 doctors per 10,000 residents, emphasising the urgency of scaling up subspecialty training and workforce planning.16

This need is further amplified by the limited availability of specialised mental health services in Oman. While developmental disorders such as ASD often involve complex comorbidities requiring multidisciplinary care, most existing services in the country are oriented toward general psychiatric illnesses. The current system lacks the capacity to meet the growing demand for developmental care.17

1.4. Population projections and needed DBP workforce by 2040

According to national statistics in 2022, Oman's population was approximately 5 million, with notable population growth projected by 2040. The data also demonstrates an uneven population distribution across the country, with a substantial concentration in Muscat and the northern regions.5 At present, DBP services are primarily centralised in Muscat, highlighting the necessity for strategic expansion and more equitable access to specialised healthcare services across other governorates. On the other hand, in alignment with Oman Vision 2040's objective to enhance well-being and healthcare accessibility, the government is establishing regional hospitals in major cities to provide specialised care beyond primary and secondary services. Workforce development and training plans should therefore account for both geographic and demographic factors to ensure nationwide equal accessibility to DBP services.

Population projections suggest that by 2040, the total number of children under 14 in Oman will reach approximately 1.5 million. Given this anticipated growth, a significant increase in DBP services is expected, with the highest demand likely concentrated in northern regions (Table 1). From a workforce planning perspective, the allocation of one developmental paediatrician each to Al Buraymi, Al Wusta and Musandam, and 2 specialists to Dhofar Governorate is recommended, as these governorates are remote from tertiary centres and require local capacity to ensure equity in service delivery (Fig. 1). This distribution strategy aligns with Oman Vision 2040 health priorities by advancing decentralisation and equity, while simultaneously reducing travel and financial burdens for families and ensuring timely, community-based care.

Table 1.

Required developmental-behavioural paediatrics subspecialists (2022–2040) classified by geographical distribution of children 0–14 years in Oman.

	Year 2022		Year 2040
Governorate	Children 0–14 years*	Headcount DBP	Children 0–14 years*	Required DBP†
Muscat	283,682	4	327,771	3
Al Batinah North	242,596	0	264,128	3
Al Batinah South	154,279	0	165,836	2
Dhofar‡	106,924	0	119,874	2
Ad Dakhliyah	160,946	0	211,180	2
Ash Sharqiyah South	87,145	0	120,071	1
Ash Sharqiyah North	84,922	0	102,452	1
Adh Dhahirah	66,521	0	78,800	1
Al Wusta‡	11,408	0	14,297	1
Musandam‡	13,619	0	12,934	1
Al Buraymi‡	31,835	0	36,695	1
Total	1,258,674	4	1,454,038	18

^*Data from the National Centre for Statistics and Information.⁵

^†Based on 1.0 DBP per 100,000 children 0–14 years.

^‡The needed DBP was increased due to the geographical location.

Fig. 1.

Projected demand for developmental–behavioural paediatricians in 2040, stratified by the anticipated geographic distribution of children aged 0–14 years across the governorates of Oman.

It is important to acknowledge that these workforce projections are subject to several limitations, as they do not account for potential attrition resulting from resignations, retirements or transitions into academic or administrative positions. Nonetheless, the transition of clinicians into leadership roles—estimated to reach up to 7% annually depending on seniority—may contribute positively to healthcare delivery by enhancing service quality and efficiency, fostering innovation, strengthening strategic collaborations, supporting evidence-based decision-making, promoting service integration and, ultimately, improving patient outcomes. However, these transitions may simultaneously reduce the number of practising clinicians directly available for frontline service delivery, thereby posing challenges to workforce capacity and sustainability.18,19

Similar concerns arise in the context of multidisciplinary team (MDT) service delivery in DBP. While MDTs are designed to ensure individualised, comprehensive care through the collaboration of developmental paediatricians, psychologists, behavioural analysts, therapists, social workers and specialised nurses, their effectiveness is often constrained by workforce shortages, variability in training backgrounds and fragmented service coordination. Moreover, limited availability of certain subspecialists, particularly outside central hubs, further complicates service integration. Although parallel efforts are underway across health, education and social sectors to expand human resources, the sustainability of MDT-based care will ultimately depend on structured workforce planning, intersectoral collaboration and long-term investment in capacity building.

1.5. Current initiatives and future opportunities

Building on these needs, postgraduate medical education in Oman has evolved significantly since the establishment of the Oman Medical Speciality Board (OMSB) in 1994. In April 2006, OMSB was restructured as an autonomous entity responsible for overseeing, regulating and promoting postgraduate training across all medical specialties within Oman. Since its reconstitution, OMSB has engaged in strategic, long-term planning aimed at advancing medical speciality training nationwide.

The recent announcement of a dedicated fellowship programme in DBP, scheduled to commence in 2026, represents a pivotal step toward addressing the workforce shortage in this essential subspecialty. Globally, the establishment of structured DBP training pathways has been recognised as a key strategy to address the rising prevalence of neurodevelopmental disorders and the associated demand for specialised care. Fellowship training not only expands clinical capacity but also advances research, policy development and interdisciplinary collaboration.20 In Oman, the programme is designed to enrol 1–2 fellows per cycle following completion of general paediatric training, with a 36-month duration aligned with the OMSB and Accreditation Council for Graduate Medical Education standards. The curriculum emphasises a standardised, multidisciplinary approach, preparing fellows to become clinicians, leaders, scholars and trainers. A core objective of the programme is to help ensure equitable distribution of trained DBP specialists across regions, thereby reducing disparities in access to care and supporting national health equity goals. By leveraging existing academic expertise and training resources concentrated in Muscat, this fellowship positions Oman within the global movement toward strengthening developmental paediatric services, while also contributing to the long-term sustainability and resilience of the national paediatric health system.

Despite these aspirations, several challenges remain that warrant consideration from a public health workforce planning perspective. While there is clear and growing interest among paediatric trainees in pursuing DBP locally, the current intake of only 1–2 fellows per cycle is modest when viewed against the projected needs of a child population expected to reach 1.5 million under 14 years by 2040. Based on current enrolment capacity, approximately 16 developmental paediatricians are expected to graduate by 2040. However, workforce projections must account for potential attrition risks, including the retirement of senior trainers, migration of specialists to private practice or early exit from clinical work. Importantly, the early cohorts of graduates are expected to assume training and mentorship roles, thereby gradually strengthening local teaching capacity and mitigating some of these risks.

To ensure resilience in workforce development, a gradual expansion of fellowship intake might be required, coupled with ongoing measures to safeguard the continuity of clinical supervision and mentorship. While the core of training is expected to be delivered nationally, strategies will be in place to help diversify experiences, foster international collaboration and enhance the competencies of Omani DBP specialists, ultimately securing the long-term sustainability of this pioneering fellowship. Explicitly, carefully selected opportunities for external exposure—through short-term courses, workshops or observerships in established centres abroad—may provide additional enrichment and benchmarking, without undermining the centrality of the local training programme.

2. Conclusion

By 2040, Oman is expected to have approximately 1,454,038 children aged 0–14 years, highlighting the need for at least 18 DBP specialists to meet this projected demand. While equitable distribution across governorates is essential, a greater concentration of specialists in Muscat and the northern governorates may be warranted based on population density. The recent announcement of a DBP fellowship programme by OMSB is well-positioned to fill this gap and reduce the cost of sending fellows abroad. With careful planning and strategic deployment of specialists, this initiative can support the broader goals of Oman Vision 2040, advancing child health, promoting equity and enhancing the quality of paediatric care nationwide.

Authors' Contribution

Watfa Al-Mamari: Conceptualization, Supervision. Ahmed B. Idris: Conceptualization, Methodology, Writing- Original draft, Reviewing and Editing. Rola Al-Balushi: Data curation, Writing- Reviewing and Editing. Kamila Al-Alawi: Visualisation, Writing- Reviewing and Editing. Saquib Jalees: Data curation, Writing- Reviewing and Editing. Ahmed Al-Saidi: Writing- Reviewing and Editing.