Provider-Reported Readiness of Chronic Healthcare Services in Saudi Arabia Under the Health Sector Transformation Program

Summary

Objective:

To assess provider-reported readiness of chronic healthcare services in Saudi Arabia within the context of the Health Sector Transformation Program (HSTP), using a validated, context-specific assessment instrument.

Methods:

A national cross-sectional survey was conducted between November 2024 and February 2025 among 254 healthcare providers across 5 health regions and both public and private healthcare sectors. A 34-item instrument, informed by the Chronic Care Model (CCM) and adapted to the Saudi context, assessed 7 system readiness dimensions. Descriptive statistics, independent-samples t-tests, one-way analysis of variance, and Pearson correlation analyses were performed.

Results:

Overall system readiness was moderately positive. Health system organization and community resource linkages demonstrated the highest mean scores, indicating relative strengths in governance and system coordination. In contrast, clinical information systems and workforce awareness showed lower scores, reflecting gaps in digital integration and workforce engagement. Significant differences were observed across sectors and regions, with private-sector providers reporting higher readiness in several dimensions (p < 0.05). Strong positive correlations were identified among system readiness dimensions.

Conclusion:

Chronic healthcare services in Saudi Arabia demonstrate moderate system readiness, with established structural foundations but persistent gaps in operational integration. Strengthening digital health systems, workforce engagement, and community-based care integration may enhance the effective implementation of HSTP objectives and support improved chronic care delivery.

Introduction

Chronic diseases represent one of the most pressing challenges confronting healthcare systems globally, accounting for a substantial proportion of morbidity, mortality, and healthcare expenditure. The growing prevalence of long-term health conditions has exposed the limitations of traditional acute-care models, which are not designed to address the continuity, coordination, and proactive management required for chronic disease care [1,2,3,4,5]. In response, health systems worldwide have increasingly adopted structured frameworks for chronic care delivery, which emphasize system readiness and organizational capacity as essential foundations for effective service delivery [6,7,8,9].

In Saudi Arabia, the burden of chronic diseases has risen rapidly over recent decades, driven by demographic transitions, lifestyle-related risk factors, and population growth. Chronic conditions now account for more than two-thirds of national mortality and healthcare utilization, placing sustained pressure on healthcare resources and service delivery capacity [10,11]. Recognizing these challenges, Saudi Arabia launched the Health Sector Transformation Program (HSTP) under Vision 2030, aiming to transition toward an integrated, value-based, and patient-centered healthcare system [12,13]. Within this reform, the new Model of Care identifies chronic care as a core pathway intended to improve the continuity, coordination, and quality of services to individuals living with long-term conditions [14].

Despite this strategic emphasis, there remains limited empirical evidence on the extent to which these reforms have translated into system-level readiness within healthcare organizations.

Existing studies in Saudi Arabia have predominantly focused on specific diseases or individual healthcare settings, providing fragmented insights that do not adequately capture system-wide readiness across regions and sectors [15,16,17]. Furthermore, previous research has rarely examined readiness from the perspective of healthcare providers, who play a central role in implementing chronic care delivery models. Importantly, there is also a lack of comprehensive, validated, context-specific instruments that align chronic care system readiness with both the Chronic Care Model (CCM) and the HSTP strategic framework.

Addressing this gap is critical, as the successful implementation of HSTP objectives depends not only on policy design but also on the preparedness of healthcare organizations, clinical teams, and supporting systems to deliver coordinated and sustainable chronic healthcare services [18,19,20]. Assessing provider-reported system readiness offers valuable insight into key dimensions, including health system organization, community linkages, self-management support, decision support systems, delivery system design, and clinical information systems, as well as workforce awareness of national transformation objectives [6,7,11,18,21].

Accordingly, this study aims to assess the readiness of chronic healthcare services in Saudi Arabia from the perspective of healthcare providers, using a structured assessment aligned with the CCM and the HSTP strategic pillars. Specifically, the study seeks to address the following research questions:

• What is the level of system readiness for chronic healthcare services across key CCM-aligned dimensions within the Saudi healthcare system?

• Which dimensions of system readiness demonstrate relative strengths and which indicate areas requiring improvement?

• How does system readiness vary across regions and healthcare sectors?

• What are the system-level drivers of provider perceived readiness?

By examining readiness across multiple system dimensions, this study provides a comprehensive assessment of provider-reported system preparedness and identifies priority areas for improvement. The findings contribute to the evidence base on chronic care transformation in Saudi Arabia and offer practical insights for healthcare leaders and policymakers seeking to strengthen system readiness in alignment with national reform objectives.

Methods

A national cross-sectional quantitative study was conducted to assess the readiness of chronic healthcare services in Saudi Arabia from the perspective of healthcare providers. The study was implemented across 5 main health regions and included both the public and private healthcare sectors, reflecting the organizational diversity of chronic disease care delivery within the Saudi healthcare system. The design aligns with the study objective of evaluating system readiness in relation to the HSTP's strategic priorities.

The assessment instrument used in this study was a provider-reported tool specifically developed to evaluate system readiness for chronic healthcare services within the Saudi healthcare context. The development and psychometric validation of this instrument have been reported previously [22].

The instrument was informed by the CCM and adapted from established tools, particularly the Assessment of Chronic Illness Care (ACIC), to enhance contextual relevance and alignment with national reform priorities. In addition to the 6 CCM domains, a seventh dimension, “Workforce Awareness of National Health Programs”, was incorporated to capture provider engagement with HSTP initiatives.

The final instrument comprises 34 items across 7 dimensions, measured using a 5-point Likert scale, with higher scores indicating greater perceived system readiness. Evidence of internal consistency, reliability, and construct validity was established in the original validation study using Cronbach's alpha and exploratory factor analysis. In the present study, the instrument was applied as an outcome measure to assess provider-reported readiness across regions and sectors, rather than to re-evaluate its psychometric properties.

The study population included healthcare providers involved in the delivery, coordination, or management of chronic healthcare services in Saudi Arabia. Eligible participants included physicians, nurses, allied health professionals, and healthcare administrators with experience in chronic healthcare settings.

Exclusion criteria included providers not involved in chronic care delivery, incomplete survey responses, and respondents with insufficient professional experience in relevant clinical or administrative roles. A non-probability purposive-convenience sampling approach was employed. Survey invitations were distributed through digital platforms (email, WhatsApp, X, and LinkedIn), institutional channels, and professional networks. A total of 254 healthcare providers completed the survey and were included in the final analysis. This sample size was considered adequate for descriptive and inferential statistical analysis. This approach was appropriate given the study's aim to capture a broad range of provider perspectives across regions and sectors.

Data were collected between November 2024 and February 2025 using a secure web-based survey platform. Participants were informed about the study objectives, the voluntary nature of participation, and confidentiality measures prior to survey completion. Completion of the survey was considered as implied informed consent. No personally identifiable information was collected. Data were analyzed using IBM SPSS Statistics for Windows, version 18.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize participant characteristics and dimension-level readiness scores. Mean scores were calculated for each dimension to represent provider-reported system readiness.

Inferential analyses included independent-sample t-tests and one-way analysis of variance to examine differences in readiness across groups. Pearson correlation coefficients were used to assess associations between study dimensions. All statistical tests were selected based on the level of measurement and distributional assumptions of the data. Statistical significance was set at p < 0.05, and exact p-values were reported where applicable. The analysis was primarily descriptive and comparative, consistent with the study's exploratory objectives.

Patients and members of the public were not involved in the design, conduct, reporting, or dissemination of this research. Study participants contributed solely as survey respondents.

This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline, and the completed STROBE checklist is provided as a Supplementary File [23,24].

Results

A total of 254 healthcare providers participated in the study. Providers from the Eastern and Central regions were most represented, accounting for 28% and 26.4%, respectively. Participants included physicians (28.3%), nurses (32.3%), and allied health professionals (39.4%), recruited from both the public (62.6%) and private (37.4%) healthcare sectors across 5 health regions in Saudi Arabia.

The mean age of participants was 42.4 years (SD = 8.7), and the mean professional experience was 18.5 years (SD = 7.6). Slightly more than half the participants were male (50.8%), and a majority were Saudi nationals (67.7%). Most respondents held a bachelor's degree (51.2%) or postgraduate qualifications (38.6%). The majority (72%) were engaged in clinical roles, while 28% held administrative positions (Table 1,Table 2).

Table 1.

Demographic characteristics of healthcare providers (N = 254).

Variable	Category	N	%	Mean (SD)
Age	From 25 to 35	55	21.7	42.4 (8.7)
	From 36 to 46	122	48
	47 and more	77	30.3
Gender	Male	129	50.8	–
	Female	125	49.2
Nationality	Saudi	172	67.7	–
	Non-Saudi	82	32.3
Education	Diploma or less	26	10.2	–
	Bachelors	130	51.2
	Postgraduate	98	38.6
Experience	From 1 to 13	62	24.4	18.5 (7.6)
	From 14 to 26	147	57.9
	27 and more	45	17.7
Occupation	Physicians	72	28.3	–
	Nurses	82	32.3
	Allied health	100	39.4
Work nature	Clinical	183	72	–
	Administrative	71	28

^*SD = standard deviation

Table 2.

Distribution of healthcare providers by region, sector, and organization type (N = 254).

Health Region	N	%
Eastern	71	28
Central	67	26.4
Western	44	17.3
Northern	41	16.1
Southern	31	12.2
Sector Type	N	%
Public sector	159	62.6
Private sector	95	37.4
Organization Type	N	%
PHC	52	20.5
Secondary hospital	120	47.2
Tertiary hospital	82	32.3

^*PHC = primary healthcare center

Participants were distributed across primary healthcare centers (20.5%), secondary hospitals (47.2%), and tertiary hospitals (32.3%). Providers reported involvement in a wide range of chronic disease services, with the most frequently reported conditions being diabetes (76.4%), respiratory diseases (74.8%), renal diseases (70.5%), and cardiac conditions (66.5%) (Table 3).

Table 3.

Chronic health conditions covered by healthcare providers (N = 254).

Chronic Health Conditions	N	%
Diabetes	194	76.4
Respiratory	190	74.8
Renal	179	70.5
Cardiac	169	66.5
Stroke	139	54.7
Mental	136	53.5
Cancer	126	49.6
Other	13	5.1

Descriptive analysis of system readiness dimensions

Mean scores were calculated to assess the provider-reported readiness of chronic healthcare services. The overall mean system readiness score was 3.42 (SD = 0.67), indicating a moderately positive level of readiness across the study sample.

Among individual dimensions, the highest mean score was observed for Health System Organization (mean = 3.67, SD = 0.84), followed by Community Resource Linkages (mean = 3.57, SD = 0.90). Decision Support Systems, Self-Management Support, and Delivery System Design demonstrated comparable mean scores, ranging from 3.44 to 3.48.

Lower mean scores were observed for Clinical Information Systems (mean = 3.28, SD = 0.75) and Workforce Awareness of National Health Programs (mean = 3.13, SD = 0.87), indicating comparatively lower perceived readiness in these areas (Table 4).

Table 4.

Mean scores of provider-reported system readiness dimensions.

Dimension	No. of Items	Mean	SD	Rank
Health System Organization	6	3.67	0.84	1
Community Resource Linkages	3	3.57	0.9	2
Decision Support System	4	3.48	0.86	3
Self-Management Support	4	3.44	0.88	4
Delivery System Design	6	3.44	0.80	4
Clinical Information System	5	3.28	0.75	6
Workforce Awareness	6	3.13	0.87	7
Total Instrument Score	34	3.42	0.67

^*Higher scores indicate greater system readiness

Reliability and construct validity

The instrument demonstrated high internal consistency across all dimensions, consistent with findings reported in the prior development and validation study [22]. These findings support the reliability of the instrument when applied in a national context.

The observed dimensional structure was consistent with the CCM-aligned domains reported in the original validation study, including the additional Workforce Awareness dimension. This consistency supports the applicability of the instrument for assessing system readiness in real-world healthcare settings.

Comparative analysis

Statistically significant differences were observed across selected groups. Sector type emerged as the most influential factor shaping providers’ perceptions. Private-sector providers reported significantly higher scores in community resource linkages, self-management support, delivery system design, and clinical information systems (p < 0.05), whereas public-sector providers reported higher scores in workforce awareness of HSTP objectives (p < 0.05) (Fig. 1).

Fig. 1.

Provider-reported system readiness by healthcare sector.

Regional variation was also evident. Providers in the Eastern and Northern regions reported significantly higher scores in health system organization and self-management support compared to other regions (p < 0.05). Additionally, organization type influenced perceptions, with primary healthcare center providers reporting higher awareness of HSTP objectives than those in secondary and tertiary hospitals (p < 0.05) (Fig. 2). No statistically significant differences were observed across other demographic or professional characteristics.

Fig. 2.

Provider-reported system readiness by organization type.

Correlation among system readiness dimensions

Pearson correlation analysis demonstrated statistically significant positive associations among all system readiness dimensions (p < 0.05). Stronger correlations were observed between Healthcare Practice-related dimensions and Health System Organization, indicating the interdependence between organizational structures and care delivery processes.

Overall, the findings indicate a moderately positive level of chronic healthcare system readiness, with variation across system domains, sectors, and organizational characteristics.

Discussion

This study provides a national provider-reported assessment of chronic healthcare service readiness in Saudi Arabia within the context of the HSTP and CCM. Overall, healthcare providers reported moderately positive levels of system readiness, with variation observed across system dimensions, healthcare sectors, and regions. These findings suggest that while structural foundations of chronic care delivery have improved, gaps remain in operational consistency and system integration.

Organizational readiness and governance

Health system organization emerged as the most positively perceived dimension, indicating that chronic care is increasingly embedded within institutional governance and long-term strategic planning. This reflects the impact of recent reforms, including corporatization, cluster-based governance, and strengthened accountability mechanisms under the HSTP. These structural advancements appear to have enhanced organizational clarity and alignment with national chronic care priorities.

Similar findings have been reported in national studies highlighting improvements in governance structures and strategic planning within the Saudi healthcare system [17,25]. However, while governance structures are well established, their effectiveness depends on the extent to which they are translated into consistent operational practices across healthcare settings.

Community resource linkages

Community resource linkages were also rated relatively favorably, reflecting expanding collaboration between healthcare institutions and community entities, particularly in awareness and screening initiatives. However, these collaborations remain largely program-based rather than systematically integrated into chronic care pathways [26,27].

This finding suggests that while community engagement is recognized at the policy level, there is a need to institutionalize these linkages through formal governance frameworks and sustainable partnership models. Without such integration, community-based interventions may remain fragmented and limited in their long-term impact on chronic disease prevention and management.

Operational dimensions of chronic care delivery

Moderate readiness levels observed for self-management support, decision support systems, and delivery system design indicate that although structural reforms and clinical guidelines are in place, consistent operational implementation remains limited. These findings align with previous studies in Saudi Arabia reporting similar challenges in care coordination, referral integration, and patient empowerment within chronic care settings [25,28,29,30].

One possible explanation is that these dimensions require behavioral, workflow, and interdisciplinary practice changes, which are inherently more complex and slower to implement than structural reforms. While the HSTP Model of Care promotes proactive, team-based care, the translation of these principles into routine clinical practice appears to be ongoing.

Clinical information systems and workforce awareness

Clinical information systems and workforce awareness of national health programs emerged as comparatively weaker dimensions. Providers reported that digital platforms are primarily used for documentation and reporting, with limited functionality for care coordination or outcome monitoring.

This reflects broader system-level challenges related to interoperability, integration of digital platforms, and data-driven decision-making, which have been reported in national studies [29,31,32]. Similarly, workforce awareness appears to be limited to general familiarity with reform objectives, without sufficient engagement in structured training or implementation support.

These findings highlight a critical gap between strategic intent and frontline implementation, suggesting that policy-level reforms must be accompanied by targeted workforce development and digital integration strategies.

Interpretation of sectoral and regional differences

The observed differences between public and private sector providers may be partially explained by variations in organizational flexibility, resource allocation, and operational autonomy. Private healthcare institutions may benefit from more agile decision-making structures, greater investment in digital infrastructure, and stronger incentives for performance optimization, which could contribute to higher perceived readiness in areas such as care coordination, delivery system design, and clinical information systems. In contrast, public-sector providers reported higher awareness of HSTP objectives, which may reflect closer alignment with national policy initiatives and more direct exposure to governmental transformation programs.

Regional variations may also be influenced by differences in implementation maturity, leadership engagement, and the pace of HSTP-related reforms and initiatives across health clusters. Regions demonstrating higher readiness may reflect earlier adoption of integrated care models, stronger managerial oversight, or more effective coordination across levels of care. Conversely, lower-scoring regions may be experiencing transitional challenges related to system restructuring, resource distribution, or workforce adaptation.

These findings suggest that variability in system readiness is shaped not only by policy design but also by local implementation capacity, organizational context, and system maturity. However, these interpretations should be considered within the context of the study design and non-probability sampling approach, and may reflect indicative patterns rather than definitive system-wide differences. Further research using probabilistic sampling and longitudinal designs is warranted to validate these findings and explore causal relationships.

System-level drivers of provider-perceived readiness

The observed patterns indicate that provider perceptions of system readiness are shaped by the interaction between organizational governance, care delivery processes, and digital infrastructure. Dimensions related to structural and organizational aspects were consistently rated higher than those requiring sustained behavioral and operational change.

This aligns with evidence from reform-oriented health systems, where structural reforms alone are insufficient to achieve meaningful improvements without functional integration and active workforce engagement [8,33,34].

Implications for policy and practice

The findings of this study have important implications for healthcare policy and practice in Saudi Arabia. First, efforts should focus on strengthening the operationalization of chronic care models by translating policy frameworks into standardized clinical workflows and integrated care pathways. Second, investment in digital health systems should prioritize interoperability and the use of data for care coordination and performance monitoring. Third, structured workforce development programs are needed to enhance provider engagement, particularly in relation to HSTP objectives and chronic care practices.

Additionally, formalizing community-health system linkages through governance structures and accountability mechanisms may improve the sustainability and effectiveness of preventive and community-based interventions.

Strengths and limitations

This study benefits from a national scope, the inclusion of diverse provider roles and healthcare settings, and alignment with internationally recognized frameworks and national reform priorities. However, the cross-sectional design limits causal inference, and reliance on self-reported data may introduce response bias. Additionally, the use of non-probability sampling may limit the generalizability of the findings.

Conclusion

In conclusion, this provider-reported assessment indicates that chronic healthcare system readiness in Saudi Arabia has advanced under the HSTP, particularly in relation to organizational governance and structural alignment with chronic care principles. These findings reflect the positive impact of ongoing health system reforms in establishing foundational components of chronic care delivery.

However, important gaps persist in operational integration, workforce engagement, and the effective use of clinical information systems. These gaps highlight the need to strengthen the translation of policy-level reforms into consistent, practice-level implementation across healthcare settings.

Addressing these areas is critical to ensure sustainable and coordinated chronic care delivery. In particular, efforts should focus on enhancing digital health integration, supporting workforce development, and embedding chronic care practices within routine clinical workflows. In addition, formalizing community-health system linkages may further support sustainable and preventive approaches to chronic disease management.

Overall, this study provides context-specific evidence to inform ongoing health sector transformation efforts in Saudi Arabia and supports the development of more integrated and responsive chronic healthcare systems. Future research is recommended to further examine the longitudinal impact of system readiness on care outcomes and patient experience.

Acknowledgement

The authors thank all healthcare providers who participated in this study for their valuable contributions. We also appreciate the constructive comments of the anonymous reviewers. English language editing was provided by Scribendi Inc.

Declaration

The authors declare no conflict of interest and received no specific funding for this study.

AI-based tools were used solely for language refinement and editorial support. All study design, analyses, interpretations, and conclusions were performed and verified by the authors.