Qatar

HEALTHCARE & EDUCATION OVERVIEW

Q2 2013

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

Introduction

As healthcare and education markets in the MENA region and around the world continue to evolve, the real estate and operational needs of providers and operators become increasingly complex. Trends and industry changes require investors and operators of healthcare and education facilities to make challenging decisions. Over the years, despite improvements in social infrastructure processes and systems across the region, these sectors still offer significant opportunities for investors / operators on the back of the following factors:
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482 offices in 62 countries on 6 continents United States: 140 Canada: 42 Latin America: 20 Asia Pacific: 195 EMEA: 85 $2.0 billion in revenue More than 13,500 employees 5,100 brokers $71 billion in transaction volume across more than 78,000 sale and lease transactions 1.1 billion square feet under management

High population growth rates. The MENA population increased from around 100 million in 1950 to 500 million in 2010. Current projections anticipate the population will reach 800 million by 2050, with approximately 33% under the age of 15. Poor government provision in both volume and quality. Due to the income divide in the region, the expenditure on healthcare and education is half of what it is in Europe and the US. Introduction of compulsory health insurance (by a number of regional governments). After compulsory health insurance was introduced in Abu Dhabi, the revenues of a number of private hospitals doubled in one year. High returns on healthcare and education investments. Healthcare Market
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Financial Modelling Mergers & Acquisitions Assistance Buy side Advisory/Sell side Advisory Sale and Leaseback Advisory Public Private Partnership (PPP) & Privatisation Operator Search & Selection and Contract Negotiation Land, Property and Business Valuation Asset & Performance Management Site Selection & Land / Property Acquisition Performance Management and Industry Benchmark Surveys

There is a heavy reliance on imported medicine and medical equipment. This increases the cost of establishing healthcare facilities. There are a number of medical equipment suppliers either providing medical equipment on long-term leases, or even by equity investment. Continued growth of regional medical tourism. Most governments in the region are encouraging medical tourism, with Jordan, Lebanon and Dubai leading the way.

Education Market
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The governments increasing focus on education by means of expenditure and education reforms, along with a high demand for quality education, specially from expatriate white collar families, has emphasised demand for quality branded schools. Compulsory education guidelines set by SEC (primary and preparatory). The government has plans in setting secondary education compulsory as well.

For further information please contact: Mansoor Ahmed MAS, MSc Director | Development Solutions Healthcare | Education | PPP mansoor.ahmed@colliers.com P.O. Box 71591 | Dubai | UAE Main: +971 4 453 7400 Mobile: +971 55 899 6091 Duncan Gray Director duncan.gray@colliers.com P.O. Box 71591 | Dubai | UAE Main: +971 4 453 7400 Mobile: +971 55 720 0707

With an estimated population of 1.9 million residents with an annual growth rate of 6%, Qatars healthcare and education sectors cater to a rapidly growing population and the concurrent increasing demand on hospitals and schools. Overall, the supply of healthcare and education facilities makes a considerable effort to keep pace with the burgeoning population, a situation recognised by the government which has recently introduced initiatives including increased budget allocations and reforms to support the market.

Colliers International Healthcare & Education Overview provides a brief snapshot of the key factors impacting the Qatar market and the future outlook of the sectors.

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

Exhibit 1: GDP at Constant Prices Contribution by Economic Sectors

Other Services 12% Fin, Ins, & Real Estate 9% Transport & Communication 9% Trade, Rest, Hotels 7%

1. Economic & Demographic Overview of Qatar

1.1 ECONOMIC PERFORMANCE

Oil & Gas Sector 50%

Qatars economy has become one of the fastest growing economies in the world, driven by sustained production and rapidly expanding natural gas export, the main component of the GDP (Refer to Exhibit 1). Qatars economy is forecasted to continue to enjoy high GDP growth over the next few years (Refer to Exhibit 2), underpinned by large capital expenditure programs in energy and real estate, with sustained domestic demand. Although most of this growth can be attributed to Qatars core economic engine, the hydrocarbons sector and the non-oil and gas sector also enjoy double-digit growth. Revenue generated by the hydrocarbon sector, coupled with a determined economic diversification programme on the part of the government has enabled the country to emerge as one of the wealthiest countries in the world in terms of GDP per capita (Refer to Exhibits 3 & 4) Qatars per capita income is, though, projected to grow at a relatively slower pace after 2011, according to IMF estimates, the estimated per capita income in 2016 is expected to reach $113,040.

Building & Const 7% Electricity & Water Manufacturing 1% 5%

Source: Qatar Statistics Authority, 2010 ,Colliers International 2013

Exhibit 2: Qatar GDP, constant prices

140 120 US$ Billions 100 80 60 104.92 109.80 115.14 34.07 40.41 51.23 64.25 69.80 80.95 95.99 40 20 0 2012E 2013E 2014E 2015E 2005 2006 2007 2008 2009 2010 2011 121.03

Exhibit 3: GCC Countries Per Capita Income & Population Distribution

100,000 90,000 Per Capital Income(US$) 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 Population (000) Bahrain Kuwait Oman Qatar Saudi Arabia UAE Oman, 2,846, 28,684 Bahrain, 1,324, 27,433 Kuwait, 2,818, 54,283 UAE, 7,891, 47,893 Saudi Arabia, 28,083, 24,268 Qatar, 1,840, 88,314 Highest Per Capita Income, however 2nd Lowest Population Base in GCC

Source: IMF2012, Colliers International 2013

Exhibit 4: Arab World Income & Population Distribution

Country Population (millions) Per Capital Population Income (%) (US$) GDP (%)

Bahrain Kuwait Oman Qatar Saudi Arabia UAE GCC Algeria Egypt Iraq Jordan Lebanon Libya Morocco Palestine Sudan Syria Tunisia Yemen Others Total

1,324 2,818 2,846 1,840 28,083 7,891 44,801 35,980 82,537 32,665 6,330 4,259 6,423 32,273 4,152 44,632 20,766 10,594 24,800 305,412 350,213

27,433 54,283 28,684 88,314 24,268 47,893 33,322 5,920 6,831 3,864 5,966 14,609 16,897 4,952 2,465 2,325 5,252 9,351 2,333 5,407 8,978

0.38% 0.80% 0.81% 0.53% 8.02% 2.25% 12.79% 10.27% 23.57% 9.33% 1.81% 1.22% 1.83% 9.22% 1.19% 12.74% 5.93% 3.03% 7.08% 87.21% 100.00%

0.08% 4.91% 2.62% 5.31% 21.89% 12.14% 46.95% 6.84% 18.11% 4.05% 1.21% 2.00% 3.49% 5.13% 0.33% 3.33% 3.50% 3.18% 1.86% 53.05% 100.00%

Source: Arab Human Development Report 2011 (UNDP); Colliers International 2013

Global hydrocarbon demand is expected to rise in 2013 as a result of continued growth in emerging markets, primarily Asia. This represents a positive indication for Qatars economic growth, which is highly dependent on hydrocarbon revenues. The global economic downturn in 2009 resulted in a low GDP (constant prices) growth rate of 8.6% compared to 25.4% in 2008, a figure which is expected to grow by a CAGR of approximately 5% during 2013-2016. Impact on Healthcare & Education: Overall, Qatars economy has been performing well which translates positively towards the healthcare and education industries. Anticipated increases in hydrocarbon prices and strong GDP growth forecasts will help to strengthen the market and encourage private sector investment in both sectors from Qatari nationals and expatriates in the coming years. The following sections examine the healthcare & education sectors of Qatar in more detail.

Source: Arab Human Development Report 2011 (UNDP)

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Exhibit 5: Qatar Population (million)

2.5 2 1.5 1 0.5 1.64 1.70 1.77 1.84 1.91 1.99 2.07 0 2009 2010 2011 2012 2013 2014 2015 2016
Source: IMF2012, Colliers International 2013

1. Economic & Demographic Overview of the Qatar (continued)

1.2 DEMOGRAPHIC ANALYSIS

2.15

Qatars population has more than doubled in the past decade, from approximately 700,000 in 2004 to almost 1.84 million in 2012 (Refer to Exhibit 5). The rapid increase in the population over the last few years is attributed to the strong performance of the economy, which has resulted in a large number of projects coming online, thereby leading to the influx of professionals, service workers and contracting sector staff. Taking into consideration the current large-scale construction projects as well as Qatar winning to host the 2022 FIFA World Cup, the population is estimated, by Colliers, to reach approximately over 2.2 million by 2016, and over 3 million by 2020, according to IMF. However, due to the large expatriate population in Qatar, the number of residents above the age of 55 is limited (Refer to Exhibit 6)
Exhibit 6: Distribution of Population in Qatar
75+ yrs. 70-74 yrs. 65-69 yrs. 60-64 yrs. 55-59 yrs. Male Female

50-54 yrs.

The Raise of Generation X, Y & Z and its Impact on Healthcare Demand Lifestyle diseases (also sometimes called diseases
of longevity or diseases of civilization interchangeably) are diseases that appear to increase in frequency as countries become more industrialized and people live longer. They can include Alzheimer's disease, atherosclerosis, asthma, some kinds of cancer, chronic liver disease or cirrhosis, Chronic Obstructive Pulmonary Disease, Type 2 diabetes, heart disease, metabolic syndrome, chronic renal failure, osteoporosis, stroke, depression and obesity.

45-49 yrs.

40-44 yrs.
35-39 yrs.

30-34 yrs.
25-29 yrs

20-24 yrs
15-19 yrs.

10-14 yrs.
5-9 yrs.

Some commenters maintain a distinction between

diseases of longevity and diseases of civilization. Certain diseases, such as diabetes, dental caries or asthma appear at greater rates in young populations living in the "western" way; their increased incidence is not related to age, so the terms cannot accurately be used interchangeably for all diseases.

0-4 yrs. 250

200

150

100

50

50

Source: Qatar Statistics Authority (QSA); Colliers International 2013

100 150 in Thousands

As a result of urbanisation and rising disposable

income majority of the GCC population including Qatar, have adopted a sedentary lifestyle characterised by an aversion to exercise and consumption of processed foods leading to increased chronic diseases (such as diabetes, coronary problems and other obesity-related illnesses) previously uncommon to the region. For example, in recent years the rate of diabetesrelated illnesses have witnessed an unprecedented increase in the GCC which is expected to increase from 1.5 million cases in 2000 to 4.5 million by 2030.
Source: Wikipedia 2012; Colliers International 2013

One of the major consequences of population growth is the distribution between Qatari nationals and expatriates. Qatari nationals account for approximately 25% of the countrys population, with the remaining composed of foreign expatriate workers. From an ethnic perspective, Indians and Pakistanis are the next largest groups at 18% each. Other Arabs account for 15%, Iranians 10% and other ethnic groups combined, total 14% of the population. Gender distribution in Qatar is skewed towards males, constituting 74% of the total population. The majority of males are within 25 - 45 years of age, a category between Generation X (1965-1980) and Generation Y (1981 and thereafter).

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Qatar Qatar

HEALTHCARE EDUCATION OVERVIEW HEALTHCARE& OVERVIEW

Q2 2013 Q2 2013

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

Exhibit 7: Distribution of Hospital Beds

2. Healthcare Sector Overview

Al Wakrah Hospital 13% Private Hospitals 16% The Cuban Hospital 3% Heart Hospital 5% Al Amal Hospital 2% Hamad General Hospital 25%

2.1 INTRODUCTION Qatars healthcare sector has witnessed rapid development over the past few years. Despite the global economic slowdown in late 2008, Qatars healthcare market continues to grow given the influx of expatriate population. 2.2 KEY PLAYERS

The Qatar healthcare sector is composed of both public and private hospitals. Qatars Supreme Council of Health (SCH) regulates the medical market, where it does not provide clinical services. The SCH delegates the responsibility for care to public institutions, such as Hamad Medical Corporation (HMC), and private Rumallah healthcare providers (Refer to Exhibits 7& 8).
Al Khor Hospital 5% Womens Hospital 14% Hospital 17%

Supreme Council of Health (SCH): The Supreme Council of Health (SCH) oversees and regulates the medical marketplace (both private and public), which is run under the Minister of Health and Secretary General, His Excellency Abdulla bin Khalid Al-Qahtani. Hamad Medical Corporation (HMC) Public Hospitals: Hamad Medical Corporation (HMC) is the countrys main tertiary care provider, with eight hospitals covering the country as well as a national ambulance service and a home healthcare service. Private Hospitals: The private sector comprises 4 hospitals; namely, Al Ahli, Al Emadi, American, and Doha Clinics Hospitals. Primary Healthcare Corporation (PHCC): The main primary healthcare provider in Qatar is the Primary Healthcare Corporation (PHCC), which was established in the 1950s to deliver quality care in the first instance to the population of Qatar.

Source: Qatar Supreme Council of Health 2009, Colliers International 2013

Exhibit 8: Key Healthcare Entities

Supreme Council of Health

Hamad Medical Corporation (HMC)

Private Hospitals

Primary Healthcare Corporation (PHCC)

2.3 BUDGET ALLOCATION

Source: Colliers International 2013

Qatars public healthcare budget witnessed a rapid increase during 2012. The approved budget for financial year 2012/2013 was 47% higher than that of the previous year. The SCH made equally determined efforts. By 31 December 2012, the SCH General Secretariat (GS) had utilised 98.6% of the approved budget for financial year 2012/2013 on applying plans for the future model of care (Refer to Exhibit 9). Average healthcare spending in GCC is 3% of GDP per annum. Despite increased budget allocations, healthcare spending in Qatar (1.9% of GDP), continues to remain behind GCC and many developed markets. Healthcare spending in Qatar is only one-fourth in markets such as UK (9.3% GDP) and USA (17.9%). (Refer to Exhibit 10).
Exhibit 9: Growth in Approved Budget and Actual Expenditure
10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 9,149 7,912 7,197 5,782 5,586 5,355 7,108 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0

Exhibit 10: Healthcare Spending as a % of GDP

UAE Qatar Oman Kuwait Bahrain KSA UK Germany Canada France Netherlands USA 0.0%

3.3% 1.9% 2.3% 2.7% 3.8% 3.7% 9.3%

QR Millions

11.1% 11.2% 11.6% 12.0% 17.9% 5.0% 10.0% 15.0% 20.0%

Approved Budget

Actual Expenditure

Approved Budget

Actual Expenditure

Approved Budget

Actual Expenditure

Approved Budget FY 2012/13

FY 2009/2010 HMC

FY 2010/2011 PHCC GS

FY 2011/12 Total

Source: UNDP 2012, Colliers International 2013

Source: SCH Annual Report 2012, Colliers International 2013

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

2. Healthcare Sector Overview (continued)

2.4 KEY HEALTHCARE INDICATORS

Comparing the healthcare indicators of Qatar to other GCC markets and developed countries such as the US, UK and Germany, the local market demonstrates a shortage of resources. The shortage is prevalent across all GCC countries; however, undersupply in Qatar is further intensified as the market is represented by the lowest number of beds per population even within the GCC (Refer to Exhibit 11).

Exhibit 11: Qatar Key Healthcare Indicators (per 1,000 people)

13.40 Developed Nations 9.90 11.40 GCC 9.50 Qatar

16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 -

9.80

9.30

8.30

4.70

6.60

4.60

4.50

7.40

3.40

3.00

3.20

3.70

2.90

3.00

2.80

3.90

2.40

2.10

2.20

2.10

2.00

2.00

2.80

1.90

4.10 UAE

1.80

1.80

1.50

1.80

0.90

Oman

1.20

Bahrain

Netherlands

Beds

Germany

France

Canada

Nurses

Physicians

Source: World Development Indicators (2005-2011), Colliers International 2013

Leading Causes of Death in Qatar

Healthcare expenditure represents 1.9% of GDP. Given the lower population base and high GDP, Qatar currently has the highest per capita healthcare expenditure in GCC at US$1,715 (Refer to Exhibit 13). With the bed ratio per 1,000 population in Qatar falling within the lowest range compared to both the GCC and developed countries, the market offers scope of more hospitals in the country. Given the limited healthcare resources, especially within the secondary and tertiary services, the SCH sends many patients for treatment overseas. Typical destinations include Germany, the United States, and the United Kingdom. In order to address the rapidly increasing demand for healthcare services, the SCH opened 3 new facilities in 2012 - 2 new hospitals, 1 new research/diagnosis facility; totalling to 297 hospital beds.

Unclassified

symptoms, external causes, and diseases of the circulatory system, which was the third highest cause of deaths accounting for almost 17 in every 100,000 residents. among women, was identified as the cause of death for every 12 persons per 100,000, indicating an increase of cancer related deaths (Refer to Exhibit 12).

Neoplasms, which was a common cause of death

Exhibit 12: Top 5 Leading Causes of Death

Rate per 100,000 Population 35.0 30.0 25.0 20.0 15.0 10.0 5.0 Unclassified Symptoms, signs and abnormal findings External Causes of Mortality Neoplasms Diseases of the Circulatory System Endocrine, Nutritional and Metabolic Diseases 33.9

January: Cuban Hospital, in Dukhan, 87 beds. April: a positron emission tomography computed tomography (PET-CT) facility, in Doha. This is Qatars sole integrated cancer diagnosis and treatment facility. December: Al Wakra Hospital, in Al Wakra, 210 beds, and provides a full range of specialties, such as general medicine and surgery.

26.5

16.7 12.1 9.0

Exhibit 13: Qatars Ranking within Global and Regional Healthcare Parameters
Life Expectancy at Birth
GCC Average : 76 years Qatar: 78 years

Health Expenditure (public)

GCC Average : US$ 895 Qatar: US$ 1,715

Hospital Beds
GCC Average : 1.85 per 1,000 pop Qatar: 1.2

Source: Qatar Supreme Council of Health 2009, Colliers International 2013

Source: World Bank Database, Colliers International 2013

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Kuwait

Qatar

USA

KSA

UK

1.90

OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

Exhibit 14: Growth in Public Hospital Beds
No. of Hospital Beds 2,500 2,000 1,500 1,000 500 2006 2009 2012
Source: SCH Annual Report, 2012, Colliers International 2013

2. Healthcare Sector Overview (continued)

2,208 1,641 1,623

2.5 HOSPITALS & BED CAPACITY

595

Analysis of bed capacity at hospitals in Qatar reveals (Refer to Exhibit 14): There are currently 12 hospitals in Qatar, with a capacity of over 2,200 hospital beds, both within the public and private sectors. The public sector dominates the market, representing 8 hospitals, and 80% of total hospital beds, with an average of 275 beds per hospital. The private sector accounts for 4 hospitals, but given the limited bed capacity, is represented by only 20% of total hospital beds in Qatar, with an average of 148 beds per hospital (Refer to Exhibit 15). Overall, the average bed capacity per hospital across the public and private sectors, stands at 223 beds. Hospital beds in Qatars public sector witnessed a CAGR of 5% since 2006, while the private sector witnessed 8% during the same period. Private hospitals continue to represent a minor stake in the market. Although there are only 4 private hospitals in the country, there are more than 200 private individual clinics and polyclinics in the market. These clinics are however small in size and offer limited facilities. Plans are underway for 31 further facilities (including 9 secondary and tertiary facilities) between 2013 and 2021 (Refer to Exhibit 16).

Exhibit 15: Growth in Private Hospital Beds

700 No. of Hospital Beds 600 500 400 300 200 100 0 2006 2009 2012
Source: SCH Annual Report, 2012, Colliers International 2013

383

426

Exhibit 16: Construction Plans for SCH and HMC Secondary/Tertiary Care Facilities, 2012-2021
Expected Opening 2014 HMC New Womens Hospital HMC Ambulatory and Minimally Invasive Surgery Hospital 2015 HMC Communicable Disease Hospital HMC Translational Research Institute 3 SCH Hospitals Neurosciences Institute HMC New Cancer Hospital HMC Mass Casualty Trauma Hospital 2018 2021

Exhibit 17: Patient Activity Analysis - SCH, HMC and PHCC

Activity SCH PHC Visits MC Examinations HMC Inpatient Admissions Outpatient Visits ED Visits Day Case Surgeries Home Healthcare Visits Births PEC Activity Ambulance Calls PHCC Visits Total 2011 182,468 179,811 2,657 2,068,339 64,722 793,737 675,582 12,671 2012 219,505 215,774 3,731 2,288,586 70,444 966,139 726,467 12,814 Growth (%) 20.3 20 40.4 10.65 8.84 21.72 7.53 1.13

HMC Physical Medicine and Rehabilitation Hospital

Source: SCH Annual Report, 2012, Colliers International 2013

2.6 INPATIENTS AND OUTPATIENTS:

The volume of outpatients is considerably higher than inpatients. This is in line with the nature of outpatient treatments, usually consisting only of consultations, and treatments. Based on the latest data available (SCH Annual Report 2012), out of a total volume of 2.2 million encounters in HMC, approximately 42% were outpatient visits in 2012 (Refer to Exhibit 17). Analysing patient volumes by type, the majority of encounters after outpatients, were ED (Emergency Department) visits, PEC (Physical Education Cards) activity and ambulance calls. Growing demand for healthcare facilities is further justified by the increasing utilisation/occupancy rates experienced in both public and private hospitals in Qatar. According to the latest statistics available, average bed occupancy reached 80% in 2009.

17,560 17,624 486,443 69,231 3,641,336 3,641,336 5,892,143

19,767 18,814 474,141 110,645 3,817,356 3,817,356 6,325,447

12.57 6.75 -2.53 22.77 4.83 4.83 7.35

Source: SCH Annual Report, 2012, Colliers International 2013

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Key Observations

3. Conclusion

The demand for healthcare facilities in Qatar is expected to increase rapidly given that Qatar has one of the fastest growing populations, with high life expectancy at birth and low infant mortality rates. Non-communicable diseases (NCDs), also known as lifestyle diseases, are also increasing at an alarming rate in Qatar as a result of increasing prosperity and the socio-economic transformation. The epidemiological profile of the market and the region includes high incidences of obesity, hypertension and diabetes mellitus, particularly Type-2, which is the leading cause of cardiovascular disease, kidney failures and amputations. The complications caused by these diseases will increase long-term costs, further burdening an already overstretched healthcare system. Plans are underway to implement compulsory health insurance in Qatar by the end of 2014. Regional insurance players have also identified Qatar as a growing market and have already established themselves in the country. On the back of a growing population and high income levels, Qatars healthcare market offers opportunity for expansion. At present the healthcare market is dominated by the government sector (Hamad Medical Corporation) and there is a supply gap for good quality tertiary healthcare facilities in the private sector. Despite positive government measures being implemented to meet the demand for hospital bed capacity in the country, it remains challenging to deliver new hospitals or expand existing facilities to overcome the prevailing undersupply. Moreover, it is Colliers understanding that most of the private hospitals are family owned and operated by doctors, with limited healthcare operators having substantial management experience locally, regionally and internationally. Given the present undersupplied market, and attractive returns offers by the healthcare sector in Qatar, Colliers sees a possibility of foreign investors taking a role in meeting the supply gap, especially in terms of branded regional or international operators. Overall, the demand for health services in Qatar is expected to increase gradually, especially relating to chronic diseases, such as diabetes, is expected with larger volume increases in outpatient settings. Moreover, it is also expected that there will be aggressive growth in inpatient services relating to both maternity and childcare, and diabetes.

Urbanisation

and changing lifestyle throughout the GCC has resulted in an increase in chronic diseases previously uncommon to the region, such as diabetes, coronary problems and other obesity-related illnesses. rates are expected to gradually change the demographic structure of the region over the next 20 years and at the current growth rate of 5% a year, the GCCs 35 million population is expected to double over the next two decades.

Low mortality and high fertility

80% of a persons healthcare

requirements typically occur after the age of 40-50 years. In the next 20-30 years, when most of the current young population of the GCC countries age, there is likely to be a sharp rise in healthcare demand from older people.

Compared to these challenges,

the healthcare indicators do not reflect the income level enjoyed by the majority of the population in the region. This requires heavy investment over the medium to long-term.

The GCC healthcare sector is

going through a rapid change and most of the governments in the region are encouraging private sector investment in this sector, either direct investment or through Public Private Partnership (PPP).

All these shortfalls provide an

opportunity for healthcare providers to enter into a market which offers enormous potential for growth.

Exhibit 18: Challenges and Opportunities in Qatar Healthcare Sector

Heavy Reliance on Imported Medicine and Medical Equipment High Transient Population High Population Growth Rate Increasing Income levels Raising Healthcare Expenditure Plans underway for Compulsory Health Insurance

Positive Factors

Positive returns on Healthcare Investment Continued growth of Regional Medical Tourism

Source: Colliers International 2013

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Negative Factors

Unorganised Regulatory Environment compared to Mature International Markets

OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

COLLIERS HEALTHCARE SERVICES - SNAPSHOT

Feasibility Studies; Due Diligence; Investment Memorandums (IM)

- Conducted over 50 Feasibility Studies, Investment Memorandums & Due Diligence for ; new projects, Financing & Refinancing, Merger & Acquisitions: - Countries: UAE, KSA, Qatar, Egypt, and Ecuador - Total Number of Beds (2010-2012): 5,000 plus - Mixed Use Healthcare Parks (2010-2012): 5 with a total BUA of 5+ million sqft - Total BUA of All Healthcare Projects (2010-2012):10+ million sqft Conducted Studies for the Following Specialities (2010-2012) General Hospital (20+ Hospitals) Maternity & Childcare (10+ Hospitals) Polyclinics (5+ Centres) Day-care Centre (5+ Centres)

Land; Property; Business Valuation

- Conducted over 20 Hospital Valuations for ; end of year Audit, Financing & Refinancing, Merger & Acquisition: - Countries: UAE, KSA, Qatar, Egypt, and Oman - Total Number of Beds Valued(2010-2012): 1,200 plus beds - Mixed Use Healthcare Parks (2010-2012): 5 with a total BUA of 5+ million sqft - Total BUA of All Healthcare Projects Valued (20102012): 10+ million sqft

Trauma & Rehabilitation (5+ Hospitals) Cardiac (2 Hospitals) Paediatric (2 Hospitals)

Oncology / Cancer (1 Hospital)

Orthopaedic (1 Hospital) Medical College (1 Institution) Nursing College (1 Institution)

Operator Search & Selection and Contract Negotiation

- Countries: UAE, KSA, Qatar and Egypt - Total Number of Beds (2010-2012): 1,000 plus - Total BUA of All Healthcare Projects (2010-2012): 5+ million sqft

Key Projects:
300 bed Hospital in Riyadh 200 bed Hospital in Abu Dhabi 80 bed Hospital in Abu Dhabi 100 bed Hospital in Dubai 200 bed Hospital in Sharjah

100 bed Hospital in Fujairah 100 bed Hospital in Amman 2 Healthcare Parks in Jeddah 1 Healthcare Park in Riyadh 1 Healthcare Park in Cairo

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Qatar Qatar

HEALTHCARE & EDUCATION OVERVIEW EDUCATION OVERVIEW

Q2 2013 Q2 2013

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4. Education Sector Overview

Exhibit 19: Total Number of Schools in Qatar 4.1 KEY PLAYERS

8%

Supreme Education Council (SEC): The Supreme Education Council established in 2002, directs education policy and plays a vital role in developing and implementing the National Strategy guidelines, Education for A New Era reforms. Independent Schools: All former Ministry of Education schools were approved as fully Independent schools at the start of school year 2010/2011. Each independent school has a board of trustees, a parent association and a student parliament. Independent schools form the majority of the education sector in Qatar, with a 58% share (Refer to Exhibit 19). Private Sector: Private schools are expanding in line with growing population for both Qatari and Expatriate Students, currently total private schools constitutes remaining 42% of the schools in Qatar.

26% 58% 8%

Independent International Private Arabic Community

Source: Supreme Council of Education, Qatar Statistics Centre. Colliers International 2013

Improved standards in private schools and the increasing number of expatriate population are the main drivers for growth in the number of school-going children in the private schools. Qatari parents are increasingly spending more to send their children to international private schools. The average number of students across different types of schools varies substantially in Qatar (Refer to Exhibit 20).

4.2 BUDGET ALLOCATION

The Qatari government has highlighted its intentions to improve the quality of education, with its decision to allocate US$ 6.04 billion for the education budget during the 2012/2013 fiscal year. According to the latest data from the World Bank, public expenditure on education in the region stands at 18.6% of the total government spending compared to the world average of 14.2%. Despite increased budget allocations, education spending as % of total GDP in Qatar continues to remain behind many developed markets. Education spending in Qatar (3.3% of GDP) is almost half compared to what is allocated in markets such as South Africa (6.0% GDP), Netherlands (5.9% GDP) and the United Kingdom (5.6% GDP). (Refer to Exhibit 21). Exhibit 21: Education Spending as % of GDP
Tunisia South Africa 6.3% 6.0% 5.9% 5.6% 5.4% 5.4% 4.8% 4.6% 3.3% 3.3% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

Exhibit 20: Average Number of Students per School 1,000 900 800 700 600 500 400 300 200 100 -

896

877

Netherlands United Kingdom

No. of Students

505 330 190

Switzerland USA Canada

International Schools

Community School

Independent Schools

Private Arabic Schools

Others

Germany Qatar Singapore 0.0%

Source: Supreme Council of Education, Qatar Statistics Centre. Colliers International 2013

Source: UNDP 2012, Colliers International 2013

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

4. Education Sector Overview (continued)

4.3 EDUCATION REFORMS

Education for A New Era reforms. At the heart of these reforms are increased variety and choice in education provision through a well regulated private sector alongside government-funded independent schools; internationally benchmarked curriculum standards in Arabic, English, mathematics and science; and continuous performance monitoring of schools. In its effort to achieve world-class standards, Qatar has made significant investments to improve its entire education system. Despite these continuous efforts, education performance in Qatar, as measured through international examination results, are gradually showing progress. Qatar offers a school voucher program for its citizens at selected schools, based on demand. The programme is expected to overcome financial challenges faced by children from relatively disadvantaged households to access a selected group of private schools that meet strict quality criteria; the Supreme Education Council continues to review the voucher system to determine the feasibility of extending it to a broader group of students. Exhibit 22: Key Milestones in Qatar's Education Sector
1956, the first school for girls was formally established The government established the Department of Education, later called the Ministry of Education 1995, The Qatar Foundation for Education, Science and Community Development was set up

Exhibit 23: Schools Breakdown, by level of education

17% 33% 19%

1949, the first "modern school was opened by Hamad ibn Abd Allah its one teacher taught fifty boys

1973, opening of Qatar University which evolved from teacher-training colleges separate for men and women

2002, Implementation of the independent school reform began in September 2002 and is continuing

Source: General Secretariat for Development Planning, Colliers International Research 2013

30%

4.4 SCHOOLS AND STUDENTS BY EDUCATION CYCLE

Pre-Primary Preparatory Primary General Secondary

Qatars education system entails six years of primary schooling (commencing at age 6), followed by three years at the preparatory stage and three years of secondary schooling; the first nine years are compulsory. After secondary school, several pathways are available for post-secondary education. (Refer to Exhibit 23). Despite the fact that the number of pre-primary establishments has exceeded the number of primary schools, it must be noted that kindergartens are smaller in size and comprise of fewer class rooms and less students than regular schools. With regards to Qatari children, as well as for children of non-Qataris working in the public sector, primary and secondary education is free, and thus they make up the majority of the composition of students at public schools. In addition to compulsory schooling, there has been a rapid growth in preprimary kindergarten education in support of early childhood development; the uptrend in kindergarten education has been driven by private providers, which in 2010/2011 accounted for 81% of total enrolments (Refer to Exhibit 24). Overall, the education sector in Qatar witnessed a significant rise in the number of students across all education cycles due to the increase in national population growth, and the influx of expatriate workers.

Exhibit 24: Classes Breakdown, by level of education

17%

16%

20% 47%

Pre-Primary Preparatory

Primary General Secondary

Source: Qatar Statistics Authority, Colliers International 2013

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

Exhibit 25: Gender-wise Breakdown of Student Population in Qatar - 2010/11

4. Education Sector Overview (continued)

4.5 STUDENTS

49% 51%

Analysis of student population by gender in each of the education cycles shows both male and female students have increased by almost the same CAGR over the last five years in Qatar. Free education in government funded schools have encouraged the education of more female residents. Therefore resulting in an increase of female students in government schools weighed against males, as opposed to private schools where parents are more likely to spend on education for males (Refer to Exhibit 25) . During the academic year 2010/11, 60% of the total student population was dominated by non-Qataris (Refer to Exhibit 26). Further analysis by school type reveals that while independent schools are primarily made up of Qatari nationals, they represent less than 20% of total student population in private schools.

Males

Females

Source: Supreme Council of Education, Qatar Statistics Authority, Colliers International 2013

Exhibit 27: No. of Students by Age Group in Qatar 2010/11

22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 <3 0 5,000

Exhibit 26: Breakdown of Students by Nationality

Qatari students represent the majority of the population in independent schools (Govt.) mainly due to free education Independent (Govt.) School Students Private School Students Qatari 18% Qatari 65% Non-Qatari 82%
Source: Supreme Council of Education, Qatar Statistics Authority, Colliers International 2013

Decreasing Student Volume with Age

Non-Qatari 35%

Ages

10,000

15,000

20,000

No. of Students

The education sector in Qatar has witnessed a considerable decline in the number of students as they progress upwards from 5 years, and a drastic reduction after 15 years, having completed compulsory education. Although the government has plans to make secondary education mandatory, at present, given the data analysed, the majority of demand is for primary and preparatory education (Refer to Exhibit 27). Another reason for this decline is that expatriate students parents prefer to send their children back home to their country for higher education. According to the Supreme Council of Education, 78% of the private school staff are non-Qatari females. Only 9% of the total teachers employed in the private sector are within secondary education. The comparatively low allocation of staff in the secondary cycle is in line with enrolment drops after the end of compulsory schooling. Further analysis of teachers by type of school reveals that the average number of teachers per school is the highest in international schools followed by community schools. While English is used to teach mathematics and science from Grade 1 of primary school, according to the General Secretariat of Development and Planning, not all primary school teachers are fluent in English, and only a few are adequately qualified. The minimum qualification for teachers at private schools is Bachelors degree with prior experience in the curriculum. For Grades 6 12/13, some schools require a specified degree in Education and considerable teaching experience. The General Secretariat of Development and Planning revealed that there are limited incentives for teachers to improve their overall performance, as there is no clear link from evaluation, professional development in teaching skills to financial or non-financial incentives. The teacher/student ratio across different substantially in Qatar (Refer to Exhibit 28). types of schools varies

Source: Qatar Statistics Authority, Colliers International 2013

4.6 TEACHERS:

Exhibit 28: Average Number of Students per Teacher by Type of School No. of Students per Teacher 16 14 12 10 8 6 4 2 0
Private Arabic School Communities School Independent School International School

15 13 10 6 13

Others

Source: Qatar Statistics Authority, Colliers International 2013

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

5. Conclusion

An increasing population base (due to increased economic activities as a result of increased income growth and the World Cup), together with the proposed introduction of compulsory secondary education, the education market sector in Qatar is set to grow in the short to medium term. Even though the government has undertaken some active measures to meet the demand for education staff, it remains a challenge for the education sector to deliver a student to teacher ratio that meets international standards. Addressing the significant undersupply in the education market, the government has introduced initiatives to encourage the private sector to match the shortfall and benefit from this potentially lucrative sector. Qatar, having one of the highest per capita income in world, and given the increased economic activities as a result of the World Cup 2020, it is only likely that the volume of expatriates migrating to Qatar will increase. The demographics will have a predisposition to be selective in regards to the quality of education provided to their children. The majority of staff employed within the private education sector in Qatar is mainly consisting of non-Qatari females. Qatars optimistic plans to invest over 18% of the governmental spending in education, reflects an increased appreciation of the value and commitment towards the sector. The undersupplied market along with attractive returns offered by the education sector in the private sector in Qatar, highlights significant potential for foreign investors to fill this supply gap. Given the market fundamentals, it is expected that the primary key success factor for any educational development in the existing market is the presence of a branded regional and/ international operator. The increasing levels of income have positively influenced the enrolment rate throughout the compulsory cycles, thus indicating an increased level of awareness amongst the local population. In order to attract experienced educational staff to the country, the Qatari government needs to establish a clear reward program for teachers, that is linked to professional development, in order to provide an incentive to migrate to Qatar, as opposed to other regional markets. With the existing supply unable to meet an increasing demand base, and high potential for niche markets, Qatar offers a number of opportunities for educational operators in an environment which provides high returns and vast potential for growth. Exhibit 30: Challenges and Opportunities in Qatar Education Sector
Law Freezing Tuition Fees

Key Observations

The education sector in Qatar

has experienced a period of reforms since the 1990s.

Attracting good teachers in Qatar

is relatively difficult compared to other parts of the GCC. Therefore, an aggressively and in time recruitment policy must be in place to ensure the hiring of quality teachers.

Compared to the market demand,

the education indicators do not reflect the income level enjoyed by the majority of the population in the country. This requires heavy investment over the medium to long-term.

The GCC education sector has

witnessed multiple M&A transactions over the past two years, signalling the high interest from investors, and confidence in the sector.

All these shortfalls provide an

opportunity for school operators to enter into a market which offers enormous potential for growth.

Established school operators with

facilities in their home country or in the region in the GCC are likely to be more competitive.

High Existing and Expected (Due to the World Cup) Population Growth Rate Expected Introduction of Compulsory Secondary Education High returns on Education Investment in the Private Sector

Positive Factors

Continued Growth in Local Demand for Quality International Schools Low Student to Teacher Ratio

Source: Colliers International 2013

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Negative Factors

High Reliance on Non-Qatari Teaching Staff

OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013

COLLIERS EDUCATION SERVICES - SNAPSHOT

Feasibility Studies; Due Diligence; Investment Memorandums (IM)

- Conducted over 30 Feasibility Studies, Investment Memorandums & Due Diligence for ; new projects, Financing & Refinancing, Merger & Acquisitions: - Countries: UAE, KSA, Qatar, Egypt, and Ecuador - Total Number of Students (2010-2012): 50,000 plus - Mixed Use Education Parks (2010-2012): 3 with a total BUA of 5+ million sqft - Total BUA of All Education Projects (2010-2012):10+ million sqft

Conducted Studies for the Following (2010-2012) Nurseries & Kindergartens (10+) British Schools (20+ Schools)

Land; Property; Business Valuation

- Conducted over 20 Schools / Universities Valuations for end of year Audit, Financing & Refinancing, Merger & Acquisition: - Countries: UAE, KSA, Qatar, Egypt, and Oman - Total Number of Schools Valued (2010-2012): 10,000 plus schools - Mixed Use Education Parks (2010-2012): 5 with a total BUA of 5+ million sqft - Total BUA of All Education Projects Valued (20102012): 10+ million sqft

International Baccalaureate (IB) Schools (10+ Schools)

American Schools (5+ Schools)

French School (2+ School) Indian School (2+ Schools) German School (1 School) Universities (5+ Universities) Medical College (1 Institution) Nursing College (1 Institution)

Operator Search & Selection and Contract Negotiation

- Countries: UAE, KSA, Qatar and Egypt - Total Number of Students (2010-2012): 10,000 plus - Total BUA of All Education Projects (2010-2012): 5+ million sqft

Key Projects:
2,000 Student British School Dubai 1,600 Student British School Dubai 2,000 Student British School Dubai 800 Student Girls Finishing School Dubai 1,600 Student Girls School Dubai

2,000 Student British Day & Boarding School Abu Dhabi 2,000 Student British School Doha 1,200 Student American School Dubai 2,000 Student Indian School Abu Dhabi

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OVERVIEW REPORT | QATAR | HEALTHCARE & EDUCATION | SECOND QUARTER | 2013 COLLIERS INTERNATIONAL
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