Executive summary

GCC health systems now train at a scale few countries match. The next gain lies in how that spend is managed: as a portfolio of national investments, each seat with a defined need, a defined return and someone accountable for both. Scholarship programmes have historically served several goals at once. The ones that build lasting capability are run like investment portfolios.

70,000
scholars targeted at the world’s top 200 institutions by 2030
MOE [1]
25,876
Saudi Board trainees in 195 residency programmes
MOH [2]
71%
of bonded participants fulfil their service obligation (pooled estimate, systematic review)
Bärnighausen & Bloom [3]
12 of 59
nursing ROI studies were complete return-on-investment evaluations
Yakusheva et al. [4]

This piece sets out five practices that turn training spend into national capability, drawing on regional programmes and on the international evidence on bonding and on measuring returns. It ends with questions leaders can use to test their own portfolio.

The region trains at national scale

Every GCC state now runs substantial programmes to train its own clinicians. The examples below show the range of that commitment. They use different measures and years, so they are not comparable across programmes.

ProgrammeCountryExample of published scale
Kuwait Institute for Medical Specialization5Kuwait25+ specialty training programmes (2022)
Oman Medical Specialty Board6Oman217 physicians admitted for 2026/27: 207 residents across 21 specialties and 10 fellows
Hamad Medical Corporation7, 8Qatar22 residency programmes and around 52 clinical fellowships; sponsored medical students since 2010
Custodian of the Two Holy Mosques Scholarship Program1Saudi ArabiaNew strategy launched 2022: 70,000 students at the world's top 200 institutions by 2030, designed after reviewing 90+ programmes worldwide
Saudi Board residency programmes2Saudi Arabia25,876 trainees in 195 programmes; training positions up 202% on 2018 (May 2026)
SCFHS Health Academy2Saudi Arabia40,000+ people trained through employment-linked programmes in 37+ cities
Doctor-training agreements abroad9Saudi Arabia255 seats in Germany, Sweden and Ireland in named specialties (2023)
DoH Abu Dhabi medical education programmes10UAE505 accepted from 1,711 applications across 44 specialties; all 294 UAE national applicants accepted (2024)

At this scale, the question changes. When programmes were small, the priority was how many places could be funded. Now it is what each place returns: is the seat in the right specialty, does the graduate come back to the right post, and can anyone show the difference it made?

Five practices that turn scholarships into capability

01

Prioritise by service need, not by who applies

A scholarship portfolio built from individual applications reflects what candidates want to study. A portfolio built from a workforce plan reflects what patients will need. WHO's Global Strategy on Human Resources for Health: Workforce 2030 names "the mismatch between education strategies" and population needs as a key constraint on the health workforce, and asks every country to have a workforce planning unit.11 WHO's National Health Workforce Accounts provide 78 standard indicators to support that planning.12

Saudi Arabia already applies this principle in places. Its 2023 agreements abroad fund seats in named specialties such as anaesthesiology, cardiac surgery, oncology and nursing.9 The 2015 "Your Job and Your Scholarship" programme linked 20,000 scholarships in medicine and allied health sciences to recruitment into the health sector on graduation.13 The practice to scale is a simple ranking: every funded seat should trace back to a service gap in the plan.

02

Bond the scholar, and design the bond to work

Return-of-service bonds are common, and the evidence supports them with caveats. A systematic review of 43 studies found that, pooled across the programmes with data, 71% of participants had fulfilled or were fulfilling their service obligation. Fulfilment was 84% where there was no buy-out option against 67% where there was one, though that difference was not statistically significant.3 WHO's 2021 guideline supports scholarships with return-of-service agreements, but only conditionally and on low-certainty evidence.14

Bonds work best as part of a package. In Japan, 98% of graduates of a university built for rural service were still fulfilling their service contract five years after graduation. The rate was 90% for regional-quota graduates with a scholarship and 81% for scholarship-only graduates.15 Singapore defines the obligation precisely: five years of public service for citizen medical graduates, counted only after the first postgraduate year, with the subsidy repayable with interest, pro-rated, on early exit.16 The lesson is that bonds work best when selection, training and a guaranteed post are designed together.

03

Balance the portfolio between home and abroad

Training at home is now possible at real scale: Saudi training positions are up 202% since 2018.2 That changes the role of overseas scholarships. A sound portfolio trains at home wherever national programmes exist and reserves overseas seats for scarce subspecialties, faculty development and new capabilities that the system then brings back and teaches locally. Each overseas seat should therefore come with a defined return role, ideally one that includes teaching others.

04

Measure the return beyond satisfaction

Most training evaluation stops at whether participants liked the course and what they learned. The established frameworks go further. Kirkpatrick's four levels end with behaviour on the job and results for the organisation.17 Phillips adds a fifth level that converts benefits to money against fully loaded costs, and insists on isolating the programme's own effect.18

Where this has been done, the results are persuasive. In a multisite US study, new nurses in a structured transition-to-practice programme had first-year turnover of 15.5%, against 26.8% in comparison hospitals. After programme costs, the programme saved between $735 and $7,265 for each nurse retained.19 Yet published evidence remains thin: a 2025 review of 59 studies found only 12 complete ROI evaluations in nursing, and just one on education.4 GCC health systems have an opportunity to lead here.

05

Plan the return before departure

The return on a scholarship is realised only when the graduate is placed well. WHO's Global Code of Practice asks countries to meet their health workforce needs from their own people and to encourage circular migration, so that skills gained abroad benefit home systems.20 Research on clinicians returning home after training abroad identifies professional reintegration as a recurring challenge.21 The practical answer is to confirm the post, the scope of practice and a duty to pass on the new skills before the scholar leaves.

The investment cycle

Every training seat should close the loop from need to measured returnThe scholarship investment cycle. Published evidence is thinnest at step 6.
01Plan the needWorkforce plan by specialty02PrioritiseRank seats by service gap03Select and bondReturn role agreed upfront04TrainHome first; abroad if scarce05Return and placeA post that uses new skills06Measure the returnBehaviour, results and ROIfeeds the next plan

Source: Verlaf synthesis of WHO workforce-planning guidance, return-of-service evidence and the Kirkpatrick and Phillips evaluation models.

The five practices fit into one cycle. Measured returns from each cohort should feed the next workforce plan, so the portfolio improves year on year.

Run training spend as a portfolio: every seat with a defined need and a defined return.

For leaders

Questions for leaders

Six questions can test whether a training portfolio is run as an investment:

  1. Traceability: can every funded seat be traced to a named service gap in the workforce plan?
  2. Ranking: is there a published, consistent method for ranking specialties and candidates, applied every cycle?
  3. The bond: does each agreement define the return post, its length, when it starts, and what happens on early exit, and is it enforced?
  4. Home and abroad: are overseas seats reserved for what cannot yet be trained at home, each with a teaching role on return?
  5. Evidence of return: does the programme report on behaviour and results (retention, service coverage, cost per retained graduate), not only on enrolments and satisfaction?
  6. Placement: is the returning graduate's post confirmed before departure, with a scope of practice that uses the new skills?

Sources

  1. Custodian of the Two Holy Mosques Scholarship Program strategy. Saudi Ministry of Education, Mar 2022.
  2. National Center reports growth in Saudi healthcare practitioners. Saudi Ministry of Health, May 2026.
  3. Financial incentives for return of service in underserved areas: a systematic review. Bärnighausen & Bloom, BMC Health Services Research, 2009.
  4. Organizational return on investment in nursing: a systematic review. Yakusheva et al., International Journal of Nursing Studies, 2025.
  5. Over 800 doctors benefited from Kuwaiti training program. Kuwait Times, Jun 2022.
  6. Oman Medical Specialty Board: 2026/27 intake (news report). Oman Observer, Aug 2026.
  7. WCM-Q sponsorship. Hamad Medical Corporation.
  8. Graduate Medical Education. Hamad Medical Corporation.
  9. 17 agreements to train Saudi doctors in three countries. Saudi Ministry of Education, May 2023.
  10. DoH welcomes over 500 applicants in 2024 medical education programmes. Department of Health Abu Dhabi, Jul 2024.
  11. Global Strategy on Human Resources for Health: Workforce 2030. WHO, 2016.
  12. National Health Workforce Accounts: a handbook. WHO, 2017.
  13. "Your Job and Your Scholarship" MOE–MOH memorandum. Saudi Ministry of Health, Jun 2015.
  14. Guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. WHO, 2021.
  15. Education policies to increase rural physicians in Japan. Matsumoto et al., Human Resources for Health, 2021.
  16. Medical/Dental Undergraduate Agreement. Ministry of Health Singapore.
  17. The Kirkpatrick Model. Kirkpatrick Partners.
  18. Comparison of Kirkpatrick and Phillips evaluation frameworks. ROI Institute.
  19. Transition to practice program: return on investment. Silvestre et al., Nursing Economic$, 2017.
  20. Global Code of Practice on the International Recruitment of Health Personnel. WHO, 2010.
  21. There is no place like home: a meta-ethnography of returning doctors. The Clinical Teacher, 2025.

All sources were opened and checked in October 2026. This paper uses publicly available information only; no client material is used.

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