This chapter focuses on leading in the public interest in describing the evolution, current state, and the ongoing transformation project of the healthcare system in the Kingdom of Saudi Arabia (KSA). Several factors drive the evolution, including a range of contextual socioeconomic factors: the critical need for improved healthcare services, the increase in oil revenues and improving the welfare and interest protection of Saudi citizens. Through gradual evolution, the system has become complex, hierarchical and, in several respects, inefficient. Nevertheless, external changes and improvements across multiple population health indicators emerged. Transformational reform rather than incremental change is essential. The reform approach is explored alongside the global challenge of the current COVID-19 pandemic. KSA's response represents a recent example of leading in the public interest at a national level. Finally, research recommendations are made to close research gaps of concern to KSA, the region and globally.
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