Leadership and Neonatal Transport in Saudi Arabia: A Comparative Health Systems Analysis

Background: Neonatal transport links initial stabilization with definitive neonatal intensive care, yet Saudi Arabia lacks a unified national framework. Regional variation in resources, staffing, equipment, and transfer coordination may contribute to inequitable access and inconsistent care. This study examined neonatal transport in Saudi Arabia from a health leadership perspective and compared the current system with international models to identify governance gaps and reform priorities. Methods: A qualitative, comparative, policy-oriented review was conducted using peer-reviewed literature, government reports, and institutional documents published between 2000 and 2024. Evidence from Saudi Arabia was compared with neonatal transport systems in the United Kingdom, Australia, Canada, and the United States. The analysis focused on governance, accountability, workforce capacity, system integration, quality standards, data monitoring, telemedicine, and equity. Results: The Saudi system was characterized by decentralized coordination, concentration of neonatal intensive care resources in major regions, reliance on general emergency medical services in peripheral areas, and absence of a national transport registry. International models consistently demonstrated centralized dispatch, specialized teams, standardized protocols, accreditation, continuous monitoring, and mechanisms supporting rural access. A phased pilot centered at King Saud Medical City was proposed to test coordination, training, digital communication, and performance monitoring. Conclusion: Leadership-driven national coordination, standardized training, telemedicine integration, and systematic data collection could strengthen neonatal transport, reduce regional disparities, and support Saudi Vision 2030 priorities.