Entering Saudi: What Companies Get Wrong

Saudi Arabia currently stands out as one of the most fascinating healthcare markets globally.

It’s now 10 years since the launch of Vision 2030. As we edge closer to the big year, it’s incredible to witness the serious investment that has been flowing into its health system. Having spent many years in the heart of it, I firmly believe that no country has spent as much time and investment in healthcare system design, than Saudi has.

At the very heart of it all, is the strong appetite for innovation in digital health, diagnostics, biotech, and AI. Looking in from the outside, the opportunities to support Vision 2030 are abound, and yes, in theory, that’s very true.

However, I have seen far too often that many innovators and entrepreneurs, who possess the right solution, the right team, and the right timing, still fall short. On the other hand, I’ve been left puzzled as to why sub-standard innovation somehow seems to make its way through, and in despair at the thought of how much will need to be undone in the future to course-correct. Perhaps this sounds familiar to most?

Having spent over a decade living and working in the region, repeated themes emerge that many readily recognise:

“We’ll find a distributor and start working straight away!”

“We’re already in the UAE, so Saudi will be similar.”

“Once registration is done, we can begin sales.”

All are reasonable assumptions.

But in most cases, they overlook the key elements. Saudi isn’t a market you can simply plug into.

From my time there, my insights to offer here are:

Saudi is a system-led, relationship-driven environment. How you present yourself matters nearly as much as what you offer, sometimes more!

Healthcare spans multiple layers: national strategy, health clusters, university hospitals, the National Guard, large private providers, and a growing innovation ecosystem that is cutting through them all. 

Each group operates differently, has varied purchasing processes, and distinct priorities.

Failing to understand this landscape early often leads to stalls. Where to start?

Many companies also over focus on regulation (SFDA approvals, pathways, and licences), all important, but this is rarely the main obstacle.

More often, issues arise from:

– Misalignment with system needs (are you complementing or disrupting current strategy?)

– Talking to the wrong stakeholders (are you jumping into the first distributor, rather than doing full due diligence?)

– Trying to sell too soon (No local presence, who is on the ground when you’re not there?)

– Underestimating the time needed to build trust (it takes more than one visit…)

– Failing to address integration and localisation first (Going to the major players first before testing and proving your solution works in the Kingdom). 

In Saudi healthcare, trust precedes transactions.

People want to know who you are, how you operate, if you’re committed to the region, and whether your solution truly solves an important problem. I used to emphasise authenticity, but now I focus more on sincerity.

Building trust takes time and consistent, structured engagement, not a single meeting.

Successful innovators and entrepreneurs think differently. They don’t rush sales; instead, they dedicate time upfront to understand the market, decision-making processes, key stakeholders, and actual demand. They tailor their message locally, not just globally. They invest in relationships, not just introductions, and are comfortable starting small.

Yes, pilots are often the best starting points because they showcase value, establish credibility, and produce tangible, scalable results. That said, I’ve found most try to go straight for large players and almost always fail. You need to be Saudi FDA-approved, have a local office (even if it’s a virtual one), and sometimes, but not always, have already proven yourself in the Kingdom before they will listen.

As the system matures, the big players are starting to create their own in-house incubators and sandpit environments, those are not to be overlooked. Capacity in these are often limited. I have always found the most successful routes to market start with more humble beginnings.

I believe that mid-tier hospitals and university hospitals are much better initial targets.

 Saudi isn’t inherently difficult; it’s just different.

For those who take the time to grasp these differences, the opportunities are there: scale, investment, and a willingness to adopt innovative approaches aligned with system priorities.

Gather momentum in Saudi and you start a much broader journey. With over 2 billion Muslims worldwide, anyone looking solely to scale within Saudi miss the point. The country isn’t just a destination; it’s a springboard. Shift the mindset from, “How do we enter quickly?” to, “How do we build credibility here for the long term?”

Adopting this approach generally leads to better outcomes.