in 2011 premarital screening and counseling were introduced with the jawda initiative, a grading system for pharmaceutical services. jawda was extended in subsequent years with hospital ratings and the monitoring of key medical services performances such as waiting times, incidents during interventions, unplanned readmissions, infections in interventions, and death rates. jawda is generated on a quarterly basis. in 2014, 421 jawda-related audits were carried out, which discovered failures in 4 healthcare centres in complying with room disinfection standards, cleanliness, medical device quality control standards, mixing sterile and non-sterile tools and storing medical files improperly.