MEA Nurse Call Systems Market

MEA Nurse Call Systems Market Size

The MEA Nurse Call Systems Market Size was valued at USD 67.41 million in 2025, is expected to have 9.67 % CAGR from 2026 to 203,4 and be worth USD 154.72 million by 2034 from USD 73.93 million in 2026.

The Middle East and Africa (MEA) Nurse Call Systems market encompasses a range of communication technologies designed to enhance patient safety, streamline caregiver responsiveness, and improve hospital workflow efficiency. These systems are integral to modern healthcare infrastructure, enabling patients to alert medical staff in real-time through wired or wireless interfaces. The adoption of nurse call systems is being driven by rising investments in healthcare digitization, increasing patient expectations for timely care, and the need for structured emergency response protocols across hospitals, clinics, and long-term care facilities.

In recent years, the MEA region has witnessed growing government focus on upgrading public healthcare infrastructure, particularly in countries like Saudi Arabia, the United Arab Emirates, and South Africa.

MARKET DRIVERS

Rising Healthcare Infrastructure Development Across the Region

One of the primary drivers fueling the growth of the MEA Nurse Call Systems market is the ongoing development and modernization of healthcare infrastructure across key countries such as Saudi Arabiathe, the UAE, Egypt, and South Africa. Governments in these nations have prioritized healthcare sector upgrades as part of broader economic diversification strategies. For instance, Saudi Arabia’s Vision 2030 initiative includes substantial allocations for expanding and digitizing healthcare services. As per the Ministry of Health and Prevention of the UAE, the country invested over AED 15 billion in healthcare infrastructure between 2020 and 2025.

New hospital constructions, expansions of existing facilities, and the establishment of specialized medical cities are creating increased demand for integrated nurse call systems. These systems are essential for ensuring efficient communication between patients and caregivers, especially in high-occupancy environments. In addition, the proliferation of private healthcare providers and international hospital chains entering the MEA market has led to higher adoption of advanced nurse call solutions that align with global standards of care delivery.

Moreover, urbanization and rising population densities, particularly in major metropolitan areas like Dubai, Riyadh, Cape Town, and Cairo, are contributing to the need for scalable and technologically advanced nurse call platforms capable of handling complex hospital workflows.

Growing Emphasis on Patient Safety and Hospital Accreditation Standards

Another critical driver of the MEA Nurse Call Systems market is the increasing emphasis on patient safety and compliance with international hospital accreditation frameworks such as Joint Commission International (JCI) and ISO standards. These accreditations mandate the implementation of structured communication systems to ensure timely response to patient calls and reduce medical errors.

Nurse call systems play a pivotal role in meeting these regulatory requirements by providing real-time alerts, centralized monitoring, and data logging capabilities. Hospitals seeking accreditation must demonstrate effective patient-to-staff communication mechanisms, which directly influence procurement decisions regarding nurse call systems. The Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) also mandates the use of standardized nurse call solutions as part of its hospital evaluation criteria.

Additionally, the rise in medical tourism—particularly in the UAE and Egypt—has heightened the need for patient-centric care models. Advanced nurse call systems equipped with multilingual interfaces, mobile notifications, and integration with electronic health records (EHRs) are becoming essential components of premium healthcare offerings in the region, further driving market growth.

MARKET RESTRAINTS

High Initial Investment and Budgetary Constraints in Public Healthcare Facilities

One of the most significant restraints impeding the widespread adoption of nurse call systems in the MEA region is the high initial investment required for system installation and integration. Modern nurse call systems often include IP-based networking, wireless connectivity, integration with hospital information systems (HIS), and real-time location tracking—all of which contribute to elevated capital expenditures. According to the African Development Bank, many public healthcare institutions in Sub-Saharan Africa operate under tight budget constraints, limiting their ability to invest in advanced communication technologies.

Even in wealthier Gulf states, where healthcare spending is relatively high, budget allocation remains a challenge due to competing priorities such as pharmaceutical procurement, workforce training, and disease prevention programs. Public hospitals in countries like Egypt and Nigeria often rely on outdated analog nurse call systems due to financial limitations, hindering the transition to digital and smart communication platforms. Furthermore, smaller healthcare centers and rural clinics lack the necessary funding and technical expertise to implement sophisticated nurse call solutions, slowing down overall market penetration in the region.

Lack of Technical Expertise and Skilled Personnel for System Maintenance

Another major restraint affecting the MEA Nurse Call Systems market is the shortage of trained personnel capable of managing and maintaining these complex communication infrastructures. Nurse call systems require regular calibration, software updates, and troubleshooting, all of which necessitate technical know-how that may not be readily available in many healthcare settings across the region. According to the World Health Organization (WHO), several African countries face severe shortages of biomedical engineers and IT specialists, making it difficult to sustain advanced healthcare technologies.

In the Middle East, while there is greater access to skilled labor, language barriers and inconsistent training programs can still pose challenges. Many healthcare professionals in the region are accustomed to traditional communication methods and may resist adopting new digital tools without adequate support. Moreover, after-sales service and technical support from vendors remain inconsistent across different MEA markets, leading to prolonged system downtime and reduced operational efficiency.

This skills gap limits the effectiveness of deployed nurse call systems and discourages hospitals from investing in more advanced versions.

MARKET OPPORTUNITIES

Expansion of Smart Hospitals and Integration with IoT Technologies

A significant opportunity emerging in the MEA Nurse Call Systems market is the rapid expansion of smart hospitals and the increasing integration of Internet of Things (IoT)-enabled technologies in healthcare. Governments and private investors in the region are actively pursuing digital transformation initiatives aimed at enhancing hospital efficiency and patient outcomes. As part of this shift, nurse call systems are evolving beyond basic alert functions to become intelligent, interconnected components of broader hospital automation networks.

According to the Dubai Health Authority, over 70% of hospitals in the emirate had implemented some level of IoT-enabled healthcare infrastructure by 2025. Similarly, Saudi Arabia’s National Health Strategy emphasizes the deployment of smart medical equipment across public hospitals.

These developments create a strong foundation for next-generation nurse call systems that offer features such as predictive alerting, voice recognition, and mobile app integration. As healthcare institutions in the MEA region continue to embrace digital innovation, the demand for intelligent nurse call solutions is expected to grow significantly.

Rising Demand for Telehealth and Remote Patient Monitoring Solutions

The increasing adoption of telehealth and remote patient monitoring (RPM) solutions in the MEA region presents another compelling opportunity for the nurse call systems market. The global pandemic accelerated the shift toward virtual care models, prompting governments and healthcare providers to explore ways to maintain patient engagement while reducing in-person visits.

Nurse call systems are now being adapted for use in home healthcare settings, allowing patients to communicate with caregivers via mobile applications or wearable devices. This trend is particularly relevant in countries with aging populations such as South Africa and Egypt, where chronic disease management outside traditional hospital environments is gaining traction. Moreover, the introduction of cloud-based nurse call platforms enables seamless communication between patients, nurses, and physicians regardless of location.

With continued advancements in mobile health technology and supportive policy frameworks emerging across the MEA region, nurse call system providers have a unique opportunity to expand their offerings into non-traditional healthcare environments and tap into a rapidly growing patient base.

MARKET CHALLENGES

Fragmented Regulatory Frameworks Across Countries

One of the primary challenges confronting the MEA Nurse Call Systems market is the lack of standardized regulatory frameworks governing medical device procurement and implementation across different countries in the region. Unlike Europe or North America, where unified certification processes exist, MEA countries exhibit varying levels of regulatory maturity, making it difficult for manufacturers and distributors to scale their operations efficiently. According to the African Union's African Medicines Agency (AMA), only a handful of African countries have fully developed medical device regulatory policies, leading to inconsistencies in product approval timelines and compliance requirements.

In the Gulf region, while countries like Saudi Arabia and the UAE have well-defined medical device registration procedures, others, such as Oman and Kuwait, still rely on fragmented approval mechanisms. This regulatory disparity increases time-to-market for new nurse call products and raises compliance costs for international vendors. In addition, frequent policy changes and unclear enforcement guidelines in certain jurisdictions create uncertainty for market participants.

Resistance to Digital Adoption Among Older Medical Staff

Despite growing technological advancements, resistance to digital adoption among older medical professionals remains a persistent challenge in the MEA Nurse Call Systems market. Many healthcare workers who have spent decades relying on traditional communication methods—such as manual call buttons or verbal alerts—are hesitant to transition to digital nurse call platforms.

This reluctance stems from concerns about system complexity, fear of technical failures, and a general preference for familiar workflows. Training gaps further exacerbate the issue, as many hospitals do not allocate sufficient resources to educate senior staff on new technologies. As a result, even when advanced nurse call systems are installed, they may not be utilized to their full potential, leading to suboptimal performance and diminished return on investment.

Addressing this challenge requires targeted change management strategies, including hands-on training, peer mentoring, and user-friendly interface design.

REPORT COVERAGE

SEGMENTAL ANALYSIS

By Type Insights

Button-based nurse call systems hold the largest share of the MEA Nurse Call Systems market, accounting for 38.3% of total revenue in 2025. These systems remain widely adopted due to their simplicity, reliability, and cost-effectiveness, particularly in public hospitals and smaller healthcare facilities across the region. According to the World Health Organization (WHO), over 60% of healthcare institutions in Sub-Saharan Africa still rely on basic analog communication tools, with button-based systems being the most common.

The dominance of this segment is primarily driven by affordability and ease of integration into existing hospital infrastructure without requiring extensive retrofitting or training. In countries like Egypt and Ethiopia, where budget constraints are significant, government health departments continue to prioritize cost-efficient solutions that ensure basic patient safety standards.

Also, these systems are often preferred in high-occupancy wards and intensive care units where rapid response times are crucial but complex digital integrations may not be feasible.

Mobile nurse call systems are emerging as the fastest-growing segment within the MEA Nurse Call Systems market, projected to grow at a CAGR of 11.2% through 2033. This surge is largely attributed to increasing investments in digital transformation and smart hospital development, particularly in urban centers such as Dubai, Riyadh, and Cape Town. According to the Dubai Health Authority, mobile-enabled healthcare technologies have seen adoption rates rise since 2021, driven by improved mobile network coverage and rising smartphone penetration.

These systems allow patients and caregivers to communicate via mobile applications, wearable devices, and cloud-connected platforms, significantly enhancing responsiveness and reducing missed calls. Hospitals aiming for Joint Commission International (JCI) accreditation are increasingly adopting mobile nurse call solutions as part of broader digital health strategies.

Moreover, the expansion of telehealth services, especially post-pandemic, has increased demand for remote monitoring and communication tools. As healthcare providers seek to improve efficiency and reduce workload pressures on nursing staff, mobile nurse call systems are becoming essential components of modern patient engagement models across the MEA region.

By Technology Insights

Wired communication systems accounted for the largest share of the MEA Nurse Call Systems market, representing 52% of total installations in 2025. This dominance stems from their long-standing use in traditional hospital setups, where reliability and durability are prioritized over advanced functionalities.

One of the primary drivers of this segment’s continued prevalence is the large installed base of legacy systems in older hospitals, particularly in North Africa and parts of the Middle East. Many healthcare institutions lack the financial resources or technical expertise to transition to wireless alternatives, making wired systems a practical choice for maintaining operational continuity. As per the World Bank, public hospitals in Egypt and Sudan collectively allocated only 12% of their capital budgets toward technology upgrades in 2023, limiting the pace of digital transformation.

Additionally, wired systems are often viewed as more secure and easier to maintain in environments where power fluctuations and network instability are common. While newer wireless options offer greater flexibility, the entrenched presence of wired infrastructure ensures its continued dominance across the MEA region.

Wireless communication systems are experiencing the highest growth rate in the MEA Nurse Call Systems market, expanding at a CAGR of approximately 9.7%. This growth is fueled by the ongoing digitalization of healthcare infrastructure, particularly in wealthier Gulf states and urban medical centers. Wireless systems offer greater flexibility, scalability, and integration capabilities with electronic health records (EHRs), making them ideal for modern healthcare facilities seeking to enhance patient safety and workflow efficiency. Their ability to support real-time location tracking, mobile alerts, and seamless integration with other IoT-enabled hospital equipment has made them a preferred choice for new construction projects. The African Union’s Digital Health Strategy indicates that wireless nurse call systems are increasingly being incorporated into regional health digitization roadmaps, especially in South Africa and Kenya.

Furthermore, the growing emphasis on patient-centric care models and hospital accreditation requirements under frameworks like JCI has accelerated the shift toward wireless solutions. With continuous improvements in connectivity and falling hardware costs, wireless communication systems are poised for sustained growth across the MEA region.

By Application Insights

Alarms & Communications represent the largest application segment in the MEA Nurse Call Systems market, capturing 45.3% of total usage in 2025. This dominance is rooted in the fundamental role these systems play in ensuring timely emergency responses and maintaining patient safety in clinical settings. This segment is primarily driven by the need for immediate patient-to-nurse interaction in high-risk areas such as intensive care units, operating theaters, and emergency rooms. In Saudi Arabia, the Ministry of Health mandates that all accredited hospitals implement alarm-based nurse call systems to meet national patient safety guidelines. Additionally, in countries like Egypt and Nigeria, where overcrowded public hospitals are common, alarms and communication features help manage patient flow and reduce response delays.

Moreover, regulatory bodies such as the Joint Commission International (JCI) require healthcare institutions to maintain documented emergency response protocols, further reinforcing the necessity of alarm-integrated nurse call systems.

Workflow Optimization is the fastest-growing application segment in the MEA Nurse Call Systems market, projected to expand at a CAGR of 12.4%. This rapid ascent is driven by increasing pressure on healthcare providers to enhance operational efficiency and reduce caregiver burnout, particularly in urban hospitals facing staffing shortages. According to the International Council of Nurses, nurse workloads in MEA hospitals are among the highest globally, with an average ratio of one nurse per 20–30 patients in some public facilities.

Nurse call systems integrated with workflow optimization capabilities help streamline task management by automatically assigning and prioritizing patient requests based on urgency. Hospitals in the UAE and Qatar have been early adopters of these solutions, leveraging AI-powered analytics and centralized dashboards to monitor response times and resource allocation. A 2023 report by the Gulf Centre for Healthcare Innovation found that implementing workflow-enhancing nurse call systems reduced average patient wait times in participating hospitals.

Besides, the push for digital transformation in healthcare—supported by initiatives such as Saudi Arabia’s National Health Strategy and South Africa’s eHealth Roadmap—is accelerating the deployment of intelligent nurse call platforms designed to optimize hospital operations and improve staff productivity across the MEA region.

COUNTRY LEVEL ANALYSIS

Saudi Arabia had the biggest share of the MEA Nurse Call Systems market, contributing a 22.4% of total regional revenue in 2025. This lead position is driven by the country's ambitious Vision 2030 agenda, which includes substantial investments in healthcare modernization and digital infrastructure.

Public and private healthcare institutions alike are rapidly adopting IP-based nurse call solutions that integrate with electronic health records (EHRs) and hospital information systems (HIS). The Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) mandates the implementation of structured communication systems in accredited hospitals, further fueling demand. Also, the expansion of major medical cities such as the King Abdullah Medical City in Makkah and the King Fahd Medical City in Riyadh has created new opportunities for advanced nurse call deployments.

With continued government backing and a focus on improving patient care standards, Saudi Arabia remains the dominant force in shaping the MEA Nurse Call Systems market.

The United Arab Emirates accounts for approximately 18% of the MEA Nurse Call Systems market, positioning it as the second-largest contributor after Saudi Arabia. The UAE’s healthcare sector is characterized by high levels of digitization, world-class medical infrastructure, and a growing number of internationally accredited hospitals.

Government-led initiatives such as Smart Dubai and Abu Dhabi’s Health Data Management Framework have encouraged the adoption of intelligent, cloud-connected nurse call platforms that enhance care coordination and response efficiency. The UAE Ministry of Health and Prevention has also mandated the integration of digital communication tools in new hospital constructions, aligning with broader efforts to establish a fully interconnected healthcare ecosystem.

In addition, the rise of medical tourism in cities like Dubai and Abu Dhabi has prompted private healthcare providers to invest in premium-grade nurse call systems featuring multilingual interfaces, mobile notifications, and real-time data analytics. As a result, the UAE continues to serve as a key growth engine for the MEA Nurse Call Systems market.

Israel is distinguished by its strong technological innovation ecosystem and high healthcare expenditure per capita. As one of the most digitally advanced nations in the region, Israel integrates artificial intelligence, IoT, and predictive analytics into its healthcare infrastructure, including nurse call systems.

Israeli hospitals frequently collaborate with local tech startups to develop next-generation nurse call solutions tailored for real-time alerting, workflow optimization, and fall detection. Institutions such as Sheba Medical Center and Tel Aviv Sourasky Medical Center have pioneered the use of AI-driven nurse call platforms that automatically prioritize patient calls based on severity. The country’s universal healthcare system ensures widespread access to advanced medical technologies, supporting continuous upgrades in nurse call infrastructure.

Also, Israel’s participation in international health technology forums and partnerships with European and American vendors enhances its influence in shaping future trends in the MEA Nurse Call Systems market.

South Africa is serving as a key hub for healthcare innovation in sub-Saharan Africa. The country’s well-developed private healthcare sector, coupled with ongoing government efforts to upgrade public hospitals, drives steady demand for nurse call technologies. Urban centers such as Johannesburg, Pretoria, and Cape Town host numerous private hospitals equipped with IP-based nurse call platforms that integrate with electronic health records (EHRs) and mobile communication tools. The National Department of Health’s eHealth Strategy emphasizes the importance of connected care ecosystems, encouraging the adoption of digital nurse call solutions to improve patient outcomes and reduce caregiver burden.

Furthermore, South Africa serves as a regional distribution center for multinational medical device manufacturers, facilitating technology transfer to neighboring African countries. As investment in healthcare infrastructure expands across the continent, South Africa’s role as a leading market player in the MEA Nurse Call Systems space is expected to strengthen further.

Egypt is reflecting its growing healthcare modernization efforts and expanding private hospital sector. With a population exceeding 100 million, the country faces increasing demand for efficient patient care systems, particularly in densely populated urban areas such as Cairo and Alexandria.

Government-led initiatives such as the Universal Health Insurance System (UHIS) aim to improve access to quality healthcare services, necessitating the deployment of standardized communication tools across medical facilities. Moreover, private healthcare investors have shown growing interest in digital solutions, with several hospitals opting for cloud-based nurse call platforms that enable centralized monitoring and real-time response tracking.

Despite budgetary constraints in the public sector, Egypt’s strategic location and expanding healthcare ecosystem position it as a key growth market in the MEA region, with nurse call systems playing a vital role in advancing patient care standards.

KEY MARKET PLAYERS AND COMPETITIVE LANDSCAPE

A few of the promising companies operating in the MEA nurse call systems market profiled in this report are Rauland-Borg Corporation, Hill-Rom Holdings, Inc., Ascom, Johnson Controls International Plc, Ackermann (By Honeywell), Siemens AG, and Jeron Electronic Systems, Inc.

The competition in the MEA Nurse Call Systems market is intensifying as global and regional players vie for dominance in an increasingly digitized and patient-centric healthcare environment. Established multinational corporations such as Philips, Honeywell, and Siemens continue to lead due to their technological expertise, broad product portfolios, and strong distribution networks. However, emerging local and niche players are gaining traction by offering cost-effective alternatives and tailored solutions suited to the unique infrastructural and financial constraints of certain MEA markets.

Market participants are differentiating themselves through feature-rich, interoperable, and future-ready nurse call platforms that integrate seamlessly with hospital-wide digital ecosystems. Innovation is centered around mobility, artificial intelligence-driven task prioritization, and cloud-based monitoring systems aimed at improving response times and operational efficiency. Additionally, regulatory changes, accreditation requirements, and government-led healthcare modernization programs are shaping competitive dynamics, compelling vendors to align their offerings with evolving policy frameworks.

Strategic moves such as mergers, acquisitions, and joint ventures are becoming more frequent as companies seek to strengthen their regional presence and expand their service offerings. With rising investments in smart hospitals and telehealth, the MEA Nurse Call Systems market is witnessing a shift toward more sophisticated, scalable, and interconnected communication solutions, making the competitive landscape more dynamic than ever before.

Top Players in the Market

Philips Healthcare
Philips is a global leader in healthcare technology and plays a pivotal role in shaping the MEA Nurse Call Systems market through its advanced patient communication solutions. The company offers integrated nurse call platforms that combine real-time alerts, workflow optimization, and integration with hospital information systems. In the MEA region, Philips has been instrumental in supporting smart hospital initiatives by deploying scalable and interoperable nurse call systems tailored to both public and private healthcare settings. Its emphasis on innovation, user-centric design, and compliance with international safety standards has made it a preferred partner for large-scale hospital modernization projects across the Gulf and North Africa.

Honeywell International Inc.
Honeywell contributes significantly to the MEA Nurse Call Systems market through its Life Safety and Healthcare Communication Solutions division. Known for robust system architecture and seamless integration capabilities, Honeywell provides reliable wired and wireless nurse call systems that cater to diverse clinical environments. In the MEA region, the company has focused on expanding its presence through strategic partnerships with local distributors and participation in regional healthcare infrastructure development programs. Honeywell’s commitment to durability, scalability, and compliance with global regulatory frameworks ensures high adoption rates across critical care facilities, particularly in Saudi Arabia, the UAE, and South Africa.

Siemens Healthineers AG
Siemens Healthineers is a key player in the MEA Nurse Call Systems market, offering intelligent and digitally integrated communication solutions designed for high-efficiency healthcare delivery. The company's Syngo Carepoint platform exemplifies its focus on enhancing caregiver responsiveness and optimizing patient engagement through centralized dashboards and AI-enabled prioritization tools. In the MEA region, Siemens has actively supported digital transformation efforts in hospitals by aligning its offerings with national health digitization strategies. Its strong R&D focus, combined with localized technical support, positions Siemens as a trusted provider of next-generation nurse call systems across major healthcare hubs in the Middle East and Southern Africa.

Top Strategies Used by Key Market Participants

Key players in the MEA Nurse Call Systems market are adopting strategic approaches to consolidate their foothold and drive sustainable growth in a rapidly evolving healthcare landscape. One of the most prevalent strategies is expanding regional partnerships and collaborations, where global vendors partner with local distributors and system integrators to enhance market reach and streamline product deployment. These alliances help navigate complex regulatory landscapes while ensuring alignment with regional healthcare priorities.

Another crucial strategy involves investing in localized product development and customization. Given the diversity of healthcare infrastructure across MEA countries, companies are tailoring nurse call systems to meet specific needs, such as multilingual interfaces, cost-effective models for budget-constrained public hospitals, and scalable solutions for new medical cities and private clinics. This adaptability enhances adoption rates across different market segments.

Lastly, enhancing after-sales service and technical support ecosystems has become a priority. Vendors are focusing on training programs, maintenance contracts, and digital support channels to ensure long-term system performance and customer satisfaction. By strengthening post-installation engagement, companies are reinforcing brand loyalty and encouraging repeat business across the MEA region.

RECENT HAPPENINGS IN THE MARKET

In March 2025, Philips Healthcare announced the launch of a new generation of its IntelliCall nurse call solution tailored specifically for hospitals in the Middle East. This platform integrates with electronic health records and mobile devices, enhancing real-time communication and streamlining emergency response protocols in MEA healthcare institutions.

In July 2025, Honeywell signed a strategic partnership agreement with a leading Saudi Arabian healthcare technology distributor to expand its nurse call systems’ reach across GCC countries. This collaboration aimed to accelerate the deployment of reliable and scalable nurse call technologies in both public and private hospitals.

In February 2025, Siemens Healthineers introduced its Syngo Carepoint Mobile App in the UAE, allowing nurses and caregivers to receive patient calls directly on smartphones or tablets. This innovation supports faster decision-making and improves workflow efficiency in smart hospitals across the Gulf region.

In October 2025, Ascom Holding AG expanded its operations into Egypt by setting up a regional service center dedicated to supporting nurse call system installations and maintenance across North Africa. This move was intended to improve after-sales service and increase market penetration in emerging MEA markets.

In May 2025, Johnson Controls partnered with a Dubai-based IT solutions provider to develop AI-enhanced nurse call systems capable of predictive alerting and automated task prioritization. This initiative aims to support the UAE’s Smart Hospital vision by integrating advanced analytics intopatientt communication infrastructure.

MARKET SEGMENTATION

This research report on the mea nurse call systems market has been segmented and sub-segmented into the following categories.

By Type

• Button-Based Systems
• Mobile Nurse Call Systems

By Technology

• Wired Communication Systems
• Wireless Communication Systems

By Application

• Alarms & Communications
• Workflow Optimization

By Country

• KSA
• UAE
• Israel
• rest of the GCC countries
• South Africa
• Ethiopia
• Kenya
• Egypt
• Sudan
• Rest of MEA