Citation: Mohamad Noh K, Jaafar S. Health in all policies: The primary health care approach in Malaysia. 50-years experience in addressing social determinants of health through Intersectoral Action for Health. World Conference on Social Determinants of Health. 19-21 October 2011, Rio de Janeiro, Brazil.
At Independence in 1957, Malaysia inherited a rural urban divide and racial identification of specific economic functions. Thus, the government’s welfarist policy was on growth with equity. This entailed the formulation of national social policies to reduce poverty and at the same time to restructure society by addressing economic imbalances and eventually eliminating racial identification of specific economic functions. The poverty reduction approaches placed a strong emphasis on rural socio-economic development addressing the social determinants of health. This approach has served Malaysia well over the decades but since the 1990s Malaysia has been caught in a middle income trap. Realising that achieving a high income nation status by 2020 is not possible at the present economic trajectory, Malaysia has now embarked on a national transformation agenda based on the four pillars of inculcating the cultural and societal values under the 1Malaysia Concept and the twin commitments of people first in all policies & projects and performance now; a government transformation programme (GTP); macroeconomic policies under the economic transformation programme (ETP); and the operationalisation of these policies through the 10th Malaysia Plan. The highest political commitment is given to the implementation of these national policies by the various agencies, orchestrated and coordinated by a central planning process which cascades down to the state and district administrative levels of the government machinery. The health policies follow these national policies and the thrust of the Malaysian health care system is primary health care, supported by an inclusive referral system to decentralized secondary care and regionalized tertiary care. This model of comprehensive public primary health care delivers promotive, preventive, curative and rehabilitative care across the life course. The network of static health facilities is organized into a two-tier system which includes outreach services for remote areas. Community participation is encouraged through village health promoters, health volunteers and advisory panels. The primary health care approach has delivered increased access to health care at a relatively low-cost. This has translated into health gains for the Malaysian population comparable with countries of similar economic development. As Malaysia moves towards a high income nation status, as demographic and epidemiological transitions continue, and as new health technology develops, the demand for health care by the - Draft Background Paper 7 - 2 population will continue to rise with increasing expectations for more care of even higher quality, and at ever increasing cost. This is especially challenging as Malaysia’s open economy is yet to recover fully from the Asian financial crisis of 1997. The government transformation programme, with its focus on a whole-of-government approach, is a natural progression for the primary health care approach to addressing the social determinants of health as a vehicle for social justice to reduce health inequalities.