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Exploring strategies to overcome extra-organisational challenges faced by community pharmacies in Sarawak, Malaysia

Kho BP, Hassali MA, Lim CJ, Saleem F

Int J Pharm Pract, 2018 Dec;26(6):494-500.
PMID: 29542834 DOI: 10.1111/ijpp.12438

OBJECTIVES: The aims of this research were to determine extra-organisational challenges (e.g. market competition, governing policies) faced by community pharmacies in Sarawak, the coping strategies employed to deal with these challenges and explore potential legislative changes that can attenuate the intensity of these challenges.
METHODS: Survey questionnaires (n = 184) were posted to all eligible community pharmacies in Sarawak, Malaysia. The questionnaire included sections on participants' demographic data, extra-organisational challenges faced, coping strategies employed and proposals to improve community pharmacy legislations. Items were constructed based on the findings of a prior qualitative research supplemented with relevant literature about these issues.
KEY FINDINGS: High levels of homogeneity in responses were recorded on various extra-organisational challenges faced, particularly those economy-oriented. Strategic changes to counter these challenges were focused on pricing and product stocked, rather than services provision. Highly rated strategies included increasing discounts for customers (n = 54; 68%) and finding cheaper suppliers (n = 70; 88%). Legislative changes proposed that might increase their share of the pharmaceutical market were strongly supported by respondents, particularly about making it compulsory for general practitioners to provide patients the option to have their medicines dispensed in community pharmacies (n = 72; 90%).
CONCLUSIONS: Current legislative conditions and Malaysian consumer mindset may have constrained the strategic choices of community pharmacies to deal with the strong extra-organisational challenges. A long-term multipronged approach to address these issues and increased involvement of community pharmacists themselves in this agenda are required to influence practice change.

Matched MeSH terms: Legislation, Pharmacy
Environmental management for dredging sediments - the requirement of developing nations

Manap N, Voulvoulis N

J Environ Manage, 2015 Jan 1;147:338-48.
PMID: 25304520 DOI: 10.1016/j.jenvman.2014.09.024

Scientific research has characterized the effects of dredging, an underwater excavation process for navigational purposes or material extraction, and has shown its association with a number of chemical, physical and biological impacts. Due to this, much environmental management has been applied in the dredging industry in order to manage its detrimental effects. However, developing nations may have different approaches towards their dredging environmental management to compare to their companions with higher economic strength. Moreover, scientific evidence to make an informed decision is often lacking, hence affecting the number of research executed at these nations, limiting their efforts to preserve the environment. This paper reviews the dredging environmental impacts and its two important factors, dredging technology and sediment characteristic, that determine the magnitude of impacts through literature review, and discusses the need for a more integrated dredging environmental management to be developed for developing nations.

Matched MeSH terms: Conservation of Natural Resources/legislation & jurisprudence
An exploration of compulsory licensing as an effective policy tool for antiretroviral drugs in India

Jain D, Darrow JJ

Health Matrix Clevel, 2013;23(2):425-57.
PMID: 24341078

Access to affordable drugs for the treatment of HIV/AIDS and other diseases is increasingly challenging in many developing countries such as Brazil, South Africa, and India. These challenges are in part the result of strengthened patent laws mandated by the 1994 Trade-Related Aspects of Intellectual Property Rights (TRIPS) treaty. However, there are underutilized instruments within TRIPS that governments can use to limit the adverse effects of patent protection and thereby ensure a supply of affordable generic drugs to their people. One such instrument is compulsory licensing, which allows generic manufacturers to produce pharmaceutical products that are currently subject to patent protection. Compulsory licensing has been used by a number of countries in the last few years, including the United States, Canada, Indonesia, Malaysia, Brazil, and Thailand, and is particularly significant for countries such as India, where large numbers of people are infected with HIV. This Article explores the feasibility of compulsory licensing as a tool to facilitate access to essential medicines within the current patent regime in India, drawing on the experiences of other countries.

Matched MeSH terms: Patents as Topic/legislation & jurisprudence*
Tobacco consumption: the Asia-Pacific Region's major public health problem

Low WY, Binns C

Asia Pac J Public Health, 2013 Sep;25(5 Suppl):7S-9S.
PMID: 24092814 DOI: 10.1177/1010539513489501
Matched MeSH terms: Advertising as Topic/legislation & jurisprudence*
Fulltext A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options

Rani M, Nusrat S, Hawken LH

BMC Public Health, 2012;12:877.
PMID: 23067232 DOI: 10.1186/1471-2458-12-877

Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes.

Matched MeSH terms: Preventive Medicine/legislation & jurisprudence
Trends in sustainable landfilling in Malaysia, a developing country

Fauziah SH, Agamuthu P

Waste Manag Res, 2012 Jul;30(7):656-63.
PMID: 22455994 DOI: 10.1177/0734242X12437564

In Malaysia, landfills are being filled up rapidly due to the current daily generation of approximately 30,000 tonnes of municipal solid waste. This situation creates the crucial need for improved landfilling practices, as sustainable landfilling technology is yet to be achieved here. The objective of this paper is to identify and evaluate the development and trends in landfilling practices in Malaysia. In 1970, the disposal sites in Malaysia were small and prevailing waste disposal practices was mere open-dumping. This network of relatively small dumps, typically located close to population centres, was considered acceptable for a relatively low population of 10 million in Malaysia. In the 1980s, a national programme was developed to manage municipal and industrial wastes more systematically and to reduce adverse environmental impacts. The early 1990s saw the privatization of waste management in many parts of Malaysia, and the establishment of the first sanitary landfills for MSW and an engineered landfill (called 'secure landfill' in Malaysia) for hazardous waste. A public uproar in 2007 due to contamination of a drinking water source from improper landfilling practices led to some significant changes in the government's policy regarding the country's waste management strategy. Parliament passed the Solid Waste and Public Cleansing Management (SWPCM) Act 2007 in August 2007. Even though the Act is yet to be implemented, the government has taken big steps to improve waste management system further. The future of the waste management in Malaysia seems somewhat brighter with a clear waste management policy in place. There is now a foundation upon which to build a sound and sustainble waste management and disposal system in Malaysia.

Matched MeSH terms: Refuse Disposal/legislation & jurisprudence
Fulltext Breast cancer prevention and control programs in Malaysia

Dahlui M, Ramli S, Bulgiba AM

Asian Pac J Cancer Prev, 2011;12(6):1631-4.
PMID: 22126511

Breast cancer is the most common cancer in Malaysian females. The National Cancer Registry in 2003 and 2006 reported that the age standardized incidence of breast cancer was 46.2 and 39.3 per 100,000 populations, respectively. With the cumulative risk at 5.0; a woman in Malaysia had a 1 in 20 chance of developing breast cancer in her lifetime. The incidence of cancer in general, and for breast cancer specifically was highest in the Chinese, followed by Indians and Malays. Most of the patients with breast cancers presented at late stages (stage I: 15.45%, stage II: 46.9%, stage III: 22.2% and stage IV: 15.5%). The Healthy Lifestyles Campaign which started in the early nineties had created awareness on breast cancer and after a decade the effort was enhanced with the Breast Health Awareness program to promote breast self examination (BSE) to all women, to perform annual clinical breast examination (CBE) on women above 40 and mammogram on women above 50. The National Health Morbidity Survey in 2006 showed that the prevalence rate of 70.35% by any of three methods of breast screening; 57.1% by BSE, 51.8% by CBE and 7.6% by mammogram. The current screening policy for breast cancer focuses on CBE whereby all women at the age of 20 years and above must undergo breast examination by trained health care providers every 3 years for age between 20-39 years, and annually for age 40 and above. Several breast cancer preventive programs had been developed by various ministries in Malaysia; among which are the RM50 subsidy for mammogram by the Ministry of Women, Family and Community Development and the SIPPS program (a call-recall system for women to do PAP smear and CBE) by the Ministry of Health. Measures to increase uptake of breast cancer screening and factors as to why women with breast cancer present late should be studied to assist in more development of policy on the prevention of breast cancer in Malaysia.

Matched MeSH terms: Health Policy/legislation & jurisprudence*
Fulltext Changes in forest land use and management in Sabah, Malaysian Borneo, 1990-2010, with a focus on the Danum Valley region

Reynolds G, Payne J, Sinun W, Mosigil G, Walsh RP

Philos Trans R Soc Lond B Biol Sci, 2011 Nov 27;366(1582):3168-76.
PMID: 22006960 DOI: 10.1098/rstb.2011.0154

In an earlier special issue of this journal, Marsh & Greer summarized forest land use in Sabah at that time and gave an introduction to the Danum Valley Conservation Area. Since that assessment, during the period 1990-2010, the forests of Sabah and particularly those of the ca 10 000 km(2) concession managed on behalf of the State by Yayasan Sabah (the Sabah Foundation) have been subject to continual, industrial harvesting, including the premature re-logging of extensive tracts of previously only once-logged forest and large-scale conversion of natural forests to agricultural plantations. Over the same period, however, significant areas of previously unprotected pristine forest have been formally gazetted as conservation areas, while much of the forest to the north, the south and the east of the Danum Valley Conservation Area (the Ulu Segama and Malua Forest Reserves) has been given added protection and new forest restoration initiatives have been launched. This paper analyses these forest-management and land-use changes in Sabah during the period 1990-2010, with a focus on the Yayasan Sabah Forest Management Area. Important new conservation and forest restoration and rehabilitation initiatives within its borders are given particular emphasis.

Matched MeSH terms: Conservation of Natural Resources/legislation & jurisprudence
Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform

Ormond M

Asia Pac Viewp, 2011;52(3):247-59.
PMID: 22216474

"Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

Matched MeSH terms: Health Care Sector/legislation & jurisprudence
Fulltext Socio-demographic and behavioural characteristics of illegal motorcycle street racers in Malaysia

Wong LP

BMC Public Health, 2011;11:446.
PMID: 21649937 DOI: 10.1186/1471-2458-11-446

This study sought to understand the factors associated with street racing among the illegal motorcycle racers in Malaysia or known as the "Mat Rempit".

Matched MeSH terms: Motorcycles/legislation & jurisprudence*
Planters, estate health & malaria in British Malaya (1900-1940)

Khiun LK

J Malays Branch R Asiat Soc, 2010;83:91-115.
PMID: 20836261
Matched MeSH terms: Agriculture/legislation & jurisprudence
Electronic health records approaches and challenges: a comparison between Malaysia and four East Asian countries

Abd Ghani MK, Bali RK, Naguib RN, Marshall IM, Nilmini S. Wickramasinghe

Int J Electron Healthc, 2008;4(1):78-104.
PMID: 18583297

An integrated Lifetime Health Record (LHR) is fundamental for achieving seamless and continuous access to patient medical information and for the continuum of care. However, the aim has not yet been fully realised. The efforts are actively progressing around the globe. Every stage of the development of the LHR initiatives had presented peculiar challenges. The best lessons in life are those of someone else's experiences. This paper presents an overview of the development approaches undertaken by four East Asian countries in implementing a national Electronic Health Record (EHR) in the public health system. The major challenges elicited from the review including integration efforts, process reengineering, funding, people, and law and regulation will be presented, compared, discussed and used as lessons learned for the further development of the Malaysian integrated LHR.

Matched MeSH terms: Medical Records Systems, Computerized/legislation & jurisprudence
Ownership, control, and contention: challenges for the future of healthcare in Malaysia

Chee HL

Soc Sci Med, 2008 May;66(10):2145-56.
PMID: 18329149 DOI: 10.1016/j.socscimed.2008.01.036

The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.

Matched MeSH terms: Health Services Accessibility/legislation & jurisprudence*
Motorcycle safety programmes in Malaysia: how effective are they?

Radin Umar RS

Int J Inj Contr Saf Promot, 2006 Jun;13(2):71-9.
PMID: 16707342

This paper presents the approach taken by the Malaysian Government to contain motorcycle casualties in Malaysia. It involves the exposure control, crash prevention, behaviour modification and injury control related to humans, vehicles and the environment based on pre-crash, crash and post-crash scenarios of motorcycle accidents. These initiatives emanated mainly from the research and development carried out by the Road Safety Research Centre at Universiti Putra Malaysia. Recent outcomes from these initiatives are presented and their impact is highlighted.

Matched MeSH terms: Safety/legislation & jurisprudence*
Sex reassignment technology: the dilemma of transsexuals in Islam and Christianity

Ishak MS, Haneef SS

J Relig Health, 2014 Apr;53(2):520-37.
PMID: 23187616 DOI: 10.1007/s10943-012-9656-z

The birth of people with confused or ambiguous sex makeup as a biological fact since the annals of history has posed the challenge of accommodating them within the binary gender of sociocultural systems. In this process, the role of religion as a defining factor in social engineering has been paramount. Major religions, such as Islam and Christianity, have addressed this issue within the frame of their God-ordained laws by devising a set of moral and legal imperatives specific to the "third gender." Modern developments in medicine and biology, however, have made sex reassignment possible for this category of people, today called transsexuals. The question is: How do Islam and Christianity respond to it. After presenting an analytical view of both Muslim scholars and Christian religious authorities on the legitimacy of sex reassignment for transsexuals, this paper attempts to explore if such a dilemma can be resolved.

Matched MeSH terms: Transgender Persons/legislation & jurisprudence*
Fulltext Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008-2011

Gupta V, Dawood FS, Muangchana C, Lan PT, Xeuatvongsa A, Sovann L, et al.

PLoS One, 2012;7(12):e52842.
PMID: 23285200 DOI: 10.1371/journal.pone.0052842

Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales.

Matched MeSH terms: Vaccination/legislation & jurisprudence*
The impact of immigration on health systems: a legal analysis from a three-country perspective

Blum J, Carstens P, Talib N

Med Law, 2005 Jun;24(2):323-36.
PMID: 16082868

The focus of this paper will be on how health care systems in three countries, Malaysia, South Africa and the United States, are responding to the health needs of immigrants with a strong focus on the legal aspects of the respective national responses. The Malaysia portion emphasizes legal immigration and analyses as to how the country's Ministry of Health and the delivery system itself is responding to the demands of immigrant's health. In the context of South Africa, the paper explores implications of the South African Constitution, which establishes a right to access health care, and explores whether such a right can be extended to non-citizens, or can be tempered by economic constraints. In the American discussion the focus is on whether publicly supported health care programs can be accessed to provide coverage for undocumented residents, and highlights recent constraints in using government monies in this area.

Matched MeSH terms: Delivery of Health Care/legislation & jurisprudence
The role of the Malaysian Medical Council in medical education

Mahmud Mohd MN

Med J Malaysia, 2005 Aug;60 Suppl D:28-31.
PMID: 16315620

The Malaysian Medical Council (MMC) operates under the Medical Act of 1971, which defines its core functions related to (a) the registration and practice of medical practitioners (b) the period of compulsory service (c) provisions to be enacted for purposes of (a) and (b). In the early years the MMC used the list of recognised colleges or Universities that appeared in the list of degrees recognised by the General Medical Council of United Kingdom (GMC). Over the years the MMC has undertaken the role of granting recognition to other medical schools in the country and overseas, and added the name of these schools to the existing register of recognised medical degrees in the second schedule of the Act. For the purpose of recognition of medical schools the MMC endorsed a guideline on standards and procedures on accreditation developed in 1996, which was later realigned with international and regional guidelines, in 2000 and 2001. It is recommended that the MMC establishes an active functional 'Education Committee' and that the role of MMC in medical education should be clearly and explicitly stated in the Act. An amendment to the Act would require the MMC to be responsible not only for undergraduate medical education but medical education in its entire phase.

Matched MeSH terms: Specialty Boards/legislation & jurisprudence*
Forensic timber identification: a case study of a CITES listed species, Gonystylus bancanus (Thymelaeaceae)

Ng KKS, Lee SL, Tnah LH, Nurul-Farhanah Z, Ng CH, Lee CT, et al.

Forensic Sci Int Genet, 2016 07;23:197-209.
PMID: 27213560 DOI: 10.1016/j.fsigen.2016.05.002

Illegal logging and smuggling of Gonystylus bancanus (Thymelaeaceae) poses a serious threat to this fragile valuable peat swamp timber species. Using G. bancanus as a case study, DNA markers were used to develop identification databases at the species, population and individual level. The species level database for Gonystylus comprised of an rDNA (ITS2) and two cpDNA (trnH-psbA and trnL) markers based on a 20 Gonystylus species database. When concatenated, taxonomic species recognition was achieved with a resolution of 90% (18 out of the 20 species). In addition, based on 17 natural populations of G. bancanus throughout West (Peninsular Malaysia) and East (Sabah and Sarawak) Malaysia, population and individual identification databases were developed using cpDNA and STR markers respectively. A haplotype distribution map for Malaysia was generated using six cpDNA markers, resulting in 12 unique multilocus haplotypes, from 24 informative intraspecific variable sites. These unique haplotypes suggest a clear genetic structuring of West and East regions. A simulation procedure based on the composition of the samples was used to test whether a suspected sample conformed to a given regional origin. Overall, the observed type I and II errors of the databases showed good concordance with the predicted 5% threshold which indicates that the databases were useful in revealing provenance and establishing conformity of samples from West and East Malaysia. Sixteen STRs were used to develop the DNA profiling databases for individual identification. Bayesian clustering analyses divided the 17 populations into two main genetic clusters, corresponding to the regions of West and East Malaysia. Population substructuring (K=2) was observed within each region. After removal of bias resulting from sampling effects and population subdivision, conservativeness tests showed that the West and East Malaysia databases were conservative. This suggests that both databases can be used independently for random match probability estimation within respective regions. The reliability of the databases was further determined by independent self-assignment tests based on the likelihood of each individual's multilocus genotype occurring in each identified population, genetic cluster and region with an average percentage of correctly assigned individuals of 54.80%, 99.60% and 100% respectively. Thus, after appropriate validation, the genetic identification databases developed for G. bancanus in this study could support forensic applications and help safeguard this valuable species into the future.

Matched MeSH terms: Conservation of Natural Resources/legislation & jurisprudence*
Forest fires and environmental haze in Southeast Asia: using the 'stakeholder' approach to assign costs and responsibilities

Quah E, Johnston D

J Environ Manage, 2001 Oct;63(2):181-91.
PMID: 11721597

The 'seasonal haze' problem is one which afflicts large parts of Southeast Asia in years of drought. The major cause is forest, bush and field fires in the states of Kalimantan and Sumatra in Indonesia, and to a lesser extent in Sabah, Sarawak, and other parts of Malaysia. Almost all of these fires now seem preventable, since they are intentionally set to clear land for cultivation. Theoretically, the government authorities at central, provincial and local levels in these countries should be responsible for controlling activities in their territory. In practice, however, air pollution control through regulatory policies and practices is extraordinarily difficult to implement and maintain in a situation of this kind in developing countries, especially at a time of crippling economic setbacks. Moreover, the establishment of legal liability, through an international tribunal or otherwise, hardly seems a politically feasible course of action for the government of an affluent 'victim state' such as Singapore. Faith in the usual solutions--science, regulation, law and diplomacy--is weakened by one's sense of current realities. The purpose of this paper is to review the issues and suggested responses, the cost implications of each, the responsibilities as well as entitlements that might apply to the various stakeholders, and the special role of Singapore as an affluent 'victim state'. We also discuss the incentive mechanisms that would be needed to manage forest fires.

Matched MeSH terms: Air Pollution/legislation & jurisprudence*

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