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Management studies in medical education

Noor Ghani S, Saimy I

Med J Malaysia, 2005 Aug;60 Suppl D:66-8.
PMID: 16315627

In 1977, the World Health Assembly (WHA) set the social target--the "Health For All" goal and in 1995, urged member states to "re-orientate medical education and medical practice for "Health For All" (resolution WHA 48.8). This led to World Health Organisation to enunciate the "5-star doctor" needing skills in healthcare management, quality assurance and health economics. The Faculty of Medicine, University of Malaya introduced the New Integrated Curriculum (NIC) in 1995. The objective was aimed at producing a competent doctor with a holistic approach to the practice of medicine. This was to be achieved by having 3 strands of studies i.e. The Scientific Basis of Medicine (SBM), the Doctor, Patient, Health and Society (DPHS), and Personal and Professional Development (PPD) over the 5-year programme, split into 3 phases. Elements of the "5-star doctor" were introduced in strand 2--DPHS and strand 3--PPD. Management studies were introduced in the Personal and Professional Development (PPD) strand. This led to an instructional module--"Principles of Management in Health Care Services (PMGT)" comprising of the Management of Self, Resources and People and incorporating a three week field programme. Evaluation is undertaken at the end of the phase IIIA of the studies. This NIC approach will be able to produce a "5-star doctor", a team player, leader, communicator and an effective manager.

Matched MeSH terms: Health Services Administration*
Fulltext Oral health care in the elderly population in Malaysia--a review

John J, Mani SA, Azizah Y

Med J Malaysia, 2004 Aug;59(3):433-9.
PMID: 15727396

One of the undeniable facts about living is that everyday we are getting older. By 2050, it is projected that one out of every five Malaysians will be 60 or older. The economic challenge of this demographic change will affect development and the financial implications of sustaining well being of this group are formidable and complex. This population group has extensive oral disease, medical problems that complicate their oral care, and unique dental treatment challenges. The authors discuss the problem of oral healthcare among the aged, its impediments and propose some approaches for improvement to better serve the needs of this group of vulnerable members of our nation.

Matched MeSH terms: Health Services for the Aged/standards*
Fulltext Facilitating a transition from compulsory detention of people who use drugs towards voluntary community-based drug dependence treatment and support services in Asia

Tanguay P, Kamarulzaman A, Aramrattana A, Wodak A, Thomson N, Ali R, et al.

Harm Reduct J, 2015 Oct 16;12:31.
PMID: 26470779 DOI: 10.1186/s12954-015-0071-0

Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia.

Matched MeSH terms: Community Health Services*
Fulltext Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

Asante A, Price J, Hayen A, Jan S, Wiseman V

PLoS One, 2016;11(4):e0152866.
PMID: 27064991 DOI: 10.1371/journal.pone.0152866

INTRODUCTION: Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA.
METHODS AND FINDINGS: Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing.
CONCLUSION: Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal of barriers to care can enhance equity. The results overall suggest that there are impediments to making health care more accessible to the poor and this must be addressed if universal health coverage is to be a reality.

Matched MeSH terms: Health Services Accessibility/economics*
Assessing the needs of caregivers of children with disabilities in Penang, Malaysia

Tan SH

Health Soc Care Community, 2017 03;25(2):447-457.
PMID: 26833929 DOI: 10.1111/hsc.12325

Disability in a child not only affects the child but also presents socioeconomic and psychological impacts to the child's family. This study aims to describe the service needs of caregivers of children with disabilities in the state of Penang, Malaysia, and to determine the child and family characteristics predisposing to having more caregiver needs. A cross-sectional survey was conducted between February and June 2013 among caregivers of children aged 0-12 years with disabilities registered with the Penang Department of Social Welfare. Caregivers completed a self-administered mailed questionnaire containing a 20-item Caregiver Needs Scale (CNS). Each item in the CNS was rated on a 5-point Likert scale ranging from 'help not at all needed' to 'help extremely needed'. A total of 273 surveys were available for analysis (response rate 34.0%). The CNS contained four domains. The 'Help getting Information and Services for child' domain had the highest mean score (3.61, 95% CI: 3.46, 3.77) followed by 'Help with Finances' (3.29, 95% CI: 3.13, 3.45) and 'Help Coping with child' (3.11, 95% CI: 2.97, 3.25), while the 'Help getting Childcare' domain had the lowest mean score (2.30, 95% CI: 2.13, 2.47). Multivariate regression analysis identified caregivers of younger children and with more severe disability as having more caregiver needs in all domains. Besides that, caregivers of children with learning disability needed more help getting information and help with coping. Caregivers of children with learning and multiple disabilities needed more help getting childcare compared to children with other disability. Caregivers of Indian ethnicity, who had less than a tertiary education and who themselves had medical problems needed more help with finances. The findings on caregiver needs in this study can help inform planning of family support services for children with disabilities in Penang, Malaysia.

Matched MeSH terms: Health Services Needs and Demand/statistics & numerical data*
Fulltext Mobile health-care information for all: a global challenge

Royston G, Hagar C, Long LA, McMahon D, Pakenham-Walsh N, Wadhwani N, et al.

Lancet Glob Health, 2015 Jul;3(7):e356-7.
PMID: 26087979 DOI: 10.1016/S2214-109X(15)00054-6
Matched MeSH terms: Health Services Needs and Demand*
Fulltext Household expenditure for dental care in low and middle income countries

Masood M, Sheiham A, Bernabé E

PLoS One, 2015;10(4):e0123075.
PMID: 25923691 DOI: 10.1371/journal.pone.0123075

This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries.
Study name: World Health Survey (Malaysia is a study site)

Matched MeSH terms: Health Services Accessibility/economics
Quality of life of community-based chronic schizophrenia patients in Penang, Malaysia

Mubarak AR, Baba I, Chin LH, Hoe QS

Aust N Z J Psychiatry, 2003 Oct;37(5):577-85.
PMID: 14511086

This is a study of the quality of life (QOL) of 174 community-based chronic schizophrenia patients in Penang, Malaysia.

Matched MeSH terms: Community Mental Health Services*
Occupational health research priorities in Malaysia: a Delphi study

Sadhra S, Beach JR, Aw TC, Sheikh-Ahmed K

Occup Environ Med, 2001 Jul;58(7):426-31.
PMID: 11404445

As part of a consultancy project on occupational health, the Delphi method was used to identify research priorities in occupational health in Malaysia.

Matched MeSH terms: Health Services Research/methods*
Clinical presentation and outcome of brain abscess over the last 6 years in community based neurological service

Abdullah J

J Clin Neurosci, 2001 Jan;8(1):18-22.
PMID: 11322120

Sixty patients with brain abscess were treated at the Neurosurgical Unit of the Department of Surgery, Hospital Universiti Sains Malaysia between January 1990 and December 1996. A retrospective study was done and data were collected from the computerise d registry of the Record Unit of Hospital Universiti Sains Malaysia. Good results were achieved in patients who were both treated surgically and medically. There were only twelve deaths in this group. The main factor that influences morbidity and mortality of brain abscess is the clinical presentation on admission. The mortality was high in patients treated solely by medical means. Death was common in patients who presented with acute onset of symptoms of less than one week duration and those with poor mental status. Brain abscess is common in the East Coast population of peninsular Malaysia, probably due in part to lower socioeconomic status. Efforts should be directed towards prevention of infection and early recognition and management.

Matched MeSH terms: Community Health Services*
Fulltext Preferential utilization of healthcare systems by a Malaysian rural community for the treatment of musculoskeletal injuries

Ariff KM

Med J Malaysia, 2000 Dec;55(4):451-8.
PMID: 11221156

The preferential utilization of healthcare systems by a rural Malaysian community in Perlis for the treatment of musculoskeletal injuries was studied using focus group discussions. The objectives of the study were to explore the pattern of utilization of healthcare systems, the factors influencing the choice of a healthcare provider, rural residents' expectations of their healthcare provider and their views on integrating traditional and modern scientific healthcare systems. Most participants considered traditional and modern scientific healthcare systems as complementing each other. For musculoskeletal injuries, the traditional system was considered the primary choice of healthcare regardless of the participants' socioeconomic and educational levels. Key factors for preferring traditional care were the nature of treatment, the perceived shorter duration for recovery and inclusion of spiritual elements in the therapy. Barriers to seeking hospital treatment were the perceived longer duration for recovery, fear of surgery, use of metallic implants and casts that were culturally unacceptable and objections from elders. For perceived life-threatening situations, in children, pregnancy, and where injuries to internal organs were suspected, hospital treatment was preferred as the primary choice. Discussions on integrating traditional and modern scientific systems were inconclusive.

Matched MeSH terms: Health Services/utilization*
75M Filipinos and still counting. But lack of direction hounds FP program

Reprowatch, 1999 May;19(3-4):4.
PMID: 12322208
Matched MeSH terms: Health Services*
Feasibility of local condom production examined

AIDS Anal Afr, 1999 Jun-Jul;10(1):13.
PMID: 12295121
Matched MeSH terms: Health Services Needs and Demand*
Knowledge and perception of oral health promotion in schools among dental nurses in Sarawak, Malaysia

Chen CJ, Jallaludin RL

Asia Pac J Public Health, 2000;12(1):12-6.
PMID: 11200211

In recent years, the concept of a Health-Promoting School has received much interest. In Malaysia, dental nurses are ideally placed to play a lead role in promoting Oral Health within the school setting. This study aims to provide information on the knowledge, perception and perceived role of Oral Health Promotion in schools, among dental nurses. A postal questionnaire was used to measure dental nurses' knowledge, perception and perceived role of Oral Health Promotion. The majority (60%) of dental nurses had good knowledge of Oral Health Promotion. Generally, they perceived that they play an important role in promoting Oral Health in schools. However, a sizeable proportion (25%) did not think they had a role to play in working together with school authorities to provide children with healthy food choices in school canteens. The majority (60%) of dental nurses did not perceive Oral Health Promotion to be important as a whole. They had a good perception of the concepts: it supports behaviour change, it has appropriate goals, it integrates oral health and general health and relieves anxiety. However, they had a poorer perception of the concepts; diverse educational approaches, participation, focus on prevention, early intervention, "spread of effect" of dental health education and "make healthier choices the easier choices". Years of service was not significantly associated with knowledge and perception of Oral Health Promotion. Dental nurses should be reoriented towards a more holistic practice of Oral Health Promotion. Workshops that invite active participation from dental nurses should be conducted to equip them with the necessary knowledge and skills.

Matched MeSH terms: School Health Services*
Advances in health in Malaysia

Suleiman AB, Lye MS, Mathews A, Ravindran J

Med J Malaysia, 1995 May;50 Suppl A:S3-10.
PMID: 10968005
Matched MeSH terms: Child Health Services/trends
Agriculture: access to technology limited

UN Chron, 1997;34(4):58.
PMID: 12293737

From country to country and even regionally, the roles of women in agriculture vary, but most of their labor is in unpaid subsistence production and their contributions tend to be underestimated, according to the results of the [UN] Secretary-General's report. Depending on circumstances, they have complementary roles with men, sharing or dividing tasks in the production of crops, care of animals, and forestry management. In sub-Saharan Africa, for example, women contribute 60-80% of labor in food production for both household consumption and sale, while in Malaysia the women account for only 35% of the agricultural labor force, and in Ireland the participation rate is only 10.4%. Although women make this important amount of labor contributions to agricultural production, "development policies tend to favor export crops to earn foreign exchange and the agricultural research tends to address the improvement of production and technologies for commercial production". This results in limited access for women to technical knowledge and innovations, including irrigation, machinery, farming techniques and extension services. This is strengthened by the fact that most of the extension services target farmers who own land and can obtain credit to invest in input and technology.

Matched MeSH terms: Health Services Needs and Demand*
Asia needs political commitment to fight AIDS

AIDS Wkly Plus, 1997 Jun 2.
PMID: 12347936
Matched MeSH terms: Health Services Needs and Demand*
Child health in Malaysia

Ariffin W

Arch Dis Child, 1994 Nov;71(5):452-6.
PMID: 7826121
Matched MeSH terms: Child Health Services/organization & administration*
The condom controversy: should latex prophylactics be part of everyday life?

Asiaweek, 1994 Jan 19.
PMID: 12288297
Matched MeSH terms: Marketing of Health Services*
Impact of the east Asian economic crisis on health and health care: Malaysia's response

Suleiman AB, Lye MS, Yon R, Teoh SC, Alias M

Asia Pac J Public Health, 1998;10(1):5-9.
PMID: 10050200

In the wake of the east Asian economic crisis, the health budget for the public sector in Malaysia was cut by 12%. The Ministry of Health responded swiftly with a series of broad-based and specific strategies. There was a careful examination of the operating expenditure and where possible measures were taken to minimise the effects of the budget constraints at the service interface. The MOH reprioritised the development of health projects. Important projects such as rural health projects and training facilities, and committed projects, were continued. In public health, population-based preventive and promotive activities were expected to experience some form of curtailment. There is a need to refocus priorities, maximise the utilisation of resources, and increase productivity at all levels and in all sectors, both public and private, in order to minimise the impact of the economic downturn on health.

Matched MeSH terms: Health Services/economics*

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