With about 1% of Malaysian medical practitioners being psychiatrist, the patients need the psychiatric skill and care of general practitioners for both early referral and follow-up care. The psychological reactions aroused by the mentally ill patients may be jointly managed by the doctors and their families. The primary care doctor can play an effective therapeutic and supporting role in the rehabilitation of the patient that may include, when available, other workers in social and psychiatric services.
In the light of present HIV worldwide epidemic. there is a need to teach the busy general practitioners how to recognise HIV & AIDS. Due to the deadly nature of this infection and its manifold presentations from opportunistic diseases. the busy general practitioners in primary care may be misled in making the correct diagnosis. In Malaysia. the doctors in the primary care level constitute 70 to 75% of the doctors' population. The rest are specialists in secondary and tertiary care institutions. Family Physicians from the Font liners to recognise and detect early cases of HlV in all its early manifestalions on the various systems. Any doctors in primary medicine whether from private or public sector, amy be confronted by patients who present with trivial complaints. These patients may be fee-paying, or particularly those doctors involved with welfare and health of factory workers and the other forms of the main work force should well arm themselves with updates in HIV and AIDS.
Socioeconomic development in Malaysia, over the past few decades, has led to the improvement and expansion of the public healthcare system. This system has provided universal access to a low-priced package of comprehensive health care leading Malaysia to claim to have achieved universal health coverage (UHC). However, the Malaysian health landscape is changing rapidly. Provision of private care has grown especially in large urban towns, mainly in response to public demand. Thus far, private care has been predominantly bought and utilised by the rich but because of differentials in quality of care between the public and private sector, unabated expansion of the private health sector has the potential to adversely affect universal access to care. This effect may be accentuated in the coming years by demographic changes in the country specifically by the ageing of the population. This paper is intended to highlight challenges to UHC in Malaysia in the face of the changing health landscape in the country and to offer some suggestions as to how these challenges can be met.
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.
Public health nursingis a specialized nursing combining both nursing and public health principles with the primary focus of improving the health of the whole community rather than just an individual. Its documented history started in the 1800s and has evolved from home visiting to the varied settings that public health nurses find themselves working in as members of public health teams in clinics, schools, workplaces and government health departments.Public health nursing has been a critical component of the country’s health care system, uplifting of the health status of Malaysians and playing a dominant role in the fight against communicable diseases, and is set to face the challenges of the 21st century with public health nurses practising to the full capacity of their training in a restructured Malaysian health system – 1Care for 1Malaysia. The health sector reform allows for optimisation of scarce health care resources to deliver expansion of quality services based on needs, appropriateness, equity &allocative efficiency. The proposed model will be better than the current system, preserving the strengths of the current system but able to respond to increasing population health needs and expectations. There will be increased autonomy for healthcare providers with incentives in place for greater performance. Some of the implications of reform include allowing public- private integration, a slimmer Ministry of Health with a stronger governance role, enhancing the gatekeeping role of the primary care providers and the autonomous management of the public healthcare providers. In this restructured health system, the roles of the public health nurses are no less important than in the current one. In fact, with the increasing emphasis placed on prevention and primary care as the hub of community care with nurses as part of the primary care team delivering continuous comprehensive person-centered care,public health nurses in the future will be able to meet the challenge of refocusing on the true mission of public health: to look at the health problems of a community as a whole and work with the community in alleviating those problems by applying the nursing process to improve health, not just as providers of personal care only.
Khoo EM, Sararaks S, Lee WK, Liew SM, Abdul Samad A, Cheong AT, et al.
Citation: Khoo EM, Sararaks S, Lee WK, Liew SM, Abdul Samad A, Cheong AT, et al. Patient Safety in MOH Primary Care Clinics - A Community Trial. Kuala Lumpur: Institute for Health Systems Research; 2010
Citation: Savedoff WD, Smith AL. Achieving Universal Health Coverage: Learning from Chile, Japan, Malaysia and Sweden. Maine, United States: Result for Development Institute; 2011
Over the last hundred years, most countries have made substantial progress toward universal health coverage. The shared trends includes rising incomes, increasing total health expenditures and an expanding role for government in improving access to health care. Despite this, countries vary significantly in their particular routes to universal health coverage. These routes are shaped by prominent leaders and strong popular movements and framed by particular moral claims and world views. They are affected by unpredictable events related to economic cycles, wars, epidemics and initiatives in other public policy spheres. They are also influenced by a country’s own institutional development and experiences in other countries. As a result of these highly contingent paths, countries reach universal health coverage at different income levels and with disparate institutional arrangements for expanding health care access and mitigating financial risk. This paper examines the histories of attaining universal health coverage in four countries – Sweden, Japan, Chile and Malaysia. It shows that domestic pressures for universalizing access to health care are extremely varied, widespread, and persistent. Secondly, universal health coverage is everywhere accompanied by a large role for government, although that role takes many forms. Third, the path to universal health coverage is contingent, emerging from negotiation rather than design. Finally, universal health coverage is attained incrementally and over long periods of time. These commonalities are shared by all four cases despite substantial differences in income, political regimes, cultures, and health sector institutions. Attention to these commonalities will help countries seeking to expand health coverage today.
Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH
Citation: Sivasampu S, Lim Y, Abdul Rahman N, Hwong WY, Goh PP, Abdullah NH. National Medical Care Statistics: Primary Care, 2012. Kuala Lumpur: National Clinical Research Centre, Ministry of Health, Malaysia; 2014