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Fulltext A case study on institutional development in the water and sanitation sectors and integration of PHC with rural water supply and sanitation in Malaysia

Citation: A case study on institutional development in the water and sanitation sectors and integration of PHC with rural water supply and sanitation in Malaysia. Manila: World Health Organization, Regional Office for the Western Pacific; 1985

Matched MeSH terms: Primary Health Care
Fulltext 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

Mohamad Noh K, Jaafar S

World Conference on Social Determinants of Health, 2011.

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.

Matched MeSH terms: Primary Health Care
Fulltext Public health nursing in 1Care

Jaafar S, Mohd Noh K, Suhaili MR, Kiyu A, Ong F, Wong M

Int J Public Health Res, 2011;1(Special Issue):1-8.

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.

Matched MeSH terms: Primary Health Care
The Patient's Charter - Validating actual services provided to the outpatient

Khoo CM, Lim YL, Abdul H, Zaharudin R, Sharipah A, Azirawati J, et al.

JUMMEC, 1997;2:107-110.

The Patient's Charter tells about the rights and standard of service a patient can expect. However, little information is available to gauge the reality of the charter in real practice. This survey was performed to determine the validity of the charter to the services provided and to identify areas of improvement if the charter is to be revised. A questionnaire-based survey was used to seek information from 196 patients who attended the Outpatient Department in Banting District Hospital over a period of four days. The overall waiting time for registration, to be seen by a doctor and for medication were 17.4 ± 2.0 minutes, 25.3 ± 2.6 minutes and 15.8 ± 1.3 minutes respectively. The overall waiting time for the whole consultation was 61.4 ± 4.9 minutes. Only 30.8% respondents knew about the Patient's Charter. The Patient's Charter appears to be valid for the actual services provided. There have to be measures to increase the awareness of the charter to the public perhaps via pamphlets and to provide a multi-linguistic charter.

Matched MeSH terms: Primary Health Care
Communication skills teaching in primary care medicine

Hanafi NS, Chia YC

Med. J. Malaysia, 2002 Dec;57 Suppl E:74-7.
PMID: 12733197

The teaching of clinical communication skills to undergraduate medical students in the Faculty of Medicine, University of Malaya is described. It is a continuous process throughout the five-year medical curriculum which is divided into Phases I, II and III. Students are introduced to communication skills early in Phase I through an interactive session as well as a workshop on general communication skills. In Phase II, small-group two-day workshops cover the basic principles of clinical communication skills using videotapes, group discussion and role-plays. Direct contact between students and patients in actual clinical setting begin in Phase IIIA. Communication skills teaching with feedback training is carried out by videotaping the consultations. In Phase IIIB the two-way mirror is utilized as well as having workshops on certain difficult areas such as 'breaking bad news' and 'taking a sexual history'. Formal assessment is done by evaluating the behavior, language and actual interview content.

Matched MeSH terms: Primary Health Care*
Fulltext Psychiatric symptomatology in a primary health setting in Malaysia

Varma SL, Azhar MZ

Med. J. Malaysia, 1995 Mar;50(1):11-6.
PMID: 7752963

This study was conducted to find out the psychiatric symptomatology in the patients and their families attending a primary health care facility. The most frequent symptoms found were of depression (13.2%), followed by hypochondriacal symptoms (8.2%), anxiety symptoms (6.1%) and psychotic symptoms. A large proportion (21.5%) of children had psychiatric symptoms. The common symptoms include enuresis, hostility, tantrums, problems of conduct and destructiveness. Surprisingly, concern for these symptoms was lacking in both the patient and their family members.

Matched MeSH terms: Primary Health Care*
Fulltext Health care in Sarawak's jungles

Chen PCY

World Health Forum, 1989;10(2):190-2.
PMID: 2610830

A primary health care system is being developed in Baram District, Sarawak, Malaysia, for the benefit of the Penans, who, until recently, were largely nomadic. Many of them are now attempting to adopt a settled mode of existence, and this in itself creates special health problems because the people lack the skills needed for living in one place. Substantial progress has already been achieved in mother and child care and in immunization coverage.

Matched MeSH terms: Primary Health Care*
Fulltext Reorientation of medical education for primary health care

Sahan AK

Med. J. Malaysia, 1987 Mar;42(1):1-8.
PMID: 3431498

There is universal concern on the current inequitable coverage and low quality of health care. The lead roles of medical practitioners in health care and how they are prepared for such roles are being re-examined in many countries. This paper attempts to rationalise the need to reorientate medical education towards primary health care, and to suggest possible emphasis and direction for change.

Matched MeSH terms: Primary Health Care/trends*
Developing primary health care for a nomad tribe: the Penans of the Baram

Chen PCY

Asia Pac J Public Health, 1987;1(1):34-7.
PMID: 3452377 DOI: 10.1177/101053958700100109

Unlike much of Peninsular Malaysia, the Baram District of Sarawak remains sparsely populated and underserved, one of the most underserved peoples being the nomadic and semi-nomadic Penans of the Baram. Until quite recently these Penans lived as small nomadic bands of hunter-gatherers. More recently, they have begun to settle in longhouses. However, lacking the necessary skills to live a settled mode of life, these Penans suffer a great deal of hunger, malnutrition, disease and death. Primary health care with its emphasis on the seven essential elements, including food production and nutrition, environmental sanitation, good maternal and child health, knowledge of disease and how it can be prevented as well as the treatment and control of locally endemic diseases, is of critical value in the survival of the semi-nomadic Penans. The specially designed primary health care programme for the Penans of the Baram is outlined briefly in this paper.
Keyword: Baram, Penans, Primary Health Care, Sarawak, Village Health Promoter.

Matched MeSH terms: Primary Health Care/organization & administration*
A systematic review of anxiety prevalence in adults within primary care and community settings in Malaysia

Wong CH, Sultan Shah ZU, Teng CL, Lin TQ, Majeed ZA, Chan CW

Asian J Psychiatr, 2016 Dec;24:110-117.
PMID: 27931891 DOI: 10.1016/j.ajp.2016.08.020

BACKGROUND: Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole.
METHODS: A systematic review of databases, reference lists, internet sources, and input from content experts revealed 42 studies that documented the prevalence of anxiety symptoms or disorders. 12 of these studies specifically evaluated anxiety disorders.
RESULTS: 4 studies looked at the prevalence of anxiety disorders in the general population, whilst the remainder focused on selected population groups: university students (4 studies); substance abuse (3 studies); and victims of abuse (1 study). Studies in the general population showed that the prevalence of generalised anxiety disorder was 0.4-5.6%, mixed anxiety and depression were 3-5%, panic without agoraphobia 0.4%, phobia unspecified 0.5-%, and anxiety not-otherwise-specified 0.3-6.5%. We found significant variability in anxiety disorders in the studies in selected population groups. The variability could also have been affected by methodological factors within each study.
CONCLUSION: This study provides a broad overview of the prevalence of anxiety disorders in Malaysia. More research is required to develop diagnostic instruments that are validated for local use and comparable with international standards. Reliable prevalence estimates are lacking within certain groups, e.g. those in rural, indigenous, migrant population groups and those exposed to natural disasters.

Matched MeSH terms: Primary Health Care/statistics & numerical data*
Fulltext Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography

Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, et al.

PLoS ONE, 2018;13(2):e0192533.
PMID: 29466383 DOI: 10.1371/journal.pone.0192533

OBJECTIVE: To describe and explain stroke survivors and informal caregivers' experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services.
DESIGN: Systematic review and meta-ethnography.
DATA SOURCES: Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015).
ELIGIBILITY CRITERIA: Primary qualitative studies focused on adult community-dwelling stroke survivors' and/or informal caregivers' experiences of primary care and/or community healthcare services.
DATA SYNTHESIS: A set of common second order constructs (original authors' interpretations of participants' experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods' criteria.
RESULTS: 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke.
LIMITATIONS: Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems.
CONCLUSIONS: Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services.
SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2015:CRD42015026602.

Matched MeSH terms: Primary Health Care*
Fulltext Delay in diagnosis of lung cancer: a case report

Ching SM, Chia YC, Cheong AT

Pertanika Journal of Science & Technology, 2014;22(2):587-592.
MyJurnal

This case report highlights delay in the diagnosis of adenoma carcinoma of the lung in a female patient who has never smoked. It took three months to reach the diagnosis of stage IV lung carcinoma despite the presence of symptoms and an abnormal chest radiograph finding from the beginning. The clinical characteristics and predictors of missed opportunities for an early diagnosis of lung cancer are discussed. In this case, patient and doctor factors contributed to the delay in diagnosis. Thus, early suspicions of lung cancer in a woman with the presence of respiratory symptoms despite being a non-smoker are important in primary care setting.

Matched MeSH terms: Primary Health Care
Results of the international field trial with the Reason for Encounter Classification

Lamberts H, Meads S, Wood M

Soz Praventivmed, 1985;30(2):80-7.
PMID: 4002871

The Reason for Encounter Classification (RFEC) was designed by a WHO Working Party to classify the reasons why patients seek care at the primary care level. It is designed along two axes: Chapters and Components. Each chapter carries an alpha-code which is the first character of the basic 3-character alphanumeric code. Each chapter is subdivided into seven "components" carrying 2-digit numeric codes. The field trial was undertaken by family physicians and nurses in: Australia, Barbados, Brazil, Hungary, Malaysia, the Netherlands, Norway and the US. 90497 RFE's were analysed. Their distribution over the chapters and components characterize the content of international primary care. Listings with the most common RFE's in the participating countries reflect the cultural differences. It is concluded that the RFEC is not only feasible to classify reasons why patients seek care but also to classify the diagnosis and the process of primary care. As a result of this, the International Classification of Primary Care (ICPC) succeeds the RFEC.

Matched MeSH terms: Primary Health Care
Fulltext Depression In Primary Care Part 2: Management

Pereira XV, Zainab AM

Malays Fam Physician, 2007;2(3):102-105.
PMID: 25606094 MyJurnal

The management of depression in the primary care setting should ideally take a biological, psychological, and sociological approach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychological therapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy. Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.

Matched MeSH terms: Primary Health Care
Fulltext Mental health issues : revisited

Osman Che Bakar, Ainsah Omar

Medical Health Reviews, 2009;2009(2):17-26.
MyJurnal

The various shortcomings involving issues related to managing patients with mental health are compared to those with physical health which are mainly attributed to attitude, misconception and stigma attached to mental health. There is a strong need to have a comprehensive collective efforts and a paradigm shift on how to deal with these critical issues especially in the area of Primary care for mentally ill.

Matched MeSH terms: Primary Health Care
Fulltext Developing a primary care research agenda through collaborative efforts - a proposed "6E" model

Tan NC, Ng CJ, Rosemary M, Wahid K, Goh LG

Asia Pac Fam Med, 2014;13(1):17.
PMID: 25606021 DOI: 10.1186/s12930-014-0017-9

Primary care research is at a crossroad in South Pacific. A steering committee comprising a member of WONCA Asia Pacific Regional (APR) council and the President of Fiji College of General Practitioners garnered sponsorship from Fiji Ministry of Health, WONCA APR and pharmaceutical agencies to organize the event in October 2013. This paper describes the processes needed to set up a national primary research agenda through the collaborative efforts of local stakeholders and external facilitators using a test case in South Pacific.

Matched MeSH terms: Primary Health Care
Fulltext Bereavement in the elderly: the role of primary care

Mohd Hashim S, Tan CE, Tohit N, Wahab S

Ment Health Fam Med, 2013 Sep;10(3):159-62.
PMID: 24427183

Bereavement in the elderly is a concern to primary care physicians (PCPs) as it can lead to psychological illness such as depression. Most people are able to come to terms with their grief without any intervention, but some people are not. This case highlights the importance of early recognition of bereavement-related depressive illness in elderly people. PCPs need to optimise support and available resources prior to, and throughout, the bereavement period in order to reduce the family members' burden and suffering.

Matched MeSH terms: Primary Health Care
Fulltext Roles of primary care physicians in managing bipolar disorders in adults

Awaluddin A, Jali N, Bahari R, Jamil Z, Haron N

Malays Fam Physician, 2015;10(3):27-31.
PMID: 27570605 MyJurnal

Management of bipolar disorder (BD) is challenging due to its multiple and complex facets of presentations as well as various levels of interventions. There is also limitation of treatment accessibility especially at the primary care level. Local evidence-based clinical practice guidelines address the importance of integrated care of BD at various levels. Primary care physicians hold pertinent role in maintaining remission and preventing relapse by providing systematic monitoring of people with BD. Pharmacological treatment in particular mood stabilisers remain the most effective management with psychosocial interventions as adjunct. This paper highlights the role of primary care physicians in the management of BD.

Matched MeSH terms: Primary Health Care
Fulltext Future of family medicine in developing countries

Rajakumar MK

10th WONCA World Conference, 1983.

Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 23-26

Matched MeSH terms: Primary Health Care
Fulltext Variation of polypharmacy in older primary care attenders occurs at prescriber level

Ong SM, Lim YMF, Sivasampu S, Khoo EM

BMC Geriatr, 2018 02 23;18(1):59.
PMID: 29471806 DOI: 10.1186/s12877-018-0750-2

BACKGROUND: Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics.
METHODS: We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics.
RESULTS: A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level.
CONCLUSION: Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.

Matched MeSH terms: Primary Health Care/standards; Primary Health Care/trends*; Primary Health Care/statistics & numerical data

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