Human & Health: Malaysia's Scenario Towards Sustainable Healthcare & Services


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Human & Health: Malaysia's Scenario Towards Sustainable Healthcare & Services

  1. 1. 1 SFGS 6120Introduction to Science, Technology & Sustainability Lecturer: Dr. Amran Muhammad Mohd Fadhli Rahmat Fakri SMB110010 Department of Science & Technology Studies, Faculty of Science, University of Malaya
  2. 2. » Chapter 1: Human & Health» Chapter 2: Malaysia at Glance: Health Status» Chapter 3: Challenges in Current Health Issues in Malaysia» Chapter 4: Policy Options and Integration of Practical Ethics of Health & Indigenous/Alternative Knowledge» Chapter 5: Case Study» Summary & Recommendations 2
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  4. 4. Definition of Key Terminology1) Human: Human (known taxonomically as Homo sapiens, Latin for "wise man" or "knowing man") are the only living species in the Homo genus. Reference: A man, woman, or child of the species Homo sapiens, distinguished from other animals by superior mental development, power of articulate speech, and upright stance Reference: Google dictionary In general, human is defined as biological, social and spiritual being but Quran considers human as a responsible being. Reference:( 4 Image taken from
  5. 5. Human in Quran:  A human being is created from a drop of semen,  When he/she grows, a thorn, a sting, or a wound can easily cause him sleeplessness.  Any harm fated for him/her may cause his end and a germ may cause his weakness or perhaps death. “So let man see from what he is created! He is created from a water gushing forth, proceeding from between the backbone and the ribs. Verily, (Allah) is able to bring him back (to life)! The Day when all the secrets (deeds, prayers, fasting) will be examined (as to their truth). Then he will have no power, nor any helper.” (Surah al-Tariq: verse 5-10) Reference: Tafsir al-Quran from 5Image taken from http://
  6. 6. 2) Health  “…The state of being free from illness or injury. Reference:  “Islam takes a holistic approach to health. Just as religious life is inseparable from secular life, physical, emotional and spiritual health cannot be separated; they are three parts that make a completely healthy person. When one part is injured or unhealthy, the other parts suffer…” Reference: 6Image taken from http://
  7. 7. Health Image taken from “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The bibliographic citation for this definition is: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 7 1948.
  8. 8. “Everyone has the right to a standard of livingadequate for the health and well-being ofhimself and of his family, includingfood, clothing, housing and medical care andnecessary social services, and the right tosecurity in the event ofunemployment, sickness, disability, widowhood, old age or other lack of livelihood incircumstances beyond his control.”—Universal Declaration of Human Rights(Article 25, paragraph 1) 8
  9. 9. Universal Declaration on Bioethics and HumanRightsArticle 14 – Social Responsibility and Healtha) The promotion of health and social development for theirpeople is a central purpose of governments, that all sectors ofsociety share.b) Taking into account that the enjoyment of the highest standard ofhealth care is one of the fundamental rights of every human beingwithout distinction of race, religion, political belief, economic or socialcondition, progress in science and technology should advance:(i) access to quality health care and essential medicines,including especially for the health of women and children, because healthis essential to life itself and must be considered as a social and humangood;(ii) access to adequate nutrition and water;(iii) improvement of living conditions and the environment;(iv) elimination of the marginalization and the exclusion of persons on 9the basis of any grounds; and(v) reduction of poverty and illiteracy.
  10. 10. „Healthy habits start from young. A recenthealthy survey indicates that 43% ofMalaysians are overweight or obese‟. (NST, June 8, 2010: 19)„Malaysians take too much salt. Dailyconsumption is higher than WHOrecommendation.‟ (Star, April 21, 2010: 6)„Junk food maybe as addictive as heroin andtobacco. Obesity researches found fatty andsugary snacks trigger the same „pleasurecentre‟ in the brain that drive people intodrug addictions – making them binge onunhealthy food.‟ (NST, April 6, 2010: 4) 10
  11. 11. » Total Population: 28.3 million (2010)» Life Expectancy at Birth (years) ˃Male : 71.7 ˃Female : 76.5 11
  12. 12. “…Healthcare challenges are a matterof global concern involving everycountry in the world, and countries in Asiaare no exception. For some countries, theissues are about improving access tobasic health services and tacklingpoverty-related problems such ascommunicable diseases and infantmortality. For others, it could be battlingrising chronic, lifestyle-linkeddiseases and caring for an ageingpopulation…” 12
  13. 13. Ministry of Health, Malaysia» Vision for Health:“A Nation working together for better health”» Mission of MOH is to lead & work in partnership:  To facilitate and support the people to: + Attain fully their potential in health + Appreciate health as a valuable asset + Take individual responsibility and positive action for their health  To ensure a high quality health system,  With emphasis on: professionalism (caring and teamwork value), respect for human dignity and community participation Source: Health Facts (Published August, 2011) Ministry of Health Malaysia 13
  14. 14. » Malaysia achieving developed nation – Vision 2020» Stressing the element of enjoying relatively high standards of: ˃ Livings ˃ Above average health status ˃ Political and economic stability» 21st century : numerous challenges ˃ Ensure the availability of sustained quality health care and services + Recent economic and financial climate pose serious challenges + Changing demography, rapid social change – Modernisation /urbanization – Newly emerging as well as re-emerging diseases (previously well controlled) 14
  15. 15. TRANSFORMING HEALTHCARE TOIMPROVE QUALITY AND PROVIDEUNIVERSAL ACCESS Malaysia Government plans to reform the healthcare delivery system with a focus on 4 key areas:  Transforming delivery of the healthcare system;  Increasing quality, capacity and coverage of the healthcare infrastructure;  Shifting towards wellness and disease prevention, rather than treatment; and  Increasing the quality of human resource for health 15
  16. 16.  Health care provided at nominal charge for all Malaysians (& even for non-citizens) Financial Allocation: 2010’s Allocation 2009’s Allocation (RM Billion) (RM Billion) Total MoH Budget 15.349 13.716 MoH Operating 11.765 11.433 Budget MoH Development 3.584 2.283 Budget Total Expenditure on 4.75% 4.75% Health (% of GDP) Percentage of Total 8.02 % 6.60 % MoH Allocation to National Budget Source: Health Facts (Published August, 2011) Ministry of Health Malaysia 16
  17. 17. Source: Economic Transformation Programme Chapter 16: Healthcare 17
  18. 18. » Current Scenario: Ministry of Health VS Private MoH (units) Private (units) Year 2010 2009 2010 2009 Health Clinics 2, 833 808 6, 442 6,307 Hospitals 131 130 217 209 No. of beds 33,211 33,083 13, 186 12,216 Additional feature for MoH:  1Malaysia Clinics (53)  Mobile Health Clinics and Teams(165)  Mobile Health Clinics & Teams for 1Malaysia Clinic (3)  Flying Doctor Stations (13) Source: Health Facts 2010 (Published August, 2011) & Health Facts 2009 Ministry of Health Malaysia 18
  19. 19. » Increasing expectations on quality of healthcare ˃With increasing wealth, more spending in healthcare, increasing utilisation and demanding higher quality» Increasing pressure on the public healthcare system» Changing lifestyles and demography ˃Increasing prevalence of lifestyle-related diseases» Advancements in technology 19
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  23. 23. Communicable Diseases (CD) 23
  24. 24. Non-Communicable Diseases (NCD) 24
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  26. 26. » Demographic and health transition ˃ Impact on morbidity patterns  Changes in the age composition of the populations  Urbanization Images taken from: – Influenced society values and behavior (impact to both communicable and non-communicable disease)» Environmental degradation and health ˃ Contributors to the health problems ˃ Water pollution, air pollution and management of solid waste» Migration and health» Globalization» Mental health and wellness» Equity health care
  27. 27. » Currently about 60-70% of total health clinic attendances are due to Non-Communicable Diseases (NCD)» Excluding normal deliveries, NCD contributes to over 20% of total hospitalization in MoH Hospitals» NCD is also in the top five most common cause of death in MoH Hospitals in the past five years» Most common cause of premature death (below 60 years of age) in Malaysia are due to cardiovascular Sources: Health Informatics Centre, MOH diseases Malaysian Burden of Disease & Injury Study 2004 27
  28. 28. NCD & NCD Risk Factors: The causation pathway for chronic diseases Prevalence of obesity: 14.0% (1.7 million Malaysians) Physically inactive: Ministry of Health 43.7% (5.5 million) Prevalence of diabetes: Malaysia 14.9% (1.4 million)Underlying Common Risk Intermediate Main NCDDeterminants Factors Risk Factors •Heart Disease •Unhealthy diet •Physical Inactivity •Overweight/obesity •Diabetes•Globalisation •Raised blood sugar •Tobacco & Alcohol •Stroke•Urbanisation •Raised blood•Population use pressure •Cancer Ageing •Age (non modifiable) •Abnormal blood •Chronic resp. •Heredity lipids diseases (non modifiable) Current smokers: Prevalence of hypertension: 21.5% (2.8 million) 32.2% (4.8 million) 28
  29. 29. Prevalence of NCD Risk Factors in Malaysia (1996-2006) Smoking (18 years & above) 25.0% NHMS II (1996) NHMS III (2006) 20.0% 15.0% Age group ≥18 years ≥18 years 10.0% 5.0% Ministry of HealthSmoking 24.8% 21.5% 0.0% Malaysia NHMS II NHMS IIIPhysically Inactive 88.4% 43.7% In 2006, there is an estimatedOverweight(BMI ≥25 & <30 kg/m2) 16.6% 29.1% 2.8 million Malaysians age 18 years and above are currentObesity (BMI ≥30 kg/m2) 4.4% 14.0% smokers, 5.5 millionHypercholesterolaemia physically inactive, 3.6 million N.A. 20.6% overweight and 1.7 million Overweight (18 years & above) obese Malaysians. Obese (18 years & above) 30.0% 25.0% 20.0% 15.0% 14.0% 12.0% Increase of over 10.0% 10.0% 5.0% 8.0% 200% 6.0% 0.0% NHMS II NHMS III 4.0% 2.0% 0.0% NHMS II NHMS III 29
  30. 30. Prevalence of Diabetes & Hypertension in Malaysia (1986-2006) In 2006, there is an NHMS I NHMS II NHMS III estimated 4.8 million (1986) (1996) (2006) Malaysians age 18 Ministry of Health Age group ≥25 years ≥30 years ≥30 years years and above living Malaysia with hypertension andPrevalence of HPT 14.4% 32.9% 42.6% 1.5 million Malaysians Age group ≥35 years ≥30 years ≥30 years living with diabetes Prevalence of 6.3% 8.3% 14.9% Diabetes Hypertension (30 years & above) Diabetes (30 years & above) 50.0% 15.0% 40.0% 30.0% 10.0% Increase of 20.0% over 80% 10.0% 5.0% 0.0% NHMS II NHMS III 0.0% NHMS I NHMS II NHMS III 30
  31. 31. Top Ten Causes of DALYs forMales in Malaysia, 2000Rank Disease Category Total % Total DALY 1 Ischaemic heart diseases 164,846 10.0 Ministry of Health Malaysia 2 Road traffic injuries 133,789 8.2 3 Cerebrovascular disease/stroke 94,059 5.7 4 Septicaemia 70,232 4.3 5 Acute lower respiratory tract infections 49,649 3.0 6 Diabetes mellitus 47,060 2.9 7 Chronic obstructive pulmonary 45,459 2.8 disease 8 Hearing loss 44,566 2.7 9 Unipolar major depression 42,259 2.6 DALYs: Disability Adjusted Life- 10 Cirrhosis 37,902 2.3 Year, measure of overall Total (111 diseases) 1,646,896 100.0 disease burden 31 Sources: Malaysian Burden of Disease & Injury Study 2004
  32. 32. Top Ten Causes of DALYs forFemales in Malaysia, 2000Rank Disease Category Total % Total DALY 1 Ischaemic heart diseases 113,887 9.2 Ministry of Health Malaysia 2 Cerebrovascular disease/stroke 86,372 7.0 3 Unipolar major depression 67,211 5.4 4 Septicaemia 57,483 4.6 5 Diabetes mellitus 56,390 4.6 6 Hearing loss 38,994 3.1 7 Acute lower respiratory tract infections 37,890 3.1 8 Asthma 32,815 2.6 9 Road traffic injuries 28,946 2.3 10 Osteoarthritis 26,925 2.2 Total (111 diseases) 1,240,997 100.0 32 Sources: Malaysian Burden of Disease & Injury Study 2004
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  34. 34. Health Policy - Definitions• WHO defines a Health Policy as a set of decisions to pursue courses of action aimed at achieving defined goals for Ministry of Health improving the health situation Malaysia – Forms the basis of health strategies• Policies can be understood as political, management, financial and administrative mechanisms arranged to reach explicit goals• Health policy can be in the form of: – Written official government policy (e.g. legislative, guidelines) – Verbal instruction of policymakers (e.g. in manifestos, official speeches)• Policies can be at many levels• Policies are dynamic, not just static list of goals and plans. 34
  35. 35. Rancangan Malaysia or“Malaysia Plan”• Malaysia does not have a “National Health Policy” per se Ministry of Health – Forms an integral component of the 5- Malaysia yearly medium-term national development policy - the “Malaysia Plan”• The health policy component is formulated based on the mix of rational planning and intuitive planning processes – Evidence-based policy development – Situational analyses is conducted both at the State level and Programme level (MOH) 35
  36. 36. 9th Malaysia Plan (2006-2010) and10th Malaysia Plan (2011-2015)• In 9th MP, the theme for health is “Achieving better health through consolidation of services” Ministry of Health Malaysia – Emphasis on sustainability of current health services – Emphasis on reducing NCDs• In the 10th MP, health is placed in Chapter 6: “Building an Environment that Enhances Quality of Life” – Again, emphasis on the prevention on NCD, not just for the health sector, but for the government as a whole – Sustainability again is a recurring theme 36
  37. 37. Mapping of current health system activities of NCD in Malaysia • Malaysia have fulfilled most indicators of the building blocks Health System Building Blocks by WHO • However current activities are: Ministry of Health PRIORITY CHRONIC DISEASES – Disjointed, not well Malaysia Preventable cancers coordinated, restricted to „health rso Chronic respiratory disease ct Fa sector‟ & not truly multi-sectoral k Cardiovascular disease is R CROSS CUTTING OBJECTIVES CROSS CUTTING OBJECTIVES HEALTH OUTCOMES Diabetes Equity HEALTH SYSTEM BUILDING BLOCKS Quality and safety – Lack of policy & regulatory interventions (create a health-POLICY AND STRATEGIC ALIGNMENT Stewardship Patient centered promoting built environment) care Health financing Community Health workforce – Lack of strong civil society engagement Information and evidence Sustained capacity for prevention and Medicines and technologies health promotion Health services organisation and delivery Stewardship: Government mandate for NCD policies  Health financing: Government pays for bulk of primary care  Heath workforce: Information & skills in NCD part of basic training  Info & evidence: Availability of nationwide risk factor data  Medicines & technology: First & second line drugs available  37 Health services: Risk factor screening & intervention 
  38. 38. National Strategic Plan for NCD(NSP-NCD): Seven Action Areas for Malaysia 1. Prevention and Promotion 2. Clinical Management 3. Increasing Patient Compliance Ministry of Health Malaysia 4. Action with NGOs, Professional Bodies & Other Stakeholders 5. Monitoring, Research and Surveillance 6. Capacity Building 7. Policy and Regulatory interventions• •Action Areas are in line the framework for NCD NSP-NCD provides with WHO mandates and resolutions•NSP-NCD provides the framework for NCD prevention & control at prevention & control at the National levelthe National level • Diabetes & Obesity selected as entry points• Diabetes & Obesity selected as entry points, while tackling • Action Areas in line with WHO recommendationshypertension, cardiovascular diseases and stroke as well 38
  39. 39. NSP-NCD: Basis for formulation &development• To ensure “acceptability” of the strategies contained in NSP-NCD Ministry of Health – It was developed based on current global Malaysia themes and mandates, particularly from WHO – Also draws references from the experiences of developed countries• MOH also does not want to create the impression that NCD prevention and control program is a “new initiative” – The strategies of NSP-NCD also relies heavily from the various “Action Plans” documents on NCD prevention and control in Malaysia, published since late 1990s 39
  40. 40. Policy recommendations relevant to NCDprevention and control in Malaysia• National Nutrition Policy and the National Plan of Action for Nutrition of Malaysia (2006-2015) Ministry of Health• Food Act 1983 and Food Regulations Malaysia 1985• National Sports Policy• Agriculture Policy• National Adolescent Policy• National Policy for Elderly• National Health Policy for Elderly• Convention on the Rights of the Child• National Policy for Women• National Youth Policy• Education Act 1996 40
  41. 41. Implementation of NSP-NCD: Perspective from the Causation Pathway for NCD Treatment: MOH & Health SectorDisease Prevention: All other Ministry of Healthrelated Stakeholders, with support Malaysiafrom Health Sector Common Risk Underlying Factors Intermediate Main NCD Risk Factors •Heart Disease Determinants •Unhealthy diet •Overweight/ •Physical Inactivity obesity •Diabetes •Tobacco & Alcohol •Raised blood sugar •Stroke •Globalisation use •Urbanisation •Raised blood •Cancer •Age (non pressure •Population modifiable) •Chronic resp. •Abnormal blood Ageing •Heredity lipids diseases (non modifiable) The NCD epidemic can only be effectively managed via: • At the environmental level, through policy and regulatory interventions; • At the level of common and intermediate risk factors, through population- based lifestyle interventions; and • At the level of early and established disease, through clinical interventions 41 targeted at high-risk individuals. 41
  42. 42. A Multilevel Approach to Epidemiology Ministry of Health Malaysia Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. 42
  43. 43. Compendium of Actors & Stakeholders Ministry of Health Malaysia Regulatory Bodies (in health system monitoring ) Religious Leader Public & (integration NGOs: International of ethics) Local Agencies & PolicyCommuni Experts: Makers ty WHO & etc 43
  44. 44. An Ecological Perspective: Levels ofInfluence Ministry of Health Malaysia 44
  45. 45. » Scientific progress is a significant basis for change in public-health policy and practice, but the field also invests in value-laden concepts and responds daily to sociopolitical, cultural and evaluative concerns.» Health policy-making and public-health practice in such a context involves complex processes where a mix of experiences, politics, evidence, finance, values and ethics all interweave; the failure of any one component can be fatal to any policy.» In this form, ethics is an organizational, development- oriented force that provides both methodological and motivational support to public-health practitioners and policy-makers. 45
  46. 46. » Characteristics of Ethics in Health System/Policy Perspectives: ˃Should be conceptualize through the lens of public-health and health systems: knowledge of society and social institutions, ˃differs from knowledge of diseases or nature-society interactions 46 i
  47. 47. » 3 core concerns frequently arise at the formative stages of public-health policy development: ˃Prevention, Accountability, and Social Justice. Prevention Accountabiiity Social Justice 47 i
  48. 48. » Prevention: the essential concern to intervene systematically in the causal processes by which risk factors threaten health and survival in human populations. E.g: the provision of sanitation and clean water to protect a population from waterborne diseases.» Accountability: refers to the notion that people and organizations should be held responsible for the plans, behaviors and foreseeable results of commitments that they willingly pursue. E.g: difficulty in accessing relevant information (i.e. lack of transparency) often hinders accountability» Social Justice: fairness in the distribution of the benefits and burdens of social cooperation. E.g: as in the case of seatbelt or helmet laws, the effect is to limit the freely chosen actions of some individuals who might otherwise willingly accept their own exposure to the risks in question. 48
  49. 49. Social Justice:» Issues of social justice may arise in this context when burdensome public-health measures are not adequately counterbalanced by benefit or» when they target some segments of the population but not others.» Policy processes can also be deficient in social justice when they include some perspectives at the expense of others; research suggests that perspectives of the poor and marginalized are often excluded. 49
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  51. 51. » Characteristics of such practices: Complementary & alternative forms of medicine Not taught widely in medical schools Not generally used in hospitals Not governed under the Medical Act which only covers the western form of medical practice but restricted under following Acts: the Poison Act 1952, Sale of Drug Act 1952, Advertisement and Sale Act 1956, the Control of Drug and Cosmetic Regulations 1984. FACT: WHO estimates that about 4 billion people use it globally (80% of the world population). (Ismail ,2002) Includes: traditional Chinese medicine, traditional medicine man (bomoh/dukun), traditional birth attendant (bidan kampung), acupuncture, ayurveda, homeopathy, tai chi, yoga and etc. 51
  52. 52.  Initiatives of MoH in realizing the-almost-equal importance of such practices especially herbs and traditional local medicine (Malay, Chinese and Indian):  Drafting of the Traditional and Complementary Medicine Act (2007)  Registration of Traditional Medicines by the National Pharmaceuticals Control Bureau (NPCB)  Implementation of pilot projects in 3 government hospitals: acupuncture, reflexology, generally to offset side effects of chemotherapy in cancer patients  Identifying suitable training institutions for the traditional medicine in China to which Western trained doctors can be sent for training.  Establishment of Herbal Medicine Research Centre under 9BIO research on identified herbal plants to provide a scientific base for its use. 52
  53. 53. ETHICS:Knowledge of Society & Social Institutions 53
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  55. 55. » Set-up in the urban areas to provide fast and cheap treatment for the poor citizen» 1Malaysia Clinic programme is under the Government’s 1Care Programme aimed at providing quality healthcare to public.» As for a start, Malaysia Government has launched 53 1Malaysia Clinics to offer the cheapest medical services at the cost of RM1 (less than US$0.35). 55
  56. 56. » Manned by Assistant Medical Officers Image taken from: (MA) & Nurses with at least 5 years’ experience: ˃ Capable in providing treatment at common illness ˃ Providing follow-up checks for chronic diseases.  Strategy to ease the overcrowding at government hospitals  Saving time and money to the public» Operating hours: ˃ 10am-10pm, 7 days a week» Budget Allocated & Spent: ˃ Malaysia has spent RM10 million for the set-up of 50 1Malaysia clinics include the facilities. 56
  57. 57. » Scope of 1Malaysia Clinics Services include: Minor treatment for fever, cough and flu Follow-up treatments for stable chronic patients: diabetic, high blood pressure, asthma cases Minor surgical procedures: cleaning wounds & taking out stitches Simple laboratory tests Stabilizing patients under the emergency cases before referring them to hospitals Health consultation/promotion for patients 57 Images taken from:
  58. 58. States (Specific Location): Numbers:1 SARAWAK (Sibu, Kuching, Miri, Bintulu) 42 PERLIS (Kangar) 13 KEDAH (Sg. Petani, Kulim) 24 PENANG (Jelutong, Butterworth, Seberang Perai Selatan, Bayan 5 Lepas, Bukit Mertajam)5 PERAK (Teluk Intan, Perak Tengah, Taiping, Ipoh) 46 SELANGOR (Petaling Jaya-2, Puchong, Shah Alam, Batu Caves) 57 KUALA LUMPUR (Kg. Pandan, Pantai Dalam, Taman Melati, 5 Kepong, Setapak)8 NEGERI SEMBILAN (Taman Rasah Jaya, Taman Seremban Jaya, 3 Nilai)9 MELAKA (Batu Berendam, Bukit Katil, Alor Gajah) 310 JOHOR (Masai, Kulai, Johor Bahru-2, Kluang) 511 PAHANG (Kuantan, Kg Pandan Jaya, Temerloh) 312 TERENGGANU (Marang, Kuala Terengganu, Kemaman) 3 5813 KELANTAN (Kota Baharu, Bachok, Pasir Mas) 314 SABAH (Tawau, Penampang, Sandakan, Kota Kinabalu) 4
  59. 59. » Other feature of 1Malaysia Health Services: Mobile 1Malaysia Clinic“…been introduced to ensure another25% of rural areas throughout Malaysiawhich are out of range of 25kms fromthe nearest medical & healthcarecentres to enjoy access to healthservices…” Sources: 59
  60. 60. » “If this concept can succeed, we will Images taken from set-up more of them. Our government aims to continuously improving healthcare of our people…as for a record, 1Malaysia Clinics launched this year (2010) as an instance, have succeeded in providing healthcare treatment to 1.2 million patients since last January (2010)…” 60
  61. 61. » “…this initiative fulfilling 2 of 6 thrusts in National Key Result Areas (NKRA):Images taken from CRIME REDUCTION COMBATING CORRUPTION WIDENING ACCESS TO AFFORDABLE AND QUALITY EDUCATION Raising The Living Standard Of The Low Income Households Improving Infrastructure In Rural Areas IMPROVING PUBLIC TRANSPORT IN THE MEDIUM TERM 61
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  63. 63. 1) Dr. Hadita Sapari (Surgeon, Serdang Hospital)2) Mr. Afif Ahmad (Medical Student, UMS)3) Mr. Saifuddin Mohd Yasin (Nursing Student, City University College of Science & Technology, KL)4) Mr. Mohamad Fazlin Mohamad Idros (Nursing Student, SEGi University College, KL)5) Mr. Megat Aliff Megat Zainuddin (Medical Student, UM) 63
  64. 64. 1. What is your comment on current Malaysian Health Education (since you enrolled in it present/past)?2. What is your hope for Malaysia on Ministry of Health’s Vision to become “A Nation working together for Better Health”?3. Personal view on 1Malaysia Clinic? 64
  65. 65. 1. What is your comment on current Malaysian Health Education (since you enrolled in it present/past)?• Different approaches & syllabus being implemented/practiced from one universities to another (public universities)• Example: UMS – focus more on epidemiology (full with statistics, research founding – for most students: a waste of time since they can‟t really apply them to cure people once graduated)• For Medical Doctor (MD): only those graduated from Universiti Malaya & Universiti Kebangsaan Malaysia can work in Singapore.• Different Learning/Class Schedule: UM (3-4 hours only per day), UMS (8.30AM – 5PM)• Enhancing one very critical courses beside MD; nursing. WHY? In 3 years: not in depth-but- on-surfaces type of learning (on which skills & knowledge must be mastered) Based on life-experiences comment of a patient: “how am i supposed to trust them to make an intravenous line?” 65
  66. 66. 2. What is your hope for Malaysia on Ministry of Health’s Vision to become “A Nation working together for Better Health”?• “…I hope that vision can be realized.. Not simply being a vision for a documentation-sake. For instance, in Kota Kinabalu, majority doesn‟t go to hospitals/clinic due to none/lack of basic health education and awareness. So in realizing that vision, education of the people must comes first”.• “totally second this vision and hoping all good citizens of Malaysia could work hand-in-hand in „upgrading‟ our health status as a whole just like the motto: „Rakyat Sihat, Negara Maju’. It‟s not just on the shoulder of doctors and nurses in taking care of health matters, but it includes all of us, you, me and every single human being on planet Earth…keyword for today: COOPERATION!”• “…I‟m looking forward for this vision to be a reality, but our government and NGOs should work together in synergy by approaching local community especially in rural areas: promoting health education and awareness campaign via community engagement programme – focusing and empowering grass root level…”• “…for me, Malaysian must have good insight on diseases that they are dealing with, it will help us to treat such diseases at early stage. Don‟t come to us at the 11th hour….and should practice healthy living lifestyle as prevention is always better than cure..” 66
  67. 67. 3. Personal view on 1Malaysia Clinic?• “….well, more or less like an emergency department hospital, exceptionally they can operate without doctors, just with presence of Medical Officers/Medical Assistants and few nurse.. Personally, it‟s better to abolish this concept, what our government should do is to build/set up more hospitals, since number of graduated in MD keep on increasing year after year not to mention other fields such as nursing, pharmacy and etc…”• “indeed, very useful for those in rural areas…about time for our MoH to be more inclusive rather than exclusive…but publicity and awareness of public are still lacking behind (low level) on 1Malaysia Clinic: thus, less support from public…”• “…Simply happy and grateful for this effort from our Government in taking care of it‟s people welfare; health. With RM2, regardless of what you are suffering with, I would recommend this for low income families to get their access on healthcare services at 1Malaysia Clinic rather than going to other health/private clinics…”• “…sorry to say: impractical clinics (such a political clinic)…only provide simple medicine that we (public) can get at the pharmacy such as paracetamol, benadryl…insufficient equipment on which Health Clinics are enough in providing such services. It is just a waste of government money to set up a lot of clinic and payment of the medical human resources but sadly, the QUALITY is not there…” 67
  68. 68. Recommendation in managing Health Issues in Malaysia: Advocacy• Advocacy is a combination of individual and social actions designed to gain political and community support for a Ministry of Health particular health issue or objectives Malaysia• These actions can be taken by, or on behalf of, individuals and groups to create living environments which promote health and healthy lifestyles• There are four main principles of advocacy: – Be focused and relevant; – Work in partnership; NCD Heads of State Summit 2011 (New York, 19 September 2011) – Be credible and appealing; and – Be tactical• Currently prevention and control of NCD is being strongly advocated at the global level – United Nations Special Summit on NCD in New 68 York (September 2011)
  69. 69. Advocacy (continued…)• Advocacy is a very important tool – As the broad determinants of NCD risk largely fall outside of the reach of the health sector Ministry of Health Malaysia• Strong advocacy is important to execute the “whole-of-government” approach effectively – Not only from the health sector – NGOs and professional bodies can play very strong advocacy roles.• Even within the health sector itself, strong advocacy for the prevention and control of NCD is important: – Due to “chronicity” of NCD – Different approach for chronic disease management 69
  70. 70. Strategies for health sector development ˃ Improving accessibility to affordable and quality health care ˃ Expanding the wellness programme ˃ Enhancing and promoting coordinating and collaboration between public-private sector provides health care ˃ Increasing the supply of various categories of health manpower ˃ Strengthening the health system to promote Malaysia involves in the regionsFuture Prospects» Enhancing research capacity and capability» Developing and instituting a health care financing scheme and» Strengthening the regulatory and enforcement functions to administer the health sector including traditional practitioners and medical products 70
  71. 71. » Being proactive, resilient and innovative, the Malaysian would forge ahead towards MoH‟s Vision for Health in the 21st century: That is, to be a nation of healthy individuals, families, and communities, through a health system that is equitable, affordable, efficient, technologic ally appropriate, and environmentally adaptable, with emphasis on quality, innovation, health promotion and respect for human dignity, and which promotes individual responsibility and community participation towards an enhanced quality of life (sustainable healthcare & healthy lifestyle) 71
  72. 72. » Regarding the case study of 1Malaysia Clinics, from personal point of view, the good intention of our government in ensuring welfare of her rakyat’s there.» Consecutively, based upon my reading and mini-sampling (with some critical view/input), it is safe to say that the following points should be taken into consideration:  Most people are not fully aware on the concept of 1Malaysia Clinics more promotion & community outreach to gain more support/trust from local community  Not sufficient equipment providing basic equipment that could support and ensuring quality aspect of healthcare provided  Only manned by MA & Nurses with at least 5 years working experiences some review should be made on its fundamental concept: as to eliminate fears/social stigma on the importance of the presence of a doctor 72
  73. 73. “Theres only one corner of the universe youcan be certain of improving, and thats yourown self. So you have to begin there, notoutside, not on other people. That comesafterward, when youve worked on your owncorner.” by Aldous Huxley, Time Must Have a Stop Reference: 73
  74. 74. Paper Presentation at the International Conference on Health Behavioral Sciences, Faculty of Law, 2010:» Burden of Disease and Policy on Health in Malaysia. (Dr. Feisul Idzwan Mustapha)» Glocalisational Bridging Human Security, Well-Being and Environmental Health. (Prof. Habib Chirzin)» Realizing Sustainable Health Promotion in the Context of Global Public Health and Future Challenges. (Professor Dr. Darryl Macer)» Malaysian Society and Health: Issues and Challenges in 21st Century. (Professor Dr. Mohd Amin Jalaluddin)» Toward Sustainable Health Promotion in the Glocal Context of Health Care: Through Dialogue between Life and Environment. (Professor Fumiaki Taniguchi)» Dialogue between Religion & Science Regarding Bioethics for Well-Human Being & Human Security at the Glocal Level. (Professor Datin Dr. Azizan Baharuddin).Interviewees:» Dr. Hadita Sapari,» Mr. Afif Ahmad,» Mr. Saifuddin Mohd Yassin,» Mr. Mohamad Fazlin Mohamad Idros &» Mr. Megat Aliff Megat ZainuddinArticle:» Integrating ethics, health policy and health systems in low-and middle-income countries: case studies from Malaysia and Pakistan by Adnan A Hyder, Maria Merritt, Joseph Ali, Nhan T Tran, Kulanthayan Subramaniam & Tasleem Akhtar (Published in 2008 in Bulletin of World Health)Others:» Sirajoon Noor Ghani & Hematram Yadav. (2008). Health Care in Malaysia. UM Press: Kuala Lumpur» Health Facts 2008 – 2010, Ministry of Health Malaysia» The Official Site of Malaysia Healthcare Travel & Medical Tourism:» Department of Occupational Safety and Health:» Institute of Medical Research:» Medical Device Control Division - Ministry of Health Malaysia»» Ministry of Health Malaysia:»»» 74