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Malaysian healthcare-system

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THE MALAYSIAN
 HEALTH CARE
   SYSTEM
      Dr Mahani Binti Ahmad Hamidy
     Senior Principal Assistant Director
 Planning...

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MALAYSIA

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80

75                                           76.46

70                                                   Male
        ...

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Malaysian healthcare-system

  1. 1. THE MALAYSIAN HEALTH CARE SYSTEM Dr Mahani Binti Ahmad Hamidy Senior Principal Assistant Director Planning and Development Division, MOH
  2. 2. MALAYSIA
  3. 3. 80 75 76.46 70 Male 71.7 65 Female 60 55 50 1957 1970 1980 1990 1995 2003 Year
  4. 4. BURDEN OF DISEASE STUDY (mortality & morbidity)   The principle cause of death in Malaysia for both males and females in 2000 were : •  ischaemic health disease and •  cerebrovascular disease.   Top 5 burden of diseases (taking into consideration mortality and morbidity) in Malaysia are: •  IHD, •  Mental Illness, •  Cerebrovascular disease / stoke and road traffic accidence, cancers, •  asthma and chronic obstructive pulmonary diseases, •  diabetes mellitus Source : Burden of Disease Study
  5. 5. MALAYSIAN HEALTH CARE SYSTEM PUBLIC SECTOR PRIVATE SECTOR& NGO FEDERAL GOVERNMENT STATE-LOCAL GOVERNMENT PRIVATE HEALTH CARE ENVIRONMENTAL SANIT. FACILITIES PUBLIC HEALTH / MEDICINE HOUSING STANDARDS DISEASE CONTROL IMPLEMENTATION LAW ENFORCEMENT LAW ENFORCEMENT PUBLIC HEALTH/ PREVENTION DISTRICT HEALTH OFFICE PRIVATE HOSPITAL HOSPITALS WITH SPECIALIST PRIVATE MEDICAL PRACTITIONER CLINICS HOSPITALS HOSPITALS WITHOUT SPECIALIST ESTATE & MINES HEALTH CLINICS HOSPITALS CLINICS RURAL CLINICS MINISTRY OF HEALTH CLINICS IN FACTORIES SPECIAL INSTITUTIONS LEPROSY/ PSYCHIATRY/ & INDUSTRIES TUBERCULOSIS OTHERS MATERNAL/ CHILD HEALTH RURAL/ MIDWIFE CLINICS ARMED FORCES NURSE/ PARAMEDIC TRAINING CENTRES EDUCATION NURSING HOMES ENFORCEMENT/SUPERVISION DEPT. OF ABORIGINES PHARMACEUTICALMS •  DENTAL PRACTITIONERS LICENSING PRIVATE HOSPITALS •  PHARMACISTS •  LABORATORIES MILITARY HOSPITALS •  X-RAY SURGERIES MIN. OF HOME AFFAIRS SPECIAL INSTITUTIONS •  NURSING HOMES ABORIGINE HOSPITAL •  MEDICAL SCHOOLS DRUG ADDICT REHAB. CENTRE • TRADITIONA/ALTERNATIVE MEDICINE PRACTITIONERS UNI. EDUCATION / MIN. OF EDUCATION UNIVERSITY HOSPITALS MEDICAL SCHOOLS
  6. 6. ORGANISATION OF THE MINISTRY OF HEALTH (CENTRALISED SYSTEM) MINISTER OF HEALTH DEPUTY MINISTER OF HEALTH SECRETARY -GENERAL DIRECTOR-GENERAL PUBLIC OF HEALTH RELATIONS OFFICER LEGAL ADVISOR DEP. D-G OF DEP. D-G OF HEALTH DEP. D-G OF HEALTH DIRECTOR HEALTH (RESEARCH & DIRECTOR (MEDICAL) (DENTAL) (PUBLIC HEALTH) TECHNICAL (PHARMACY) INTERNAL AUDITOR SUPPORT) * Medical Development * Disease Control * Planning & Development D POLICY & •  Medical Practice * Dental Services * Engineering Services •  Telehealth * Family Health * TCM INTERNATIONAL •  Nursing Development * Research / NIH (7 Institutes) AFFAIRS * Food Quality Control * Health Education DEP. SEC-GENERAL DEP. SEC-GENERAL (MANAGEMENT) (FINANCE) * Information Technology Centre * Finance 13 State Health Directors * Human Resource * Procurement and Privatization * Manpower Planning & Training * Accounts •  Management •  Competency
  7. 7. ORGANISATION AT STATE HEALTH DEPARTMENT STATE HEALTH DIRECTOR DEPUTY STATE DEPUTY STATE DEPUTY STATE DEPUTY STATE DEPUTY STATE HEALTH HEALTH HEALTH HEALTH HEALTH DIRECTOR DIRECTOR DIRECTOR DIRECTOR DIRECTOR (PUBLIC (MEDICAL) (DENTAL) (PHARMACY) (MANAGEMENT) HEALTH)
  8. 8. FLOW OF RESOURCES (CENTRALISED SYSTEM) FEDERAL Allocation of resources (money, man, material) STATES
  9. 9. Reference
  10. 10. PROGRAMMES AND ACTIVITIES (9 & 10MP) PUBLIC HEALTH PROGRAMME MEDICAL PROGRAMME •  DISEASE CONTROL ACTIVITY •  MEDICAL CARE ACTIVITY •  FAMILY HEALTH DEVELOPMENT •  EXTENDED MEDICAL CARE ACTIVITY ACTIVITY •  MEDICAL LEGISLATION AND •  HEALTH EDUCATION ACTIVITY REGULATIONS ACTIVITY •  FOOD SAFETY & QUALITY •  MEDICAL CARE QUALITY ACTIVITY ACTIVITY RESEARCH AND TECHNICAL SUPPORT MANAGEMENT PROGRAMME PROGRAMME •  HQ/STATE MANAGEMENT ACTIVITY •  RESEARCH ACTIVITY •  HUMAN RESOURCE ACTIVITY •  PLANNING AND DEVELOPMENT ACTIVITY •  FINANCE ACTIVITY •  HEALTH ENGINEERING ACTIVITY •  MANPOWER PLANNING & TRAINING •  TRADITIONAL & COMPLEMENTARY ACTIVITY MEDICINE ACTIVITY* •  INFORMATION TECHNOLOCY ACTIVITY DENTAL PROGRAMME PHARMACY PROGRAMME •  DENTAL POLICY AND DEVELOPMENT •  PHARMACY ENFORCEMENT •  DENTAL PRACTICES, CONTROL •  PHARMACY PRACTICES & DEVELOPMENT AND PROMOTION •  NATIONAL PHARMACEUTICAL BIRO
  11. 11. Management Programme   Plan, formulate, implement, monitor and evaluate policies related to : •  human resource planning and training and competencies of HR •  ICT /technologies & communication system •  Financing and audit •  Logistic needs •  Privatization effort
  12. 12. Public Health Programme   Plan, formulate, implement, monitor and evaluate policies related to : •  Disease control •  Food quality and safety •  Family Health Development •  Health Promotion and education •  Technical input on public health roles and functions •  Formulation and enforcement of Acts pertaining to public health •  Resource planning and distribution – Health Services
  13. 13. Medical Programme   Plan, formulate, implement, monitor and evaluate policies related to : •  Medical activity and treatment •  HTA •  Medical practices and quality of medical services •  HR development •  Accreditation and Credentialling •  Telehealth and teleconsultation •  Resource Planning and Distribution – Medical Services
  14. 14. Research and Technical Support Programme •  Health System Research •  Health and Facility Planning, Implementation, Monitoring and Evaluation •  Traditional and Complementary Medicine •  Engineering Services
  15. 15. DENTAL PROGRAMME   Formulate policies, guidelines & standards for public and private sectors   Registration, licensing and enforcement   Formulation of Acts related to Dentistry   Resource planning and distribution
  16. 16. PHARMACY PROGRAMME   Formulate policies, guidelines & standards for public and private sectors   Registration, lisencing and enforcement of pharmaceutical products •  Monitor & analyses •  Ensure effectiveness, quality and safety of products (local and imported)   Formulation of Acts related to Pharmaceutical Products   Resource planning and distribution
  17. 17. TENTH MALAYSIA HEALTH PLAN HEALTH SECTOR STRATEGIC DIRECTION 1CARE FOR 1MALAYSIA
  18. 18. Formulation of Health Plan •  Health plan is an integral part of national development Malaysia Development Plans Outline Perspectives Plan OPPI (1971 -1990) OPP2 (1991-2000) OPP3 (2001 - 2010) Five Year Malaysia Plan First Malaya Plan (1956-1960) Second Malaya Plan (1961 - 1965) First Malaysia Plan (1966- 1970)... Eighth Malaysia Plan (2001 - 2005) Ninth Malaysia Plan (2006 - 2010) Tenth Malaysia Plan (2011 – 2015)
  19. 19. The Outline Perspective Plan - Long Term Strategic Plan OPP-1 OPP-2 New Economic Policy National Development Policy (1971-1990) (1991-2000)   alleviating poverty   restructuring of   eliminating economic imbalances community   private sector as engine of growth   eradication of poverty OPP3- National Vision Policy   fostering unity & eradicating poverty   sustaining high economic growth & enhancing competitiveness   developing a knowledge-based economy   strengthening human resource development   pursuing environmentally sustainable development
  20. 20. VISION 2020 States that "by the year 2020, Malaysia is to be a united nation with a confident Malaysian Society infused by strong moral and ethical values, living in a society that is democratic, liberal and tolerant, caring, economically just and equitable, progressive and prosperous, and in full possession of an economy that is competitive, dynamic, robust and resilient". 23
  21. 21. NATIONAL MISSION THRUSTS (Introduced during 9MP)   THRUST 1 :To move the economy up the value chain   THRUST 2 :To raise the capacity for knowledge and innovation and nurture ‘first class mentality’   THRUST 3 : To address persistent socio-economic inequalities constructively and productively   THRUST 4 : To improve the standard and sustainability of quality of life   THRUST 5 :To strengthen the institutional and implementation capacity 24
  22. 22. INTRODUCTION MONITORING IMPLEMENTATION & CONTROL PLAN EVALUATION FORMULATION 10MP : 5 YEAR PLAN (2011-2015) HEALTH PRIORITISATION SITUATIONAL ANALYSIS PROBLEM/ NEEDS IDENTIFICATION 25
  23. 23. Background MTR 9MP Outcome Based Assessment Approach 7 Sept 2009 10MP : 1ST GUIDELINE – 10MP Strategic Directions 5 Dec 2009 10MP : 2nd GUIDELINE – Preparation of Programmes & Projects 26
  24. 24. CHALLENGE In order to achieve Vision 2020, Malaysia needs to become a country of high income economy. To achieve the lowest limit for a high income nation, Malaysia has to make at least 5.5% yearly growth 27
  25. 25. 28
  26. 26. FOCUS OF 10MP HIGH INCOME ADVANCED ECONOMY 29
  27. 27. 10MP 6 STRATEGIC DIRECTIONS (HALATUJU STRATEGIK – HS) HS 1 Competitive HS2 Private Sector as Productivity & Engine of Growth Innovation HS 6 Government Through K-Economy As an Effective Facilitator HIGH INCOME ADVANCED ECONOMY HS3 Creative & Innovative HS5 Human Capital Quality Of Life With 21st Century Of An Advanced Skill HS4 Nation Inclusiveness In Bridging Development Gap 30
  28. 28. KRAs for HS5 : Quality of Life of An Advanced Nation KRA2 KRA1 Ensure Access Enhance HIGH INCOME To Quality Public ADVANCED Healthcare & Safety & Promote ECONOMY Security Healthy Lifestyle HS5. Quality KRA3 Of Life Commit to the Of An Intensify Delivery of Preservation & Advanced Efficient Acculturate Public Nation Appreciation Transport Of Culture & Heritage KRA6 Mainstream Sustainable Nurture civil KRA4 Development Society KRA5 31
  29. 29. FOCUS OF 10MP HIGH INCOME HS 1 ADVANCED HS 6 ECONOMY HS 2 KRA 6 KRA 5 HS 3 HS 5 HS 4 Quality of life KRA 4 of an advanced nation KRA 3 KRA 1 KRA 2 Ensure Access to Quality Healthcare & Promote Healthy 32 Lifestyle
  30. 30. 10MP STRATEGIES FOR KRA 2 : Ensure Access to Quality Healthcare & Promote Healthy Lifestyle HS5 Quality HIGH INCOME Of Life ADVANCED Of An ECONOMY Advanced Nation KRA 2 Ensure Access To Quality Healthcare & Promote Healthy Lifestyle OUTCOME (Ensure provision of and Increase accessibility to Quality health care and Public recreational and Sports facilities to support Active healthy lifestyle) STRATEGY 1 STRATEGY 2 STRATEGY 3 STRATEGY 4 Establish a Transform the Encourage Empower the community to plan comprehensive health sector to health awareness or conduct individual wellness healthcare system increase the efficiency & healthy lifestyle programme (responsible for own & recreational & effectiveness of the activities health) infrastructure delivery system 33
  31. 31. 10MP STRATEGIES FOR KRA 2 : Ensure Access to Quality Healthcare & Promote Healthy Lifestyle STRATEGY 1   Establish a comprehensive healthcare system & recreational infrastructure STRATEGY 2   Encourage health awareness & healthy lifestyle activities 34
  32. 32. 10MP STRATEGIES FOR KRA 2 : Ensure Access to Quality Healthcare & Promote Healthy Lifestyle STRATEGY 3 o  Empower the community to plan or conduct individual wellness programme (responsible for own health) STRATEGY 4   Transform the health sector to increase the efficiency & effectiveness of the delivery system 35
  33. 33. SUMMARY Transformation Agenda VISION 2020 NATIONAL MISSION THRUST 2006-2020 THRUST 1 THRUST 2 THRUST 3 THRUST 4 THRUST 5 To move the To raise the capacity To address persistent socio-economic To improve the To strengthen the economy up the for knowledge & innovation & inequalities standard & sustainability institutional & value chain nurture ‘first class mentality’ constructively & of quality of life implementation capacity productively Quality of Life of An 10MPSTRATEGIC DIRECTION 5 (HS5) Advanced Nation Ensure access to quality 10MP KRA 2 FOR HS5 Healthcare & promote Healthy lifestyle 10MP OUTCOME FOR HS5 Ensure provision of & Increase accessibility to Quality health care & Public Recreational & Sports facilities to support Active healthy lifestyle 10MP STRATEGIES FOR HS5 Strategy 4 Strategy 1 Strategy 2 Strategy 3 -- Health Sector 36 -- comprehensive -- health awareness & -- Empowering the Community Transformation 36 healthcare & recreation Healthy lifestyle towards self care (Universal Access)
  34. 34. 10MP STRATEGY & HEALTH SECTOR KEY RESULT AREAS 10MP STRATEGY HEALTH SECTOR KRAs Strategy 1 Establish a comprehensive KRA 1 Health Sector Transformation healthcare system & recreational Towards A More Efficient & infrastructure Effective Health System in Ensuring Universal Access to Healthcare Strategy 4 Transform the health sector to increase the efficiency & effectiveness of the delivery system Strategy 2 Encourage health awareness & KRA 2 Health Awareness & healthy lifestyle activities Healthy Lifestyle Strategy 3 Empower the community to plan or KRA 3 Empowerment of Individual and conduct individual wellness Community to be responsible for programme (responsible for own their health health) 37
  35. 35. HEALTH SECTOR KRAs 1.  Health Sector Transformation Towards A More Efficient & Effective Health System in Ensuring Universal Access to Healthcare 2.  Health Awareness & Healthy Lifestyle 3.  Empowerment of Individual and Community to be responsible for their health 38
  36. 36. Outcome, Strategy and KPIs for Health Sector KRA 1 HEALTH SECTOR OUTCOME STRATEGY HEALTH SECTOR KRA OUTCOME KPI I. Health Sector 1. DELIVERY 1. Streamline / realign healthcare delivery system 1. Integrated PHC plan by 2011 Transformation 1.1 Integrated public - (keywords: PHC as thrust, gatekeeping, zoning, referral 2. Integrated secondary care plan by 2013 Towards A More private health services system, preventive/ promotive, resource sharing, Efficient & Effective delivery resource mobilization, appropriate technologies, Health System In registered population, registered providers) Ensuring Universal 1.2 Universal Access All population will get access to the basic Access To Equity of access – physical 2.Unified healthcare financing system PHC services by (2014) Healthcare ease of access (keywords: Safety net, financial risk protection, case 1. All PHC providers will be registered by mix, benefit packages, provider-payment mechanism, 2011 social health insurance, co-payment, increase 2. All population will be registered to a government contribution, equity in resource allocation, Primary Health Care Physician starting equity in distribution of facilities, enforcement of PHFSA 2011 1.3 High quality and safe 1998, cost structure information) 1. Decrease mortality & morbidity of care selected conditions 3.Common quality and standard of care (keywords: Accreditation, credentialing, CPD, HTA, 2. FINANCE practice guidelines, clinical governance, care, uniform 1. Reduce Out Of Pocket ( OOP ) 2.1Universal access standard of care, standardised regulations, laws and Equity of access - financial enforcement) 2.2 Cost containment 2. Reduce medical inflation rate 4.Adequate and competent workforce (keywords: number, mix, competency, performance reward/ incentive , quality, distribution ) 3. GOVERNANCE 1. Increase GDP in health 3.1 Sustainability of 5.Strengthening healthcare legislation and healthcare delivery enforcement system (keywords: review, revise act & regulation, codes of ethic & conducts, capacity ) 3.2 Compliance to defined 2. % of accredited facilities quality and standard 6. Strengthening implementation, monitoring and evaluation system 3.3 Responsiveness to 3. Waiting time for selected procedures (keywords: competency in stewardship, real time, data population needs & information, research, evidence, informed decision, capacity) 7.ICT as enabler (keywords: prerequisites for integrated unified system ) 39
  37. 37. Outcome, Strategy and KPIs for Health Sector KRA 2 & 3 HEALTH SECTOR OUTCOME STRATEGY HEALTH SECTOR KRA OUTCOME KPI II. Health 1.Malaysians will 1. Increase access to health knowledge 1. % health literacy Awareness & be health literate (keywords: innovative, incentive, 2. Increase in the Healthy Lifestyle 2.Malaysian empowerment, information sharing) percentage of physical practise healthy 2. Motivate individuals, family and activity of Malaysian adult lifestyle community to acquire knowledge and skill 3. Reduce the prevalence (keywords: innovative, incentive) of overweight and obesity 3. Increase opportunities to practice among adult healthy lifestyle at workplace, schools, 4. Reduce the prevalence home etc. among adolescent 4. Formulate and enforce public policy smokers towards healthy lifestyle III. Empowerment Individuals, family 1. Strategies to increase health literacy % of individuals able to Of Individual And and community to 2. Provision of health information, including make decision on their Community To Be have adequate cost of care and governance policies own health Responsible For knowledge and 2. Providing avenues for effective Their Health skills to make complaints or enquiries regarding health decision about providers their health 4. Mobilize civil society ( selfcare, choice of (NGOs, support groups, community treatment / leaders) provider) 40
  38. 38. DEVELOPMENT BUDGET 9MP BUDGET  230 B 10MP BUDGET 165 B Development Expenditure  15 B PFI Facilitation Fund TOTAL  50 B PFI 230 B Ceiling for 2011-2012 (2 year rolling plan) (RM 75 B for the whole country) NKRA projects – 21B Continued 9MP Projects – 40B New projects & Private Facilitation Fund – 14B 41
  39. 39. 42

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