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A Review of Primary Health Care in Malaysia A Report for the World Health Organization Western Pacific Region Dr Narimah Awin Director Division of Family Health Development Ministry of Health This report was commissioned by the World Health Organization, and is strictly confidential to the World Health Organization. The findings, interpretations and conclusions expressed in this report are those of the author and do not necessarily reflect the policy or views of the World Health Organization or the relevant Member State. While efforts have been made to ensure factual accuracy of the information contained herein, readers wishing to use this information are urged to contact the relevant Member State forthe latest official information or views on any particular aspect related to this report. This report should not be referenced or quoted. The designations employed and the presentation of the material in this report do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or ofits authorities, oF concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products or services does not imply thet they are endorsed or recommended by the Worid Health Organization in preference to others of a similar nature that are not mentioned. REVIEW OF PRIMARY HEALTH CARE IN MALAYSIA 1. EXECUTIVE SUMMARY| ‘An overtiding policy in Malaysia is that Primary Health Care (PHC) shall be the taruse and foundation of the total health system. Based on this clear policy, the health care system in ‘Malaysia continuously makes efforts to achieve equity in health and health care, encourages inter- sectoral collaboration and community participation, and provides a basic package of services that is to be delivered to all. The PHC is also linked to the other levels of care in the system, as well to the other PHC players in the country. There are many players, besides the Ministry of Health in the Malaysian PHC, both as formal providers (such as the fast expanding private care) and the {informal providers (such as the many types of traditional and complementary health systems). ‘The development of PHC in Malaysia has encompassed policy formulation, infrastructure and ‘manpower, sustainable financing, and a health management and information system development. In addition to this, the scope of the basic package of care has expanded to meet changing needs, priorities and capabilities, as exemplified by the newer activities for adolescent health, elderly health, community mental health, non-communicable disease control, food safety ancl workers" health. One of the mote recent major developments in PHIC in many countries including Malaysia is the need for health reforms, and how these will impact on PHC. The achievement of PHC can be measured by several effectiveness, health impact and efficiency measures. More recently, this has been added by quality measures as well. ‘There are, however, many challenges to the success of PHC and these include issues related to responding to changing consumers’ perceptions and expectations, the external environment such as environmental and socio-economic changes as well as population aging, the rapid pace of advancement in both medical and information-communication technologies, and globalization. Many of these challenges are also opportunities for 2 better health care fo the population, such as the optimal use of information technology as an enabler for better equity and quality of PHC. {As one of the main principles of PHC, community participation has been given due emphasis. ‘There are several examples of community development projects at PHC level, and two of these are described in detail in this report, one each in the states of Sabah and Sarawak, where difficult ‘access has made such community development projects very relevant and usefil Many lessons are learned from the experience of Malaysia in developing its PHC system, either from the successes or from the challenges. There is a clear rote of WHO and other international organizations in enhancing the further development of PHC in the country by providing resources and expertise, and by being the agent or “broker” for countries to avail of resources and expertise, as well as being the single most effective intemational body for all aspects of health. B. TABLE OF CONTENTS 1. Executive Summary Table of Contents, Introduction ReN Policies 4.1. Policy on the definition and concept of PHC 4.2. Health and health-related policies 4.3, Health planning Coordination and partnership . Governance, legislation and other enabling instruments 4.6. Health reforms and their implications on PHC 5. Development of PHC S.A. Background 5.2. Physical infrastructure 5.3, Scope and content of services 5.4. Human resource 5.5. Financing and budgeting system 5.6. Health management and information system 5.7. Streamlining PHC and improving integration / referral system 5.8. Improving quality 5.9. Optimizing medical and information technology 5.10. Hamessing traditional and complementary medicine 6. Challenges 6.1, The consumers of PHC 6.2. The external environment 6.3. Advances in medical and information-communication technologies 64, PHC and the wider world — globalization and the new world order 7. Health impact 7.1. Health service utilization 7.2. Impact and outcome on health status 7.3. Other impact 8. Community development approaches 8.1. The Village Health Promoter of Sarawak 8.2. The PHC Volunteer of Sabah 8.3. Other community participation approaches 9. WHO and other organizations 10, References and bibliography 11. Acknowledgement 12, Annexes . INTRODUCTION ‘When the historical conference was held at Alma Ata in 1978 to address the gross inequities in health for the populations of the world, the ambitious goal of “Health For All By The Year 2000” ‘was thought to be achievable by the Primary Health Care (PHC) approach. Unfortunately for ‘many peoples of the world today, this has not been achieved, and health for all has to be seen as a “timeless ideal”, or at best, 2s “health for all in the twenty-first century”. Twenty-three years after Alma Ata, 2 review of PHC in countries of the world, including Malaysia, will be beneficial, ‘This is especially so in the light of health care reforms that many countries, including Malaysia, will need to undergo, to ensure that such reforms not only promise continued sustainability of the PHC system, but also improve its quality. f. POLICIES, 4.1. Policy on the concepts and definitions of Primary Health Care (PHC) One of the major policy statements of the health system in Malaysia is that health care shall be driven by and based upon Primary Health Care. PHC then is the foundation upon which the total health care is built. ‘The terma “Primary Health Care (PHC)” is taken to mean the philosophy and approach’vehicle to achieve health for all as defined by the Alma Ata conference. Inherent in this bbroad definition are the principles of PHC as well as the concept of the basic package of service. Italso can refer to the simple meaning of a level of care, but generally for this connotation, the term “Primary Care” is used. Therefore, Malaysia accepts and implements PHC as defined at Alima Ata: Primary Health Care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cast that the community ‘and country can afford to maintain at every stage of their development in the spirit of self- reliance and self-deiermination. It forms an integral part both of the country’s health system, of which itis the central function and main focus, and of the overall social and economic development of the community This also the first level of contact of individuals, the family and community with the national health system, bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process 4.2. Health and health related policies ‘The WHO defines a health policy a5 “a set of decisions to pursue courses of action aimed at achieving defined goals for improving the health situation”. While there is no single “health policy” in Malaysia, the Ministry of Falth has enunciated several poliey statements, and foremost in these policies is “Primary Health Care shall be the foundation and engine of the country’s health care system”

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