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                     SFGS 6120
Introduction to Science, Technology & Sustainability
         Lecturer: Dr. Amran Muhammad
                      Mohd Fadhli Rahmat Fakri
                      SMB110010
                      Department of Science & Technology
                      Studies, Faculty of Science, University of Malaya
» 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
3
Definition of Key Terminology
1) Human:
 Human (known taxonomically as Homo sapiens, Latin for
  "wise man" or "knowing man") are the only living species
  in the Homo genus.
                           Reference: http://en.wikipedia.org/wiki/Human_Being


 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:(http://www.lubnaa.com/article.php?id=27)
                                                                                          4


                                                      Image taken from http://bahip.org
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 http://qurannet.tripod.com/086tariq.html


                                                                                                   5


Image taken from http:// 3dscience.com
2) Health
    “…The state of being free from illness
                         or injury. Reference:
               http://oxforddictionaries.com/definition/health

          “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:
                  http://www.islamreligion.com/articles/1891/
                                                                 6


Image taken from http:// 3dscience.com
Health




                                                                   Image taken from http://www.who.int/
 “…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.
“Everyone has the right to a standard of living
adequate for the health and well-being of
himself and of his family, including
food, clothing, housing and medical care and
necessary social services, and the right to
security in the event of
unemployment, sickness, disability, widowhood,
 old age or other lack of livelihood in
circumstances beyond his control.”

—Universal Declaration of Human Rights
(Article 25, paragraph 1)



                                                  8
Universal Declaration on Bioethics and Human
Rights
Article 14 – Social Responsibility and Health
a) The promotion of health and social development for their
people is a central purpose of governments, that all sectors of
society share.
b) Taking into account that the enjoyment of the highest standard of
health care is one of the fundamental rights of every human being
without distinction of race, religion, political belief, economic or social
condition, 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 health
is essential to life itself and must be considered as a social and human
good;
(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  9
the basis of any grounds; and
(v)     reduction of poverty and illiteracy.
„Healthy habits start from young. A recent
healthy survey indicates that 43% of
Malaysians are overweight or obese‟.
                                   (NST, June 8, 2010: 19)

„Malaysians take too much salt. Daily
consumption is higher than WHO
recommendation.‟
                             (Star, April 21, 2010: 6)

„Junk food maybe as addictive as heroin and
tobacco. Obesity researches found fatty and
sugary snacks trigger the same „pleasure
centre‟ in the brain that drive people into
drug addictions – making them binge on
unhealthy food.‟
                                    (NST, April 6, 2010: 4)

                                                              10
» Total Population: 28.3 million
  (2010)
» Life Expectancy at Birth (years)
   ˃Male : 71.7
   ˃Female : 76.5


                                     11
“…Healthcare challenges are a matter
of global concern involving every
country in the world, and countries in Asia
are no exception. For some countries, the
issues are about improving access to
basic health services and tackling
poverty-related problems such as
communicable diseases and infant
mortality. For others, it could be battling
rising chronic, lifestyle-linked
diseases and caring for an ageing
population…”


                                              12
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
» 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
TRANSFORMING HEALTHCARE TO
IMPROVE QUALITY AND PROVIDE
UNIVERSAL 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
 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
Source: Economic Transformation Programme Chapter 16: Healthcare   17
» 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
» 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
20
21
22
Communicable Diseases (CD)




                             23
Non-Communicable Diseases (NCD)




                                  24
25
» Demographic and health transition
    ˃ Impact on morbidity patterns
         Changes in the age composition of the populations
         Urbanization




                                                                       Images taken from: http://africa.upenn.edu
            – 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
» 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
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 NCD
Determinants        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
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 Health
Smoking                                     24.8%                     21.5%           0.0%
                                                                                                               Malaysia
                                                                                               NHMS II        NHMS III

Physically Inactive                         88.4%                     43.7%
                                                                                    In 2006, there is an estimated
Overweight
(BMI ≥25 & <30 kg/m2)
                                            16.6%                     29.1%         2.8 million Malaysians age 18
                                                                                    years and above are current
Obesity (BMI ≥30 kg/m2)                      4.4%                     14.0%         smokers, 5.5 million
Hypercholesterolaemia                                                               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
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 and
Prevalence 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
Top Ten Causes of DALYs for
Males in Malaysia, 2000
Rank               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
Top Ten Causes of DALYs for
Females in Malaysia, 2000
Rank             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
33
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
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
9th Malaysia Plan (2006-2010) and
10th 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
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 
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 level
the National level
 • Diabetes & Obesity selected as entry points
• Diabetes & Obesity selected as entry points, while tackling
 • Action Areas in line with WHO recommendations
hypertension, cardiovascular diseases and stroke as well        38
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
Policy recommendations relevant to NCD
prevention 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
Implementation of NSP-NCD: Perspective from
  the Causation Pathway for NCD       Treatment: MOH
                                                                                    & Health Sector


Disease Prevention: All other
                                                                                          Ministry of Health
related Stakeholders, with support
                                                                                              Malaysia
from 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
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
Compendium of Actors & Stakeholders


                                        Ministry of Health
                                            Malaysia


                                     Regulatory
                                        Bodies
                                      (in health
                                        system
                                     monitoring )


                                       Religious
                                        Leader
 Public &                            (integration
  NGOs:     International              of ethics)
  Local      Agencies &     Policy
Communi        Experts:     Makers
    ty       WHO & etc                            43
An Ecological Perspective: Levels of
Influence


                                   Ministry of Health
                                       Malaysia




                                             44
» 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
» 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
» 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
» 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
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
50
» 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
 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
ETHICS:
Knowledge of Society &
  Social Institutions

                         53
54
» 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
» Manned by Assistant Medical Officers




                                                                Image taken from: http://thestar.com.my
  (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
» 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: http://hybridrastamama.blogspot.com
States (Specific Location):                                    Numbers:
1    SARAWAK (Sibu, Kuching, Miri, Bintulu)                            4
2    PERLIS (Kangar)                                                   1
3    KEDAH (Sg. Petani, Kulim)                                         2
4    PENANG (Jelutong, Butterworth, Seberang Perai Selatan, Bayan      5
     Lepas, Bukit Mertajam)
5    PERAK (Teluk Intan, Perak Tengah, Taiping, Ipoh)                  4
6    SELANGOR (Petaling Jaya-2, Puchong, Shah Alam, Batu Caves)        5
7    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)                   3
10   JOHOR (Masai, Kulai, Johor Bahru-2, Kluang)                       5
11   PAHANG (Kuantan, Kg Pandan Jaya, Temerloh)                        3
12   TERENGGANU (Marang, Kuala Terengganu, Kemaman)                    3
                                                                               58
13   KELANTAN (Kota Baharu, Bachok, Pasir Mas)                         3
14   SABAH (Tawau, Penampang, Sandakan, Kota Kinabalu)                 4
» Other feature of 1Malaysia
  Health Services:
 Mobile 1Malaysia Clinic
“…been introduced to ensure another
25% of rural areas throughout Malaysia
which are out of range of 25kms from
the nearest medical & healthcare
centres to enjoy access to health
services…”
              Sources: http://www.1malaysia.com.my




                                                     59
» “If this concept can succeed, we will




                                                 Images taken from http://topnews.com.sg
  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
» “…this initiative fulfilling 2 of 6 thrusts in National
                                            Key Result Areas (NKRA):
Images taken from http://topnews.com.sg




                                                                     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
62
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
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
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
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
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
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 www.who.int/nmh/events/2011/ncd_summit
                                             New                           68

     York (September 2011)
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
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 regions
Future 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
» 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
» 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
“There's only one corner of the universe you
can be certain of improving, and that's your
own self. So you have to begin there, not
outside, not on other people. That comes
afterward, when you've worked on your own
corner.”

                  by Aldous Huxley, Time Must Have a Stop
               Reference: http://globalstewards.org/quotes.htm




                                                                 73
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 Zainuddin

Article:
»    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: www.myhealthcare.gov.my/
»    Department of Occupational Safety and Health: www.dosh.gov.my/
»    Institute of Medical Research: www.imr.gov.my/
»    Medical Device Control Division - Ministry of Health Malaysia
»    www.mdb.gov.my/
»    Ministry of Health Malaysia: http://www.moh.gov.my/
»    http://www.who.int/suggestions/faq/en/index.html
»    http://pmr.penerangan.gov.my
»    http://unmsia.com




                                                                                                                                                      74

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

  • 1. 1 SFGS 6120 Introduction 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. » 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
  • 3. 3
  • 4. Definition of Key Terminology 1) Human:  Human (known taxonomically as Homo sapiens, Latin for "wise man" or "knowing man") are the only living species in the Homo genus. Reference: http://en.wikipedia.org/wiki/Human_Being  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:(http://www.lubnaa.com/article.php?id=27) 4 Image taken from http://bahip.org
  • 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 http://qurannet.tripod.com/086tariq.html 5 Image taken from http:// 3dscience.com
  • 6. 2) Health  “…The state of being free from illness or injury. Reference: http://oxforddictionaries.com/definition/health  “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: http://www.islamreligion.com/articles/1891/ 6 Image taken from http:// 3dscience.com
  • 7. Health Image taken from http://www.who.int/  “…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. “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” —Universal Declaration of Human Rights (Article 25, paragraph 1) 8
  • 9. Universal Declaration on Bioethics and Human Rights Article 14 – Social Responsibility and Health a) The promotion of health and social development for their people is a central purpose of governments, that all sectors of society share. b) Taking into account that the enjoyment of the highest standard of health care is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition, 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 health is essential to life itself and must be considered as a social and human good; (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 9 the basis of any grounds; and (v) reduction of poverty and illiteracy.
  • 10. „Healthy habits start from young. A recent healthy survey indicates that 43% of Malaysians are overweight or obese‟. (NST, June 8, 2010: 19) „Malaysians take too much salt. Daily consumption is higher than WHO recommendation.‟ (Star, April 21, 2010: 6) „Junk food maybe as addictive as heroin and tobacco. Obesity researches found fatty and sugary snacks trigger the same „pleasure centre‟ in the brain that drive people into drug addictions – making them binge on unhealthy food.‟ (NST, April 6, 2010: 4) 10
  • 11. » Total Population: 28.3 million (2010) » Life Expectancy at Birth (years) ˃Male : 71.7 ˃Female : 76.5 11
  • 12. “…Healthcare challenges are a matter of global concern involving every country in the world, and countries in Asia are no exception. For some countries, the issues are about improving access to basic health services and tackling poverty-related problems such as communicable diseases and infant mortality. For others, it could be battling rising chronic, lifestyle-linked diseases and caring for an ageing population…” 12
  • 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. » 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. TRANSFORMING HEALTHCARE TO IMPROVE QUALITY AND PROVIDE UNIVERSAL 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.  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. Source: Economic Transformation Programme Chapter 16: Healthcare 17
  • 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. » 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
  • 20. 20
  • 21. 21
  • 22. 22
  • 25. 25
  • 26. » Demographic and health transition ˃ Impact on morbidity patterns  Changes in the age composition of the populations  Urbanization Images taken from: http://africa.upenn.edu – 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. » 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. 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 NCD Determinants 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. 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 Health Smoking 24.8% 21.5% 0.0% Malaysia NHMS II NHMS III Physically Inactive 88.4% 43.7% In 2006, there is an estimated Overweight (BMI ≥25 & <30 kg/m2) 16.6% 29.1% 2.8 million Malaysians age 18 years and above are current Obesity (BMI ≥30 kg/m2) 4.4% 14.0% smokers, 5.5 million Hypercholesterolaemia 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. 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 and Prevalence 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. Top Ten Causes of DALYs for Males in Malaysia, 2000 Rank 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. Top Ten Causes of DALYs for Females in Malaysia, 2000 Rank 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
  • 33. 33
  • 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. 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. 9th Malaysia Plan (2006-2010) and 10th 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. 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. 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 level the National level • Diabetes & Obesity selected as entry points • Diabetes & Obesity selected as entry points, while tackling • Action Areas in line with WHO recommendations hypertension, cardiovascular diseases and stroke as well 38
  • 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. Policy recommendations relevant to NCD prevention 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. Implementation of NSP-NCD: Perspective from the Causation Pathway for NCD Treatment: MOH & Health Sector Disease Prevention: All other Ministry of Health related Stakeholders, with support Malaysia from 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. 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. Compendium of Actors & Stakeholders Ministry of Health Malaysia Regulatory Bodies (in health system monitoring ) Religious Leader Public & (integration NGOs: International of ethics) Local Agencies & Policy Communi Experts: Makers ty WHO & etc 43
  • 44. An Ecological Perspective: Levels of Influence Ministry of Health Malaysia 44
  • 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. » 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. » 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. » 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. 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
  • 50. 50
  • 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.  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. ETHICS: Knowledge of Society & Social Institutions 53
  • 54. 54
  • 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. » Manned by Assistant Medical Officers Image taken from: http://thestar.com.my (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. » 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: http://hybridrastamama.blogspot.com
  • 58. States (Specific Location): Numbers: 1 SARAWAK (Sibu, Kuching, Miri, Bintulu) 4 2 PERLIS (Kangar) 1 3 KEDAH (Sg. Petani, Kulim) 2 4 PENANG (Jelutong, Butterworth, Seberang Perai Selatan, Bayan 5 Lepas, Bukit Mertajam) 5 PERAK (Teluk Intan, Perak Tengah, Taiping, Ipoh) 4 6 SELANGOR (Petaling Jaya-2, Puchong, Shah Alam, Batu Caves) 5 7 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) 3 10 JOHOR (Masai, Kulai, Johor Bahru-2, Kluang) 5 11 PAHANG (Kuantan, Kg Pandan Jaya, Temerloh) 3 12 TERENGGANU (Marang, Kuala Terengganu, Kemaman) 3 58 13 KELANTAN (Kota Baharu, Bachok, Pasir Mas) 3 14 SABAH (Tawau, Penampang, Sandakan, Kota Kinabalu) 4
  • 59. » Other feature of 1Malaysia Health Services:  Mobile 1Malaysia Clinic “…been introduced to ensure another 25% of rural areas throughout Malaysia which are out of range of 25kms from the nearest medical & healthcare centres to enjoy access to health services…” Sources: http://www.1malaysia.com.my 59
  • 60. » “If this concept can succeed, we will Images taken from http://topnews.com.sg 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. » “…this initiative fulfilling 2 of 6 thrusts in National Key Result Areas (NKRA): Images taken from http://topnews.com.sg 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
  • 62. 62
  • 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. 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. 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. 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. 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. 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 www.who.int/nmh/events/2011/ncd_summit New 68 York (September 2011)
  • 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. 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 regions Future 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. » 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. » 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. “There's only one corner of the universe you can be certain of improving, and that's your own self. So you have to begin there, not outside, not on other people. That comes afterward, when you've worked on your own corner.” by Aldous Huxley, Time Must Have a Stop Reference: http://globalstewards.org/quotes.htm 73
  • 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 Zainuddin Article: » 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: www.myhealthcare.gov.my/ » Department of Occupational Safety and Health: www.dosh.gov.my/ » Institute of Medical Research: www.imr.gov.my/ » Medical Device Control Division - Ministry of Health Malaysia » www.mdb.gov.my/ » Ministry of Health Malaysia: http://www.moh.gov.my/ » http://www.who.int/suggestions/faq/en/index.html » http://pmr.penerangan.gov.my » http://unmsia.com 74