Finals of Kant get Marx 2.0 : a general politics quiz
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
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
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
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
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
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
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
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
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?”
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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..”
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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…”
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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
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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)
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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
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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
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