KUDOS TO MALAYSIA'S HEALTH CARE SYSTEM

By Melati Mohd Ariff

KUALA LUMPUR, May 24 (Bernama) -- Dr John Tomaro, Programme Director, Health
of the Aga Khan Foundation (AKF), an agency of the Aga Khan Development Network
(AKDN) is no newcomer to Malaysia.

He was here in 2006 with some officers from the Ministry of Health of
Tajikistan to learn about Malaysia's health care system.

Last April, Dr Tomaro led a joint technical mission from the Syrian Ministry
of Health. The goal was to study the Malaysian Family Medicine Programme and to
review the components of Malaysia's district health system and its models of
health care delivery.

They collected information that could improve health service delivery
programmes in other countries, particularly in the Middle East and Central Asia.

FULL OF PRAISE

In an interview with Bernama at the end of the four-day visit, Dr Tomaro was
full of praise for Malaysia's health care system.

"We came to this country because, like Syria, Malaysia is a middle income
country. Also, Malaysia has done an excellent job of providing access to health
care for its population.

"This access, from our observations and the briefings given to us, extends
to all levels, from the community up to university hospitals," Dr Tomaro said.

He earlier explained that the Syrian delegation has a keen interest in
knowing more about the family medicine programme in Malaysia and the functioning
of the district health system because it wants to strengthen these elements of
the Syrian health system.

According to Dr Tomaro, most of the countries in which AKDN works are in
the low to lower income bracket, including countries such as India, Pakistan,
Tajikistan and Afghanistan.

"From AKDN's perspective, showing the Syrians what is taking place in other
countries in which we work would not be as valuable as exposing them to the
health system and practices in Malaysia.

"Given Malaysia's good system and practices, AKDN is interested in seeing if
we can facilitate some form of cooperation and collaboration between the
Ministry of Health of Syria and the Ministry of Health of Malaysia.

"Malaysia's health care system, which is a remarkable example of well
organised delivery of care, has several elements that are worthy of adoption by
other countries," said Dr Tomaro.

Based in AKF's headquarters in Geneva, Switzerland, Dr Tomaro and his AKDN
colleagues are working closely with the Syrian Ministry of Health to develop the
Syrian health care system, especially in the Salamieh District of the Hama
Governorate.

DEEP COMMITMENT

According to Dr Tomaro, the visits to health clinics in Sabak Bernam and
Hulu Langat were among the highlights of the visit. He described what he saw as
'very remarkable'.

"We started at the lowest health clinic level, which is in Sabak Bernam, and
had an opportunity to see what the Ministry of Health and the Government of
Malaysia are providing to Malaysian citizens.

"We made several observations in the written remarks we left at each clinic.
The most important one is that health care in Malaysia is very comprehensive.
The system is seamless in terms of enabling the population to access care at any
point.

"The public system has everything from basic maternal and child health care
to outpatient curative care to a wide range of services for special conditions.
The system offers physical rehabilitation programmes, mental health services and
programmes to treat infectious diseases," explained Dr Tomaro.

He also pointed out that the services provided at the health clinics were
organised and delivered according to well-defined guidelines and protocols.

"In the Malaysian health system both staff and patients follow the
treatment guidelines. Patients are counselled and staff complete the data forms
which go to a central location. The data are analysed and the results are fed
back to the clinic location and used to improve the delivery of information and
care," observed Dr Tomaro.

He also commented that clinic staffs appeared to be very dedicated and well
informed on the ministry's policies and procedures.

"A community health nurse, a facility nurse or a Family Medicine specialist
can describe how the services are organised and summarise the responsibilities
of the health professional and the client. Everyone is well briefed.

"The only patient complaint that we heard when we looked at the quality
assurance assessments was about waiting time. Clients were not happy about long
waits for service in public health clinics. Still, no concerns were voiced about
the quality of care or the skills of ministry staff. Communication between the
staff and the clients was assessed as very good.

"Clients reported that they felt as though they were respected and that
staffs were well informed and communicated clearly. All of these are important
indicators of a well functioning health system," he added.

IN COMPARISON

One service that was highly lauded by Dr Tomaro was the antenatal, delivery
and postpartum care offered to mothers and their infants.

He described it as a very good, well developed system and well ahead of
those in some countries where AKDN is working.

"A woman who attends antenatal care in Malaysia receives a mother's card or
booklet that allows the system to follow her during her pregnancy, delivery and
in the postpartum period.

"The mother is followed closely throughout her pregnancy, given a choice of
where she wants to deliver and attends a well defined series of postpartum
visits.

"When a mother comes into the clinic with her baby, both are treated at the
same time. The maternal and child services comprise a remarkable programme,"
said Dr Tomaro.

According to him, postpartum care for mothers is often overlooked in other
health systems. In some systems, mothers are only seen when they return to the
clinic to seek care for a sick infant. Postpartum care is not routinely
delivered.

Dr Tomaro was also surprised to see so many men in the maternal and child
health clinics. He described the presence of fathers in these clinics as
"encouraging," at least in his experience.

He was impressed also with what he called the maternity waiting house, a
facility present in East Malaysia where communities are some distance from a
health clinic that performs deliveries. The presence of these waiting homes
ensures that women have access to appropriate care when they need to deliver.

His only disappointment was that there was no available data on how the
presence of the maternity waiting homes had contributed to reductions in
maternal mortality.

"I was told that the maternity waiting home has a major effect on
reducing the maternal mortality ratio because it brought appropriate care closer
to the community.

"The ministry has yet to study and document this important intervention.
Documenting this experience is an important step in convincing other countries
to apply a model that Malaysia has introduced."

Dr Tomaro noted that AKDN has introduced the maternity waiting home in
Afghanistan and hopes to achieve the same good results that have been attained
in Malaysia.

WOMEN AND CHILDREN

According to Dr Tomaro, the AKDN has a strong commitment to addressing the
health and developmental needs of mothers, infants and young children.

"Women and children are the most vulnerable in every society. Programmes
that address the critical needs of mothers and their young children result in
improvements in the overall health situation of the general population," he
stressed.

Dr Tomaro was impressed with the clinic facilities and services, and he was
also surprised by the large number of clients frequenting the facilities.
According to him, this widespread attendance contrasts with the low attendance
in public health clinics in many countries.

"In many countries, the public health facilities do not charge for care,
just as in Malaysia. However, it is often the case that staff are not present,
pharmaceuticals are not available, and services are almost non existent. In some
countries, public health clinics are just an empty piece of infrastructure," he
said.

PUBLIC AND PRIVATE HEALTH SERVICES

By using a very simple mathematical formula, Dr Tomaro estimated that the
Malaysian government spends about US$75 per person per year on health
services.

"How did we arrive at this figure? We divided the total health budget, which
I think is about RM27 billion, by the total population. Malaysia spends much
more than other countries that could invest more."

"This level of financial commitment indicates that the Malaysian government
is serious about the health of its population. That is in itself is a
significant indicator," he remarked.

Dr Tomaro also commented that clients who use public health facilities can
obtain all the care needed, including pharmaceuticals, for only RM1.

While commending the system,for providing such a wide variety of
services for a fee of only RM1 (30 cents), Dr Tomaro personally felt that such
practice cannot continue indefinitely in the face of dramatic increases in costs
for services, medical technology and equipment.

He also noted that some of the public university hospitals in Malaysia have
introduced private wards and services in which clients pay higher charges for
care.

He noted that his Syrian colleagues were interested in this approach and
wanted to determine whether this model could be introduced in Syria.

At a minimum, he suggested that the approach could ease the heavy burden
being shouldered by government hospitals.

"At the moment," he observed, "it appears that for every patient in a
private hospital in Malaysia, there may be 15 in public hospitals. This is an
enormous financial burden on the public health system."

Dr Tomaro noted that one challenge facing Malaysia and many other countries
is to find new ways to finance health care and to ensure that the private sector
plays a more active role in protecting the health of the population.

AKDN'S ACTIVITIES

AKDN operates a number of health programmes in large geographical areas in
Central and South Asia, as well as East Africa, and operates 325 health
facilities including nine hospitals.

These programmes have been developed and managed by the Aga Khan Health
Services and the Aga Khan University, both institutional members of the AKDN.

These institutions are viewed as operating one of the most comprehensive
private not-for-profit health care systems in the developing world.

The health institutions of the AKDN provide primary health care and curative
medical care in countries including Afghanistan, India, Kenya, Pakistan and
Tanzania.

In addition AKDN health institutions offer technical assistance to
government health systems in Syria, Tajikistan and other countries.
-- BERNAMA


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