Malaysian healthcare-system

THE MALAYSIAN HEALTH CARE

SYSTEM

Dr Mahani Binti Ahmad Hamidy Senior Principal Assistant Director

Planning and Development Division, MOH

MALAYSIA

50

55

60

65

70

75

80

1957 1970 1980 1990 1995 2003

Year

Male Female

76.46

71.7

BURDEN OF DISEASE STUDY (mortality & morbidity)

  The principle cause of death in Malaysia for both males and females in 2000 were : •  ischaemic health disease and •  cerebrovascular disease.

  Top 5 burden of diseases (taking into consideration mortality and morbidity) in Malaysia are: •  IHD, •  Mental Illness, •  Cerebrovascular disease / stoke and road traffic accidence,

cancers, •  asthma and chronic obstructive pulmonary diseases, •  diabetes mellitus

Source : Burden of Disease Study

HEALTH CLINICS

RURAL CLINICS

MILITARY HOSPITALS

PUBLIC SECTOR

MALAYSIAN HEALTH CARE SYSTEM

PUBLIC HEALTH/ PREVENTION

UNI. EDUCATION / MEDICAL SCHOOLS

DRUG ADDICT REHAB. CENTRE

ENFORCEMENT/SUPERVISION

NURSE/ PARAMEDIC EDUCATION

MATERNAL/ CHILD HEALTH

SPECIAL INSTITUTIONS

CLINICS

HOSPITALS

MINISTRY OF HEALTH

ARMED FORCES

DEPT. OF ABORIGINES

MIN. OF HOME AFFAIRS

MIN. OF EDUCATION UNIVERSITY HOSPITALS

ABORIGINE HOSPITAL

STATE-LOCAL GOVERNMENT

ENVIRONMENTAL SANIT. HOUSING STANDARDS IMPLEMENTATION LAW ENFORCEMENT

FEDERAL GOVERNMENT

PUBLIC HEALTH / MEDICINE DISEASE CONTROL LAW ENFORCEMENT

PRIVATE HOSPITALS

NURSING HOMES

TRAINING CENTRES

RURAL/ MIDWIFE CLINICS

PRIVATE SECTOR& NGO

PRIVATE HEALTH CARE FACILITIES

•  DENTAL PRACTITIONERS •  PHARMACISTS •  LABORATORIES •  X-RAY SURGERIES •  NURSING HOMES •  MEDICAL SCHOOLS

HOSPITALS WITHOUT SPECIALIST

HOSPITALS WITH SPECIALIST

DISTRICT HEALTH OFFICE

• TRADITIONA/ALTERNATIVE MEDICINE PRACTITIONERS

PRIVATE HOSPITAL

PRIVATE MEDICAL PRACTITIONER CLINICS

ESTATE & MINES HOSPITALS

CLINICS IN FACTORIES & INDUSTRIES

OTHERS

SPECIAL INSTITUTIONS

LICENSING

LEPROSY/ PSYCHIATRY/ TUBERCULOSIS

PHARMACEUTICALMS

MINISTER OF HEALTH

SECRETARY -GENERAL

LEGAL ADVISOR

INTERNAL AUDITOR

PUBLIC RELATIONS OFFICER

DEP. SEC-GENERAL (MANAGEMENT)

DEP. SEC-GENERAL (FINANCE)

* Information Technology Centre * Human Resource * Manpower Planning & Training •  Management •  Competency

* Medical Development •  Medical Practice •  Telehealth •  Nursing

DIRECTOR-GENERAL OF HEALTH

DEP. D-G OF HEALTH

(PUBLIC HEALTH)

DEP. D-G OF HEALTH (MEDICAL)

DEP. D-G OF HEALTH (RESEARCH &

TECHNICAL SUPPORT)

* Finance * Procurement and Privatization * Accounts

* Planning & Development D * Engineering Services * TCM * Research / NIH (7 Institutes)

* Disease Control * Dental Services * Family Health

Development * Food Quality Control * Health Education

13 State Health Directors

DEPUTY MINISTER OF

HEALTH

ORGANISATION OF THE MINISTRY OF HEALTH (CENTRALISED SYSTEM)

POLICY & INTERNATIONAL

AFFAIRS

DIRECTOR (DENTAL) DIRECTOR

(PHARMACY)

ORGANISATION AT STATE HEALTH DEPARTMENT

STATE HEALTH

DIRECTOR

DEPUTY STATE HEALTH

DIRECTOR (MEDICAL)

DEPUTY STATE HEALTH

DIRECTOR (DENTAL)

DEPUTY STATE HEALTH

DIRECTOR (PUBLIC HEALTH)

DEPUTY STATE HEALTH

DIRECTOR (PHARMACY)

DEPUTY STATE HEALTH

DIRECTOR (MANAGEMENT)

Allocation of resources (money, man, material)

FLOW OF RESOURCES (CENTRALISED SYSTEM)

STATES

FEDERAL

Reference

PROGRAMMES AND ACTIVITIES (9 & 10MP)

•  HQ/STATE MANAGEMENT ACTIVITY •  HUMAN RESOURCE ACTIVITY •  FINANCE ACTIVITY •  MANPOWER PLANNING & TRAINING ACTIVITY •  INFORMATION TECHNOLOCY ACTIVITY

•  DISEASE CONTROL ACTIVITY •  FAMILY HEALTH DEVELOPMENT ACTIVITY •  HEALTH EDUCATION ACTIVITY •  FOOD SAFETY & QUALITY ACTIVITY

•  MEDICAL CARE ACTIVITY •  EXTENDED MEDICAL CARE ACTIVITY •  MEDICAL LEGISLATION AND REGULATIONS ACTIVITY •  MEDICAL CARE QUALITY ACTIVITY

•  RESEARCH ACTIVITY •  PLANNING AND DEVELOPMENT ACTIVITY •  HEALTH ENGINEERING ACTIVITY •  TRADITIONAL & COMPLEMENTARY MEDICINE ACTIVITY*

PUBLIC HEALTH PROGRAMME

MANAGEMENT PROGRAMME

MEDICAL PROGRAMME

RESEARCH AND TECHNICAL SUPPORT PROGRAMME

PHARMACY PROGRAMME DENTAL PROGRAMME

•  DENTAL POLICY AND DEVELOPMENT •  DENTAL PRACTICES, CONTROL AND PROMOTION

•  PHARMACY ENFORCEMENT •  PHARMACY PRACTICES & DEVELOPMENT •  NATIONAL PHARMACEUTICAL BIRO

Management Programme

  Plan, formulate, implement, monitor and evaluate policies related to : • human resource planning and training and

competencies of HR •  ICT /technologies & communication system • Financing and audit • Logistic needs • Privatization effort

Public Health Programme

  Plan, formulate, implement, monitor and evaluate policies related to : • Disease control •  Food quality and safety •  Family Health Development • Health Promotion and education •  Technical input on public health roles and

functions •  Formulation and enforcement of Acts pertaining to

public health • Resource planning and distribution – Health

Services

Medical Programme

  Plan, formulate, implement, monitor and evaluate policies related to : • Medical activity and treatment • HTA • Medical practices and quality of medical services • HR development •  Accreditation and Credentialling •  Telehealth and teleconsultation • Resource Planning and Distribution – Medical

Services

Research and Technical Support Programme

• Health System Research • Health and Facility Planning, Implementation,

Monitoring and Evaluation • Traditional and Complementary Medicine • Engineering Services

DENTAL PROGRAMME

  Formulate policies, guidelines & standards for public and private sectors

  Registration, licensing and enforcement   Formulation of Acts related to Dentistry   Resource planning and distribution

PHARMACY PROGRAMME   Formulate policies, guidelines & standards

for public and private sectors   Registration, lisencing and enforcement of

pharmaceutical products • Monitor & analyses •  Ensure effectiveness, quality and safety of

products (local and imported)   Formulation of Acts related to

Pharmaceutical Products   Resource planning and distribution

TENTH MALAYSIA HEALTH PLAN HEALTH SECTOR STRATEGIC DIRECTION

1CARE FOR 1MALAYSIA

Formulation of Health Plan

Five Year Malaysia Plan First Malaya Plan (1956-1960) Second Malaya Plan (1961 - 1965) First Malaysia Plan (1966- 1970)... Eighth Malaysia Plan (2001 - 2005) Ninth Malaysia Plan (2006 - 2010) Tenth Malaysia Plan (2011 – 2015)

•  Health plan is an integral part of national development

Malaysia Development Plans

Outline Perspectives Plan OPPI (1971 -1990) OPP2 (1991-2000) OPP3 (2001 - 2010)

The Outline Perspective Plan - Long Term Strategic Plan

OPP-1 New Economic Policy

(1971-1990)   restructuring of

community   eradication of poverty

OPP-2 National Development Policy

(1991-2000)   alleviating poverty   eliminating economic imbalances   private sector as engine of growth

OPP3- National Vision Policy   fostering unity & eradicating poverty   sustaining high economic growth & enhancing

competitiveness   developing a knowledge-based economy   strengthening human resource development   pursuing environmentally sustainable

development

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VISION 2020

States that "by the year 2020, Malaysia is to be a united nation with a confident Malaysian Society infused by strong moral and ethical values, living in a society that is democratic, liberal and tolerant, caring, economically just and equitable, progressive and prosperous, and in full possession of an economy that is competitive, dynamic, robust and resilient".

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NATIONAL MISSION THRUSTS (Introduced during 9MP)   THRUST 1 :To move the economy up the value chain   THRUST 2 :To raise the capacity for knowledge and

innovation and nurture ‘first class mentality’

  THRUST 3 : To address persistent socio-economic inequalities constructively and productively

  THRUST 4 : To improve the standard and sustainability of quality of life

  THRUST 5 :To strengthen the institutional and implementation capacity

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INTRODUCTION

10MP : 5 YEAR PLAN (2011-2015)

MONITORING &

CONTROL

PLAN FORMULATION

IMPLEMENTATION

PRIORITISATION

PROBLEM/ NEEDS

IDENTIFICATION

HEALTH SITUATIONAL

ANALYSIS

EVALUATION

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Background

MTR 9MP Outcome Based Assessment Approach

7 Sept 2009 10MP : 1ST GUIDELINE – 10MP Strategic Directions

5 Dec 2009 10MP : 2nd GUIDELINE – Preparation of Programmes & Projects

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CHALLENGE

In order to achieve Vision 2020, Malaysia needs to become a country of high income economy.

To achieve the lowest limit for a high income nation, Malaysia has to make at least 5.5%

yearly growth

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HIGH INCOME ADVANCED ECONOMY

FOCUS OF 10MP

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10MP 6 STRATEGIC DIRECTIONS (HALATUJU STRATEGIK – HS)


HS 6 Government

As an Effective Facilitator

HS3 Creative & Innovative

Human Capital With 21st Century

Skill

HS5 Quality Of Life

Of An Advanced Nation

HS4 Inclusiveness

In Bridging Development

Gap

HS2 Productivity &

Innovation Through K-Economy

HS 1 Competitive

Private Sector as Engine of Growth

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KRAs for HS5 : Quality of Life of An Advanced Nation


HS5. Quality Of Life Of An

Advanced Nation

Intensify Preservation &

Acculturate Appreciation Of Culture &

Heritage

Nurture civil Society

Mainstream Sustainable

Development

Ensure Access To Quality

Healthcare & Promote Healthy

Lifestyle

Commit to the Delivery of

Efficient Public

Transport

Enhance Public

Safety & Security

KRA1 KRA2

KRA3

KRA4

KRA5

KRA6

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FOCUS OF 10MP

HS 1

HS 2

HS 3

HS 4 HS 5 Quality of life of an advanced nation

HS 6

KRA 6 KRA 5

KRA 4

KRA 3

KRA 2 Ensure Access to Quality Healthcare & Promote Healthy Lifestyle

KRA 1

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10MP STRATEGIES FOR KRA 2 : Ensure Access to Quality Healthcare & Promote Healthy Lifestyle


HS5 Quality Of Life Of An

Advanced Nation

OUTCOME (Ensure provision of and Increase accessibility to Quality health care and

Public recreational and Sports facilities to support Active healthy lifestyle)

Establish a comprehensive healthcare system & recreational infrastructure

Encourage health awareness & healthy lifestyle activities

Empower the community to plan or conduct individual wellness programme (responsible for own health)

Transform the health sector to increase the efficiency & effectiveness of the delivery system

KRA 2

STRATEGY 1 STRATEGY 2 STRATEGY 3 STRATEGY 4

Ensure Access To Quality Healthcare & Promote Healthy Lifestyle

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STRATEGY 1   Establish a comprehensive healthcare

system & recreational infrastructure

STRATEGY 2   Encourage health awareness & healthy

lifestyle activities


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STRATEGY 3 o  Empower the community to plan or conduct

individual wellness programme (responsible for own health)

STRATEGY 4   Transform the health sector to increase the

efficiency & effectiveness of the delivery system


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SUMMARY Transformation Agenda

VISION 2020

NATIONAL MISSION THRUST 2006-2020

THRUST 1 To move the

economy up the value chain

THRUST 2 To raise the capacity

for knowledge & innovation & nurture ‘first class mentality’

THRUST 3 To address persistent

socio-economic inequalities

constructively & productively

THRUST 4 To improve the

standard & sustainability of quality of life

THRUST 5 To strengthen the

institutional & implementation capacity

Quality of Life of An Advanced Nation

Ensure provision of & Increase accessibility to Quality health care & Public Recreational & Sports facilities to support Active healthy

lifestyle

Strategy 1 -- comprehensive

healthcare & recreation

Strategy 2 -- health awareness &

Healthy lifestyle

Strategy 3 -- Empowering the Community

towards self care

Strategy 4 -- Health Sector Transformation

(Universal Access)

10MPSTRATEGIC DIRECTION 5 (HS5)

10MP OUTCOME FOR HS5

10MP STRATEGIES FOR HS5

Ensure access to quality Healthcare & promote

Healthy lifestyle 10MP KRA 2 FOR HS5

10MP STRATEGY & HEALTH SECTOR KEY RESULT AREAS 10MP STRATEGY HEALTH SECTOR KRAs

Strategy 1 Establish a comprehensive healthcare system & recreational infrastructure

KRA 1 Health Sector Transformation Towards A More Efficient & Effective Health System in Ensuring Universal Access to Healthcare

Strategy 4 Transform the health sector to increase the efficiency & effectiveness of the delivery system

Strategy 2 Encourage health awareness & healthy lifestyle activities

KRA 2 Health Awareness & Healthy Lifestyle

Strategy 3 Empower the community to plan or conduct individual wellness programme (responsible for own health)

KRA 3 Empowerment of Individual and Community to be responsible for their health

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HEALTH SECTOR KRAs

1.  Health Sector Transformation Towards A More Efficient & Effective Health System in Ensuring Universal Access to Healthcare

2.  Health Awareness & Healthy Lifestyle 3.  Empowerment of Individual and Community to

be responsible for their health

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Outcome, Strategy and KPIs for Health Sector KRA 1

HEALTH SECTOR KRA

OUTCOME STRATEGY HEALTH SECTOR OUTCOME KPI

I. Health Sector Transformation Towards A More Efficient & Effective Health System In Ensuring Universal Access To Healthcare

1. DELIVERY 1.1 Integrated public -private health services delivery

1. Streamline / realign healthcare delivery system (keywords: PHC as thrust, gatekeeping, zoning, referral system, preventive/ promotive, resource sharing, resource mobilization, appropriate technologies, registered population, registered providers)

2.Unified healthcare financing system (keywords: Safety net, financial risk protection, case mix, benefit packages, provider-payment mechanism, social health insurance, co-payment, increase government contribution, equity in resource allocation, equity in distribution of facilities, enforcement of PHFSA 1998, cost structure information)

3.Common quality and standard of care (keywords: Accreditation, credentialing, CPD, HTA, practice guidelines, clinical governance, care, uniform standard of care, standardised regulations, laws and enforcement)

4.Adequate and competent workforce (keywords: number, mix, competency, performance reward/ incentive , quality, distribution )

5.Strengthening healthcare legislation and enforcement (keywords: review, revise act & regulation, codes of ethic & conducts, capacity )

6. Strengthening implementation, monitoring and evaluation system (keywords: competency in stewardship, real time, data & information, research, evidence, informed decision, capacity)

7.ICT as enabler (keywords: prerequisites for integrated unified system )

1. Integrated PHC plan by 2011 2. Integrated secondary care plan by 2013

1.2 Universal Access Equity of access – physical ease of access

All population will get access to the basic PHC services by (2014) 1. All PHC providers will be registered by 2011 2. All population will be registered to a Primary Health Care Physician starting 2011

1.3 High quality and safe care

1. Decrease mortality & morbidity of selected conditions

2. FINANCE 2.1Universal access Equity of access - financial

1. Reduce Out Of Pocket ( OOP )

2.2 Cost containment 2. Reduce medical inflation rate

3. GOVERNANCE 3.1 Sustainability of healthcare delivery system

1. Increase GDP in health

3.2 Compliance to defined quality and standard

2. % of accredited facilities

3.3 Responsiveness to population needs

3. Waiting time for selected procedures

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HEALTH SECTOR KRA

OUTCOME STRATEGY HEALTH SECTOR OUTCOME KPI

II. Health Awareness & Healthy Lifestyle

1.Malaysians will be health literate 2.Malaysian practise healthy lifestyle

1. Increase access to health knowledge (keywords: innovative, incentive, empowerment, information sharing) 2. Motivate individuals, family and community to acquire knowledge and skill (keywords: innovative, incentive) 3. Increase opportunities to practice healthy lifestyle at workplace, schools, home etc. 4. Formulate and enforce public policy towards healthy lifestyle

1. % health literacy 2. Increase in the percentage of physical activity of Malaysian adult 3. Reduce the prevalence of overweight and obesity among adult 4. Reduce the prevalence among adolescent smokers

III. Empowerment Of Individual And Community To Be Responsible For Their Health

Individuals, family and community to have adequate knowledge and skills to make decision about their health ( selfcare, choice of treatment / provider)

1. Strategies to increase health literacy 2. Provision of health information, including cost of care and governance policies 2. Providing avenues for effective complaints or enquiries regarding health providers 4. Mobilize civil society (NGOs, support groups, community leaders)

% of individuals able to make decision on their own health

Outcome, Strategy and KPIs for Health Sector KRA 2 & 3

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DEVELOPMENT BUDGET 9MP BUDGET 230 B

10MP BUDGET 165 B Development Expenditure 15 B PFI Facilitation Fund 50 B PFI

Ceiling for 2011-2012 (2 year rolling plan) (RM 75 B for the whole country)

NKRA projects – 21B Continued 9MP Projects – 40B New projects & Private Facilitation Fund – 14B

TOTAL 230 B

Malaysian healthcare-system

Health & Medicine

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