Rural clinic services to be improved

KOTA KINABALU (Sept 22): Medical services in rural Sabah and Sarawak will be improved as the Ministry of Health (MOH) is planning to place two family medicine specialists at every health clinic.

Health Director General Tan Sri Dr Noor Hisham Abdullah said that health clinics in the rural areas of Sabah and Sarawak used to be manned by a medical officer.

“But in our planning, we want family medicine specialists, at least two of them, to be at the health clinics,” he said to reporters after launching the 24th National Level Family Health Specialists Scientific Conference held at the Sabah International Convention Centre here on Thursday.

He explained that with the two family medicine specialists in each health clinic, the quality of services and safety will be improved.

He disclosed the MOH needs about 8,000 family medicine specialists to be placed in its clinics in an effort to provide the best treatment and services to the community, especially in rural areas.

Dr Noor Hisham also noted the difficulties of the rural communities in Sabah and Sarawak to acquire medical treatment where there is a clinic for every five kilometers.

He said that they also conducted outreach programmes in the interiors.

He said that this investment is for the mature development of the family medicine and increase more family medicine process in the interiors.

In order to increase the processes involved, he said the Health Ministry has implemented two methods of training the specialty in family medicine that is offered at local universities for the Master in Family Medicine and under a programme offered at AFPM overseas.

“We will raise the capacity to 100. Before there were only 42 family medicine specialist facilities,” he said.

“The country’s medical spectrum has 1,100 (family medicine specialists) with 700 under the Health Ministry. This programme is expected to add between 100 and 120 capacity every year,” he said.

He added that this concept will facilitate the concept of equality between hospital and health clinic and make it easier for the community to attain medical treatment that is nearer to them.

“This will also reduce congestion at the hospital and empower family medicine in the community,” he said.

Dr Noor Hisham also said that he hoped for their allocation to be increased, to allow them to repair dilapidated clinics in the interiors and family medicine specialists placed at the clinic.

The director-general also said surgical services in primary healthcare facilities need to be expanded and empowered.

He said surgical services in primary healthcare facilities were low nationwide, and the need to increase surgical healthcare was due to over dependence and congestion in hospitals.

“There are clinics doing biopsies (extraction of sample cells or tissues for clinical tests), minor surgeries for lumps and bumps among other minor procedures but not many,” he said.

He added by empowering surgical healthcare at these facilities, the services can be provided better and widely in the community, and help decongest hospitals.

On the proposed Control of Tobacco Product and Smoking Bill 2022, Dr Noor Hisham said it aimed at preventing the new generation from picking up smoking habit.

“For the old generation, we are not disturbing what ever been done in the past…we are focusing on the new generation, those born in 2007,” he said.

The bill, which was tabled for its first reading in the Dewan Rakyat by Health Minister Khairy Jamaluddin on July 27, seeks to prohibit those born on and after Jan 1, 2007, from purchasing or possessing cigarettes or vape products.

Earlier in his opening speech,

Dr Noor Hisham said over the past 25 years, family medicine specialists have played an essential role in establishing primary care as an indispensable pillar of Malaysia’s healthcare system.

He said that this will continue as the Ministry of Health prepares the Health White Paper to reform the healthcare system.

He added that family medicine specialists provide effective and outstanding care at the community level by providing holistic, preventive, curative, rehabilitative and palliative care.

Dr Noor Hisham also said that robust primary care is linked to greater lifespan, patient outcomes, population health, and cost-effective healthcare.

“Additionally, there has been emerging evidence indicating that strong primary health care can contribute significantly to health security and improve health system responsiveness by integrating public health and primary care capacity in the frontline combined with high-quality hospital care,” he said.

According to Dr Noor Hisham, primary care has a substantial role in disease prevention, early detection and treatment to improve the population’s overall health.

“The effective provision of primary care services has also inadvertently avoided overcrowding of tertiary care facilities,” he said.

He added that increasing emphasis on primary care is a cost effective and efficient way to reduce the burden of disease in the community, improve the nation’s productivity and control the escalation of healthcare costs.

“Whether in crises or even during ordinary times, a health system can count on strong primary healthcare to save lives and improve the well-being of the people,” he said.

He also said that although the nation’s response to the Covid-19 public health crisis was undoubtedly praiseworthy compared to the response of some others, we should not rest on our laurels and, just as quickly, prepare ourselves with the right strategies to move ahead.

He stressed that strong primary health care will ensure universal health coverage, health security and the attainment of the United Nations Sustainable Development Goals that promote quality, people-centred primary care.

Back in 1956, there were only 42 Primary Health Care (PHC) facilities in the country, he recollected.

“Since the Independence of Malaysia in 1957, there has been a significant reorganisation of healthcare services in the country. The first reorganisation started at the public primary health care services and has accelerated since the Alma-Ata Declaration in 1978. At that point, the focus was mainly on maternal and child health with basic infrastructure and human resources. In the early years, the main burden of the healthcare system was primarily on the curative components of healthcare, based mainly on the hospitals’ secondary and tertiary care. This changed under the 10th Malaysia Plan, whereby the government has initiated efforts to improve the accessibility to quality primary care, especially to the underserved areas in both urban and rural areas. To date, there are over a thousand health clinic facilities with 100 maternal and child health clinics and 1806 community clinics all over the country,” he said.

Dr Noor Hisham also reminded that the primary healthcare’s immense role and contribution to the country cannot be denied.

“They are a great partner to the various specialities of the hospital in helping to co-manage patients of diverse backgrounds and diseases, from managing psychiatric patients with addiction problems under the Methadone Maintenance Therapy programme to managing stable HIV and Tuberculosis patients managed by infectious disease speciality.

“Our addiction clinics cover opioid addiction, cigarette smoking, and alcohol addiction. On the maternal health side, primary health care helps by providing contraception to the population and giving prepregnancy care counselling to future expectant mothers, reducing maternal and neonatal morbidity and mortality,” he said.

Dr Noor Hisham also said that the primary healthcare’s role as the backbone in battling the Covid-19 pandemic is immeasurable.

“From screening the population by carrying out sampling at government clinics nationwide to giving immunisation under the National Covid-19 Immunisation Programme up to reviewing patients who have recovered from the Covid-19 infection, our healthcare force, especially those in primary care, has worked tirelessly in helping to curb and control the spread of this sinister pandemic,” he said.

As per Sabah, he said that the state saw the third wave of the Covid-19 pandemic, and has bounced back stronger by being able to contain the spread of the virus and also contributing to establishing the National Covid-19 guidelines.

“During this Covid-19 pandemic, we have also witnessed the dynamic partnership and teamwork between the Ministry of Health (MOH) and various ministries, such as the Ministry of Defence (MINDEF) and Ministry of Education (MOE), as well as various NGOs in combating this pandemic. This partnership has helped tremendously in our Covid-19 vaccination programme,” he said.

He added that as of September 2022, the country has achieved an average 80 percent vaccination rate for those receiving two doses of vaccine in most of the states in Malaysia; and 47.5 percent booster coverage as of January 25, this year.

To increase the booster dose capacity, four vaccination centres (PPVs) with higher capacities have been set up in the Klang Valley, which are the Putra World Trade Centre, Kuala Lumpur; Axiata Arena, Bukit Jalil; Ideal Convention Centre; Shah Alam and Dewan Soka Gakkai; Klang from 15th January this year.

Dr Noor Hisham said that the Health Ministry also remembered the marginalised groups or communities.

“The Primary Care and Public Health divisions established an outreach programme to remote areas for Covid-19 vaccination. Outreach programmes are carried out during the weekdays as well as weekends. Strategically, the Ministry of Health procured CanSino and Johnson & Johnson vaccines. These single-dose regimens made it easier for the ministry to reach out and vaccinate people in these hard-to-reach locations and other communities, such as the homeless and undocumented,” he said.

He added that he was proud of their commitment to addressing the healthcare accessibility issues in Sabah.

“The unique Flying Doctor Services (FDS) assisted the Ministry of Health in providing healthcare treatment to areas not accessible by roads or by rivers,” he said.

He also shared that in meeting the significant challenges arising from the current Covid-19 pandemic, the Ministry of Health (MOH), especially the primary care division, has adapted in various ways, such as telemedicine and staggered appointment booking via apps.

“Telemedicine is when consultations are done online via video call with the patients. This saves both parties time and lessens our patients’ exposure to the virus, especially during the initial phase of the pandemic.

“The online staggered appointment system has also been introduced whereby patients can choose the time and date of their convenience to come to the clinic for consultation of chronic diseases such as Diabetes Mellitus, Hypertension and others,” he said.

He added that various apps have been introduced to facilitate patients making online clinic appointments, such as the Bookdoc example, which is currently being used at the Kuala Lumpur Health Clinic.