1Malaysia clinics – in the spirit of primary healthcare
In the past CAP has called for more government clinics in urban areas across the country to help reduce the number of patients in General Hospitals. A random survey by CAP on the number of private clinics within a 500 meter radius in an urban area in Penang showed not less than 15 clinics in operation. Most people living in the area were from lower and middle income groups who if given a choice, preferred to seek treatment from a public healthcare facility instead of these clinics due to the high cost of treatments.
The Government’s initiative is timely in light of the present socio-economic status of the rakyat. With escalating private healthcare costs and all round inflation, it is important that the rakyat be provided with a choice of easily accessible public and private healthcare providers to choose from.
The 1Malaysia clinic primary healthcare system is indeed a well organized initiative aimed at providing the delivery of equitable quality healthcare to the rakyat.
As explained by Tan Sri Dr. Mohd Ismail Merican, Director-general of Health, it is estimated that by 2015, more than 50 per cent of the population will be living in urban settings. The reality of our society today is that even now, due to the economic situation the middle income population is rapidly diminishing into larger low income groups which find private healthcare increasingly unaffordable. With the migration of people to urban areas, there is a growing concern for their plight and specific health needs of the urban poor now and in the future. Many face various socio-economic problems, including access to quality healthcare. This is where the 1Malaysia community clinic will play an important part in addressing these needs.
In countries like Hong Kong, Australia, Singapore, Britain and the United States, community clinics are commonplace and play an important role in addressing the primary healthcare needs of urban and rural communities effectively while being staffed by paramedics and/or doctors. The idea of community based primary healthcare is not new even in Malaysia. Rural clinics have been in operation since the 60’s and have mainly been staffed by Medical Assistants (MA’s). They have done the poor and rural based rakyat a great service by taking care of their primary healthcare needs without them having to fork out ill affordable money to travel distances to hospitals in towns. In more recent times, primary public healthcare has largely manifested itself in oral health care, maternity clinics and in rural areas as well as some urban areas.
These clinics while being managed by paramedics under the supervision of doctors have been very effective in ensuring quality primary healthcare for the rakyat and CAP trusts that under the 1Malaysia clinic system, the facilities will more efficiently serve the needs of the rakyat.
The implementation of a full fledged public health community clinic system to provide comprehensive primary healthcare for the rakyat is actually 10 years late going by the Governments concord with the international agreement, the Alma Ata Declaration of 1978 whereby “A main social target of governments, international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this target as part of development in the spirit of social justice.”
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care, Almaty (formerly Alma-Ata), currently in Kazakhstan in September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of “Health for All”.
One of its components states that “(Primary healthcare) should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need.” Another states that “(Primary healthcare) relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.”
The International Conference on Primary Health Care called for governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, non-governmental organizations, funding agencies, all health workers and the whole world community to support national and international commitment to primary health care and to channel increased technical and financial support to it, particularly in developing countries.
CAP trusts that the true spirit of the Alma Ata Declaration will be observed by the Ministry of Health and put into practice for the altruistic benefit of the rakyat.
Recently, Margaret Chan, the Director-General of the WHO has reaffirmed the primary health care approach as the most efficient and cost-effective way to organize a health system. She also pointed out that international evidence overwhelmingly demonstrates that health systems oriented towards primary health care produce better outcomes, at lower costs, and with higher user satisfaction.
With such proven outcomes, CAP believes that the Government is on the right track and all that is left to do now is to prove the detractors of this system wrong by successfully accomplishing its objectives with the interests of the rakyat wholly at heart.
Letter to the Editor, 6 January 2010