malaysian healthcare-system
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THE MALAYSIAN HEALTH CARE
SYSTEM
Dr Mahani Binti Ahmad Hamidy Senior Principal Assistant Director
Planning and Development Division, MOH
MALAYSIA
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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)
HIGH INCOME ADVANCED ECONOMY
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
HIGH INCOME ADVANCED ECONOMY
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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HIGH INCOME ADVANCED ECONOMY
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
HIGH INCOME ADVANCED ECONOMY
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
10MP STRATEGIES FOR KRA 2 : Ensure Access to Quality Healthcare & Promote Healthy Lifestyle
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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
10MP STRATEGIES FOR KRA 2 : Ensure Access to Quality Healthcare & Promote Healthy Lifestyle
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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
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