OFFICIATING ADDRESS BY YB DATO’ LIOW TIONG LAI
MINISTER OF HEALTH MALAYSIA
NATIONAL CONFERENCE ON PRIMARY HEALTH CARE
“30 YEARS AFTER ALMA ATA, HARNESSING THE PASSION AND
MOVING PRIMARY HEALTH CARE FORWARD”
SUNWAY CONVENTION CENTRE, PETALING JAYA, 15 APRIL 2008
Y.Bhg Tan Sri Datuk Dr Hj Mohd Ismail bin Merican,
Director General of Health, Malaysia.
Y.Bhg Dato Dr Hj Ramlee bin Hj Rahmat,
Deputy Director General of Health (Public Health).
Dr Hjh Safurah binti Jaafar,
Director of Family Health Development Division and
Chairperson of the Organizing Committee.
Distinguished guests, ladies and gentlemen.
Good afternoon to all of you.
1. First and foremost, allow me to thank the Organizer for inviting me to officiate at your Conference this afternoon, with the theme, “30 Years after Alma Ata, Harnessing the Passion and Moving Primary Health Care Forward”.
2. By 12 September this year, it will be 30 years since the Alma Ata Declaration was made in 1978. This landmark declaration formally adopted Primary Health Care as the means to provide comprehensive, universal, equitable and affordable health care for all. Unfortunately for many parts of the world, till today, Health for All has not been achieved. As noted by the Director General of the World Health Organization during her opening remarks at the primary health care conference in Buenos Aires in August last year, health care is not reaching the poorest sectors at the necessary scale.
3. Malaysia, as a nation, had achieved “Health for All by the year 2000” – the original target set by the Alma Ata Declaration. However, there are still pockets of population caught in the vicious cycle of poverty and ill-health, with difficulties in accessing not only health but also educational and economic services. That is why the theme of this conference is still relevant even to Malaysia today, in order to uplift the disadvantaged sub-sets of the population into the mainstream of Malaysians who are enjoying the health status of developed countries.
4. When the Alma Ata Declaration was put forth to attain “Health for All by the year 2000”, the Primary Health Care concept was groundbreaking because its broad-based interventions not only looked at the health system and at the reduction of the burden of diseases, but also called for multi-sectoral collaboration to uplift the socio-economic status of the population which impacts on health.
5. The World Health Report 2000 identified inadequate funding, insufficient training and insufficient equipment for health care workers as the basis for some of the failures of the Primary Health Care approach in meeting its global targets. Nevertheless, Primary Health Care is now sparking renewed interest globally. Since the 2001 Report of the Commission on Macroeconomics and Health, a number of countries have set up multi-sectoral national commissions or similar bodies to scale up health investments and expand access to essential health services.
6. In Malaysia, the Ministry of Health is the guardian of the public’s health, and the guiding ethical principle in public health is equity. Therefore, the Ministry has always sought to ensure that access to life-saving and health-promoting interventions is not denied to anyone for unfair reasons, including social or economic ones.
7. Since Malaysia’s Independence in 1957, the Ministry of Health has not only sought to ensure the provision of safe water, safe food and quality medicine, but has also strived to keep the Malaysian public informed of the means to protect their own health. The Malaysian health care system has always been practicing the principles of Primary Health Care, thanks to the foresight of our post-independence political leadership who placed social equity high on their agenda and has developed many “pro-poor” policies that see Malaysia spending more of public funds on the poorest 20% of the population.
8. In 1956, that is, pre-independence, we had only 42 primary health care facilities in the country, but by 2005 our primary health care facilities had grown to 2,874, comprising 809 health clinics, 1,919 community clinics and 146 mobile clinics. The Second National Health and Morbidity Survey in 1996 found that 88.5% of the population already lived within 5 km of a health facility and 81% lived within 3 km of one. There is not only progress in terms of health facilities, the scope of services in Primary Health Care has also expanded to include women’s health, community mental health, health of older persons, adolescent health, management of non-communicable diseases and dental care.
Ladies and gentlemen,
9. What are some of the topical issues relevant to Primary Health Care in Malaysia, and how are we addressing them?
10. For one, there is a rising demand by consumers for high quality, high technology, and affordable medical care; free from errors and incompetence; and delivered by healthcare professionals who are caring, competent, compassionate and trustworthy. The clients of primary health care services in Malaysia now have higher expectations of the services rendered by our facilities. They are more educated and have the means to choose between private and public care. They are better informed and have more demands. One of these demands is access to newer technology. Although the original aim of primary health care is to provide basic health services, Malaysia has been fortunate to be able to introduce appropriate but affordable technology into its primary health care services. The introduction of new technology is used to upgrade the services as well as to increase access. A case in point is the use of information technology to bring specialist care nearer to the home, especially in the rural areas.
11. If constant upgrading of services at the Primary Health Care level is not pursued to meet the growing needs and expectations of the community, then our Primary Health Care is liable to be by-passed by the community. From the Second National Health and Morbidity Survey (1996), it was seen that 39.6% of the respondents by-passed the nearest health clinic. 72.5% of those who bypassed the nearest health clinic chose to go to a private clinic, 14.2% to the district hospital, 6.5% to the state hospital and 2.9% to a traditional healer. The main reasons given for by-passing were waiting time, availability of a specific doctor and appropriateness of treatment. The frequent complaints on long waiting time are a reflection of the increased demand for quality services. Although work processes can be re-engineered to reduce waiting time in the short term, investment in the health infrastructure and human resources takes time to bear fruit, and the lack of these contribute significantly to the waiting time.
12. Another issue is that of changing demography and the rising importance of non-communicable diseases. The Malaysian population now lives longer and their lifestyle has changed to make them prone to chronic degenerative diseases. That is why the range of services at the Primary Health Care facility has been broadened to include the management of chronic diseases like diabetes. Indeed our services now cover a comprehensive spectrum of health care from womb to tomb. Preventive and promotive care are also given due recognition, and wellness activities for the various age groups, including the elderly, are now part of the services of the Primary Health Care facility in Malaysia.
13. A third issue is that of health manpower. As experienced by other countries, Malaysia is also facing a shortage of skilled health care workers. The focus is on careful planning of health manpower needs, so that enough will be trained in basic training and a sufficient number further undergo post-basic training to meet the needs of the expanding services. An equally important area to focus on is retaining these skilled health care workers in our government system. This requires the careful adoption of incentives, improved career structure, and improved working conditions to discourage them from moving to greener pastures, whether to the private sector within the country or even to other countries where the remuneration may be better.
14. Yet another issue is that of equity and access to primary health care. Despite Malaysia’s impressive gains in socio-economic development, there still exist the disadvantaged and the very poor. These include groups like the aborigines, the indigenous groups living in remote areas, the hard-core poor in the rural areas, and urban squatters. The government has responded by implementing strategies that are relatively expensive but deemed necessary, for example, the mobile health teams via land, river and air. The involvement of the communities, through volunteer health workers, also extends the reach of the health services to the remote areas. As these issues of equity and access are not only determined by the delivery of health services but also by other social determinants of health, it is necessary for us to work with other governmental agencies, the private sector and non governmental agencies to achieve our goals. We have established platforms for such inter-sectoral actions for health at the various levels of our health delivery system.
15. Increasing health care costs is another emerging issue. Presently, the main source of funding for health care services is from general taxation, and health funds are procured from the federal budget. Healthcare costs in the public sector are heavily subsidized by the government. Fees collected amount to less than 5% of the Ministry of Health’s annual operating expenses. We have conducted more than a dozen studies on healthcare financing since 1984. But because healthcare financing in itself can have a powerful impact on the development and future direction of health care, we need to consider the various options carefully. The stakeholders, healthcare providers and the people will be consulted.
16. Finally, we need to consider newly emerging global public health threats. As a member of the global village, Malaysia is not immune from threats facing the whole world as a result of human activities and rapid international spread of infectious diseases or their vectors. This has necessitated not only regional cooperation for health with countries within the ASEAN region but also within the Western Pacific Region of the WHO and the world.
17. In conclusion, ladies and gentlemen, Malaysia’s successes in uplifting the health status of her population, rivalling that of the developed countries, are in part attributable to the government’s philosophy of consciously adopting Primary Health Care as the thrust of the health care system. Not only has the Ministry increased the number of modern healthcare facilities to improve physical and geographical coverage, it has also expanded the range of services provided. These services now include promotive, preventive, curative and rehabilitative care, far beyond the few basic elements of primary health care services originally envisaged by the Alma Ata Declaration.
18. I understand that participants at this Conference, comprising the various stakeholders in Primary Health Care, have sat down and formulated a Declaration that will serve as a guide in formulating and strengthening respective implementation plans. I will be pleased to receive it from you.
19. On that note, ladies and gentlemen, I have pleasure in declaring open your National Conference on Primary Health Care. Thank you.