PUBLIC HEALTH PERSONAL PROJECT

MALAYSIA

(I) General social economic characteristics of residential life in a given country (region)

Government structure and a political regimen

Administrative and territorial subdivisions

Climatic and geographic peculiarities

General economic growth and the types of production: industrial and agriculture

a. Government structure and a political regimen

Federal constitutional 

elective monarchy

Head of state is the Yang di-

Pertuan Agong (the King)

Legislative power: divided between federal

and state legislatures

Constitutional monarchy

Elective Monarchy

Constitutional elective monarchy

Federal constitutional elective monarchy

Elective Monarchy

An elective monarchy is a monarchy ruled by an elected monarch.

True elective monarchy is Malaysia

The Yang di-Pertuan Agong (Supreme Head of State) is elected to a five-year term.

9 hereditary rules from the Malay States (the other 4 states, which have titular Governors, do not participate in the selection) form a Council of Rulers who will determine the next Agong via a secret ballot.

Yang Di Pertuan Agong

By informal agreement the position is systematically rotated among the nine, and has been held by Sultan Abdul Halim Mu’adzam Shah of Kedah since December 2011.

He is the 5th YDPA (1970-1975) and the 14th YDPA (since 13th Dec 2011) of Malaysia.

Constitutional (limited) Monarchy

Constitutional monarchy is a form of government in which a monarch acts as head of state within the guidelines of a constitution, whether it be a written, uncodified, or blended constitution.

Most constitutional monarchies employ a parliamentary system. Under most modern constitutional monarchies there is also a prime minister who is the head of government and exercises effective political power. 

Legislative Power

Federal legislatureBicameral federal parliament: the lower house (the House of Representatives) and the upper house (the Senate)

The 222-member House of Representatives is elected for a maximum term of five years from single-member constituencies.

All 70 senators sit for three-year terms; 26 are elected by the 13 state assemblies, and the remaining 44 are appointed by the King upon the Prime Minister's recommendation. 

The parliament follows a multi-party system and the government is elected through a first-past-the-post system

Parliamentary elections are held at least once every five years, the most recent of which took place on 05.05.2013.

Registered voters of age 21 and above may vote for the members of the House of Representatives and, in most of the states, for the state legislative chamber. Voting is not mandatory.

State legislatureState governments are led by Chief Ministers, who are state assembly members from the majority party in the assembly.

The CabinetExecutive power is vested in the Cabinet, led by the Prime Minister (must be a member of the house of representatives, who in the opinion of the King, commands a majority in parliament).

The cabinet is chosen from members of both houses of Parliament.

Prime Minister

The Prime Minister is both the head of cabinet and the head of government.

The incumbent, Najib Razak, appointed in 2009, is the sixth prime minister.

b. Administrative and territorial subdivisions

Governance of the states is divided between the federal and the state governments, and the Federal government has direct administration of the federal territories.

The 13 states are based on historical Malay Kingdoms, and 9 of the 11 Peninsular states retain their royal families.

Each state has a unicameral legislature known as the State Legislative Assembly. The states of East Malaysia (Sabah and Sarawak) have separate immigration policies and controls, and a unique residency status.

These are divided between two regions, with 11 states and two federal territories on Peninsular

Malaysia and the other two states and one federal territory

in East Malaysia.

Malaysia is a federation of 13 states

and three federal territories.

Malaysia

3 federal territories 13 states

Districts (Peninsular)

Mukim

Divisions (Sabah & Sarawak)

The federal parliament is permitted to legislate on issues of land, the Islamic religion and local government, in order to provide for a uniform law among all states.

It may also intervene at the request of the state assembly concerned.

Except for some land related laws, the in question must also be passed by the state assembly.

Non-Islamic issues that fall under the purview of the state may also be legislated at the federal level for the purpose of conforming with Malaysian treaty obligations.

c. Climatic and geographic peculiarities

Land area: 329,847 square kilometres (127,355 sq mi).

It has land borders with Thailand in West Malaysia, and Indonesia & Brunei in East Malaysia. It is linked to Singapore by a narrow causeway and a bridge. The Strait of Malacca (lying between Sumatra and Peninsular Malaysia) carrying 40 per cent of the world's trade.

The two parts of Malaysia is separated from each other by the South China Sea.

1) Equatorial climate

2) High humidity, annual rainfall ~250 centimetres (98 in)

Local climates can be divided into 3 regions

- The annual southwest (April to October) and the annual northeast

(October to February) monsoons

- The temperature is moderated by the presence of the

surrounding oceans.

- Highland- Lowland- Coastal

d. General economic growth and the types of production: industrial and agriculture

Had one of the best economic records in Asia, with GDP growing an average 6.5% annually from 1957 to 2005.

- In 2011 the GDP (PPP) was about $450  billion.

- The 3rd largest economy in ASEAN and 29th largest in the world.

1970s: Predominantly mining and agricultural-based economy.

Since the 1980s: Industrial sector (high levels of investment). The economy recovered from the 1997 Asian Financial Crisis sooner than neighbouring countries. 

International trade, facilitated by the adjacent Strait of Malacca shipping route, and manufacturing are key sectors of the country's economy. 

Malaysia is an exporter of natural and agricultural resources, the most valuable exported resource being petroleum.

It is one of the world's largest producers of palm oil.

Tourism has become Malaysia’s third largest source of income from foreign exchange. 

Knowledge-based services are also expanding (e.g. Health Care Tourism)

(IIA) Organization of the health service system in the country

State sources of health service financing (part of charges from GNP to the health service in %: government programs, financing from social funds).

System of medical insurance (obligatory, voluntary, occupational, and private medical insurance).

Private medical institutions. Paid medical services forms.

Other financing sources (private, profitable insurance organizations, non profitable organization, etc.).

Relations between international organization and health service system in the country: WHO programs; provisions of different programs (program for eradication of malaria, probes for TB, leprosy, family planning, introduction of telemedicine, etc.)

Financial problems in health service system and other disadvantages.

a. State sources of health service financing

Main source - Gross National Product (GNP) directed to the public health care services: 3.8% (2008), 4.6% (2009), 4.4% (2010).

Malaysia’s public health services is practically free, with a minimal charge of RM1 (USD 0.30) for outpatient services and maximal charge of RM500 (USD 152.32) for inpatient services for non gov. servants.

Private health services require payments – directly from the patient or some coverage from his/her medical insurance.

b. System of medical insurance

Two main types:

Occupational insurance-In the private sectors who earns less than RM3000 a month are protected by the Employee's Social Security Act 1969 (ESSA 1969).

Private insurance -Charged based on the health status, type of insurance and level of coverage of insurance. Voluntarily purchased.

c. Private medical institutions. Paid medical services forms

Public sector Private sector

Government / public hospitals (153 as of 2014)

Private hospitals and medical centers (140 as of

2014)

Government clinics (~5300 as of 2008)

Private practitioner clinics (~7000 as of 2010)

Government Medical Institutions

MOH provides primary care, secondary care and tertiary care.

An open-door policy in regard to general outpatient services and hospital admissions.

Access to specialist services is however controlled through a national system of referral, available at designated hospitals.

Private Medical Institution

Private hospitals exist in a variety of sizes. Newly built private hospitals are equipped with large, ultramodern and lavish medical technology.

Private general practitioners' clinics - convenient medical service but generally more expensive than public facilities.

d. Other financing sources

Non Profitable Organization

Others

Profitable Insurance

Organization

Some private hospitals are established as charitable institutions.

Private insurance is voluntarily purchased by individuals, who pay different premiums depending on the type of health insurance and level of coverage.  Examples of non profitable organizations: MERCY Malaysia, UNICEF Malaysia. Industries or companies involved in importing, manufacturing or marketing tobacco products, alcohol or any other products, known to be a health hazard, should make a special contribution (sin tax) to the National Health Financing Authority.

e. Relations between international organizations and health service system in the country

- Malaria- Tuberculosis

MalariaMalaysia has achieved major success in greatly reducing malaria incidences from urban and other densely populated areas.

• Before 1960, there were about 300,000 cases per year.

• Generally, the incidence of malaria has declined from as high as 1,400 cases per 100,000 persons three decades ago to 45.2 per 100,000 persons in 2002.

In Peninsular Malaysia, the greatest declines in malaria during the 1990s have been in those states with the highest rates, namely, Pahang and Kelantan .

Certain areas in Peninsular Malaysia, namely Perlis, the Federal Territory of Kuala Lumpur, Selangor, Melaka, and Kedah, had virtually eliminated malaria by year 2000.

The number of cases in the less developed and more rural East Malaysian states of Sabah and Sarawak (approximately 216 and 142 per 100,000 respectively in 2001) remain far higher than those in the states in the Peninsula.

Malaria – eradication programsVector–Borne Diseases Control Programme (VBDCP)

VBDCP is a section under the Disease Control Division of the Public Health Department, MOH. This programme employs several measures to eradicate malarial incidences in Malaysia:

- stratification and mapping of malaria risk areas(identifications of malarious, malaria-prone, and malaria-free areas)

- early case detection- parasite control: early and appropriate treatment- effective and sustainable mosquito vector control- protecting the human host- surveillance activities- implementation of the quality assurance programme procedures

research contributing to the formulation and evaluation of health programs.

Tuberculosis

Despite reductions in poverty and improvements in the control and treatment of the disease, TB remains a significant health issue. There were more new TB cases (14,400) notified in 2002 than for any other infectious disease apart from dengue fever. TB also had the highest number of deaths (1,300) among infectious diseases in 2002, far exceeding those from dengue or malaria, which recorded around 50 deaths each year.

Tuberculosis – eradication programsNational TB control program and strategies

• Set up in 1961 with the aim to control and reduce the prevalence of TB throughout the country.

• Strategies

- BCG vaccination for all newborn babies

- Screening of symptomatic cases and high-risk groups, including mandatory screening of foreign workers and HIV patients in prisons and drug rehabilitation centers

- Raising awareness of the disease through mass media

- Training health staff about the disease

- Conducting research relating TB epidemiology and treatment outcomes, including national TB prevalence study and a multi drug resistance survey.

f. Health Care Costs & Challenges for Malaysia

Healthcare Spending & Access Issue

In 2008, healthcare spending was still suboptimum in Malaysia, the government spending just 6.9% of its total expenditure on health care services.

The private sector came up with 2.6% of the GDP spending on health care.

In 2003, Malaysians spent just USD 374 in total per person per year on healthcare expenditure, with the government contributing USD 218.

So the question is - can we expect 6-star services and comfort levels from limited 3-star spending??

Malaysians remain disbelieving that we cannot expect the same level of healthcare services, when we have a subsidy mentality, we remain steadfast and unwilling to spend more, or to be taxed more.

Malaysian private household out-of-pocket (OOP) spending, forms the largest component of the private health care expenditure.

OOP spending takes up 57.09% (RM 10.8 billion) of the total; with some form of private prepaid plans (e.g. insurance) contributing 11.9 to 15.7% over the years from 1999 to 2008.

This is clearly disproportionately high, and that is why many people in Malaysia complain about ‘high’ health care costs, although this is relatively true only in the private sector.

Access Failure & Medical Assistance Fund

Concerns as to failures in access continue to pop up sporadically in the mass media. Poorer patients have resorted to the mass media appealing for financial assistance to help defray medical costs-almost weekly and sometimes daily, we get newspaper appeals for financial help.

RESOLUTION!?

Thus, this has prompted some stopgap measures such as setting up a Medical Assistance Fund (MAF) of RM 25 million, by the Ministry of Health.

However, this fund can only be utilised at public or quasi- governmental healthcare facilities, and appeals have to be vetted stringently to ensure need and priority, being too bureaucratic and slow, even unfair.

4 types of hospitals in the Public Sector under Ministry of Health

National Referral Center

In Kuala Lumpur

State General Hospitals

Specialized Institutions

District Hospitals

List of Notifiable Infectious Disease In Malaysia

Part I:

1. Chancroid

2. Cholera

3. DF & DHF

4. Diphteria

5. Dysenteries (All forms)

6. Ebola

7. Food Poisoning

8. Gonoccocal Infection. (All)

9. Leprosy

10. Malaria

11. Measles

12. Myocarditis

13. Plague

14. Poliomyelitis (Acute)

15. Rabies

• 16. Relapsing Fever

17. Syphilis (All forms)

18. Tetanus (All forms)

19. Tuberculosis (All forms)

20. Typhus & Other Rickettsioses

21. Typhoid & Paratyphoid Fevers

22. Viral Encephalitis

23. Viral Hepatitis

24. Whooping Cough

25. Yellow Fever

26. Any other life threatening microbial infection

Part II:

HIV Infection (All forms)

DIFFERENT LEVELS OF DISEASE PREVENTION

Childhood immunization programs includes promoting healthy lifestyles and education specific to preventing the transmission of communicable diseases.

Understanding the risk factors in the population and implementing methods of screening will help to detect diseases in early stages.

Efforts of health care providers to minimize the effects of an agent and prevents disability as a result of infection

1901- consisted of identifyingbreeding sites of malaria vectors and mounting a specific

and systematic attack against those vectors

1911- Malaria Advisory Board, control efforts to focus on environmental management techniques in cities, n estates as

well

Next decade, decrease malaria disease burden in rubber plantation workers. Death decrease from 73/1000 pop in 1908

to 8/1000 pop in 1920

1920-1940 Tambunan project: study methods for vector control in jungle setting, in Sabah. Interruptured by Japanese invasion in

WWII. Project resumed from 1949-19521960-1964: Gov carried out succesful elimination pilot project in Sabah + WHO Global Malaria Eradication Program. In 1967:

Implemented in Peninsular Malaysia, 1970: malaria control program in East Malaysia.

1992: target high risk pop, synchronising preventing and control efforts across district borders, increase survaillance, promote

community participation, scaling up vector control, rapid diagnostic testing, and new treatment regimens.

Since 1995, 90% decrease in indigenous cases has been attibuted to improved diagnosis and treatment, nationwide implementation of

insecticide treated bed nets and regular indoor resideal spraying. In 2010, national malaria program strategy was reoriented from control

to elimination.

PROGRESS TOWARDS ELIMINATION OF MALARIA

The proportion of urban population has increased from 62.0% in the year 2000 to 71.0% in the year 2010.

States with high level urbanisation were Selangor and Pulau Pinang with 91.4% and 90.8% respectively.

Conversely, the states with lower urbanisation levels were Kelantan (42.4%), Pahang (50.5%) and Perlis (51.4%).

HEALTH FACILITIES

NO BEDS

Hospitals (MoH) 130 33,004

Special Medical Institutions 7 5,000

National Institutes of Health 6 -

Non-MoH Government Hospitals 7 3,245

Private Hospitals 209 11,689

Private Maternity Homes 22 174

Private Nursing Homes 12 274

Private Hospice 3 28

MoH Health Clinics 802

MoH Community Clinics 1,927

MoH Maternal & Child Health Clinics 95

MoH Mobile Health Clinics 193

Private Medical Clinics 6,371

Rural medical care is  area that is located outside cities and towns with less densely populated

Malaysia has a population of 28 million of which 44% resides in rural areas.

A major priority of healthcare providers has been the enhancement of health of 'disadvantaged' rural communities particularly the rural poor, women, infants, children and the disabled.

Components of service: Pre-hospital care

Primary responder services to scene of emergency

Emergency transportation services Medical Emergency Coordinating Centre(MECC) and 999 Emergency Call Management System.

Major medical incident and disaster management

Major gathering and major event medical coverage

Hospital based care Triage service system

Emergency clinical care

Observational medicine

One stop crisis centre

Minor emergency medicine and trauma limited follow up clinic

Child Act 2001 (Act 611)

Domestic Violence Act 1994 (Act 521)

Domestic violence is defined as willfully placing the victim in fear of physical injury, causing physical injury, compelling the victim by force of threat to engage in any conduct or act, sexual of otherwise from which the victim has a right to abstain and harassment of psychological harm so as to cause ill health.

Population size in Malaysia Malaysia population 2014

29,999,530 citizens (February 2014)

51.5% male population, 48.5% female population

Religions and traditions

Age-sexual composition of the population

Major Trauma

Major Trauma Cases by Age Group