Health Care Delivery System in

Malaysia
Year 3 Medical Program
Assoc. Prof. Dr Noorzilawati Sahak
Public Health Medicine Specialist
Community Medicine & Public Health Department
FMHS
Adapted from slides prepared by Prof Dr Mohamad Taha Arif

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Learning Objectives
At the end of the lecture students will be able to understand:

1.Why is the government responsible to provide health

services in Malaysia
2.What are the agencies available to provide the service
3. What are the services provided by these agencies
4. Understand the types of resources required for running the
services
5. Comprehend who or what agency pay or fund the services
6. How much fund is required to run the services
7. Understand the meaning of Health System

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Health Delivery System in Malaysia
⚫ Where do you seek medical treatment when you get sick?
⚫ Where do people go to seek medical treatment when they
are sick ?
⚫ Where do you seek advice to keep yourself healthy ?
⚫ Where do your parents go to check their blood cholesterol
and blood sugar ?
⚫ All these actions are called health seeking behavior of
people.

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Health Delivery System in Malaysia
⚫ First let us look at these places where people get advice or
treatment to keep themselves healthy.
⚫ These are part of the Health delivery system.

⚫ Before looking at this you may wish to know what is

“Health” and what is “Health System”

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Health Delivery System in Malaysia
⚫ Health
⚫ is a state of complete physical, social and mental
wellbeing and not merely the absence of disease or
infirmity (WHO 1948)

⚫ Health System
⚫ is a system that is concerned with all the activities
⚫ whose primary purpose is to
⚫ promote, restore or maintain health (WHO).

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Health Delivery System in Malaysia
⚫ Health care activities encompass:

⚫ Health promotion
⚫ Disease prevention
⚫ Curative
⚫ Rehabilitation
⚫ Health policy & Regulation

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7
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Health Delivery System in Malaysia
⚫ Health system differs from country to country
⚫ In Malaysia it is formed by 3 sectors:
-public
-private
-traditional and complementary medicine (service)

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Health Delivery System in Malaysia
⚫ Let us look at these 3 sectors.
⚫ 1.The private sectors provide care
⚫ at hospitals, clinics, laboratories and others
⚫ Who own the services in private sectors?
⚫ owned by private individual or group of people or
company
⚫ private hospitals, GP clinics,
⚫ clinical laboratories all over Malaysia

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Hospitals in Private Sector

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Private Clinic

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 Health Delivery System in
Malaysia
2. Traditional and Complementary Medicine
Practitioners
⚫still in abundance throughout Malaysia.
⚫found in rural as well as urban areas.
⚫often called bomoh, sinseh, manang, ayuverdic
practitioners, herbalist, spiritual healers,
masseurs, homeopathy practitioners, acupuncturist
and others

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Definition of T&CM
T&CM is a form of health-related practice
⚫designed to prevent / treat / manage ailment
or illnesses or preserve the mental and
physical wellbeing of an individual
⚫excludes medical or dental practices used
by a medical or dental practitioner
respectively.

Traditional and Complementary Medicine Act 2016 [Act 775]

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National Policy of Traditional and
Complementary Medicine

Traditional &
Complementary Medicine
system (T&CM) shall be an
important component of
the healthcare system. It
will co-exist with modern
medicine and contribute
towards enhancing the
health and quality of life of
all Malaysians.

National Policy of Traditional and Complementary Medicine

Ministry of Health Malaysia 2007

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Important milestones on the development
of T&CM in Public Sector, Malaysia
1987 1992 1996 2000 2004
A proposal Registration of T&CM Unit was formed Formation of Herbal T&CM Division
for research Traditional under the Family Health Medical Research Center was established
in Medicine (TM) Development Division (HMRC) under Institute under Research
alternative Product by for Medical Research & Technical
medicine National 1997 (IMR) Support
was Pharmaceutical Good Manufacturing Programme
prepared Control Bureau Practice (GMP) was 2001
(NPCB) implemented for TM National Policy on T&CM
manufacturers was launched

1998 2002
T&CM Standing Committee Global Information Hub
was established and National Committee
in R&D for Herbal
1999 Medicine was established
Formation of 5 umbrella under IMR
bodies for T&CM

1990 1995 2000

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Important milestones on the development
of T&CM in Public Sector, Malaysia

2015 2016 2017

T&CM Branch Office Gazettement of T&CM Pilot Project of T&CM
in Perak was Act 2016 [Act 775] Service Therapy Varmam
established (Mar 2016) in Sungai Buloh Hospital
National Health & Enforcement of T&CM Gazettement of T&CM
Morbidity Survey Act 2016 [Act 775] Order 2017
(NHMS) 2015 on (1 Aug 2016 – Phase 1) (Recognized Practice
T&CM Areas)
(Designation of
T&CM incorporated into Practitioner Body)
the 11th Malaysian Plan as (1 Aug 2017)
a potential new source of
economic growth

2015 2016 2017

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Health Care Delivery System in Malaysia
⚫ 3. The Public sector are services provided by the
government.
⚫ The Ministries involved in health services are:
a) the Ministry of Health (the major player),
b) the Ministry of Higher Learning (providing teaching hospitals),
c) the Ministry of Defense (providing army hospitals, clinics and
mobile services) and
d) the State or Local government or local council
⚫ providing services like road cleansing, drainage in towns, garbage disposal,
waste disposal, clearing nuisances, water supplies, food safety and others).

⚫ In all the sectors above how could the delivery of these services be
made possible?
-We need resources

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 Facilities for the Health Care System in Malaysia
Health
Delivery
system

Traditional &
Public Private Compl
Medicine

Ministry of Min of Higher GP Homeopath

Min of Health Local Govt Hospitals Bomoh, sinseh
Defence Learning clinics acupuncture

University
Waste
Hospital Teaching Hospitals
disposal
Hospitals

Health
Clinics scavenging
Centers

Mobile clinic Food safety

Klinik Desa
And FDS And control

Disease
Mobile Clinics
control

1-Malaysia
clinics
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Health Care Delivery System in
Malaysia
⚫ To run these services mentioned above,
resources are needed.
⚫ What are the resources ?
1.manpower (human resource)
2.money (finance)
3.materials (building, tools, instruments, drugs and
others)
4.methods ( a good system to provide the
services effectively and efficiently)
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Health Care Delivery System in Malaysia
-Human resource
⚫ Let us look at these 4 elements
⚫ 1. Manpower or Human Resource
⚫ comprise of:
a. professional group like doctors, dentists, pharmacist, others

b. support professional and technical group like nurses,

laboratory technicians, radiographers, assistant
environmental health officers and others

c. support clerical and manual group like clerks, attendants,

cooks, watchmen and others

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 Number of Health Human Resources Available
in the MOH Facilities and the Private Sector for
2016 in Malaysia and Staff to Population Ratio

Category of No. in public No. in private Total public Staff to

staff sector sector and private population
ratio

Doctors 36,403 13,684 50,087 ?

Dentists 4,591 2,592 7,186 ?

Nurses 65,227 30,539 102,564 ?

Source: Health Human Resources, 2016 (as of 31 December), Health Facts 2017, MOH Malaysia

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 How do you calculate the staff to
population ratio ?
⚫ What does it mean by staff to population ratio?
⚫ How many people one staff provides care for at one time
⚫ OR a number to describe the number of people assigned to each staff
⚫ Example: Doctor to Population Ratio
⚫ in the table in the previous slide,
⚫ take the number of doctors in public X
⚫ take the number of doctors in private Y
⚫ calculate the sum of X and Y
⚫ divide population of the country P by the X+Y
⚫ P/X+Y = 632
⚫ Thus the doctor to population ratio was:
⚫ 1: 632
Similarly you can calculate the dentist population ratio, the nurse
population ratio and others.
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 Number of Health Human Resources Available
in the MOH Facilities and the Private Sector for
2016 in Malaysia and Staff to Population Ratio

Category of No. in public No. in private Total public Staff to

staff sector sector and private population
ratio

Doctors 36,403 13,684 50,087 1:632

Dentists 4,591 2,592 7,186 1:4,406

Nurses 65,227 30,539 102,564 1:309

Source: Health Human Resources, 2016 (as of 31 December), Health Facts 2017, MOH Malaysia

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Why are these numbers and ratios
important ?
⚫ For estimating the needs of the particular category of staff

⚫ For estimating the numbers required for training

⚫ For the planning and development of the services

⚫ For comparison over time and between places.

⚫ For example: the doctor to population ratio in Selangor for 2010 was
1: 921 and in Sarawak it was 1:1,491
This indicates that the people in Selangor was better served by doctors
compared to people in Sarawak for the same year and therefore more
doctors need to be sent to Sarawak to serve there.

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 Money (Finance)
⚫ Where does the public sectors obtain finance to run the services ?

1. The federal government gives financial allocation to the ministries

concerned which run the health services. It is a big amount and the
MOH gets most of it
⚫ The allocation increases every year

2. from general taxation

3. local council obtain fund from the collection of rates and also
4. contribution from the State government

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Payment for the services
⚫ How do the public pay for the services rendered by these
service providers?
⚫ In Public services:
either free (government servant, students, pensioners, OKU) or
subsidized (97 % government, 3 % patient)
through personal insurance
paid by employer
⚫ In Private sectors :
out of patient own pocket money
through insurance
paid by employer

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 Methods
⚫ This refers to the way services is delivered, the spread and
scope of services
⚫ Availability and accessibility of services
⚫ Standards of medical practice
⚫ Safety to patients and clients
⚫ Procedures and protocols in laboratories, operation theaters,
wards and clinics
⚫ Level of care
⚫ Public and private integration
⚫ IT usage (I.R 4 etc)
⚫ Others

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HEALTH SERVICES DELIVERY LEVELS
 PROMOTIVE PREVENTIVE

Safe water supplies

Healthy Village Programme Immunisation Programme

Scope of Health Services in Sarawak

REHABILITATIVE
CURATIVE Orthodontic
Unit

Ultrasound Physiotherapy
Unit
Scan
Intensive Care Unit
 GOVERNMENT HEALTH FACILITIES IN SARAWAK, 2016
23 hospitals
228 health clinics & MCH clinics
7 Rural Community Clinics
35 ‘1 Malaysia Clinics’
LAWAS
Keys : 101 Mobile health teams (FDS, KB1M, VHT)
LIMBANG
Hospital 5 hospital outpatient departments

Klinik Kesihatan
N MIRI
A MARUDI
Klinik Desa T
A
MCHC L
E
S
VHT by river A
IN
C
VHT by road T
U
A
WKK L BINTULU

FDS Bases
FDS Locations MUKAH

DARO
BELAGA

SIBU
KANOWIT
SARIKEI
LUNDU KAPIT
SARATOK

KUCHING
BAU
BETONG
KOTA SAMARAHAN
SIMUNJAN SRI AMAN
SERIAN KALIMANTAN
KALIMANTAN
Sarawak Health Department 2002
 HEALTH SERVICES BY
MINISTRY OF HEALTH

12km
RURAL

m
5k
CLINIC
12km
m
5k RURAL
CLINIC
WKK

District Hospital
Urban Clinic Divisional Hospital

TERTIARY HOSPITAL
 REFERRAL SYSTEM,
GOVERNMENT HEALTH SERVICES, SARAWAK
Mobile Health Teams

Flying Doctor Service

12km

m
RURAL CLINIC

5k
Village Health Representatives

District Hospital

URBAN CLINIC Divisional Hospital

SARAWAK GENERAL
HOSPITAL
Prepared by Sarawak Health
Department 35
HEALTH CLINIC OPERATIONAL AREA

Extended operational
area

Immediate operational area

5 km radius 12 km radius

Health Clinic
TYPE 1: >800 daily attendances

TYPE 2: 500 – 800 daily attendances

TYPE 3: 300 – 500 daily attendances

TYPE 4: 150 – 300 daily attendances

TYPE 5: <150 daily attendances

TYPE 6: <50 daily attendances

HEALTH CLINIC TYPE 1

KK JALAN LANANG, SIBU

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HEALTH CLINIC TYPE 2

KK JALAN MASJID, KUCHING KK BINTULU,BINTULU

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HEALTH CLINIC TYPE 3

KK KOTA SAMARAHAN, SAMARAHAN

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HEALTH CLINIC TYPE 4

KK ASAJAYA, SAMARAHAN

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HEALTH CLINIC TYPE 5

KK TEBAKANG, SAMARAHAN

KK BALAI RINGIN, SAMARAHAN

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HEALTH CLINIC TYPE 6

KK NANGA TAROH, MUKAH

KK LADANG SAWIT, MUKAH

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HEALTH CLINIC TYPE 6

KK PA’ DALLIH, MIRI

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RURAL HEALTH CLINIC (Klinik Desa)

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MATERNAL & CHILD HEALTH (MCH) CLINIC

MCH Jalan Jawa, Kuching

KKIA JAWA, KUCHING

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MOBILE HEALTH TEAMS

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 VILLAGE HEALTH REPRESENTATIVES
⚫ Community-based village health
volunteer programme
⚫ Launched in 1983 to improve
access to basic health care in
under-served areas
⚫ Volunteers undergo two weeks of
training in basic health care &
return to serve their
communities

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Materials
⚫ These are infrastructures :
building
vehicles
boats,
medical equipment
laboratory instruments
food, drugs and chemicals
linen
others

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 Modes of transportation

Land Air (FDS)

Boat –KB1M
Water/ river
To be continued…..

⚫ More in part 2

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