Materia Medica Malaysiana

Taking care of rural health

HEALTH in the rural areas has been well developed over the last 47 years, since independence.

The Government has taken numerous steps to ensure that the population in rural and remote areas, including Sabah and Sarawak, are not neglected in terms of health care and facilities.

Initially there were only seven maternal and child health clinics in the late ‘50s but now we have over 4,000 health clinics, of which almost 80 per cent are located in the rural areas.

These clinics provide maternal and child health and dental services which cover a comprehensive range of promotive, preventive, curative and rehabilitative services.

Health Minister Datuk Dr Chua Soi Lek says: "We did not stop there however." Since the Seventh Malaysia Plan, we have moved towards providing a wider scope of health services, beyond just maternal and child health. Adolescent, women, geriatric health has been introduced. Mental and rehabilitative health has also been expanded. Over the last 10 years more than 30 per cent of the health clinics have started such services and the number is growing by the day.

Family medicine has made its debut. There are 110 such specialists giving not only specialist services but also clinical leadership at the health clinic level.

These clinics, where the family medicine specialists are posted, are equipped with radiology, pathology services and specialist drugs.

Dr Chua says more diagnostic equipment has also been sent to such clinics.

"We will still have a wide spectrum of progress, ranging from very basic clinics, run by a one-person community nurse or medical assistant, that see a minimum of 20 patients a day, to a health clinic that has a comprehensive range of services seeing over 1,000 patients a day." Hence, depending on the type of services available in a particular clinic and the illness of the patient, he or she will be treated accordingly or referred to the nearest clinic or the hospital.

The re-employment of retired doctors and employing private doctors to work in health clinics are among the steps taken by the ministry to overcome a shortage of doctors in rural areas.

Dr Chua says the ministry has also recruited 643 foreign doctors — 203 specialists and 440 medical officers — to work in rural hospitals, health centres and polyclinics.

"We have re-employed 34 retired doctors to work in rural areas," he says.

"Concerned with the shortage of doctors in rural areas, efforts are being made to make rural health postings more attractive." The measures taken include providing quarters and allowing career development with the creation of family medicine speciality. Those posted to Sabah and Sarawak will be given a regional allowance — 12.5 to 17.5 per cent of their basic pay.

The use of friendly information communication technology is also being explored to allow doctors in rural areas establish continuous and reliable connections both in follow-up of cases as well as educational and professional contacts.

As of December last year, there are 864 community polyclinics, 1,927 community, 95 maternal and child health and 168 mobile clinics in rural areas.

The Government had allocated RM460 million under the Seventh Malaysia Plan and RM862 million under the Eighth Malaysia Plan (8MP) for rural health development, that is for 425 projects.

The main thrust of the 8MP is to upgrade existing facilities and the construction of new health facilities in rural areas. However, this objective is somewhat obscured by the zest of building new hospitals. Almost 53 per cent of the revised ceiling approved under the 8MP has to be channelled to fund these new hospitals.

As for the overall shortage of doctors in the country, Dr Chua says as of March 3 this year, there were 13,457 vacancies, of which 10,195 or 76 per cent were filled. These included 2,191 specialist posts, of which 1,525 were filled and 11,266 non-specialist/clinical specialist posts (8,570 filled).

The ministry's long-term plan to resolve the shortage is to increase the output of medical graduates.

There are now 15 approved local medical universities and colleges but only eight public and five private institutions are expected to produce some 2,000 students starting this year.

In view of the shortage of doctors, the ministry wants doctors in private hospitals to serve a certain number of hours a week in government hospitals.

On health standards, the minister says it is influenced by several factors which include socio-economic status, educational attainment, provision of good basic amenities as housing, water and electricity and not just the provision of health services alone.

The main health problems in rural areas are basically diseases of the respiratory and digestive systems, skin and parasitic infections such as malaria, scabies, and worms.

As for health awareness among the rural population, he adds that there are health programmes provided on antenatal care, child health, school health, family planning, diabetic conrol, and cardiovascular prevention.

"Local findings on the health of rural people are also done through home visits and patient's responses during their visits to the health clinics." The ministry's vision is to develop a nation of healthy individuals, families and communities through a health system that is equitable, affordable, technologically appropriate, environmentally adaptable, consumer friendly and which promotes individual responsibility and community participation for an enhanced quality of life.

The ministry aims to build partnerships for health to facilitate and support Malaysians in attaining their potential in health, motivate them in appreciating health as a valuable asset and taking positive action to improve and sustain their health status to enjoy a better quality of life.