Francis Ngu
16th August 2010, 09:34 PM
A PRELIMINARY OUTLINE OF UNMET HEALTH CARE NEEDS IN SARAWAK
Dr. Francis H.H. Ngu, Kuching.
Health Services and Welfare Bureau,
Parti Keadilan Rakyat in Sarawak
Media release on 12th August, 2010
Preamble: “Health Care for All by the Year 2000”, WHO.
An overview of the unmet health care needs of Sarawak was presented by our party in 2008. Since then there has generally been no substantive response from State and Federal governments, while the need for new facilities and pressures on existing services continue to grow. The umet needs are now reviewed and updated, given more justifiable demands which have arisen from statements by community and political representatives from both sides in and out State and Federal legislature.
We hope the government is now moving away from the political window-dressing of 1Malaysia Clinics, to more serious consideration of macro-reforms to improve a health care system under stress and growing intolerable unmet needs of the population.
Firstly we wish to put it to the citizens of this State and Nation that no expedient political slogan like 1Malaysia (or what about better Reformasi or Ketuanan Rakyat Clinics in future !) should be latched on to any Government Health Care facility and service.
The provision of health care by government must be guided by professionalism and not give an impression of over-arching political partisan influences.
Our current review will be in 3 parts:
1. Primary Care/ Outpatient Services
2. Hospital Inpatient Services.
3. Primary Care in small remote communities: Flying Doctor Service, etc.
Issues arising will be discussed in later media releases.
Caveat:
This assessment is partial and incomplete, being mostly focused on urban centres. Many rural clinics do not have population concentrations, thus only attracting regular or irregular visits by Medical Officers from Hospitals instead of having resident medical officers. The health care and other basic infrastructure in rural areas should surely command the serious attention of any government.
PT 1. PRIMARY CARE / GENERAL OUTPATIENT SERVICES
THE LIST OF NEW FACILITIES NEEDED :
Greater Kuching
1. 3 or more new polyclinics, each for:
PetraJaya/Matang/Samariang/Santubong/Bako
Batu Kawa/Moyan
Padawan
2. Siburan/Kuching Serian Road
Sibu Up to 4 polyclinics, and improvement to Bintangor
Miri 1 more polyclinic to serve the southern side
Maternal and Child Health Clinics (2), Central and Southern Miri.
(There may be need for more MCH clinics other than for Miri, but these have not been assessed by us.)
The party will update the above list as further information comes to hand and assessment made.
SCORE Regions : Government and private sector should be expected to jointly make proactive planning for the industrial and community primary care needs in view of the faster than previously expected population growth rates in these regions.
The time it takes from budget submissions for Development under Malaysia Plans to budget approval, implementation, project completion and commissioning for service may be more than 5 years. It is common knowledge that a “miss out” in 1 Malaysia Plan, means another wait for 5 years for the next Malaysia Plan, unless an interim bid is made in Mid-Term Plan Reviews.
Discussion
Greater Kuching :
This comprises the cities of Kuching South, Kuching north and the municipality of Padawan. The population is generally quoted at some 600,000-700,000. If the hinterland catchment of adjoining districts are latched in, the service population is about 1 million.
The needs are glaring and have been canvassed by us in and out of Dewan Undangan Negeri. It is a fact that at Polyclinic Mosque Road, up to 12 or more persons are crowded into consultation rooms. This not only gives rise to problems of patient confidentiality, and medical staff inhibition from carrying out proper patient assessment, but may be a communicable disease hazard !
We note with encouragement an appreciation that a large clinic, possibly a polyclinc, is under construction at MJC township at Batu Kawa, although there is little official information.
While we should immediately approve and build a Polyclinic “across-river” in Kuching City North, the explosive growth of population “across-river” may need 2 polyclinics 5-10 years later. The provision of a Matang 1Malaysia Clinic not manned by a Medical Officer is an insult and mockery to the intelligence of the people.
There is now a community demand for Polyclinic and General Hospital for Siburan/Bengoh/Mambong. The residential and commercial growth and sizable hinterland population certainly indicates true community need for a Polyclinic.
Sibu:
A government senior minister recently stated that Sibu needs 4 more polyclinics to supplement 2 existing polyclinics. Certainly 1 or 2 new ones should be approved immediately, and the workload of all clinics be reassessed. We commend the Minister concerned to be wise enough not to bid for more of the band-aid 1Malaysia Clinics.
There is also demand for upgraded health clinic services at Bintangor, and we have received negative feedbacks from Julau and Pakan on certain aspects of service facility/provision.
Miri:
This is covered in our media release to the Chinese press in Miri on 30th July and to the English media in Kuching on 2nd of August. The incumbent ADUN (Pujut)(legislator) had earlier highlighted the unmet OPD/MCH needs of Miri.
The general town/city planning principle should be the provision of various services including primary health care at all areas of population concentrations and future growth. Bringing services closer to the residents and reducing waiting times improve social and economic efficiency, with dispersal of some traffic to outlying areas, thus reducing family and community stress.
Widening the scope of Primary Care
In providing more standard polyclinics, it means providing more of the same. Some areas of improvenment and additional services are desired and should be incorporated in future OPD/primary care planning projects :
1. Developing the specialities of Primary Care Physicians and Emergency Response personnel;
2. Meeting the needs of mental health in primary care; the prevalence of mental problems in the Malaysian population is quoted as 10% or more;
3. Health promotion, lifestyle counseling;
4. Multi-disciplinary teams, including dieticians, physiotherapists, social workers, etc;
5. Day surgery; renal dialysis;
6. Rehabilitation and counseling;
7. Home visiting
8. Examining IT needs and potential IT contribution to primary care.
9. Quarantined waiting areas during communicable disease outbreaks.
On the MCH side, the excellent record in child health, ante-natal care and family planning, should be augmented by, among others,
1. Adolescent health service, including adolescent mental health;
2. Counselling on pregnancy, AIDS and other STDs, lifestyle.
Impending Health Care Reform
We are keenly watching the Health Care Financing Reform outlined recently by the Minister of Health, though details are still under wraps. The unmet needs in Sarawak alone requires a substantial increase of Health Care Budget, not a reduction as we are currently experiencing.
If the proposed reforms get underway, outpatient services will be handed out to private practitioners, funded by a National Health Fund providing full or partial payment for patients. Intense negotiations between stakeholders are said to be underway.
In the interim, primary care /OPD service development will apparently be in a limbo for a year or more. Apparently, few if any polyclinics will be built, subject to the adoption of public-private cooperation model in primary care under the proposed reform.
We contend that even under the proposed reforms, there is still a duty of government to build primary care polyclinics, which later on can be leased out to individual private practitioners and private practitioner groups in a transparent manner.
Consideration should be given to expanding the scope and depth of primary care at large population centres. An expanded scope of OPD/ambulatory/home service is an important option to take the load off large hospitals, and the increasing pressure on expensive hospital beds. The experiment in “Super Clinics” in Australia should be keenly watched for strengths and drawbacks.
The medical co-contribution proposals under the suggested reform will be triggering a robust public debate in the near and medium term. The public should be fully engaged in the debate.
Better Health Care for All
Due next:
PT.2 :The Unmet Hospital/Inpatient needs of Sarawak.
PT. 3 ; Remote rural communities/ Flying Doctor Service review.
Dr. Francis H.H. Ngu, Kuching.
Health Services and Welfare Bureau,
Parti Keadilan Rakyat in Sarawak
Media release on 12th August, 2010
Preamble: “Health Care for All by the Year 2000”, WHO.
An overview of the unmet health care needs of Sarawak was presented by our party in 2008. Since then there has generally been no substantive response from State and Federal governments, while the need for new facilities and pressures on existing services continue to grow. The umet needs are now reviewed and updated, given more justifiable demands which have arisen from statements by community and political representatives from both sides in and out State and Federal legislature.
We hope the government is now moving away from the political window-dressing of 1Malaysia Clinics, to more serious consideration of macro-reforms to improve a health care system under stress and growing intolerable unmet needs of the population.
Firstly we wish to put it to the citizens of this State and Nation that no expedient political slogan like 1Malaysia (or what about better Reformasi or Ketuanan Rakyat Clinics in future !) should be latched on to any Government Health Care facility and service.
The provision of health care by government must be guided by professionalism and not give an impression of over-arching political partisan influences.
Our current review will be in 3 parts:
1. Primary Care/ Outpatient Services
2. Hospital Inpatient Services.
3. Primary Care in small remote communities: Flying Doctor Service, etc.
Issues arising will be discussed in later media releases.
Caveat:
This assessment is partial and incomplete, being mostly focused on urban centres. Many rural clinics do not have population concentrations, thus only attracting regular or irregular visits by Medical Officers from Hospitals instead of having resident medical officers. The health care and other basic infrastructure in rural areas should surely command the serious attention of any government.
PT 1. PRIMARY CARE / GENERAL OUTPATIENT SERVICES
THE LIST OF NEW FACILITIES NEEDED :
Greater Kuching
1. 3 or more new polyclinics, each for:
PetraJaya/Matang/Samariang/Santubong/Bako
Batu Kawa/Moyan
Padawan
2. Siburan/Kuching Serian Road
Sibu Up to 4 polyclinics, and improvement to Bintangor
Miri 1 more polyclinic to serve the southern side
Maternal and Child Health Clinics (2), Central and Southern Miri.
(There may be need for more MCH clinics other than for Miri, but these have not been assessed by us.)
The party will update the above list as further information comes to hand and assessment made.
SCORE Regions : Government and private sector should be expected to jointly make proactive planning for the industrial and community primary care needs in view of the faster than previously expected population growth rates in these regions.
The time it takes from budget submissions for Development under Malaysia Plans to budget approval, implementation, project completion and commissioning for service may be more than 5 years. It is common knowledge that a “miss out” in 1 Malaysia Plan, means another wait for 5 years for the next Malaysia Plan, unless an interim bid is made in Mid-Term Plan Reviews.
Discussion
Greater Kuching :
This comprises the cities of Kuching South, Kuching north and the municipality of Padawan. The population is generally quoted at some 600,000-700,000. If the hinterland catchment of adjoining districts are latched in, the service population is about 1 million.
The needs are glaring and have been canvassed by us in and out of Dewan Undangan Negeri. It is a fact that at Polyclinic Mosque Road, up to 12 or more persons are crowded into consultation rooms. This not only gives rise to problems of patient confidentiality, and medical staff inhibition from carrying out proper patient assessment, but may be a communicable disease hazard !
We note with encouragement an appreciation that a large clinic, possibly a polyclinc, is under construction at MJC township at Batu Kawa, although there is little official information.
While we should immediately approve and build a Polyclinic “across-river” in Kuching City North, the explosive growth of population “across-river” may need 2 polyclinics 5-10 years later. The provision of a Matang 1Malaysia Clinic not manned by a Medical Officer is an insult and mockery to the intelligence of the people.
There is now a community demand for Polyclinic and General Hospital for Siburan/Bengoh/Mambong. The residential and commercial growth and sizable hinterland population certainly indicates true community need for a Polyclinic.
Sibu:
A government senior minister recently stated that Sibu needs 4 more polyclinics to supplement 2 existing polyclinics. Certainly 1 or 2 new ones should be approved immediately, and the workload of all clinics be reassessed. We commend the Minister concerned to be wise enough not to bid for more of the band-aid 1Malaysia Clinics.
There is also demand for upgraded health clinic services at Bintangor, and we have received negative feedbacks from Julau and Pakan on certain aspects of service facility/provision.
Miri:
This is covered in our media release to the Chinese press in Miri on 30th July and to the English media in Kuching on 2nd of August. The incumbent ADUN (Pujut)(legislator) had earlier highlighted the unmet OPD/MCH needs of Miri.
The general town/city planning principle should be the provision of various services including primary health care at all areas of population concentrations and future growth. Bringing services closer to the residents and reducing waiting times improve social and economic efficiency, with dispersal of some traffic to outlying areas, thus reducing family and community stress.
Widening the scope of Primary Care
In providing more standard polyclinics, it means providing more of the same. Some areas of improvenment and additional services are desired and should be incorporated in future OPD/primary care planning projects :
1. Developing the specialities of Primary Care Physicians and Emergency Response personnel;
2. Meeting the needs of mental health in primary care; the prevalence of mental problems in the Malaysian population is quoted as 10% or more;
3. Health promotion, lifestyle counseling;
4. Multi-disciplinary teams, including dieticians, physiotherapists, social workers, etc;
5. Day surgery; renal dialysis;
6. Rehabilitation and counseling;
7. Home visiting
8. Examining IT needs and potential IT contribution to primary care.
9. Quarantined waiting areas during communicable disease outbreaks.
On the MCH side, the excellent record in child health, ante-natal care and family planning, should be augmented by, among others,
1. Adolescent health service, including adolescent mental health;
2. Counselling on pregnancy, AIDS and other STDs, lifestyle.
Impending Health Care Reform
We are keenly watching the Health Care Financing Reform outlined recently by the Minister of Health, though details are still under wraps. The unmet needs in Sarawak alone requires a substantial increase of Health Care Budget, not a reduction as we are currently experiencing.
If the proposed reforms get underway, outpatient services will be handed out to private practitioners, funded by a National Health Fund providing full or partial payment for patients. Intense negotiations between stakeholders are said to be underway.
In the interim, primary care /OPD service development will apparently be in a limbo for a year or more. Apparently, few if any polyclinics will be built, subject to the adoption of public-private cooperation model in primary care under the proposed reform.
We contend that even under the proposed reforms, there is still a duty of government to build primary care polyclinics, which later on can be leased out to individual private practitioners and private practitioner groups in a transparent manner.
Consideration should be given to expanding the scope and depth of primary care at large population centres. An expanded scope of OPD/ambulatory/home service is an important option to take the load off large hospitals, and the increasing pressure on expensive hospital beds. The experiment in “Super Clinics” in Australia should be keenly watched for strengths and drawbacks.
The medical co-contribution proposals under the suggested reform will be triggering a robust public debate in the near and medium term. The public should be fully engaged in the debate.
Better Health Care for All
Due next:
PT.2 :The Unmet Hospital/Inpatient needs of Sarawak.
PT. 3 ; Remote rural communities/ Flying Doctor Service review.