FIVE YEAR HEALTH PLAN MALAYSIA

Global Health Informatics Technology Standards SummitSustainable Healthcare Information Technology Funding

18TH October 2009

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Dual Healthcare Systems in Malaysia - Choices

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Formulation of Health Plan

Five Year Malaysia Plan First Malaya Plan (1956-1960)Second Malaya Plan (1961 - 1965)First Malaysia Plan (1966- 1970)...Eighth Malaysia Plan (2001 - 2005)Ninth Malaysia Plan (2006 - 2010)

Health plan is an integral part of national development plan

Malaysia Development Plans

Outline Perspectives PlanOPPI (1971 -1990)OPP2 (1991-2000) OPP3 (2001 - 2010)

The Outline Perspective Plan - Long Term Strategic Plan

OPP-1 New Economic Policy (1971-

1990)restructuring of communityeradication of poverty

OPP-2National Development Policy (1991-

2000)alleviating povertyeliminating economic imbalancesprivate sector as engine of growth

National Unity Growth with Equity

OPP3- National Vision Policy • fostering unity & eradicating poverty• sustaining high economic growth & enhancing

competitiveness• developing a knowledge-based economy• strengthening human resource development• pursuing environmentally sustainable

development

National Solidarity

The Outline Perspective Plan - Long Term Strategic Plan

• NATIONAL VISION POLICY (2001-2010)Building a resilient nationPromoting an equitable societySustaining high economic growthEnhancing competitiveness to meet the challenges of globalisation and liberalisationDeveloping a knowledge-based economyStrengthening human resource developmentPursuing environmentally sustainable development to reinforce long-term growth

KNOWLEDGEBLE SOCIETY

How do we plan?• PRAGMATIC PLANNING

APPROACHbased on experience and intuitive skillmost common sense

knowledgenot necessarily written downno clearly defined methodologydata have limited impact on decision-makingflexible

• RATIONAL PLANNING APPROACH

Making current decisions based on likely future effectsMore evidence basedSetting goals, objectives and targetsDetermine different between current status

& desired goals, objectives & targetsIdentify needs & likely

available resourcesDevelop feasible option for achieving desired result against resource availabilityImplement - Evaluate - Recycle

EXAMPLE

FORMULATION OF 9TH MALAYSIA PLAN

(HEALTH)

9MP9MP

ISSUES &

CHALLENGES

ISSUES &

CHALLENGES

Wellness paradigm -

health promotionDisease burden

Health services delivery

Resource OptimisationResearch & development

Stewardship and governance of MOH

Health management information systemHealth sector reforms

Globalization and liberalizationCrisis & disaster management

Intersectoral

coordination & collaboration Maximise

the role of private sector & NGOs

TWG PAPERS FOR 9MP

1. Consolidation of Malaysian Health Care Delivery System• Primary Health Care Services• Medical Care Services

2. Re-enforcement of Wellness Paradigm: Towards Making Individuals Responsible For Their Health

3. Public Health Development4. Enhancing Human Capital5. Enhancing Research Capacity & Capability6. Options for Acquisition of Health Care Services7. Challenges in Meeting Globalization & Liberalization: What is there for the

Country?8. Crisis and Disaster Management9. Achieving Greater Health Through Quality10. Enhancing Governance and Stewardship of MOH Through Legislation and

Regulation 11. Integration In Health: The Way Forward12. Transforming Health Care Services Through ICT: The Way Forward13. Additional Reference Papers:

• Report of Disease Burden Study• National Health Financing Mechanism

(including the Malaysian National Health Account)

GOALS OF 9MP

1. Prevent and Reduce Disease Burden

2. Enhance Health Care Delivery System

PRIMARY GOALS

3. Optimise Resources (include Enhancing Human Resource Development)

4. Enhance Research & Development

5. Manage Crisis & Disasters Effectively

6. Strengthen Health Information Management System

SUPPORTING GOALS

CONSOLIDATION

Malaysian health system is a success stories among countries of equivalent socio-economic status

“The better one does, the harder it is to do better”

Way Forward:• To continue present approach • Focus on selected areas based on THRUST & GOALS

…using optimum resources to get maximum impacts…• In-line with KSN Circular (Pekeliling Perkhidmatan Am Bil.5/2004)

9TH

MALAYSIA HEALTH PLAN – focus and priorities

THE NINTH MALAYSIA HEALTH PLAN ….Translating Policy into Practice….

ThrustGoals

Broad Objectives

National Health Priorities

DIRECTION Objectives,Strategies &Indicators

Country Health Plan

(BOOK 1)

Health PROJECTS&

SERVICES

TRANSLATED

Health Plan of Programmes &

Activities(BOOK 11)

MARGINAL BUDGETING

(BOOK III)

DIRECTION

TRANSLATED

TRANSLATED

PROGRAMMES AND ACTIVITIES OF MoH DURING THE 5-YEAR PLAN

(1) 6 Programmes DURING 9MP :• PUBLIC HEALTH PROGRAMME• MEDICAL PROGRAMME• RESEARCH AND TECHNICAL SUPPORT

PROGRAMME• MANAGEMENT PROGRAMME• PHARMACY PROGRAMME• DENTAL PROGRAMME

(2) Activities under each Programme couldbe reviewed / New Activities couldbe developed further (eg. Traditional & Complementary Medicine Activity)

ISSUES & CHALLENGES

• Wellness paradigm• Disease Burden• Optimization of resources• Health Informatics• Globalisation &

Liberalisation• stewardship & governance

of the MOH• Maximize private & NGOs

GOAL 1: PREVENT & REDUCE DISEASE BURDEN1(….. EXAMPLE………..)

OBJECTIVES

• Objective 1 (Performance)The MoH will empower

individuals, families & communities in attaining optimal life long wellness

• Objective 2 (Capacity)The MoH will change

organizational structures and service practices to promote and support the public’s wellness

MACRO STRATEGIES

• Health promotion will be strengthen through the use of the most effective & appropriate media to impart knowledge for behavior change.

• Review existing National Healthy Lifestyle Campaign into a holistic National Wellness Campaign in collaboration with other relevant agencies with more focus on priority areas & target groups eg smoking

GOAL 1: PREVENT AND REDUCE DISEASE BURDEN2Objective 1 (Performance)The MOH will empower individuals, families & communities in attaining optimal life long wellness (….. EXAMPLE………..)

INDICATORS /TARGETS

• … % annual reductions in the DALY related to health priorities (life style diseases) in year 2007

• …% reduction of incident rate & prevalence of smoking

OBJECTIVES, STRATEGIES AND INDICATORS

FOLLOWS SIMILAR FORMAT

OTHER GOALS

WHAT ARE OUR PRIORITIES?

DISEASE BURDEN, MALAYSIA (2000)TOTAL DALY Status & Rank Order

Rank Diseases DALY %No. Total Total1 Ischaemic Heart Disease 278,733 9.8%2 All mental illness 206,898 7.3%3 Cerebrovascular Disease/stroke 180,431 6.4%4 Road Traffic Injuries 162,736 5.7%5 All Cancers 137,675 4.9%6 Septicemia 127,714 4.5%7 Asthma & Chronic Obstructive Pulmonary Diseases 121,733 4.3%8 Diabetes mellitus 103,449 3.7%9 Acute Lower Respiratory Tract Infection 87,539 3.1%10 Hearing loss 83,560 3.0%11 Other Respiratory Diseases 82,032 2.9%12 Infectious Dieases (TB, Dengue, Malaria, HIV/AIDS, Viral Hepatitis) 75,405 2.7%13 Cirrhosis 54,687 1.9%14 Other cardiovascular diseases 51,315 1.8%15 Nephritis & Nephrosis 46,786 1.7%16 Osteoarthritis 46,028 1.6%17 Nutritional anaemia 43,076 1.5%18 Other unintentional injuries 42,070 1.5%19 Birth Trauma/Asphyxia 40,607 1.4%20 Other sense organ disorders 40,289 1.4%21 Otitis media 39,271 1.4%22 Blood disorders 38,339 1.4%23 Low Birth Weight 37,447 1.3%24 Cataract 34,835 1.2%25 Other Infectious Diseases 34,320 1.2%26 Down Syndrome & other Chromosonal 32,702 1.2%27 Drug Dependence/harmful use 31,941 1.1%28 Self Inflicted Injury 31,894 1.1%29 Other Congenital 29,308 1.0%30 Hypertensive Heart Disease 28,754 1.0%

Total Top 30 (after regrouping) 2,351,574 83%Total All Diseases (111) 2,832,030 100%

Disease Priorities

• Ischaemic heart diseases

• Mental illness

• Cerebrovascular disease

/ Stroke

• Road traffic injuries

• Cancers

• Asthma and chronic obstructive

pulmonary diseases

• Diabetes mellitus and

• Of major public health problems such

as dengue, HIV /AIDS and othersBased on identified criteria,WHO Guideline / Tool & Workshop 30.11.2004

Risk Factor Priorities

• Tobacco use

• Blood Pressure

• Overweight

• Cholesterol

• Physical Inactivity

• Stress

• Alcohol

• Factors influencing the

infectious diseases of

major public health

problems

Considerations

ROLE OF MOH•Regulatory•Enforcement•Policy making•Monitoring•Financing and •Provision of certain health services particularly for population health

Steps towards Research Optimization and Consolidation…

•Establishment of the National Institute of Health (Consists of 7 institutes)

•Focus is on consolidation and optimization of MOH research output

‘Pekeliling Am Bil. 5 / 2004’

…emphasis on human capital…human touch services

…enhancement of the delivery of healthcare

KSN CIRCULAR ON 9MP

QUALITYACCESSIBILITY

EQUITYEFFICIENCY

REDUCE BRAIN DRAINAUTONOMY

PREPARATORY WORK FOR THE RESTRUCTURING OF MoH HEALTHCARE

DELIVERY SYSTEM

PREPARATORY WORK FOR THE DEVELOPMENT OF THE NATIONAL

HEALTHCARE FINANCING MECHANISM

• equity• accessibility • quality• better regulation• national solidarity• caring society• mobilised resources

• Address at all times• Certificate of needs• Right to practice• Accreditation programme• Implemented at all levels

– Technical– Non - Technical

• Adminstrative & Management

QUALITY

TELEHEALTH & ICT

•K-economy•Evidenced-based planning & decision making•Surveillance & forecast•PHFSA 1998

INTEGRATION, COLLABORATION COORDINATION

Public/ Private/NGOsPrimary/Secondary/TertiaryVertical/Horizontal Integration

BUDGET ALLOCATION?

9MP Allocation • A total of RM10.2 billion is allocated for

Development Projects under the 9MP compared to RM9.5billion during 8MP– Total of 1646 projects – + 4 PFI (Private Funding Initiatives)

• NINPVB (National Institute of Natural Products and Biologicals)

• Hospital Rembau• National Cancer Institute• Communicable Disease Centre

• Allocation of budget is in accordance to a given code

RM 10.2 billion(9MP)

100 series 100 series –– Training (RM1.5 Training (RM1.5 bilbil) ) and biggest allocation to building and biggest allocation to building of new colleges (RM700 mil) of new colleges (RM700 mil)

200 series – Public Health (RM2.2 Bil)Urban = rural (RM 1.1 Bil)

300 series – Hospitalfacilities (RM2 Bil)- Upgrading – new wards, OTs

400 series – New Hospitals(RM1.5 Bil) = 15% of total Allocation of 9MP

500 series – Research &Development (RM90 mil)

600 series – Upgrading of Other Projects other than Hospitals(RM 300 mil)

700 series – Land(RM130 mil)

800 series – ICT(RM 500 mil)

900 series – Staff facilities(quarters & new offices)

1000 series – Health Promtion& Tourism (RM 50 mil)

1100 series – equipment &Transportation (RM600 mil)_

9MP ALLOCATION

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HOW DO WE MONITOR?

PLAN OF ACTION FOR THE IMPLEMENTATION OF THE 9TH MALAYSIA PLAN (9MP)Fourth Thrust : To improve the standard and sustainability of quality of lifeField : HealthStrategy : Prevent and reduce disease burden to enhance health status

Plan of Action

9MP allocation Indicators Current

status TargetsImpleme

nting agency

•Purchasing of vehicle and equipment (including boats)

RM 526.2 mil

•Total allocation spent for 337 projects

To be identified

Total allocation spent :- 2006 - RM 50.5 mil- 2007 - RM 194 mil- 2008 - RM 153.5 mil- 2009 - RM 61.1 mil- 2010 - RM 66.9 milTotal - RM 526.2 mil

MOH

MONITORING OF PROGRAMMES & PROJECTS

Need for Indicators

• For the purpose of Monitoring & Evaluation

• To set targets for achievements

(Scenario Painting)• Beginning (2005 /2006)

& End (2008/2009) of the 9MP

• Availability of data• Specific, valid and able

to answer specific objectives and strategies

• Input / process / output• Qualitative / quantitative• Proxy indicators if

needed

Choice of IndicatorsChoice of Indicators

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Lelaki 55.8 61.6 63.1 64.3 66.4 67.7 69 69.4 69.9 70 71

Wnita 58.2 65.6 66 68.7 70.5 72.4 73 74.2 74.9 75.1 75.5

1957 1966 1970 1975 1980 1985 1990 1995 1999 2000 2003

Life Expectancy At Birth 1957- 2003

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CBR 46.2 40.9 32.5 30.3 28 25.9 24.5 21.9

CDR 12.4 9.5 7 5.5 4.7 4.6 4.4 4.7

IMR 75.5 69 40.8 24 13.1 10.4 6.6 6.3

NMR 29.6 30 22.9 15.6 8.5 6.8 3.8 3.2

TMR 10.7 8 4.2 2.1 1 0.8 0.6 0.5

PMR NA NA NA 24.6 13.9 9.8 7.5 6.3

1957 1960 1970 1980 1990 1995 2000 2003

Selected Vital Statistic 1957 - 2003

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MMR 2.8 2.4 1.5 0.8 0.6 0.4 0.2 0.2 0.3 0.3 0.3 0.3

1957 1960 1970 1975 1980 1985 1990 1995 1998 1999 2000 2003

Maternal Mortality Rate 1957 - 2003

Building New Hospitals

• Buiding new hospital and upgrading existing hospital

HOSPITAL SUNGAI BULOHHOSPITAL SUNGAI BULOH-- 620 KATIL 620 KATIL ––an example of a HIS Hospitalan example of a HIS Hospital

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