United Nation Public Service Award Nominee Miri Hospital, Sarawak, Malaysia

Category 1: Reaching the poorest and most vulnerable through inclusive services and partnerships;

I am honoured to write this letter of reference for Miri Hospital’s submission for the United Nation’s Public Service Award in “Category 1: Reaching the poorest and most vulnerable through inclusive services and partnerships”. While Malaysia has a very good health care delivery system that has virtually achieved Universal Health Coverage in Peninsular Malaysia, the state of Sarawak on Borneo Island, is still struggling to achieve Universal Health Coverage, especially to those inhabitants who live in the remote and rugged interior areas of the State. Those inhabitants (e.g., the semi- nomadic Penan tribes) include the poorest and most vulnerable sections of the population. They live in small groups either in settlements or villages making it uneconomical to provide fixed health care facilities such as clinics. So, they are covered by mobile health care teams that travel along logging roads or by the Flying Doctor services. Such mobile teams are constrained by time and by the weather; thus, they can provide only the most basic of health services such as childhood immunisation and basic antenatal and postnatal care. The services are also provided solely by Sarawak Health Department. Baram District (population 64,000), in the northern part of Sarawak, is one of the most remote areas of the State. Provision of healthcare in such remote areas of Sarawak has always been a challenge due to poor accessibility and high operational cost. Most of the rural areas are served by a network of primary care clinics under the public health program of Sarawak Health Department whereas specialised medical care is available in urban hospitals. Miri Division has two hospitals: a District Hospital (Marudi Hospital) serving Baram District and a larger Divisional hospital (Miri Hospital) with specialists serving Miri Division (population 364,000, including the 64,000 in Baram District). Miri Hospital is the coordinator and main player of the Ulu Baram (meaning the hinterland of the Baram River area) Medical Outreach Carnival project. What they have done is to adopt a blue ocean collaborative and partnership approach to provide not just basic health care but also specialised medical care to these far-flung population. In addition to Miri Hospital and Miri Health Office staff, the partners include private hospitals, service organisations, and timber and plantation industry players. The smart partnerships and engagement with various agencies have allowed hospital services to be offered to the poor and underprivileged communities in Ulu Baram free of charge. Volunteers, including the doctors are provided with the chance of experiencing provision of healthcare away from the usual hospital setting. The initiative and effort introduced in this programme fit well with the objective of Sustainable Development Goal No 3 which is to ensure good health and wellbeing of underserved population. The project has been sustained since it started almost 10 years ago in 2009. During each trip (of two to three days) they would be registering between 1000 to over 3000 people from around 10 to 20 villages and settlements. The cost of transport from the settlements to the Carnival site and back, are borne by the private company partner, as are the cost of the medicine and consumables, referrals for further treatment and surgical procedures in Miri Hospital. The cost of food for the volunteers and the patients are also provided by the company. The services provided are inclusive in the sense that they go beyond the health sector; for instance, the National Registration Department were also present to provide birth registration and national identity card services. Even barbers joined some of the trips. Within the health sector, the services provided are inclusive because they include many disciplines such as dental, ophthalmology, pharmacy, physiotherapy, and so on. I am convinced that in many ways, the Ulu Baram Medical Carnival has met, if not exceeded, the challenging requirements and expectations for the Award. Should Miri Hospital be given the award, it will complement the stellar community of past recipients of the Award. To further support this nomination, I would be pleased to answer any queries via my email at [email protected]

PROF. DR ANDREW KIYU MBBS (UM), MPH (UM), DrPH (Tulane, USA), FACE, AM, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia