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Malaysiahealth2005.Pdf foreword The Ministry of Health, as the lead agency in healthcare provision, and authority on health in Malaysia, leads the way in directing the development of healthcare services in the country. We are proud to present Malaysia’s Health 2005 which provides the latest developments in the Ministry of Health, population health, health system management as well as research and development in the health sector in Malaysia. The 2005 report covers several current issues, among them the National Influenza Pandemic Preparedness Plan; Harm Reduction in the Prevention and Control of HIV/AIDs; and plans for the Development of Regulations on Medical Devices. Topics on Control of Unregistered Drugs; Malaysia’s approach to Suicide Prevention and New Generation Hospitals provide interesting reading on health sector development in Malaysia. We will continue to strive towards further improvements to this technical report series and make it an important source of information on health sector development in the country. We hope this report will enlighten our readers on the evolving health scenario in Malaysia, especially for those who are directly involved in the healthcare sector. TAN SRI DATUK DR. MOHAMAD ISMAIL MERICAN DIRECTOR-GENERAL OF HEALTH, MALAYSIA vision mission vision FOR HEALTH Malaysia is to be a nation of healthy individuals, families and communities, through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally-adaptable and consumer-friendly, with emphasis on quality, innovation, health promotion and respect of human dignity and which promotes individual responsibility and community participation towards an enhanced quality of life. mission OF THE MINISTRY OF HEALTH The mission of the Ministry of Health is to build partnership for health to facilitate and support the people to : • Attain fully their potential in health. • Motivate them to appreciate health as valuable asset. • Take positive action to improve further and sustain their health status to enjoy a better quality of life. contents Foreward Vision for Health Mission PART 1 CHAPTER 1 - HEALTHCARE SERVICE 11 Emergency Medical and Trauma Care Service in Malaysia 20 Rehabilitative Services in Malaysia 30 Specialisation and subspecialisation in the ministry of Health 52 Hospital Infection Control 62 Optimising Intensive Care Service in Malaysia 78 Chronic Pain Management Service 87 Advances in Oral Healthcare in Malaysia 104 Challenges for Generic Drugs CHAPTER 2 - POPULATION HEALTH 129 Dengue Control in Malaysia 139 Prevention and Control of Zoonotic Diseases 148 National Influenza Pandemic Preparedness Plan 156 Harm Reduction in the Prevention and Control of HIV/AIDS 160 Suicide Prevention in Malaysia contents CHAPTER 3 - HEALTH SYSTEM MANAGEMENT 177 New Generation Hospital - IT Hospitals 187 Control of Unregistered Drugs and Healthcare Products in Malaysia 195 Information versus Advertising 201 Health Technology Assessment in Malaysia 210 Development and Implementation of Medical Devices Regulation in Malaysia CHAPTER 4 - RESEARCH AND DEVELOPMENT 227 Meeting Outpatient Expectations at Public Hospital Specialist Clinics in Peninsular Malaysia 239 Job Satisfaction Among Staff in Selayang Hospital 252 National Laboratory Biosafety PART 2 261 EDITORIAL COMMITTEE 262 CONTRIBUTORS 264 ACKNOWLEDGEMENT CHAPTER 3 - HEALTH SYSTEM MANAGEMENT New Generation Hospital - IT Hospitals Control of Unregistered Drugs and Healthcare Products in Malaysia Information versus Advertising Health Technology Assessment in Malaysia Development and Implementation of Medical Devices Regulation in Malaysia CHAPTER 4 - RESEARCH AND DEVELOPMENT Meeting Outpatient Expectations at Public Hospital Specialist Clinics in part Peninsular Malaysia Job Satisfaction Among Staff in Selayang Hospital 1 National Laboratory Biosafety CHAPTER 1 HEALTHCARE SERVICE PART 2 CHAPTER 2 POPULATION HEALTH EDITORIAL COMMITTEE CHAPTER 3 HEALTH SYSTEM MANAGEMENT CONTRIBUTORS ACKNOWLEDGEMENT CHAPTER 4 RESEARCH AND DEVELOPMENT part one Healthcare Service 13 EMERGENCY MEDICAL AND TRAUMA CARE SERVICE IN MALAYSIA SUMMARY Emergency medical and trauma care service (EMTS) is a major and important component of hospital care service in the country. The development of the Emergency Medicine as a specialty and the commencement of local Masters Programme in the training of Emergency Physicians in 1998 have helped to improve and upgrade the provision of EMTS in the country. However, much more needs to be done to enhance the quality and level of EMTS in the country, among them, improvements to pre-hospital care service; adequate staffing; enhancing skills and competence of emergency department personnel. Improvements to structure, equipment and work processes as well as adoption of quality standards would further help to upgrade EMTS provided to the public. Introduction Emergency medical and trauma care service (EMTS) is a crucial ED, critical first component of any hospital service, providing 24 hour non-stop point of contact service throughout the year. It is a critical ‘first point of contact’ with patients between healthcare providers and the acutely ill and trauma Epatients where early and appropriate intervention could greatly influence morbidity and mortality of cases coming to the hospital. Therefore, a high level of skill is required for emergency medical personnel to ensure prompt, effective and high quality service is delivered to improve patient outcome. EMTS has seen some new developments over the last 5-10 years, New ED especially with the emergence of our locally trained emergency leadership medicine specialists. The first batch of such specialists graduated in 2003 and since then, almost all state capital hospitals have emergency physicians heading the Emergency Departments. These emergency physicians have provided the leadership for the further development of emergency care service in the country. Healthcare Service 13 A total of 4.409 million attendances at the emergency departments/ ED attendance units were recorded in 2005 of which about 3.5 million were recorded in hospitals in Peninsular Malaysia, 0.5 million in Sabah and another 400,000 attendances in Sarawak. However, a large proportion of the patients seen were not real emergencies but rather, non-emergency acute illnesses. Mission To provide initial, comprehensive and holistic emergency medical and trauma care services in the hospital and pre-hospital settings which include resuscitation, stabilisation and definitive treatment to all patients in need so as to lessen morbidity and reduce mortality in such patients. Objectives The objectives of emergency medical and trauma care service are as follows : i) Providing holistic emergency care with emphasis on technical aspects and corporate culture of professionalism, teamwork and caring service ii) Providing emergency care through skilful emergency medical personnel who meet professional standards. iii) Developing an organisation that emphasis on research and continual professional development Scope and service system The scope of service and the service system offered by the Emergency ED before and Department (ED) were unclear for many years. Emergency now Departments, therefore, became a dumping ground for patients where diagnosis were unclear, as well as for medical officers who have no career plan. This was due to the lack of ‘senior cover’ or specialist overseeing the running of the department. However over the years, this has changed. Emergency service is now recognised as the most important front line service in a hospital, and emergency medicine has gain more respect with its emergence as a specialty. The current scope of service in the Emergency Department are as follows : 14 MALAYSIA’S HEALTH 2005 Healthcare Service 15 i) Pre-hospital care service ( Ambulance ) service This is a first responder service provided by all Ministry of Pre-hospital Health (MOH) hospitals except Hospital Kuala Lumpur where the care service is provided by the St. John’s Ambulance, the Red Crescent Society and the Civil Defence. ii) Emergency medicine This service is the back bone of the EMTS which comprise of holistic Emergency care and comprehensive approach to diagnostic, therapeutic and definitive treatment provided to patients in the emergency department. iii) Emergency medicine specialist service This is provided by emergency physicians who are stationed at the ED. Emergency ED specialist service was started at HKL in 1993 and is now provided specialist care at all state capital MOH hospitals. It will eventually be extended to all the district hospitals with specialist services. iv) Medical observation Providing temporary on-bed monitoring of patients pending decision Observation on admission. These observation bays with beds are only available in the state capital and bigger district hospitals. v) Medical standby Medical cover for special events which are mainly government Medical cover functions involving the Head of State or Government. From time to time, it covers international events hosted by the Government and attended by Heads of States from foreign countries. Some of the major events that had been covered are as follows : • Commonwealth Games (SUKOM ) in 1998 • South East Asia (SEA) Games, 2001 • Non-Aligned Nation Members (NAM) Meeting, 2003 • Organisation of Islamic Countries (OIC) Meeting, 2003 • Association of South East Asian Nations(ASEAN) Summit, 2005 14 MALAYSIA’S HEALTH 2005 Healthcare Service 15 vi) Disaster management This is one of the ‘core business’ of
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