MINISTRY OF HEALTH

NCRC/HSU/2013.1 NATIONAL HEALTHCARE STATISTICS INITIATIVE

EDITED BY: NATIONAL HEALTHCARE Sivasampu S, Arunah C ESTABLISHMENT & Kamilah D, Fatihah M WORKFORCE STATISTICS Goh PP, Hisham AN

HOSPITAL 2011 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

National Healthcare Establishment and Workforce Statistics (Hospital) 2011

September 2013 ©Ministry of Health Malaysia

Published by: The National Healthcare Statistics Initiative (NHSI) National Clinical Research Centre Ministry of Health 3rd Floor, MMA House 124, Jalan 53000 Malaysia

Tel. : (603) 40439300/400 Fax : (603) 40439500 E-mail : [email protected] Website : http://www.crc.gov.my/nhsi/

This report is copyrighted. Reproduction and dissemination of its contents in part or in whole for research, educational or non-commercial purposes is authorized without any prior written permission provided the source is fully acknowledged. The suggested citation is `National Clinical Research Centre. National Healthcare Establishment & Workforce Statistics (Hospital) 2011. Kuala Lumpur 2013.’

This report is also available electronically on the website of the National Healthcare Statistics Initiative at: http://www.crc.gov.my/nhsi/

Funding: The National Healthcare Statistics Initiative was funded by a grant from the Ministry of Health Malaysia (MRG Grant No. NMRR-09-842-4718)

Please note that there is potential for minor corrections of data in this report. Please check the online version at http://www.crc.gov.my/nhsi/ for any amendments.

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Contents

ACKNOWLEDGEMENTS vi

ABOUT NATIONAL HEALTHCARE ESTABLISHMENT AND WORKFORCE SURVEY (NHEWS) – HOSPITAL vii

MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM viii

MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS ix

SUMMARY OF STUDY PROCESS xi

STUDY METHODOLOGY xii

CONSORT DIAGRAM xix Consort Diagram NHEWS 2011 (Acute Curative Hospitals) xix Consort Diagram NHEWS 2011 (Maternity Services) xx Consort Diagram NHEWS 2011 (General Surgery Services) xxi Consort Diagram NHEWS 2011 (Oncology Services) xxii Consort Diagram NHEWS 2011 (Psychiatry Services) xxiii Consort Diagram NHEWS 2011 (Ophthalmology Services) xxiv

ABBREVIATIONS xxv

SYMBOLS xxvi

CHAPTER 1 | OVERVIEW OF HOSPITALS AND SPECIALISTS SERVICES IN MALAYSIA 1

CHAPTER 2 | ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA 5 Table 2.1 Hospitals Providing Acute Curative Care 7 Table 2.2 Types of Hospitals Establishment Providing Acute Curative Care 8 Table 2.3 Different Types of Private Hospital’s Entrepreneurship 9 Table 2.4 Inpatient beds 10 Table 2.5 Operating theatre (OT), Operating Rooms (ORs) and Functioning ORs 11 Table 2.6 Doctors and Patients Admission 12 Table 2.7 Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Turnover Interval (TOI) 13 Table 2.8 Average Length of Stay (ALOS) by Acute Hospital Type 14 Table 2.9 Bed Occupancy Rate (BOR) 15 Table 2.10 Turnover Interval (TOI) by Acute Hospital Type 16 Table 2.11 Hospital Doctors, Staff Nurses (with and without Post Basic Training) 17 Table 2.12 Community Nurses and Assistant Nurses 18 Table 2.13 Assistant Medical Officers (AMO) 19 Table 2.14 Pharmacists, Physiotherapists, Occupational Therapists, and Dieticians 20 Table 2.15 Medical Record Officers and Medical Social Officers 21 Table 2.16 Computed Tomography (CT) Scanners and Rate of CT scan Procedures 22 Table 2.17 Magnetic Resonance Imaging (MRI) and Rate of MRI Procedures 23 Table 2.18 Positron Emission Tomography (PET) and Rate of PET Procedures 24 ii NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CHAPTER 3 | MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES 25 Table 3.1 Hospitals Providing Maternity Services 28 Table 3.2 Functioning Delivery Beds 29 Table 3.3 Dedicated OT Facilities and Functioning ORs 30 Table 3.4 Functional Obstetric High Dependency Unit (HDU) Beds 30 Table 3.5 Total Deliveries 31 Table 3.6 Spontaneous Vertex Deliveries (SVD) 32 Table 3.7 Vaginal Breech Deliveries 33 Table 3.8 Instrumental Deliveries using Vacuum 34 Table 3.9 Instrumental Deliveries using Forceps 35 Table 3.10 Caesarean Surgeries 36 Table 3.11 Lower Segment Caesarean Section (LSCS), Caesarean Hysterectomy and Hysterotomy 37 Table 3.12 Multiple Pregnancies Deliveries 38 Table 3.13 Eclampsia 39 Table 3.14 Post Partum Haemorrhage (PPH) 40 Table 3.15 Newborns Delivered & Admitted to Paediatrics, NICU & SCN 41 Table 3.16 Obstetrics & Gynaecology (O&G) Specialists and Medical Officers 42 Table 3.17 Staff Nurses and Community Nurses in O&G services 43 Table 3.18 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Obstetric Ward) 44 Table 3.19 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Labour Ward) 44 Table 3.20 Staff Nurses with Midwifery and Community Nurses (Public Hospitals Obstetric HDU) 45

CHAPTER 4 | SURGICAL SERVICES IN MALAYSIAN HOSPITALS 47 Table 4.1 Hospitals Providing General Surgery Services 49 Table 4.2 Total Surgeons, Operation Theatre (OT) and Theatre Scrub Nurses 50 Table 4.3 Dedicated Emergency/Trauma Theatres (Public Hospitals) 51 Table 4.4 General Surgeons and Total Elective Operating Hours (Public Hospitals) 51 Table 4.5 Elective Cases in General Surgery (Public Hospitals) 52 Table 4.6 Emergency Cases in General Surgery (Public Hospitals) 52 Table 4.7 Mastectomies 53 Table 4.8 Total, Open and Laparoscopic Inguinal Hernia Surgeries 54 Table 4.9 Total, Open and Laparoscopic Cholecystectomies 55 Table 4.10 OGDS Scopes and OGDS Cases by Surgical and Medical Specialists (Public Hospitals) 56 Table 4.11 OGDS Scopes and OGDS Cases (Private Hospitals) 56 Table 4.12 Colonoscopes and Colonoscopy Cases by Surgical and Medical Specialists (Public Hospitals) 57 Table 4.13 Colonoscopes and Colonoscopy Cases (Private Hospitals) 57 Table 4.14 ERCP Scopes and ERCP Cases by Surgical and Medical Specialists (Public Hospitals) 58 Table 4.15 ERCP Scopes and ERCP Cases (Private Hospitals) 58 Table 4.16 OGDS Scopes, Colonoscopes and ERCP Scopes 59 Table 4.17 Theatre Scrub Nurses 60 Table 4.18 General Surgeons and Anaesthesiologists 61 Table 4.19 Breast Surgeons, Breast and Endocrine Surgeons 62 Table 4.20 Vascular Surgeons, Hepatobiliary Surgeons, and Colorectal Surgeons 63

CHAPTER 5 | ONCOLOGY SERVICES IN MALAYSIAN HOSPITALS 65 Table 5.1 Hospitals Providing Oncology Services 67 Table 5.2 Hospitals Providing Oncology Services (with and without Oncologist) 68 Table 5.3 Clean Room for Reconstitution of Cytotoxic Drugs 69 Table 5.4 Hospitals Providing Cytotoxic Drug Reconstitution (CDR) Services 70 Table 5.5 Chemotherapy Day Care Services, Chemotherapy Beds and Chairs 71 Table 5.6 Oncologists 72 Table 5.7 Oncology Trained Nurses, Radiation Therapists and Physicists 73 Table 5.8 Megavoltage Machines, Brachytherapy Machines and Simulators 74 Table 5.9 Physics Equipment and Treatment Planning System Devices 75 Table 5.10 Equipment Capable of Carrying Out Intensity Modulated Radiotherapy (IMR), Image Guided Radiotherapy (IGRT) & Stereotactic Procedure 76

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CHAPTER 6 | PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS 77 Table 6.1 Hospitals Providing Psychiatry Services 80 Table 6.2 Inpatient Dedicated Beds and Functioning Inpatient Dedicated Beds 81 Table 6.3 Inpatient Psychiatry Admissions, Dedicated Beds and Mean Bed Occupancy Rate 82 Table 6.4 Follow up Outpatient Visits, New Cases and Referrals from Wards or Emergency Department 83 Table 6.5 Community Psychiatric and Psychiatric Rehabilitation Services (Public Hospital) 84 Table 6.6 Hospital Visits with Patients below 18 Years Old and above 60 Years Old 85 Table 6.7 Methadone Replacement Therapy (MRT) Services & Total MRT Patients (Public Hospital) 86 Table 6.8 ECT Machines and Procedures 89 Table 6.9 Psychiatrists 88 Table 6.10 Clinical Psychologists 89 Table 6.11 Counsellors in Psychiatry Services (Full Time and Common User) 90 Table 6.12 Medical Social Workers in Psychiatry Services (Full Time and Common User) (Public Hospital) 91 Table 6.13 Nurses in Psychiatry 92 Table 6.14 Assistant Medical Officers in Psychiatry Service (Public Hospital) 93

CHAPTER 7 | OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS 95 Table 7.1 Hospitals Providing Ophthalmology Services 97 Table 7.2 Dedicated Ophthalmology Operating Rooms (ORs) (Public Hospitals) 98 Table 7.3 Ophthalmology Elective Operating Hours (Public Hospitals) 98 Table 7.4 Cataract Surgery (Day care and Inpatient) 99 Table 7.5 Glaucoma Surgery (with and without Implant) 100 Table 7.6 Vitreoretinal Surgeries 101 Table 7.7 Ophthalmologists 102 Table 7.8 Optometrists 103 Table 7.9 Assistant Medical Officers (AMOs) in Ophthalmology Services (Public Hospital) 104 Table 7.10 Nurses in Ophthalmology Services (Public Hospital) 104 Table 7.11 Ophthalmology Devices 105

APPENDICES 107

APPENDIX 1 | LIST OF DEFINITIONS 109 Chapter 2 : Hospital 109 Chapter 3 : Obstetrics 112 Chapter 4 : General Surgery 113 Chapter 5 : Oncology 114 Chapter 6 : Psychiatry 116 Chapter 7 : Ophthalmology 117

APPENDIX 2 | PARTICIPANTS FOR NHEWS (HOSPITAL) 2011 119 Hospital Sector: Public/ Ministry Of Health 119 Hospital Sector: Public/ Ministry Of Health/Psychiatric Institution 120 Hospital Sector: Public/ University 121 Hospital Sector: Public/ Jabatan Kemajuan Orang Asli 121 Hospital Sector: Private 122 Hospital Sector: Private/ Maternity Homes 123

APPENDIX 3 | MALAYSIAN POPULATION, 2011 125 Table A3.1 Total Population by State, Malaysia 2011 125 Table A3.2 Total Population of Females by State, Malaysia 2011 125 Table A3.3 Number of Live Births by State, Malaysia 2011 126 Table A3.4 Total Population Under 19 Years Old by State, Malaysia 2011 126 Table A3.5 Total Population above 60 Years Old by State, Malaysia 2011 127

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APPENDIX 4 | DATA QUALITY STATEMENT 129

APPENDIX 5 | SURVEY PROFILES & RESPONSE RATE 133 Chapter 2: Hospital Services in Malaysia 133 Chapter 3: Maternity Services in Malaysian Hospitals and Maternity Homes 135 Chapter 4: Surgical Services in Malaysian Hospitals 137 Chapter 5: Oncology Services in Malaysian Hospitals 139 Chapter 6: Psychiatric Services in Malaysian Hospitals 141 Chapter 7: Ophthalmology Services In Malaysian Hospitals 143

APPENDIX 6 | MEDICAL SUBSPECIALTIES 145 Table A6.1 Anaesthesiologists, Emergency Medicine Specialists and Paediatricians 145 Table A6.2 Internal Medicine and Infectious Diseases Specialists 146 Table A6.3 Nephrologists and Endocrinologists 147 Table A6.4 Cardiologists and Respiratory Medicine Specialists 148 Table A6.5 Hepatologists and Gastroenterologists 149 Table A6.6 Clinical Haematologists 150 Table A6.7 Neurologists and Rheumatologists 151 Table A6.8 Geriatric Medicine Specialists 152

APPENDIX 7 | OTHER SPECIALTIES IN MEDICINE 153 Table A7.1 Cardiothoracic and Paediatric Surgeons 153 Table A7.2 Plastic and Reconstructive Surgeons 154 Table A7.3 Neurosurgery and Urology Specialists 155 Table A7.4 Orthopaedic Surgeons and Sport Medicine Specialists 156 Table A7.5 Radiologists and Nuclear Medicine Specialists 157 Table A7.6 Pathologists and Forensic Pathologists 158 Table A7.7 Rehabilitation Medicine Specialists and Otorhinolaryngologists 159

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ACKNOWLEDGEMENTS

The National Healthcare Statistics Initiative team would like to thank the Director General of Health Malaysia for his continuous support towards this survey and permission to publish the report.

Also, our sincere appreciation to the following for their participation, assistance, support and contributions:

• Deputy Director General of Health (Research and Technical Support), MOH

• Deputy Director General of Health (Medical), MOH

• Deputy Director General of Health (Public Health), MOH

• Director, National Clinical Research Centre (NCRC), National Institutes of Health (NIH)

• Director, Medical Development Division, MOH

• Director, Medical Practice Division, MOH

• Health Informatics Centre, MOH

• Private Medical Practice Control Section (National level)

• Private Medical Practice Control Unit (State level)

• The Association of Private Hospitals of Malaysia (APHM)

• All participating public, private and university hospitals which provided or allowed access to their establishment and workforce data.

• KPJ Healthcare Berhad

• Pantai Holdings Berhad

• Columbia Asia Sdn Bhd

• Malaysian Medical Council, Association of Private Hospitals of Malaysia, Obstetrical & Gynaecological Society of Malaysia, Malaysian Psychiatric Association, Malaysian Oncological Society

• Head of Clinical Services, MOH

• Members of NHEWS (Hospital) Expert Panels

• All medical doctors and support personnel who participated in the NHEWS (Hospital)

• All those who have supported or contributed to the success of the NHEWS (Hospital) and publication of this report

Thank you.

National Healthcare Statistics Initiative (NHSI) Ministry of Health Malaysia

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ABOUT NATIONAL HEALTHCARE ESTABLISHMENT AND WORKFORCE SURVEY (NHEWS) – HOSPITAL

Background

The National Healthcare Establishment and Workforce Survey (NHEWS) – Hospital is an initiative to gather information on the Hospital establishment and specialty clinical services, facilities, workforce and the medical devices available in the country. This survey covers all acute curative hospitals and related specialty services within the public and private settings.

The rationale for this survey was to gather the relevant information that would be important for the country to develop an accurate and robust capacity for evaluating, monitoring and implementing its healthcare policies.

Objectives

General Objective

To document the availability and distribution of the healthcare facilities, services, workforce and devices in the country.

Specific Objectives • To estimate the number and density of hospital or related healthcare establishments and specialty service in Malaysia by geographical area • To establish trends in these services through continuous, consistent and reliable data collection

The NHSI data was collected based on the key user needs for local health service research. Other users should understand that the inclusion and exclusion criteria, service and data definitions used in this report may differ from other sources. Therefore, any interpretation or comparison should be made with caution. The Health Informatics Centre, Ministry of Health Malaysia is the official source of Health data in the country. Harmonization of health data for the purpose of International comparisons should preferably be obtained from this official source.

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MEMBERS OF NHEWS (HOSPITAL) PROJECT TEAM

PRINCIPAL INVESTIGATOR DATUK DR. NOOR HISHAM ABDULLAH

DR. SHEAMINI SIVASAMPU PRINCIPAL CO-INVESTIGATORS DR. GOH PIK PIN

DATO’ DR. NOORAINI BABA

CO-INVESTIGATORS DR. MD KHADZIR SHEIKH AHMAD

MR. ZAMANE ABDUL RAHMAN

DR. LAILI MURNI MOKHTAR PROJECT LIASON OFFICERS DR. AFIDAH ALI

DR. TAHRANI PERIANA KOVINDEAR

PROJECT MANAGERS DR. ARUNAH CHANDRAN

DR. FOO CHEE YOONG (JAN 2013 – PRESENT)

MS. FAIZAH AHMAD

SURVEY COORDINATORS MS. KAMILAH DAHIAN

MRS. FATIHAH MAHMUD

STATISTICIAN MS. LENA YEAP LAY LING

DATABASE DEVELOPER/ADMINISTRATOR ALTUS SOLUTIONS SDN. BHD.

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MEMBERS OF NHEWS (HOSPITAL) EXPERT PANELS

HOSPITAL SERVICES EXPERT PANEL INSTITUTION Datin Dr. Nor Akma Yusuf Medical Development Division, Ministry of Health Dato’ Dr. Hjh. Juita Ghazalie Hospital Sultanah Bahiyah, Alor Setar Dr. Siti Zaleha Mohd Salleh Hospital Selayang Dr. Laili Murni Mokhtar Medical Development Division, Ministry of Health Dr. Khalid Ibrahim Hospital Sungai Buloh Dr. Farique Rizal Abd Hamid Hospital Sultanah Bahiyah, Alor Setar Matron Hjh. Rosena Abdul Ghani Nursing Division, Ministry of Health Dr. Sheamini Sivasampu National Clinical Research Centre, Ministry of Health Mrs. Fatihah Mahmud National Clinical Research Centre, Ministry of Health

MATERNITY SERVICES EXPERT PANEL INSTITUTION Dr. Ravichandran Jeganathan Hospital Sultanah Aminah, Bahru Dato’ Dr. Ravindran Jegasothy Hospital Kuala Lumpur Dr. Sharmini Diana Parampalam Hospital Seberang Jaya Dr. Shamala Devi Karalasingam National Clinical Research Centre, Ministry of Health Dr. Arunah Chandran National Clinical Research Centre, Ministry of Health Ms. Faizah Ahmad National Clinical Research Centre, Ministry of Health

SURGICAL SERVICES EXPERT PANEL INSTITUTION Dato’ (Mr.) Abdul Jamil Abdullah Hospital Sultanah Nur Zahirah Mr. Andrew Gunn Kean Beng Hospital Sultanah Aminah, Johor Bahru Dato’ (Mr.) Wan Khamizar Wan Khazim Hospital Sultanah Bahiyah, Alor Setar Dato’ (Mr.) Jiffre Din Hospital Tengku Ampuan Afzan, Kuantan Dato’ (Mr) Mohamed Yusof Abd. Wahab Hospital Tengku Ampuan Rahimah, Klang Mr. Tan Wee Jin Hospital Pulau Pinang Mr. Nik Azim Nik Abdullah Hospital Umum Mr. Yan Yang Wai Hospital Raja Permaisuri Bainun, Mr. Chuah Jitt Aun Hospital Queen Elizabeth, Kota Kinabalu Mr. Clement Edward Thaumanavar Hospital Tuanku Fauziah, Kangar Mr. Nik Mohamad Shukri Nik Yahya Hospital Raja Perempuan Zainab II, Kota Bharu Ms. Jasiah Zakaria Hospital Tuanku Jaafar, Seremban Dr. Tahrani Periana Kovindear National Clinical Research Centre, Ministry of Health Ms. Faizah Ahmad National Clinical Research Centre, Ministry of Health

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ONCOLOGY SERVICES EXPERT PANEL INSTITUTION Dr. Gerard Lim Chin Chye Hospital Kuala Lumpur Assoc. Prof. (Clinical) Dato’ Dr. Fuad Ismail Universiti Kebangsaan Malaysia Medical Center Dr. Nellie Cheah Hospital Pulau Pinang Dr. Nik Muhd. Aslan Abdullah Universiti Kebangsaan Malaysia Medical Center Dr. Lau Kah Liew Hospital Kuala Lumpur Mdm. Lim Yeok Siew Hospital Ampang Dr. Hafizah Zaharah Ahmad Hospital Kuala Lumpur Mdm. Sarah Lee Abdullah Hospital Kuala Lumpur Dr. Foo Chee Yoong National Clinical Research Centre, Ministry of Health Ms. Kamilah Dahian National Clinical Research Centre, Ministry of Health

PSYCHIATRY SERVICES EXPERT PANEL INSTITUTION Dr. Toh Chin Lee Hospital Selayang Dr. Lim Chong Hum Hospital Ampang Dr. Khairuddin Abdul Wahab Hospital Melaka Dr. Azizul Awaluddin Hospital Putrajaya Dr. Siti Nor Aizah Ahmad Hospital Kuala Lumpur Dr. Chee Kok Yoon Hospital Kuala Lumpur Dr. Rahima Dahlan @ Mohd Shafie Hospital Kajang Dr. Ong Lieh Yan Hospital Bahagia, Ulu Kinta Mrs. Fatihah Mahmud National Clinical Research Centre, Ministry of Health

OPHTHALMOLOGY SERVICES EXPERT PANEL INSTITUTION Dr. Elias Hussien Hospital Selayang Dr. Anusiah K. Selvaathurai Hospital Melaka Dr. Mariam Ismail Hospital Selayang Dr. Chandramalar T. Santhirathelagan Hospital Sungai Buloh Dr. Norlaila Talib Hospital Serdang Dr. Thayanithi K. Sandragasu Hospital Kuala Lumpur Dr. Arunah Chandran National Clinical Research Centre, Ministry of Health Ms. Kamilah Dahian National Clinical Research Centre, Ministry of Health

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SUMMARY OF STUDY PROCESS

CRF Development and Pilot Test

Survey P opulation

Hospital Induction and CRF Distribution Q

U

Data Collection and Data Entry

E

R

Data Cleaning, Verification and Standardisation I

E

Data Analysis S

Report / Manuscript Writing

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STUDY METHODOLOGY

Survey Population Framework Development

To determine the total hospitals and related healthcare establishment population, we first matched the records of the hospitals in the existing National Healthcare Establishment and Workforce Survey (NHEWS) Hospital database against the independent databases of the Private Medical Practice Control Division (private hospitals), and Medical Development Division, MOH (public hospitals). Both, the matched and unmatched records were then reviewed by the NHEWS team. Verification was conducted by contacting each unmatched site to confirm their operational status and establishment details as of 31st December 2011. These processes were performed for both the private and public hospital list. All verified changes were updated to our database (Figure 1).

Figure 1 Process of Determining the Total Hospitals, Maternity Homes and Psychiatry Institutions Population

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The NHEWS 2011 survey collected data from all related healthcare establishments in Malaysia that fulfilled the criteria and definition relevant to the specific survey as shown below:

Table 1 Inclusion and Exclusion Criteria of the Respective Surveys Survey Inclusion criteria Exclusion criteria Acute Curative Hospital All general and specialized hospital providing ● Aboriginals (Orang Asli) Hospital acute curative care ● Military hospitals ● Hospital units of institution, such as prison hospitals ● NGO hospitals ● Long term care hospitals e.g. rehabilitation and palliative care, nursing homes, leprosy centres and psychiatric institutions ● Hospitals that were non-operational in 2011 General Surgery Services All hospitals providing general surgical services Independent, stand-alone general surgery centres Ophthalmology Services All hospitals providing ophthalmology services Independent, stand-alone eye clinics or day surgery centre Maternity Services All hospitals providing maternity services. Public health clinics that conduct deliveries All maternity homes Psychiatry Services All hospitals providing psychiatry services. Stand alone psychiatric clinics All public psychiatric institutions Oncology Services All hospitals providing basic oncology services

Table 2 Definition of Specialty Services Service Definition Remarks General Surgical Services Services provided by permanent/ resident ● Include general, breast & endocrine, upper gastrointestinal, or visiting general surgeons with procedures colorectal, vascular, hepatobilliary, trauma and thoracic performed within the establishment surgeries ● Exclude paediatric, plastic, urology, neurosurgery and cardiothoracic surgeries Ophthalmology Services Services provided by permanent/ resident or visiting ophthalmologist with procedures performed within the establishment Obstetric Services Not specified Psychiatry Services Services headed by a permanent/ resident psychiatrists Oncology Services Services provided by permanent/ resident and Exclude services provided by haematologists and paediatric visiting medical or clinical oncologists, surgeons oncologists or respiratory physicians with a special interest in oncology, including hospitals that deliver basic chemotherapies

Note: List of data definitions used in this survey are included in Appendix 1.

The total number of the establishments (included and excluded) in the study is summarised in Table 3. Table 3 Summary of Total Number of Healthcare Establishment by Category Total Number Number of Hospitals Hospitals by Sector Category of Healthcare Establishment in the Population Included in the Study Public Acute Curative Hospitals Ministry of Health 131 131 University 3 3 Aboriginals 1 0 Psychiatric Institutions 4 4 Private Acute Curative Hospitals (General) 124 124 Single Specialty 11 11 Maternity Homes 70 70

Note: Hospitals excluded from the study are available in Consort Diagram NHEWS Hospital 2011.

Details of hospitals that participated in NHEWS hospital survey are available in Appendix 2.

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Survey Structure

NHEWS 2011 comprised one main and 5 sub-surveys (Figure 2). The Acute Curative Hospitals survey was the main survey that provided the population framework. Maternity homes and psychiatric institutions were included only for the specific service surveys. General Surgical, Ophthalmology and Oncology surveys were conducted using a specific subset of the total hospital population that provides for the specific services.

NHEWS 2011

Acute Curative Hospitals Survey (n=339)

Maternity Maternity Services Survey Services Survey (n=317) (n=26) Survey (Hospitals) (Maternity Homes) Maternity Services

General Surgery Services Survey (n=166) (Hospitals) Services Survey General Surgery

Psychiatry Psychiatry Services Survey Services (n=90) Survey (n=4) (Psychiatric Psychiatry (Hospitals) Institutions) Services Survey

Opthalmology Services Survey (n=98)

Opthalmology (Hospitals) Services Survey

Oncology Services Survey (n=98) Oncology (Hospitals) Services Survey

Figure 2 NHEWS (Hospital) 2011 Survey Structure

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Case Report Form (CRF) Development and Pilot Testing

The CRF was developed by the NHEWS project team with input from the respective NHEWS expert panels. Separate sets of CRFs were developed for the public and private sector because of their different practices and administrative structures.

Variables were grouped by sections based on their establishment details, facilities, activities and services, workforce and medical device. Two different types of CRF were developed, Printed and Online. English and Malay versions of the CRF were available for the main hospital survey. However, only the English version of CRF was used for the specialty services survey. This is to cater for the English literacy among the respondents for the specialty services; they were most likely to be doctors or nurses and they would not have problems understanding the the CRF in English.

Definitions of services were stated at the beginning of the general surgery, ophthalmology and oncology survey forms to ensure a more accurate and consistent response since these services are generally poorly defined.

Suitable respondents for certain specialty services were selected from the responding establishment to improve on the reliability of the data. These included obstetrics, general surgery and psychiatry service survey. This was based on our experiences from the two previous cycles where, general support staff had shown difficulty in understanding the survey content and providing reliable answers.

Additional feature of historical consistency references was available for respondents who submitted an online CRF upon request. This was designed to assist in the consistency of data.

A process of verification was incorporated into the CRF: Information on the person who coordinates or completes the survey was first obtained. This was followed by a verification of the information by the CEO or the relevant Department heads and with their signature incorporated.

Specified text boxes were provided for each question on both of the survey forms. The online forms had incorporated automated validation rules that applied directly at time of data entry. No data could be submitted if it did not pass the validation rules. Units of certain answers (e.g. in days, %) were also specified. Answers marked “to be auto calculated” required no input from the respondent.

Lists of the definition of terms and specialty code (for workforce list) were provided at the end of each survey form, and arranged by sections.

The CRFs were pilot-tested with the Person-In-Charge (PIC) of the respective services. Revisions and improvements were then made to the form accordingly. Lists of definitions used in this survey are included in Appendix 1 of this report.

CRF Distribution

Induction of MOH hospitals was undertaken by briefing the hospital directors or representatives first.

The following documents were distributed to them and in their respective hospitals:

● Survey instruction manual

● An endorsement letter from the State Health Directors (for public hospital) or Association of Private Hospital Malaysia (APHM)

● Username and password access details for electronic CRF

● NHEWS 2010 hospital report

The induction session began with a presentation by a NHEWS hospital team member with a brief overview on the project and the aims of the survey. This was followed by a demonstration on how to fill in the paper and electronic CRFs. Hospitals that were not represented at the induction meeting were contacted and briefed later by phone and the survey instrument sets were delivered to them by post.

For private hospitals, the induction was done by sending a compilation of self-explanatory documents to the hospital’s highest authority e.g. CEO. An endorsement letter by the Association of Private Hospitals Malaysia (APHM) was attached. Follow-up calls were made to each private hospital to ensure the documents were received.

Hospital representatives were given 2 weeks to complete and submit CRFs. Non responders after this period were contacted and reminded, and their progress monitored.

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Data Collection

Respondents had the option to choose between two modes of data submission which included:

1. Paper data submission via hardcopy Case Report Form (Printed CRF) 2. Electronic data submission via web application (eCRF)

The processed datasets of the list of doctors for each hospital were pre-uploaded to the online eCRFs to minimize the need for manual data entry. These datasets were obtained from record matches on the doctor workforce from the previous year’s NHEWS survey against the databases of Malaysian Medical Council, National Specialist Register (NSR) and Medical Development Division (MDD). The edited list was then sent to the corresponding heads of services in the MOH or other related authorized personnel for verification.

Data Entry

Data from paper submissions were checked manually and reviewed for their completeness and logical consistency before data entry by trained members. Data entry through eCRF was submitted directly into the NHEWS database and monitored in real-time basis. Quality of data entry was constantly checked and maintained by several built-in features such as a compulsory data checking function, consistency checks, auto calculations and auto default data from the previous year’s survey. Activities performed in the database were recorded by a built-in tracking system. Historical consistency check was used for repeated variables.

Data Processing

Data cleaning was performed in parallel with data entry and based on the results of edit checks. An edit check is a checking procedure for tracing doubtful data being entered. The editing was performed by NHEWS team members who were familiar with hospital settings. Any queries were then attended to by contacting the data entry personnel or any authorised representative at the participant’s site to seek further clarification or verification.

Exploratory data analysis was performed before database locking to ensure that the data was acceptable for analysis. Data duplication, range and consistency checks were done to detect outliers and data that deviated; these procedures were undertaken with the source data providers. In cases where the data was not verifiable with the source, cross checks were done against other sources such as the Health Information Management System Reports, Malaysian Medical Council Doctor Database, professional societies, National Specialist Register and Registry Central Surveys.

Statistical and Estimation Procedures

NHEWS uses the census of all hospitals and related establishments from the Medical Development Division and the Private Healthcare Registration and Enforcement Unit (CKAPS) to derive its estimates of the total facility, devices, activity and workforce of related healthcare services within the country. As participation is voluntary, non-response was anticipated and two sources of non-response were accounted for:

Unit non-response – occured as a result of the healthcare establishment not responding to the survey. Item non-response – occured as some respondents returned partially completed survey forms.

A survey unit will be considered as non-response if the item non-response exceeds 50% of the total questions. Imputation techniques were used to account for item non-response and weighting for unit non-response.

Imputation: Estimating Item Non-Response

The imputation process consists of 2 stages. First, the missing values are imputed with reasonable assumptions (Logical/ Conditional Imputation). For example, hospitals without CT scans will have zero CT imaging performed. Similarly, it is assumed that centres without operating microscopes do not perform any cataract surgery.

The remaining missing values after logical and conditional imputation is further accessed for its suitability of other imputation techniques. Regression imputation is used in cases where the proportion of missing values is less than 5% of the total. One fundamental assumption of missing data imputation is that respondent and non-respondent share similar characteristics.

Weighting: Estimating Unit Non-Response

Each survey unit will be assigned a weight in order to provide a population estimate of each variable while compensating for the missing value of unit non-response. The weight is calculated by dividing the population number to respondent number in a stratified manner based on characteristics that are known for the whole population. These characteristic variables include state, sector, and year of establishment, type of establishment, bed and staff strength, obtained from the above mentioned census. Each chapter of non-response weight is calculated separately as different health services differ in terms of their non-response and overall population characteristics. This procedure also assumes similar characteristics of both respondents and non-respondents. xvi NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Estimates of the Total Number of the Device/ Activity/ Facility/ Workforce (T)

Where: th Ti is the number of device/ activity/ facility/ workforce available in the i facility in the year,

th Wi is the calculated weight of the i facility

Limitation of the Estimating Procedures

NHEWS is a census survey because all in-scope Malaysian Hospitals and related healthcare establishments of study were given the survey forms. However, because response is not mandatory, there will be a significant level of “respondent-bias” in the data. Because of this non-random response in our survey, standard errors are not a suitable means of gauging variability.

The fundamental purpose of imputation and weighting is to adjust for bias in the responding units and produce estimates. However, these procedures can only account for and adjust to known population characteristics. If information for a variable is not known for the whole population, the adjustment process will not be possible.

Furthermore, as mentioned above, assumptions of the similarity of respondent and non-respondent in terms of their population characteristics is made when imputation and weighting is used to derive estimates. Thus, if the assumption is wrong i.e. non-respondents are different from respondents, then the estimates will have a certain degree of bias. The level of bias in the estimates will not be quantifiable without a further study of the non-respondents.

List of Formula

Facilities, devices, activities and workforce of related healthcare establishment and services are expressed as an absolute count by state, sector and year.

Turnover interval (TOI) is calculated as:

Where: B is number of inpatient beds N is number of inpatient admissions ALOS is average length of stay

The densities of hospitals and respective healthcare services are calculated as follows:

Number of hospitals and healthcare services details/ 10,000 population =

Number of hospitals and healthcare services details/ million population =

Where: T is an estimate of the total quantity of the variable available in the country in the year under consideration. P is the midyear population of Malaysia or the relevant geographic region where the survey was conducted.

xvii NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

For maternity services:

Number of hospitals and healthcare services details/ 10,000 female population =

Where: T is an estimate of the total quantity of the variable available in the country in the year under consideration. P is the midyear female population of Malaysia or the relevant geographic region where the survey was conducted.

Number of hospitals and specialist services details/ 100 deliveries =

Number of hospitals and specialist services details/ 1,000 deliveries =

Where: T is an estimate of the total quantity of the variable available in the country in the year under consideration. P is the total obstetric deliveries of Malaysia or the relevant geographic region where the survey was conducted.

Details of the Malaysian population statistics for 2011 by state are available in Appendix 3.

Data-Set Finalisation and Locking

All processed data were reviewed by the project team and all members of the expert panel to ensure validity and accuracy before the finalization. The decision to lock the data-set was made by the project team only after the finalization. No further amendments to the data-set were allowed except for errors supported by valid evidence as determined by the project team and/or expert panel. All amendments of data-set, if any, must be approved by the co-investigator(s).

Data Security

The NHEWS hospital data collection was authorized under the Private Healthcare Facilities and Services Act 1998. However, participation was voluntary. Data collected in the NHEWS survey is regulated by the Personal Data Protection Act 2010 where applicable. All information collected is held in the strictest confidence and according to legal and research ethics guidelines.

Data Quality

A full description of data quality of the data set is contained in Appendix 4.

xviii NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CONSORT DIAGRAM NHEWS 2011 (ACUTE CURATIVE HOSPITALS(a))

Total number of hospitals in Malaysia Losses (Closed premise), n = 4 n = 353 1. Establishments ceased operations = 2

a. Multimedic Specialist & Maternity Centre

b. Hope Children Hospital – Farlim Number of hospitals (operational) 2. Establishment changed from Hospital n = 349 to Maternity Home =2 a. Pusat Rawatan Mahsuri b. Klinik Wanita Nara Public Private University n = 138 n = 208 n = 3

Ministry of Health Aboriginals (JAKOA) n = 137 n = 1

Excluded, n = 6(b) 1. Zero beds, n = 1 Excluded, n = 1 Excluded, n = 3 a. Hospital Tuaran 1.Chronic (curative) care(b), n = 1 1. Chronic (curative) care(b), n = 2 2. Chronic (curative) care(b), n = 5 a. Hospital Kemajuan Orang Asli a. Columbia Asia Extended a. Leprosy, n = 1 Care Hospital – Shah Alam i. Rajah Charles Brooke b. Pudu Specialists Centre Memorial Hospital 2. Fertility centre = 1 b. Psychiatry, n = 4 a. TMC Women’s Specialist (Kuantan) Sdn. Bhd. i. Hospital Mesra Bukit Padang ii. Hospital Bahagia Ulu Kinta iii. Hospital Permai iv. Hospital Sentosa

Included Included Included

n = 131 n = 205 n = 3

Total in-scope hospitals n = 339

(a) Acute Curative Hospital ALOS<10 days Analysis (b) Chronic Curative Hospital ALOS≥10 days

Note: List of new hospitals in 2011, n = 8: Ministry of Health 1. Hospital Queen Elizabeth II Private 2. Columbia Asia Extended Care Hospital – Seremban 3. Columbia Asia Hospital – Cheras 4. Darul Makmur Medical Centre Sdn Bhd 5. iHeal Medical Centre Kuala Lumpur 6. Pusat Perubatan UniKL-RCMP 7. Bintulu Medical Centre 8. Sethu Medical Centre

Abbreviation: JAKOA – Jabatan Kemajuan Orang Asli (Aboriginals Hospital) xix NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CONSORT DIAGRAM NHEWS 2011 (MATERNITY SERVICES)

NHEWS 2011 (Maternity Services) n = 348

Ministry of Health & University Private n = 133 n = 212

Hospital Hospital Maternity Centre Maternity Home n = 133 n = 119 n = 69 n = 27

Losses, n = 2 Status changed from hospital to maternity homes a. Pusat Rawatan Mahsuri b. Klinik Wanita Nara

Losses, n = 1

Establisments ceased operations Losses, n = 1 a. Multimedic Specialist & Establishments closed operations Maternity Centre a. Asia Maternity Homes

Excluded, n = 1 Excluded, n = 2 No admissions 1. Zero beds a. Helen Ngu Women Hospital a. Joe Medical Centre - Pandan Jaya b. Joe Medical Centre - Pandan Indah

Included Included Included Included

n = 133 n = 119 n = 65 n = 26

Total In-scope Establishment with Maternity Services n = 343

Analysis

Note:

List of new private hospitals with maternity services in 2011, n = 2:

1. Pusat Perubatan UniKL-RCMP

2. Darul Makmur Medical Centre

List of new maternity centre in 2011, n = 1:

1. Sethu Medical Centre xx NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CONSORT DIAGRAM NHEWS 2011 (GENERAL SURGERY SERVICES)

NHEWS 2011 (General Surgery Services) n = 169

Private Public n = 109 n = 60

Excluded, n = 3 Provide only consultation a) Klinik Bersalin Yasmin b) Sentul Medical Centre c) Hospital Pusrawi SMC MOH Non-Specialist MOH Specialist University Included Hospital Hospital Hospital n = 106 n = 7 n = 50 n = 3

Included Included Included n = 7 n = 50 n = 3

Total In-scope Establishment with General Surgery Services n = 166

Analysis

Abbreviation: MOH – Ministry of Health

xxi NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CONSORT DIAGRAM NHEWS 2011 (ONCOLOGY SERVICES)

NHEWS 2011 (Oncology Services) n = 58

Private Public n = 27 n = 31

MOH Specialist University Hospital Hospital n = 28 n = 3

Included Included Included n = 27 n = 28 n = 3

Total In-scope Establishment with Oncology Services n = 58

Analysis

Note: List of hospitals included in 2011 survey but not in 2010 survey due to the difference in the definition of inclusion criteria, n = 3: 1. Hospital Sandakan 2. Hospital Tawau 3. Hospital Selayang

Abbreviation: MOH – Ministry of Health

xxii NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CONSORT DIAGRAM NHEWS 2011 (PSYCHIATRY SERVICES)

NHEWS 2011 (Psychiatry Services) n = 94

Private Public n = 45 n = 49

University MOH Psychiatry Acute Curative Hospital Institution Psychiatry Hospital n = 3 n = 4 n = 42

Included Included Included Included Hospital n = 45 n = 3 n = 4 n = 42

Total In-scope Establishment with Psychiatry Services n = 94

Analysis

Abbreviation: MOH – Ministry of Health

xxiii NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CONSORT DIAGRAM NHEWS 2011 (OPHTHALMOLOGY SERVICES)

NHEWS 2011 (Ophthalmology Services) n = 102

Private Public n = 63 n = 39

Excluded, n = 3 Provide only consultation(a) a) Perdana Specialist Hospital MOH Specialist University b) Kota Bharu Medical Centre Included Specialist Hospital Hospital Hospital c) Columbia Asia Nusajaya n = 59 d) Kuantan Clinical Diagnostic n = 36 n = 3

Included Included n = 36 n = 3

Total In-scope Establishment with Ophthalmology Services n = 98

Analysis

(a) Have visiting ophthalmologist for consultation, but all the procedures to be carried out are referred to hospitals or clinics.

Abbreviation: MOH – Ministry of Health

xxiv NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

ABBREVIATIONS ALOS Average Length of Stay AMO Assistant Medical Officer APHM Association of Private Hospitals Malaysia BER Beyond Economic Repair BOR Bed Occupancy Rate CDR Cytotoxic Drug Reconstitution CEO Chief Executive Officer CKAPS Cawangan Kawalan Amalan Perubatan Swasta CRF Case Report Form CS Caesarean Section CT Computed Tomography DOS Department of Statistics eCRF Electronic Case Report Form ECT Electroconvulsive Therapy EOH Elective Operating Hours ERCP Endoscopic Retrograde Cholangio-Pancreatography GA General Anaesthesia HDR High Dose Radiation HDU High Dependency Unit ICU Intensive Care Unit IGRT Image-Guided Radiotherapy IMRT Intensity Modulated Radiotherapy IOP Intraocular Pressure IPH Institute for Public Health LA Local Anaesthesia LDR Low Dose Radiation LSCS Lower Segment Caesarean Section MDD Medical Development Division MMA Malaysian Medical Association MMC Malaysian Medical Council MREC MOH Medical Research and Ethics Committee MRG Malaysian Research Grant MRI Magnetic Resonance Imaging NHEWS National Healthcare Establishment and Workforce Survey NHSI National Healthcare Statistics Initiative NICU Neonatal Intensive Care Unit NIH National Institute of Health NMRR National Medical Research Register NRIG National Radiotherapy Implementation Group O&G Obstetrics and Gynaecology OECD Organisation For Economic Co-operation and Development OGDS Oesophagogastroduodenoscopy OR Operating Room OT Operating Theatre PET Positron Emission Tomography PIC Person In-Charge

xxv NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

PMP Per Million Population PMPCS Private Medical Practice Control Section PPH Post Partum Haemorrhage QA Quality Assurance RT Radiotherapy SCN Special Care Nursery SDP Source Data Provider SRS Stereotactic Radiotherapy SVD Spontaneous Vertex Delivery TOI Turn Over Interval UK United Kingdom WP Wilayah Persekutuan WPKL Wilayah Persekutuan Kuala Lumpur

SYMBOLS na not applicable

- not available

xxvi NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 1 | OVERVIEW OF HOSPITALS AND SPECIALISTS SERVICES IN MALAYSIA Sivasampu S1*, Foo CY1, Tahrani PK1,Arunah C1, Kamilah D1, Fatihah M1, Faizah A1

1. National Clinical Research Centre, Ministry of Health * Corresponding author.

Our third NHEWS report aims to provide consistent and reliable data on healthcare establishments, activities, selected devices and the workforce in the country. In addition, it was to show the trends in those activities. This report consists of six chapters. The first chapter covers the overall statistics on the acute curative hospitals. The other chapters examine the specific healthcare services:

● Chapter 2 : Acute curative hospital establishment survey

● Chapter 3 : Maternity services survey

● Chapter 4 : General surgical services survey

● Chapter 5 : Oncology services survey

● Chapter 6 : Psychiatry services survey

● Chapter 7 : Ophthalmology services survey

Improved methods of data collection and in project management have contributed to better data quality and response rates. Here is the summary of those changes:

● Development of different and separate Case Report Forms (CRFs) for public and private establishments to accommodate their different practices and administrative requirements

● Specified definition of each service to avoid ambiguity of inclusion and exclusion criteria

● Suitable respondents were suggested for both private and public sector for more reliable data collection e.g. the operating theatre manager was identified as the suitable respondent for the surgical chapter.

● Incorporated two levels of data verification process to improve accuracy of data:

m First level – verified by Hospital Director/ Department Heads before submission

m Second level – verified with the relevant personnel of the responding establishment during the review process after submission

● Enhancing electronic data validation for online data submissions

● Redefining channels of distributing survey forms to facilitate the process of reaching the appropriate personnel and to shorten the response and submission times

● Enabling historical consistency checks for repeated variables. Any inconsistent data was verified with source personnel and corrected accordingly.

Summary of response rate by chapter: No. Service Survey Survey Population (n) Response Rate (%) 1 Acute Curative Hospital 339 77.9% 2 Maternity Service 317 81.4% 3 General Surgery Service 166 85.4% 4 Oncology Service 58 100.0% 5 Psychiatry Service 94 95.7% 6 Ophthalmology Service 98 91.8%

Note: Details of item and unit non-response by chapter are available in Appendix 5.

We felt that the improved productivity and efficiency for 2011 was firstly, due to the above changes and secondly, due to the experience gained Overview on Hospitals and Specialists Services in Malaysia

from the two previous reports. 1 1 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Here we summarise our key findings of this report:

Acute Curative Hospital Survey

● Overall, 51,076 bed facilities were available in 339 acute curative hospitals; the majority of them were public hospitals (73%).

● The hospital admission rates have increased by 8% for both sectors in 2011. The mean bed occupancy rate (BOR) for private hospitals (41.9%) was lower than that of public hospitals (59.6%).

● Of the hospital healthcare workforces, most doctors (78%), staff nurses (72.4%) and assistant medical officers (AMO) (98.8%) worked in the public hospitals.

● The use of Computed Tomography (CT) scanners, Magnetic Resonance Imaging (MRIs) and Positron Emission Tomography (PET) scanners increased by 14%, 15% and 22% respectively in 2011.

● The number of medical doctors has increased over the past 3 years (2009-2011).

Maternity Services Survey

● Three hundred and seventeen hospitals and 26 maternity homes provided maternity services in 2011. These included 130 Ministry of Health (MOH) hospitals, 3 public University Hospitals and 184 private hospitals.

● Eighty per cent of deliveries were conducted in public hospitals. The Caesarean section rate in private hospitals (34.7%) was almost twice that of the public hospitals (19.7%).

● The instrumental delivery rate in the public hospitals (3.2 per 100 deliveries) was less than that in the private hospitals (14.85 per 100 deliveries).

● There were 839 obstetricians and gynaecologists (O&G) of whom 327 (39%) worked in the public sector and 512 (61%) in the private sector.

● The ratio of midwifery-trained nurse to delivery beds in specialist hospitals was 1.6 to 1 per shift.

General Surgical Services Survey

● The majority (64%) of hospitals providing general surgical services were from the private sector (n=106).

● There was a marked increase in the number of mastectomies done (18.6%, n=662) over the two years. The private sector reported an increase of 1,414 to 1,993 (41%) over the 2 year period.

● There was an increased preference for laparoscopic inguinal hernia surgery (11.8%) and laparoscopic cholecystectomy (7.3%) over the same period of time.

● In 2011, there were 557 general surgeons, 298 in the public and 259 in the private sector. When compared to 2010, there was an increase of 21 surgeons (3.9%) all of whom came from the private sector.

Oncology Services Survey

● There were 58 hospitals providing oncology services in 2011, with a density of 0.02 per 10,000 population

● Only 4 hospitals provided data on selected oncology activities, e.g. chemotherapy and radiotherapy with curative intent (please refer to relevant chapter).

● A total of 67 oncologists were providing services in the country for 2011, with 68% of them serving in the West Coast of .

● Core oncology devices including 29 simulators, 36 megavoltage machines and 14 brachytherapy machines were available within the country in 2011.

● There was no significant increase in the overall manpower and facilities from 2010.

2 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Psychiatry Services Survey

● Twenty percent of hospitals in Malaysia provided psychiatric services of which, 49 were public and 45 were private hospitals.

● The majority of the psychiatric services were carried out in the public hospitals; public hospitals providing 88.7% of out-patient care and 97.1% of the in-patient care.

● Most psychiatrists (79.5%, n=186) were employed by the public sector.

● The availability of allied health personnel in psychiatry was low and limited to few centres.

● Overall inpatient and outpatient electroconvulsive therapy (ECT) had decreased to 14% and 1% respectively for 2011 when compared to 2010.

Ophthalmology Services Survey

● Thirty-six MOH, three Universities, and 59 private hospitals provided ophthalmology services in Malaysia with the Klang Valley and Melaka having the highest density.

● Fifty-two per cent of the cataract surgeries were performed as day care and 48% as inpatient. The majority (70%) of them being done in the public sector.

● Most of the vitreoretinal surgeries were performed in public hospitals.

● The ratio of ophthalmologist to population was 1 to 76,923 for 2011.

● The private sector had a higher number of ophthalmological devices with the exception of stand-alone vitrectomy and automated perimetry devices.

In our appendices, we have also included the number of specialists available in the various specialties and subspecialties other than the 5 fields mentioned above (Appendices 6 and 7). Overview on Hospitals and Specialists Services in Malaysia 1

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Chapter 2 | ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA Sivasampu S1*, Fatihah M1*, Akma NY2, Laili MM2, Khalid I3, Siti ZS4, Juita5, Farique5, Rosena O6

1. National Clinical Research Centre, Ministry of Health 2. Medical Development Division, Ministry of Health 3. Hospital Sungai Buloh, 4. Hospital Selayang 5. Hospital Sultanah Bahiyah, Alor Setar, 6. Nursing Division, Ministry of Health * Corresponding author.

Summary: This chapter highlights several issues with regards to hospital efficiency in terms of the underutilisation and/ or overutilization of hospital beds, especially in the public hospitals. This is the first time such information on functioning beds is available from both, the public and private hospitals. Surprisingly, the private specialist hospitals reported low bed occupancy rates in 2011. With an increasing number of medical doctors in the public hospitals, there is a need to redistribute them, taking into account the hospital workload (BOR, admission to doctor ratio) and the hospital type (specialists or non specialists’ hospitals). This chapter also demonstrates the maldistribution of human resources in the public sector both, at national and state levels, especially those of nurses and assistant medical officers (AMOs) with post basic training. Furthermore, the proper allocation of medical devices such as PET scanners need to be looked into since an increase in the use of these devices has been seen over the past three years.

There were 339 acute curative hospitals in 2011, of which 134 were public and 205 were private hospitals. (Table 2.1) There were 8 new acute curative hospitals in 2011, but only one was public – the Hospital Queen Elizabeth II (HQEII), a 291-bedded hospital in . During the same period, two existing private hospitals were closed and another two more had changed their status from hospital to maternity homes. The hospital designated for the aborigines and one private hospital with average length of stay (ALOS) of more than 10 days were excluded from this year’s analysis. This raised the total number of private hospitals from 203 in 2010 to 205 in 2011 (Table 2.1).

The response rate increased from 75% in 2010 to 78%in 2011. The endorsement given by Association of Private Hospitals of Malaysia (APHM) may have contributed to this increase from the private sector (from 59% to 64%). Many of the non respondents (36.6%) were private maternity centres.

We have categorised the hospitals into three main types (Table 2.2), namely:

• Non specialist hospitals These are hospitals without resident/ permanent specialists. They were seen mainly in the public sector. There was only one hospital in the private sector that fell into this category.

• Specialist hospitals These are hospitals that provide secondary and tertiary care (Appendix 1) and also those who provide services for specific disciplines e.g. the National Heart Institute and the Tun Hussein Onn Eye Hospitals from the private sector and the Institute of Respiratory Medicine from the public sector.

• Maternity centres are centres that provide obstetric or delivery services. They were all in the private sector.

In this report, entrepreneurship refers to ownership of the hospitals (Table 2.3). Most of the private hospitals were incorporated as corporate bodies (84.9%) followed by sole proprietorship (12.7%), partnership (1.5%) and societies (1.0%).

Facilities

There were 51,076 inpatient beds in all acute curative hospitals, of which 73% (37,493 beds) were in the public hospitals. A new term of “functioning bed” was introduced in the present report to address the issue of inpatient beds being non-functioning. Without a precise definition of `functioning beds’, assessing the bed occupancy rate (BOR) may be an issue because, a hospital with high non-functioning bed may have a misleadingly low BOR despite actually being crowded. Based on this new definition, we found that only 74% of the beds in public hospitals were reported as `functioning’ (35,415 beds). In contrast, 90 per cent (12,273 beds) of the private hospital beds were functioning (Table 2.4).

In 2011, there were 575 operating rooms in public hospitals of which, 511 were functioning (88.9%). These were mostly concentrated in Wilayah Persekutuan Kuala Lumpur (WPKL) and with a density of 0.5 per 10,000 population (Table 2.5). ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE 2

5 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Activities

The majority (67.9%) of admissions were to the public hospitals. The ratio of the number of admissions to doctors in public hospitals was 181.9 per doctor per year as compared to 316.4 admissions per doctor per year in the private hospitals (Table 2.6). The overall ALOS in 2011 was 3.3 days in the public hospitals and 2.4 days in the private hospitals (Table 2.7). The ALOS for non specialists and specialists’ public hospitals was 2.82 and 3.88 respectively (Table 2.8).

The mean BOR of the public hospitals had increased from 56.2% to 59.6% over three years. Further analysis showed that the mean BOR of the public specialist hospitals was 70.7% when compared to 50.0% for the non specialists public hospitals (Table 2.9). This shows that the demand for specialists care has increased (Table 2.9). We feel that underutilisation of non specialist hospitals needs to be addressed. In contrast, the mean BOR of the private sector has decreased from 46.6 to 41.9% over the three years. The mean BOR for the private specialist hospitals was 52.0% and it was 22.9% for the maternity centres.

The mean turn over interval (TOI) for public hospitals was 3.4 days in non specialist hospitals and 2 days in specialist hospitals. Melaka had the lowest TOI with 0.68 days followed by 0.74 days and 0.94. (Table 2.10)

Health Workforce

There were 16,643 doctors serving in all the hospitals in 2011; a density of 5.8 doctors per 10,000 populations (Table 2.11). Of the total, 12,966 (79%) were employed in the public hospitals. For the purposes of this report, medical doctors include hospital clinical specialists and medical officers only.

There were 58,780 hospital staff nurses, of which 42,548 were in the public and 16,232 in the private sector. The highest density of staff nurses with or without post basic training was seen in WPKL (Table 2.11). Out of 18,215 staff nurse with post basic training, 16.2 % were employed in WPKL (Table 2.11) .

There were 8,712 community nurses working in hospitals in 2011, of which 8,474 (97.3 %) were employed by the public hospitals. However, most (85.3 %) of the 3,091 assistant nurses worked in the private hospitals. The MOH is in the process of phasing out the assistant nurses in the public sector. At the same time, it is upgrading the training of community nurses to staff nurses (Table 2.12).

There were 6,064 assistant medical officers (AMOs) (with and without post basic training) working in hospitals in 2011. Most were employed by the public hospitals (Table 2.13).

There were 2,654 pharmacists in 2011 of which 90% were in the public sector. Of the 845 physiotherapist employed, 63% were in the public sector. Of the 643 occupational therapist employed, 94% were in the public sector and of the 271 dieticians, 70% were in the public sector (Table 2.14). However, of the 473 medical record officers 57% worked in the private sector. By comparison, only 21 medical social officers (9%) worked in private sector (Table 2.15).

Medical Devices and Procedures

Over the past three years, the number of Computed Tomography (CT) Scanners and Magnetic Resonance imaging (MRIs) in the country has decreased by 1.4% (Table 2.16 and Table 2.17). But the number of Positron Emission Tomography (PET) scanners available has remained constant since 2009 (Table 2.18).

Limitations

1. The BOR and TOI of some private hospitals, especially the maternity centres, may have been under-reported because, the number of admissions was unrealistically low. This may have skewed some of the overall state figures. The NHEWS team has made attempts to query such data. Corrections and resubmissions have been made to those who have responded. However the data cannot be corrected for the non-responders.

2. In this survey, hospital units of special institution e.g. prison hospitals, military hospitals and hospitals operated by NGOs were excluded. We felt it was justified because of their unique nature of practice and the kind of patients being served.

3. Only the national average has been highlighted. This may give a misconception of what is going on in some individual hospitals e.g. states that lie below average may in fact be doing well.

6 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.1 Number and Density of Hospitals Providing Acute Curative Care Services in Malaysia by State and Sector, 2009 – 2011 Year 2009 Year 2010 Year 2011 State Sector Per 10,000 Per 10,000 Per 10,000 Number Number Number population population population Malaysia Public 133 - 134 - 134 - Malaysia Private 201 - 203 - 205 - Malaysia Total 334 0.12 337 0.12 339 0.12 Public 1 - 1 - 1 - Perlis Private na na na na na na Perlis Total 1 0.04 1 0.04 1 0.04 Kedah Public 9 - 9 - 9 - Kedah Private 11 - 10 - 9 - Kedah Total 20 0.1 19 0.10 18 0.09 Kedah & Perlis Public 10 - 10 - 10 - Kedah & Perlis Private 11 - 10 - 9 - Kedah & Perlis Total 21 0.1 20 0.09 19 0.09 Pulau Pinang Public 6 - 6 - 6 - Pulau Pinang Private 23 - 23 - 22 - Pulau Pinang Total 29 0.18 29 0.19 28 0.18 Public 14 - 14 - 14 - Perak Private 15 - 15 - 16 - Perak Total 29 0.12 29 0.12 30 0.13 & WP Putrajaya Public 11 - 12 - 11 - Selangor & WP Putrajaya Private 46 - 48 - 49 - Selangor & WP Putrajaya Total 57 0.11 60 0.11 60 0.11 WP Kuala Lumpur Public 4 - 4 - 4 - WP Kuala Lumpur Private 41 - 37 - 36 - WP Kuala Lumpur Total 45 0.26 41 0.24 40 0.24 Selangor & WP Putrajaya & WPKL Public 15 - 16 - 15 - Selangor & WP Putrajaya & WPKL Private 87 - 85 - 85 - Selangor & WP Putrajaya & WPKL Total 102 0.15 101 0.14 100 0.14 Public 6 - 6 - 6 - Negeri Sembilan Private 6 - 8 - 9 - Negeri Sembilan Total 12 0.12 14 0.14 15 0.14 Melaka Public 3 - 3 - 3 - Melaka Private 4 - 4 - 4 - Melaka Total 7 0.09 7 0.09 7 0.08 Johor Public 11 - 11 - 11 - Johor Private 29 - 30 - 30 - Johor Total 40 0.12 41 0.12 41 0.12 Pahang Public 10 - 10 - 10 - Pahang Private 7 - 7 - 9 - Pahang Total 17 0.11 17 0.11 19 0.12 Terengganu Public 6 - 6 - 6 - Terengganu Private 1 - 1 - 1 - Terengganu Total 7 0.07 7 0.07 7 0.07 Public 10 - 10 - 10 - Kelantan Private 3 - 3 - 3 - Kelantan Total 13 0.08 13 0.08 13 0.08 Sabah & WP Public 22 - 22 - 23 - Sabah & WP Labuan Private 6 - 5 - 5 - Sabah & WP Labuan Total 28 0.09 27 0.08 28 0.08 Sarawak Public 20 - 20 - 20 - Sarawak Private 9 - 12 - 12 - Sarawak Total 29 0.12 32 0.13 32 0.13 ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE Abbreviation: na – not applicable; - – not available 2

7 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.2 Number and Density of Types of Hospitals Establishment Providing Acute Curative Care Services in Malaysia by State & Sector, 2011 Specialist Hospital Non Specialist Hospital Hospital with Special Hospital with Tertiary Secondary Maternity Centre State Sector Institutions Services Services Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. population population population population population Malaysia Public 72 - 14 - 47 - 1 - 0 - Malaysia Private 1 - 38 - 85 - 11 - 70 - Malaysia Total 73 0.03 52 0.02 132 0.05 12 0.00 70 0.02 Perlis Public 0 - 1 - 0 - 0 - 0 - Perlis Private 0 na na na na na na na na Perlis Total 0 0.00 1 0.04 0 0.00 0 0.00 0 0.00 Kedah Public 5 - 1 - 3 - 0 - 0 - Kedah Private 0 - 1 - 4 - 0 - 4 - Kedah Total 5 0.03 2 0.01 7 0.04 0 0.00 4 0.02 Kedah & Perlis Public 5 - 2 - 3 - 0 - 0 - Kedah & Perlis Private 0 - 1 - 4 - 0 - 4 - Kedah & Perlis Total 5 0.02 3 0.01 7 0.03 0 0.00 4 0.02 Pulau Pinang Public 2 - 1 - 3 - 0 - 0 - Pulau Pinang Private 0 - 6 - 5 - 4 - 7 - Pulau Pinang Total 2 0.01 7 0.04 8 0.05 4 0.03 7 0.04 Perak Public 9 - 1 - 4 - 0 - 0 - Perak Private 0 - 3 - 9 - 0 - 4 - Perak Total 9 0.04 4 0.02 13 0.05 0 0.00 4 0.02 Selangor & WP Putrajaya Public 3 - 1 - 7 - 0 - 0 - Selangor & WP Putrajaya Private 0 - 12 - 20 - 2 - 15 - Selangor & WP Putrajaya Total 3 0.01 13 0.02 27 0.05 2 0.00 15 0.03 WP Kuala Lumpur Public 0 - 1 - 2 - 1 - 0 - WP Kuala Lumpur Private 0 - 9 - 10 - 4 - 13 - WP Kuala Lumpur Total 0 0.00 10 0.06 12 0.07 5 0.03 13 0.08 Selangor & WP Putrajaya & WPKL Public 3 - 2 - 9 - 1 - 0 - Selangor & WP Putrajaya & WPKL Private 0 - 21 - 30 - 6 - 28 - Selangor & WP Putrajaya & WPKL Total 3 0.00 23 0.03 39 0.05 7 0.01 28 0.04 Negeri Sembilan Public 3 - 1 - 2 - 0 - 0 - Negeri Sembilan Private 0 - 1 - 6 - 0 - 2 - Negeri Sembilan Total 3 0.03 2 0.02 8 0.08 0 0.00 2 0.02 Melaka Public 2 - 1 - 0 - 0 - 0 - Melaka Private 0 - 3 - 0 - 1 - 0 - Melaka Total 2 0.02 4 0.05 0 0.00 1 0.01 0 0.00 Johor Public 5 - 1 - 5 - 0 - 0 - Johor Private 1 - 2 - 11 - 0 - 16 - Johor Total 6 0.02 3 0.01 16 0.05 0 0.00 16 0.05 Pahang Public 6 - 1 - 3 - 0 - 0 - Pahang Private 0 - 0 - 5 - 0 - 4 - Pahang Total 6 0.04 1 0.01 8 0.05 0 0.00 4 0.03 Terengganu Public 4 - 1 - 1 - 0 - 0 - Terengganu Private 0 - 0 - 1 - 0 - 0 - Terengganu Total 4 0.04 1 0.01 2 0.02 0 0.00 0 0.00 Kelantan Public 6 - 1 - 3 - 0 - 0 - Kelantan Private 0 - 0 - 3 - 0 - 0 - Kelantan Total 6 0.04 1 0.01 6 0.04 0 0.00 0 0.00 Sabah & WP Labuan Public 15 - 1 - 7 - 0 - 0 - Sabah & WP Labuan Private 0 - 0 - 3 - 0 - 2 - Sabah & WP Labuan Total 15 0.04 1 0.00 10 0.03 0 0.00 2 0.01 Sarawak Public 12 - 1 - 7 - 0 - 0 - Sarawak Private 0 - 1 - 8 - 0 - 3 - Sarawak Total 12 0.05 2 0.01 15 0.06 0 0.00 3 0.01

Please refer to Appendix 1 for Tertiary, Secondary and Special Institution definition. Abbreviation: na – not applicable; - – not available

8 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.3 Number and Density of Different Types of Private Hospital’s Entrepreneurship in Malaysia by State, 2011 Number of Sole Proprietor Partnership Corporate Body Society Hospitals State in Private No. % No. % No. % No. % Sector Malaysia 205 26 12.68 3 1.46 174 84.88 2 0.98 Perlis 0 0 - 0 - 0 - 0 - Kedah 9 0 0.00 0 0.00 9 100.00 0 0.00 Kedah & Perlis 9 0 0.00 0 0.00 9 100.00 0 0.00 Pulau Pinang 22 2 9.09 0 0.00 19 86.36 1 4.55 Perak 16 2 12.50 0 0.00 14 87.50 0 0.00 Selangor & WP Putrajaya 49 7 14.29 0 0.00 42 85.71 0 0.00 WP Kuala Lumpur 36 4 11.11 2 5.56 29 80.56 1 2.78 Selangor & WP Putrajaya & WPKL 85 11 12.94 2 2.35 71 83.53 1 1.18 Negeri Sembilan 9 0 0.00 0 0.00 9 100.00 0 0.00 Melaka 4 0 0.00 0 0.00 4 100.00 0 0.00 Johor 30 4 13.33 0 0.00 26 86.67 0 0.00 Pahang 9 4 44.44 1 11.11 4 44.44 0 0.00 Terengganu 1 0 0.00 0 0.00 1 100.00 0 0.00 Kelantan 3 0 0.00 0 0.00 3 100.00 0 0.00 Sabah & WP Labuan 5 0 0.00 0 0.00 5 100.00 0 0.00 Sarawak 12 3 25.00 0 0.00 9 75.00 0 0.00

Abbreviation: - – not available

ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE 2

9 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.4 Number and Density of Inpatient Beds in Acute Curative Hospital in Malaysia by State and Sector, 2010 and 2011 2010 2011 Functioning Total Inpatient Beds Total Inpatient Beds State Sector Inpatient Beds Per 10,000 Per 10,000 Per 10,000 Number Number Number population population population Malaysia Public 36,256 - 37,493 - 35,415 - Malaysia Private 12,605 - 13,583 - 12,273 - Malaysia Total 48,861 17.24 51,076 17.63 47,688 16.46 Perlis Public 404 - 404 - 390 - Perlis Private na na na na na na Perlis Total 404 17.45 404 17.01 390 16.42 Kedah Public 2,350 - 2,390 - 2,294 - Kedah Private 542 - 535 - 530 - Kedah Total 2,892 14.85 2,925 14.82 2,824 14.31 Kedah & Perlis Public 2,754 - 2,794 - 2,684 - Kedah & Perlis Private 542 - 535 - 530 - Kedah & Perlis Total 3,296 15.12 3,329 15.06 3,214 14.54 Pulau Pinang Public 1,939 - 1,947 - 1,947 - Pulau Pinang Private 2,135 - 2,147 - 2,041 - Pulau Pinang Total 4,074 26.09 4,094 25.69 3,988 25.03 Perak Public 3,470 - 3,580 - 3,324 - Perak Private 988 - 974 - 894 - Perak Total 4,458 18.95 4,554 18.99 4,218 17.59 Selangor & WP Putrajaya Public 4,797 - 4,877 - 4,391 - Selangor & WP Putrajaya Private 2,836 - 3,282 - 2,962 - Selangor & WP Putrajaya Total 7,633 13.79 8,159 14.43 7,353 13.01 WP Kuala Lumpur Public 4,137 - 4,651 - 4,075 - WP Kuala Lumpur Private 2,859 - 2,915 - 2,454 - WP Kuala Lumpur Total 6,996 41.78 7,566 44.65 6,529 38.53 Selangor & WP Putrajaya & WPKL Public 8,934 - 9,528 - 8,466 - Selangor & WP Putrajaya & WPKL Private 5,695 - 6,197 - 5,416 - Selangor & WP Putrajaya & WPKL Total 14,629 20.29 15,725 21.40 13,882 18.89 Negeri Sembilan Public 1,527 - 1,527 - 1,513 - Negeri Sembilan Private 428 - 512 - 510 - Negeri Sembilan Total 1,955 19.15 2,039 19.55 2,023 19.40 Melaka Public 1,006 - 1,006 - 1,006 - Melaka Private 690 - 813 - 686 - Melaka Total 1,696 20.66 1,819 21.84 1,692 20.31 Johor Public 3,609 - 3,634 - 3,578 - Johor Private 1,111 - 1,126 - 1,041 - Johor Total 4,720 14.10 4,760 13.99 4,619 13.58 Pahang Public 1,907 - 2,030 - 1,962 - Pahang Private 204 - 326 - 324 - Pahang Total 2,111 14.07 2,356 15.45 2,286 14.99 Terengganu Public 1,342 - 1,342 - 1,342 - Terengganu Private 20 - 33 - 33 - Terengganu Total 1,362 13.15 1,375 12.80 1,375 12.80 Kelantan Public 2,399 - 2,399 - 2,399 - Kelantan Private 162 - 162 - 162 - Kelantan Total 2,561 16.63 2,561 15.86 2,561 15.86 Sabah & WP Labuan Public 3,962 - 4,253 - 3,884 - Sabah & WP Labuan Private 165 - 269 - 173 - Sabah & WP Labuan Total 4,127 12.53 4,522 13.28 4,057 11.91 Sarawak Public 3,407 - 3,453 - 3,310 - Sarawak Private 465 - 489 - 463 - Sarawak Total 3,872 15.67 3,942 15.67 3,773 14.99

Abbreviation: na – not applicable; - – not available

10 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.5 Number and Density of Operating theatre (OT), Operating Rooms (OR) and Functioning Operating Rooms (OR) in Acute Curative Public Hospitals in Malaysia by State 2011 Functioning Operating Operating Theatre (OT) Operating Rooms (OR) Rooms (OR) State Per 10,000 Per 10,000 Per 10,000 Number Number Number population population population Malaysia 178 0.06 575 0.20 511 0.18 Perlis 1 0.04 5 0.21 5 0.21 Kedah 12 0.06 39 0.20 29 0.15 Kedah & Perlis 13 0.06 44 0.20 34 0.15 Pulau Pinang 7 0.04 28 0.18 26 0.16 Perak 19 0.08 37 0.15 31 0.13 Selangor & WP Putrajaya 18 0.03 105 0.19 99 0.18 WP Kuala Lumpur 12 0.07 85 0.50 78 0.46 Selangor & WP Putrajaya & WPKL 30 0.04 190 0.26 177 0.24 Negeri Sembilan 6 0.06 15 0.14 14 0.13 Melaka 4 0.05 13 0.16 12 0.14 Johor 13 0.04 47 0.14 39 0.11 Pahang 16 0.10 36 0.24 30 0.20 Terengganu 8 0.07 17 0.16 15 0.14 Kelantan 15 0.09 36 0.22 33 0.20 Sabah & WP Labuan 27 0.08 57 0.17 53 0.16 Sarawak 20 0.08 55 0.22 47 0.19 ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE 2

11 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.6 Number and Density of Admissions, Admission to Doctors Ratio and Rate of Patients Admission Per Day in Acute Curative Hospitals in Malaysia by State and Sector, 2010 and 2011 Admission 2010 Admission 2011 State Sector Per 10,000 Rate per Ratio to Per 10,000 Rate per Ratio to Number Number population Day Doctors population Day Doctors Malaysia Public 2,286,079 - 6,263.2 198.7 2,381,244 - 6,524.0 181.9 Malaysia Private 959,758 - 2,629.5 282.4 1,123,350 - 3,077.7 316.4 Malaysia Total 3,245,837 1,145.56 8,892.7 217.8 3,504,594 1,209.97 9,601.6 210.6 Perlis Public 28,808 - 78.9 240.1 29,721 - 81.4 212.3 Perlis Private na na na na na na na na Perlis Total 28,808 1,244.41 78.9 240.1 29,721 1,251.41 81.4 212.3 Kedah Public 178,728 - 489.7 278.8 186,124 - 509.9 240.8 Kedah Private 51,321 - 140.6 450.2 49,375 - 135.3 411.5 Kedah Total 230,049 1,181.13 630.3 304.7 235,499 1,193.55 645.2 263.7 Kedah & Perlis Public 207,536 - 568.6 272.7 215,845 - 591.4 236.4 Kedah & Perlis Private 51,321 - 140.6 450.2 49,375 - 135.3 411.5 Kedah & Perlis Total 258,857 1,187.85 709.2 295.8 265,220 1,199.76 726.6 256.7 Pulau Pinang Public 139,734 - 382.8 191.2 140,929 - 386.1 158.7 Pulau Pinang Private 142,134 - 389.4 343.3 177,300 - 485.8 419.1 Pulau Pinang Total 281,868 1,805.23 772.2 246.2 318,229 1,996.92 871.9 242.7 Perak Public 217,608 - 596.2 242.9 224,969 - 616.4 221.4 Perak Private 75,122 - 205.8 293.4 76,839 - 210.5 284.6 Perak Total 292,730 1,244.23 802.0 254.1 301,808 1,258.79 826.9 234.7 Selangor & WP Putrajaya Public 322,814 - 884.4 176.4 333,429 - 913.5 164.7 Selangor & WP Putrajaya Private 246,923 - 676.5 275.3 271,525 - 743.9 277.1 Selangor & WP Putrajaya Total 569,737 1,029.43 1,560.9 208.9 604,954 1,070.00 1,657.4 201.4 WP Kuala Lumpur Public 204,172 - 559.4 82.3 205,994 - 564.4 79.0 WP Kuala Lumpur Private 146,692 - 401.9 181.5 245,936 - 673.8 319.4 WP Kuala Lumpur Total 350,864 2,095.21 961.3 106.7 451,930 2,667.04 1,238.2 133.8 Selangor & WP Putrajaya & WPKL Public 526,986 - 1,443.8 122.3 539,423 - 1,477.9 116.5 Selangor & WP Putrajaya & WPKL Private 393,615 - 1,078.4 230.9 517,461 - 1,417.7 295.7 Selangor & WP Putrajaya & WPKL Total 920,601 1,277.00 2,522.2 153.1 1,056,884 1,438.27 2,895.6 165.6 Negeri Sembilan Public 104,661 - 286.7 231.0 103,034 - 282.3 191.9 Negeri Sembilan Private 44,847 - 122.9 332.2 69,153 - 189.5 467.3 Negeri Sembilan Total 149,508 1,464.19 409.6 254.3 172,187 1,651.04 471.7 251.4 Melaka Public 77,711 - 212.9 218.3 79,441 - 217.6 181.0 Melaka Private 53,018 - 145.3 323.3 52,399 - 143.6 284.8 Melaka Total 130,729 1,592.12 358.2 251.4 131,840 1,582.71 361.2 211.6 Johor Public 267,297 - 732.3 289.3 281,388 - 770.9 249.0 Johor Private 116,567 - 319.4 455.3 98,235 - 269.1 363.8 Johor Total 383,864 1,146.44 1,051.7 325.3 379,623 1,115.95 1,040.1 271.2 Pahang Public 127,637 - 349.7 243.1 129,537 - 354.9 207.3 Pahang Private 18,000 - 49.3 281.3 18,505 - 50.7 250.1 Pahang Total 145,637 970.40 399.0 247.3 148,042 970.89 405.6 211.8 Terengganu Public 108,551 - 297.4 282.7 110,374 - 302.4 270.5 Terengganu Private 2,200 - 6.0 200.0 2,774 - 7.6 231.2 Terengganu Total 110,751 1,069.03 303.4 280.4 113,148 1,053.52 310.0 269.4 Kelantan Public 148,758 - 407.6 170.4 151,102 - 414.0 161.8 Kelantan Private 12,990 - 35.6 302.1 14,611 - 40.0 332.1 Kelantan Total 161,748 1,050.58 443.1 176.6 165,713 1,025.96 454.0 169.4 Sabah & WP Labuan Public 193,087 - 529.0 288.2 231,719 - 634.8 271.7 Sabah & WP Labuan Private 12,649 - 34.7 186.0 12,391 - 33.9 169.7 Sabah & WP Labuan Total 205,736 624.65 563.7 278.8 244,110 716.66 668.8 263.6 Sarawak Public 166,513 - 456.2 267.3 173,483 - 475.3 241.3 Sarawak Private 37,295 - 102.2 220.7 34,307 - 94.0 188.5 Sarawak Total 203,808 824.77 558.4 257.3 207,790 825.81 569.3 230.6

Abbreviation: na – not applicable; - – not available

12 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.7 Mean of Average Length of Stay (ALOS), Bed Occupancy Rate (BOR), and Turnover Interval (TOI) in Acute Curative Hospitals in Malaysia by State and Sector, 2009 - 2011 ALOS BOR TOI State Sector 2009 2010 2011 2009 2010 2011 2009 2010 2011 Malaysia Public 3.31 3.43 3.31 56.22 56.62 59.59 3.24 3.35 2.75 Malaysia Private 3.17 2.76 2.35 46.66 43.71 41.93 6.34 12.58 20.96 Malaysia Total 3.23 3.03 2.73 50.57 48.85 48.91 5.07 8.91 13.76 Perlis Public 3.70 3.59 3.40 75.11 67.40 70.94 1.21 1.53 1.39 Perlis Private na na na na na na na na na Perlis Total 3.70 3.59 3.40 75.11 67.40 70.94 1.21 1.53 1.39 Kedah Public 2.90 2.95 2.93 56.93 59.79 58.99 2.38 2.85 2.34 Kedah Private 3.79 2.59 2.29 46.74 40.69 47.15 5.97 5.21 3.01 Kedah Total 3.43 2.76 2.61 50.86 49.74 53.07 4.52 4.09 2.68 Kedah & Perlis Public 2.98 3.02 2.98 58.69 60.55 60.18 2.27 2.72 2.25 Kedah & Perlis Private 3.79 2.59 2.29 46.74 40.69 47.15 5.97 5.21 3.01 Kedah & Perlis Total 3.44 2.80 2.65 51.87 50.62 54.01 4.38 3.96 2.61 Pulau Pinang Public 4.09 3.70 3.82 68.06 70.53 73.99 2.16 1.72 1.64 Pulau Pinang Private 3.24 2.50 2.62 60.46 49.16 44.76 2.20 15.98 10.26 Pulau Pinang Total 3.49 2.75 2.88 62.72 53.58 51.03 2.18 13.03 8.41 Perak Public 2.80 2.88 2.95 46.94 47.70 57.27 3.43 3.53 2.62 Perak Private 2.27 2.13 2.37 39.31 42.57 38.92 5.18 2.98 6.47 Perak Total 2.50 2.49 2.64 42.60 45.05 47.48 4.43 3.24 4.67 Selangor & WP Putrajaya Public 3.47 5.10 3.47 57.55 67.42 69.85 2.82 2.74 1.66 Selangor & WP Putrajaya Private 4.84 2.76 2.33 55.50 41.85 42.87 3.44 12.23 6.24 Selangor & WP Putrajaya Total 4.56 3.23 2.54 55.92 46.96 47.82 3.31 10.34 5.40 WP Kuala Lumpur Public 6.14 6.01 5.90 66.38 65.65 64.77 4.39 4.29 4.05 WP Kuala Lumpur Private 3.31 3.92 2.45 46.94 39.52 44.97 7.44 23.78 17.56 WP Kuala Lumpur Total 3.62 4.12 2.80 49.09 42.07 46.95 7.10 21.87 16.21 Selangor & WP Putrajaya & WPKL Public 4.06 5.33 4.12 59.52 66.98 68.50 3.17 3.13 2.30 Selangor & WP Putrajaya & WPKL Private 4.27 3.27 2.38 52.31 40.83 43.76 4.93 17.26 11.03 Selangor & WP Putrajaya & WPKL Total 4.23 3.59 2.65 53.55 44.97 47.47 4.63 15.02 9.72 Negeri Sembilan Public 2.90 2.95 3.20 51.04 53.90 55.56 3.93 3.10 2.68 Negeri Sembilan Private 3.23 3.29 2.55 59.77 63.61 65.69 1.75 2.99 2.18 Negeri Sembilan Total 3.06 3.14 2.81 55.35 59.45 61.64 2.85 3.04 2.38 Melaka Public 3.14 3.20 3.31 64.25 61.37 74.54 2.62 2.05 1.22 Melaka Private 3.31 3.53 2.98 55.64 59.85 53.11 3.00 3.87 2.84 Melaka Total 3.26 3.38 3.12 58.50 60.50 62.29 2.87 3.09 2.14 Johor Public 3.09 3.00 2.98 65.55 68.84 66.92 2.01 1.91 1.71 Johor Private 2.05 2.09 1.66 37.85 35.81 29.51 9.77 15.71 17.32 Johor Total 2.30 2.34 2.01 44.35 44.67 39.55 7.95 12.00 13.13 Pahang Public 3.13 3.13 3.24 63.16 58.37 58.56 2.06 2.46 2.64 Pahang Private 2.46 2.28 1.95 63.57 58.35 29.00 2.62 5.04 249.73 Pahang Total 2.91 2.78 2.63 63.29 58.36 44.55 2.25 3.52 119.69 Terengganu Public 2.94 2.81 2.88 60.79 60.47 66.10 2.33 1.83 1.65 Terengganu Private 3.00 3.00 3.00 65.00 90.30 69.04 1.98 0.32 1.35 Terengganu Total 2.95 2.83 2.90 61.72 64.73 66.52 2.25 1.61 1.61 Kelantan Public 3.21 3.25 3.27 70.59 70.29 73.48 1.48 1.73 1.57 Kelantan Private 3.48 2.29 2.19 50.41 59.17 55.69 3.16 2.00 1.70 Kelantan Total 3.28 3.03 3.02 65.37 67.72 69.37 1.92 1.79 1.60 Sabah & WP Labuan Public 3.63 3.44 3.46 52.65 49.43 54.87 4.11 4.26 3.22 Sabah & WP Labuan Private 2.00 2.80 2.40 25.17 53.20 37.83 8.21 2.66 5.92 Sabah & WP Labuan Total 3.19 3.32 3.27 45.24 50.13 51.83 5.22 3.96 3.70 Sarawak Public 3.24 3.27 3.19 40.04 40.87 41.91 5.67 6.01 5.03 Sarawak Private 2.06 2.05 3.18 30.83 38.51 39.02 16.94 4.81 14.10

Sarawak Total 2.79 2.82 3.19 36.54 39.99 40.83 9.95 5.56 8.43 SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE

Abbreviation: na – not applicable 2 13 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.8 Mean of Average Length of Stay (ALOS) in Malaysia by Acute Curative Hospital Type, State and Sector, 2011 Mean ALOS State Sector Non Specialist Hospital Specialist Hospital Maternity Centre Malaysia Public 2.82 3.88 na Malaysia Private 1.00 2.52 2.02 Malaysia Total 2.79 2.95 2.02 Perlis Public na 3.40 na Perlis Private na na na Perlis Total na 3.40 na Kedah Public 2.48 3.49 na Kedah Private na 2.38 2.14 Kedah Total 2.48 2.84 2.14 Kedah & Perlis Public 2.48 3.47 na Kedah & Perlis Private na 2.38 2.14 Kedah & Perlis Total 2.48 2.90 2.14 Pulau Pinang Public 4.11 3.68 na Pulau Pinang Private na 3.01 1.92 Pulau Pinang Total 4.11 3.15 1.92 Perak Public 2.66 3.47 na Perak Private na 2.59 1.93 Perak Total 2.66 2.87 1.93 Selangor & WP Putrajaya Public 2.52 3.83 na Selangor & WP Putrajaya Private na 2.39 2.23 Selangor & WP Putrajaya Total 2.52 2.68 2.23 WP Kuala Lumpur Public na 5.89 na WP Kuala Lumpur Private na 2.64 1.60 WP Kuala Lumpur Total na 3.03 1.60 Selangor & WP Putrajaya & WPKL Public 2.52 4.52 na Selangor & WP Putrajaya & WPKL Private na 2.51 2.06 Selangor & WP Putrajaya & WPKL Total 2.52 2.84 2.06 Negeri Sembilan Public 3.17 3.24 na Negeri Sembilan Private na 2.55 na Negeri Sembilan Total 3.17 2.72 na Melaka Public 3.00 3.93 na Melaka Private na 2.97 na Melaka Total 3.00 3.17 na Johor Public 2.50 3.38 na Johor Private 1.00 2.08 1.46 Johor Total 2.22 2.56 1.46 Pahang Public 2.69 4.07 na Pahang Private na 2.62 1.29 Pahang Total 2.69 3.30 1.29 Terengganu Public 2.82 3.00 na Terengganu Private na 3.00 na Terengganu Total 2.82 3.00 na Kelantan Public 2.74 4.06 na Kelantan Private na 2.19 na Kelantan Total 2.74 3.26 na Sabah & WP Labuan Public 3.06 4.22 na Sabah & WP Labuan Private na 2.85 1.96 Sabah & WP Labuan Total 3.06 3.89 1.96 Sarawak Public 2.78 3.81 na Sarawak Private na 2.02 6.67 Sarawak Total 2.78 2.86 6.67

Abbreviation: na – not applicable 14 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.9 Bed Occupancy Rate (BOR) in Malaysia by Acute Curative Hospital Type, State and Sector, 2011 Mean BOR State Sector Non Specialist Hospital Specialist Hospital Maternity Centre Malaysia Public 50.00 70.73 na Malaysia Private 0.63 51.95 22.89 Malaysia Total 49.22 57.85 22.89 Perlis Public na 70.94 na Perlis Private na na na Perlis Total na 70.94 na Kedah Public 41.83 80.42 na Kedah Private na 57.33 30.18 Kedah Total 41.83 66.93 30.18 Kedah & Perlis Public 41.83 78.53 na Kedah & Perlis Private na 57.33 30.18 Kedah & Perlis Total 41.83 67.30 30.18 Pulau Pinang Public 58.16 81.91 na Pulau Pinang Private na 52.57 30.70 Pulau Pinang Total 58.16 59.04 30.70 Perak Public 50.64 69.19 na Perak Private na 47.73 21.29 Perak Total 50.64 54.58 21.29 Selangor & WP Putrajaya Public 43.97 79.56 na Selangor & WP Putrajaya Private na 49.52 30.47 Selangor & WP Putrajaya Total 43.97 55.54 30.47 WP Kuala Lumpur Public na 64.77 na WP Kuala Lumpur Private na 51.79 14.29 WP Kuala Lumpur Total na 53.34 14.29 Selangor & WP Putrajaya & WPKL Public 43.97 74.63 na Selangor & WP Putrajaya & WPKL Private na 50.61 25.99 Selangor & WP Putrajaya & WPKL Total 43.97 54.54 25.99 Negeri Sembilan Public 47.75 63.36 na Negeri Sembilan Private na 65.69 na Negeri Sembilan Total 47.75 65.11 na Melaka Public 69.22 85.18 na Melaka Private na 53.11 na Melaka Total 69.22 59.52 na Johor Public 61.52 71.41 na Johor Private 0.63 58.83 14.82 Johor Total 50.10 63.44 14.82 Pahang Public 52.17 68.13 na Pahang Private na 47.00 10.99 Pahang Total 52.17 56.95 10.99 Terengganu Public 58.00 82.30 na Terengganu Private na 69.04 na Terengganu Total 58.00 77.88 na Kelantan Public 71.23 76.85 na Kelantan Private na 55.69 na Kelantan Total 71.23 67.78 na Sabah & WP Labuan Public 47.70 68.31 na Sabah & WP Labuan Private na 51.32 24.35 Sabah & WP Labuan Total 47.70 64.27 24.35 Sarawak Public 34.15 53.55 na Sarawak Private na 39.04 38.97 Sarawak Total 34.15 45.87 38.97 ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE Abbreviation: na – not applicable 2

15 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.10 Turnover Interval (TOI) in Malaysia by Acute Curative Hospital Type, State and Sector, 2011 Mean TOI State Sector Non Specialist Hospital Specialist Hospital Maternity Centre Malaysia Public 3.44 1.95 na Malaysia Private 157.80 13.30 33.75 Malaysia Total 5.88 9.73 33.75 Perlis Public na 1.39 na Perlis Private na na na Perlis Total na 1.39 na Kedah Public 3.47 0.94 na Kedah Private na 1.73 5.15 Kedah Total 3.47 1.40 5.15 Kedah & Perlis Public 3.47 1.03 na Kedah & Perlis Private na 1.73 5.15 Kedah & Perlis Total 3.47 1.40 5.15 Pulau Pinang Public 2.89 1.01 na Pulau Pinang Private na 13.33 4.73 Pulau Pinang Total 2.89 10.61 4.73 Perak Public 3.07 1.81 na Perak Private na 5.05 9.30 Perak Total 3.07 4.02 9.30 Selangor & WP Putrajaya Public 3.21 1.08 na Selangor & WP Putrajaya Private na 6.37 6.00 Selangor & WP Putrajaya Total 3.21 5.31 6.00 WP Kuala Lumpur Public na 4.05 na WP Kuala Lumpur Private na 4.16 77.84 WP Kuala Lumpur Total na 4.15 77.84 Selangor & WP Putrajaya & WPKL Public 3.21 2.07 na Selangor & WP Putrajaya & WPKL Private na 5.31 25.89 Selangor & WP Putrajaya & WPKL Total 3.21 4.78 25.89 Negeri Sembilan Public 3.49 1.86 na Negeri Sembilan Private na 2.18 na Negeri Sembilan Total 3.49 2.10 na Melaka Public 1.48 0.68 na Melaka Private na 2.84 na Melaka Total 1.48 2.41 na Johor Public 2.00 1.47 na Johor Private 157.80 1.53 17.43 Johor Total 31.21 1.51 17.43 Pahang Public 2.86 2.32 na Pahang Private na 250.72 248.75 Pahang Total 2.86 133.83 248.75 Terengganu Public 2.11 0.74 na Terengganu Private na 1.35 na Terengganu Total 2.11 0.94 na Kelantan Public 1.69 1.39 na Kelantan Private na 1.70 na Kelantan Total 1.69 1.53 na Sabah & WP Labuan Public 3.92 1.91 na Sabah & WP Labuan Private na 2.73 9.11 Sabah & WP Labuan Total 3.92 2.11 9.11 Sarawak Public 5.79 3.88 na Sarawak Private na 3.56 45.72 Sarawak Total 5.79 3.71 45.72

Abbreviation: na – not applicable

16 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.11 Number and Density of Hospital Doctors, Staff Nurses with Post Basic Training and without Post Basic Training in Malaysia by State and Sector, 2011 Staff Nurses with Post Staff Nurses without Hospital Doctors Basic Training Post Basic Training State Sector Per 10,000 Per 10,000 Per 10,000 Number Number Number population population population Malaysia Public 13,093 14,735 - 27,813 - Malaysia Private 3,550 - 3,480 - 12,752 - Malaysia Total 16,643 5.75 18,215 6.29 40,565 14.01 Perlis Public 140 - 175 - 368 - Perlis Private 0 - na na na na Perlis Total 140 5.89 175 7.37 368 15.49 Kedah Public 773 - 1,122 - 1,815 - Kedah Private 120 - 90 - 424 - Kedah Total 893 4.53 1,212 6.14 2,239 11.35 Kedah & Perlis Public 913 - 1,297 - 2,183 - Kedah & Perlis Private 120 - 90 - 424 - Kedah & Perlis Total 1,033 4.67 1,387 6.27 2,607 11.79 Pulau Pinang Public 888 - 714 - 1,346 - Pulau Pinang Private 423 - 585 - 1,875 - Pulau Pinang Total 1,311 8.23 1,299 8.15 3,221 20.21 Perak Public 1,016 - 1,156 - 2,522 - Perak Private 270 - 213 - 742 - Perak Total 1,286 5.36 1,369 5.71 3,264 13.61 Selangor & WP Putrajaya Public 2,024 - 1,401 - 3,772 - Selangor & WP Putrajaya Private 980 - 757 - 3,292 - Selangor & WP Putrajaya Total 3,004 5.31 2,158 3.82 7,064 12.49 WP Kuala Lumpur Public 2,607 - 1,959 - 4,324 - WP Kuala Lumpur Private 770 - 997 - 3,374 - WP Kuala Lumpur Total 3,377 19.93 2,956 17.44 7,698 45.43 Selangor & WP Putrajaya & WPKL Public 4,631 - 3,360 - 8,096 - Selangor & WP Putrajaya & WPKL Private 1,750 - 1,754 - 6,666 - Selangor & WP Putrajaya & WPKL Total 6,381 8.68 5,114 6.96 14,762 20.09 Negeri Sembilan Public 537 - 474 - 1,044 - Negeri Sembilan Private 148 - 209 - 698 - Negeri Sembilan Total 685 6.57 683 6.55 1,742 16.70 Melaka Public 439 - 645 - 579 - Melaka Private 184 - 105 - 604 - Melaka Total 623 7.48 750 9.00 1,183 14.20 Johor Public 1,130 - 1,374 - 3,152 - Johor Private 270 - 300 - 821 - Johor Total 1,400 4.12 1,674 4.92 3,973 11.68 Pahang Public 625 - 985 - 1,353 - Pahang Private 74 - 56 - 201 - Pahang Total 699 4.58 1,041 6.83 1,554 10.19 Terengganu Public 408 - 885 - 1,100 - Terengganu Private 12 - 1 - 34 - Terengganu Total 420 3.91 886 8.25 1,134 10.56 Kelantan Public 934 - 1,161 - 1,883 - Kelantan Private 44 - 43 - 135 - Kelantan Total 978 6.05 1,204 7.45 2,018 12.49 Sabah & WP Labuan Public 853 - 1,562 - 2,843 - Sabah & WP Labuan Private 73 - 36 - 143 - Sabah & WP Labuan Total 926 2.72 1,598 4.69 2,986 8.77 Sarawak Public 719 - 1,122 - 1,712 - Sarawak Private 182 - 88 - 409 - Sarawak Total 901 3.58 1,210 4.81 2,121 8.43 ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE Abbreviation: na – not applicable; - – not available 2

17 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.12 Number and Density of Community Nurses and Assistant Nurses in Malaysia by State and Sector, 2011 Community Nurses Assistant Nurses State Sector Per 10,000 Per 10,000 Number Number population population Malaysia Public 8,474 - 455 - Malaysia Private 238 - 2,636 - Malaysia Total 8,712 3.01 3,091 1.07 Perlis Public 80 - 11 - Perlis Private na na na na Perlis Total 80 3.37 11 0.46 Kedah Public 482 - 16 - Kedah Private 10 - 127 - Kedah Total 492 2.49 143 0.72 Kedah & Perlis Public 562 - 27 - Kedah & Perlis Private 10 - 127 - Kedah & Perlis Total 572 2.59 154 0.70 Pulau Pinang Public 334 - 22 - Pulau Pinang Private 60 - 577 - Pulau Pinang Total 394 2.47 599 3.76 Perak Public 661 - 36 - Perak Private 8 - 237 - Perak Total 669 2.79 273 1.14 Selangor & WP Putrajaya Public 1,282 - 22 - Selangor & WP Putrajaya Private 49 - 473 - Selangor & WP Putrajaya Total 1,331 2.35 495 0.88 WP Kuala Lumpur Public 256 - 15 - WP Kuala Lumpur Private 23 - 619 - WP Kuala Lumpur Total 279 1.65 634 3.74 Selangor & WP Putrajaya & WPKL Public 1,538 - 37 - Selangor & WP Putrajaya & WPKL Private 72 - 1,092 - Selangor & WP Putrajaya & WPKL Total 1,610 2.19 1,129 1.54 Negeri Sembilan Public 183 - 14 - Negeri Sembilan Private 5 - 60 - Negeri Sembilan Total 188 1.80 74 0.71 Melaka Public 197 - 9 - Melaka Private 3 - 118 - Melaka Total 200 2.40 127 1.52 Johor Public 567 - 41 - Johor Private 27 - 168 - Johor Total 594 1.75 209 0.61 Pahang Public 534 - 38 - Pahang Private 10 - 26 - Pahang Total 544 3.57 64 0.42 Terengganu Public 386 - 26 - Terengganu Private 0 - 25 - Terengganu Total 386 3.59 51 0.47 Kelantan Public 447 - 44 - Kelantan Private 6 - 4 - Kelantan Total 453 2.80 48 0.30 Sabah & WP Labuan Public 1,585 - 151 - Sabah & WP Labuan Private 5 - 67 - Sabah & WP Labuan Total 1,590 4.67 218 0.64 Sarawak Public 1,480 - 10 - Sarawak Private 32 - 135 - Sarawak Total 1,512 6.01 145 0.58

Abbreviation: na – not applicable; - – not available

18 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.13 Number and Density of Assistant Medical Officers (AMO) with Post Basic Training and without Post Basic Training in Acute Curative Hospitals in Malaysia by State and Sector, 2011 AMO with Post Basic Training AMO without Post Basic Training State Sector No. Per 10,000 population No. Per 10,000 population Malaysia Public 2,451 - 3,541 - Malaysia Private 23 - 56 - Malaysia Total 2,474 0.85 3,590 1.24 Perlis Public 53 - 47 - Perlis Private na na na na Perlis Total 53 2.23 47 1.98 Kedah Public 162 - 272 - Kedah Private 1 - 2 - Kedah Total 163 0.83 274 1.39 Kedah & Perlis Public 215 - 319 - Kedah & Perlis Private 1 - 2 - Kedah & Perlis Total 216 0.98 321 1.45 Pulau Pinang Public 138 - 241 - Pulau Pinang Private 2 - 3 - Pulau Pinang Total 140 0.88 244 1.53 Perak Public 242 - 275 - Perak Private 0 - 0 - Perak Total 242 1.01 275 1.15 Selangor & WP Putrajaya Public 212 - 537 - Selangor & WP Putrajaya Private 2 - 21 - Selangor & WP Putrajaya Total 214 0.38 558 0.99 WP Kuala Lumpur Public 152 - 231 - WP Kuala Lumpur Private 3 - 15 - WP Kuala Lumpur Total 155 0.91 246 1.45 Selangor & WP Putrajaya & WPKL Public 364 - 768 - Selangor & WP Putrajaya & WPKL Private 5 - 36 - Selangor & WP Putrajaya & WPKL Total 369 0.50 804 1.09 Negeri Sembilan Public 88 - 162 - Negeri Sembilan Private 3 - 3 - Negeri Sembilan Total 91 0.87 165 1.58 Melaka Public 141 - 110 - Melaka Private 1 - 3 - Melaka Total 142 1.70 113 1.36 Johor Public 222 - 316 - Johor Private 4 - 0 - Johor Total 226 0.66 309 0.91 Pahang Public 152 - 291 - Pahang Private 0 - 2 - Pahang Total 152 1.00 293 1.92 Terengganu Public 117 - 123 - Terengganu Private 0 - 0 - Terengganu Total 117 1.09 123 1.15 Kelantan Public 153 - 189 - Kelantan Private 0 - 1 - Kelantan Total 153 0.95 190 1.18 Sabah & WP Labuan Public 334 - 386 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 334 0.98 386 1.13 Sarawak Public 285 - 361 - Sarawak Private 7 - 6 - Sarawak Total 292 1.16 367 1.46 ACUTE CURATIVE HOSPITAL SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE

Abbreviation: na – not applicable; - – not available 2 19 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.14 Number of Pharmacists, Physiotherapists, Occupational Therapists, and Dieticians in Acute Curative Hospitals in Malaysia by State and Sector, 2011 Occupational Pharmacists Physiotherapists Dieticians Therapists State Sector Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population population Malaysia Public 2,654 - 845 - 643 - 271 - Malaysia Private 302 - 508 - 43 - 118 - Malaysia Total 2,956 1.02 1,353 0.47 686 0.24 389 0.13 Perlis Public 47 - 13 - 7 - 4 - Perlis Private na na na na na na na na Perlis Total 47 1.98 13 0.55 7 0.29 4 0.17 Kedah Public 180 - 40 - 35 - 14 - Kedah Private 3 - 18 - 0 - 3 - Kedah Total 183 0.93 58 0.29 35 0.18 17 0.09 Kedah & Perlis Public 227 - 53 - 42 - 18 - Kedah & Perlis Private 3 - 18 - 0 - 3 - Kedah & Perlis Total 230 1.04 71 0.32 42 0.19 21 0.09 Pulau Pinang Public 165 - 55 - 50 - 13 - Pulau Pinang Private 28 - 69 - 8 - 25 - Pulau Pinang Total 193 1.21 124 0.78 58 0.36 38 0.24 Perak Public 276 - 59 - 61 - 24 - Perak Private 13 - 27 - 0 - 7 - Perak Total 289 1.21 86 0.36 61 0.25 31 0.13 Selangor & WP Putrajaya Public 432 - 92 - 65 - 44 - Selangor & WP Putrajaya Private 75 - 121 - 11 - 29 - Selangor & WP Putrajaya Total 507 0.90 213 0.38 76 0.13 73 0.13 WP Kuala Lumpur Public 333 - 126 - 85 - 57 - WP Kuala Lumpur Private 121 - 121 - 16 - 29 - WP Kuala Lumpur Total 454 2.68 247 1.46 101 0.60 86 0.51 Selangor & WP Putrajaya & WPKL Public 765 - 218 - 150 - 101 - Selangor & WP Putrajaya & WPKL Private 196 - 242 - 27 - 58 - Selangor & WP Putrajaya & WPKL Total 961 1.31 460 0.63 177 0.24 159 0.22 Negeri Sembilan Public 93 - 32 - 31 - 10 - Negeri Sembilan Private 20 - 45 - 2 - 8 - Negeri Sembilan Total 113 1.08 77 0.74 33 0.32 18 0.17 Melaka Public 72 - 27 - 24 - 6 - Melaka Private 6 - 15 - 1 - 7 - Melaka Total 78 0.94 42 0.50 25 0.30 13 0.16 Johor Public 225 - 60 - 47 - 22 - Johor Private 10 - 51 - 1 - 5 - Johor Total 235 0.69 111 0.33 48 0.14 27 0.08 Pahang Public 127 - 38 - 28 - 8 - Pahang Private 6 - 11 - 0 - 2 - Pahang Total 133 0.87 49 0.32 28 0.18 10 0.07 Terengganu Public 107 - 31 - 24 - 17 - Terengganu Private 0 - 0 - 0 - 0 - Terengganu Total 107 1.00 31 0.29 24 0.22 17 0.16 Kelantan Public 173 - 75 - 45 - 20 - Kelantan Private 1 - 4 - 0 - 1 - Kelantan Total 174 1.08 79 0.49 45 0.28 21 0.13 Sabah & WP Labuan Public 215 - 107 - 80 - 22 - Sabah & WP Labuan Private 4 - 4 - 0 - 1 - Sabah & WP Labuan Total 219 0.64 111 0.33 80 0.23 23 0.07 Sarawak Public 209 - 90 - 61 - 10 - Sarawak Private 15 - 22 - 4 - 1 - Sarawak Total 224 0.89 112 0.45 65 0.26 11 0.04 Abbreviation: na – not applicable; - – not available 20 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.15 Number and Density of Medical Record Officers and Medical Social Officers in Acute Curative Hospitals in Malaysia by State and Sector, 2011 Medical Record Officers Medical Social Officers State Sector Per 10,000 Per 10,000 Number Number population population Malaysia Public 330 - 215 - Malaysia Private 437 - 21 - Malaysia Total 767 0.26 236 0.08 Perlis Public 2 - 1 - Perlis Private na na na na Perlis Total 2 0.08 1 0.04 Kedah Public 26 - 7 - Kedah Private 9 - 0 - Kedah Total 35 0.18 7 0.04 Kedah & Perlis Public 28 - 8 - Kedah & Perlis Private 9 - 0 - Kedah & Perlis Total 37 0.17 8 0.04 Pulau Pinang Public 14 - 10 - Pulau Pinang Private 20 - 13 - Pulau Pinang Total 34 0.21 23 0.14 Perak Public 34 - 12 - Perak Private 19 - 0 - Perak Total 53 0.22 12 0.05 Selangor & WP Putrajaya Public 35 - 27 - Selangor & WP Putrajaya Private 102 - 4 - Selangor & WP Putrajaya Total 137 0.24 31 0.05 WP Kuala Lumpur Public 40 - 59 - WP Kuala Lumpur Private 164 - 2 - WP Kuala Lumpur Total 204 1.20 61 0.36 Selangor & WP Putrajaya & WPKL Public 75 - 86 - Selangor & WP Putrajaya & WPKL Private 266 - 6 - Selangor & WP Putrajaya & WPKL Total 341 0.46 92 0.13 Negeri Sembilan Public 18 - 8 - Negeri Sembilan Private 38 - 0 - Negeri Sembilan Total 56 0.54 8 0.08 Melaka Public 9 - 5 - Melaka Private 25 - 0 - Melaka Total 34 0.41 5 0.06 Johor Public 29 - 16 - Johor Private 22 - 0 - Johor Total 51 0.15 16 0.05 Pahang Public 18 - 12 - Pahang Private 10 - 2 - Pahang Total 28 0.18 14 0.09 Terengganu Public 16 - 9 - Terengganu Private 0 - 0 - Terengganu Total 16 0.15 9 0.08 Kelantan Public 23 - 14 - Kelantan Private 3 - 0 - Kelantan Total 26 0.16 14 0.09 Sabah & WP Labuan Public 40 - 20 - Sabah & WP Labuan Private 3 - 0 - Sabah & WP Labuan Total 43 0.13 20 0.06 Sarawak Public 26 - 15 - Sarawak Private 22 - 0 -

Sarawak Total 48 0.19 15 0.06 SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE

Abbreviation: na – not applicable; - – not available 2 21 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.16 Number and Density of Computed Tomography (CT) Scanner and Rate of CT Scan Procedure Performed in Acute Curative Hospitals in Malaysia by State and Sector, 2010 and 2011 CT Scan Machine CT Scan Procedure Performed 2010 2011 2010 2011 State Sector Per 10,000 Per 10,000 No. PMP No. PMP No. No. Population Population Malaysia Public 53 - 52 - 267,278 - 333,739 - Malaysia Private 92 - 91 - 217,553 - 219,097 - Malaysia Total 145 5.12 143 4.94 484,831 171.11 552,836 190.87 Perlis Public 1 - 0 - 1,902 - 0 - Perlis Private na na na na na na na na Perlis Total 1 4.32 0 0.00 1,902 82.16 0 0.00 Kedah Public 3 - 3 - 17,914 - 19,557 - Kedah Private 4 - 4 - 9,362 - 8,615 - Kedah Total 7 3.59 7 3.55 27,276 140.04 28,172 142.78 Kedah & Perlis Public 4 - 3 - 19,816 - 19,557 - Kedah & Perlis Private 4 - 4 - 9,362 - 8,615 - Kedah & Perlis Total 8 3.67 7 3.17 29,178 133.89 28,172 127.44 Pulau Pinang Public 2 - 2 - 24,615 - 26,681 - Pulau Pinang Private 10 - 11 - 40,888 - 36,308 - Pulau Pinang Total 12 7.69 13 8.16 65,503 419.51 62,989 395.26 Perak Public 3 - 3 - 22,565 - 26,864 - Perak Private 7 - 6 - 13,009 - 11,172 - Perak Total 10 4.25 9 3.75 35,574 151.21 38,036 158.64 Selangor & WP Putrajaya Public 10 - 11 - 45,030 - 51,927 - Selangor & WP Putrajaya Private 17 - 18 - 48,196 - 48,936 - Selangor & WP Putrajaya Total 27 4.88 29 5.13 93,226 168.45 100,863 178.40 WP Kuala Lumpur Public 11 - 10 - 44,115 - 76,626 - WP Kuala Lumpur Private 15 - 15 - 27,331 - 41,301 - WP Kuala Lumpur Total 26 15.53 25 14.75 71,446 426.65 117,927 695.94 Selangor & WP Putrajaya & WPKL Public 21 - 21 - 89,145 - 128,553 - Selangor & WP Putrajaya & WPKL Private 32 - 33 - 75,527 - 90,237 - Selangor & WP Putrajaya & WPKL Total 53 7.35 54 7.35 164,672 228.42 218,790 297.74 Negeri Sembilan Public 1 - 1 - 10,984 - 13,862 - Negeri Sembilan Private 8 - 6 - 10,328 - 10,749 - Negeri Sembilan Total 9 8.81 7 6.71 21,312 208.72 24,611 235.99 Melaka Public 1 - 1 - 9,506 - 10,612 - Melaka Private 4 - 4 - 16,451 - 16,772 - Melaka Total 5 6.09 5 6.00 25,957 316.12 27,384 328.74 Johor Public 5 - 4 - 30,333 - 35,126 - Johor Private 10 - 10 - 30,125 - 22,385 - Johor Total 15 4.48 14 4.12 60,458 180.56 57,511 169.06 Pahang Public 2 - 2 - 10,467 - 12,152 - Pahang Private 2 - 3 - 2,870 - 2,934 - Pahang Total 4 2.67 5 3.28 13,337 88.87 15,086 98.94 Terengganu Public 1 - 1 - 4,297 - 5,173 - Terengganu Private 1 - 1 - 95 - 190 - Terengganu Total 2 1.93 2 1.86 4,392 42.39 5,363 49.93 Kelantan Public 4 - 4 - 12,718 - 12,920 - Kelantan Private 1 - 1 - 903 - 1,115 - Kelantan Total 5 3.25 5 3.10 13,621 88.47 14,035 86.89 Sabah & WP Labuan Public 4 - 5 - 12,318 - 19,044 - Sabah & WP Labuan Private 3 - 3 - 8,643 - 6,313 - Sabah & WP Labuan Total 7 2.13 8 2.35 20,961 63.64 25,357 74.44 Sarawak Public 5 - 5 - 20,514 - 23,195 - Sarawak Private 10 - 9 - 9,352 - 12,307 - Sarawak Total 15 6.07 14 5.56 29,866 120.86 35,502 141.09 Abbreviation: na – not applicable; - – not available; PMP – per million population 22 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.17 Number and Density of Magnetic Resonance Imaging (MRI) and Rate of MRI Procedure Performed in Acute Curative Hospitals in Malaysia by State and Sector, 2010 and 2011 MRI Machine MRI Procedure Performed 2010 2011 2010 2011 State Sector Per 10,000 Per 10,000 No. PMP No. PMP No. No. Population Population Malaysia Public 31 - 30 - 47,875 - 52,739 - Malaysia Private 76 - 75 - 122,135 - 142,985 - Malaysia Total 107 3.78 105 3.63 170,010 60.00 195,724 67.57 Perlis Public 1 - 0 - 532 - 0 - Perlis Private na na na na na na na na Perlis Total 1 4.32 0 0.00 532 22.98 0 0.00 Kedah Public 2 - 1 - 2,617 - 1,702 - Kedah Private 4 - 4 - 5,331 - 4,807 - Kedah Total 6 3.08 5 2.53 7,948 40.81 6,509 32.99 Kedah & Perlis Public 3 - 1 - 3,149 - 1,702 - Kedah & Perlis Private 4 - 4 - 5,331 - 4,807 - Kedah & Perlis Total 7 3.21 5 2.26 8,480 38.91 6,509 29.44 Pulau Pinang Public 2 - 2 - 4,111 - 4,237 - Pulau Pinang Private 7 - 8 - 18,905 - 26,035 - Pulau Pinang Total 9 5.76 10 6.28 23,016 147.41 30,272 189.96 Perak Public 2 - 1 - 1,789 - 2,611 - Perak Private 5 - 4 - 7,255 - 6,567 - Perak Total 7 2.98 5 2.09 9,044 38.44 9,178 38.28 Selangor & WP Putrajaya Public 5 - 5 - 6,115 - 6,609 - Selangor & WP Putrajaya Private 18 - 18 - 31,645 - 34,528 - Selangor & WP Putrajaya Total 23 4.16 23 4.07 37,760 68.23 41,137 72.76 WP Kuala Lumpur Public 6 - 7 - 17,180 - 17,947 - WP Kuala Lumpur Private 17 - 14 - 20,301 - 30,219 - WP Kuala Lumpur Total 23 13.73 21 12.39 37,481 223.82 48,166 284.25 Selangor & WP Putrajaya & WPKL Public 11 - 12 - 23,295 - 24,556 - Selangor & WP Putrajaya & WPKL Private 35 - 32 - 51,946 - 64,747 - Selangor & WP Putrajaya & WPKL Total 46 6.38 44 5.99 75,241 104.37 89,303 121.53 Negeri Sembilan Public 1 - 1 - 1,925 - 2,016 - Negeri Sembilan Private 5 - 4 - 3,481 - 4,794 - Negeri Sembilan Total 6 5.88 5 4.79 5,406 52.94 6,810 65.30 Melaka Public 1 - 1 - 1,643 - 1,537 - Melaka Private 3 - 3 - 7,301 - 8,872 - Melaka Total 4 4.87 4 4.80 8,944 108.93 10,409 124.96 Johor Public 3 - 2 - 3,161 - 3,743 - Johor Private 7 - 8 - 15,490 - 13,178 - Johor Total 10 2.99 10 2.94 18,651 55.70 16,921 49.74 Pahang Public 2 - 2 - 1,709 - 1,650 - Pahang Private 2 - 3 - 2,004 - 2,051 - Pahang Total 4 2.67 5 3.28 3,713 24.74 3,701 24.27 Terengganu Public 1 - 1 - 945 - 1,162 - Terengganu Private 0 - 0 - 0 - 0 - Terengganu Total 1 0.97 1 0.93 945 9.12 1,162 10.82 Kelantan Public 2 - 3 - 2,125 - 1,728 - Kelantan Private 1 - 1 - 637 - 796 - Kelantan Total 3 1.95 4 2.48 2,762 17.94 2,524 15.63 Sabah & WP Labuan Public 1 - 2 - 1,359 - 4,335 - Sabah & WP Labuan Private 2 - 2 - 4,072 - 3,671 - Sabah & WP Labuan Total 3 0.91 4 1.17 5,431 16.49 8,006 23.50 Sarawak Public 2 - 2 - 2,664 - 3,462 - Sarawak Private 5 - 6 - 5,713 - 7,467 -

Sarawak Total 7 2.83 8 3.18 8,377 33.90 10,929 43.43 SERVICES IN MALAYSIA HOSPITAL ACUTE CURATIVE

Abbreviation: na – not applicable; - – not available; PMP – per million population 2 23 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 2.18 Number and Density of Positron Emission Tomography (PET) and Rate of PET Procedure Performed in Acute Curative Hospitals in Malaysia by State and Sector, 2010 and 2011 PET MACHINE PET PROCEDURE PERFORMED 2010 2011 2010 2011 State Sector PER 10,000 PER 10,000 NO. PMP NO. PMP NO. NO. POPULATION POPULATION Malaysia Public 2 - 2 - 1,133 - 1,343 - Malaysia Private 6 - 6 - 1,015 - 1,278 - Malaysia Total 8 0.28 8 0.28 2,148 0.76 2,621 0.90 Perlis Public 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 0 - 0 - 0 - Kedah Private 0 - 0 - 0 - 0 - Kedah Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah & Perlis Public 0 - 0 - 0 - 0 - Kedah & Perlis Private 0 - 0 - 0 - 0 - Kedah & Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Pulau Pinang Public 1 - 1 - 307 - 469 - Pulau Pinang Private 3 - 3 - 232 - 480 - Pulau Pinang Total 4 2.56 4 2.51 539 3.45 949 5.96 Perak Public 0 - 0 - 0 - 0 - Perak Private 0 - 0 - 0 - 0 - Perak Total 0 0.00 0 0.00 0 0.00 0 0.00 Selangor & WP Putrajaya Public 1 - 1 - 826 - 874 - Selangor & WP Putrajaya Private 2 - 2 - 713 - 584 - Selangor & WP Putrajaya Total 3 0.54 3 0.53 1,539 2.78 1,458 2.58 WP Kuala Lumpur Public 0 - 0 - 0 - 0 - WP Kuala Lumpur Private 1 - 1 - 70 - 214 - WP Kuala Lumpur Total 1 0.60 1 0.59 70 0.42 214 1.26 Selangor & WP Putrajaya & WPKL Public 1 - 1 - 826 - 874 - Selangor & WP Putrajaya & WPKL Private 3 - 3 - 783 - 798 - Selangor & WP Putrajaya & WPKL Total 4 0.55 4 0.54 1,609 2.23 1,672 2.28 Negeri Sembilan Public 0 - 0 - 0 - 0 - Negeri Sembilan Private 0 - 0 - 0 - 0 - Negeri Sembilan Total 0 0.00 0 0.00 0 0.00 0 0.00 Melaka Public 0 - 0 - 0 - 0 - Melaka Private 0 - 0 - 0 - 0 - Melaka Total 0 0.00 0 0.00 0 0.00 0 0.00 Johor Public 0 - 0 - 0 - 0 - Johor Private 0 - 0 - 0 - 0 - Johor Total 0 0.00 0 0.00 0 0.00 0 0.00 Pahang Public 0 - 0 - 0 - 0 - Pahang Private 0 - 0 - 0 - 0 - Pahang Total 0 0.00 0 0.00 0 0.00 0 0.00 Terengganu Public 0 - 0 - 0 - 0 - Terengganu Private 0 - 0 - 0 - 0 - Terengganu Total 0 0.00 0 0.00 0 0.00 0 0.00 Kelantan Public 0 - 0 - 0 - 0 - Kelantan Private 0 - 0 - 0 - 0 - Kelantan Total 0 0.00 0 0.00 0 0.00 0 0.00 Sabah & WP Labuan Public 0 - 0 - 0 - 0 - Sabah & WP Labuan Private 0 - 0 - 0 - 0 - Sabah & WP Labuan Total 0 0.00 0 0.00 0 0.00 0 0.00 Sarawak Public 0 - 0 - 0 - 0 - Sarawak Private 0 - 0 - 0 - 0 - Sarawak Total 0 0.00 0 0.00 0 0.00 0 0.00

Abbreviation: na – not applicable; - – not available; PMP – per million population 24 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 3 | MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES Ravichandran J1, Ravindran J2, Parampalam SD3, Shamala K4, Arunah C4*, Faizah A4* 1. Hospital Sultanah Aminah, Johor Bahru, 2. Hospital Kuala Lumpur, 3. Hospital Seberang Jaya, 4. National Clinical Research Centre, Ministry of Health * Corresponding author.

Summary: There were 839 Obstetrics and Gynaecology (O&G) specialists working with medical officers and nurses providing maternity services in 317 hospitals and 26 maternity homes in 2011. The Caesarean section rate for 2011 was 23.76 per 100 live births. This was lower than the average rate across OECD countries which had a rate of 25.8 per 100 live births. The ratio of specialist to total deliveries in the public sector was 1:1,265 as compared to 1:202 in the private sector. In specialist hospitals, the ratio of midwifery trained nurses to delivery beds was 1.6 to 1 per shift. The ratio of midwifery trained nurse to delivery in these labour rooms was 1 per 100. The ratio of eclampsia to delivery in was 1.75 times more than that of Peninsular Malaysia. In addition to providing care for the mother, the staff of the maternity services in the public sector also looked after 83% of newborns during the mother’s stay in the hospital.

This survey was conducted in all hospitals that received patients and provided specialist, nursing and midwifery care for women in labour and for women soon after childbirth. Facilities that did not conduct inpatient deliveries such as the delivery centres in health clinics were excluded. In addition, five hospitals from the Ministry of Defence were excluded.

There were 317 hospitals providing maternity services. These included 130 Ministry of Health (MOH) facilities, three University Hospitals and 184 private hospitals (Table 3.1). The response rate in this survey was 81.4%; 100% from the public sector and 67.9% from the private sector. This was higher than in the 2010 survey which had a response rate of 74.9%. The improved response rate was contributed entirely from the private sector.

Facilities

Wilayah Persekutuan Kuala Lumpur (WPKL) recorded the highest density of maternity services at 0.20 per 10,000 population, followed by Pulau Pinang at 0.14 per 10,000 population and Sarawak, Perak, Negeri Sembilan and Pahang at 0.12 per 10,000 population. The hospitals with lowest density of maternity services were in Perlis (0.04 per 10,000 population), followed by Melaka and Terengganu, both at 0.07 per 10,000 population (Table 3.1).

Seven states (WPKL, Pulau Pinang, Perak, Negeri Sembilan, Pahang, Sarawak and Johor) were at or above the national average of 0.11 per 10,000 population. These were also the states that had higher private sector providers (Table 3.1).

A total of 1,310 delivery beds were available nationwide, of which 774 (59.1%) were in the public sector and the remaining 536 (40.9%) in the private sector. In terms of workload, there were 1.87 delivery beds per 1,000 deliveries in the public sector whereas there were 5.18 beds per 1,000 deliveries in the private side. The national average was 2.53 delivery beds per 1,000 deliveries (Table 3.2).

Of the 56 public hospitals with O&G specialists, only 33 had dedicated maternity operation theatres (OT) with 47 operating rooms that were functioning. This translates to 0.11 dedicated OTs per 1,000 deliveries. This was an improvement when compared to 2010 which had a rate of 0.07 per 1,000 deliveries (Table 3.3).

Nationwide, 30 public hospitals had a dedicated high dependency unit (HDU) within the O&G Department. There were 103 obstetrics HDU beds in these public hospitals. The national public hospital average of obstetrics HDU beds was 0.25 per 1,000 deliveries. Kelantan had the lowest number of HDU beds (0.03 beds per 1,000 deliveries), followed by Selangor and WP Putrajaya, Sabah and WP Labuan (0.12). In contrast to the previous report, every state in Malaysia had access to a dedicated obstetrics HDU (Table 3.4).

Activities

A total of 517,081 deliveries were reported from both public and private hospitals in 2011. Of these, 413,657 (80%) deliveries were from the public sector and 103,424 (20%) from the private sector. This did not include home deliveries, maternity home deliveries and deliveries in transit (Table 3.5).

Kelantan had the highest rate of deliveries at 231 per 10,000 population followed by WPKL (224 per 10,000) and Terengganu (198 per 10,000). Pulau Pinang had the lowest rate of deliveries at 154 per 10,000 population. All the states registered proportionally higher deliveries in public MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY hospitals (Table 3.5). 3

25 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Of the total deliveries in Malaysia, 368,010 were spontaneous vertex deliveries (SVD). Sabah and Kelantan recorded the highest ratio of SVD with 894.59 and 845.37 deliveries per 1,000 live births respectively. Selangor and WP Putrajaya had the lowest density of SVDs (641 per 1,000 deliveries) (Table 3.6). There were 1,823 vaginal breech deliveries in the public sector when compared to 175 breech deliveries in the private sector (Table 3.7).

Five per cent (26,040) of the total deliveries were instrumental deliveries, almost all using vacuum. About 2.9% and 13.7% of all deliveries were conducted using vacuum in the public and private sector, respectively (Table 3.8). Only 0.5% of all deliveries were conducted using forceps; 0.4% of deliveries in the public sector and 1% of deliveries in the private sector (Table 3.9).

There were a total of 117,526 Caesarean sections (CS) in 2011. This accounted for 22.7% of all deliveries captured in this survey, which is marginally higher than the rate reported (22.1%) in 2010. We had a national CS rate of 23.76 per 100 live births. This was lower than the rate across the Organisation for Economic Co-operation and Development (OECD) countries which had an average rate of 25.8 per 100 live births (Table 3.10).

Almost all states recorded a higher number of Caesarean sections when compared to the previous year. A total of 35,897 (34.71 per 100 deliveries) of CS were performed in the private sector and 81,629 (19.73 per 100 deliveries) CS were recorded in public hospitals. The states with the lowest CS rates were Kelantan at 14.66 per 100 deliveries, followed by Terengganu at 14.74 per 100 deliveries. WPKL had the highest Caesarean section rate (32.48 per 100 deliveries), followed by Pulau Pinang (29.26 per 100 deliveries). In the private sector, Sabah had the highest CS rate (51.27 per 100 deliveries) with Terengganu having the lowest (19.43 per 100 deliveries). In the public sector, WPKL had the highest CS rate at 29.5 per 100 deliveries while Sabah recorded the lowest (13.31 per 100 deliveries) (Table 3.10). About 76% of all CS in the public sector were emergency surgeries (Table 3.10).

A total of 4,008 deliveries (0.78 per 100 deliveries) were from multiple pregnancies, of which 3,284 deliveries (82%) were in public hospitals (Table 3.12). There were 490 eclampsia cases reported, a rate of 0.95 cases per 1,000 deliveries. Sabah had the highest incidence per 1,000 deliveries (1.82) whereas Pahang had the lowest with 0.19 cases per 1,000 deliveries. The ratio of eclampsia to delivery in East Malaysia was 1.75 times more than that of Peninsular Malaysia (Table 3.13).

A total of 12,662 cases of post partum haemorrhage (PPH) were reported nationwide, a rate of 2.5%. Perlis had the highest PPH rate of 14.7% followed by Pulau Pinang at 4.4%. The lowest rate was in Sarawak at 0.9%, followed by Terengganu at 1.3% (Table 3.14). There were 166 recorded cases of Caesarean hysterectomies in public hospitals in this survey, a rate of 0.04% (Table 3.11). Further details of such surgeries performed in public hospitals are shown in Table 3.11.

In addition to caring for mothers, the obstetrics fraternity also provided care for 83% of newborns in the public sector. (Table 3.15)

Human Workforce

There were 839 obstetricians and gynaecologists identified in this survey, of whom 327 (39%) worked in the public sector and 512 (61%) in the private sector. This equated to 5.96 specialists per 100,000 female population. This is low when compared to the OECD standards of 26.8 specialists per 100,000 female population. The ratio of specialists to total deliveries in the public sector was 1:1,265 as compared to the private sector which was 1:202 (Table 3.16).

In 2011, 5,901 staff nurses and 3,280 community nurses worked in the O&G services in both public and private hospitals (Table 3.17). Of these, 1,689 staff nurses with midwifery training and 1,312 community nurses worked in public specialist hospitals (Table 3.18). In contrast, 1,216 staff nurses with midwifery training and 814 community nurses worked in labour wards in public specialist hospitals. Only 60% of nurses in the labour ward in public specialist hospitals were staff nurses with midwifery training. The remaining 40% were community nurses. In specialist hospitals, the ratio of midwifery trained nurses to delivery beds was 1.6 to per shift. The ratio of nurse to delivery in these labour rooms was 1:100 per year (Table 3.19). A total of 110 staff nurses with midwifery training and 50 community nurses worked in public specialist hospital HDUs. The ratio of nurses with midwifery to functional obstetrics HDU bed per shift was 0.5:1 (Table 3.20).

Maternity Homes

Of the 26 maternity homes, 10 or 38.5% responded to the survey. They accounted for 1,823 deliveries. Seven vacuum and 7 forceps deliveries. There were 2 specialists, 20 medical officers, 29 staff nurses, 20 nurses with midwifery training, 12 community nurses and 53 clinic assistants serving these homes.

26 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Limitations

1. Estimation of total deliveries conducted within all inpatient establishments was not possible due to the poor response rate from maternity homes and, as a result, we were unable to capture the total deliveries conducted in all inpatient establishments in the country.

2. Changes in the definitions of the relevant variables limited our efforts to study trends in the data over the years

3. Lack of comprehensive national and international norms for obstetrics services restricted international comparisons MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY 3

27 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.1 Number, Density and Percentage of Hospitals Providing Maternity Services in Malaysia by State and Sector, 2010 and 2011 Year 2010 Year 2011 Hospitals Hospitals Providing Total Hospitals Providing Total Hospitals Providing Providing Maternity Maternity Services Maternity Services Maternity with State Sector with Specialists Specialists % of % Per % of % Per Per 10,000 Per 10,000 No. facilities No. Maternity No. facilities No. Maternity population population by Sector Hospital by Sector Hospital Malaysia Public 133 - 42.20 53 39.80 133 - 42 56 42.10 Malaysia Private 182 - 57.80 182 100.00 184 - 58 184 100.00 Malaysia Total 315 0.11 100.00 235 74.60 317 0.11 100 240 75.70 Perlis Public 1 - 100.00 1 100.00 1 - 100 1 100.00 Perlis Private na na na na na na na na na na Perlis Total 1 0.04 100.00 1 100.00 1 0.04 100 1 100.00 Kedah Public 9 - 47.40 4 44.40 9 - 50 4 44.40 Kedah Private 10 - 52.60 10 100.00 9 - 50 9 100.00 Kedah Total 19 0.10 100.00 14 73.70 18 0.09 100 13 72.20 Kedah & Perlis Public 10 - 50.00 5 50.00 10 - 52.6 5 50.00 Kedah & Perlis Private 10 - 50.00 10 100.00 9 - 47.4 9 100.00 Kedah & Perlis Total 20 0.09 100.00 15 75.00 19 0.09 100 14 73.70 Pulau Pinang Public 6 - 26.10 3 50.00 6 - 26.1 3 50.00 Pulau Pinang Private 17 - 73.90 17 100.00 17 - 73.9 17 100.00 Pulau Pinang Total 23 0.15 100.00 20 87.00 23 0.14 100 20 87.00 Perak Public 14 - 50.00 5 35.70 14 - 48.3 5 35.70 Perak Private 14 - 50.00 14 100.00 15 - 51.7 15 100.00 Perak Total 28 0.12 100.00 19 67.90 29 0.12 100 20 69.00 Selangor & WP Putrajaya Public 12 - 21.10 8 66.70 12 - 20.7 8 66.70 Selangor & WP Putrajaya Private 45 - 78.90 45 100.00 46 - 79.3 46 100.00 Selangor & WP Putrajaya Total 57 0.10 100.00 53 93.00 58 0.10 100 54 93.10 WP Kuala Lumpur Public 3 - 8.60 3 100.00 3 - 8.8 3 100.00 WP Kuala Lumpur Private 32 - 91.40 32 100.00 31 - 91.2 31 100.00 WP Kuala Lumpur Total 35 0.21 100.00 35 100.00 34 0.20 100 34 100.00 Selangor & WP Putrajaya & WPKL Public 15 - 16.30 11 73.30 15 - 16.3 11 73.30 Selangor & WP Putrajaya & WPKL Private 77 - 83.70 77 100.00 77 - 83.7 77 100.00 Selangor & WP Putrajaya & WPKL Total 92 0.13 100.00 88 95.70 92 0.13 100 88 95.70 Negeri Sembilan Public 6 - 50.00 2 33.30 6 - 50 3 50.00 Negeri Sembilan Private 6 - 50.00 6 100.00 6 - 50 6 100.00 Negeri Sembilan Total 12 0.12 100.00 8 66.70 12 0.12 100 9 75.00 Melaka Public 3 - 50.00 1 33.30 3 - 50 1 33.30 Melaka Private 3 - 50.00 3 100.00 3 - 50 3 100.00 Melaka Total 6 0.07 100.00 4 66.70 6 0.07 100 4 66.70 Johor Public 11 - 28.20 6 54.50 11 - 28.2 6 54.50 Johor Private 28 - 71.80 28 100.00 28 - 71.8 28 100.00 Johor Total 39 0.12 100.00 34 87.20 39 0.11 100 34 87.20 Pahang Public 10 - 58.80 3 30.00 10 - 52.6 3 30.00 Pahang Private 7 - 41.20 7 100.00 9 - 47.4 9 100.00 Pahang Total 17 0.11 100.00 10 58.80 19 0.12 100 12 63.20 Terengganu Public 6 - 85.70 2 33.30 6 - 85.7 2 33.30 Terengganu Private 1 - 14.30 1 100.00 1 - 14.3 1 100.00 Terengganu Total 7 0.07 100.00 3 42.90 7 0.07 100 3 42.90 Kelantan Public 10 - 76.90 4 40.00 10 - 76.9 4 40.00 Kelantan Private 3 - 23.10 3 100.00 3 - 23.1 3 100.00 Kelantan Total 13 0.08 100.00 7 53.80 13 0.08 100 7 53.80 Sabah & WP Labuan Public 22 - 81.50 5 22.70 22 - 81.5 6 27.30 Sabah & WP Labuan Private 5 - 18.50 5 100.00 5 - 18.5 5 100.00 Sabah & WP Labuan Total 27 0.08 100.00 10 37.00 27 0.08 100 11 40.70 Sarawak Public 20 - 64.50 6 30.00 20 - 64.5 7 35.00 Sarawak Private 11 - 35.50 11 100.00 11 - 35.5 11 100.00 Sarawak Total 31 0.13 100.00 17 54.80 31 0.12 100 18 58.10 Abbreviation: na – not applicable; - – not available

28 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.2 Number, Density and Percentage of Functioning Delivery Beds in Malaysia by State and Sector, 2011 Functioning Delivery Beds State Sector Delivery Beds per No. % of Beds by sector 1,000 Deliveries Malaysia Public 774 59.10 1.87 Malaysia Private 536 40.90 5.18 Malaysia Total 1,310 100.00 2.53 Perlis Public 6 100.00 1.46 Perlis Private na na na Perlis Total 6 100.00 1.46 Kedah Public 51 64.60 1.68 Kedah Private 28 35.40 4.63 Kedah Total 79 100.00 2.17 Kedah & Perlis Public 57 67.10 1.66 Kedah & Perlis Private 28 32.90 4.63 Kedah & Perlis Total 85 100.00 2.10 Pulau Pinang Public 33 36.30 2.32 Pulau Pinang Private 58 63.70 5.61 Pulau Pinang Total 91 100.00 3.70 Perak Public 74 67.90 2.41 Perak Private 35 32.10 4.66 Perak Total 109 100.00 2.85 Selangor & WP Putrajaya Public 85 35.40 1.30 Selangor & WP Putrajaya Private 155 64.60 4.79 Selangor & WP Putrajaya Total 240 100.00 2.45 WP Kuala Lumpur Public 42 32.30 1.72 WP Kuala Lumpur Private 88 67.70 6.47 WP Kuala Lumpur Total 130 100.00 3.42 Selangor & WP Putrajaya & WPKL Public 127 34.30 1.41 Selangor & WP Putrajaya & WPKL Private 243 65.70 5.29 Selangor & WP Putrajaya & WPKL Total 370 100.00 2.72 Negeri Sembilan Public 32 64.00 2.34 Negeri Sembilan Private 18 36.00 3.34 Negeri Sembilan Total 50 100.00 2.62 Melaka Public 20 54.10 1.77 Melaka Private 17 45.90 5.02 Melaka Total 37 100.00 2.51 Johor Public 89 55.60 1.92 Johor Private 71 44.40 6.00 Johor Total 160 100.00 2.74 Pahang Public 52 71.20 2.25 Pahang Private 21 28.80 8.08 Pahang Total 73 100.00 2.84 Terengganu Public 35 92.10 1.67 Terengganu Private 3 7.90 9.46 Terengganu Total 38 100.00 1.79 Kelantan Public 72 87.80 2.09 Kelantan Private 10 12.20 3.65 Kelantan Total 82 100.00 2.20 Sabah & WP Labuan Public 107 92.20 1.90 Sabah & WP Labuan Private 9 7.80 3.01 Sabah & WP Labuan Total 116 100.00 1.96 Sarawak Public 76 76.80 2.00 Sarawak Private 23 23.20 5.30 Sarawak Total 99 100.00 2.34 MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY Abbreviation: na – not applicable 3

29 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.3 Number and Density of Hospital with Dedicated Maternity Operating Theatre (OT) Facilities and Functioning Maternity Operating Room (OR) in Public Hospitals in Malaysia by State, 2011 2011 State Dedicated OT Facilities Functioning Operating Room (OR) No. Per 1,000 Deliveries No. Per 1,000 Deliveries Malaysia 33 0.08 47 0.11 Perlis 0 0.00 0 0.00 Kedah 2 0.07 4 0.13 Kedah & Perlis 2 0.06 4 0.12 Pulau Pinang 2 0.14 2 0.14 Perak 4 0.13 6 0.20 Selangor & WP Putrajaya 5 0.08 7 0.11 WP Kuala Lumpur 3 0.12 7 0.29 Selangor & WP Putrajaya & WPKL 8 0.09 14 0.16 Negeri Sembilan 1 0.07 1 0.07 Melaka 1 0.09 1 0.09 Johor 1 0.02 1 0.02 Pahang 2 0.09 3 0.13 Terengganu 1 0.05 1 0.05 Kelantan 3 0.09 3 0.09 Sabah & WP Labuan 2 0.04 3 0.05 Sarawak 6 0.16 8 0.21

Table 3.4 Number and Density of Functional Obstetrics High Dependency Unit (HDU) Beds within O&G Department in Public Hospitals in Malaysia by State, 2010 and 2011 2010 2011 Functional HDU Beds Hospital with HDU within Functional HDU Beds State within O&G Department O&G Department within O&G Department Per 1,000 Per 1,000 Per 1,000 No. No. No. Deliveries Deliveries Deliveries Malaysia 106 0.27 30 0.07 103 0.25 Perlis 2 0.51 1 0.24 2 0.49 Kedah 7 0.24 2 0.07 7 0.23 Kedah & Perlis 9 0.27 3 0.09 9 0.26 Pulau Pinang 8 0.57 1 0.07 4 0.28 Perak 8 0.27 2 0.07 10 0.33 Selangor & WP Putrajaya 13 0.21 3 0.05 8 0.12 WP Kuala Lumpur 15 0.64 3 0.12 16 0.66 Selangor & WP Putrajaya & WPKL 28 0.33 6 0.07 24 0.27 Negeri Sembilan 2 0.15 1 0.07 2 0.15 Melaka 0 0.00 1 0.09 2 0.18 Johor 24 0.53 4 0.09 24 0.52 Pahang 8 0.36 2 0.09 8 0.35 Terengganu 3 0.15 1 0.05 2 0.10 Kelantan 2 0.06 1 0.03 1 0.03 Sabah & WP Labuan 8 0.15 4 0.07 7 0.12 Sarawak 6 0.17 4 0.11 10 0.26

30 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.5 Number, Density and Percentage of Total Deliveries in Malaysia by State and Sector, 2010 and 2011 Year 2010 Year 2011 % of % of State Sector No Of Per 10,000 No Of Per 10,000 Deliveries Deliveries Deliveries population Deliveries population by Sector by Sector Malaysia Public 396,836 - 77.70 413,657 - 80.00 Malaysia Private 114,098 - 22.30 103,424 - 20.00 Malaysia Total 510,934 180.32 100.00 517,081 178.52 100.00 Perlis Public 3,949 - 100.00 4,100 - 100.00 Perlis Private na na na na na na Perlis Total 3,949 170.58 100.00 4,100 172.63 100.00 Kedah Public 29,397 - 85.60 30,338 - 83.40 Kedah Private 4,955 - 14.40 6,051 - 16.60 Kedah Total 34,352 176.37 100.00 36,389 184.43 100.00 Kedah & Perlis Public 33,346 - 87.10 34,438 - 85.10 Kedah & Perlis Private 4,955 - 12.90 6,051 - 14.90 Kedah & Perlis Total 38,301 175.76 100.00 40,489 183.16 100.00 Pulau Pinang Public 14,013 - 55.30 14,251 - 57.90 Pulau Pinang Private 11,332 - 44.70 10,342 - 42.10 Pulau Pinang Total 25,345 162.32 100.00 24,593 154.32 100.00 Perak Public 29,741 - 75.90 30,763 - 80.40 Perak Private 9,424 - 24.10 7,505 - 19.60 Perak Total 39,165 166.47 100.00 38,268 159.61 100.00 Selangor & WP Putrajaya Public 61,061 - 59.60 65,604 - 67.00 Selangor & WP Putrajaya Private 41,310 - 40.40 32,333 - 33.00 Selangor & WP Putrajaya Total 102,371 184.97 100.00 97,937 173.22 100.00 WP Kuala Lumpur Public 23,260 - 60.70 24,376 - 64.20 WP Kuala Lumpur Private 15,041 - 39.30 13,611 - 35.80 WP Kuala Lumpur Total 38,301 228.72 100.00 37,987 224.18 100.00 Selangor & WP Putrajaya & WPKL Public 84,321 - 59.90 89,980 - 66.20 Selangor & WP Putrajaya & WPKL Private 56,351 - 40.10 45,944 - 33.80 Selangor & WP Putrajaya & WPKL Total 140,672 195.13 100.00 135,924 184.97 100.00 Negeri Sembilan Public 13,297 - 76.20 13,668 - 71.70 Negeri Sembilan Private 4,143 - 23.80 5,384 - 28.30 Negeri Sembilan Total 17,440 170.80 100.00 19,052 182.68 100.00 Melaka Public 10,585 - 77.20 11,334 - 77.00 Melaka Private 3,129 - 22.80 3,385 - 23.00 Melaka Total 13,714 167.02 100.00 14,719 176.70 100.00 Johor Public 45,560 - 79.90 46,481 - 79.70 Johor Private 11,447 - 20.10 11,831 - 20.30 Johor Total 57,007 170.26 100.00 58,312 171.42 100.00 Pahang Public 22,302 - 87.70 23,092 - 89.90 Pahang Private 3,126 - 12.30 2,598 - 10.10 Pahang Total 25,428 169.43 100.00 25,690 168.48 100.00 Terengganu Public 20,510 - 98.40 20,968 - 98.50 Terengganu Private 333 - 1.60 317 - 1.50 Terengganu Total 20,843 201.19 100.00 21,285 198.18 100.00 Kelantan Public 33,381 - 94.10 34,485 - 92.60 Kelantan Private 2,100 - 5.90 2,738 - 7.40 Kelantan Total 35,481 230.46 100.00 37,223 230.45 100.00 Sabah & WP Labuan Public 53,646 - 94.80 56,238 - 95.00 Sabah & WP Labuan Private 2,949 - 5.20 2,990 - 5.00 Sabah & WP Labuan Total 56,595 171.83 100.00 59,228 173.88 100.00 Sarawak Public 36,134 - 88.30 37,959 - 89.70 Sarawak Private 4,809 - 11.70 4,339 - 10.30

Sarawak Total 40,943 165.69 100.00 42,298 168.10 100.00 HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY

Abbreviation: na – not applicable; - – not available 3 31 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.6 Number and Density of Spontaneous Vertex Deliveries (SVD) in Malaysia by State and Sector, 2010 and 2011 Spontaneous Vertex Deliveries (SVD) 2010 2011 State Sector Per 100 Per 1,000 Per 100 Per 1,000 No. No. Deliveries Live Birth Deliveries Live Birth Malaysia Public 305,930 77.09 - 316,273 76.46 - Malaysia Private 59,417 52.08 - 51,737 50.02 - Malaysia Total 365,347 71.51 685.86 368,010 71.17 744.05 Perlis Public 2,899 73.41 - 2,926 71.37 - Perlis Private na na na na na na Perlis Total 2,899 73.41 662.58 2,926 71.37 725.16 Kedah Public 21,678 73.74 - 21,759 71.72 - Kedah Private 1,886 38.06 - 2,102 34.74 - Kedah Total 23,564 68.60 643.53 23,861 65.57 685.35 Kedah & Perlis Public 24,577 73.70 - 24,685 71.68 - Kedah & Perlis Private 1,886 38.06 - 2,102 34.74 - Kedah & Perlis Total 26,463 69.09 645.56 26,787 66.16 689.48 Pulau Pinang Public 10,318 73.63 - 10,240 71.85 - Pulau Pinang Private 6,723 59.33 - 5,404 52.25 - Pulau Pinang Total 17,041 67.24 695.15 15,644 63.61 719.36 Perak Public 21,608 72.65 - 22,217 72.22 - Perak Private 4,167 44.22 - 3,243 43.21 - Perak Total 25,775 65.81 689.03 25,460 66.53 698.55 Selangor & WP Putrajaya Public 44,150 72.30 - 46,710 71.20 - Selangor & WP Putrajaya Private 20,862 50.50 - 16,463 50.92 - Selangor & WP Putrajaya Total 65,012 63.51 567.47 63,173 64.50 641.23 WP Kuala Lumpur Public 15,171 65.22 - 16,062 65.89 - WP Kuala Lumpur Private 8,308 55.24 - 6,504 47.78 - WP Kuala Lumpur Total 23,479 61.30 834.56 22,566 59.40 775.25 Selangor & WP Putrajaya & WPKL Public 59,321 70.35 - 62,772 69.76 - Selangor & WP Putrajaya & WPKL Private 29,170 51.76 - 22,967 49.99 - Selangor & WP Putrajaya & WPKL Total 88,491 62.91 620.13 85,739 63.08 671.79 Negeri Sembilan Public 10,085 75.84 - 10,542 77.13 - Negeri Sembilan Private 2,294 55.37 - 2,868 53.27 - Negeri Sembilan Total 12,379 70.98 658.87 13,410 70.39 783.39 Melaka Public 8,027 75.83 - 8,296 73.20 - Melaka Private 989 31.61 - 1,330 39.29 - Melaka Total 9,016 65.74 566.00 9,626 65.40 710.25 Johor Public 35,133 77.11 - 35,885 77.20 - Johor Private 6,192 54.09 - 6,402 54.11 - Johor Total 41,325 72.49 667.14 42,287 72.52 748.80 Pahang Public 17,040 76.41 - 17,551 76.00 - Pahang Private 2,313 73.99 - 1,841 70.86 - Pahang Total 19,353 76.11 720.40 19,392 75.48 741.09 Terengganu Public 17,675 86.18 - 17,683 84.33 - Terengganu Private 288 86.49 - 146 46.06 - Terengganu Total 17,963 86.18 777.53 17,829 83.76 742.38 Kelantan Public 28,342 84.90 - 28,810 83.54 - Kelantan Private 1,753 83.48 - 2,138 78.09 - Kelantan Total 30,095 84.82 849.88 30,948 83.14 845.37 Sabah & WP Labuan Public 44,678 83.28 - 47,256 84.03 - Sabah & WP Labuan Private 1,202 40.76 - 1,058 35.38 - Sabah & WP Labuan Total 45,880 81.07 780.85 48,314 81.57 894.59 Sarawak Public 29,126 80.61 - 30,336 79.92 - Sarawak Private 2,440 50.74 - 2,238 51.58 - Sarawak Total 31,566 77.10 683.11 32,574 77.01 775.83 Abbreviation: na – not applicable; - – not available 32 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.7 Number and Density of Vaginal Breech Deliveries in Malaysia by State and Sector, 2010 and 2011 Vaginal Breech Deliveries 2010 2011 State Sector Per 100 Per 1,000 Per 100 Per 1,000 No. No. Deliveries Live Birth Deliveries Live Birth Malaysia Public 2,246 0.57 - 1,823 0.44 - Malaysia Private 157 0.14 - 175 0.17 - Malaysia Total 2,403 0.47 4.51 1,998 0.39 4.04 Perlis Public 22 0.56 - 28 0.68 - Perlis Private na na na na na na Perlis Total 22 0.56 5.03 28 0.68 6.94 Kedah Public 178 0.61 - 168 0.55 - Kedah Private 16 0.32 - 24 0.40 - Kedah Total 194 0.56 5.30 192 0.53 5.52 Kedah & Perlis Public 200 0.60 - 196 0.57 - Kedah & Perlis Private 16 0.32 - 24 0.40 - Kedah & Perlis Total 216 0.56 5.27 220 0.54 5.66 Pulau Pinang Public 65 0.46 - 68 0.48 - Pulau Pinang Private 19 0.17 - 15 0.15 - Pulau Pinang Total 84 0.33 3.43 83 0.34 3.82 Perak Public 163 0.55 - 88 0.29 - Perak Private 6 0.06 - 3 0.04 - Perak Total 169 0.43 4.52 91 0.24 2.50 Selangor & WP Putrajaya Public 292 0.48 - 284 0.43 - Selangor & WP Putrajaya Private 34 0.08 - 49 0.15 - Selangor & WP Putrajaya Total 326 0.32 2.85 333 0.34 3.38 WP Kuala Lumpur Public 201 0.86 - 138 0.57 - WP Kuala Lumpur Private 36 0.24 - 42 0.31 - WP Kuala Lumpur Total 237 0.62 8.42 180 0.47 6.18 Selangor & WP Putrajaya & WPKL Public 493 0.58 - 422 0.47 - Selangor & WP Putrajaya & WPKL Private 70 0.12 - 91 0.20 - Selangor & WP Putrajaya & WPKL Total 563 0.40 3.95 513 0.38 4.02 Negeri Sembilan Public 136 1.02 - 45 0.33 - Negeri Sembilan Private 3 0.07 - 2 0.04 - Negeri Sembilan Total 139 0.80 7.40 47 0.25 2.75 Melaka Public 46 0.43 - 27 0.24 - Melaka Private 1 0.03 - 3 0.09 - Melaka Total 47 0.34 2.95 30 0.20 2.21 Johor Public 326 0.72 - 251 0.54 - Johor Private 35 0.31 - 22 0.19 - Johor Total 361 0.63 5.83 273 0.47 4.83 Pahang Public 100 0.45 - 95 0.41 - Pahang Private 3 0.10 - 5 0.19 - Pahang Total 103 0.41 3.83 100 0.39 3.82 Terengganu Public 86 0.42 - 94 0.45 - Terengganu Private 1 0.30 - 0 0.00 - Terengganu Total 87 0.42 3.77 94 0.44 3.91 Kelantan Public 218 0.65 - 201 0.58 - Kelantan Private 2 0.10 - 8 0.29 - Kelantan Total 220 0.62 6.21 209 0.56 5.71 Sabah & WP Labuan Public 227 0.42 - 212 0.38 - Sabah & WP Labuan Private 0 0.00 - 0 0.00 - Sabah & WP Labuan Total 227 0.40 3.86 212 0.36 3.93 Sarawak Public 186 0.51 - 124 0.33 - Sarawak Private 1 0.02 - 2 0.05 -

Sarawak Total 187 0.46 4.05 126 0.30 3.00 HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY

Abbreviation: na – not applicable; - – not available 3 33 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.8 Number and Density of Instrumental Deliveries using Vacuum in Malaysia by State and Sector, 2010 and 2011 Instrumental Deliveries using Vacuum 2010 2011 State Sector Per 100 Per 1,000 Per 100 Per 1,000 No. No. Deliveries Live Birth Deliveries Live Birth Malaysia Public 11,182 2.82 - 11,832 2.86 - Malaysia Private 15,458 13.55 - 14,208 13.74 - Malaysia Total 26,640 5.21 50.01 26,040 5.04 52.65 Perlis Public 149 3.77 - 110 2.68 - Perlis Private na na na na na na Perlis Total 149 3.77 34.05 110 2.68 27.26 Kedah Public 1,174 3.99 - 1,063 3.50 - Kedah Private 1,042 21.03 - 1,334 22.05 - Kedah Total 2,216 6.45 60.52 2,397 6.59 68.85 Kedah & Perlis Public 1,323 3.97 - 1,173 3.41 - Kedah & Perlis Private 1,042 21.03 - 1,334 22.05 - Kedah & Perlis Total 2,365 6.17 57.69 2,507 6.19 64.53 Pulau Pinang Public 243 1.73 - 200 1.40 - Pulau Pinang Private 1,550 13.68 - 1,460 14.12 - Pulau Pinang Total 1,793 7.07 73.14 1,660 6.75 76.33 Perak Public 350 1.18 - 194 0.63 - Perak Private 1,935 20.53 - 1,533 20.43 - Perak Total 2,285 5.83 61.08 1,727 4.51 47.38 Selangor & WP Putrajaya Public 2,332 3.82 - 3,212 4.90 - Selangor & WP Putrajaya Private 6,371 15.42 - 5,134 15.88 - Selangor & WP Putrajaya Total 8,703 8.50 75.97 8,346 8.52 84.72 WP Kuala Lumpur Public 851 3.66 - 880 3.61 - WP Kuala Lumpur Private 1,519 10.10 - 1,534 11.27 - WP Kuala Lumpur Total 2,370 6.19 84.24 2,414 6.35 82.93 Selangor & WP Putrajaya & WPKL Public 3,183 3.77 - 4,092 4.55 - Selangor & WP Putrajaya & WPKL Private 7,890 14.00 - 6,668 14.51 - Selangor & WP Putrajaya & WPKL Total 11,073 7.87 77.60 10,760 7.92 84.31 Negeri Sembilan Public 402 3.02 - 389 2.85 - Negeri Sembilan Private 741 17.89 - 1,048 19.47 - Negeri Sembilan Total 1,143 6.55 60.84 1,437 7.54 83.95 Melaka Public 432 4.08 - 431 3.80 - Melaka Private 363 11.60 - 340 10.04 - Melaka Total 795 5.80 49.91 771 5.24 56.89 Johor Public 1,846 4.05 - 1,992 4.29 - Johor Private 1,148 10.03 - 974 8.23 - Johor Total 2,994 5.25 48.33 2,966 5.09 52.52 Pahang Public 790 3.54 - 846 3.66 - Pahang Private 102 3.26 - 86 3.31 - Pahang Total 892 3.51 33.20 932 3.63 35.62 Terengganu Public 177 0.86 - 118 0.56 - Terengganu Private 4 1.20 - 48 15.14 - Terengganu Total 181 0.87 7.84 166 0.78 6.91 Kelantan Public 271 0.81 - 370 1.07 - Kelantan Private 85 4.05 - 94 3.43 - Kelantan Total 356 1.00 10.05 464 1.25 12.67 Sabah & WP Labuan Public 1,210 2.26 - 1,146 2.04 - Sabah & WP Labuan Private 375 12.72 - 379 12.68 - Sabah & WP Labuan Total 1,585 2.80 26.98 1,525 2.57 28.24 Sarawak Public 955 2.64 - 881 2.32 - Sarawak Private 223 4.64 - 244 5.62 - Sarawak Total 1,178 2.88 25.49 1,125 2.66 26.80 Abbreviation: na – not applicable; - – not available 34 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.9 Number and Density of Instrumental Deliveries using Forceps in Malaysia by State and Sector, 2010 and 2011 Instrumental Deliveries using Forceps 2010 2011 State Sector Per 100 Per 1,000 Per 100 Per 1,000 No. No. Deliveries Live Birth Deliveries Live Birth Malaysia Public 1,455 0.37 - 1,633 0.39 - Malaysia Private 1,339 1.17 - 1,146 1.11 - Malaysia Total 2,794 0.55 5.25 2,779 0.54 5.62 Perlis Public 9 0.23 - 12 0.29 - Perlis Private na na na na na na Perlis Total 9 0.23 2.06 12 0.29 2.97 Kedah Public 71 0.24 - 53 0.17 - Kedah Private 188 3.79 - 127 2.10 - Kedah Total 259 0.75 7.07 180 0.49 5.17 Kedah & Perlis Public 80 0.24 - 65 0.19 - Kedah & Perlis Private 188 3.79 - 127 2.10 - Kedah & Perlis Total 268 0.70 6.54 192 0.47 4.94 Pulau Pinang Public 28 0.20 - 59 0.41 - Pulau Pinang Private 41 0.36 - 42 0.41 - Pulau Pinang Total 69 0.27 2.82 101 0.41 4.64 Perak Public 80 0.27 - 64 0.21 - Perak Private 118 1.25 - 83 1.11 - Perak Total 198 0.51 5.29 147 0.38 4.03 Selangor & WP Putrajaya Public 597 0.98 - 515 0.79 - Selangor & WP Putrajaya Private 328 0.79 - 212 0.66 - Selangor & WP Putrajaya Total 925 0.90 8.07 727 0.74 7.38 WP Kuala Lumpur Public 76 0.33 - 106 0.43 - WP Kuala Lumpur Private 266 1.77 - 376 2.76 - WP Kuala Lumpur Total 342 0.89 12.16 482 1.27 16.56 Selangor & WP Putrajaya & WPKL Public 673 0.80 - 621 0.69 - Selangor & WP Putrajaya & WPKL Private 594 1.05 - 588 1.28 - Selangor & WP Putrajaya & WPKL Total 1,267 0.90 8.88 1,209 0.89 9.47 Negeri Sembilan Public 86 0.65 - 76 0.56 - Negeri Sembilan Private 32 0.77 - 20 0.37 - Negeri Sembilan Total 118 0.68 6.28 96 0.50 5.61 Melaka Public 39 0.37 - 72 0.64 - Melaka Private 27 0.86 - 42 1.24 - Melaka Total 66 0.48 4.14 114 0.77 8.41 Johor Public 172 0.38 - 323 0.69 - Johor Private 107 0.93 - 60 0.51 - Johor Total 279 0.49 4.50 383 0.66 6.78 Pahang Public 10 0.04 - 34 0.15 - Pahang Private 69 2.21 - 68 2.62 - Pahang Total 79 0.31 2.94 102 0.40 3.90 Terengganu Public 33 0.16 - 37 0.18 - Terengganu Private 2 0.60 - 0 0.00 - Terengganu Total 35 0.17 1.52 37 0.17 1.54 Kelantan Public 121 0.36 - 130 0.38 - Kelantan Private 4 0.19 - 0 0.00 - Kelantan Total 125 0.35 3.53 130 0.35 3.55 Sabah & WP Labuan Public 54 0.10 - 63 0.11 - Sabah & WP Labuan Private 15 0.51 - 19 0.64 - Sabah & WP Labuan Total 69 0.12 1.17 82 0.14 1.52 Sarawak Public 79 0.22 - 89 0.23 - Sarawak Private 142 2.95 - 97 2.24 -

Sarawak Total 221 0.54 4.78 186 0.44 4.43 HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY

Abbreviation: na – not applicable; - – not available 3 35 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.10 Number and Density of Caesarean Sections in Malaysia by State and Sector, 2010-2011 2010 2011 Total LSCS Total Caesarean Sections Elective Surgeries Emergency Surgeries Per Per Per State Sector Per 1,000 Per 100 Per 100 1,000 Per 100 1,000 Per 100 1,000 No. Live No. No. No. Deliveries Deliveries Live Deliveries Live Deliveries Live Birth Birth Birth Birth Malaysia Public 75,692 19.07 - 81,629 19.73 - 18,869 4.56 38.15 62,760 15.17 126.89 Malaysia Private 37,075 32.49 - 35,897 34.71 ------Malaysia Total 112,767 22.07 211.697 117,526 22.73 237.62 ------Perlis Public 870 22.03 - 1,019 24.85 - 222 5.41 55.02 797 19.44 197.52 Perlis Private na na na na na na na na na na na na Perlis Total 870 22.03 198.841 1,019 24.85 252.54 ------Kedah Public 6,454 21.95 - 7,407 24.41 - 1,831 6.04 52.59 5,576 18.38 160.16 Kedah Private 1,823 36.79 - 2,455 40.57 ------Kedah Total 8,277 24.09 226.044 9,862 27.10 283.26 ------Kedah & Perlis Public 7,324 21.96 - 8,426 24.47 - 2,053 5.96 52.84 6,373 18.51 164.04 Kedah & Perlis Private 1,823 36.79 - 2,455 40.57 ------Kedah & Perlis Total 9,147 23.88 223.141 10,881 26.87 280.07 ------Pulau Pinang Public 3,516 25.09 - 3,784 26.55 - 1,091 7.66 50.17 2,693 18.90 123.83 Pulau Pinang Private 2,996 26.44 - 3,411 32.98 ------Pulau Pinang Total 6,512 25.69 265.644 7,195 29.26 330.85 ------Perak Public 7,541 25.36 - 8,197 26.65 - 1,683 5.47 46.18 6,514 21.17 178.73 Perak Private 2,784 29.54 - 2,640 35.18 ------Perak Total 10,325 26.36 276.011 10,837 28.32 297.34 ------Selangor & WP Putrajaya Public 13,602 22.28 - 14,476 22.07 - 3,499 5.33 35.52 10,977 16.73 111.42 Selangor & WP Putrajaya Private 13,469 32.6 - 10,542 32.60 ------Selangor & WP Putrajaya Total 27,071 26.44 236.296 25,018 25.54 253.94 ------WP Kuala Lumpur Public 6,972 29.97 - 7,190 29.50 - 1,777 7.29 61.05 5,413 22.21 185.96 WP Kuala Lumpur Private 4,904 32.6 - 5,149 37.83 ------WP Kuala Lumpur Total 11,876 31.01 422.134 12,339 32.48 423.90 ------Selangor & WP Putrajaya & WPKL Public 20,574 24.4 - 21,666 24.08 - 5,276 5.86 41.34 16,390 18.22 128.42 Selangor & WP Putrajaya & WPKL Private 18,373 32.6 - 15,691 34.15 ------Selangor & WP Putrajaya & WPKL Total 38,947 27.69 272.934 37,357 27.48 292.71 ------Negeri Sembilan Public 2,543 19.12 - 2,526 18.48 - 804 5.88 46.97 1,722 12.60 100.60 Negeri Sembilan Private 1,074 25.92 - 1,430 26.56 ------Negeri Sembilan Total 3,617 20.74 192.514 3,956 20.76 231.10 ------Melaka Public 2,087 19.72 - 2,511 22.15 - 490 4.32 36.15 2,021 17.83 149.12 Melaka Private 1,564 49.98 - 1,663 49.13 ------Melaka Total 3,651 26.62 229.2 4,174 28.36 307.98 ------Johor Public 7,868 17.27 - 7,994 17.20 - 2,245 4.83 39.75 5,749 12.37 101.80 Johor Private 3,959 34.59 - 4,095 34.61 ------Johor Total 11,827 20.75 190.932 12,089 20.73 214.07 ------Pahang Public 4,362 19.56 - 4,660 20.18 - 1,017 4.40 38.87 3,643 15.78 139.22 Pahang Private 639 20.44 - 601 23.13 ------Pahang Total 5,001 19.67 186.158 5,261 20.48 201.06 ------Terengganu Public 2,486 12.12 - 3,015 14.38 - 726 3.46 30.23 2,289 10.92 95.31 Terengganu Private 38 11.41 - 123 38.80 ------Terengganu Total 2,524 12.11 109.251 3,138 14.74 130.66 ------Kelantan Public 4,483 13.43 - 4,960 14.38 - 801 2.32 21.88 4,159 12.06 113.61 Kelantan Private 428 20.38 - 498 18.19 ------Kelantan Total 4,911 13.84 138.686 5,458 14.66 149.09 ------Sabah & WP Labuan Public 7,209 13.44 - 7,485 13.31 - 1,373 2.44 25.42 6,112 10.87 113.17 Sabah & WP Labuan Private 1,380 46.8 - 1,533 51.27 ------Sabah & WP Labuan Total 8,589 15.18 146.18 9,018 15.23 166.98 ------Sarawak Public 5,699 15.77 - 6,405 16.87 - 1,310 3.45 31.20 5,095 13.42 121.35 Sarawak Private 2,017 41.94 - 1,757 40.49 ------Sarawak Total 7,716 18.85 166.978 8,162 19.30 194.40 ------Abbreviation: na – not applicable; - – not available

36 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.11 Number and Density of Lower Segment Caesarean Section (LSCS), Caesarean Hysterectomy and Hysterotomy Performed in Public Hospitals in Malaysia by State, 2010 and 2011 2010 2011 Caesarean LSCS LSCS Caesarean Hysterectomy Hysterotomy Hysterectomy State Per Per Per Per Per Per 100 1,000 Per 100 1,000 Per 100 1,000 Per 100 1,000 Per 100 1,000 No. No. No. No. No. Deliveries Live Deliveries Live Deliveries Live Deliveries Live Deliveries Live Birth Birth Birth Birth Birth Malaysia 75,692 19.07 142.10 233 0.06 0.44 81,331 19.66 164.44 166 0.04 0.34 71 0.02 0.14 Perlis 870 22.03 198.84 1 0.03 0.23 1,019 24.85 252.54 4 0.10 0.99 0 0.00 0.00 Kedah 6,454 21.95 176.26 21 0.07 0.57 7,389 24.36 212.23 35 0.12 1.01 7 0.02 0.20 Kedah & Perlis 7,324 21.96 178.67 22 0.07 0.54 8,408 24.41 216.42 39 0.11 1.00 7 0.02 0.18 Pulau Pinang 3,516 25.09 143.43 13 0.09 0.53 3,786 26.57 174.09 5 0.04 0.23 0 0.00 0.00 Perak 7,541 25.36 201.59 27 0.09 0.72 7,985 25.96 219.09 26 0.08 0.71 21 0.07 0.58 Selangor & WP 13,602 22.28 118.73 37 0.06 0.32 14,476 22.07 146.94 12 0.02 0.12 2 0.00 0.02 Putrajaya WP Kuala Lumpur 6,972 29.97 247.82 12 0.05 0.43 7,190 29.50 247.01 7 0.03 0.24 5 0.02 0.17 Selangor & WP 20,574 24.40 144.18 49 0.06 0.34 21,666 24.08 169.76 19 0.02 0.15 7 0.01 0.06 Putrajaya & WPKL Negeri Sembilan 2,543 19.12 135.35 9 0.07 0.48 2,524 18.47 147.45 3 0.02 0.18 0 0.00 0.00 Melaka 2,087 19.72 131.02 2 0.02 0.13 2,511 22.15 185.27 8 0.07 0.59 0 0.00 0.00 Johor 7,868 17.27 127.02 19 0.04 0.31 7,982 17.17 141.34 18 0.04 0.32 7 0.02 0.12 Pahang 4,362 19.56 162.37 8 0.04 0.30 4,660 20.18 178.09 10 0.04 0.38 1 0.00 0.04 Terengganu 2,486 12.12 107.61 15 0.07 0.65 3,015 14.38 125.54 4 0.02 0.17 15 0.07 0.63 Kelantan 4,483 13.43 126.60 6 0.02 0.17 4,960 14.38 135.49 9 0.03 0.25 1 0.00 0.03 Sabah & WP Labuan 7,209 13.44 122.69 41 0.08 0.70 7,539 13.41 139.59 15 0.03 0.28 8 0.01 0.15 Sarawak 5,699 15.77 123.33 22 0.06 0.48 6,295 16.58 149.93 10 0.03 0.24 4 0.01 0.10 MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY 3

37 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.12 Number and Density of Multiple Pregnancies Delivered in Malaysia by State and Sector, 2010 and 2011 Multiple Pregnancies Delivered State Sector 2010 2011 No. Per 100 deliveries No. Per 100 deliveries Malaysia Public 3,131 0.79 3,284 0.79 Malaysia Private 732 0.64 724 0.70 Malaysia Total 3,863 0.76 4,008 0.78 Perlis Public 23 0.58 31 0.76 Perlis Private na na na na Perlis Total 23 0.58 31 0.76 Kedah Public 247 0.84 228 0.75 Kedah Private 23 0.46 28 0.46 Kedah Total 270 0.79 256 0.70 Kedah & Perlis Public 270 0.81 259 0.75 Kedah & Perlis Private 23 0.46 28 0.46 Kedah & Perlis Total 293 0.76 287 0.71 Pulau Pinang Public 101 0.72 148 1.04 Pulau Pinang Private 103 0.91 75 0.73 Pulau Pinang Total 204 0.80 223 0.91 Perak Public 208 0.70 276 0.90 Perak Private 25 0.27 33 0.44 Perak Total 233 0.59 309 0.81 Selangor & WP Putrajaya Public 514 0.84 500 0.76 Selangor & WP Putrajaya Private 317 0.77 195 0.60 Selangor & WP Putrajaya Total 831 0.81 695 0.71 WP Kuala Lumpur Public 289 1.24 288 1.18 WP Kuala Lumpur Private 97 0.64 124 0.91 WP Kuala Lumpur Total 386 1.01 412 1.08 Selangor & WP Putrajaya & WPKL Public 803 0.95 788 0.88 Selangor & WP Putrajaya & WPKL Private 414 0.73 319 0.69 Selangor & WP Putrajaya & WPKL Total 1,217 0.87 1,107 0.81 Negeri Sembilan Public 102 0.77 133 0.97 Negeri Sembilan Private 21 0.51 48 0.89 Negeri Sembilan Total 123 0.71 181 0.95 Melaka Public 92 0.87 89 0.79 Melaka Private 24 0.77 17 0.50 Melaka Total 116 0.85 106 0.72 Johor Public 329 0.72 397 0.85 Johor Private 47 0.41 100 0.85 Johor Total 376 0.66 497 0.85 Pahang Public 155 0.70 142 0.61 Pahang Private 18 0.58 11 0.42 Pahang Total 173 0.68 153 0.60 Terengganu Public 123 0.60 170 0.81 Terengganu Private 0 0.00 1 0.32 Terengganu Total 123 0.59 171 0.80 Kelantan Public 289 0.87 277 0.80 Kelantan Private 7 0.33 6 0.22 Kelantan Total 296 0.83 283 0.76 Sabah & WP Labuan Public 457 0.85 394 0.70 Sabah & WP Labuan Private 13 0.44 51 1.71 Sabah & WP Labuan Total 470 0.83 445 0.75 Sarawak Public 202 0.56 211 0.56 Sarawak Private 37 0.77 35 0.81 Sarawak Total 239 0.58 246 0.58 Abbreviation: na – not applicable 38 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.13 Number and Density of Eclampsia in Malaysia by State and Sector, 2010 and 2011 Eclampsia State Sector 2010 2011 No. Per 1,000 Deliveries No. Per 1,000 Deliveries Malaysia Public 390 0.98 390 0.94 Malaysia Private 150 1.31 100 0.97 Malaysia Total 540 1.06 490 0.95 Perlis Public 5 1.27 5 1.22 Perlis Private na na na na Perlis Total 5 1.27 5 1.22 Kedah Public 21 0.71 28 0.92 Kedah Private 6 1.21 6 0.99 Kedah Total 27 0.79 34 0.93 Kedah & Perlis Public 26 0.78 33 0.96 Kedah & Perlis Private 6 1.21 6 0.99 Kedah & Perlis Total 32 0.84 39 0.96 Pulau Pinang Public 4 0.29 2 0.14 Pulau Pinang Private 11 0.97 4 0.39 Pulau Pinang Total 15 0.59 6 0.24 Perak Public 11 0.37 24 0.78 Perak Private 0 0.00 1 0.13 Perak Total 11 0.28 25 0.65 Selangor & WP Putrajaya Public 79 1.29 59 0.90 Selangor & WP Putrajaya Private 62 1.50 42 1.30 Selangor & WP Putrajaya Total 141 1.38 101 1.03 WP Kuala Lumpur Public 9 0.39 29 1.19 WP Kuala Lumpur Private 38 2.53 29 2.13 WP Kuala Lumpur Total 47 1.23 58 1.53 Selangor & WP Putrajaya & WPKL Public 88 1.04 88 0.98 Selangor & WP Putrajaya & WPKL Private 100 1.77 71 1.55 Selangor & WP Putrajaya & WPKL Total 188 1.34 159 1.17 Negeri Sembilan Public 7 0.53 14 1.02 Negeri Sembilan Private 0 0.00 0 0.00 Negeri Sembilan Total 7 0.40 14 0.73 Melaka Public 4 0.38 10 0.88 Melaka Private 4 1.28 4 1.18 Melaka Total 8 0.58 14 0.95 Johor Public 42 0.92 36 0.77 Johor Private 0 0.00 3 0.25 Johor Total 42 0.74 39 0.67 Pahang Public 17 0.76 4 0.17 Pahang Private 7 2.24 1 0.38 Pahang Total 24 0.94 5 0.19 Terengganu Public 21 1.02 16 0.76 Terengganu Private 11 33.03 0 0.00 Terengganu Total 32 1.54 16 0.75 Kelantan Public 19 0.57 26 0.75 Kelantan Private 0 0.00 1 0.37 Kelantan Total 19 0.54 27 0.73 Sabah & WP Labuan Public 118 2.20 99 1.76 Sabah & WP Labuan Private 0 0.00 9 3.01 Sabah & WP Labuan Total 118 2.08 108 1.82 Sarawak Public 33 0.91 38 1.00 Sarawak Private 11 2.29 0 0.00 Sarawak Total 44 1.07 38 0.90

Abbreviation: na – not applicable HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY 3

39 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.14 Number and Density of Post Partum Haemorrhage (PPH) in Malaysia by State and Sector, 2010-2011 2010 2011 Post Partum Post Partum Primary PPH Massive PPH State Sector Haemorrhage Haemorrhage Per 1,000 Per 1,000 Per 1,000 Per 1,000 No No No No Deliveries Deliveries Deliveries Deliveries Malaysia Public 8,045 20.27 11,843 28.63 10,329 24.97 1,927 4.66 Malaysia Private 1,222 10.71 819 7.92 758 7.33 80 0.77 Malaysia Total 9,267 18.14 12,662 24.49 11,087 21.44 2,007 3.88 Perlis Public 39 9.88 602 146.83 542 132.20 60 14.63 Perlis Private na na na na na na na na Perlis Total 39 9.88 602 146.83 542 132.20 60 14.63 Kedah Public 253 8.61 786 25.91 611 20.14 174 5.74 Kedah Private 49 9.89 19 3.14 19 3.14 1 0.17 Kedah Total 302 8.79 805 22.12 630 17.31 175 4.81 Kedah & Perlis Public 292 8.76 1,388 40.30 1,153 33.48 234 6.79 Kedah & Perlis Private 49 9.89 19 3.14 19 3.14 1 0.17 Kedah & Perlis Total 341 8.90 1,407 34.75 1,172 28.95 235 5.80 Pulau Pinang Public 568 40.53 1,024 71.85 927 65.05 97 6.81 Pulau Pinang Private 143 12.62 67 6.48 58 5.61 15 1.45 Pulau Pinang Total 711 28.05 1,091 44.36 985 40.05 112 4.55 Perak Public 1,497 50.33 1,451 47.17 1,275 41.45 176 5.72 Perak Private 156 16.55 101 13.46 95 12.66 6 0.80 Perak Total 1,653 42.21 1,552 40.56 1,370 35.80 182 4.76 Selangor & WP Putrajaya Public 1,662 27.22 2,199 33.52 2,385 36.35 206 3.14 Selangor & WP Putrajaya Private 394 9.54 247 7.64 238 7.36 13 0.40 Selangor & WP Putrajaya Total 2,056 20.08 2,446 24.98 2,623 26.78 219 2.24 WP Kuala Lumpur Public 515 22.14 378 15.51 235 9.64 143 5.87 WP Kuala Lumpur Private 108 7.18 115 8.45 104 7.64 16 1.18 WP Kuala Lumpur Total 623 16.27 493 12.98 339 8.92 159 4.19 Selangor & WP Putrajaya & WPKL Public 2,177 25.82 2,577 28.64 2,620 29.12 349 3.88 Selangor & WP Putrajaya & WPKL Private 502 8.91 362 7.88 342 7.44 29 0.63 Selangor & WP Putrajaya & WPKL Total 2,679 19.04 2,939 21.62 2,962 21.79 378 2.78 Negeri Sembilan Public 57 4.29 639 46.75 592 43.31 47 3.44 Negeri Sembilan Private 90 21.72 76 14.12 76 14.12 0 0.00 Negeri Sembilan Total 147 8.43 715 37.53 668 35.06 47 2.47 Melaka Public 26 2.46 497 43.85 452 39.88 45 3.97 Melaka Private 6 1.92 23 6.79 19 5.61 4 1.18 Melaka Total 32 2.33 520 35.33 471 32.00 49 3.33 Johor Public 993 21.80 1,038 22.33 870 18.72 168 3.61 Johor Private 71 6.20 104 8.79 92 7.78 14 1.18 Johor Total 1,064 18.66 1,142 19.58 962 16.50 182 3.12 Pahang Public 355 15.92 512 22.17 424 18.36 88 3.81 Pahang Private 19 6.08 44 16.94 35 13.47 9 3.46 Pahang Total 374 14.71 556 21.64 459 17.87 97 3.78 Terengganu Public 67 3.27 270 12.88 177 8.44 93 4.44 Terengganu Private 1 3.00 0 0.00 0 0.00 0 0.00 Terengganu Total 68 3.26 270 12.68 177 8.32 93 4.37 Kelantan Public 853 25.55 1,115 32.33 701 20.33 414 12.01 Kelantan Private 6 2.86 4 1.46 3 1.10 1 0.37 Kelantan Total 859 24.21 1,119 30.06 704 18.91 415 11.15 Sabah & WP Labuan Public 984 18.34 960 17.07 835 14.85 148 2.63 Sabah & WP Labuan Private 5 1.70 0 0.00 0 0.00 0 0.00 Sabah & WP Labuan Total 989 17.48 960 16.21 835 14.10 148 2.50 Sarawak Public 176 4.87 372 9.80 303 7.98 68 1.79 Sarawak Private 174 36.18 19 4.38 19 4.38 1 0.23 Sarawak Total 350 8.55 391 9.24 322 7.61 69 1.63

Abbreviation: na – not applicable

40 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.15 Number of Newborns Delivered and Admitted to Paediatrics, NICU and SCN in Public Hospitals in Malaysia by State, 2010-2011 2010 2011 State Newborns Newborns Admitted to Newborns Newborns Admitted to Delivered Paediatrics, NICU & SCN Delivered Paediatrics, NICU & SCN Malaysaia 404,396 70,501 413,736 82,980 Perlis 3,973 1,310 4,100 1,398 Kedah 29,534 4,171 30,338 6,359 Kedah & Perlis 33,507 5,481 34,438 7,757 Pulau Pinang 14,117 3,660 14,251 3,893 Perak 29,821 5,526 30,763 5,994 Selangor & WP Putrajaya 61,842 10,522 65,683 9,802 WP Kuala Lumpur 23,599 7,277 24,376 5,590 Selangor & WP Putrajaya & WPKL 85,441 17,799 90,059 15,392 Negeri Sembilan 13,423 1,843 13,668 2,499 Melaka 10,675 2,307 11,334 3,755 Johor 50,529 6,006 46,481 10,079 Pahang 22,361 6,497 23,092 7,685 Terengganu 20,548 5,309 20,968 6,056 Kelantan 33,761 4,227 34,485 4,938 Sabah & WP Labuan 54,020 8,347 56,238 8,300 Sarawak 36,193 3,499 37,959 6,632 MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY 3

41 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.16 Number and Density of Obstetrics & Gynaecology (O&G) Specialists and Medical Officers in Malaysia by State and Sector, 2010-2011 2010 2011 O&G Specialist Medical Officers O&G Specialist Medical Officers State Sector Per Per Per Per No. 100,000 No. 100,000 No. 100,000 No. 100,000 Female Female Female Female Malaysia Public 310 - 643 - 327 - 741 5.27 Malaysia Private 446 - 92 - 512 - - - Malaysia Total 756 5.49 735 5.34 839 5.97 - - Perlis Public 5 - 8 - 6 - 13 10.77 Perlis Private 0 na na na na na na na Perlis Total 5 4.25 8 6.80 6 4.97 - - Kedah Public 22 - 41 - 23 - 61 6.25 Kedah Private 16 - 4 - 21 - - - Kedah Total 38 3.95 45 4.68 44 4.51 - - Kedah & Perlis Public 27 - 49 - 29 - 74 6.75 Kedah & Perlis Private 16 - 4 - 21 - - - Kedah & Perlis Total 43 3.98 53 4.91 50 4.56 - - Pulau Pinang Public 14 - 40 - 16 - 38 4.78 Pulau Pinang Private 48 - 10 - 52 - - - Pulau Pinang Total 62 7.96 50 6.42 68 8.56 - - Perak Public 24 - 51 - 21 - 59 4.98 Perak Private 42 - 0 - 43 - - - Perak Total 66 5.66 51 4.38 64 5.40 - - Selangor & WP Putrajaya Public 64 - 108 - 61 - 126 4.62 Selangor & WP Putrajaya Private 119 - 25 - 139 - - - Selangor & WP Putrajaya Total 183 6.84 133 4.97 200 7.33 - - WP Kuala Lumpur Public 44 - 91 - 57 - 82 9.88 WP Kuala Lumpur Private 98 - 38 - 102 - - - WP Kuala Lumpur Total 142 17.26 129 15.68 159 19.17 - - Selangor & WP Putrajaya & WPKL Public 108 - 199 - 118 - 208 5.85 Selangor & WP Putrajaya & WPKL Private 217 - 63 - 241 - - - Selangor & WP Putrajaya & WPKL Total 325 9.29 262 7.49 359 10.09 - - Negeri Sembilan Public 10 - 28 - 12 - 40 7.93 Negeri Sembilan Private 18 - 0 - 20 - - - Negeri Sembilan Total 28 5.69 28 5.69 32 6.35 - - Melaka Public 9 - 31 - 5 - 29 7.01 Melaka Private 18 - 0 - 20 - - - Melaka Total 27 6.61 31 7.59 25 6.04 - - Johor Public 27 - 57 - 31 - 70 4.35 Johor Private 36 - 2 - 50 - - - Johor Total 63 3.99 59 3.73 81 5.04 - - Pahang Public 15 - 27 - 15 - 34 4.75 Pahang Private 7 - 9 - 11 - - - Pahang Total 22 3.12 36 5.11 26 3.63 - - Terengganu Public 10 - 17 - 11 - 29 5.51 Terengganu Private 1 - 1 - 2 - - - Terengganu Total 11 2.17 18 3.55 13 2.47 - - Kelantan Public 22 - 44 - 24 - 48 5.97 Kelantan Private 6 - 3 - 5 - - - Kelantan Total 28 3.66 47 6.14 29 3.61 - - Sabah & WP Labuan Public 23 - 55 - 22 - 67 4.10 Sabah & WP Labuan Private 13 - 0 - 17 - - - Sabah & WP Labuan Total 36 2.26 55 3.46 39 2.39 - - Sarawak Public 21 - 45 - 23 - 45 3.71 Sarawak Private 24 - 0 - 30 - - - Sarawak Total 45 3.76 45 3.76 53 4.37 - - Abbreviation: na – not applicable; - – not available

42 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.17 Number and Density of Staff Nurses and Community Nurses in Obstetrics & Gynaecology (O&G) in Malaysia by State and Sector, 2010-2011 2010 2011 Staff Nurses Community Nurses Staff Nurses Community Nurses State Sector Per Per Per Per Per 1,000 Per 1,000 Per 1,000 Per 1,000 No. 100,000 No. 100,000 No. 100,000 No. 100,000 Deliveries Deliveries Deliveries Deliveries Female Female Female Female Malaysia Public 3,914 - 9.86 2,528 - 6.37 4,521 - 10.93 2,978 - 7.20 Malaysia Private 1,479 - 12.96 256 - 2.24 1,380 - 13.34 302 - 2.92 Malaysia Total 5,393 39.16 10.56 2,784 20.22 5.45 5,901 41.99 11.41 3,280 23.34 6.34 Perlis Public 31 - 7.85 18 - 4.56 39 - 9.51 31 - 7.56 Perlis Private na na na na na na na na na na na na Perlis Total 31 26.34 7.85 18 15.29 4.56 39 32.31 9.51 31 25.68 7.56 Kedah Public 370 - 12.59 193 - 6.57 340 - 11.21 234 - 7.71 Kedah Private 55 - 11.10 16 - 3.23 45 - 7.44 20 - 3.31 Kedah Total 425 44.17 12.37 209 21.72 6.08 385 39.44 10.58 254 26.02 6.98 Kedah & Perlis Public 401 - 12.03 211 - 6.33 379 - 11.01 265 - 7.69 Kedah & Perlis Private 55 - 11.10 16 - 3.23 45 - 7.44 20 - 3.31 Kedah & Perlis Total 456 42.22 11.91 227 21.02 5.93 424 38.66 10.47 285 25.98 7.04 Pulau Pinang Public 178 - 12.70 102 - 7.28 198 - 13.89 134 - 9.40 Pulau Pinang Private 136 - 12.00 38 - 3.35 175 - 16.92 40 - 3.87 Pulau Pinang Total 314 40.29 12.39 140 17.96 5.52 373 46.95 15.17 174 21.90 7.08 Perak Public 283 - 9.52 178 - 5.99 432 - 14.04 229 - 7.44 Perak Private 93 - 9.87 17 - 1.80 97 - 12.92 26 - 3.46 Perak Total 376 32.26 9.60 195 16.73 4.98 529 44.65 13.82 255 21.52 6.66 Selangor & WP Public 500 - 8.19 455 - 7.45 581 - 8.86 490 - 7.47 Putrajaya Selangor & WP Private 516 - 12.49 69 - 1.67 384 - 11.88 53 - 1.64 Putrajaya Selangor & WP Total 1,016 37.97 9.92 524 19.58 5.12 965 35.38 9.85 543 19.91 5.54 Putrajaya WP Kuala Lumpur Public 325 - 13.97 76 - 3.27 513 - 21.05 108 - 4.43 WP Kuala Lumpur Private 278 - 18.48 22 - 1.46 254 - 18.66 38 - 2.79 WP Kuala Lumpur Total 603 73.31 15.74 98 11.91 2.56 767 92.45 20.19 146 17.60 3.84 Selangor & WP Public 825 - 9.78 531 - 6.30 1,094 - 12.16 598 - 6.65 Putrajaya & WPKL Selangor & WP Private 794 - 14.09 91 - 1.61 638 - 13.89 91 - 1.98 Putrajaya & WPKL Selangor & WP Total 1,619 46.28 11.51 622 17.78 4.42 1,732 48.70 12.74 689 19.37 5.07 Putrajaya & WPKL Negeri Sembilan Public 124 - 9.33 37 - 2.78 163 - 11.93 123 - 9.00 Negeri Sembilan Private 47 - 11.34 3 - 0.72 60 - 11.14 11 - 2.04 Negeri Sembilan Total 171 34.75 9.81 40 8.13 2.29 223 44.22 11.70 134 26.57 7.03 Melaka Public 104 - 9.83 73 - 6.90 97 - 8.56 90 - 7.94 Melaka Private 59 - 18.86 4 - 1.28 77 - 22.75 1 - 0.30 Melaka Total 163 39.88 11.89 77 18.84 5.61 174 42.07 11.82 91 22.00 6.18 Johor Public 473 - 10.38 258 - 5.66 501 - 10.78 308 - 6.63 Johor Private 185 - 16.16 26 - 2.27 153 - 12.93 38 - 3.21 Johor Total 658 41.62 11.54 284 17.97 4.98 654 40.65 11.22 346 21.51 5.93 Pahang Public 291 - 13.05 215 - 9.64 295 - 12.77 218 - 9.44 Pahang Private 27 - 8.64 9 - 2.88 39 - 15.01 9 - 3.46 Pahang Total 318 45.14 12.51 224 31.80 8.81 334 46.69 13.00 227 31.73 8.84 Terengganu Public 224 - 10.92 157 - 7.65 193 - 9.20 125 - 5.96 Terengganu Private 5 - 15.02 2 - 6.01 1 - 3.15 0 - 0.00 Terengganu Total 229 45.12 10.99 159 31.33 7.63 194 36.88 9.11 125 23.76 5.87 Kelantan Public 352 - 10.54 137 - 4.10 346 - 10.03 146 - 4.23 Kelantan Private 14 - 6.67 6 - 2.86 10 - 3.65 3 - 1.10 Kelantan Total 366 47.79 10.32 143 18.67 4.03 356 44.26 9.56 149 18.53 4.00 Sabah & WP Public 357 - 6.65 315 - 5.87 425 - 7.56 384 - 6.83 Labuan Sabah & WP Private 24 - 8.14 8 - 2.71 24 - 8.03 25 - 8.36 Labuan Sabah & WP Total 381 23.95 6.73 323 20.31 5.71 449 27.49 7.58 409 25.04 6.91 Labuan Sarawak Public 302 - 8.36 314 - 8.69 398 - 10.48 358 - 9.43 Sarawak Private 40 - 8.32 36 - 7.49 61 - 14.06 38 - 8.76

Sarawak Total 342 28.55 8.35 350 29.22 8.55 459 37.81 10.85 396 32.62 9.36 HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY Abbreviation: na – not applicable; - – not available 3

43 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.18 Number and Density of Staff Nurses with Midwifery and Community Nurses in Public Hospitals Obstetric Ward in Malaysia with Specialist Services by State, 2010-2011 2010 2011 Staff Nurses with Midwifery Staff Nurses with Midwifery Community Nurses State Per Per Per Per 1,000 Per 1,000 Per 1,000 No. 100,000 No. 100,000 No. 100,000 Deliveries Deliveries Deliveries Female Female Female Malaysia 2,743 19.92 6.91 1,689 12.02 4.08 1,312 9.34 3.17 Perlis 27 22.94 6.84 17 14.08 4.15 10 8.29 2.44 Kedah 201 20.89 6.84 127 13.01 4.19 114 11.68 3.76 Kedah & Perlis 228 21.11 6.84 144 13.13 4.18 124 11.31 3.60 Pulau Pinang 115 14.76 8.21 78 9.82 5.47 63 7.93 4.42 Perak 331 28.39 11.13 207 17.47 6.73 99 8.36 3.22 Selangor & WP Putrajaya 236 8.82 3.86 154 5.65 2.35 227 8.32 3.46 WP Kuala Lumpur 299 36.35 12.85 249 30.01 10.21 92 11.09 3.77 Selangor & WP Putrajaya & WPKL 535 15.29 6.34 403 11.33 4.48 319 8.97 3.55 Negeri Sembilan 104 21.13 7.82 72 14.28 5.27 67 13.29 4.90 Melaka 105 25.69 9.92 47 11.36 4.15 41 9.91 3.62 Johor 221 13.98 4.85 175 10.88 3.76 128 7.96 2.75 Pahang 205 29.10 9.19 67 9.37 2.90 94 13.14 4.07 Terengganu 187 36.85 9.12 63 11.97 3.00 66 12.55 3.15 Kelantan 180 23.50 5.39 162 20.14 4.70 54 6.71 1.57 Sabah & WP Labuan 313 19.68 5.83 105 6.43 1.87 122 7.47 2.17 Sarawak 219 18.28 6.06 166 13.67 4.37 135 11.12 3.56

Table 3.19 Number and Density of Staff Nurses with Midwifery and Community Nurses in Public Hospitals Labour Ward in Malaysia with Specialist Services by State, 2010-2011 2010 2011 Staff Nurses with Staff Nurses with Community Nurses Midwifery Midwifery State Per Per Per Per 1,000 Per 1,000 Per 1,000 No. 100,000 No. 100,000 No. 100,000 Deliveries Deliveries Deliveries Female Female Female Malaysia 2,025 14.70 5.10 1,216 8.65 2.94 814 5.79 1.97 Perlis 20 16.99 5.06 22 18.23 5.37 11 9.11 2.68 Kedah 199 20.68 6.77 90 9.22 2.97 66 6.76 2.18 Kedah & Perlis 219 20.28 6.57 112 10.21 3.25 77 7.02 2.24 Pulau Pinang 102 13.09 7.28 62 7.80 4.35 32 4.03 2.25 Perak 192 16.47 6.46 115 9.71 3.74 62 5.23 2.02 Selangor & WP Putrajaya 228 8.52 3.73 158 5.79 2.41 197 7.22 3.00 WP Kuala Lumpur 111 13.50 4.77 115 13.86 4.72 16 1.93 0.66 Selangor & WP Putrajaya & WPKL 339 9.69 4.02 273 7.68 3.03 213 5.99 2.37 Negeri Sembilan 60 12.19 4.51 35 6.94 2.56 36 7.14 2.63 Melaka 54 13.21 5.10 27 6.53 2.38 26 6.29 2.29 Johor 233 14.74 5.11 155 9.64 3.33 98 6.09 2.11 Pahang 141 20.01 6.32 70 9.78 3.03 53 7.41 2.30 Terengganu 128 25.22 6.24 52 9.88 2.48 31 5.89 1.48 Kelantan 148 19.32 4.43 104 12.93 3.02 33 4.10 0.96 Sabah & WP Labuan 231 14.52 4.31 90 5.51 1.60 66 4.04 1.17 Sarawak 178 14.86 4.93 121 9.97 3.19 87 7.17 2.29

44 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 3.20 Number and Density of Staff Nurses with Midwifery and Community Nurses in Public Hospitals Obstetric HDU in Malaysia with Specialist Services by State, 2011 2011 Staff Nurses with Midwifery Community Nurses State Per 100,000 Per 1,000 Per 100,000 Per 1,000 No. No. Female Deliveries Female Deliveries Malaysia 110 0.78 0.27 50 0.36 0.12 Perlis 0 0.00 0.00 10 8.29 2.44 Kedah 16 1.64 0.53 22 2.25 0.73 Kedah & Perlis 16 1.46 0.46 32 2.92 0.93 Pulau Pinang 4 0.50 0.28 5 0.63 0.35 Perak 10 0.84 0.33 0 0.00 0.00 Selangor & WP Putrajaya 16 0.59 0.24 0 0.00 0.00 WP Kuala Lumpur 10 1.21 0.41 0 0.00 0.00 Selangor & WP Putrajaya & WPKL 26 0.73 0.29 0 0.00 0.00 Negeri Sembilan 7 1.39 0.51 0 0.00 0.00 Melaka 0 0.00 0.00 0 0.00 0.00 Johor 22 1.37 0.47 1 0.06 0.02 Pahang 6 0.84 0.26 0 0.00 0.00 Terengganu 5 0.95 0.24 0 0.00 0.00 Kelantan 0 0.00 0.00 0 0.00 0.00 Sabah & WP Labuan 0 0.00 0.00 0 0.00 0.00 Sarawak 14 1.15 0.37 12 0.99 0.32 MATERNITY SERVICES IN MALAYSIAN HOSPITALS AND MATERNITY HOMES AND MATERNITY HOSPITALS SERVICES IN MALAYSIAN MATERNITY 3

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Chapter 4 | SURGICAL SERVICES IN MALAYSIAN HOSPITALS Abdul JA1, Tahrani PK2*, Faizah A2*, Gunn AKB3, Tan WJ4, Nik ANA5, Clement ET6, Jiffre D7, Nik MSNY8, Yan YW9, Chuah JA10, Wan KWK11, Mohamed YAB12, Jasiah Z13

1. Hospital Sultanah Zahirah, Kuala Terengganu, 2. National Clinical Research Centre, Ministry of Health, 3. Hospital Sultanah Aminah, Johor Bahru, 4. Hospital Pulau Pinang, 5. , 6. Hospital Tuanku Fauziah, Kangar, 7. Hospital Tengku Ampuan Afzan, Kuantan, 8. Hospital Raja Perempuan Zainab II, Kota Bharu, 9. Hospital Raja Permaisuri Bainun, Ipoh, 10. Hospital Queen Elizabeth, Kota Kinabalu, 11. Hospital Sultanah Bahiyah, Alor Setar, 12. Hospital Tengku Ampuan Rahimah, Klang, 13. Hospital Tuanku Jaafar, Seremban * Corresponding author.

Summary: The facility, workforce and surgical output has not changed significantly since 2010. The distribution of hospitals providing general surgical services in 2011 was similar to that of 2010; more than 50% being in the private sector. The highest density of surgeons was in Wilayah Persekutuan Kuala Lumpur (WPKL) and the lowest in Sabah. There was an increase in the number of surgeons in private hospitals. However, the number of hours allocated to elective operations has increased in the public hospitals. There was a marked increase in the number of mastectomies, most cases being done in the private hospitals. Laparoscopic repairs for inguinal hernias and laparoscopic cholecystectomies are now preferred to open procedures, both in the public and private sectors. Endoscopic procedures in public hospitals were done mostly by surgeons when compared to gastroenterologists. However, this increase in laparoscopic surgeries and endoscopic procedures in the public hospitals also faced the limitation of availability of equipment. This needs to be looked into for future planning.

General surgical services in this report refers to the general surgery and its subspecialties of breast and endocrine, upper gastrointestinal, colorectal, vascular, hepatobiliary, trauma and thoracic surgeries only. This survey was undertaken in all Ministry of Health (MOH), University and private hospitals in Malaysia, irrespective of whether the surgical services were provided by resident or visiting general surgeons. Furthermore, hospitals with visiting surgeons were included only if elective surgery was performed there. The response rate was 98.3% for public hospitals and 78.3% for private hospitals.

Facilities

There were 166 hospitals providing general surgical services in 2011; 60 were from the public sector, three from the university and 106 from the private sector. WPKL had the highest density (0.12 per 10,000 populations) and Sabah had the lowest density of 0.03 per 10,000 populations. Private hospitals made up 64% of the total number of hospitals providing surgical services (Table 4.1).

There were 235 operation theatres (OTs) in Malaysia, 128 (54.5%) in public hospitals and 107 (45.5%) in private hospitals. The highest numbers were in WPKL with 33 OTs. Perlis had the least with only one OT (Table 4.2).

Activities and Workload

A total of 91,144 surgeries were performed in public hospitals in 2011 of which 49.5% were elective cases and the remaining 50.5% were emergencies. Of these surgeries, 72,859 or 80% were done under general anaesthesia, 60% being emergency cases. There was an increase of 11.3% in the time allocated for elective operating hours for general surgery from 2010 (Table 4.4, Table 4.5, Table 4.6).

A total of 4,228 mastectomies were reported in 2011, an increase of 18.6% (662 cases) from 2010. Most of these were performed in the three tertiary breast centres i.e. Hospital Putrajaya (n= 83), Hospital Kuala Lumpur (n=135) and University Malaya Medical Centre (n= 220). In the private sector the increase was from 1,414 to 1,993, an increase of 41% (Table 4.7).

A total of 11,660 inguinal hernia repairs were reported in 2011, with 11.6% being done laparoscopically, an increase of 3% from the 8.6% reported in the previous year. There was a significant increase of 27.3% in the number of these procedures being done laparoscopically in the public sector (Table 4.8).

In all, 10,404 cholecystectomies were performed in 2011 with 78.4% being done laparoscopically, a small increase from the 76.7% reported in the previous year. Of these, 67.5% were performed in private sector. This shows that laparoscopic approach is the preferred method (Table 4.9).

Endoscopic services in Malaysia were provided both by surgeons and gastroenterologists. In the public sector, surgeons performed more of the oesophago-gastroduodenoscopies (OGDS), (45,574 or 71.7%), colonoscopies (24,416 or 78.9%) and endoscopic retrograde cholangio- pancreatography (ERCP) cases (3,458 or 69.1%). There were a total of 251 OGDS scopes, 178 Colonoscopes and 134 ERCP scopes done in the public hospitals. Most of these scopes were being done in the Klang Valley (Selangor, WPKL, WP Putrajaya). The least were in Melaka (Table 4.10, Table 4.12, Table 4.14, and Table 4.16). In 2011, about a quarter of the scopes were non functional and awaiting repair or replacement in the public hospitals. HOSPITALS SURGICAL SERVICES IN MALAYSIAN 4

47 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Workforce

There were a total of 3,708 OT scrub nurses in the country, with 53.3% (1,978) serving the public hospitals. Almost half (44.2%) of them had post basic training. On the other hand, in the private sector, only 22.1% out of 1,730 OT scrub nurses had post basic training (Table 4.17).

There were 557 (public: 298; private: 259) general surgeons in 2011 as compared to 540 in 2010. This translates to a surgeon to population ratio of 0.2 per 10,000. There was an increase of 21 surgeons (3.9%) in private sector from 2010. The highest concentration was seen in WPKL (0.66 per 10,000 population) while Terengganu and Sabah had the lowest (0.08 per 10,000 population) (Table 4.18).

Limitation

1. This survey does not reflect the total workload of surgeons as it only captures selected types of surgeries performed.

48 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.1 Number and Density of Hospitals Providing General Surgery Services in Malaysia by State and Sector, 2010-2011 2010 2011 State Sector Per 10,000 Per 10,000 No. No. population population Malaysia Public 60 - 60 - Malaysia Private 107 - 106 - Malaysia Total 167 0.06 166 0.06 Perlis Public 1 - 1 - Perlis Private na na na na Perlis Total 1 0.04 1 0.04 Kedah Public 4 - 4 - Kedah Private 4 - 5 - Kedah Total 8 0.04 9 0.05 Kedah & Perlis Public 5 - 5 - Kedah & Perlis Private 4 - 5 - Kedah & Perlis Total 9 0.04 10 0.05 Pulau Pinang Public 4 - 4 - Pulau Pinang Private 11 - 10 - Pulau Pinang Total 15 0.10 14 0.09 Perak Public 5 - 5 - Perak Private 10 - 11 - Perak Total 15 0.06 16 0.07 Selangor & WP Putrajaya Public 7 - 7 - Selangor & WP Putrajaya Private 25 - 23 - Selangor & WP Putrajaya Total 32 0.06 30 0.05 WP Kuala Lumpur Public 3 - 3 - WP Kuala Lumpur Private 19 - 18 - WP Kuala Lumpur Total 22 0.13 21 0.12 Selangor & WP Putrajaya & WPKL Public 10 - 10 - Selangor & WP Putrajaya & WPKL Private 44 - 41 - Selangor & WP Putrajaya & WPKL Total 54 0.07 51 0.07 Negeri Sembilan Public 2 - 2 - Negeri Sembilan Private 6 - 6 - Negeri Sembilan Total 8 0.08 8 0.08 Melaka Public 1 - 1 - Melaka Private 3 - 3 - Melaka Total 4 0.05 4 0.05 Johor Public 7 - 7 - Johor Private 12 - 11 - Johor Total 19 0.06 18 0.05 Pahang Public 2 - 2 - Pahang Private 3 - 4 - Pahang Total 5 0.03 6 0.04 Terengganu Public 3 - 3 - Terengganu Private 1 - 1 - Terengganu Total 4 0.04 4 0.04 Kelantan Public 6 - 6 - Kelantan Private 2 - 3 - Kelantan Total 8 0.05 9 0.06 Sabah & WP Labuan Public 8 - 8 - Sabah & WP Labuan Private 3 - 3 - Sabah & WP Labuan Total 11 0.03 11 0.03 Sarawak Public 7 - 7 - Sarawak Private 8 - 8 - Sarawak Total 15 0.06 15 0.06 SURGICAL SERVICES IN MALAYSIAN HOSPITALS SURGICAL SERVICES IN MALAYSIAN Abbreviation: na – not applicable; - – not available 4

49 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.2 Number of Total Surgeons, Operation Theatre (OT) and Theatre Scrub Nurses in Malaysia by State and Sector, 2011 Total OT Theatre Scrub Nurses State Sector Surgeonsa No. No. No. Per Surgeonsa Per Functioning OT Malaysia Public 1,431 128 1,978 1.38 15.45 Malaysia Private 1,555 107 1,730 1.11 16.17 Malaysia Total 2,986 235 3,708 1.24 15.78 Perlis Public 20 1 27 1.35 27.00 Perlis Private na na na na na Perlis Total 20 1 27 1.35 27.00 Kedah Public 85 9 143 1.68 15.89 Kedah Private 63 5 75 1.19 15.00 Kedah Total 148 14 218 1.47 15.57 Kedah & Perlis Public 105 10 170 1.62 17.00 Kedah & Perlis Private 63 5 75 1.19 15.00 Kedah & Perlis Total 168 15 245 1.46 16.33 Pulau Pinang Public 64 7 128 2.00 18.29 Pulau Pinang Private 184 10 338 1.84 33.80 Pulau Pinang Total 248 17 466 1.88 27.41 Perak Public 80 12 181 2.26 15.08 Perak Private 120 11 133 1.11 12.09 Perak Total 200 23 314 1.57 13.65 Selangor & WP Putrajaya Public 270 16 343 1.27 21.44 Selangor & WP Putrajaya Private 416 25 378 0.91 15.12 Selangor & WP Putrajaya Total 686 41 721 1.05 17.59 WP Kuala Lumpur Public 312 16 170 0.54 10.63 WP Kuala Lumpur Private 325 17 268 0.82 15.76 WP Kuala Lumpur Total 637 33 438 0.69 13.27 Selangor & WP Putrajaya & WPKL Public 582 32 513 0.88 16.03 Selangor & WP Putrajaya & WPKL Private 741 42 646 0.87 15.38 Selangor & WP Putrajaya & WPKL Total 1,323 74 1,159 0.88 15.66 Negeri Sembilan Public 44 4 56 1.27 14.00 Negeri Sembilan Private 58 6 90 1.55 15.00 Negeri Sembilan Total 102 10 146 1.43 14.60 Melaka Public 29 3 47 1.62 15.67 Melaka Private 86 3 108 1.26 36.00 Melaka Total 115 6 155 1.35 25.83 Johor Public 120 13 226 1.88 17.38 Johor Private 135 11 179 1.33 16.27 Johor Total 255 24 405 1.59 16.88 Pahang Public 67 11 77 1.15 7.00 Pahang Private 34 4 41 1.21 10.25 Pahang Total 101 15 118 1.17 7.87 Terengganu Public 43 6 81 1.88 13.50 Terengganu Private 3 1 8 2.67 8.00 Terengganu Total 46 7 89 1.93 12.71 Kelantan Public 133 13 108 0.81 8.31 Kelantan Private 18 3 25 1.39 8.33 Kelantan Total 151 16 133 0.88 8.31 Sabah & WP Labuan Public 84 10 206 2.45 20.60 Sabah & WP Labuan Private 41 3 20 0.49 6.67 Sabah & WP Labuan Total 125 13 226 1.81 17.38 Sarawak Public 80 7 185 2.31 26.43 Sarawak Private 72 8 67 0.93 8.38 Sarawak Total 152 15 252 1.66 16.80

(a) Surgeons include surgeons, obstetricians & gynaecologists, opthalmologists, orthopedics surgeons and otorhinolaryngologists Abbreviation: na – not applicable; - – not available

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Table 4.3 Number and Density of Dedicated Emergency/ Trauma Theatres in Malaysian Public Hospitals by State, 2010-2011 2010 2011 Dedicated Emergency / Dedicated Emergency / State Sector Trauma Theatres Trauma Theatres Per 10,000 Per 10,000 No. No. population population Malaysia Public 55 0.02 57 0.02 Perlis Public 1 0.04 1 0.04 Kedah Public 6 0.03 4 0.02 Kedah & Perlis Public 7 0.03 5 0.02 Pulau Pinang Public 2 0.01 2 0.01 Perak Public 5 0.02 5 0.02 Selangor & WP Putrajaya Public 7 0.01 7 0.01 WP Kuala Lumpur Public 4 0.03 5 0.03 Selangor & WP Putrajaya & WPKL Public 11 0.02 12 0.02 Negeri Sembilan Public 1 0.01 0 0.00 Melaka Public 2 0.02 3 0.04 Johor Public 5 0.02 6 0.02 Pahang Public 4 0.03 2 0.01 Terengganu Public 2 0.02 3 0.03 Kelantan Public 1 0.01 1 0.01 Sabah & WP Labuan Public 8 0.02 9 0.03 Sarawak Public 7 0.03 9 0.04

Note: Discrepancies in 2010 and 2011 data due to changes in data definition

Definition 2010: A 24 hours operating theatre dedicated for urgent patient intervention. Urgent is defined as acute onset or deterioration of conditions that threaten life, limb or organ survival.

Definition 2011: A 24 hours operating theatre dedicated for emergency cases only. OTs dedicated for emergency LSCS and orthopedics were excluded.

Table 4.4 Number and Density of General Surgeons and Total Elective Operating Hours in Malaysian Public Hospitals by State, 2010-2011 2010 2011 General Total Elective Operating General Total Elective Operating Hours State Surgeons Hours /Weeks Surgeons /Weeks Ratio to General Ratio to General No. No. No. No. Surgeons Surgeons Malaysia 302 1,445 4.78 298 1,609 5.40 Perlis 2 23 11.50 3 23 7.67 Kedah 23 104 4.52 22 145 6.59 Kedah & Perlis 25 127 5.08 25 168 6.72 Pulau Pinang 14 113 8.07 15 123 8.20 Perak 15 144 9.60 16 126 7.88 Selangor & WP Putrajaya 62 228 3.68 55 275 5.00 WP Kuala Lumpur 56 124 2.21 61 188 3.08 Selangor & WP Putrajaya & 118 352 2.98 116 463 3.99 WPKL Negeri Sembilan 10 61 6.10 11 61 5.55 Melaka 8 47 5.88 7 47 6.71 Johor 24 117 4.88 25 127 5.08 Pahang 18 81 4.50 13 63 4.85 Terengganu 5 68 13.60 8 86 10.75 Kelantan 26 103 3.96 25 98 3.92 Sabah & WP Labuan 18 128 7.11 20 118 5.90 Sarawak 21 104 4.95 17 129 7.59

Note: Discrepancies in 2010 and 2011 data due to changes in data definition Definition 2010: Total hours of elective cases performed within OR time divided by the hours of allocated block time.

Definition 2011: The allocated elective GA/regional block time for general surgery. The times included are from daycare OT and Saturday OT. Locum OT time and time given to specialties outside general HOSPITALS SURGICAL SERVICES IN MALAYSIAN surgery were excluded. 4

51 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.5 Number and Density of Elective Cases in General Surgery in Malaysian Public Hospitals by State, 2011 Total Elective Cases Elective Cases Under GA Elective Cases Under LA State Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia 45,149 15.59 29,525 10.19 15,624 5.39 Perlis 661 27.83 534 22.48 127 5.35 Kedah 2,622 13.29 2,162 10.96 460 2.33 Kedah & Perlis 3,283 14.85 2,696 12.20 587 2.66 Pulau Pinang 2,757 17.30 1,569 9.85 1,188 7.45 Perak 5,656 23.59 3,117 13.00 2,539 10.59 Selangor & WP Putrajaya 7,829 13.85 5,639 9.97 2,190 3.87 WP Kuala Lumpur 5,314 31.36 3,052 18.01 2,262 13.35 Selangor & WP Putrajaya & WPKL 13,143 17.89 8,691 11.83 4,452 6.06 Negeri Sembilan 2,016 19.33 1,810 17.36 206 1.98 Melaka 829 9.95 708 8.50 121 1.45 Johor 4,138 12.16 2,561 7.53 1,577 4.64 Pahang 2,174 14.26 1,621 10.63 553 3.63 Terengganu 2,126 19.80 1,623 15.11 503 4.68 Kelantan 1,866 11.55 1,480 9.16 386 2.39 Sabah & WP Labuan 3,177 9.33 1,810 5.31 1,367 4.01 Sarawak 3,984 15.83 1,839 7.31 2,145 8.52 Abbreviation: GA - general anaesthesia; LA - local anaesthesia

Table 4.6 Number and Density of Emergency Cases in General Surgery in Malaysian Public Hospitals by State, 2011 Emergency Cases Emergency Cases Total Emergency Cases Under GA Under LA State Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia 45,995 15.88 43,334 14.96 2,661 0.92 Perlis 718 30.23 709 29.85 9 0.38 Kedah 4,193 21.25 4,189 21.23 4 0.02 Kedah & Perlis 4,911 22.22 4,898 22.16 13 0.06 Pulau Pinang 2,115 13.27 2,088 13.10 27 0.17 Perak 5,129 21.39 4,821 20.11 308 1.28 Selangor & WP Putrajaya 6,280 11.11 6,063 10.72 217 0.38 WP Kuala Lumpur 5,158 30.44 4,714 27.82 444 2.62 Selangor & WP Putrajaya & WPKL 11,438 15.57 10,777 14.67 661 0.90 Negeri Sembilan 1,570 15.05 1,566 15.02 4 0.04 Melaka 2,422 29.08 2,045 24.55 377 4.53 Johor 6,701 19.70 6,129 18.02 572 1.68 Pahang 2,127 13.95 2,117 13.88 10 0.07 Terengganu 2,005 18.67 1,884 17.54 121 1.13 Kelantan 1,713 10.61 1,647 10.20 66 0.41 Sabah & WP Labuan 3,191 9.37 2,829 8.31 362 1.06 Sarawak 2,673 10.62 2,533 10.07 140 0.56

Abbreviation: GA - general anaesthesia; LA - local anaesthesia

52 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.7 Number and Density of Mastectomies in Malaysia by State and Sector, 2010-2011 2010 2011 State Sector Per 10,000 Per 10,000 No. No. population population Malaysia Public 2,152 - 2,235 - Malaysia Private 1,414 - 1,993 - Malaysia Total 3,566 1.26 4,228 1.46 Perlis Public 20 - 21 - Perlis Private na na na na Perlis Total 20 0.86 21 0.88 Kedah Public 105 - 136 - Kedah Private 41 - 33 - Kedah Total 146 0.75 169 0.86 Kedah & Perlis Public 125 - 157 - Kedah & Perlis Private 41 - 33 - Kedah & Perlis Total 166 0.76 190 0.86 Pulau Pinang Public 174 - 127 - Pulau Pinang Private 276 - 483 - Pulau Pinang Total 450 2.88 610 3.83 Perak Public 132 - 164 - Perak Private 121 - 225 - Perak Total 253 1.08 389 1.62 Selangor & WP Putrajaya Public 342 - 319 - Selangor & WP Putrajaya Private 208 - 175 - Selangor & WP Putrajaya Total 550 0.99 494 0.87 WP Kuala Lumpur Public 625 - 575 - WP Kuala Lumpur Private 281 - 345 - WP Kuala Lumpur Total 906 5.41 920 5.43 Selangor & WP Putrajaya & WPKL Public 967 - 894 - Selangor & WP Putrajaya & WPKL Private 489 - 520 - Selangor & WP Putrajaya & WPKL Total 1,456 2.02 1,414 1.92 Negeri Sembilan Public 96 - 41 - Negeri Sembilan Private 25 - 52 - Negeri Sembilan Total 121 1.18 93 0.89 Melaka Public 62 - 57 - Melaka Private 128 - 97 - Melaka Total 190 2.31 154 1.85 Johor Public 204 - 256 - Johor Private 200 - 255 - Johor Total 404 1.21 511 1.50 Pahang Public 62 - 128 - Pahang Private 33 - 105 - Pahang Total 95 0.63 233 1.53 Terengganu Public 45 - 40 - Terengganu Private 1 - 0 - Terengganu Total 46 0.44 40 0.37 Kelantan Public 84 - 101 - Kelantan Private 4 - 14 - Kelantan Total 88 0.57 115 0.71 Sabah & WP Labuan Public 106 - 126 - Sabah & WP Labuan Private 37 - 31 - Sabah & WP Labuan Total 143 0.43 157 0.46 Sarawak Public 95 - 144 - Sarawak Private 59 - 178 -

Sarawak Total 154 0.62 322 1.28 HOSPITALS SURGICAL SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available 4 53 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.8 Number and Density of Inguinal Hernia Surgeries in Malaysia by State and Sector, 2010-2011 2010 2011 Total Inguinal Laparoscopic Total Inguinal Laparoscopic Open Procedures Open Procedures State Sector Hernia Surgeries Procedures Hernia Surgeries Procedures Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. population population population population population population Malaysia Public 7,486 - 6,795 - 691 - 6,472 - 5,592 - 880 - Malaysia Private 6,634 - 6,108 - 524 - 5,188 - 4,709 - 478 - Malaysia Total 14,120 4.98 12,903 4.55 1,215 0.43 11,660 4.03 10,301 3.56 1,358 0.47 Perlis Public 184 - 157 - 27 - 101 - 83 - 18 - Perlis Private na na na na na na na na na na na na Perlis Total 184 7.95 157 6.78 27 1.17 101 4.25 83 3.49 18 0.76 Kedah Public 549 - 515 - 34 - 410 - 349 - 61 - Kedah Private 310 - 284 - 26 - 256 - 252 - 4 - Kedah Total 859 4.41 799 4.10 60 0.31 666 3.38 601 3.05 65 0.33 Kedah & Perlis Public 733 - 672 - 61 - 511 - 432 - 79 - Kedah & Perlis Private 310 - 284 - 26 - 256 - 252 - 4 - Kedah & Perlis Total 1,043 4.79 956 4.39 87 0.40 767 3.47 684 3.09 83 0.38 Pulau Pinang Public 522 - 441 - 81 - 376 - 337 - 39 - Pulau Pinang Private 827 - 625 - 201 - 1,008 - 752 - 256 - Pulau Pinang Total 1,349 8.64 1,066 6.83 282 1.81 1,384 8.68 1,089 6.83 295 1.85 Perak Public 829 - 631 - 198 - 694 - 482 - 212 - Perak Private 697 - 673 - 24 - 420 - 396 - 24 - Perak Total 1,526 6.49 1,304 5.54 222 0.94 1,114 4.65 878 3.66 236 0.98 Selangor & Public 1,156 - 1,073 - 83 - 1,037 - 939 - 98 - WP Putrajaya Selangor & Private 1,853 - 1,823 - 31 - 820 - 748 - 72 - WP Putrajaya Selangor & Total 3,009 5.44 2,896 5.23 114 0.21 1,857 3.28 1,687 2.98 170 0.30 WP Putrajaya WP Kuala Lumpur Public 503 - 429 - 74 - 460 - 349 - 111 - WP Kuala Lumpur Private 562 - 410 - 152 - 549 - 514 - 35 - WP Kuala Lumpur Total 1,065 6.36 839 5.01 226 1.35 1,009 5.95 863 5.09 146 0.86 Selangor & WP Public 1,659 - 1,502 - 157 - 1,497 - 1,288 - 209 - Putrajaya & WPKL Selangor & WP Private 2,415 - 2,233 - 183 - 1,369 - 1,262 - 107 - Putrajaya & WPKL Selangor & WP Total 4,074 5.65 3,735 5.18 340 0.47 2,866 3.90 2,550 3.47 316 0.43 Putrajaya & WPKL Negeri Sembilan Public 294 - 253 - 41 - 202 - 123 - 79 - Negeri Sembilan Private 240 - 235 - 5 - 209 - 200 - 8 - Negeri Sembilan Total 534 5.23 488 4.78 46 0.45 411 3.94 323 3.10 87 0.83 Melaka Public 241 - 241 - 0 - 325 - 320 - 5 - Melaka Private 259 - 182 - 76 - 272 - 236 - 36 - Melaka Total 500 6.09 423 5.15 76 0.93 597 7.17 556 6.67 41 0.49 Johor Public 756 - 749 - 7 - 721 - 695 - 26 - Johor Private 1,216 - 1,216 - 0 - 1,100 - 1,067 - 33 - Johor Total 1,972 5.89 1,965 5.87 7 0.02 1,821 5.35 1,762 5.18 59 0.17 Pahang Public 366 - 312 - 54 - 339 - 287 - 52 - Pahang Private 162 - 160 - 1 - 109 - 109 - 0 - Pahang Total 528 3.52 472 3.14 55 0.37 448 2.94 396 2.60 52 0.34 Terengganu Public 381 - 380 - 1 - 152 - 152 - 0 - Terengganu Private 15 - 15 - 0 - 8 - 8 - 0 - Terengganu Total 396 3.82 395 3.81 1 0.01 160 1.49 160 1.49 0 0.00 Kelantan Public 532 - 517 - 15 - 554 - 543 - 11 - Kelantan Private 70 - 70 - 0 - 73 - 73 - 0 - Kelantan Total 602 3.91 587 3.81 15 0.10 627 3.88 616 3.81 11 0.07 Sabah & WP Public 548 - 548 - 0 - 606 - 605 - 1 - Labuan Sabah & WP Private 103 - 103 - 0 - 82 - 82 - 0 - Labuan Sabah & WP Total 651 1.98 651 1.98 0 0.00 688 2.02 687 2.02 1 0.00 Labuan Sarawak Public 625 - 549 - 76 - 495 - 328 - 167 - Sarawak Private 320 - 312 - 8 - 282 - 272 - 10 - Sarawak Total 945 3.82 861 3.48 84 0.34 777 3.09 600 2.38 177 0.70 Abbreviation: na – not applicable; - – not available

54 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.9 Number and Density of Cholecystectomies in Malaysia by State and Sector, 2010-2011 2010 2011 Total Open Laparoscopic Total Open Laparoscopic State Sector Cholecystectomies Cholecystectomies Cholecystectomies Cholecystectomies Cholecystectomies Cholecystectomies Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. population population population population population population Malaysia Public 2,924 - 930 - 1,994 - 3,386 - 1,168 - 2,218 - Malaysia Private 6,985 - 1,378 - 5,607 - 7,016 - 1,075 - 5,939 - Malaysia Total 9,909 3.50 2,308 0.81 7,601 2.68 10,402 3.59 2,243 0.77 8,157 2.82 Perlis Public 82 - 15 - 67 - 39 - 9 - 30 - Perlis Private na na na na na na na na na na na na Perlis Total 82 3.54 15 0.65 67 2.89 39 1.64 9 0.38 30 1.26 Kedah Public 306 - 55 - 251 - 368 - 104 - 264 - Kedah Private 271 - 108 - 163 - 346 - 85 - 261 - Kedah Total 577 2.96 163 0.84 414 2.13 714 3.62 189 0.96 525 2.66 Kedah & Perlis Public 388 - 70 - 318 - 407 - 113 - 294 - Kedah & Perlis Private 271 - 108 - 163 - 346 - 85 - 261 - Kedah & Perlis Total 659 3.02 178 0.82 481 2.21 753 3.41 198 0.90 555 2.51 Pulau Pinang Public 186 - 65 - 121 - 284 - 193 - 91 - Pulau Pinang Private 1,063 - 108 - 955 - 1,270 - 147 - 1,123 - Pulau Pinang Total 1,249 8.00 173 1.11 1,076 6.89 1,554 9.75 340 2.13 1,214 7.62 Perak Public 273 - 51 - 222 - 301 - 55 - 246 - Perak Private 693 - 257 - 436 - 588 - 131 - 456 - Perak Total 966 4.11 308 1.31 658 2.80 889 3.71 186 0.78 702 2.93 Selangor & WP Public 447 - 126 - 321 - 510 - 148 - 362 - Putrajaya Selangor & WP Private 1,534 - 187 - 1,347 - 1,599 - 171 - 1,428 - Putrajaya Selangor & WP Total 1,981 3.58 313 0.57 1,668 3.01 2,109 3.73 319 0.56 1,790 3.17 Putrajaya WP Kuala Lumpur Public 227 - 74 - 153 - 320 - 70 - 250 - WP Kuala Lumpur Private 791 - 192 - 599 - 996 - 172 - 823 - WP Kuala Lumpur Total 1,018 6.08 266 1.59 752 4.49 1,316 7.77 242 1.43 1,073 6.33 Selangor & WP Public 674 - 200 - 474 - 830 - 218 - 612 - Putrajaya & WPKL Selangor & WP Private 2,325 - 379 - 1,946 - 2,595 - 343 - 2,251 - Putrajaya & WPKL Selangor & WP Total 2,999 4.16 579 0.80 2,420 3.36 3,425 4.66 561 0.76 2,863 3.90 Putrajaya & WPKL Negeri Sembilan Public 97 - 37 - 60 - 83 - 7 - 76 - Negeri Sembilan Private 192 - 28 - 164 - 328 - 25 - 302 - Negeri Sembilan Total 289 2.83 65 0.64 224 2.19 411 3.94 32 0.31 378 3.62 Melaka Public 103 - 41 - 62 - 121 - 63 - 58 - Melaka Private 423 - 112 - 311 - 420 - 52 - 368 - Melaka Total 526 6.41 153 1.86 373 4.54 541 6.49 115 1.38 426 5.11 Johor Public 374 - 224 - 150 - 455 - 226 - 229 - Johor Private 1,393 - 237 - 1,156 - 773 - 178 - 596 - Johor Total 1,767 5.28 461 1.38 1,306 3.90 1,228 3.61 404 1.19 825 2.43 Pahang Public 130 - 31 - 99 - 132 - 34 - 98 - Pahang Private 73 - 29 - 44 - 115 - 8 - 107 - Pahang Total 203 1.35 60 0.40 143 0.95 247 1.62 42 0.28 205 1.34 Terengganu Public 48 - 26 - 22 - 70 - 35 - 35 - Terengganu Private 2 - 0 - 2 - 2 - 0 - 2 - Terengganu Total 50 0.48 26 0.25 24 0.23 72 0.67 35 0.33 37 0.34 Kelantan Public 147 - 24 - 123 - 177 - 17 - 160 - Kelantan Private 44 - 21 - 23 - 57 - 11 - 46 - Kelantan Total 191 1.24 45 0.29 146 0.95 234 1.45 28 0.17 206 1.28 Sabah & WP Labuan Public 184 - 55 - 129 - 215 - 86 - 129 - Sabah & WP Labuan Private 151 - 32 - 119 - 156 - 30 - 126 - Sabah & WP Labuan Total 335 1.02 87 0.26 248 0.75 371 1.09 116 0.34 255 0.75 Sarawak Public 320 - 106 - 214 - 311 - 121 - 190 - Sarawak Private 355 - 67 - 288 - 366 - 65 - 301 - Sarawak Total 675 2.73 173 0.70 502 2.03 677 2.69 186 0.74 491 1.95 SURGICAL SERVICES IN MALAYSIAN HOSPITALS SURGICAL SERVICES IN MALAYSIAN Abbreviation: na – not applicable; - – not available 4

55 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.10 Number of OGDS Scopes and OGDS Procedures Performed by Surgical and Medical Specialists in Malaysian Public Hospitals by State, 2011

Total OGDS Functioning Total OGDS OGDS PROCEDURES OGDS PROCEDURES State Scopes OGDS Scopes PROCEDURES by Surgical by Medical

Malaysia 251 175 63,864 45,574 18,323 Perlis 4 3 885 869 16 Kedah 27 20 4,113 2,647 1,466 Kedah & Perlis 31 23 4,998 3,516 1,482 Pulau Pinang 15 13 4,846 3,867 979 Perak 19 11 6,136 5,285 851 Selangor & WP Putrajaya 41 24 10,258 7,315 2,976 WP Kuala Lumpur 39 29 10,556 4,346 6,210 Selangor & WP Putrajaya & WPKL 80 53 20,814 11,661 9,186 Negeri Sembilan 8 5 2,284 2,059 225 Melaka 2 1 1,903 1,903 0 Johor 18 12 6,926 6,626 300 Pahang 8 6 2,798 1,998 800 Terengganu 6 4 1,062 938 124 Kelantan 17 16 2,700 1,453 1,247 Sabah & WP Labuan 23 18 4,543 1,813 2,730 Sarawak 24 13 4,854 4,455 399

Table 4.11 Number of OGDS Scopes and OGDS Procedures Performed in Malaysian Private Hospitals by State, 2011 State Total OGDS Scopes Total OGDS PROCEDURES Malaysia 209 79,791 Perlis na na Kedah 7 2,783 Kedah & Perlis 7 2,783 Pulau Pinang 34 13,256 Perak 19 9,826 Selangor & WP Putrajaya 46 17,391 WP Kuala Lumpur 37 10,775 Selangor & WP Putrajaya & WPKL 83 28,166 Negeri Sembilan 10 5,550 Melaka 12 5,500 Johor 20 9,005 Pahang 6 1,268 Terengganu 1 52 Kelantan 2 242 Sabah & WP Labuan 4 1,397 Sarawak 11 2,746

Abbreviation: na – not applicable

56 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.12 Number of Colonoscopes and Colonoscopy Procedures Performed by Surgical and Medical Specialists in Malaysian Public Hospitals by State, 2011 Total Colonoscopy Colonoscopy Total Functioning State Colonoscopy PROCEDURES PROCEDURES Colonoscopes Colonoscopes PROCEDURES by Surgical by Medical Malaysia 178 133 30,939 24,416 6,274 Perlis 3 1 286 286 0 Kedah 20 14 1,733 1,236 497 Kedah & Perlis 23 15 2,019 1,522 497 Pulau Pinang 10 9 2,394 2,182 212 Perak 14 11 3,284 3,025 259 Selangor & WP Putrajaya 29 18 5,503 4,808 695 WP Kuala Lumpur 27 26 5,026 1,734 3,292 Selangor & WP Putrajaya & WPKL 56 44 10,529 6,542 3,987 Negeri Sembilan 7 5 1,395 1,110 36 Melaka 2 1 1,053 1,053 0 Johor 12 9 3,098 3,088 10 Pahang 7 4 1,408 1,186 222 Terengganu 4 2 543 504 39 Kelantan 10 9 1,039 854 185 Sabah & WP Labuan 18 14 2,199 1,439 760 Sarawak 15 10 1,978 1,911 67

Table 4.13 Number of Colonoscopes and Colonoscopy Procedures Performed in Malaysian Private Hospitals by State, 2011 State Total Colonoscopes Total Colonoscopy PROCEDURES Malaysia 171 51,144 Perlis na na Kedah 6 1,435 Kedah & Perlis 6 1,435 Pulau Pinang 25 9,638 Perak 19 4,718 Selangor & WP Putrajaya 34 11,255 WP Kuala Lumpur 29 6,971 Selangor & WP Putrajaya & WPKL 63 18,226 Negeri Sembilan 10 4,223 Melaka 9 3,103 Johor 15 6,016 Pahang 7 785 Terengganu 1 12 Kelantan 2 109 Sabah & WP Labuan 4 1,048 Sarawak 10 1,831

Abbreviation: na – not applicable SURGICAL SERVICES IN MALAYSIAN HOSPITALS SURGICAL SERVICES IN MALAYSIAN 4

57 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.14 Number of ERCP Scopes and ERCP Procedures Performed by Surgical and Medical Specialists in Malaysian Public Hospitals by State, 2011

Total ERCP Functioning Total ERCP ERCP PROCEDURES ERCP PROCEDURES State Scopes ERCP Scopes PROCEDURES by Surgical by Medical

Malaysia 134 70 5,007 3,458 1,549 Perlis 3 1 0 0 0 Kedah 18 7 542 530 12 Kedah & Perlis 21 8 542 530 12 Pulau Pinang 9 5 327 310 17 Perak 5 3 236 236 0 Selangor & WP Putrajaya 22 13 825 301 524 WP Kuala Lumpur 27 17 826 71 755 Selangor & WP Putrajaya & WPKL 49 30 1,651 372 1,279 Negeri Sembilan 5 1 109 109 0 Melaka 2 2 245 245 0 Johor 9 4 447 447 0 Pahang 7 5 243 220 23 Terengganu 3 1 75 75 0 Kelantan 8 4 246 200 46 Sabah & WP Labuan 11 6 427 255 172 Sarawak 5 1 459 459 0

Table 4.15 Number of ERCP Scopes and ERCP Procedures Performed in Malaysian Private Hospitals by State, 2011 State Total ERCP Scopes Total ERCP PROCEDURES

Malaysia 129 2,549

Perlis na na

Kedah 5 52

Kedah & Perlis 5 52

Pulau Pinang 22 725

Perak 14 282

Selangor & WP Putrajaya 27 527

WP Kuala Lumpur 23 283

Selangor & WP Putrajaya & WPKL 50 810

Negeri Sembilan 7 52

Melaka 9 132

Johor 11 303

Pahang 5 46

Terengganu 0 0

Kelantan 1 3

Sabah & WP Labuan 2 46

Sarawak 3 98

Abbreviation: na – not applicable

58 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.16 Total Number and Density of OGDS Scopes, Colonoscopes and ERCP Scopes in Malaysian Hospitals by State and Sector, 2011 Total OGDS Scopes Total Colonoscopes Total ERCP Scopes State Sector No. PMP No. PMP No. PMP Malaysia Public 251 - 178 - 134 - Malaysia Private 209 - 171 - 129 - Malaysia Total 460 15.88 349 12.05 263 9.08 Perlis Public 4 - 3 - 3 - Perlis Private na na na na na na Perlis Total 4 16.84 3 12.63 3 12.63 Kedah Public 27 - 20 - 18 - Kedah Private 7 - 6 - 5 - Kedah Total 34 17.23 26 13.18 23 11.66 Kedah & Perlis Public 31 - 23 - 21 - Kedah & Perlis Private 7 - 6 - 5 - Kedah & Perlis Total 38 17.19 29 13.12 26 11.76 Pulau Pinang Public 15 - 10 - 9 - Pulau Pinang Private 34 - 25 - 22 - Pulau Pinang Total 49 30.75 35 21.96 31 19.45 Perak Public 19 - 14 - 5 - Perak Private 19 - 19 - 14 - Perak Total 38 15.85 33 13.76 19 7.92 Selangor & WP Putrajaya Public 41 - 29 - 22 - Selangor & WP Putrajaya Private 46 - 34 - 27 - Selangor & WP Putrajaya Total 87 15.39 63 11.14 49 8.67 WP Kuala Lumpur Public 39 - 27 - 27 - WP Kuala Lumpur Private 37 - 29 - 23 - WP Kuala Lumpur Total 76 44.85 56 33.05 50 29.51 Selangor & WP Putrajaya & WPKL Public 80 - 56 - 49 - Selangor & WP Putrajaya & WPKL Private 83 - 63 - 50 - Selangor & WP Putrajaya & WPKL Total 163 22.18 119 16.19 99 13.47 Negeri Sembilan Public 8 - 7 - 5 - Negeri Sembilan Private 10 - 10 - 7 - Negeri Sembilan Total 18 17.26 17 16.30 12 11.51 Melaka Public 2 - 2 - 2 - Melaka Private 12 - 9 - 9 - Melaka Total 14 16.81 11 13.21 11 13.21 Johor Public 18 - 12 - 9 - Johor Private 20 - 15 - 11 - Johor Total 38 11.17 27 7.94 20 5.88 Pahang Public 8 - 7 - 7 - Pahang Private 6 - 7 - 5 - Pahang Total 14 9.18 14 9.18 12 7.87 Terengganu Public 6 - 4 - 3 - Terengganu Private 1 - 1 - 0 - Terengganu Total 7 6.52 5 4.66 3 2.79 Kelantan Public 17 - 10 - 8 - Kelantan Private 2 - 2 - 1 - Kelantan Total 19 11.76 12 7.43 9 5.57 Sabah & WP Labuan Public 23 - 18 - 11 - Sabah & WP Labuan Private 4 - 4 - 2 - Sabah & WP Labuan Total 27 7.93 22 6.46 13 3.82 Sarawak Public 24 - 15 - 5 - Sarawak Private 11 - 10 - 3 - Sarawak Total 35 13.91 25 9.94 8 3.18 SURGICAL SERVICES IN MALAYSIAN HOSPITALS SURGICAL SERVICES IN MALAYSIAN Abbreviation: na – not applicable; - – not available; PMP – per million population 4

59 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.17 Number and Density of Theatre Scrub Nurses, 2011 Theatre Scrub Nurses Theatre Scrub Nurses Total Theatre Scrub with Peri-operative without Peri-operative Nurses State Sector Post Basic Post Basic Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 1,978 - 874 - 1,107 - Malaysia Private 1,730 - 383 - 1,340 - Malaysia Total 3,708 1.28 1,257 0.43 2,447 0.84 Perlis Public 27 - 14 - 13 - Perlis Private na na na na na na Perlis Total 27 1.14 14 0.59 13 0.55 Kedah Public 143 - 66 - 77 - Kedah Private 75 - 15 - 60 - Kedah Total 218 1.10 81 0.41 137 0.69 Kedah & Perlis Public 170 - 80 - 90 - Kedah & Perlis Private 75 - 15 - 60 - Kedah & Perlis Total 245 1.11 95 0.43 150 0.68 Pulau Pinang Public 128 - 66 - 62 - Pulau Pinang Private 338 - 62 - 268 - Pulau Pinang Total 466 2.92 128 0.80 330 2.07 Perak Public 181 - 79 - 102 - Perak Private 133 - 39 - 95 - Perak Total 314 1.31 118 0.49 197 0.82 Selangor & WP Putrajaya Public 343 - 159 - 184 - Selangor & WP Putrajaya Private 378 - 88 - 291 - Selangor & WP Putrajaya Total 721 1.28 247 0.44 475 0.84 WP Kuala Lumpur Public 170 - 48 - 122 - WP Kuala Lumpur Private 268 - 66 - 202 - WP Kuala Lumpur Total 438 2.58 114 0.67 324 1.91 Selangor & WP Putrajaya & WPKL Public 513 - 207 - 306 - Selangor & WP Putrajaya & WPKL Private 646 - 154 - 493 - Selangor & WP Putrajaya & WPKL Total 1,159 1.58 361 0.49 799 1.09 Negeri Sembilan Public 56 - 33 - 23 - Negeri Sembilan Private 90 - 31 - 59 - Negeri Sembilan Total 146 1.40 64 0.61 82 0.79 Melaka Public 47 - 30 - 17 - Melaka Private 108 - 13 - 95 - Melaka Total 155 1.86 43 0.52 112 1.34 Johor Public 226 - 64 - 162 - Johor Private 179 - 31 - 148 - Johor Total 405 1.19 95 0.28 310 0.91 Pahang Public 77 - 35 - 42 - Pahang Private 41 - 11 - 29 - Pahang Total 118 0.77 46 0.30 71 0.47 Terengganu Public 81 - 47 - 34 - Terengganu Private 8 - 0 - 8 - Terengganu Total 89 0.83 47 0.44 42 0.39 Kelantan Public 108 - 58 - 50 - Kelantan Private 25 - 6 - 19 - Kelantan Total 133 0.82 64 0.40 69 0.43 Sabah & WP Labuan Public 206 - 87 - 119 - Sabah & WP Labuan Private 20 - 2 - 18 - Sabah & WP Labuan Total 226 0.66 89 0.26 137 0.40 Sarawak Public 185 - 88 - 100 - Sarawak Private 67 - 19 - 48 - Sarawak Total 252 1.00 107 0.43 148 0.59 Abbreviation: na – not applicable; - – not available 60 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.18 Number of General Surgeons and Anaesthesiologists in Malaysia by State and Sector, 2011 General Surgeons Anaesthesiologists State Sector Per 10,000 Per General No. No. population Surgeon Malaysia Public 298 - 381 1.28 Malaysia Private 259 - 304 1.17 Malaysia Total 557 0.19 685 1.23 Perlis Public 3 - 4 1.33 Perlis Private na na na na Perlis Total 3 0.13 4 1.33 Kedah Public 22 - 17 0.77 Kedah Private 11 - 10 0.91 Kedah Total 33 0.17 27 0.82 Kedah & Perlis Public 25 - 21 0.84 Kedah & Perlis Private 11 - 10 0.91 Kedah & Perlis Total 36 0.16 31 0.86 Pulau Pinang Public 15 - 20 1.33 Pulau Pinang Private 29 - 35 1.21 Pulau Pinang Total 44 0.28 55 1.25 Perak Public 16 - 29 1.81 Perak Private 19 - 23 1.21 Perak Total 35 0.15 52 1.49 Selangor & WP Putrajaya Public 55 - 72 1.31 Selangor & WP Putrajaya Private 68 - 86 1.26 Selangor & WP Putrajaya Total 123 0.22 158 1.28 WP Kuala Lumpur Public 61 - 87 1.43 WP Kuala Lumpur Private 49 - 71 1.45 WP Kuala Lumpur Total 110 0.65 158 1.44 Selangor & WP Putrajaya & WPKL Public 116 - 159 1.37 Selangor & WP Putrajaya & WPKL Private 117 - 157 1.34 Selangor & WP Putrajaya & WPKL Total 233 0.32 316 1.36 Negeri Sembilan Public 11 - 11 1.00 Negeri Sembilan Private 11 - 9 0.82 Negeri Sembilan Total 22 0.21 20 0.91 Melaka Public 7 - 10 1.43 Melaka Private 13 - 17 1.31 Melaka Total 20 0.24 27 1.35 Johor Public 25 - 35 1.40 Johor Private 27 - 25 0.93 Johor Total 52 0.15 60 1.15 Pahang Public 13 - 17 1.31 Pahang Private 6 - 6 1.00 Pahang Total 19 0.12 23 1.21 Terengganu Public 8 - 12 1.50 Terengganu Private 0 - 1 0.00 Terengganu Total 8 0.07 13 1.63 Kelantan Public 25 - 27 1.08 Kelantan Private 3 - 2 0.67 Kelantan Total 28 0.17 29 1.04 Sabah & WP Labuan Public 20 - 22 1.10 Sabah & WP Labuan Private 7 - 5 0.71 Sabah & WP Labuan Total 27 0.08 27 1.00 Sarawak Public 17 - 18 1.06 Sarawak Private 16 - 14 0.88 Sarawak Total 33 0.13 32 0.97

Abbreviation: na – not applicable; - – not available HOSPITALS SURGICAL SERVICES IN MALAYSIAN 4

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Table 4.19 Number and Density of Breast Surgeons, Breast and Endocrine Surgeons in Malaysia by State and Sector, 2010-2011 2010 2011 Breast and Breast and Breast Surgeons Endocrine Breast Surgeons Endocrine State Sector Surgeons Surgeons Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population population Malaysia Public 3 - 12 - 3 - 19 - Malaysia Private 3 - 5 - 4 - 4 - Malaysia Total 6 0.00 17 0.01 7 0.00 23 0.01 Perlis Public 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 0 - 0 - 0 - Kedah Private 0 - 0 - 0 - 0 - Kedah Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah & Perlis Public 0 - 0 - 0 - 0 - Kedah & Perlis Private 0 - 0 - 0 - 0 - Kedah & Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Pulau Pinang Public 0 - 0 - 0 - 0 - Pulau Pinang Private 1 - 0 - 1 - 0 - Pulau Pinang Total 1 0.01 0 0.00 1 0.01 0 0.00 Perak Public 0 - 0 - 0 - 0 - Perak Private 0 - 0 - 0 - 0 - Perak Total 0 0.00 0 0.00 0 0.00 0 0.00 Selangor & WP Putrajaya Public 1 - 5 - 1 - 8 - Selangor & WP Putrajaya Private 0 - 2 - 0 - 2 - Selangor & WP Putrajaya Total 1 0.00 7 0.01 1 0.00 10 0.02 WP Kuala Lumpur Public 2 - 4 - 2 - 8 - WP Kuala Lumpur Private 2 - 3 - 2 - 2 - WP Kuala Lumpur Total 4 0.02 7 0.04 4 0.02 10 0.06 Selangor & WP Putrajaya & WPKL Public 3 - 9 - 3 - 16 - Selangor & WP Putrajaya & WPKL Private 2 - 5 - 2 - 4 - Selangor & WP Putrajaya & WPKL Total 5 0.01 14 0.02 5 0.01 20 0.03 Negeri Sembilan Public 0 - 0 - 0 - 0 - Negeri Sembilan Private 0 - 0 - 0 - 0 - Negeri Sembilan Total 0 0.00 0 0.00 0 0.00 0 0.00 Melaka Public 0 - 0 - 0 - 0 - Melaka Private 0 - 0 - 1 - 0 - Melaka Total 0 0.00 0 0.00 1 0.01 0 0.00 Johor Public 0 - 1 - 0 - 1 - Johor Private 0 - 0 - 0 - 0 - Johor Total 0 0.00 1 0.00 0 0.00 1 0.00 Pahang Public 0 - 0 - 0 - 0 - Pahang Private 0 - 0 - 0 - 0 - Pahang Total 0 0.00 0 0.00 0 0.00 0 0.00 Terengganu Public 0 - 1 - 0 - 1 - Terengganu Private 0 - 0 - 0 - 0 - Terengganu Total 0 0.00 1 0.01 0 0.00 1 0.01 Kelantan Public 0 - 1 - 0 - 1 - Kelantan Private 0 - 0 - 0 - 0 - Kelantan Total 0 0.00 1 0.01 0 0.00 1 0.01 Sabah & WP Labuan Public 0 - 0 - 0 - 0 - Sabah & WP Labuan Private 0 - 0 - 0 - 0 - Sabah & WP Labuan Total 0 0.00 0 0.00 0 0.00 0 0.00 Sarawak Public 0 - 0 - 0 - 0 - Sarawak Private 0 - 0 - 0 - 0 - Sarawak Total 0 0.00 0 0.00 0 0.00 0 0.00

Abbreviation: na – not applicable; - – not available

62 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 4.20 Number and Density of Vascular Surgeons, Hepatobiliary Surgeons, and Colorectal Surgeons in Malaysia by State and Sector, 2010-2011 2010 2011 Vascular Hepatobiliary Colorectal Vascular Hepatobiliary Colorectal State Sector Surgeons Surgeons Surgeons Surgeons Surgeons Surgeons Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. population population population population population population Malaysia Public 10 - 18 - 9 - 10 - 18 - 7 - Malaysia Private 9 - 11 - 17 - 9 - 12 - 23 - Malaysia Total 19 0.01 29 0.01 26 0.01 19 0.01 30 0.01 30 0.01 Perlis Public 0 - 0 - 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 2 - 1 - 0 - 2 - 1 - Kedah Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah Total 0 0.00 2 0.01 1 0.01 0 0.00 2 0.01 1 0.01 Kedah & Perlis Public 0 - 2 - 1 - 0 - 2 - 1 - Kedah & Perlis Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Total 0 0.00 2 0.01 1 0.00 0 0.00 2 0.01 1 0.00 Pulau Pinang Public 0 - 1 - 1 - 0 - 1 - 0 - Pulau Pinang Private 2 - 1 - 1 - 2 - 1 - 2 - Pulau Pinang Total 2 0.01 2 0.01 2 0.01 2 0.01 2 0.01 2 0.01 Perak Public 0 - 0 - 0 - 0 - 0 - 0 - Perak Private 0 - 0 - 2 - 0 - 0 - 2 - Perak Total 0 0.00 0 0.00 2 0.01 0 0.00 0 0.00 2 0.01 Selangor & WP Public 2 - 6 - 1 - 2 - 7 - 1 - Putrajaya Selangor & WP Private 4 - 7 - 7 - 4 - 7 - 7 - Putrajaya Selangor & WP Total 6 0.01 13 0.02 8 0.01 6 0.01 14 0.02 8 0.01 Putrajaya WP Kuala Lumpur Public 7 - 6 - 2 - 7 - 6 - 2 - WP Kuala Lumpur Private 1 - 3 - 4 - 2 - 3 - 5 - WP Kuala Lumpur Total 8 0.05 9 0.05 6 0.04 9 0.05 9 0.05 7 0.04 Selangor & WP Public 9 - 12 - 3 - 9 - 13 - 3 - Putrajaya & WPKL Selangor & WP Private 5 - 10 - 11 - 6 - 10 - 12 - Putrajaya & WPKL Selangor & WP Total 14 0.02 22 0.03 14 0.02 15 0.02 23 0.03 15 0.02 Putrajaya & WPKL Negeri Sembilan Public 0 - 0 - 1 - 0 - 0 - 1 - Negeri Sembilan Private 0 - 0 - 1 - 0 - 1 - 1 - Negeri Sembilan Total 0 0.00 0 0.00 2 0.02 0 0.00 1 0.01 2 0.02 Melaka Public 0 - 1 - 0 - 0 - 1 - 0 - Melaka Private 1 - 0 - 0 - 0 - 0 - 0 - Melaka Total 1 0.01 1 0.01 0 0.00 0 0.00 1 0.01 0 0.00 Johor Public 0 - 0 - 1 - 0 - 0 - 1 - Johor Private 1 - 0 - 2 - 1 - 0 - 3 - Johor Total 1 0.00 0 0.00 3 0.01 1 0.00 0 0.00 4 0.01 Pahang Public 1 - 0 - 1 - 1 - 0 - 0 - Pahang Private 0 - 0 - 0 - 0 - 0 - 2 - Pahang Total 1 0.01 0 0.00 1 0.01 1 0.01 0 0.00 2 0.01 Terengganu Public 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Private 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kelantan Public 0 - 0 - 1 - 0 - 0 - 1 - Kelantan Private 0 - 0 - 0 - 0 - 0 - 0 - Kelantan Total 0 0.00 0 0.00 1 0.01 0 0.00 0 0.00 1 0.01 Sabah & WP Labuan Public 0 - 0 - 0 - 0 - 0 - 0 - Sabah & WP Labuan Private 0 - 0 - 0 - 0 - 0 - 0 - Sabah & WP Labuan Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Sarawak Public 0 - 2 - 0 - 0 - 1 - 0 - Sarawak Private 0 - 0 - 0 - 0 - 0 - 1 - Sarawak Total 0 0.00 2 0.01 0 0.00 0 0.00 1 0.00 1 0.00 SURGICAL SERVICES IN MALAYSIAN HOSPITALS SURGICAL SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available 4

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Chapter 5 | ONCOLOGY SERVICES IN MALAYSIAN HOSPITALS Gerard LCC1, Foo CY2*, Kamilah D2*, Fuad I3, Hafizah ZA4, Lim YS5, Aslan NMA3, Cheah NLC4, Lau KL1, Sarah Lee A1

1. Hospital Kuala Lumpur 2. National Clinical Research Centre, Ministry of Health 3. Universiti Kebangsaan Malaysia Medical Centre 4. Hospital Pulau Pinang 5. Hospital Ampang * Corresponding author

Summary: There were 58 hospitals offering oncology services 2011. Of these, only 22 of the hospitals had radiotherapy facilities. There were 67 oncologists in 2011. In all, there was no significant change in manpower and facilities since the last report in 2010. There was a disproportionately higher allocation of oncology resources in the urban areas. The East Coast of Peninsular Malaysia were particularly lacking in the services. More trained staff, newer centres with more sophisticated equipment and upgrading of the existing services are needed to improve access of our services to the population and provide quality treatment.

Facilities

We had a 100% response rate in 2011. There were 58 hospitals providing oncology services in 2011. Thirty-one were in the public sector, including three University hospitals. The remaining 27 were in the private sector (Table 5.1). Of the 58 hospitals, only 46 had resident or visiting oncologist. The remaining 12 hospitals did not have either a clinical, medical or radiation oncologists (Table 5.2). However, these centres were supervised by physicians, surgeons or gynaecologists with a special interest in oncology. The distribution for oncology services was skewed towards the urban areas, especially the Klang Valley and the West coast of Peninsular Malaysia. The three regions with the highest number of oncology centres were Selangor and Putrajaya (10 centres), Pulau Pinang (9 centres), and Wilayah Persekutuan Kuala Lumpur (WPKL) (8 centres). There was an additional three hospitals providing oncology services in 2011.

There were 46 hospitals providing clean rooms (Table 5.3) and 35 with isolators for cytotoxic drug reconstitution (Table 5.4). Five hospitals (2 public and 3 private) outsourced their cytotoxic drug reconstitution services (Table 5.3). Fifty hospitals (26 public and 24 private) with 290 chemotherapy beds and 253 chemotherapy chairs provided chemotherapy day care services (Table 5.5).

Activities

The number of patients and the type of oncology activities were studied in 4 public oncology centres and these were representative of both Peninsular and East Malaysia. These centres provided chemotherapy with intent to cure to 2,305, 1,078, 567 and 474 patients respectively. In all these four centres, at least 90% of the patients were given treatment within 2 weeks from the time of consent to the time of chemotherapy administration. We did not collect data on palliative chemotherapy in this survey. The same centres also provided radiotherapy with intent to cure to 1,072, 1,217, 696 and 1665 patients respectively. Radiotherapy was given within four weeks from the time of simulation in 47%, 93%, 65% and 33% of patients respectively. One of these centres reported 2,874 new cancer cases in 2011 and of these, 40% were given appointment for their first consultation within 2 weeks.

Workforce

There were 67 oncologists in the country with 43% practicing in the public sector. The number of oncologists were higher in urban areas, i.e. WPKL (23), Pulau Pinang (13), Selangor and Putrajaya (10), and these represented 68% of the oncologists in Malaysia (Table 5.6).

There were 230 oncology trained nurses working in hospitals in 2011. Of these, 75% were in public sector. There were 101 Cytotoxic Drug Reconstitution (CDR) pharmacists in the country and of these, 63% were in the public sector. There were 283 radiation therapists of which 73% were in the public sector (Table 5.7). There were 82 physicists, of whom 50% were in the public sector.

Medical Equipment

In 2011, there were 29 simulators, 36 megavoltage machines and 14 brachytherapy machines; 40% of these were in the public sector. Perlis, Kedah, Terengganu and Pahang did not have any radiotherapy equipment (Table 5.8). Most centres had either one or two megavoltage machine(s). The exceptions were Hospital Kuala Lumpur (4 megavoltage machines), Mount Miriam Hospital and Sarawak General Hospital (3 megavoltage machines each).

There were 22 hospitals with treatment planning devices and quality assurance tools (Table 5.9). There were 20 machines capable of carrying out Intensity Modulated Radiotherapy (IMRT); 14 machines capable of Image Guided Radiotherapy (IGRT) and 12 machines capable of Stereotactic Radiotherapy (SRS) (Table 5.10). HOSPITALS ONCOLOGY SERVICES IN MALAYSIAN 5

65 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Discussion

There were no significant changes in the oncology services provided for in 2011 when compared to 2010; the number of hospitals with oncology services, megavoltage machines and oncologists being the same. This may be expected as only a year has elapsed between the 2 surveys. The ratio of megavoltage machine to population was 1.27 per million populations. This is below the recommended ratio of 5 per million population. 1, 2 As a comparison, the United Kingdom in 2012 had 265 linear accelerators providing of 4.2 per million population.3 However, we do accept that changes in services will take time due to the complexity of commissioning and decommissioning therapy machines.

There were 67 oncologists in Malaysia, giving a density of 2 per million populations. In comparison, the density of clinical oncologists in the UK was 3 8.6 per million populations in 2011. Furthermore, the number of clinical oncologists there had increased to 544 in 2012.

There was a disproportionate distribution in the oncology workforce between private and public sectors. On the one hand, the number of oncologists in the private sector was more than the public sector (56% vs. 44%). On the other hand, the number of support staff, namely oncology trained nurses, radiation therapists and CDR pharmacists, was higher in the public sector. Furthermore, more megavoltage machines were located in the private sector.

Eighty one percent of the hospitals providing oncology services had a clean room for reconstitution of cytotoxic drugs. There was an apparent decrease in the number of oncology trained nurses in 2011 when compared to 2010. This may have been due to a revised definition used in the 2011 survey.

In conclusion, there were no significant changes in the number of oncologists, paramedical staff and facilities, both in the public and private sector over the past year. We are lagging behind most developed nations and there is therefore, room for improvement.3, 5 We also recognise that improving the oncology services nationally needs time, proper planning, a strong commitment, optimal interagency cooperation and engaging the public-private partnership.

Radiotherapy remains an important priority for the services. The authorities should ensure that access to this service should be increased. As an indicator of the quality of service, the time interval between treatment decision and initiation of therapy will be a useful guide. This report has shown that more needs to be done to optimise our services.

Limitations

Changes made to the survey in 2011 have resulted in differences in the kind of responses when compared to 2010.

1. Oncology services were defined in 2011 as services provided by permanent/resident and visiting oncologists including those hospitals that delivered basic chemotherapy and included services provided by medical oncologists, clinical oncologists, surgeons, ear, nose, throat (ENT), gynaecologist and respiratory physicians with special interest in oncology. The definition was different in 2010, where the inclusion of hospitals providing oncology services was based on the decision of the expert panel. 2. The survey in 2011 excluded services provided by haematologists and paediatric oncologists. Although not explicitly stated in the survey for 2010, the expert panel had excluded them only in the final report. 3. The role of oncology trainee doctors was withdrawn in survey in 2011. 4. The survey in 2011 included additional questions like “Does your establishment have an oncologist” and “if yes, total number (permanent/ resident/visiting)”. This restructuring of the questions had allowed for a more accurate capture of the number of practising oncologist(s) in these centres. Internal and historical consistency checks were performed to improve reliability and accuracy of the data. 5. The definition of oncology trained nurse was specifically defined in 2011 as “nurse who has undergone training in post basic oncology and served in an oncology setting during 2011”. This definition was not stated in the 2010 report. Based on this definition, the number of oncology trained nurse in 2011 was reduced when defined as such. 6. An additional section on oncology activities (chemotherapy and radiotherapy) was included in 2011 for the public sector. However, most of the centres were unable to provide these data. We thus decided to report only those centres that could provide accurate data in order to provide the actual situation for oncology services in the public sector for 2011. 7. Another new variable captured in survey in 2011 included hospitals outsourcing their CDR service and their chemotherapy beds and chairs. This was not present in 2010. References

1. Guidance on the Development and Management of Devolved Radiotherapy Services. The Royal College of Radiologists. 2004 2. The Royal College of Radiologists (2000) the Provision and Replacement of Radiotherapy Equipment BCFO (00)2. London: Royal College of Radiologists 3. Radiotherapy Services in England. National Radiotherapy Implementation Group (NRIG). Department of Health Cancer Policy Team. 2012 (https://www.gov.uk/government/publications/radiotherapy-services-in-england-2012) 4. Planning for the Best. Tripartite National Strategic Plan for Radiation Oncology 2012-2022. The Royal Australian and New Zealand College of 66 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Radiologists, Australian Institute of Radiography, Australasian Institute of Physical Scientists and Engineers in Medicine 2012 Table 5.1 Number and Density of Hospitals Providing Oncology Services in Malaysia by State and Sector in 2010 and 2011 Hospitals Providing Oncology Hospitals Providing Oncology Services 2010 Services 2011 State Sector Per 10,000 Per 10,000 Number Number population population Malaysia Public 28 - 31 - Malaysia Private 27 - 27 - Malaysia Total 55 0.02 58 0.02 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 2 - 2 - Kedah Private 0 - 0 - Kedah Total 2 0.01 2 0.01 Kedah & Perlis Public 2 - 2 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 2 0.01 2 0.01 Pulau Pinang Public 2 - 2 - Pulau Pinang Private 7 - 7 - Pulau Pinang Total 9 0.06 9 0.06 Perak Public 4 - 4 - Perak Private 3 - 3 - Perak Total 7 0.03 7 0.03 Selangor & WP Putrajaya Public 3 - 4 - Selangor & WP Putrajaya Private 6 - 6 - Selangor & WP Putrajaya Total 9 0.02 10 0.02 WP Kuala Lumpur Public 3 - 3 - WP Kuala Lumpur Private 5 - 5 - WP Kuala Lumpur Total 8 0.05 8 0.05 Selangor & WP Putrajaya & WPKL Public 6 - 7 - Selangor & WP Putrajaya & WPKL Private 11 - 11 - Selangor & WP Putrajaya & WPKL Total 17 0.02 18 0.02 Negeri Sembilan Public 1 - 1 - Negeri Sembilan Private 1 - 1 - Negeri Sembilan Total 2 0.02 2 0.02 Melaka Public 1 - 1 - Melaka Private 2 - 2 - Melaka Total 3 0.04 3 0.04 Johor Public 4 - 4 - Johor Private 1 - 1 - Johor Total 5 0.01 5 0.01 Pahang Public 1 - 1 - Pahang Private 0 - 0 - Pahang Total 1 0.01 1 0.01 Terengganu Public 1 - 1 - Terengganu Private 0 - 0 - Terengganu Total 1 0.01 1 0.01 Kelantan Public 2 - 2 - Kelantan Private 0 - 0 - Kelantan Total 2 0.01 2 0.01 Sabah & WP Labuan Public 1 - 3 - Sabah & WP Labuan Private 1 - 1 - Sabah & WP Labuan Total 2 0.01 4 0.01 Sarawak Public 3 - 3 -

Sarawak Private 1 - 1 - HOSPITALS ONCOLOGY SERVICES IN MALAYSIAN 5

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Hospitals Providing Oncology Hospitals Providing Oncology Services 2010 Services 2011 State Sector Per 10,000 Per 10,000 Number Number population population Sarawak Total 4 0.02 4 0.02 Abbreviation: na – not applicable; - – not available Table 5.2 Number and Density of Hospitals Providing Oncology Services with and without Oncologist in Malaysia by State and Sector in 2010 and 2011 2010 2011 Hospitals Hospitals Hospitals Hospitals Hospitals Providing Hospitals Providing Providing Providing Providing Basic Oncology Providing Basic Oncology Oncology Oncology State Sector Oncology Services without Oncology Services Services with Services with Services oncologist Services without oncologist oncologist oncologist Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. population population population population population population Malaysia Public 28 - 24 - 4 - 31 - 20 - 11 - Malaysia Private 27 - 26 - 1 - 27 - 26 - 1 - Malaysia Total 55 0.02 50 0.02 5 0.00 58 0.02 46 0.02 12 0.00 Perlis Public 0 - 0 - 0 - 0 - 0 - 0 - Perlis Private 0 na na na na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 2 - 1 - 1 - 2 - 1 - 1 - Kedah Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah Total 2 0.01 1 0.01 1 0.01 2 0.01 1 0.01 1 0.01 Kedah & Perlis Public 2 - 1 - 1 - 2 - 1 - 1 - Kedah & Perlis Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Total 2 0.01 1 0.00 1 0.00 2 0.01 1 0.00 1 0.00 Pulau Pinang Public 2 - 2 - 0 - 2 - 2 - 0 - Pulau Pinang Private 7 - 7 - 0 - 7 - 7 - 0 - Pulau Pinang Total 9 0.06 9 0.06 0 0.00 9 0.06 9 0.06 0 0.00 Perak Public 4 - 2 - 2 - 4 - 2 - 2 - Perak Private 3 - 2 - 1 - 3 - 2 - 1 - Perak Total 7 0.03 4 0.02 3 0.01 7 0.03 4 0.02 3 0.01 Selangor & WP Public 3 - 3 - 0 - 4 - 1 - 3 - Putrajaya Selangor & WP Private 6 - 6 - 0 - 6 - 6 - 0 - Putrajaya Selangor & WP Total 9 0.02 9 0.02 0 0.00 10 0.02 7 0.01 3 0.01 Putrajaya WP Kuala Lumpur Public 3 - 3 - 0 - 3 - 3 - 0 - WP Kuala Lumpur Private 5 - 5 - 0 - 5 - 5 - 0 - WP Kuala Lumpur Total 8 0.05 8 0.05 0 0.00 8 0.05 8 0.05 0 0.00 Selangor & WP Public 6 - 6 - 0 - 7 - 4 - 3 - Putrajaya & WPKL Selangor & WP Private 11 - 11 - 0 - 11 - 11 - 0 - Putrajaya & WPKL Selangor & WP Total 17 0.02 17 0.02 0 0.00 18 0.02 15 0.02 3 0.00 Putrajaya & WPKL Negeri Sembilan Public 1 - 1 - 0 - 1 - 1 - 0 - Negeri Sembilan Private 1 - 1 - 0 - 1 - 1 - 0 - Negeri Sembilan Total 2 0.02 2 0.02 0 0.00 2 0.02 2 0.02 0 0.00 Melaka Public 1 - 1 - 0 - 1 - 1 - 0 - Melaka Private 2 - 2 - 0 - 2 - 2 - 0 - Melaka Total 3 0.04 3 0.04 0 0.00 3 0.04 3 0.04 0 0.00 Johor Public 4 - 4 - 0 - 4 - 2 - 2 - Johor Private 1 - 1 - 0 - 1 - 1 - 0 - Johor Total 5 0.01 5 0.01 0 0.00 5 0.01 3 0.01 2 0.01 Pahang Public 1 - 1 - 0 - 1 - 1 - 0 - Pahang Private 0 - 0 - 0 - 0 - 0 - 0 - Pahang Total 1 0.01 1 0.01 0 0.00 1 0.01 1 0.01 0 0.00 Terengganu Public 1 - 1 - 0 - 1 - 1 - 0 - Terengganu Private 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Total 1 0.01 1 0.01 0 0.00 1 0.01 1 0.01 0 0.00 Kelantan Public 2 - 2 - 0 - 2 - 1 - 1 - Kelantan Private 0 - 0 - 0 - 0 - 0 - 0 - Kelantan Total 2 0.01 2 0.01 0 0.00 2 0.01 1 0.01 1 0.01 Sabah & WP Public 1 - 1 - 0 - 3 - 3 - 0 - Labuan

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2010 2011 Hospitals Hospitals Hospitals Hospitals Hospitals Providing Hospitals Providing Providing Providing Providing Basic Oncology Providing Basic Oncology Oncology Oncology State Sector Oncology Services without Oncology Services Services with Services with Services oncologist Services without oncologist oncologist oncologist Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. population population population population population population Sabah & WP Private 1 - 1 - 0 - 1 - 1 - 0 - Labuan Sabah & WP Total 2 0.01 2 0.01 0 0.00 4 0.01 4 0.01 0 0.00 Labuan Sarawak Public 3 - 2 - 1 - 3 - 1 - 2 - Sarawak Private 1 - 1 - 0 - 1 - 1 - 0 - Sarawak Total 4 0.02 3 0.01 1 0.00 4 0.02 2 0.01 2 0.01 Abbreviation: na – not applicable; - – not available ONCOLOGY SERVICES IN MALAYSIAN HOSPITALS ONCOLOGY SERVICES IN MALAYSIAN 5

69 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.3 Number and Density of Hospitals with Clean Room for Reconstitution of Cytotoxic Drugs and Number of Total Clean Room for Reconstitution of Cytotoxic Drugs in Malaysia by State and Sector in 2010 and 2011 2010 2011 Hospitals Hospital Hospitals Hospital providing Total Hospitals sproviding providing Total sOutsourcing Clean Room Clean Room providing Clean Room Clean Room Clean Room for Reconstitution State Sector for Cytotoxic for Cytotoxic Clean Room for for Cytotoxic for Cytotoxic Cytotoxic drugs of Cytotoxic drugs with drugs Cytotoxic drugs drugs with drugs drugs Oncologists Oncologists Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. No. Population Population Population Population Population Population Population Malaysia Public 24 - 20 - 27 - 26 - 17 - 28 - 2 - Malaysia Private 22 - 21 - 22 - 20 - 20 - 21 - 3 - Malaysia Total 46 0.02 41 0.01 49 0.02 46 0.02 37 0.01 49 0.02 5 0.00 Perlis Public 0 - 0 - 0 - 0 - 0 - 0 - 0 - Perlis Private 0 na 0 na na na na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 2 - 1 - 2 - 2 - 1 - 2 - 0 - Kedah Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - Kedah Total 2 0.01 1 0.01 2 0.01 2 0.01 1 0.01 2 0.01 0 0.00 Kedah & Perlis Public 2 - 1 - 2 - 2 - 1 - 2 - 0 - Kedah & Perlis Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Total 2 0.01 1 0.00 2 0.01 2 0.01 1 0.00 2 0.01 0 0.00 Pulau Pinang Public 0 - 0 - 0 - 2 - 2 - 2 - 0 - Pulau Pinang Private 6 - 6 - 6 - 5 - 5 - 5 - 0 - Pulau Pinang Total 6 0.04 6 0.04 6 0.04 7 0.04 7 0.04 7 0.04 0 0.00 Perak Public 3 - 1 - 3 - 3 - 1 - 3 - 0 - Perak Private 3 - 2 - 3 - 2 - 2 - 2 - 0 - Perak Total 6 0.03 3 0.01 6 0.03 5 0.02 3 0.01 5 0.02 0 0.00 Selangor & WP Putrajaya Public 3 - 3 - 4 - 4 - 1 - 4 - 0 - Selangor & WP Putrajaya Private 5 - 5 - 5 - 5 - 5 - 5 - 1 - Selangor & WP Putrajaya Total 8 0.01 8 0.01 9 0.02 9 0.02 6 0.01 9 0.02 1 0.00 WP Kuala Lumpur Public 3 - 3 - 4 - 3 - 3 - 4 - 0 - WP Kuala Lumpur Private 3 - 3 - 3 - 3 - 3 - 3 - 2 - WP Kuala Lumpur Total 6 0.04 6 0.04 7 0.04 6 0.04 6 0.04 7 0.04 2 0.01 Selangor & WP Putrajaya Public 6 - 6 - 8 - 7 - 4 - 8 - 0 - & WPKL Selangor & WP Putrajaya Private 8 - 8 - 8 - 8 - 8 - 8 - 3 - & WPKL Selangor & WP Putrajaya Total 14 0.02 14 0.02 16 0.02 15 0.02 12 0.02 16 0.02 3 0.00 & WPKL Negeri Sembilan Public 1 - 1 - 1 - 1 - 1 - 1 - 0 - Negeri Sembilan Private 1 - 1 - 1 - 1 - 1 - 2 - 0 - Negeri Sembilan Total 2 0.02 2 0.02 2 0.02 2 0.02 2 0.02 3 0.03 0 0.00 Melaka Public 1 - 1 - 1 - 1 - 1 - 1 - 0 - Melaka Private 2 - 2 - 2 - 1 - 1 - 1 - 0 - Melaka Total 3 0.04 3 0.04 3 0.04 2 0.02 2 0.02 2 0.02 0 0.00 Johor Public 4 - 4 - 4 - 2 - 1 - 2 - 2 - Johor Private 1 - 1 - 1 - 1 - 1 - 1 - 0 - Johor Total 5 0.01 5 0.01 5 0.01 3 0.01 2 0.01 3 0.01 2 0.01 Pahang Public 1 - 1 - 1 - 1 - 1 - 1 - 0 - Pahang Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - Pahang Total 1 0.01 1 0.01 1 0.01 1 0.01 1 0.01 1 0.01 0 0.00 Terengganu Public 1 - 1 - 1 - 1 - 1 - 1 - 0 - Terengganu Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Total 1 0.01 1 0.01 1 0.01 1 0.01 1 0.01 1 0.01 0 0.00 Kelantan Public 1 - 1 - 1 - 2 - 1 - 3 - 0 - Kelantan Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - Kelantan Total 1 0.01 1 0.01 1 0.01 2 0.01 1 0.01 3 0.02 0 0.00 Sabah & WP Labuan Public 1 - 1 - 1 - 2 - 2 - 2 - 0 - Sabah & WP Labuan Private 0 - 0 - 0 - 1 - 1 - 1 - 0 - Sabah & WP Labuan Total 1 0.00 1 0.00 1 0.00 3 0.01 3 0.01 3 0.01 0 0.00 Sarawak Public 3 - 2 - 4 - 2 - 1 - 2 - 0 - Sarawak Private 1 - 1 - 1 - 1 - 1 - 1 - 0 - Sarawak Total 4 0.02 3 0.01 5 0.02 3 0.01 2 0.01 3 0.01 0 0.00 Abbreviation: na – not applicable; - – not available

70 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.4 Number and Density of Hospitals Providing Cytotoxic Drug Reconstitution (CDR) in Malaysia by State and Sector in 2010 & 2011 2010 2011 Hospitals with Cytotoxic Drug Hospitals with Cytotoxic Drug State Sector Reconstitution (CDR) Isolator Reconstitution (CDR) Isolator Per 10,000 Per 10,000 No. No. population population Malaysia Public 8 - 14 - Malaysia Private 20 - 21 - Malaysia Total 28 0.01 35 0.01 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0 Kedah Public 0 - 2 - Kedah Private 0 - 0 - Kedah Total 0 0.00 2 0.01 Kedah & Perlis Public 0 - 2 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 0 0.00 2 0.01 Pulau Pinang Public 2 - 2 - Pulau Pinang Private 6 - 7 - Pulau Pinang Total 8 0.05 9 0.06 Perak Public 2 - 2 - Perak Private 2 - 2 - Perak Total 4 0.02 4 0.02 Selangor & WP Putrajaya Public 0 - 1 - Selangor & WP Putrajaya Private 4 - 4 - Selangor & WP Putrajaya Total 4 0.01 5 0.01 WP Kuala Lumpur Public 1 - 1 - WP Kuala Lumpur Private 3 - 3 - WP Kuala Lumpur Total 4 0.02 4 0.02 Selangor & WP Putrajaya & WPKL Public 1 - 2 - Selangor & WP Putrajaya & WPKL Private 7 - 7 - Selangor & WP Putrajaya & WPKL Total 8 0.01 9 0.01 Negeri Sembilan Public 0 - 0 - Negeri Sembilan Private 1 - 1 - Negeri Sembilan Total 1 0.01 1 0.01 Melaka Public 0 - 1 - Melaka Private 2 - 2 - Melaka Total 2 0.02 3 0.04 Johor Public 0 - 2 - Johor Private 1 - 1 - Johor Total 1 0.00 3 0.01 Pahang Public 0 - 0 - Pahang Private 0 - 0 - Pahang Total 0 0.00 0 0 Terengganu Public 0 - 0 - Terengganu Private 0 - 0 - Terengganu Total 0 0.00 0 0 Kelantan Public 1 - 1 - Kelantan Private 0 - 0 - Kelantan Total 1 0.01 1 0.01 Sabah & WP Labuan Public 1 - 1 - Sabah & WP Labuan Private 1 - 0 - Sabah & WP Labuan Total 2 0.01 1 0 Sarawak Public 1 - 1 - Sarawak Private 0 - 1 -

Sarawak Total 1 0.00 2 0.01 HOSPITALS ONCOLOGY SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available 5

71 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.5 Number and Density of Hospitals Providing Chemotherapy Daycare Services, Chemotherapy Beds and Chairs in Malaysia by State and Sector in 2011 Hospitals Providing Chemotherapy Daycare Chemotherapy Beds Chemotherapy Chairs State Sector Services Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 26 - 180 - 112 - Malaysia Private 24 - 110 - 141 - Malaysia Total 50 0.02 290 0.10 253 0.09 Perlis Public 0 - 0 - 0 - Perlis Private na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 Kedah Public 1 - 2 - 0 - Kedah Private 0 - 0 - 0 - Kedah Total 1 0.01 2 0.01 0 0.00 Kedah & Perlis Public 1 - 2 - 0 - Kedah & Perlis Private 0 - 0 - 0 - Kedah & Perlis Total 1 0.00 2 0.01 0 0.00 Pulau Pinang Public 2 - 14 - 12 - Pulau Pinang Private 7 - 29 - 51 - Pulau Pinang Total 9 0.06 43 0.27 63 0.40 Perak Public 3 - 26 - 5 - Perak Private 2 - 4 - 11 - Perak Total 5 0.02 30 0.13 16 0.07 Selangor & WP Putrajaya Public 3 - 23 - 12 - Selangor & WP Putrajaya Private 5 - 40 - 15 - Selangor & WP Putrajaya Total 8 0.01 63 0.11 27 0.05 WP Kuala Lumpur Public 3 - 22 - 25 - WP Kuala Lumpur Private 4 - 17 - 33 - WP Kuala Lumpur Total 7 0.04 39 0.23 58 0.34 Selangor & WP Putrajaya & WPKL Public 6 - 45 - 37 - Selangor & WP Putrajaya & WPKL Private 9 - 57 - 48 - Selangor & WP Putrajaya & WPKL Total 15 0.02 102 0.14 85 0.12 Negeri Sembilan Public 1 - 20 - 6 - Negeri Sembilan Private 1 - 6 - 0 - Negeri Sembilan Total 2 0.02 26 0.25 6 0.06 Melaka Public 1 - 6 - 0 - Melaka Private 2 - 1 - 23 - Melaka Total 3 0.04 7 0.08 23 0.28 Johor Public 4 - 20 - 13 - Johor Private 1 - 2 - 8 - Johor Total 5 0.01 22 0.06 21 0.06 Pahang Public 1 - 6 - 0 - Pahang Private 0 - 0 - 0 - Pahang Total 1 0.01 6 0.04 0 0.00 Terengganu Public 1 - 4 - 0 - Terengganu Private 0 - 0 - 0 - Terengganu Total 1 0.01 4 0.04 0 0.00 Kelantan Public 1 - 4 - 0 - Kelantan Private 0 - 0 - 0 - Kelantan Total 1 0.01 4 0.02 0 0.00 Sabah & WP Labuan Public 2 - 25 - 12 - Sabah & WP Labuan Private 1 - 3 - 0 - Sabah & WP Labuan Total 3 0.01 28 0.08 12 0.04 Sarawak Public 3 - 8 - 27 - Sarawak Private 1 - 8 - 0 - Sarawak Total 4 0.02 16 0.06 27 0.11 Abbreviation: na – not applicable; - – not available 72 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.6 Number and Density of Oncologists in Malaysian Hospitals by State and Sector in 2009, 2010 and 2011 2009 2010 2011 Oncologists Oncologists Oncologists State Sector Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 29 - 33 - 29 - Malaysia Private 28 - 34 - 38 - Malaysia Total 57 0.02 67 0.02 67 0.02 Perlis Public 0 - 0 - 0 - Perlis Private na na na na na na Perlis Total 0 0 0 0.00 0 0.00 Kedah Public 0 - 0 - 0 - Kedah Private 0 - 0 - 0 - Kedah Total 0 0 0 0.00 0 0.00 Kedah & Perlis Public 0 - 0 - 0 Kedah & Perlis Private 0 - 0 - 0 Kedah & Perlis Total 0 0 0 0.00 0 0.00 Pulau Pinang Public 2 - 2 - 2 - Pulau Pinang Private 7 - 10 - 11 - Pulau Pinang Total 9 0.06 12 0.08 13 0.08 Perak Public 0 - 0 - 0 - Perak Private 2 - 2 - 2 - Perak Total 2 0.01 2 0.01 2 0.01 Selangor & WP Putrajaya Public 0 - 0 - 0 - Selangor & WP Putrajaya Private 6 - 9 - 10 - Selangor & WP Putrajaya Total 6 0.01 9 0.02 10 0.02 WP Kuala Lumpur Public 17 - 21 - 18 WP Kuala Lumpur Private 6 - 5 - 5 WP Kuala Lumpur Total 23 0.14 26 0.16 23 0.14 Selangor & WP Putrajaya & WPKL Public 17 - 21 - 18 - Selangor & WP Putrajaya & WPKL Private 12 - 14 - 15 - Selangor & WP Putrajaya & WPKL Total 29 0.04 35 0.05 33 0.05 Negeri Sembilan Public 1 - 1 - 0 - Negeri Sembilan Private 2 - 2 - 3 - Negeri Sembilan Total 3 0.03 3 0.03 3 0.03 Melaka Public 0 - 0 - 0 - Melaka Private 3 - 3 - 5 - Melaka Total 3 0.04 3 0.04 5 0.06 Johor Public 2 - 2 - 2 - Johor Private 1 - 2 - 1 - Johor Total 3 0.01 4 0.01 3 0.01 Pahang Public 1 - 1 - 1 - Pahang Private 0 - 0 - 0 - Pahang Total 1 0.01 1 0.01 1 0.01 Terengganu Public 0 - 0 - 0 - Terengganu Private 0 - 0 - 0 - Terengganu Total 0 0 0 0.00 0 0.00 Kelantan Public 2 - 2 - 2 - Kelantan Private 0 - 0 - 0 - Kelantan Total 2 0.01 2 0.01 2 0.01 Sabah & WP Labuan Public 1 - 1 - 1 - Sabah & WP Labuan Private 1 - 1 - 1 - Sabah & WP Labuan Total 2 0.01 2 0.01 2 0.01 Sarawak Public 3 - 3 - 3 - Sarawak Private 0 - 0 - 0 -

Sarawak Total 3 0.01 3 0.01 3 0.01 HOSPITALS ONCOLOGY SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available 5 73 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.7 Number and Density of Oncology Trained Nurses, Radiation Therapists and Physicists in Malaysia by State and Sector in 2010 & 2011 2010 2011 Oncology CDR Radiation Oncology CDR Radiation Physicists Physicists State Sector Trained Nurses Pharmacists Therapists Trained Nurses Pharmacists Therapists Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. No. No. No. population population population population population population population population Malaysia Public 244 - 47 - 188 - 42 - 173 - 64 - 206 - 41 - Malaysia Private 68 - 31 - 69 - 41 - 57 - 37 - 77 - 41 - Malaysia Total 312 0.11 78 0.03 257 0.09 83 0.03 230 0.08 101 0.03 283 0.10 82 0.03 Perlis Public 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 19 - 3 - 0 - 0 - 0 - 2 - 0 - 0 - Kedah Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - Kedah Total 19 0.10 3 0.02 0 0.00 0 0.00 0 0.00 2 0.01 0 0.00 0 0.00 Kedah & Perlis Public 19 - 3 - 0 - 0 - 0 - 2 - 0 - 0 - Kedah & Perlis Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Total 19 0.09 3 0.01 0 0.00 0 0.00 0 0.00 2 0.01 0 0.00 0 0.00 Pulau Pinang Public 8 - 4 - 15 - 2 - 8 - 8 - 15 - 1 - Pulau Pinang Private 18 - 10 - 19 - 11 - 13 - 15 - 21 - 10 - Pulau Pinang Total 26 0.17 14 0.09 34 0.22 13 0.08 21 0.13 23 0.14 36 0.23 11 0.07 Perak Public 8 - 6 - 0 - 0 - 16 - 6 - 0 - 0 - Perak Private 9 - 4 - 4 - 3 - 3 - 2 - 3 - 2 - Perak Total 17 0.07 10 0.04 4 0.02 3 0.01 19 0.08 8 0.03 3 0.01 2 0.01 Selangor & WP Public 24 - 6 - 0 - 2 - 7 - 7 - 0 - 0 - Putrajaya Selangor & WP Private 18 - 6 - 20 - 10 - 18 - 7 - 21 - 11 - Putrajaya Selangor & WP Total 42 0.08 12 0.02 20 0.04 12 0.02 25 0.04 14 0.02 21 0.04 11 0.02 Putrajaya WP Kuala Lumpur Public 94 - 11 - 82 - 20 - 66 - 13 - 89 - 21 - WP Kuala Lumpur Private 10 - 4 - 11 - 6 - 11 - 6 - 15 - 6 - WP Kuala Lumpur Total 104 0.62 15 0.09 93 0.56 26 0.16 77 0.45 19 0.11 104 0.61 27 0.16 Selangor & WP Public 118 - 17 - 82 - 22 - 73 - 20 - 89 - 21 - Putrajaya & WPKL Selangor & WP Private 28 - 10 - 31 - 16 - 29 - 13 - 36 - 17 - Putrajaya & WPKL Selangor & WP Total 146 0.20 27 0.04 113 0.16 38 0.05 102 0.14 33 0.04 125 0.17 38 0.05 Putrajaya & WPKL Negeri Sembilan Public 4 - 2 - 0 - 0 - 6 - 1 - 0 - 0 - Negeri Sembilan Private 4 - 1 - 5 - 2 - 3 - 1 - 5 - 2 - Negeri Sembilan Total 8 0.08 3 0.03 5 0.05 2 0.02 9 0.09 2 0.02 5 0.05 2 0.02 Melaka Public 1 - 1 - 0 - 0 - 2 - 2 - 0 - 0 - Melaka Private 4 - 3 - 6 - 5 - 4 - 3 - 7 - 6 - Melaka Total 5 0.06 4 0.05 6 0.07 5 0.06 6 0.07 5 0.06 7 0.08 6 0.07 Johor Public 50 - 3 - 26 - 5 - 16 - 12 - 27 - 6 - Johor Private 3 - 1 - 3 - 3 - 3 - 2 - 3 - 3 - Johor Total 53 0.16 4 0.01 29 0.09 8 0.02 19 0.06 14 0.04 30 0.09 9 0.03 Pahang Public 6 - 1 - 0 - 2 - 3 - 1 - 0 - 0 - Pahang Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - Pahang Total 6 0.04 1 0.01 0 0.00 2 0.01 3 0.02 1 0.01 0 0.00 0 0.00 Terengganu Public 0 - 1 - 0 - 0 - 6 - 2 - 0 - 0 - Terengganu Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Total 0 0.00 1 0.01 0 0.00 0 0.00 6 0.06 2 0.02 0 0.00 0 0.00 Kelantan Public 14 - 2 - 8 - 4 - 23 - 3 - 15 - 3 - Kelantan Private 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - Kelantan Total 14 0.09 2 0.01 8 0.05 4 0.03 23 0.14 3 0.02 15 0.09 3 0.02 Sabah & WP Public 3 - 1 - 14 - 1 - 10 - 2 - 15 - 4 - Labuan Sabah & WP Private 0 - 2 - 1 - 1 - 0 - 0 - 2 - 1 - Labuan Sabah & WP Total 3 0.01 3 0.01 15 0.05 2 0.01 10 0.03 2 0.01 17 0.05 5 0.01 Labuan Sarawak Public 13 - 6 - 43 - 6 - 10 - 5 - 45 - 6 Sarawak Private 2 - 0 - 0 - 0 - 2 - 1 - 0 - 0 - Sarawak Total 15 0.06 6 0.02 43 0.17 6 0.02 12 0.05 6 0.02 45 0.18 6 0.02 Abbreviation: na – not applicable; - – not available; CDR – Cytotoxic Drug Reconstitution 74 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.8 Number and Density of Megavoltage Machines, Brachytherapy Machines and Simulators in Malaysia by State and Sector in 2010 and 2011 2010 2011 Megavoltage Brachytherapy Megavoltage Brachytherapy State Sector Simulators Simulators Machines Machines Machines Machines No. PMP No. PMP No. PMP No. PMP No. PMP No. PMP Malaysia Public 15 - 6 - 11 - 14 - 6 - 11 - Malaysia Private 24 - 10 - 18 - 22 - 8 - 18 - Malaysia Total 39 1.38 16 0.56 29 1.02 36 1.27 14 0.49 29 1.02 Perlis Public 0 - 0 - 0 - 0 - 0 - 0 Perlis Private na na na na na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 0 - 0 - 0 - 0 - 0 - Kedah Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah & Perlis Public 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Pulau Pinang Public 0 - 0 - 0 - 0 0 - 0 - Pulau Pinang Private 6 - 1 - 5 - 6 - 1 - 4 - Pulau Pinang Total 6 3.84 1 0.64 5 3.20 6 3.84 1 0.64 4 2.56 Perak Public 0 - 0 - 0 - 0 - 0 - 0 - Perak Private 1 - 0 - 1 - 1 - 0 - 1 - Perak Total 1 0.43 0 0.00 1 0.43 1 0.43 0 0.00 1 0.43 Selangor & WP Public 0 - 0 - 0 - 0 - 0 - 0 - Putrajaya Selangor & WP Private 6 - 4 - 4 - 6 - 3 - 5 - Putrajaya Selangor & WP Total 6 1.08 4 0.72 4 0.72 6 1.08 3 0.54 5 0.90 Putrajaya WP Kuala Public 8 - 3 - 6 7 - 3 - 6 - Lumpur WP Kuala Private 4 - 1 - 3 4 - 1 - 3 - Lumpur WP Kuala Total 12 7.17 4 2.39 9 5.37 11 6.57 4 2.39 9 5.37 Lumpur Selangor & WP Public 8 - 3 - 6 - 7 - 3 - 6 - Putrajaya & WPKL Selangor & WP Private 10 - 5 - 7 - 10 - 4 - 8 - Putrajaya & WPKL Selangor & WP Total 18 2.50 8 1.11 13 1.80 17 2.36 7 0.97 14 1.94 Putrajaya & WPKL Negeri Sembilan Public 0 - 0 - 0 - 0 - 0 - 0 - Negeri Sembilan Private 2 - 1 - 1 - 2 - 1 - 1 - Negeri Sembilan Total 2 1.96 1 0.98 1 0.98 2 1.96 1 0.98 1 0.98 Melaka Public 0 - 0 - 0 - 0 - 0 - 0 - Melaka Private 3 - 2 - 2 - 2 - 2 - 3 - Melaka Total 3 3.65 2 2.44 2 2.44 2 2.44 2 2.44 3 3.65 Johor Public 2 - 1 - 2 - 2 - 1 - 2 - Johor Private 1 - 0 - 1 - 1 - 0 - 1 - Johor Total 3 0.90 1 0.30 3 0.90 3 0.90 1 0.30 3 0.90 Pahang Public 0 - 0 - 0 - 0 - 0 - 0 - Pahang Private 0 - 0 - 0 - 0 - 0 - 0 - Pahang Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Terengganu Public 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Private 0 - 0 - 0 - 0 - 0 - 0 - Terengganu Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kelantan Public 2 - 1 - 1 - 1 - 1 - 1 - Kelantan Private 0 - 0 - 0 - 0 - 0 - 0 - Kelantan Total 2 1.30 1 0.65 1 0.65 1 0.65 1 0.65 1 0.65 Sabah & WP Public 0 - 0 - 0 - 1 - 0 - 0 - Labuan Sabah & WP Private 1 - 1 - 1 - 0 - 0 - 0 - Labuan Sabah & WP Total 1 0.30 1 0.30 1 0.30 1 0.30 0 0.00 0 0.00 Labuan Sarawak Public 3 - 1 - 2 - 3 - 1 - 2 - Sarawak Private 0 - 0 - 0 - 0 - 0 - 0 -

Sarawak Total 3 1.21 1 0.40 2 0.81 3 1.21 1 0.40 2 0.81 HOSPITALS ONCOLOGY SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available; PMP – per million population 5 75 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 5.9 Number and Density of Hospital with Physics Equipment and Treatment Planning System Devices in Malaysia by State and Sector in 2010 and 2011 2010 2011 Hospitals with Hospitals with Hospitals with Physics Hospitals with Physics Treatment Planning Treatment Planning State Sector Equipment Equipment System Devices System Devices Number PMP Number PMP Number PMP Number PMP Malaysia Public 6 - 6 - 7 - 7 - Malaysia Private 16 - 16 - 15 - 15 - Malaysia Total 22 0.78 22 0.78 22 0.78 22 0.78 Perlis Public 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 0 - 0 - 0 - Kedah Private 0 - 0 - 0 - 0 - Kedah Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah & Perlis Public 0 - 0 - 0 - 0 - Kedah & Perlis Private 0 - 0 - 0 - 0 - Kedah & Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Pulau Pinang Public 0 - 0 - 0 - 0 - Pulau Pinang Private 3 - 3 - 3 - 3 - Pulau Pinang Total 3 1.92 3 1.92 3 1.92 3 1.92 Perak Public 0 - 0 - 0 - 0 - Perak Private 1 - 1 - 1 - 1 - Perak Total 1 0.43 1 0.43 1 0.43 1 0.43 Selangor & WP Public 0 - 0 - 0 - 0 - Putrajaya Selangor & WP Private 4 - 4 - 4 - 4 - Putrajaya Selangor & WP Total 4 0.72 4 0.72 4 0.72 4 0.72 Putrajaya WP Kuala Lumpur Public 3 - 3 - 3 - 3 - WP Kuala Lumpur Private 3 - 3 - 3 - 3 - WP Kuala Lumpur Total 6 3.58 6 3.58 6 3.58 6 3.58 Selangor & WP Public 3 - 3 - 3 - 3 - Putrajaya & WPKL Selangor & WP Private 7 - 7 - 7 - 7 - Putrajaya & WPKL Selangor & WP Total 10 1.39 10 1.39 10 1.39 10 1.39 Putrajaya & WPKL Negeri Sembilan Public 0 - 0 - 0 - 0 - Negeri Sembilan Private 1 - 1 - 1 - 1 - Negeri Sembilan Total 1 0.98 1 0.98 1 0.98 1 0.98 Melaka Public 0 - 0 - 0 - 0 - Melaka Private 2 - 2 - 2 - 2 - Melaka Total 2 2.44 2 2.44 2 2.44 2 2.44 Johor Public 1 - 1 - 1 - 1 - Johor Private 1 - 1 - 1 - 1 - Johor Total 2 0.60 2 0.60 2 0.60 2 0.60 Pahang Public 0 - 0 - 0 - 0 - Pahang Private 0 - 0 - 0 - 0 - Pahang Total 0 0.00 0 0.00 0 0.00 0 0.00 Terengganu Public 0 - 0 - 0 - 0 - Terengganu Private 0 - 0 - 0 - 0 - Terengganu Total 0 0.00 0 0.00 0 0.00 0 0.00 Kelantan Public 1 - 1 - 1 - 1 - Kelantan Private 0 - 0 - 0 - 0 - Kelantan Total 1 0.65 1 0.65 1 0.65 1 0.65 Sabah & WP Labuan Public 0 - 0 - 1 - 1 - Sabah & WP Labuan Private 1 - 1 - 0 - 0 - Sabah & WP Labuan Total 1 0.30 1 0.30 1 0.30 1 0.30 Sarawak Public 1 - 1 - 1 - 1 - Sarawak Private 0 - 0 - 0 - 0 - Sarawak Total 1 0.40 1 0.40 1 0.40 1 0.40 Abbreviation: na – not applicable; - – not available; PMP – per million population 76 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

CHAPTER 6 | PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS

Toh CL1, Sivasampu S2*, Fatihah M2*, Lim CH3, Azizul A4, Rahima D5, Chee KY6, Khairuddin AW7, Aizah SNA6, Ong LY8

1. Hospital Selayang 2. National Clinical Research Centre, Ministry of Health, 3. Hospital Ampang 4. Hospital Putrajaya 5.Hospital Kajang 6. Hospital Kuala Lumpur, 7. Hospital Melaka. 8. Hospital Bahagia Ulu Kinta, Perak. *Corresponding author.

Summary: This chapter presents information relating to psychiatric services in Malaysian hospitals in 2011. Services provided outside the hospital setting were not represented. Psychiatric services were offered by 49 public and 45 private hospitals and with a total of 94 hospitals for the whole country. In 2011, the number of psychiatrists practising was 234 with the majority (186) in the public sector and the remaining 48 in the private sector. Within the psychiatric services, the availability of allied health professionals such as paramedics with post basic training, clinical psychologists, counsellors and medical social workers was generally low and confined to a few centres. Despite the acknowledged limitations of the survey, the impression was that there was a need for further resources to improve the services in Malaysia.

The psychiatric services in Malaysia were provided mainly by hospitals within the Ministry of Health, the Ministry of Higher Education (University Hospitals), the Ministry of Defence (Armed Forces Hospitals), the private sector, and several non-governmental organisations (NGOs). Despite an expansion in the services, the gap between demand and the service provided remains wide. This is contrary to the WHO’s vision of narrowing the gap between psychiatric services and demands of the users.1 This gap becomes very significant when viewed against the prevalence of substantial psychiatric morbidity in the country, as shown by the recent National Health and Morbidity Survey (NHMS) 2011: Generalized Anxiety Disorder (prevalence 1.7%), lifetime depression (2.4%), suicidal ideation (1.7%), suicidal plan (0.9%) and suicidal attempt (0.5%). 2

Psychiatric services available in Malaysian hospitals are:

● Outpatient care at the specialist clinics ● Inpatient care in the wards ● Community and rehabilitation psychiatric services (e.g. supported employment) ● Subspeciality services in various disciplines (e.g. child and adolescent psychiatry, forensic psychiatry, psychogeriatric services, neuropsychiatric service, etc) ● Specific psychological interventions (e.g. cognitive behavioural therapy) ● Physical interventions (e.g. electroconvulsive therapy) ● Specific programmes for substance related disorders ● Psychiatric collaborative networking with other clinical disciplines or mental health providers.

The present survey is based on data collected from all public hospitals and private hospitals providing psychiatric services in the country. Ninety of the 93 eligible hospitals (96.8%) responded to the survey.

Facilities

In 2011, there were 49 public and 45 private hospitals providing psychiatric services, a density of 1 hospital to 333,333 population (Table 6.1). A total of 5,367 dedicated in-patient psychiatric beds were available of which, more than 99% were in the public hospitals (Table 6.2). This gave a bed density of 1.85 beds per 10,000 population. The majority (4,240) of the psychiatric beds were located in four mental institutions in the country. The remaining 1,127 beds (21.0%) were located in specialist hospitals that provided acute and short stay psychiatric care. Of these, 1,127 acute beds, 45 (4.1%) were located in private hospitals. Selangor and Putrajaya had the lowest ratio of beds to population (0.11 beds per 10,000).

Services

In 2011, there were 21,529 psychiatric admissions of which 18% were to mental institutions (Table 6.3). This does not mean that there were all unique admissions. Some patients were admitted first to acute curative hospitals and subsequently transferred to the mental institutions and usually because they required a prolonged hospital stay. The mean bed occupancy rate (BOR) was 63% and average length of stay (ALOS) was 35 days for the hospitals with psychiatry services. The highest BOR was 104% and in Wilayah Persekutuan Kuala Lumpur (WPKL). The lowest was HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC 51% and in Perak. Sarawak was found to have the longest ALOS of 72 days while Perlis had the shortest at 9 days (Table 6.3). 6 77 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

A total of 460,824 outpatient follow-up visits were reported in 2011, giving a rate of 159.1 visits per 10,000 population (Table 6.4). The highest rate of outpatient visits was for WPKL with 402.0 visits per 10,000 and lowest in Sabah with 73.5 visits per 10,000. The total number of new outpatient cases was 39,730 in 2011 with a rate of 13.7 cases per 10,000 population. The highest rate of new outpatients was for WPKL at 32.7 cases per 10,000 population and the lowest was for Sabah and WP Labuan with a rate of 5.1 cases per 10,000 population (Table 6.4).

There were a total of 24,394 referrals to psychiatry from wards and emergency departments within the 66 hospitals surveyed; a rate of 8.42 referrals per 10,000 population (Table 6.4). Hospitals in Kelantan reported the highest rate of referrals with a rate of 20.8 referrals per 10,000 population. The lowest rate was for Sabah and WP Labuan with the rate of 2.45 per 10,000 population.

In line with the National Mental Health Policy and the implementation of the Mental Health Act 2001 and Mental Health Regulations 2010 in June 15th 2010, the country is currently in the process of developing a more comprehensive community and rehabilitative services. 4, 5, 6 There were 46 hospitals providing community services, an increase four hospitals from 2010 (Table 6.5). Perak had the highest rate of home/workplace visits with 84.5 visits per 10,000 population. Sabah and WP Labuan recorded the lowest rate with 5.4 visits per 10,000 population.

A total of 37 hospitals provided psychiatric rehabilitation services and there were 178,535 visits recorded, giving a rate of 61.6 visits per 10,000 population. WPKL recorded the highest rate of psychiatric rehabilitation visits at 237.9 per 10,000 population and Kelantan had the lowest rate at 4.0 visits per 10,000 population (Table 6.5).

The psychiatric services provided care to a wide range of patients, from children to the elderly. Data from 84 hospitals in 2011 showed that the number of patient visits for those of ages below 18 years was 36.9 per 10,000 population. For those above 60 years it was 229.1 per 10,000 populations (Table 6.6). However, the density for those below 18 years of age is an underestimate because the denominator used for the calculation was the population aged below 19 years (Table A3.4).

For 2011, 25 hospitals provided Methadone replacement therapy service to 7,220 patients, giving a density of 2.49 methadone patients per 10,000 population. Data from Sabah and Sarawak were not available (Table 6.7).

There were 51 hospitals that provided electroconvulsive therapy (ECT) in 2011, both for in-patients (2.23 procedures per 10,000 population) as well as out-patients (0.15 procedures per 10,000 population) (Table 6.8).

Human Workforce

In 2011, there were 234 psychiatrists in the country, of whom 186 practised in the public sector and 48 in the private sector, giving an overall density of 0.08 psychiatrists per 10,000 population (Table 6.9). The distribution of psychiatrists varied considerably across states. The majority were concentrated in WPKL with a density of 0.35 psychiatrists per 10,000 population. Sabah and WP Labuan had the lowest density at 0.02 psychiatrists per 10,000 population. These densities were far below the World Health Organisation (WHO) recommendation of 1 psychiatrist per 10,000 population. 7

The numbers of clinical psychologists, counsellors and medical social workers available were very low in 2011, a density of 0.01 professionals per 10,000 population for all 3 categories. Furthermore, in 2010 their services were only available in certain states. There was a decline in the number of permanent/resident clinical psychologists from 25 in 2010 to 16 in 2011 (Table 6.10, Table 6.11, and Table 6.12).

The number of nurses working in psychiatric services and in hospitals was 1,185 in 2011 giving a density of 0.41 nurses per 10,000 population. There was an absolute increase of 1,159 nurses when compared to 2010. Although they made up the largest proportion of the workforce in any psychiatric facility in the country, their numbers are still low when compared to the WHO recommendation8 of 0.97 nurses per 10,000 population for countries in the upper middle income group. The number of nurses with post basic training was 270 in 2011 (0.10 nurses per 10,000 population) (Table 6.13). There was a reduction in the number of assistant medical officers (AMO) from 739 in 2010 to 700 in 2011 (Table 6.14). The ratio of AMOs to population was 0.24 AMOs per 10,000 population in 2011.

Limitations 1. No data was obtained for the psychiatric services provided by Armed Forces Hospitals. 2. This report focused only on hospital-based psychiatric services. Mental health services are also provided at the Primary Health Care level and by individual clinic-based private practitioners, but these were not captured in this survey 3. Services delivered outside the hospital setting (e.g. home psychiatric rehabilitation for the child and adolescent service) were not represented in this survey. 4. A number of private hospitals did not report having psychiatric services although they did report having a resident or visiting psychiatrist. Therefore the provision of psychiatric services by private hospitals may have been underestimated. 5. Several items in the questionnaire were misinterpreted by some respondents. The respondents were contacted and the affected data verified and corrected.

78 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

References

1. World Health Organization. Mental Health Action Programme 2008. mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings. Geneva; 2010 2. Institute for Public Health (IPH). The National Health Morbidity Survey 2011. Prevalence of Psychiatric Morbidity. Ministry of Health, Malaysia; 2011. 3. Clinical research Centre. National Healthcare Establishment and Workforce Survey (Hospital) 2010. Kuala Lumpur 2012 4. Malaysia Mental Health Act, 2001. 5. Malaysia Mental Health Regulations, 2010. 6. Malaysia National Mental Health Policy, 1998, Ministry of Health, Malaysia. 7. Mental Health Workforce Advisory Committee Mental Health Workforce: supply of psychiatrist. Australia; February, 2008. 1-5p. 8. World Health Organization. Mental Health Atlas 2011: mental health care delivery Geneva; 2011.48-59p. PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC 6

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Table 6.1 Number and Density of Hospitals Providing Psychiatry Services in Malaysia by State and Sector, 2010-2011 2010 2011 State Sector Per 10,000 Per 10,000 NO. NO. population population Malaysia Public 46 - 49 - Malaysia Private 38 - 45 - Malaysia Total 84 0.03 94 0.03 Perlis Public 1 - 1 - Perlis Private na na na na Perlis Total 1 0.04 1 0.04 Kedah Public 2 - 3 - Kedah Private 2 - 2 - Kedah Total 4 0.02 5 0.03 Kedah & Perlis Public 3 - 4 - Kedah & Perlis Private 2 - 2 - Kedah & Perlis Total 5 0.02 6 0.03 Pulau Pinang Public 2 - 2 - Pulau Pinang Private 4 - 5 - Pulau Pinang Total 6 0.04 7 0.04 Perak Public 6 - 6 - Perak Private 3 - 5 - Perak Total 9 0.04 11 0.05 Selangor & WP Putrajaya Public 7 - 7 - Selangor & WP Putrajaya Private 9 - 9 - Selangor & WP Putrajaya Total 16 0.03 16 0.03 WP Kuala Lumpur Public 3 - 3 - WP Kuala Lumpur Private 11 - 9 - WP Kuala Lumpur Total 14 0.08 12 0.07 Selangor & WP Putrajaya & WPKL Public 10 - 10 - Selangor & WP Putrajaya & WPKL Private 20 - 18 - Selangor & WP Putrajaya & WPKL Total 30 0.04 28 0.04 Negeri Sembilan Public 2 - 2 - Negeri Sembilan Private 2 - 2 - Negeri Sembilan Total 4 0.04 4 0.04 Melaka Public 1 - 1 - Melaka Private 2 - 3 - Melaka Total 3 0.04 4 0.05 Johor Public 7 - 7 - Johor Private 0 - 2 - Johor Total 7 0.02 9 0.03 Pahang Public 3 - 3 - Pahang Private 0 - 0 - Pahang Total 3 0.02 3 0.02 Terengganu Public 2 - 3 - Terengganu Private 0 - 0 - Terengganu Total 2 0.02 3 0.03 Kelantan Public 3 - 4 - Kelantan Private 1 - 1 - Kelantan Total 4 0.03 5 0.03 Sabah & WP Labuan Public 3 - 3 - Sabah & WP Labuan Private 1 - 1 - Sabah & WP Labuan Total 4 0.01 4 0.01 Sarawak Public 4 - 4 - Sarawak Private 3 - 6 - Sarawak Total 7 0.03 10 0.04 Abbreviation: na – not applicable; - – not available

80 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.2 Number and Density of Inpatient Dedicated Beds and Functioning Inpatient Dedicated Beds in Malaysia by State and Sector, 2010-2011 2010 2011 Inpatient Inpatient Functioning Inpatient State Sector Dedicated Beds Dedicated Beds Dedicated Beds Per 10,000 Per 10,000 No. No. No. Per 10,000 population population population Malaysia Public 5,230 - 5,322 - 5,096 - Malaysia Private 46 - 45 - 45 - Malaysia Total 5,276 1.86 5,367 1.85 5,141 1.77 Perlis Public 16 - 16 - 16 - Perlis Private na na na na na na Perlis Total 16 0.69 16 0.67 16 0.67 Kedah Public 46 - 46 - 46 - Kedah Private 0 - 0 - 0 - Kedah Total 46 0.24 46 0.23 46 0.23 Kedah & Perlis Public 62 - 62 - 62 - Kedah & Perlis Private 0 - 0 - 0 - Kedah & Perlis Total 62 0.28 62 0.28 62 0.28 Pulau Pinang Public 72 - 104 - 74 - Pulau Pinang Private 34 - 28 - 28 - Pulau Pinang Total 106 0.68 132 0.83 102 0.64 Perak Public 2,306 - 2,328 - 2,303 - Perak Private 12 - 15 - 15 - Perak Total 2,318 9.85 2,343 9.77 2,318 9.67 Selangor & WP Putrajaya Public 34 - 60 - 46 - Selangor & WP Putrajaya Private 0 - 0 - 0 - Selangor & WP Putrajaya Total 34 0.06 60 0.11 46 0.08 WP Kuala Lumpur Public 170 - 174 - 174 - WP Kuala Lumpur Private 0 - 2 - 2 - WP Kuala Lumpur Total 170 1.02 176 1.04 176 1.04 Selangor & WP Putrajaya & WPKL Public 204 - 234 - 220 - Selangor & WP Putrajaya & WPKL Private 0 - 2 - 2 - Selangor & WP Putrajaya & WPKL Total 204 0.28 236 0.32 222 0.30 Negeri Sembilan Public 48 - 52 - 52 - Negeri Sembilan Private 0 - 0 - 0 - Negeri Sembilan Total 48 0.47 52 0.50 52 0.50 Melaka Public 60 - 40 - 40 - Melaka Private 0 - 0 - 0 - Melaka Total 60 0.73 40 0.48 40 0.48 Johor Public 1,464 - 1,472 - 1,472 - Johor Private 0 - 0 - 0 - Johor Total 1,464 4.37 1,472 4.33 1,472 4.33 Pahang Public 94 - 110 - 110 - Pahang Private na - 0 - 0 - Pahang Total 94 0.63 110 0.72 110 0.72 Terengganu Public 30 - 30 - 30 - Terengganu Private na - 0 - 0 - Terengganu Total 30 0.29 30 0.28 30 0.28 Kelantan Public 169 - 169 - 169 - Kelantan Private 0 - 0 - 0 - Kelantan Total 169 1.10 169 1.05 169 1.05 Sabah & WP Labuan Public 330 - 330 - 270 - Sabah & WP Labuan Private 0 - 0 - 0 - Sabah & WP Labuan Total 330 1.00 330 0.97 270 0.79 Sarawak Public 391 - 391 - 294 - Sarawak Private 0 - 0 - 0 -

Sarawak Total 391 1.58 391 1.55 294 1.17 HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC

Abbreviation: na – not applicable; - – not available 6 81 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.3 Number and Density of Inpatient Psychiatry Admission, Mean Bed Occupancy Rate (BOR) and Mean Average Length of Stay (ALOS) in Malaysia by State and Sector, 2011 Inpatient Psychiatry Admission State Sector Per 10,000 Mean BOR Mean ALOS No. population Malaysia Public 20,913 - 63 35 Malaysia Private 616 - na na Malaysia Total 21,529 7.43 63 35 Perlis Public 348 - 55 9 Perlis Private 0 - na na Perlis Total 348 14.65 55 9 Kedah Public 571 - 92 35 Kedah Private 0 - na na Kedah Total 571 2.89 92 35 Kedah & Perlis Public 919 - 80 26 Kedah & Perlis Private 0 - na na Kedah & Perlis Total 919 4.16 80 26 Pulau Pinang Public 1,116 - 73 16 Pulau Pinang Private 370 - na na Pulau Pinang Total 1,486 9.32 73 16 Perak Public 3,573 - 51 57 Perak Private 55 - na na Perak Total 3,628 15.13 51 57 Selangor & WP Putrajaya Public 1,209 - 59 11 Selangor & WP Putrajaya Private 79 - na na Selangor & WP Putrajaya Total 1,288 2.28 59 11 WP Kuala Lumpur Public 3,643 - 104 18 WP Kuala Lumpur Private 38 - na na WP Kuala Lumpur Total 3,681 21.72 104 18 Selangor & WP Putrajaya & WPKL Public 4,852 - 81 14 Selangor & WP Putrajaya & WPKL Private 117 - na na Selangor & WP Putrajaya & WPKL Total 4,969 6.76 81 14 Negeri Sembilan Public 884 - 57 14 Negeri Sembilan Private 5 - na na Negeri Sembilan Total 889 8.52 57 14 Melaka Public 694 - 57 12 Melaka Private 12 - na na Melaka Total 706 8.48 57 12 Johor Public 2,807 - 53 45 Johor Private 4 - na na Johor Total 2,811 8.26 53 45 Pahang Public 1,389 - 62 19 Pahang Private 0 - na na Pahang Total 1,389 9.11 62 19 Terengganu Public 724 - 75 12 Terengganu Private 0 - na na Terengganu Total 724 6.74 75 12 Kelantan Public 1,765 - 64 23 Kelantan Private 0 - na na Kelantan Total 1,765 10.93 64 23 Sabah & WP Labuan Public 1,108 - 56 48 Sabah & WP Labuan Private 6 - na na Sabah & WP Labuan Total 1,114 3.27 56 48 Sarawak Public 1,082 - 56 72 Sarawak Private 47 - na na Sarawak Total 1,129 4.49 56 72 Abbreviation: na – not applicable; - – not available 82 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.4 Number and Density of Follow up Outpatient Visits, New Cases, Referrals to Psychiatry from Wards or Emergency Department in Malaysia by State and Sector, 2010-2011 2010 2011 Outpatient Outpatient Referrals to Psychiatry Outpatient Follow Outpatient Follow State Sector Psychiatry New Psychiatry New from Wards or Emergency Up Patient Visits Up Patient Visits Cases Cases Department

Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. of No. of Per 10,000 No. No. No. No. Population Population Population Population Hospital Referrals Population Malaysia Public 392,244 - 28,240 - 411,329 - 32,884 - 45 23,510 - Malaysia Private 46,390 - 5,912 - 49,495 - 6,846 - 21 884 - Malaysia Total 438,634 154.81 34,152 12.05 460,824 159.1 39,730 13.72 66 24,394 8.42 Perlis Public 8,993 - 291 - 7,898 - 345 - 1 98 - Perlis Private na na na na na na na na na na na Perlis Total 8,993 388.47 291 12.57 7,898 332.55 345 14.53 1 98 4.13 Kedah Public 26,147 - 1,421 - 27,466 - 1,840 - 3 1,190 - Kedah Private 6,098 - 581 - 5,099 - 407 - 1 124 - Kedah Total 32,245 165.55 2,002 10.28 32,565 165.04 2,247 11.39 4 1,314 6.66 Kedah & Perlis Public 35,140 - 1,712 - 35,364 - 2,185 - 4 1,288 - Kedah & Perlis Private 6,098 - 581 - 5,099 - 407 - 1 124 - Kedah & Perlis Total 41,238 189.23 2,293 10.52 40,463 183.04 2,592 11.73 5 1,412 6.39 Pulau Pinang Public 22,235 - 1,640 - 19,952 - 1,527 - 2 629 - Pulau Pinang Private 12,086 - 1,309 - 15,260 - 1,515 - 4 145 - Pulau Pinang Total 34,321 219.81 2,949 18.89 35,212 220.96 3,042 19.09 6 774 4.86 Perak Public 51,462 - 4,289 - 58,234 - 3,739 - 5 1,714 - Perak Private 2,006 - 247 - 4,406 - 429 - 4 159 - Perak Total 53,468 227.26 4,536 19.28 62,640 261.26 4,168 17.38 9 1,873 7.81 Selangor & WP Putrajaya Public 33,282 - 3,397 - 39,903 - 5,801 - 7 6,373 - Selangor & WP Putrajaya Private 7,848 - 821 - 7,730 - 1,582 - 2 27 - Selangor & WP Putrajaya Total 41,130 74.32 4,218 7.62 47,633 84.25 7,383 13.06 9 6,400 11.32 WP Kuala Lumpur Public 47,271 - 3,436 - 60,814 - 4,161 - 3 2,138 - WP Kuala Lumpur Private 11,167 - 2,090 - 7,308 - 1,383 - 4 241 - WP Kuala Lumpur Total 58,438 348.97 5,526 33 68,122 402.02 5,544 32.72 7 2,379 14.04 Selangor & WP Putrajaya Public 80,553 - 6,833 - 100,717 - 9,962 - 10 8,511 - & WPKL Selangor & WP Putrajaya Private 19,015 - 2,911 - 15,038 - 2,965 - 6 268 - & WPKL Selangor & WP Putrajaya Total 99,568 138.11 9,744 13.52 115,755 157.53 12,927 17.59 16 8,779 11.95 & WPKL Negeri Sembilan Public 15,160 - 1,571 - 18,831 - 1,909 - 2 518 - Negeri Sembilan Private 140 - 80 - 214 - 79 - 1 17 - Negeri Sembilan Total 15,300 149.84 1,651 16.17 19,045 182.62 1,988 19.06 3 535 5.13 Melaka Public 19,381 - 1,479 - 17,749 - 1,263 - 1 1,089 - Melaka Private 4,542 - 414 - 6,094 - 820 - 1 64 - Melaka Total 23,923 291.35 1,893 23.05 23,843 286.23 2,083 25.01 2 1,153 13.84 Johor Public 60,139 - 4,016 - 54,369 - 5,373 - 7 3,367 - Johor Private 0 - 0 - 412 - 192 - 0 0 - Johor Total 60,139 179.61 4,016 11.99 54,781 161.04 5,565 16.36 7 3,367 9.9 Pahang Public 16,437 - 1,134 - 17,993 - 1,250 - 3 797 - Pahang Private na - na - 0 - 0 - 0 0 - Pahang Total 16,437 109.52 1,134 7.56 17,993 118 1,250 8.2 3 797 5.23 Terengganu Public 9,835 - 841 - 9,908 - 817 - 2 379 - Terengganu Private na - na - 0 - 0 - 0 0 - Terengganu Total 9,835 94.93 841 8.12 9,908 92.25 817 7.61 2 379 3.53 Kelantan Public 28,392 - 1,521 - 20,824 - 1,717 - 4 3,360 - Kelantan Private 30 - 0 - 31 - 2 - 0 0 - Kelantan Total 28,422 184.61 1,521 9.88 20,855 129.12 1,719 10.64 4 3,360 20.8 Sabah & WP Labuan Public 22,200 - 1,352 - 24,272 - 1,571 - 2 790 - Sabah & WP Labuan Private 475 - 123 - 753 - 157 - 1 45 - Sabah & WP Labuan Total 22,675 68.85 1,475 4.48 25,025 73.47 1,728 5.07 3 835 2.45 Sarawak Public 31,310 - 1,852 - 33,116 - 1,571 - 3 1,068 - Sarawak Private 1,998 - 247 - 2,188 - 280 - 3 62 -

Sarawak Total 33,308 134.79 2,099 8.49 35,304 140.31 1,851 7.36 6 1,130 4.49 HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC 6 Abbreviation: na – not applicable; - – not available 83 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.5 Number and Density of Public Hospitals with Community Psychiatry and Psychiatric Rehabilitation Services in Malaysia by State, 2011 Community Psychiatry Psychiatric Rehabilitation State No. of No of Home / Per 10,000 No. of No. of patient Per 10,000 Hospitals Workplace Visits population Hospitals Visits population Malaysia 46 91,264 31.51 37 178,535 61.64 Perlis 1 1,393 58.65 1 3,708 156.13 Kedah 3 1,965 9.96 2 4,700 23.82 Kedah & Perlis 4 3,358 15.19 3 8,408 38.03 Pulau Pinang 2 6,120 38.40 1 5,689 35.70 Perak 6 20,258 84.49 5 9,537 39.78 Selangor & WP Putrajaya 5 5,394 9.54 4 4,631 8.19 WP Kuala Lumpur 3 5,450 32.16 3 40,305 237.86 Selangor & WP Putrajaya & WPKL 8 10,844 14.76 7 44,936 61.15 Negeri Sembilan 2 787 7.55 2 3,746 35.92 Melaka 1 4,447 53.39 1 3,501 42.03 Johor 7 22,586 66.39 5 58,618 172.31 Pahang 3 2,570 16.85 3 7,252 47.56 Terengganu 3 3,255 30.31 3 1,801 16.77 Kelantan 4 5,469 33.86 2 645 3.99 Sabah & WP Labuan 2 1,828 5.37 2 9,471 27.81 Sarawak 4 9,742 38.72 3 24,931 99.08

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Table 6.6 Number of Hospitals and Hospital Visits with Patients below 18 Years Old and above 60 Years Old in Malaysia by State and Sector, 2011 Patients Below Patients Above 18 Years Old 60 Years Old No. of No. of State Sector No. of No. of Hospitals Per 10,000 Hospitals Per 10,000 Patients Patients population(a) population(b) Visits Visits Malaysia Public 49 38,009 - 47 50,871 - Malaysia Private 35 1,074 - 37 2,694 - Malaysia Total 84 39,083 36.87 84 53,565 229.08 Perlis Public 1 329 - 1 847 - Perlis Private na na na na na na Perlis Total 1 329 35.57 1 847 327.03 Kedah Public 3 1,180 - 3 2,871 - Kedah Private 2 131 - 1 394 - Kedah Total 5 1,311 17.05 4 3,265 172.11 Kedah & Perlis Public 4 1,509 - 4 3,718 - Kedah & Perlis Private 2 131 - 1 394 - Kedah & Perlis Total 6 1,640 19.04 5 4,112 131.29 Pulau Pinang Public 2 4,188 - 2 4,464 - Pulau Pinang Private 5 451 - 5 1,167 - Pulau Pinang Total 7 4,639 93.70 7 5,631 339.42 Perak Public 6 2,903 - 6 9,454 - Perak Private 4 29 - 5 86 - Perak Total 10 2,932 33.45 11 9,540 329.99 Selangor & WP Putrajaya Public 7 3,503 - 6 3,728 - Selangor & WP Putrajaya Private 6 102 - 7 158 - Selangor & WP Putrajaya Total 13 3,605 19.59 13 3,886 111.38 WP Kuala Lumpur Public 3 8,523 - 2 4,416 - WP Kuala Lumpur Private 7 242 - 7 232 - WP Kuala Lumpur Total 10 8,765 173.32 9 4,648 352.12 Selangor & WP Putrajaya & WPKL Public 10 12,026 - 8 8,144 - Selangor & WP Putrajaya & WPKL Private 13 344 - 14 390 - Selangor & WP Putrajaya & WPKL Total 23 12,370 52.74 22 8,534 177.46 Negeri Sembilan Public 2 1,146 - 2 2,691 - Negeri Sembilan Private 2 11 - 2 28 - Negeri Sembilan Total 4 1,157 30.30 4 2,719 281.76 Melaka Public 1 282 - 1 124 - Melaka Private 1 12 - 1 12 - Melaka Total 2 294 9.60 2 136 16.61 Johor Public 7 7,368 - 7 9,513 - Johor Private 2 21 - 2 63 - Johor Total 9 7,389 61.16 9 9,576 333.31 Pahang Public 3 1,806 - 3 1,702 - Pahang Private 0 0 - 0 0 - Pahang Total 3 1,806 29.59 3 1,702 133.39 Terengganu Public 3 889 - 3 189 - Terengganu Private 0 0 - 0 0 - Terengganu Total 3 889 18.80 3 189 23.36 Kelantan Public 4 1,944 - 4 1,822 - Kelantan Private 1 3 - 1 3 - Kelantan Total 5 1,947 26.43 5 1,825 129.62 Sabah & WP Labuan Public 3 2,227 - 3 2,625 - Sabah & WP Labuan Private 1 5 - 1 113 - Sabah & WP Labuan Total 4 2,232 16.60 4 2,738 177.68 Sarawak Public 4 1,721 - 4 6,425 - Sarawak Private 4 67 - 5 438 - Sarawak Total 8 1,788 18.62 9 6,863 315.40

(a) Population Below 20 Years old (0-19 years old) (b) Population Above 60 Years old (>60 years old) PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC Abbreviation: na – not applicable 6

85 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.7 Number of Public Hospitals Providing Methadone Replacement Therapy (MRT) Services and Total MRT Patients in Malaysia by State, 2010-2011 2010 2011 Hospitals Hospitals Providing Total MRT Patients Providing Total MRT Patients State MRT Services MRT Services Per 10,000 Per 10,000 No. No. No. No. population population Malaysia 22 6,361 2.24 25 7,220 2.49 Perlis 1 123 5.31 1 113 4.76 Kedah 1 276 1.42 1 290 1.47 Kedah & Perlis 2 399 1.83 2 403 1.82 Pulau Pinang 2 993 6.36 2 1,089 6.83 Perak 4 1,253 5.33 5 1,533 6.39 Selangor & WP Putrajaya 2 243 0.44 2 319 0.56 WP Kuala Lumpur 2 1,628 9.72 2 1,481 8.74 Selangor & WP Putrajaya & WPKL 4 1,871 2.60 4 1,800 2.45 Negeri Sembilan 2 297 2.91 2 291 2.79 Melaka 1 228 2.78 1 246 2.95 Johor 1 239 0.71 1 498 1.46 Pahang 2 561 3.74 2 583 3.82 Terengganu 2 445 4.30 3 675 6.28 Kelantan 2 75 0.49 3 102 0.63 Sabah & WP Labuan 0 0 0.00 0 0 0.00 Sarawak 0 0 0.00 0 0 0.00

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Table 6.8 Number and Density of Electroconvulsive Therapy (ECT) Machines and Procedures in Malaysian Hospitals by State and Sector, 2010-2011 2010 2011 Outpatient ECT Inpatient ECT Outpatient ECT Inpatient ECT ECT Machines ECT Machines State Sector Procedures Procedures Procedures Procedures Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. PMP No. No. No. PMP No. No. population population population population Malaysia Public 46 - 442 - 6,098 - 44 - 287 - 5,870 - Malaysia Private 6 - 61 - 426 - 7 - 146 - 587 - Malaysia Total 52 1.84 503 0.18 6,524 2.30 51 1.76 433 0.15 6,457 2.23 Perlis Public 0 - 0 - 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 2 - 0 - 211 - 2 - 0 - 186 - Kedah Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah Total 2 1.03 0 0.00 211 1.08 2 1.01 0 0.00 186 0.94 Kedah & Perlis Public 2 - 0 - 211 - 2 - 0 - 186 - Kedah & Perlis Private 0 - 0 - 0 - 0 - 0 - 0 - Kedah & Perlis Total 2 0.92 0 0.00 211 0.97 2 0.90 0 0.00 186 0.84 Pulau Pinang Public 2 - 41 - 38 - 2 - 117 - 142 - Pulau Pinang Private 3 - 24 - 418 - 4 - 35 - 539 - Pulau Pinang Total 5 3.20 65 0.42 456 2.92 6 3.77 152 0.95 681 4.27 Perak Public 7 - 0 - 1,011 - 6 - 0 - 1,269 - Perak Private 1 - 6 - 0 - 1 - 0 - 40 - Perak Total 8 3.40 6 0.03 1,011 4.30 7 2.92 0 0.00 1,309 5.46 Selangor & WP Putrajaya Public 4 - 0 - 192 - 3 - 0 - 355 - Selangor & WP Putrajaya Private 0 - 0 - 0 - 0 - 0 - 0 - Selangor & WP Putrajaya Total 4 0.72 0 0.00 192 0.35 3 0.53 0 0.00 355 0.63 WP Kuala Lumpur Public 8 - 80 - 1,150 - 7 - 21 - 1,065 - WP Kuala Lumpur Private 0 - 0 - 0 - 0 - 0 - 0 - WP Kuala Lumpur Total 8 4.78 80 0.48 1,150 6.87 7 4.13 21 0.12 1,065 6.29 Selangor & WP Putrajaya & WPKL Public 12 - 80 - 1,342 - 10 - 21 - 1,420 - Selangor & WP Putrajaya & WPKL Private 0 - 0 - 0 - 0 - 0 - 0 - Selangor & WP Putrajaya & WPKL Total 12 1.66 80 0.11 1,342 1.86 10 1.36 21 0.03 1,420 1.93 Negeri Sembilan Public 2 - 6 - 51 - 2 - 10 - 212 - Negeri Sembilan Private 0 - 0 - 0 - 0 - 0 - 0 - Negeri Sembilan Total 2 1.96 6 0.06 51 0.50 2 1.92 10 0.10 212 2.03 Melaka Public 1 - 18 - 477 - 1 - 0 - 120 - Melaka Private 1 - 31 - 8 - 2 - 111 - 8 - Melaka Total 2 2.44 49 0.60 485 5.91 3 3.60 111 1.33 128 1.54 Johor Public 5 - 36 - 477 - 7 - 91 - 938 - Johor Private 0 - 0 - 0 - 0 - 0 - 0 - Johor Total 5 1.49 36 0.11 477 1.42 7 2.06 91 0.27 938 2.76 Pahang Public 3 - 0 - 62 - 3 - 0 - 180 - Pahang Private na - na - na - na - na - na - Pahang Total 3 2.00 0 0.00 62 0.41 3 1.97 0 0.00 180 1.18 Terengganu Public 1 - 54 - 0 - 1 - 20 - 33 - Terengganu Private na - na - na - na - na - na - Terengganu Total 1 0.97 54 0.52 0 0.00 1 0.93 20 0.19 33 0.31 Kelantan Public 3 - 0 - 1,058 - 3 - 0 - 259 - Kelantan Private 0 - 0 - 0 - 0 - 0 - 0 - Kelantan Total 3 1.95 0 0.00 1,058 6.87 3 1.86 0 0.00 259 1.60 Sabah & WP Labuan Public 3 - 36 - 411 - 2 - 5 - 458 - Sabah & WP Labuan Private 1 - 0 - 0 - 0 - 0 - 0 - Sabah & WP Labuan Total 4 1.21 36 0.11 411 1.25 2 0.59 5 0.01 458 1.34 Sarawak Public 5 - 171 - 960 - 5 - 23 - 653 - Sarawak Private 0 - 0 - 0 - 0 - 0 - 0 - Sarawak Total 5 2.02 171 0.69 960 3.88 5 1.99 23 0.09 653 2.60 PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC

Abbreviation: na – not applicable; PMP – per million population 6

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Table 6.9 Number and Density of Psychiatrists, in Malaysian Hospitals by State and Sector, 2010-2011 2010 2011 Psychiatrists Psychiatrists State Sector Per 10,000 Per 10,000 No. No. population population Malaysia Public 179 - 186 - Malaysia Private 49 - 48 - Malaysia Total 229 0.08 234 0.08 Perlis Public 2 - 2 - Perlis Private na na na na Perlis Total 2 0.09 2 0.08 Kedah Public 7 - 6 - Kedah Private 2 - 2 - Kedah Total 9 0.05 8 0.04 Kedah & Perlis Public 9 - 8 - Kedah & Perlis Private 2 - 2 - Kedah & Perlis Total 11 0.05 10 0.05 Pulau Pinang Public 10 - 8 - Pulau Pinang Private 6 - 6 - Pulau Pinang Total 16 0.10 14 0.09 Perak Public 17 - 18 - Perak Private 3 - 3 - Perak Total 20 0.09 21 0.09 Selangor & WP Putrajaya Public 27 - 26 - Selangor & WP Putrajaya Private 12 - 15 - Selangor & WP Putrajaya Total 39 0.07 41 0.07 WP Kuala Lumpur Public 42 - 47 - WP Kuala Lumpur Private 18 - 12 - WP Kuala Lumpur Total 61 0.36 59 0.35 Selangor & WP Putrajaya & WPKL Public 69 - 73 - Selangor & WP Putrajaya & WPKL Private 31 - 27 - Selangor & WP Putrajaya & WPKL Total 100 0.14 100 0.14 Negeri Sembilan Public 6 - 6 - Negeri Sembilan Private 2 - 2 - Negeri Sembilan Total 8 0.08 8 0.08 Melaka Public 4 - 3 - Melaka Private 3 - 3 - Melaka Total 7 0.09 6 0.07 Johor Public 19 - 19 - Johor Private 0 - 2 - Johor Total 19 0.06 21 0.06 Pahang Public 11 - 11 - Pahang Private na - 0 - Pahang Total 11 0.07 11 0.07 Terengganu Public 4 - 6 - Terengganu Private na - 0 - Terengganu Total 4 0.04 6 0.06 Kelantan Public 16 - 17 - Kelantan Private 0 - 0 - Kelantan Total 16 0.10 17 0.11 Sabah & WP Labuan Public 6 - 7 - Sabah & WP Labuan Private 1 - 1 - Sabah & WP Labuan Total 7 0.02 8 0.02 Sarawak Public 8 - 10 - Sarawak Private 2 - 2 - Sarawak Total 10 0.04 12 0.05 Abbreviation: na – not applicable; - – not available

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Table 6.10 Number and Density of Clinical Psychologists in Malaysian Hospitals by State and Sector, 2010-2011 2010 2011 Clinical Clinical Clinical Clinical Psychologists Psychologists Psychologists Psychologists State Sector Permanent / Permanent / Visiting Visiting Resident Resident Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population population Malaysia Public 10 - 0 - 6 - 9 - Malaysia Private 15 - 16 - 10 - 17 - Malaysia Total 25 0.01 16 0.01 16 0.01 26 0.01 Perlis Public 0 - 0 - 0 - 0 - Perlis Private na na na na na na na na Perlis Total 0 0.00 0 0.00 0 0.00 0 0.00 Kedah Public 0 - 0 - 0 - 0 - Kedah Private 1 - 0 - 1 - 0 - Kedah Total 1 0.01 0 0.00 1 0.01 0 0.00 Kedah & Perlis Public 0 - 0 - 0 - 0 - Kedah & Perlis Private 1 - 0 - 1 - 0 - Kedah & Perlis Total 1 0.00 0 0.00 1 0.00 0 0.00 Pulau Pinang Public 0 - 0 - 0 - 2 - Pulau Pinang Private 2 - 2 - 2 - 4 - Pulau Pinang Total 2 0.01 2 0.01 2 0.01 6 0.04 Perak Public 0 - 0 - 0 - 0 - Perak Private 0 - 1 - 1 - 3 - Perak Total 0 0.00 1 0.00 1 0.00 3 0.01 Selangor & WP Putrajaya Public 2 - 0 - 0 - 6 - Selangor & WP Putrajaya Private 7 - 11 - 5 - 0 - Selangor & WP Putrajaya Total 9 0.02 11 0.02 5 0.01 6 0.01 WP Kuala Lumpur Public 7 - 0 - 5 - 0 - WP Kuala Lumpur Private 4 - 2 - 1 - 9 - WP Kuala Lumpur Total 11 0.07 2 0.01 6 0.04 9 0.05 Selangor & WP Putrajaya & WPKL Public 9 - 0 - 5 - 6 - Selangor & WP Putrajaya & WPKL Private 11 - 13 - 6 - 9 - Selangor & WP Putrajaya & WPKL Total 20 0.03 13 0.02 11 0.01 15 0.02 Negeri Sembilan Public 0 - 0 - 0 - 1 - Negeri Sembilan Private 0 - 0 - 0 - 1 - Negeri Sembilan Total 0 0.00 0 0.00 0 0.00 2 0.02 Melaka Public 0 - 0 - 0 - 0 - Melaka Private 0 - 0 - 0 - 0 - Melaka Total 0 0.00 0 0.00 0 0.00 0 0.00 Johor Public 0 - 0 - 0 - 0 - Johor Private 0 - 0 - 0 - 0 - Johor Total 0 0.00 0 0.00 0 0.00 0 0.00 Pahang Public 0 - 0 - 0 - 0 - Pahang Private na - na - na - na - Pahang Total 0 0.00 0 0.00 0 0.00 0 0.00 Terengganu Public 0 - 0 - 0 - 0 - Terengganu Private na - na - na - na - Terengganu Total 0 0.00 0 0.00 0 0.00 0 0.00 Kelantan Public 1 - 0 - 1 - 0 - Kelantan Private 0 - 0 - 0 - 0 - Kelantan Total 1 0.01 0 0.00 1 0.01 0 0.00 Sabah & WP Labuan Public 0 - 0 - 0 - 0 - Sabah & WP Labuan Private 1 - 0 - 0 - 0 - Sabah & WP Labuan Total 1 0.00 0 0.00 0 0.00 0 0.00 Sarawak Public 0 - 0 - 0 - 0 - Sarawak Private 0 - 0 - 0 - 0 -

Sarawak Total 0 0.00 0 0.00 0 0.00 0 0.00 HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC

Abbreviation: na – not applicable; - – not available 6 89 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.11 Number and Density of Counsellors in Malaysian Hospitals by State and Sector, 2011 Counsellors Full Time Counsellors Common User State Sector No. Per 10,000 population No. Per 10,000 population Malaysia Public 33 - 35 - Malaysia Private 1 - 0 - Malaysia Total 34 0.01 35 0.01 Perlis Public 0 - 1 - Perlis Private na na na na Perlis Total 0 0.00 1 0.04 Kedah Public 3 - 2 - Kedah Private 0 - 0 - Kedah Total 3 0.02 2 0.01 Kedah & Perlis Public 3 - 3 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 3 0.01 3 0.01 Pulau Pinang Public 1 - 2 - Pulau Pinang Private 0 - 0 - Pulau Pinang Total 1 0.01 2 0.01 Perak Public 4 - 3 - Perak Private 0 - 0 - Perak Total 4 0.02 3 0.01 Selangor & WP Putrajaya Public 3 - 6 - Selangor & WP Putrajaya Private 1 - 0 - Selangor & WP Putrajaya Total 4 0.01 6 0.01 WP Kuala Lumpur Public 9 - 9 - WP Kuala Lumpur Private 0 - 0 - WP Kuala Lumpur Total 9 0.05 9 0.05 Selangor & WP Putrajaya & WPKL Public 12 - 15 - Selangor & WP Putrajaya & WPKL Private 1 - 0 - Selangor & WP Putrajaya & WPKL Total 13 0.02 15 0.02 Negeri Sembilan Public 0 - 3 - Negeri Sembilan Private 0 - 0 - Negeri Sembilan Total 0 0.00 3 0.03 Melaka Public 1 - 0 - Melaka Private 0 - 0 - Melaka Total 1 0.01 0 0.00 Johor Public 5 - 3 - Johor Private 0 - 0 - Johor Total 5 0.01 3 0.01 Pahang Public 1 - 1 - Pahang Private na - na - Pahang Total 1 0.01 1 0.01 Terengganu Public 2 - 0 - Terengganu Private na - na - Terengganu Total 2 0.02 0 0.00 Kelantan Public 1 - 2 - Kelantan Private 0 - 0 - Kelantan Total 1 0.01 2 0.01 Sabah & WP Labuan Public 0 - 2 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 0 0.00 2 0.01 Sarawak Public 3 - 1 - Sarawak Private 0 - 0 - Sarawak Total 3 0.01 1 0.00

Abbreviation: na – not applicable; - – not available

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Table 6.12 Number and Density of Public Hospitals Medical Social Workers in Malaysia by State, 2011 Medical Social WorkerS Full Time Medical Social WorkerS Common user State No. Per 10,000 population No. Per 10,000 population Malaysia 17 0.01 94 0.03 Perlis 0 0.00 2 0.08 Kedah 0 0.00 2 0.01 Kedah & Perlis 0 0.00 4 0.02 Pulau Pinang 0 0.00 3 0.02 Perak 5 0.02 6 0.03 Selangor & WP Putrajaya 0 0.00 16 0.03 WP Kuala Lumpur 0 0.00 3 0.02 Selangor & WP Putrajaya & WPKL 0 0.00 19 0.03 Negeri Sembilan 0 0.00 5 0.05 Melaka 0 0.00 2 0.02 Johor 6 0.02 15 0.04 Pahang 0 0.00 3 0.02 Terengganu 0 0.00 6 0.06 Kelantan 2 0.01 12 0.07 Sabah & WP Labuan 1 0.00 9 0.03 Sarawak 3 0.01 10 0.04 PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC 6

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Table 6.13 Number and Density of Nurses in Psychiatry Services Malaysian Hospitals by State and Sector, 2010-2011 2010 2011 Nurses With Post Nurses With Post Nurses Nurses Community Nurse State Sector Basic training Basic training Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. population population population population population Malaysia Public 1,144 - 269 - 1,150 - 270 - 127 - Malaysia Private 15 - 7 - 35 - na na na na Malaysia Total 1,159 0.41 276 0.10 1,185 0.41 270 0.09 127 0.04 Perlis Public 9 - 4 - 10 - 4 - 2 - Perlis Private na - na - 0 - na na na na Perlis Total 9 0.39 4 0.17 10 0.42 4 0.17 2 0.08 Kedah Public 35 - 7 - 41 - 9 - 8 - Kedah Private 0 - 0 - 0 - na na na na Kedah Total 35 0.18 7 0.04 41 0.21 9 0.05 8 0.04 Kedah & Perlis Public 44 - 11 - 51 - 13 - 10 - Kedah & Perlis Private 0 - 0 - 0 - na na na na Kedah & Perlis Total 44 0.20 11 0.05 51 0.23 13 0.06 10 0.05 Pulau Pinang Public 28 - 5 - 25 - 3 - 0 - Pulau Pinang Private 12 - 5 - 15 - na na na na Pulau Pinang Total 40 0.26 10 0.06 40 0.25 3 0.02 0 0.00 Perak Public 283 - 99 - 271 - 79 - 14 - Perak Private 3 - 0 - 18 - na na na na Perak Total 286 1.22 99 0.42 289 1.21 79 0.33 14 0.06 Selangor & WP Public 37 - 4 - 53 - 4 - 5 - Putrajaya Selangor & WP Private 0 - 0 - 0 - na na na na Putrajaya Selangor & WP Total 37 0.07 4 0.01 53 0.09 4 0.01 5 0.01 Putrajaya WP Kuala Lumpur Public 119 - 16 - 162 - 27 - 39 - WP Kuala Lumpur Private 0 - 2 - 1 - na na na na WP Kuala Lumpur Total 119 0.71 18 0.11 163 0.96 27 0.16 39 0.23 Selangor & WP Public 156 - 20 - 215 - 31 - 44 - Putrajaya & WPKL Selangor & WP Private 0 - 2 - 1 - na na na na Putrajaya & WPKL Selangor & WP Total 156 0.22 22 0.03 216 0.29 31 0.04 44 0.06 Putrajaya & WPKL Negeri Sembilan Public 26 - 3 - 23 - 6 - 0 - Negeri Sembilan Private 0 - 0 - 0 - na na na na Negeri Sembilan Total 26 0.25 3 0.03 23 0.22 6 0.06 0 0.00 Melaka Public 25 - 4 - 17 - 2 - 2 - Melaka Private 0 - 0 - 0 - na na na na Melaka Total 25 0.30 4 0.05 17 0.20 2 0.02 2 0.02 Johor Public 205 - 61 - 205 - 60 - 5 - Johor Private 0 - 0 - 0 - na na na na Johor Total 205 0.61 61 0.18 205 0.60 60 0.18 5 0.01 Pahang Public 49 - 5 - 44 - 8 - 4 - Pahang Private na - na - 0 - na na na na Pahang Total 49 0.33 5 0.03 44 0.29 8 0.05 4 0.03 Terengganu Public 20 - 3 - 19 - 6 - 3 - Terengganu Private na - na - 0 - na na na na Terengganu Total 20 0.19 3 0.03 19 0.18 6 0.06 3 0.03 Kelantan Public 47 - 16 - 55 - 15 - 3 - Kelantan Private 0 - 0 - 0 - na na na na Kelantan Total 47 0.31 16 0.10 55 0.34 15 0.09 3 0.02 Sabah & WP Labuan Public 128 - 18 - 97 - 19 - 10 - Sabah & WP Labuan Private 0 - 0 - 1 - na na na na Sabah & WP Labuan Total 128 0.39 18 0.05 98 0.29 19 0.06 10 0.03 Sarawak Public 133 - 24 - 128 - 28 - 32 - Sarawak Private 0 - 0 - 0 - na na na na Sarawak Total 133 0.54 24 0.10 128 0.51 28 0.11 32 0.13

Abbreviation: na – not applicable; - – not available 92 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 6.14 Number and Density of Public Hospitals Assistant Medical Officers in Psychiatry Services Malaysia by State, 2010- 2011 2010 2011 Assistant Assistant Assistant Assistant Medical Assistant Medical Medical Officers Medical Officers With Medical Officers State With Post Basic Officers Post Basic Officers Without Post training training Basic training Per 10,000 Per 10,000 Per 10,000 Per 10,000 Per 10,000 No. No. No. No. No. population population population population population Malaysia 739 0.26 176 0.06 700 0.24 176 0.06 524 0.18 Perlis 7 0.30 2 0.09 5 0.21 2 0.08 3 0.13 Kedah 22 0.11 5 0.03 24 0.12 4 0.02 20 0.10 Kedah & Perlis 29 0.13 7 0.03 29 0.13 6 0.03 23 0.10 Pulau Pinang 23 0.15 1 0.01 21 0.13 1 0.01 20 0.13 Perak 189 0.80 87 0.37 200 0.83 87 0.36 113 0.47 Selangor & WP Putrajaya 21 0.04 2 0.00 30 0.05 1 0.00 29 0.05 WP Kuala Lumpur 31 0.19 5 0.03 42 0.25 4 0.02 38 0.22 Selangor & WP Putrajaya 52 0.07 7 0.01 72 0.10 5 0.01 67 0.09 & WPKL Negeri Sembilan 17 0.17 0 0.00 16 0.15 0 0.00 16 0.15 Melaka 14 0.17 2 0.02 10 0.12 2 0.02 8 0.10 Johor 114 0.34 40 0.12 135 0.40 37 0.11 98 0.29 Pahang 37 0.25 3 0.02 35 0.23 4 0.03 31 0.20 Terengganu 117 1.13 2 0.02 20 0.19 3 0.03 17 0.16 Kelantan 36 0.23 9 0.06 35 0.22 12 0.07 23 0.14 Sabah & WP Labuan 43 0.13 7 0.02 61 0.18 6 0.02 55 0.16 Sarawak 68 0.28 11 0.04 66 0.26 13 0.05 53 0.21 PSYCHIATRIC SERVICES IN MALAYSIAN HOSPITALS SERVICES IN MALAYSIAN PSYCHIATRIC 6

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CHAPTER 7 | OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS

Elias S1, Arunah C2*, Kamilah D2, Mariam Ismail1, Anusiah K. Selvathurai3, Norlaila Talib4, Chandramalar TS5, Thayanithi KS6

1. Hospital Selayang, 2. National Clinical Research Centre, Kuala Lumpur, 3.Hospital Melaka, 4. Hospital Serdang, 5. Hospital Sungai Buloh, 6. Hospital Kuala lumpur *Corresponding author.

Summary: There were a total of 348 hospitals in the country of which, 98 had ophthalmology services available. This chapter analyses their facilities such as the availability of dedicated operating rooms, the distribution of workforce, the number of surgeries done e.g. cataract, glaucoma, vitreoretinal surgeries and the use of some devices. The response rate to this survey was 91.8%; 100% from the 39 public hospitals and 86.4% from the 51 private hospitals.

Facilities

There were 36 Ministry of Health (MOH) hospitals, 3 University Hospitals and 59 hospitals in the private sector providing Ophthalmology services in Malaysia in 2011.

The Klang Valley (Wilayah Persekutuan Kuala Lumpur/WPKL, WP Putrajaya, Selangor) and Melaka had the highest density of hospitals providing ophthalmology services, a density of 0.05 hospitals per 10,000 population. The states with the lowest density of hospitals providing services were Terengganu, Sabah and WP Labuan with a density of 0.01 per 10,000 population (Table 7.1).

All 39 public hospitals providing ophthalmology services had dedicated ophthalmology operating rooms. There were 54 functioning dedicated operating rooms (Table 7.2). On average, an ophthalmologist in the public sector had 26 elective operating hours per month (Table 7.3). However ophthalmologists from some states e.g. the Klang Valley (18 hours), Perlis (19 hours), Melaka (18 hours) and Terengganu (18 hours) did not achieve this national average.

Services

All 98 hospitals offered cataract surgery (Table 7.4). However, only 61 hospitals provided surgery for glaucoma (Table 7.5) and 49 hospitals for vitreoretinal (VR) surgery (Table 7.6). A total of 51,887 cataract surgeries were performed in Malaysia in 2011, of which 36,068 (69.5%) were done in the public and 15,819 (30.5%) were done in the private sector (Table 7.4). Fifty two percent of these cataract surgeries were performed as day care surgery and the remaining 48% as inpatient. In the MOH hospitals, 49% of cataract surgeries were performed as day care*.

A total 61 hospitals offered glaucoma surgery. However in 49 of these hospitals only 10 or less surgeries were done. In all, 1,250 surgeries were performed in Malaysia in 2011, of which, 974 (78%) were done in the public and 276 (22%) were done in the private sector (Table 7.5). Of these, 321 (26%) were done with glaucoma drainage implants, 21% being from the public sector and 43% from the private sector.

A total of 49 hospitals offered VR surgeries. However in 24 of these, only 10 or less surgeries were being done. In all, 4,327 VR surgeries were performed in 2011, of which 3,754 (87%) were performed in the public hospitals (Table 7.6). A total of 1,632 (38%) VR surgeries were done for complications of diabetic retinopathy. Of these, 92% were performed in the public sector.

Forty-three percent of all glaucoma surgeries and 49% of VR surgeries in the country were done in the Klang Valley itself. Of these, 70% of the glaucoma and 78% of the VR surgeries were done in the public sector.

Workforce

There were a total of 382 ophthalmologists in the country i.e. one ophthalmologist to a population of 76,923; a density of 0.13 per 10,000 population (Table 7.7). Of these, 218 (57%) were in public service and 164 (43%) in the private sector. The Global Advisory Committee of Vision 2020 recommends a norm of one ophthalmologist per 50,000 population by the year 2020. Only two states, Melaka and WPKL, have met these criteria. Most of the ophthalmologists were working in Selangor, WPKL and WP Putrajaya and these states had a ratio of one ophthalmologist to a population of 41,666 (0.24 per 10,000 population). Sabah had the lowest ratio with one ophthalmologist to a population of 200,000 (0.05 per 10,000 population).

There were a total of 213 resident optometrists, of whom 189 (89%) were in the public sector (Table 7.8).

A total of 144 assistant medical officers served in the public sector, of which 66 (46%) had post basic ophthalmology training (Table 7.9). A total of

347 nurses served in the public sector, of which 152 (44%) had post basic ophthalmology training. In all, there were 218 (1:133,333) ophthalmic HOSPITALS OPHTHALMOLOGY SERVICES IN MALAYSIAN assistants with post basic training in the country (Table 7.10). 7 95 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Devices

There were 166 operating microscopes in the country in 2011. Of these, 77 (46%) were in the public sector and 89 (54%) in private sector. A total of 108 stand alone phacoemulsification machines were available; 52 in the public sector and 56 in the private sector. There were 61 combined phacoemulsification and vitrectomy machines; 23 in the public sector and 38 in the private sector. There were only 17 stand alone vitrectomy machines, with 5 in the private sector. There were 82 automated perimetry devices, 55 in the public sector and 27 in the private sector (Table 7.11).

Table: Ratio of Phacoemulsification Machines (Stand Alone and Combined) to Cataract Surgeries Sector Cataract Surgeries Phacoemulsification Machines Ratio Ministry of Health 33,404 63 530:1 University 2,664 12 222:1 Private 15,819 94 168:1

From the * National Eye Database, 52.3% of the surgeries were performed as day care; day care surgery being defined as surgery done with the patient admitted and discharged on the same day.

Limitations

1. This survey did not include: a. Hospitals in the Ministry of Defence b. Private Centres not licensed as ‘Hospitals’ as stated in the only Private Healthcare Facilities and Services Act 1998 c. Hospital Sarikei that started providing ophthalmological services in 2011

2. The surgical volume reported may be an under estimation since a large volume of cataract surgery is being done in the ambulatory care setting in private centres. These do not fall under the definition of a “hospital”.

3. The volume of day care surgery may have also been underestimated because of differences in the definition of day care centres in the various institutions.

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Table 7.1 Number and Density of Hospitals Providing Ophthalmology Services in Malaysia by State and Sector, 2011 2011 State Sector Number Per 10,000 population Malaysia Public 39 - Malaysia Private 59 - Malaysia Total 98 0.03 Perlis Public 1 - Perlis Private na na Perlis Total 1 0.04 Kedah Public 2 - Kedah Private 4 - Kedah Total 6 0.03 Kedah & Perlis Public 3 - Kedah & Perlis Private 4 - Kedah & Perlis Total 7 0.03 Pulau Pinang Public 2 - Pulau Pinang Private 5 - Pulau Pinang Total 7 0.04 Perak Public 4 - Perak Private 5 - Perak Total 9 0.04 Selangor & WP Putrajaya Public 6 - Selangor & WP Putrajaya Private 14 - Selangor & WP Putrajaya Total 20 0.04 WP Kuala Lumpur Public 3 - WP Kuala Lumpur Private 13 - WP Kuala Lumpur Total 16 0.09 Selangor & WP Putrajaya & WPKL Public 9 - Selangor & WP Putrajaya & WPKL Private 27 - Selangor & WP Putrajaya & WPKL Total 36 0.05 Negeri Sembilan Public 2 - Negeri Sembilan Private 2 - Negeri Sembilan Total 4 0.04 Melaka Public 1 - Melaka Private 3 - Melaka Total 4 0.05 Johor Public 4 - Johor Private 4 - Johor Total 8 0.02 Pahang Public 2 - Pahang Private 1 - Pahang Total 3 0.02 Terengganu Public 1 - Terengganu Private 0 - Terengganu Total 1 0.01 Kelantan Public 3 - Kelantan Private 0 - Kelantan Total 3 0.02 Sabah & WP Labuan Public 4 - Sabah & WP Labuan Private 1 - Sabah & WP Labuan Total 5 0.01 Sarawak Public 4 - Sarawak Private 7 - Sarawak Total 11 0.04 OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS OPHTHALMOLOGY SERVICES IN MALAYSIAN Abbreviation: na – not applicable; - – not available 7

97 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.2 Number and Density of Dedicated Ophthalmology Operating Rooms (ORs) in Public Hospitals in Malaysia by State and Sector, 2011 Hospitals with Total Dedicated Total Functioning Dedicated Dedicated Ophthalmology (ORs) Ophthalmology ORs State Ophthalmology (ORs) No. No. Per 10,000 population No. Per 10,000 population Malaysia 39 56 0.02 54 0.02 Perlis 1 1 0.04 1 0.04 Kedah 2 2 0.01 2 0.01 Kedah & Perlis 3 3 0.01 3 0.01 Pulau Pinang 2 3 0.02 3 0.02 Perak 4 7 0.03 7 0.03 Selangor & WP Putrajaya 6 11 0.02 9 0.02 WP Kuala Lumpur 3 7 0.04 7 0.04 Selangor & WP Putrajaya & WPKL 9 18 0.02 16 0.02 Negeri Sembilan 2 2 0.02 2 0.02 Melaka 1 1 0.01 1 0.01 Johor 4 5 0.01 5 0.01 Pahang 2 3 0.02 3 0.02 Terengganu 1 2 0.02 2 0.02 Kelantan 3 4 0.02 4 0.02 Sabah & WP Labuan 4 4 0.01 4 0.01 Sarawak 4 4 0.02 4 0.02

Table 7.3 Number and Density of Ophthalmology Elective Operating Hours in Public Hospitals in Malaysia by State and Sector, 2011 Ophthalmologists Elective Operating Hours (EOH) per 4 week-month State No. No. of Hours EOH : Ophthalmologists Ratio Malaysia 218 5,565 25.53 Perlis 3 56 18.67 Kedah 11 388 35.27 Kedah & Perlis 14 444 31.71 Pulau Pinang 9 227 25.22 Perak 8 690 86.25 Selangor & WP Putrajaya 55 922 16.76 WP Kuala Lumpur 44 837 19.02 Selangor & WP Putrajaya & WPKL 99 1,759 17.77 Negeri Sembilan 9 227 25.22 Melaka 7 128 18.29 Johor 13 357 27.46 Pahang 12 397 33.08 Terengganu 7 128 18.29 Kelantan 18 474 26.33 Sabah & WP Labuan 11 314 28.55 Sarawak 11 420 38.18

98 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.4 Number and Density of Cataract Surgery Done as Day Care and Inpatient in Malaysia by State and Sector, 2011 Hospitals providing Cataract Surgery Cataract Surgery Done Total Cataract Cataract Done as Day care as Inpatient Surgery State Sector Surgery Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population Malaysia Public 39 17,660 - 18,408 - 36,068 - Malaysia Private 59 9,475 - 6,344 - 15,819 - Malaysia Total 98 27,135 9.37 24,752 8.55 51,887 17.91 Perlis Public 1 15 - 394 - 409 - Perlis Private na na na na na na na Perlis Total 1 15 0.63 394 16.59 409 17.22 Kedah Public 2 592 - 2,197 - 2,789 - Kedah Private 4 715 - 69 - 784 - Kedah Total 6 1,307 6.62 2,266 11.48 3,573 18.11 Kedah & Perlis Public 3 607 - 2,591 - 3,198 - Kedah & Perlis Private 4 715 - 69 - 784 - Kedah & Perlis Total 7 1,322 5.98 2,660 12.03 3,982 18.01 Pulau Pinang Public 2 3,178 - 361 - 3,539 - Pulau Pinang Private 5 2,245 - 527 - 2,772 - Pulau Pinang Total 7 5,423 34.03 888 5.57 6,311 39.60 Perak Public 4 766 - 3,319 - 4,085 - Perak Private 5 523 - 718 - 1,241 - Perak Total 9 1,289 5.38 4,037 16.84 5,326 22.21 Selangor & WP Putrajaya Public 6 3,379 - 1,732 - 5,111 - Selangor & WP Putrajaya Private 14 2,933 - 1,934 - 4,867 - Selangor & WP Putrajaya Total 20 6,312 11.16 3,666 6.48 9,978 17.65 WP Kuala Lumpur Public 3 2,547 - 1,755 - 4,302 - WP Kuala Lumpur Private 13 1,045 - 1,391 - 2,436 - WP Kuala Lumpur Total 16 3,592 21.20 3,146 18.57 6,738 39.76 Selangor & WP Putrajaya & WPKL Public 9 5,926 - 3,487 - 9,413 - Selangor & WP Putrajaya & WPKL Private 27 3,978 - 3,325 - 7,303 - Selangor & WP Putrajaya & WPKL Total 36 9,904 13.48 6,812 9.27 16,716 22.75 Negeri Sembilan Public 2 1,594 - 978 - 2,572 - Negeri Sembilan Private 2 555 - 60 - 615 - Negeri Sembilan Total 4 2,149 20.61 1,038 9.95 3,187 30.56 Melaka Public 1 1,533 - 97 - 1,630 - Melaka Private 3 347 - 1,113 - 1,460 - Melaka Total 4 1,880 22.57 1,210 14.53 3,090 37.09 Johor Public 4 377 - 2,330 - 2,707 - Johor Private 4 219 - 447 - 666 - Johor Total 8 596 1.75 2,777 8.16 3,373 9.92 Pahang Public 2 442 - 789 - 1,231 - Pahang Private 1 11 - 18 - 29 - Pahang Total 3 453 2.97 807 5.29 1,260 8.26 Terengganu Public 1 371 - 407 - 778 - Terengganu Private 0 0 - 0 - 0 - Terengganu Total 1 371 3.45 407 3.79 778 7.24 Kelantan Public 3 197 - 1,293 - 1,490 - Kelantan Private 0 0 - 0 - 0 - Kelantan Total 3 197 1.22 1,293 8.01 1,490 9.22 Sabah & WP Labuan Public 4 723 - 1,870 - 2,593 - Sabah & WP Labuan Private 1 57 - 30 - 87 - Sabah & WP Labuan Total 5 780 2.29 1,900 5.58 2,680 7.87 Sarawak Public 4 1,946 - 886 - 2,832 - Sarawak Private 7 825 - 37 - 862 - Sarawak Total 11 2,771 11.01 923 3.67 3,694 14.68 OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS OPHTHALMOLOGY SERVICES IN MALAYSIAN Abbreviation: na – not applicable; - – not available 7

99 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.5 Number and Density of Glaucoma Surgery with and without Implant in Malaysia by State and Sector, 2011 Hospitals Glaucoma providing Glaucoma Surgery Total Glaucoma Surgery without Glaucoma with Implant Surgery Implant State Sector Surgery Per 10,000 Per 10,000 Per 10,000 No. No. No. No. population population population Malaysia Public 29 202 - 772 - 974 - Malaysia Private 32 119 - 157 - 276 - Malaysia Total 61 321 0.11 929 0.32 1,250 0.43 Perlis Public 1 8 - 16 - 24 - Perlis Private na na na na na na na Perlis Total 1 8 0.34 16 0.67 24 1.01 Kedah Public 2 12 - 73 - 85 - Kedah Private 1 0 - 3 - 3 - Kedah Total 3 12 0.06 76 0.39 88 0.45 Kedah & Perlis Public 3 20 - 89 - 109 - Kedah & Perlis Private 1 0 - 3 - 3 - Kedah & Perlis Total 4 20 0.09 92 0.42 112 0.51 Pulau Pinang Public 1 0 - 6 - 6 - Pulau Pinang Private 3 7 - 8 - 15 - Pulau Pinang Total 4 7 0.04 14 0.09 21 0.13 Perak Public 4 6 - 61 - 67 - Perak Private 2 36 - 3 - 39 - Perak Total 6 42 0.18 64 0.27 106 0.44 Selangor & WP Putrajaya Public 4 13 - 114 - 127 - Selangor & WP Putrajaya Private 10 28 - 105 - 133 - Selangor & WP Putrajaya Total 14 41 0.07 219 0.39 260 0.46 WP Kuala Lumpur Public 3 151 - 94 - 245 - WP Kuala Lumpur Private 6 17 - 11 - 28 - WP Kuala Lumpur Total 9 168 0.99 105 0.62 273 1.61 Selangor & WP Putrajaya & WPKL Public 7 164 - 208 - 372 - Selangor & WP Putrajaya & WPKL Private 16 45 - 116 - 161 - Selangor & WP Putrajaya & WPKL Total 23 209 0.28 324 0.44 533 0.73 Negeri Sembilan Public 0 0 - 0 - 0 - Negeri Sembilan Private 1 1 - 1 - 2 - Negeri Sembilan Total 1 1 0.01 1 0.01 2 0.02 Melaka Public 1 2 - 40 - 42 - Melaka Private 1 0 - 11 - 11 - Melaka Total 2 2 0.02 51 0.61 53 0.64 Johor Public 2 1 - 46 - 47 - Johor Private 3 4 - 8 - 12 - Johor Total 5 5 0.01 54 0.16 59 0.17 Pahang Public 1 1 - 18 - 19 - Pahang Private 0 0 - 0 - 0 - Pahang Total 1 1 0.01 18 0.12 19 0.12 Terengganu Public 1 0 - 27 - 27 - Terengganu Private 0 0 - 0 - 0 - Terengganu Total 1 0 0.00 27 0.25 27 0.25 Kelantan Public 3 8 - 116 - 124 - Kelantan Private 0 0 - 0 - 0 - Kelantan Total 3 8 0.05 116 0.72 124 0.77 Sabah & WP Labuan Public 3 0 - 87 - 87 - Sabah & WP Labuan Private 1 1 - 6 - 7 - Sabah & WP Labuan Total 4 1 0.00 93 0.27 94 0.28 Sarawak Public 3 0 - 74 - 74 - Sarawak Private 4 25 - 1 - 26 - Sarawak Total 7 25 0.10 75 0.30 100 0.40 Abbreviation: na – not applicable; - – not available

100 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.6 Number and Density of Vitreoretinal Surgery and Vitreoretinal Surgery for Diabetic Retinopathy in Malaysia by State and Sector, 2011 Hospitals providing Total Vitreoretinal Total Vitreoretinal Vitreoretinal Surgery for Diabetic Surgeries State Sector Surgery Retinopathy Per 10,000 Per 10,000 No. No. No. population population Malaysia Public 16 3,754 - 1,496 - Malaysia Private 33 573 - 136 - Malaysia Total 49 4,327 1.49 1,632 0.56 Perlis Public 0 0 - 0 - Perlis Private na na na na na Perlis Total 0 0 0.00 0 0.00 Kedah Public 1 452 - 110 - Kedah Private 0 0 - 0 - Kedah Total 1 452 2.29 110 0.56 Kedah & Perlis Public 1 452 - 110 - Kedah & Perlis Private 0 0 0 Kedah & Perlis Total 1 452 2.04 110 0.50 Pulau Pinang Public 1 347 - 172 - Pulau Pinang Private 3 52 - 0 - Pulau Pinang Total 4 399 2.50 172 1.08 Perak Public 0 0 - 0 - Perak Private 2 11 - 0 - Perak Total 2 11 0.05 0 0.00 Selangor & WP Putrajaya Public 2 1,375 - 610 - Selangor & WP Putrajaya Private 11 268 - 121 - Selangor & WP Putrajaya Total 13 1,643 2.91 731 1.29 WP Kuala Lumpur Public 3 272 - 70 - WP Kuala Lumpur Private 7 204 - 2 - WP Kuala Lumpur Total 10 476 2.81 72 0.42 Selangor & WP Putrajaya & WPKL Public 5 1,647 - 680 - Selangor & WP Putrajaya & WPKL Private 18 472 - 123 - Selangor & WP Putrajaya & WPKL Total 23 2,119 2.88 803 1.09 Negeri Sembilan Public 1 166 - 90 - Negeri Sembilan Private 1 23 - 0 - Negeri Sembilan Total 2 189 1.81 90 0.86 Melaka Public 1 67 - 20 - Melaka Private 1 0 13 Melaka Total 2 67 0.80 33 0.40 Johor Public 1 349 - 190 - Johor Private 3 9 0 Johor Total 4 358 1.05 190 0.56 Pahang Public 1 59 - 36 - Pahang Private 0 0 0 Pahang Total 1 59 0.39 36 0.24 Terengganu Public 1 70 - 17 - Terengganu Private na na na na na Terengganu Total 1 70 0.65 17 0.16 Kelantan Public 1 195 - 110 - Kelantan Private na na na na na Kelantan Total 1 195 1.21 110 0.68 Sabah & WP Labuan Public 1 74 0 Sabah & WP Labuan Private 1 4 0 Sabah & WP Labuan Total 2 78 0.23 0 0.00 Sarawak Public 2 328 71 Sarawak Private 4 2 0

Sarawak Total 6 330 1.31 71 0.28 HOSPITALS OPHTHALMOLOGY SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available 7 101 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.7 Number and Density of Ophthalmologists in Malaysian Hospitals by State and Sector, 2011 Total Permanent / Resident Visiting Ophthalmologists Ophthalmologists Ophthalmologists State Sector Per 10,000 Per 10,000 Per 10,000 No. No. No. population population population Malaysia Public 218 - 211 - 17 - Malaysia Private 164 - 86 - 88 - Malaysia Total 382 0.13 297 0.10 105 0.04 Perlis Public 3 - 3 - 0 - Perlis Private na na na na na na Perlis Total 3 0.13 3 0.13 0 0.00 Kedah Public 11 - 12 - 0 - Kedah Private 7 - 3 - 2 - Kedah Total 18 0.09 15 0.08 2 0.01 Kedah & Perlis Public 14 - 15 - 0 - Kedah & Perlis Private 7 - 3 - 2 - Kedah & Perlis Total 21 0.09 18 0.08 2 0.01 Pulau Pinang Public 9 - 9 - 0 - Pulau Pinang Private 20 - 11 - 2 - Pulau Pinang Total 29 0.18 20 0.13 2 0.01 Perak Public 8 - 9 - 3 - Perak Private 14 - 7 - 2 - Perak Total 22 0.09 16 0.07 5 0.02 Selangor & WP Putrajaya Public 55 - 49 - 3 - Selangor & WP Putrajaya Private 51 - 32 - 27 - Selangor & WP Putrajaya Total 106 0.19 81 0.14 30 0.05 WP Kuala Lumpur Public 44 - 45 - 5 - WP Kuala Lumpur Private 30 - 15 - 32 - WP Kuala Lumpur Total 74 0.44 60 0.35 37 0.22 Selangor & WP Putrajaya & WPKL Public 99 - 94 - 8 - Selangor & WP Putrajaya & WPKL Private 81 - 47 - 59 - Selangor & WP Putrajaya & WPKL Total 180 0.24 141 0.19 67 0.09 Negeri Sembilan Public 9 - 8 - 0 - Negeri Sembilan Private 6 - 2 - 3 - Negeri Sembilan Total 15 0.14 10 0.10 3 0.03 Melaka Public 7 - 7 - 0 - Melaka Private 11 - 6 - 6 - Melaka Total 18 0.22 13 0.16 6 0.07 Johor Public 13 - 13 - 0 - Johor Private 9 - 4 - 2 - Johor Total 22 0.06 17 0.05 2 0.01 Pahang Public 12 - 11 - 2 - Pahang Private 2 - 0 - 2 - Pahang Total 14 0.09 11 0.07 4 0.03 Terengganu Public 7 - 6 - 0 - Terengganu Private 0 - 0 - 0 - Terengganu Total 7 0.07 6 0.06 0 0.00 Kelantan Public 18 - 19 - 1 - Kelantan Private 1 - 0 - 0 - Kelantan Total 19 0.12 19 0.12 1 0.01 Sabah & WP Labuan Public 11 - 10 - 2 - Sabah & WP Labuan Private 6 - 2 - 4 - Sabah & WP Labuan Total 17 0.05 12 0.04 6 0.02 Sarawak Public 11 - 10 - 1 - Sarawak Private 7 - 4 - 6 - Sarawak Total 18 0.07 14 0.06 7 0.03

Abbreviation: na – not applicable; - – not available

102 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.8 Number and Density of Optometrists in Malaysian Hospitals by State and Sector, 2011 Permanent / Resident Visiting Optometrists State Sector Optometrists No. Per 10,000 population No. Per 10,000 population Malaysia Public 189 - 1 - Malaysia Private 24 - 20 - Malaysia Total 213 0.07 21 0.01 Perlis Public 2 - 0 - Perlis Private na na na na Perlis Total 2 0.08 0 0.00 Kedah Public 8 - 0 - Kedah Private 0 - 0 - Kedah Total 8 0.04 0 0.00 Kedah & Perlis Public 10 - 0 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 10 0.05 0 0.00 Pulau Pinang Public 11 - 0 - Pulau Pinang Private 2 - 0 - Pulau Pinang Total 13 0.08 0 0.00 Perak Public 15 - 0 - Perak Private 1 - 3 - Perak Total 16 0.07 3 0.01 Selangor & WP Putrajaya Public 37 - 0 - Selangor & WP Putrajaya Private 18 - 7 - Selangor & WP Putrajaya Total 55 0.10 7 0.01 WP Kuala Lumpur Public 24 - 0 - WP Kuala Lumpur Private 2 - 2 - WP Kuala Lumpur Total 26 0.15 2 0.01 Selangor & WP Putrajaya & WPKL Public 61 - 0 - Selangor & WP Putrajaya & WPKL Private 20 - 9 - Selangor & WP Putrajaya & WPKL Total 81 0.11 9 0.01 Negeri Sembilan Public 8 - 0 - Negeri Sembilan Private 0 - 8 - Negeri Sembilan Total 8 0.08 8 0.08 Melaka Public 7 - 0 - Melaka Private 0 - 0 - Melaka Total 7 0.08 0 0.00 Johor Public 20 - 0 - Johor Private 0 - 0 - Johor Total 20 0.06 0 0.00 Pahang Public 12 - 0 - Pahang Private 0 - 0 - Pahang Total 12 0.08 0 0.00 Terengganu Public 8 - 0 - Terengganu Private 0 - 0 - Terengganu Total 8 0.07 0 0.00 Kelantan Public 14 - 0 - Kelantan Private 0 - 0 - Kelantan Total 14 0.09 0 0.00 Sabah & WP Labuan Public 12 - 1 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 12 0.04 1 0.00 Sarawak Public 11 - 0 - Sarawak Private 1 - 0 -

Sarawak Total 12 0.05 0 0.00 HOSPITALS OPHTHALMOLOGY SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available 7 103 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.9 Number and Density of Assistant Medical Officers (AMOs) with and without Post-Basic in Ophthalmology Public Hospital in Malaysia by State and Sector, 2011 AMOs with Post-Basic AMOs without Post-Basic State in Ophthalmology in Ophthalmology No. Per 10,000 population No. Per 10,000 population Malaysia 66 0.02 78 0.03 Perlis 2 0.08 1 0.04 Kedah 3 0.02 7 0.04 Kedah & Perlis 5 0.02 8 0.04 Pulau Pinang 2 0.01 4 0.03 Perak 10 0.04 6 0.03 Selangor & WP Putrajaya 9 0.02 17 0.03 WP Kuala Lumpur 8 0.05 3 0.02 Selangor & WP Putrajaya & WPKL 17 0.02 20 0.03 Negeri Sembilan 4 0.04 4 0.04 Melaka 2 0.02 5 0.06 Johor 8 0.02 5 0.01 Pahang 2 0.01 9 0.06 Terengganu 3 0.03 2 0.02 Kelantan 2 0.01 4 0.02 Sabah & WP Labuan 6 0.02 7 0.02 Sarawak 5 0.02 4 0.02

Table 7.10 Number and Density of Nurses with and without Post-Basic in Ophthalmology in Public Hospital in Malaysia by State and Sector, 2011 Nurses with Post-Basic Nurses without Post-Basic State in Ophthalmology in Ophthalmology No. Per 10,000 population No. Per 10,000 population Malaysia 152 0.05 195 0.07 Perlis 1 0.04 3 0.13 Kedah 5 0.03 14 0.07 Kedah & Perlis 6 0.03 17 0.08 Pulau Pinang 12 0.08 17 0.11 Perak 12 0.05 1 0.00 Selangor & WP Putrajaya 22 0.04 14 0.02 WP Kuala Lumpur 22 0.13 56 0.33 Selangor & WP Putrajaya & WPKL 44 0.06 70 0.10 Negeri Sembilan 3 0.03 4 0.04 Melaka 7 0.08 20 0.24 Johor 7 0.02 14 0.04 Pahang 5 0.03 5 0.03 Terengganu 3 0.03 3 0.03 Kelantan 20 0.12 16 0.10 Sabah & WP Labuan 17 0.05 12 0.04 Sarawak 16 0.06 16 0.06

104 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table 7.11 Number and Density of Ophthalmology Devices in Malaysia by State and Sector, 2011 Combined Functioning Stand-Alone Stand-Alone Automated Phacoemulsification Operating Phacoemulsification Vitrectomy Perimetry and Vitrectomy State Sector Microscope Machine Machine Device Machine No. PMP No. PMP No. PMP No. PMP No. PMP Malaysia Public 77 - 52 - 23 - 12 - 55 - Malaysia Private 89 - 56 - 38 - 5 - 27 - Malaysia Total 166 5.73 108 3.73 61 2.11 17 0.59 82 2.83 Perlis Public 1 - 1 - 1 - 1 - 1 - Perlis Private na na na na na na na na na na Perlis Total 1 4.21 1 4.21 1 4.21 1 4.21 1 4.21 Kedah Public 3 - 4 - 0 - 2 - 4 - Kedah Private 4 - 4 - 0 - 0 - 3 - Kedah Total 7 3.55 8 4.05 0 0.00 2 1.01 7 3.55 Kedah & Perlis Public 4 - 5 - 1 - 3 - 5 - Kedah & Perlis Private 4 - 4 - 0 - 0 - 3 - Kedah & Perlis Total 8 3.62 9 4.07 1 0.45 3 1.36 8 3.62 Pulau Pinang Public 3 - 2 - 0 - 1 - 3 - Pulau Pinang Private 13 - 10 - 9 - 0 - 3 - Pulau Pinang Total 16 10.04 12 7.53 9 5.65 1 0.63 6 3.77 Perak Public 7 - 5 - 1 - 0 - 5 - Perak Private 4 - 2 4 - 0 - 0 - Perak Total 11 4.59 7 2.92 5 2.09 0 0.00 5 2.09 Selangor & WP Putrajaya Public 16 - 14 - 2 - 2 - 8 - Selangor & WP Putrajaya Private 26 - 16 - 8 - 4 - 10 - Selangor & WP Putrajaya Total 42 7.43 30 5.31 10 1.77 6 1.06 18 3.18 WP Kuala Lumpur Public 9 - 5 - 8 - 1 - 8 - WP Kuala Lumpur Private 18 - 8 - 4 - 0 - 3 - WP Kuala Lumpur Total 27 15.93 13 7.67 12 7.08 1 0.59 11 6.49 Selangor & WP Putrajaya & WPKL Public 25 - 19 - 10 - 3 - 16 - Selangor & WP Putrajaya & WPKL Private 44 - 24 - 12 - 4 - 13 - Selangor & WP Putrajaya & WPKL Total 69 9.39 43 5.85 22 2.99 7 0.95 29 3.95 Negeri Sembilan Public 3 - 2 - 1 - 1 - 3 - Negeri Sembilan Private 2 - 1 - 2 - 0 - 1 - Negeri Sembilan Total 5 4.79 3 2.88 3 2.88 1 0.96 4 3.84 Melaka Public 2 - 1 - 1 - 0 - 1 - Melaka Private 4 - 4 - 2 - 0 - 0 - Melaka Total 6 7.20 5 6.00 3 3.60 0 0.00 1 1.20 Johor Public 9 - 5 - 3 - 1 - 5 - Johor Private 6 - 3 - 3 - 0 - 3 - Johor Total 15 4.41 8 2.35 6 1.76 1 0.29 8 2.35 Pahang Public 4 - 4 - 2 - 1 - 4 - Pahang Private 1 - 1 - 0 - 0 - 0 - Pahang Total 5 3.28 5 3.28 2 1.31 1 0.66 4 2.62 Terengganu Public 2 - 0 - 1 - 0 - 2 - Terengganu Private 0 - 0 - 0 - 0 - 0 - Terengganu Total 2 1.86 0 0.00 1 0.93 0 0.00 2 1.86 Kelantan Public 6 - 4 - 1 - 1 - 3 - Kelantan Private 0 - 0 - 0 - 0 - 0 - Kelantan Total 6 3.71 4 2.48 1 0.62 1 0.62 3 1.86 Sabah & WP Labuan Public 8 - 2 - 1 - 1 - 5 - Sabah & WP Labuan Private 2 - 0 - 1 - 1 - 2 - Sabah & WP Labuan Total 10 2.94 2 0.59 2 0.59 2 0.59 7 2.06 Sarawak Public 4 - 3 - 1 - 0 - 3 - Sarawak Private 9 - 7 - 5 - 0 - 2 - Sarawak Total 13 5.17 10 3.97 6 2.38 0 0.00 5 1.99 OPHTHALMOLOGY SERVICES IN MALAYSIAN HOSPITALS OPHTHALMOLOGY SERVICES IN MALAYSIAN

Abbreviation: na – not applicable; - – not available; PMP – per million population 7

105 This page intentionally left blank APPENDICES

NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

APPENDIX 1 | LIST OF DEFINITIONS

ACUTE CURATIVE HOSPITAL CHAPTER

Entrepreneurship

Sole Proprietor

A business entity owned by one person. The owner may operate on his or her own or may employ others. The owner of the business has total and unlimited personal liability of the debts incurred by the business.

Corporate Body

A body incorporated under the Companies Act 1965 [Act 125].

Partnership

A business entity in which two or more people operate for the common goal of making profit. Each partner has total and unlimited personal liability of the debts incurred by the partnership.

Society

An association, club or body that function based on membership consisting of seven (7) members or more in addition to having certain purposes, whether temporary or permanent, which is registered under the Societies Act 1966 [Act 335] (considered under the Private Healthcare Facilities and Services Act 1998 [Act 586])

Hospital

An institution with primary function to provide inpatient diagnostic and therapeutic services for a variety of medical conditions both surgical and non surgical.

Non Specialist Hospital

A hospital that provides services including medicine and surgery to meet the general medicine and surgery needs of the community without permanent or resident specialists.

Specialist Hospital

A hospital that provides services including medicine, surgery and other services to meet the general medicine and surgery needs of the community with permanent or resident specialists.

Hospital with Tertiary Services

A hospital that provides up to 45 resident specialty or subspecialty services.

Hospital with Secondary Services

A hospital that provides up to 20 resident specialty or subspecialty services.

Special Institution

A hospital with specific resident specialty services.

Maternity Centre

A hospital that is used or intended to be used for the provision of obstetrics and/ or gynaecological care that extends beyond care in a normal pregnancy/ labour/ post-partum period/ normal newborns and may involve the conduct of deliveries besides spontaneous vertex deliveries.

Inpatient Bed LIST OF DEFINITIONS A bed used for patients admitted for diagnostic and/or therapeutic purposes in a hospital; both occupied and vacant on any given day.

● The reported beds are the functioning beds only A pp x 1 109 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Included beds: ● Cots/ bassinet set aside for babies requiring special care at SCN (Special Care Nursery), NICU (Neonatal Intensive Care Unit).

Excluded beds are those situated in: ● Treatment rooms ● Examination rooms ● Emergency services ● Physical therapy ● Labour rooms ● Observation or recovery room beds at in/ out-patient department ● Cots for normal newborns in the obstetrics wards

Functioning Inpatient Bed

A bed that is readily available to take in a patient and provide care according to the nurses and equipment available for that bed.

Operating Theatre

A facility within a hospital that is designed and equipped with facilities to perform sterile surgical operations and has facilities to monitor patients in the immediate post-operative period.

Operating Room

A room within an operating theatre that is designed and equipped with facilities to perform sterile surgical operations. One operating theatre (OT) usually has more than one operating room (OR).

Inpatient

A person who undergoes a formal process whereby he/ she is accepted by a hospital for the purpose of hospital treatment.

Admission

Admission (or inpatient admission) is the formal acceptance by a hospital of a patient who will occupy a hospital bed, crib or bassinet for observation, care, diagnosis or treatment and will have a medical record maintained for him / her.

Neonates born in the hospital that need medical care and for whom separate medical records are maintained; are considered as admissions, (foetal deaths or still births are not counted as admissions)

Average Length of Stay (ALOS) (in days)

The average number of days that inpatients (excluding newborns) remained in the hospital.

Length of Stay = (Sum of Length of Stay of discharged patients for a given period/Total number of discharged patients in the same period)

Bed Occupancy Rate (BOR) (%)

The percentage of inpatient beds occupied for a given period of time. Also known as the percentage of occupancy,

BOR = (Inpatient Days of Care/ Bed Days Available) x 100

Where: Inpatient Days of Care: Sum of each daily inpatient census for the given period. Beds denote inpatient beds that are set up, staffed and available for care.

Bed Days Available: The maximum number of inpatient days of care that would have been provided if all beds were filled during the given period and takes into account changes in the number of beds available for use during the same period. 110 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

For example:

Hospital X had 300 beds from July 1 to Feb 28. The number of beds in services was increased to 350 beds from March 1 to June 30. The bed days available are calculated as: 300 beds x 243 days = 72,900 (July 1- February 28) 350 beds x 122 days = 42,700 (March 1-June 30) Total bed days available= 72,900 + 42,700 = 115,600

Turnover Interval (TOI) (In Days)

Average period in days that an available bed remains empty between the discharge of one inpatient and the admission of the next.

TOI = Total number of inpatients bed X 365.25 - ALOS Total number of inpatient admissions

Nurse with Post Basic Training

A registered nurse with a degree/ diploma and has post basic training.

Nurse without Post Basic Training

A registered nurse with a degree/ diploma but without post basic training.

Community Nurse

A registered nurse with a certificate in nursing.

Assistant Medical Officer

A registered assistant medical officer with the Medical Assistant Board

Specialist

A registered medical practitioner with post-graduate qualification recognised by both the Ministry of Health and the Public Service Department Malaysia; and has the necessary core clinical competence and core procedural skills as expected of doctors with the responding recognised post- graduate qualification.

Resident

An in-house medical practitioner/specialist who is available to diagnose and treat patients at a hospital; and is a permanent staff in the establishment.

Visiting

A medical practitioner/specialist who is available to diagnose and treat patients in a hospital; but he/she is not a permanent staff. That medical practitioner may make regular visits (e.g. monthly/biweekly/weekly etc) to see patients in the hospital or is accessible on an ad-hoc or emergency basis only.

Computed Tomography Scanner (CT Scan)

Imaging equipment that uses a combination of x-rays and computer technology to produce detailed cross-sectional images (slices), both horizontally and vertically, of any part of the body.

Magnetic Resonance Imaging (MRI) unit

Imaging equipment that uses a combination of large magnets, radio frequencies and computer technology to produce detailed images of organs and structures within the body.

Positron Emission Tomography (PET)

Imaging equipment that comprises of multiple rings of detectors which record the emission of energy from radiotracers given to patients, and is LIST OF DEFINITIONS in turn, used to develop biologic images that reflect metabolic activities of cells. A pp x 1

111 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

OBSTETRICS CHAPTER

Delivery Bed

Any bed on which a delivery is conducted. It is not used for inpatient care. It would be possible to put a patient in lithotomy position on such a bed

Dedicated Maternity OT

A facility within a hospital that is designed and equipped with facilities to perform sterile surgical operations exclusively for obstetrics patients.

Obstetrics HDU

A facility that provides monitoring facilities for obstetric patients that would not normally be found in the wards. Ventilation of such patients would not be carried out in this facility.

Spontaneous Vertex Delivery (SVD)

An event whereby a pregnant woman goes into labour without the use of any drugs or techniques to induce labour and delivers the baby vaginally without any intervention.

Assisted Vaginal Breech Delivery

Delivery of the baby vaginally when the presenting part is either the buttock or foot.

Vacuum Assisted Vaginal Delivery

The use of a vacuum extractor to assist the mother to deliver the baby vaginally.

Forceps Assisted Vaginal Delivery

The use of forceps to assist the mother to deliver the baby vaginally

Lower Segment Caesarean Section (LSCS)

A surgical procedure in which a transverse incision is made in the lower uterine segment to deliver one or more babies.

Hysterotomy

A surgical procedure in which a vertical incision is made on the upper segment of the uterus to deliver one or more premature babies/ stillbirths when the lower uterine segment is not formed.

Caesarean Hysterectomies

A surgical procedure in which the uterus is removed following a caesarean section.

Multiple pregnancy

When a woman is pregnant with two or more foetuses.

Eclampsia

A complication during pregnancy or postpartum when a woman previously diagnosed with preeclampsia (elevated blood pressure with proteinuria) develops seizures or coma. Post partum refers to a period from time of delivery up to 42 days.

Primary PPH

The loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. 112 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Massive Post Partum Haemorrhage (PPH)

Blood loss of 1500mls and more within 24 hours of the birth of a baby.

Medical Officer

A registered medical practitioner who possesses an annual practicing certificate issued by the MMC and is working in the obstetrics and labour wards.

Staff Nurse/ Community Nurse with Midwifery Training in Obstetrics Wards

A nurse who is registered as a midwife with the Midwives Board Malaysia working in obstetrics wards.

Staff Nurse/ Community Nurse with Midwifery Training in Labour Wards

A nurse who is registered as a midwife with the midwives Board Malaysia working in labour wards.

Obstetrics Ward

A ward that provides care to antenatal and postnatal patients. There will be possibilities where other patients share the ward with postnatal patients.

Labour Ward

A ward that allows the monitoring of a pregnant mother in labour and provides facilities for the conduct of normal and instrumental deliveries as well as care of the newborn infant(s).

Maternity Home

Any premises, used or intended to be used for the reception of, and the provision of nursing care and midwifery in labour, or of women immediately after childbirth.

GENERAL SURGERY CHAPTER

Dedicated Emergency/ Trauma Theatre

A 24 hours operating theatre dedicated for emergency cases only. Excluded are OTs dedicated for emergency LSCS and orthopaedics emergency.

Elective Operating Hours / Month

Allocated elective GA/ regional block time for general surgery ● To include day care OT time ● To include Saturday OT time ● To exclude locum OT time ● To exclude time given to specialties outside general surgery

Elective Case

A planned, non-emergency surgical procedure performed either in main OT or day care OT.

GA Case

A case where anaesthesia is administrated by an anaesthetic team. This includes regional and plexus block.

LA Case

A case where anaesthesia is administrated as sedation, local anaesthetic or nerve block. Exclude blocks that are given by an anaesthetic team. LIST OF DEFINITIONS A pp x 1

113 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Emergency Case

A surgery that cannot be delayed, for which there is no other alternative and a delay could result in death or permanent impairment.

Mastectomy Surgery performed to remove the breast(s) with or without axillary clearance: ● To include surgery for gynaecomastia ● To include both benign and malignant cases ● To exclude breast lumpectomy, wide excision, breast hook wire surgery and other breast conservative surgery

Endoscopic Procedure

OGDS and colonoscopy cases including diagnostic and therapeutic scopes regardless of the type of anaesthesia and where it is performed. ● By the surgical team: Performed by general surgeons or; ● By the medical team: Performed by gastroenterologists / physicians

General Surgeon

● Includes: The general, breast, breast & endocrine, upper, gastrointestinal, colorectal, vascular, hepatobilliary, trauma and thoracic surgery. ● Excludes: Paediatric surgeon, plastic surgeon, urology, neuro surgeon, cardiothoracic surgeon, ENT surgeon, ophthalmologist, gynaecologist, orthopaedic surgeon and dental /maxillofacial surgeon.

Permanent/ Resident General Surgeon

An in-house general surgeon who is available to diagnose and perform surgery in the hospital and is a permanent staff. It only includes surgeons who are officially gazetted as of 31/12/2011, and does not include surgeons who are still under gazzetment.

Visiting General Surgeon

A surgeon who is available to diagnose and perform operation at a hospital; but he/she is not a permanent staff at the hospital. The surgeon may make regular visits (e.g. monthly/ weekly/ biweekly) to see patients in the hospital or is accessible only on an ad-hoc or emergency basic. Exclude the visiting surgeon from other subspecialty.

Theatre Scrub Nurse

Includes all scrub nurses (including matron & sister) working in the OT’s in the hospital. Exclude GA/anaesthetic nurses ● For HKL, only scrub nurses from main OT. To exclude scrub nurse from Urology, Emergency Department, Paediatric, Neurology and Maternity OTs.

Functioning OGDS/ Colonoscopy/ ERCP

Functioning devices that were used in daily procedures at the participating hospitals. It excludes: i. Equipment deemed as in Beyond Economic Repair (BER) or ii. Equipment which, although were still in working condition, were non-operational (not used) at the hospital.

ONCOLOGY CHAPTER

Clean Room for Reconstitution of Cytotoxic Drug

A room with highly regulated air quality, temperature and humidity to reduce contamination (microorganism and particulates) and designated for preparation of sterile cytotoxic drugs.

Outsource

Outsourcing of cytotoxic drugs reconstitution outside the hospital where chemotherapy is given.

114 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chemotherapy Day Care

Practice of planned admission to provide diagnostic and therapeutic services within the day of admission. This can include chemotherapy and other drugs given on the same day.

Cytotoxic Drug Reconstitution (CDR)

The process of preparing the cytotoxic drugs into a form ready for use.

Cytotoxic Drug Reconstitution (CDR) Isolator

A closed room in which preparation of chemotherapy is done under controlled conditions.

Simulation Time

Simulation is a treatment planning step and not an actual radiation therapy treatment. The simulation procedure is generally done by Therapists (specially trained technologists) under the supervision of the Radiation Oncologist

Palliative Radiotherapy

Radiotherapy given in one field or more with simple or conformal technique. Treatment intent is palliation.

Radical/ Adjuvant Radiotherapy

Radiotherapy given by simple or conformal technique. Treatment intent is curative.

Oncology Trained Nurse

A nurse who have undergone training in post basic oncology.

Radiation Therapist

A person who performs medical radiation procedures and applies ionizing radiation, to any part of the human body, for radiotherapy imaging and therapeutic purposes. The radiation therapist shall hold a recognised qualification in radiotherapy or other related fields that is approved by the appropriate authority and the qualifications shall be in the same field for which the duties are performed.

Physicist

A person who has qualifications of, and has undergone accredited training in the application of the principles of physics to imaging and/or therapeutic radiation as approved by the appropriate authority. The medical physicist performing medical physics duties for a facility shall have adequate experience in the same fields for which the duties are performed.

Megavoltage Machine

A high energy machine with energy greater than 1000 kilovolts. A machine that uses electricity to form a stream of fast-moving subatomic particles that creates high-energy radiation that may be used to treat cancer. Commonly used megavoltage machines includes tomography, linear accelerator, cyber knife and cobalt 60.

Brachytherapy Machine

Brachytherapy (internal radiation therapy) is delivered by placing radiation source(s) inside or next to the area requiring treatment. To include low dose radiation (LDR) and High Dose Radiation (HDR).

Simulator LIST OF DEFINITIONS Includes either conventional simulator/ CT simulator A pp x 1

115 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Physics Equipment

All types of measuring tools used in testing the performance of radiation equipment and data commissioning.

Examples:

● Water-phantom/solid water ● Ionization chambers, electrometer ● QA devices (for linac, HDR and imaging systems) ● Survey meter ● In vivo dosimetry equipment

Treatment Planning System

A treatment planning system that consists of a hardware package and a software package. It enables the input of patient data, the anatomy definition, beam set-up, the dose distribution calculation, the plan evaluation in terms of dose, volume, biological effect and the output for documentation and transfer to other units (simulator, record and verify system, treatment machine).

Examples:

● Full-capacity external beam/ brachytherapy/ RT planning system ● DICOM connections to receive images from the in-house CT, linac’s CBCT, and from outside imaging centres, to directly transfer planning parameters to the record/ verification electronic charting system ● Remote planning capability, allowing physicians, physicists and dosimetrists to review and participate in the planning process remotely.

PSYCHIATRY CHAPTER

Dedicated Bed

A bed that is readily available to take in only psychiatric patients

Bed Occupancy Rate

The percentage of inpatient beds occupied for a given period of time. Also known as the percentage of occupancy,

BOR = (Inpatient Days of Care / Bed Days Available) x 100

Where: ● Inpatient Days of Care: Sum of each daily inpatient census for the given period. ● Beds denote inpatient beds that are set up, staffed and available for care. ● Bed Days Available: The maximum number of inpatient days of care that would have been provided if all beds were filled during the given period and takes into account changes in the number of beds available for use during the same period.

For example,

Hospital X had 300 beds from July 1 to Feb 28. The number of beds in services was increased to 350 beds from March 1 to June 30. The bed days available are calculated as: ● 300 beds x 243 days = 72,900 (July 1-February 28) ● 350 beds x 122 days = 42,700 (March 1-June 30) ● Total bed days available = 72,900 + 42,700 = 115,600

Total Number of Admissions

Includes patients admitted to non psychiatric ward with co-existing psychiatric indications.

116 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Community Psychiatric Services

Psychiatric services provided in the community or homes of patients.

Psychiatric Rehabilitation

Activities carried out with psychiatric patients to achieve optimum functions.

Methadone Clinic

An outpatient programme that give opioid dependent individuals controlled access to methadone for the purpose of treating their dependence and/or for harm reduction

Clinical Psychologist

One with Masters or doctorate in Clinical Psychology.

Common User

Services used by other department besides psychiatry.

Medical Social Worker

One with degree or diploma in social work.

Community Nurse

A registered nurse with a certificate in nursing.

ECT Procedures

One application of ECT refers to one procedure.

Outpatient Psychiatry

ECT administered to patients who are registered as outpatients.

Inpatient Psychiatry

ECT administered to patients admitted to the ward.

Outpatient Follow Up

To exclude methadone patients coming for methadone supply and only depot injection.

New Cases

All patient seen and first clerked (all ages) at psychiatric clinic excluding those for drug certification, referrals from ward and emergency department and methadone patients.

OPHTHALMOLOGY CHAPTER

Functional Operating Room

An operating room which is readily available to take in patients and provide the level of care according to the equipment and nurses available for that operating room.

Number of Elective Operating Hours (4 week month)

Allocated elective local/ general anaesthesia for ophthalmic surgery which includes visiting surgeons/ Saturday OT.

Cataract Surgery LIST OF DEFINITIONS Cataract surgery is the removal of the natural lens of the eye (also called “crystalline lens”) that has developed an opacification. To include both adult and paediatric patients. A pp x 1

117 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Day Care

Services provided for patients who undergo treatment for less than 24 hours and do not require admission to a hospital and allowed to go home in the same day.

Glaucoma Surgery

A filtering surgery that reduces intraocular pressure (IOP) with implant (drainage device) or without implant (trabeculectomy).

Vitreoretinal Surgery

Any surgical procedure that involves the retina, macula, and vitreous. It includes: posterior vitrectomy for any indication, retinal detachment repair that includes sclera buckle and pneumatic retinopexy.

Diabetic Retinopathy

A common complication of diabetes affecting the blood vessels in the retina.

Optometrist

A registered eye care professional who is registered under the Optical Act 1991 and provides vision care.

Allied Health Personnel

Medical personnel, a nurse and an assistant medical officer who is dedicated and trained to assist in the provision of ophthalmology.

Allied Health Personnel With Post-Basic In Ophthalmology

Allied health personnel who have obtained certification in a post basic ophthalmology.

Operating Microscopes

An optical microscope specifically designed to be used in a surgical setting, typically to perform microsurgery.

Phacoemulsification Machine

A machine which uses ultrasound wave length to remove the cataract.

Posterior Vitrectomy Machine

A machine used for vitreoretinal surgery which may be in combination with a phacoemulsification machine. If it is in a combination machine it is considered as a posterior vitrectomy machine.

Automated Perimetry Device

Systematic measurement of differential light sensitivity in the visual field by the detection of the presence of test targets on a defined background by an automated device.

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APPENDIX 2 | PARTICIPANTS FOR NHEWS (HOSPITAL) 2011

HOSPITAL SECTOR: PUBLIC/ MINISTRY OF HEALTH

Perlis 1. Hospital Tuanku Fauziah, Kangar

Wilayah Persekutuan Putrajaya 1 Hospital Putrajaya

Wilayah Persekutuan Labuan 1 Hospital Labuan

Wilayah Persekutuan Kuala Lumpur 1 Institute of Respiratory Medicine 2 Hospital Kuala Lumpur

Melaka 1 Hospital Jasin 3 Hospital Melaka 2 Hospital Alor Gajah

Pulau Pinang 1 Hospital Balik Pulau 4 Hospital Pulau Pinang 2 Hospital Bukit Mertajam 5 Hospital Seberang Jaya 3 Hospital Kepala Batas 6 Hospital Sungai Bakap

Negeri Sembilan 1 Hospital Jelebu 4 Hospital Tampin 2 Hospital Jempol 5 Hospital Tuanku Jaafar, Seremban 3 Hospital Port Dickson 6 Hospital Tuanku Ampuan Najihah, Kuala Pilah

Terengganu 1 Hospital Besut 4 Hospital Kemaman 2 Hospital Dungun 5 Hospital Setiu 3 Hospital Hulu Terengganu 6 Hospital Sultanah Nur Zahirah, Kuala Terengganu

Kelantan 1 Hospital Gua Musang 6 Hospital Raja Perempuan Zainab II, Kota Bharu 2 Hospital Jeli 7 Hospital Tanah Merah 3 Hospital Kuala Krai 8 Hospital Tengku Anis, Pasir Puteh

4 Hospital Machang 9 Hospital Tumpat 5 Hospital Pasir Mas

Kedah 1 Hospital Baling 6 Hospital Sik 2 Hospital Jitra 7 Hospital Sultan Abdul Halim, Sungai Petani

3 Hospital Kuala Nerang 8 Hospital Sultanah Bahiyah, Alor Setar 2011 FOR NHEWS (HOSPITAL) PARTICIPANTS 4 Hospital Kulim 9 Hospital Yan

5 Hospital Langkawi A pp x 2 119 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

HOSPITAL SECTOR: PUBLIC/ MINISTRY OF HEALTH

Selangor

1 Hospital Ampang 6 Hospital Tengku Ampuan Rahimah, Klang 2 Hospital Banting 7 Hospital Serdang 3 Hospital Kuala Kubu Bharu 8 Hospital Sungai Buloh 4 Hospital Selayang 9 Hospital Tanjong Karang 5 Hospital Tengku Ampuan Jemaah, Sabak Bernam 10 Hospital Kajang

Pahang

1 Hospital Bentong 6 Hospital Pekan 2 Hospital Jengka 7 Hospital Raub 3 Hospital Jerantut 8 Hospital Sultan Haji Ahmad Shah, Temerloh 4 Hospital Kuala Lipis 9 Hospital Tengku Ampuan Afzan, Kuantan 5 Hospital Sultanah Hajjah Kalsom, 10 Hospital Muadzam Shah, Rompin Tanah Rata Cameron Highlands

Johor

1 Hospital Batu Pahat 7 Hospital Sultanah Aminah, Johor Bahru 2 Hospital Kluang 8 Hospital Sultanah Fatimah Specialist, Muar 3 Hospital Sultan Ismail, Johor Bahru 9 Hospital Kota Tinggi 4 Hospital Mersing 10 Hospital Tangkak 5 Hospital Pontian 11 Hospital Segamat 6 Hospital Temenggung Seri Maharaja Tun Ibrahim, Kulai

Perak

1 Hospital Batu Gajah 8 Hospital Seri Manjung 2 Hospital Changkat Melintang 9 Hospital Slim River 3 Hospital Gerik 10 Hospital Sungai Siput 4 Hospital Raja Permaisuri Bainun, Ipoh 11 Hospital Taiping 5 Hospital Kampar 12 Hospital Tapah 6 Hospital Kuala Kangsar 13 Hospital Teluk Intan 7 Hospital Parit Buntar 14 Hospital Selama

Sarawak

1 Bau District Hospital 12 2 Betong Hospital 13 Mukah Hospital 3 Sri Aman Hospital 14 Saratok Hospital 4 15 Serian Hospital 5 Daro Hospital 16 6 Kanowit Hospital 17 Simunjan Hospital 7 Kapit Hospital 18 Rajah Charles Brooke Memorial Hospital 8 Lawas District Hospital 19 Sarawak General Hospital 9 Limbang Hospital 20 Sarikei Hospital 10 Lundu District Hospital 21 Dalat Hospital 11 Marudi Hospital

120 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

HOSPITAL SECTOR: PUBLIC/ MINISTRY OF HEALTH

Sabah

1 Beaufort Hospital 13 Queen Elizabeth Hospital, Kota Kinabalu 2 Beluran Hospital 14 Ranau Hospital 3 , Sandakan 15 Semporna Hospital 4 Keningau Hospital 16 Sipitang Hospital 5 Kinabatangan Hospital 17 Tambunan Hospital 6 Kota Belud Hospital 18 Tawau Hospital 7 Kota Marudu Hospital 19 Tenom Hospital 8 Kudat Hospital 20 Tuaran Hospital 9 Kunak Hospital 21 Pitas Hospital 10 Lahad Datu Hospital 22 Kuala Penyu Hospital 11 Likas Hospital 23 Queen Elizabeth II Hospital 12 Papar Hospital

HOSPITAL SECTOR: PUBLIC/ MINISTRY OF HEALTH/ PSYCHIATRIC INSTITUTION

1 Hospital Bahagia, Ulu Kinta, Perak 3 Hospital Permai, Johor 2 Sentosa Hospital, Sarawak 4 Mesra Hospital, Bukit Padang, Sabah

HOSPITAL SECTOR: PUBLIC/ UNIVERSITY

1 Universiti Kebangsaan Malaysia Medical Center (UKMMC), WPKL 3 Universiti Sains Malaysia Hospital, Kubang Kerian, Kelantan

2 University Malaya Medical Center (UMMC), WPKL

HOSPITAL SECTOR: PUBLIC/ JABATAN KEMAJUAN ORANG ASLI

1 Hospital Kemajuan Orang Asli, Selangor

HOSPITAL SECTOR: PRIVATE

Terengganu

1 Kuala Terengganu Specialist Hospital

Kelantan

1 Perdana Specialist Hospital 3 Pusat Perubatan An-Nisa’ 2 Kota Bharu Medical Center

Melaka

1 Putra Specialist Hospital (Melaka) 3 Mahkota Medical Center 2011 FOR NHEWS (HOSPITAL) PARTICIPANTS 2 Pantai Hospital, Ayer Keroh 4 Damai Medical and Heart Clinic A pp x 2

121 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Pahang 1 Kuantan Medical Center 5 Pusat Rawatan Keluarga MUIP Sdn. Bhd. 2 Kuantan Specialist Hospital 6 Darul Makmur Medical Centre Sdn. Bhd. 3 Dr S.T. Chong, Maternity and Surgery 7 Sethu Medical Centre 4 W. Y. Ko Specialist Maternity and Gynaecology Center 8 Klinik Pakar Wanita Chan

Sabah

1 Tawau Maternity and Specialist Hospital 3 Kota Kinabalu Specialist Center 2 Sabah Medical Center (A Member of KPJ Healthcare Berhad) SMC Healthcare

Negeri Sembilan

1 Columbia Asia Extended Care, Seremban 4 Columbia Asia Medical Center, Seremban 2 National Cancer Institute (NCI) Hospital 5 Seremban Specialist Hospital 3 Senawang Specialist Hospital

Perak

1 Columbia Asia 7 Yeak Maternity & Gynae Center 2 Fatimah Hospital 8 Klinik Yasmin/Klinik Bersalin Yasmin 3 Taiping Medical Center 9 Kinta medical Centre Sdn. Bhd. 4 KPJ Ipoh Specialist Hospital 10 Pusat Perubatan UNIKL-RCMP 5 Tan Specialist Maternity Centre 11 Sejati Maternity & Specialist Centre 6 Pusat Perubatan Ar-Ridzuan 12 Perak Community Specialist Centre

Kedah

1 Kedah Medical Center 5 Wisma Pakar Perbidanan & Sakit Puan 2 INS Specialist Center 6 Metro Specialist Hospital 3 Pusat Pakar Amanjaya 7 Chang & Koh Maternity & Fertility Center 4 Putra Medical Center 8 Pantai Hospital, Sg. Petani

Sarawak

1 Kuching Specialist Hospital 6 Columbia Asia Hospital-Miri 2 Rejang Medical Center 7 Normah Medical Specialist Center 3 Miri City Medical Center 8 Helen Ngu Women Hospital 4 Timberland Medical Center 9 Columbia Asia Hospital-Bintulu 5 Sibu Specialist Medical Center 10 Teo’s Maternity Center

HOSPITAL SECTOR: PRIVATE

Pulau Pinang 1 Island Hospital 6 Public Specialist Center 2 Pantai Hospital Pulau Pinang 7 K.S. Wan & Liow Specialist Maternity Center 3 Lam Wah Ee Hospital 8 Loh Guan Lye Specialists Center 4 Mount Miriam Cancer Hospital 9 Pulau Pinang Adventist Hospital 5 Tan & Tan Specialist Maternity & Gynaecology Center (Adventist Hospital & Clinic Services (M)

122 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Johor

1 Columbia Asia Hospital, Nusajaya 9 Tan Klinik Pakar Perbidanan 2 Pantai Hospital, Batu Pahat 10 Ng Specialist Maternity 3 Penawar Hospital 11 Pusat Pakar Perbidanan & Sakit Puan Raja 4 Puteri Specialist Hospital 12 Hoo Specialists Maternity & Surgery 5 KPJ Johor Specialist Hospital 13 Johor Jaya Maternity Center 6 Waqaf An-Nur Hospital, Pasir Gudang 14 Kluang Utama Specialist Hospital 7 Loke Specialist Maternity Center 15 Century Specialist Maternity 8 Pelangi Medical Centre Sdn. Bhd. 16 Kempas Medical Centre

Wilayah Persekutuan Kuala Lumpur

1 Prince Court Medical Center 11 Gleneagles Hospital, Kuala Lumpur 2 Hospital Pakar KPJ Tawakal (KPJ Tawakal Specialist Hospital) 12 Institut Jantung Negara Sdn Bhd 3 Tung Shin Hospital 13 University Malaya Specialist Center (UMSC) 4 Lourdes Medical Center 14 Kuala Lumpur Sports Medicine Center (KLSMC) 5 Al-Islam Specialist Hospital 15 Pudu Specialist Centre Sdn. Bhd. 6 Pantai Hospital, Cheras 16 Cheras Specialist Maternity Center 7 Pantai Hospital, Kuala Lumpur 17 Dato Harnam E.N.T. Specialist Clinic 8 Damai Service Hospital (HQ) 18 Sentul Medical Centre 9 Sentosa Medical Center Sdn. Bhd. 19 IHEAL Medical Centre Kuala Lumpur 10 Coop Medical Center (Sambhi Clinic) 20 Universiti Kebangsaan Malaysia Specialist Center (UKMSC)

Selangor

1 KPMC Puchong 17 KPJ Damansara Specialist Hospital 2 Columbia Asia Hospital Puchong 18 Sime Darby Medical Center Subang Jaya 3 Hospital Pusrawi SMC 19 Hospital Pakar An-Nur Hasanah Sdn Bhd 4 Az-Zahrah Islamic Medical Center 20 KPJ Ampang Puteri Specialist Hospital 5 Sunway Medical Center 21 Klinik Pakar Wanita & Bersalin Subang Permai 6 Arunamari Specialist Medical Center 22 Pusat Pakar Wanita Dan Bersalin Selayang 7 KPJ Selangor Specialist Hospital 23 KPJ Kajang Specialist Hospital 8 Tun Hussein Onn National Eye Hospital 24 Wijaya International Medical Center 9 Pantai Hospital, Ampang 25 Klinik Pakar Bersalin & Bedah Serendah 10 Sri Kota Specialist Medical Center 26 Darul Aiman Sdn. Bhd. (Putra Medical Centre) 11 Columbia Asia Hospital – Cheras 27 Klinik Pakar wanita Sheela Sdn. Bhd. 12 Columbia Asia Bukit Rimau 28 DEMC Specialist Hospital, Shah Alam 13 Metro Maternity Sdn. Bhd 29 Pusat Perubatan Kohilal Sdn. Bhd. 14 Pusat Perubatan Damansara Damai 30 Hospital Bersalin Razif 15 Columbia Asia Extended Care Hospital 31 Pantai Hospital Klang 16 Assunta Hospital 32 Klinik Pakar Wanita & Keluarga Kapar Indah

HOSPITAL SECTOR: PRIVATE/ MATERNITY HOMES

1 Klinik Rawatan Keluarga, Terengganu 6 Pusat Perubatan Intan Sdn. Bhd., Terengganu 2 St. Joseph Maternity Home, Sabah 7 Pusat Rawatan Mahsuri, Kedah 3 Wisma Bersalin Ikhwan, Selangor 8 Hospital Wanita Metro, Selangor PARTICIPANTS FOR NHEWS (HOSPITAL) 2011 FOR NHEWS (HOSPITAL) PARTICIPANTS 4 Poliklinik Dan Surgeri Wanita, WPKL 9 Klinik Wanita Mentakab, Pahang

5 Poliklinik Kotaraya & Klinik Pakar Wanita, Selangor 10 Klinik Dan Rumah Bersalin Nor, Selangor A pp x 2

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APPENDIX 3 | MALAYSIAN POPULATION, 2011

Table A3.1 Total Population by State, Malaysia 2011 Source Population Malaysia 28,964,300 Selangor 5,577,400 Johor 3,401,800 Sabah 3,316,400 Sarawak 2,516,200 Perak 2,397,600 Kedah 1,973,100 WPKL 1,694,500 Kelantan 1,615,200 Pulau Pinang 1,593,600 Pahang 1,524,800 Terengganu 1,074,000 Negeri Sembilan 1,042,900 Melaka 833,000 Perlis 237,500 WP Labuan 89,800 WP Putrajaya 76,400

Source: Department of Statistics, Malaysia, 2011

Table A3.2 Total Population of Female by State, Malaysia 2011 Source Population Malaysia 14,052,300 Selangor 2,686,600 Johor 1,608,700 Sabah 1,589,900 Sarawak 1,213,900 Perak 1,184,700 Kedah 976,100 WPKL 829,600 Kelantan 804,300 Pulau Pinang 794,400 Pahang 715,400 Terengganu 526,100 Negeri Sembilan 504,300 Melaka 413,600 Perlis 120,700

WP Labuan 43,500 2011 POPULATION, MALAYSIAN WP Putrajaya 40,600 A pp x 3 Source: Department of Statistics, Malaysia, 2011 125 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A3.3 Number of Live Birth by State, Malaysia 2011 Source Population Malaysia 494,601 Selangor 98,519 Johor 56,473 Sabah 52,321 Sarawak 41,986 Kelantan 36,609 Perak 36,447 Kedah 34,816 WP Kuala Lumpur 26,227 Pahang 26,167 Terengganu 24,016 Pulau Pinang 21,747 Negeri Sembilan 17,118 Melaka 13,553 Perlis 4,035 WP Putrajaya 2,881 WP Labuan 1,686

Source: Department of Statistics, Malaysia, 2011

Table A3.4 Total Population Under 19 Years Old by State, Malaysia 2011 Source Population Malaysia 10,599,000 Selangor 1,810,800 Sabah 1,309,300 Johor 1,208,100 Sarawak 960,200 Perak 876,500 Kedah 768,900 Kelantan 736,700 Pahang 610,300 WP Kuala Lumpur 505,700 Pulau Pinang 495,100 Terengganu 472,900 Negeri Sembilan 381,900 Melaka 306,200 Perlis 92,500 WP Labuan 34,900 WP Putrajaya 29,100

Source: Department of Statistics, Malaysia, 2011

126 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A3.5 Total Population above 60 Years Old by State, Malaysia 2011 Source Population Malaysia 2,338,300 Selangor 347,900 Perak 289,100 Johor 287,300 Sarawak 217,600 Kedah 189,700 Pulau Pinang 165,900 Sabah 150,400 Kelantan 140,800 WP Kuala Lumpur 132,000 Pahang 127,600 Negeri Sembilan 96,500 Melaka 81,900 Terengganu 80,900 Perlis 25,900 WP Labuan 3,700 WP Putrajaya 1,000 Source: Department of Statistics, Malaysia, 2011 MALAYSIAN POPULATION, 2011 POPULATION, MALAYSIAN A pp x 3

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APPENDIX 4 | DATA QUALITY STATEMENT

NHEWS 2011 Quality Statement – General (Multiple Sources of Data)

Data Source: National Healthcare Establishment and Workforce Statistics Institutional Environment Data Collector(s): The data was collected by the Health Statistics Unit (HSU) of the National Clinical Research Centre (CRC) Malaysia.

Collection authority: Public hospitals and clinics under the jurisdiction of the Medical Development and Family Health Development Divisions were directed by the Ministry of Health (MOH) to provide access to available data and participate in this survey.

For private healthcare establishments, legal authorities for the collection of such data by the MOH are provided by, where applicable, the Private Healthcare Facilities and Services Act 1998 and Control of Drugs & Cosmetics Regulation 1984. The relevant Regulatory authorities in the MOH are the Medical Practice Division, National Pharmaceutical Control Bureau and Medical Device Bureau respectively. They have designated the CRC as their data collection agency.

Data Compiler(s): The data was compiled by the same organization that collected the data.

Additional information: Statistical confidentiality was maintained by ensuring that the information provided is: - Securely maintained - Used only for statistical purposes - Not inadvertently revealed in any published literature - Used safely as unidentifiable micro-data to support research and analysis

Any identified data error will be notified to the public and data user through an online notice published on the organization website where the report and data is posted. All effort will be made to ensure any data error is corrected within 5 working days and be re-released. All key data users will be specifically notified through email or telephone. Relevance Data topic: The data represents all acute curative hospitals and specified health services of both the private and public sectors within Malaysia for 2011. Health services included General Surgery, Ophthalmology, Psychiatry, Oncology and Maternity.

Level of geography: Data is available by state/region.

Key Data Items: The key data items produced from this collection include the facility, device, activity and workforce of the identified healthcare services for 2011.

Numerator/Denominator Source: Numerators and denominators of all the rates, percentages and densities was derived from the same data source and auxiliary sources e.g. vital statistics and population census obtained from the Malaysia Department of Statistic (DOS)

Additional information: Healthcare establishment and workforce data was collected to assist in evidence based health policy planning and projection.

The data is a measure of acute curative healthcare establishment characteristic and status of the above specified health services in term of facility, activity, device and workforce. Related healthcare facilities not included in this survey were:

1. Private stand-alone eye surgery centres (Ophthalmology Chapter) 2. Health establishments of Non-governmental Organizations (NGO) (Hospital Chapter) DATA QUALITY STATEMENT DATA Key variables have been defined in this survey to assist in data standardization. However, no standard international coding or classification has been used due to technical and capacity limitations. A pp x 4

129 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Data Source: National Healthcare Establishment and Workforce Statistics

Timeliness Data collected: The data is collected annually after the end of each calendar year.

Data available: The data collection is done from July-September. This is followed by data cleaning, validation and verification between September-December. The report will be signed and released by the Ministry of Health by July of the next calendar year.

Referenced Period: The data reference period is from 1st-Jan-2011 to 31st-Dec-2011

Additional information: Updates or revisions of the data may have to be done because new information may become available during the preparation of the report.

Accuracy Method of Collection: The data was collected using either printed or online survey questionnaires. These were distributed to all related healthcare establishments listed under the Ministry of Health and Private Hospital Registry.

Data Adjustments: The data was adjusted to account for item and/or unit non-responses by using imputation (logical, conditional and regressing) and weighting methods. Percentages (%) of item and unit non-response for each survey are presented below:

% ITEM % UNIT NON- NO. SURVEY CHAPTER NON-RESPONSE RESPONSE 1 Acute curative hospital establishment survey 22.1 0.6 2 Maternity services survey 18.6 0.9 3 General surgical services survey 14.5 2.9 4 Ophthalmology services survey 8.2 0.9 5 Psychiatry services survey 4.3 2.7 6 Oncology services survey 0 0

Logical and conditional imputation based on reasonable assumption was used to replace missing data. Regression imputation was used for the remaining missing data which had a 5% or less missing rate. Despite these efforts, certain variables were found to have a higher missing rate than expected. Caution will be needed when interpreting these estimates due to their inaccuracy. Percentages of missing values and the imputation status for each variable can be found at Appendix 6.

Collection size: This census survey includes all 337 registered acute curative hospitals, 26 private maternity homes and 4 public psychiatry institutions within the country.

Under and over counts: Undercounts for particular variables will not be known until a post enumeration survey is conducted to measure how effective the original survey was. The information from the post enumeration survey will help the collector to weight the data better in order to compensate for the missing sample/non-respondent. The information will also allow for an improved method for the next enumeration period to better capture the population that were undercounted.

Additional information: Any sensitive question or topics that may have the potential to cause bias was not collected. Manual data cleaning, review and verification with source personnel and automated data validation is undertaken to minimize processing errors. All hospitals in the country fulfilling the inclusion criteria were accounted for in this survey.

130 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Data Source: National Healthcare Establishment and Workforce Statistics

Coherence Consistency over time: Similar survey methods have been used for this survey in 2009 and 2010. However, the definition of certain health services and key variables has been revised in the present survey to allow for a more practical and reflective interpretation. These changes may have affected the value of certain variables collected and, any comparisons with previous years must be treated with caution.

Consistency of jurisdictions: The data consistency between establishments, state and region has not been formally assessed in this survey. For example, number of spontaneous vertex delivery has shown some discrepancy in interpretation; some establishments consider twin delivery to be 2 spontaneous vertex deliveries whereas some consider it to be one.

Numerator/ denominator: The impact of the differences between the criteria for numerators and denominators was minor in most cases. Data produced from this survey is of cross-sectional nature. No time series data was collected.

Additional information: There were no significant changes of the mode of data collection compared to the previous year. Further, there were no real world events regionally or locally that may have had an impact on the data since the last report.

Data from the Health Informatics Centre (HIC) of the Ministry of Health are broadly comparable with the data collected in this survey. HIC’s data are routine data submitted monthly and directly to the HIC centre by the healthcare establishments. However, certain data may not be directly comparable because of the differences in definition and in different inclusion and exclusion criteria. Furthermore, additional data have been collected in greater detail in this survey in order to answer specific health policy questions. Please refer to the survey questionnaire for more details on the specific survey questions.

Besides the routine monthly data collected by HIC, no other similar information or data source are available at the national level.

Interpretability Context: Due to the alterations of certain important definitions in this report, any increase or decrease reported may not reflect the actual situation. Specific issues related to this area have been discussed in the limitation sections of each chapter.

Other supporting information: Please refer to the data dictionary, revised methodology section and the discussion of limitation of each chapter for a better understanding of this data source.

Accessibility Contact details: Healthcare Statistics Unit Clinical Research Centre 3rd Floor, MMA House 124 Jalan Pahang 53000 Kuala Lumpur Malaysia. Phone: +603-4043 9300 Fax: +603- 4043 9500 Email: [email protected] Website: http://www.crc.gov.my/nhsi

Additional information: Anonymous data is available in spreadsheet format on request for custom analysis. A printed report will be mailed to all related hospital administrators upon publishing. Soft copy reports can be downloaded at http://www.crc.gov.my/nhsi

Training courses on analysing and interpreting NHSI data can be provided if required.

For further information please contact:

Name: Health Statistics Unit Telephone Number: +603-40439300 Email Address: [email protected] DATA QUALITY STATEMENT DATA A pp x 4

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APPENDIX 5 | SURVEY PROFILES AND RESPONSE RATES Chapter 2: Hospital Services in Malaysia

Table A5.1 Outcome Variables with Missing Data and Imputation Methods for Hospital Services, 2011 PERCENTAGE (%) with Outcome variable Imputation missing values Type of Establishment 0 -

Entrepreneurship 0 -

Total Number of Gazetted Inpatient Beds 0 -

Total Number of Functioning Gazetted Inpatient Beds 1 Yes

Total Number of Non Gazetted Inpatient Beds 2 Yes

Total Number of Inpatient Admissons 1 Yes

Total Number of Operation Theatre, OT 1 Yes

Total Number of Operation Room, OR 1 Yes

Total Number of Functioning Operation Room, OR 1 Yes

Total Number of Medical Doctors 0 -

ALOS 1 Yes

Bed Occupancy Rate 1 Yes

Turnover Interval 1 Yes

Total Number of CT Scanner 0 -

Total Number of CT Scan Procedures Performed 17 Yes

Total Number of MRI Scanner 0 -

Total Number of MRI Scan Procedures Performed 13 Yes

Total Number of PET Scanner 0 -

Total Number of PET Scan Procedures Performed 1 Yes

Total Number of Nurses with Post Basic Training 2 Yes

Total Number of Nurses without Post Basic Training 3 Yes

Total Number of Community Nurses 0 Yes

Total Number of Assistant Nurses 1 Yes

Total Number of Assistant Medical Officer with Post Basic Training 0 Yes

Total Number of Assistant Medical Officer without Post Basic Training 0 Yes

Total Number of Pharmacists 0 Yes

Total Number of Physiotherapists 0 Yes

Total Number of Occupational Therapists 0 Yes

Total Number of Dieticians 0 Yes

Total Number of Medical Record Officers 0 Yes AND RESPONSE RATES SURVEY PROFILES

Total Number of Medical Social Officers 0 Yes A pp x 5

133 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A5.2 Number and Rate of Respondents by State and Sector for Hospital Services, 2011 Respondent Non Respondent State Sector Total Number % Number % Malaysia Public 134 100.00 0 0.00 134 Malaysia Private 130 63.41 75 36.59 205 Malaysia Total 264 77.88 75 22.12 339 Perlis Public 1 100.00 0 0.00 1 Perlis Private na na na na na Perlis Total 1 100.00 0 0.00 1 Kedah Public 9 100.00 0 0.00 9 Kedah Private 8 88.89 1 11.11 9 Kedah Total 17 94.44 1 5.56 18 Kedah & Perlis Public 10 100.00 0 0.00 10 Kedah & Perlis Private 8 88.89 1 11.11 9 Kedah & Perlis Total 18 94.74 1 5.26 19 Pulau Pinang Public 6 100.00 0 0.00 6 Pulau Pinang Private 9 40.91 13 59.09 22 Pulau Pinang Total 15 53.57 13 46.43 28 Perak Public 14 100.00 0 0.00 14 Perak Private 12 75.00 4 25.00 16 Perak Total 26 86.67 4 13.33 30 Selangor & WP Putrajaya Public 11 100.00 0 0.00 11 Selangor & WP Putrajaya Private 31 63.27 18 36.73 49 Selangor & WP Putrajaya Total 42 70.00 18 30.00 60 WP Kuala Lumpur Public 4 100.00 0 0.00 4 WP Kuala Lumpur Private 19 52.78 17 47.22 36 WP Kuala Lumpur Total 23 57.50 17 42.50 40 Selangor & WP Putrajaya & WPKL Public 15 100.00 0 0.00 15 Selangor & WP Putrajaya & WPKL Private 50 58.82 35 41.18 85 Selangor & WP Putrajaya & WPKL Total 65 65.00 35 35.00 100 Negeri Sembilan Public 6 100.00 0 0.00 6 Negeri Sembilan Private 5 55.56 4 44.44 9 Negeri Sembilan Total 11 73.33 4 26.67 15 Melaka Public 3 100.00 0 0.00 3 Melaka Private 4 100.00 0 0.00 4 Melaka Total 7 100.00 0 0.00 7 Johor Public 11 100.00 0 0.00 11 Johor Private 16 53.33 14 46.67 30 Johor Total 27 65.85 14 34.15 41 Pahang Public 10 100.00 0 0.00 10 Pahang Private 8 88.89 1 11.11 9 Pahang Total 18 94.74 1 5.26 19 Terengganu Public 6 100.00 0 0.00 6 Terengganu Private 1 100.00 0 0.00 1 Terengganu Total 7 100.00 0 0.00 7 Kelantan Public 10 100.00 0 0.00 10 Kelantan Private 3 100.00 0 0.00 3 Kelantan Total 13 100.00 0 0.00 13 Sabah & WP Labuan Public 23 100.00 0 0.00 23 Sabah & WP Labuan Private 4 80.00 1 20.00 5 Sabah & WP Labuan Total 27 96.43 1 3.57 28 Sarawak Public 20 100.00 0 0.00 20 Sarawak Private 10 83.33 2 16.67 12 Sarawak Total 30 93.75 2 6.25 32 Abbreviation: na – not applicable 134 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 3: Maternity Services in Malaysian Hospitals and Maternity Homes

Table A5.3 Outcome Variables with Missing Data and Imputation Methods for Maternity Services, 2011 PERCENTAGE (%) with Outcome variable Imputation missing values 0 (respondent), 45 Total Number of Delivery Beds Yes (Non -respondent) Number of Hospital with OT Facilities 0 - Total Number of Functioning OR 0 - Number of Hospital HDU/ICU within the O&G unit 0 - Total Number of Functioning Obstetrics HDU/ICU Beds outside the O&G unit 0 - Total Number of All Types of Deliveries 0 - Total Number of Spontaneous Vertex Delivery (SVD) 2 Yes Total Number of Vaginal Breech Deliveries 8 Yes Total Number of Vacuum assisted Vaginal Deliveries 2 Yes Total Number of Forceps assisted Vaginal Deliveries 2 Yes Total Number of Caesarian Surgeries 3 Yes Total Number of Elective Surgeries 0 - Total Number of Emergency Surgeries 0 - Total Number of Lower Segment Caesarian Section (LSCS) 0 Yes Total Number of Hysterotomy Procedures Performed 1 Yes Total Number of Caesarean Hysterectomy Procedures Performed 2 Yes Total Number of Multiple Pregnancies Delivered 4 Yes Total Number of Eclampsia 3 Yes Number of Hospital with Post Partum Haemorrhage (PPH) 6 Yes Total Number of Post Partum Haemorrhage (PPH) 7 Yes Total Number of Primary Post Partum Haemorrhage (PPH) 11 Yes Total Number of Massive Post Partum Haemorrhage (PPH) 15 Yes Total Number of Newborns Delivered 1 Yes Total Number of Newborns Admitted to Paediatric/NICU/SCN 1 Yes Hospital with O&G Specialist 0 - Total Number of Permanent O&G Specialist 0 - Total Number of Visiting O&G Specialist 0 - Total Number of Medical Officer in O&G 0 - Total Number of Staff Nurses in O&G 5 Yes Total Number of Nurses With Midwifery Training in Obstetric Ward 0 - Total Number of Nurses With Midwifery Training in Labour Ward 0 - Total Number of Nurses With Midwife Training in Obstetric HDU 0 - Total Number of Community Nurses in O&G 13 Yes Total Number of Community Nurses With Midwifery Training in Obstetric Ward 0 -

Total Number of Community Nurses With Midwifery Training in Labour Ward 0 - AND RESPONSE RATES SURVEY PROFILES Total Number of Community Nurses With Midwife Training in Obstetric HDU 0 - A pp x 5

135 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A5.4 Number and Rate of Respondents by State and Sector for Maternity Services, 2011 Respondent Non Respondent State Sector Total Number % Number % Malaysia Public 133 100.00 0 0.00 133 Malaysia Private 125 67.93 59 32.07 184 Malaysia Total 258 81.39 59 18.61 317 Perlis Public 1 100.00 0 0.00 1 Perlis Private na na na na na Perlis Total 1 100.00 0 0.00 1 Kedah Public 9 100.00 0 0.00 9 Kedah Private 8 88.89 1 11.11 9 Kedah Total 17 94.44 1 5.56 18 Kedah & Perlis Public 10 100.00 0 0.00 10 Kedah & Perlis Private 8 88.89 1 11.11 9 Kedah & Perlis Total 18 94.74 1 5.26 19 Pulau Pinang Public 6 100.00 0 0.00 6 Pulau Pinang Private 14 82.35 3 17.65 17 Pulau Pinang Total 20 86.96 3 13.04 23 Perak Public 14 100.00 0 0.00 14 Perak Private 12 80.00 3 20.00 15 Perak Total 26 89.66 3 10.34 29 Selangor & WP Putrajaya Public 12 100.00 0 0.00 12 Selangor & WP Putrajaya Private 29 63.04 17 36.96 46 Selangor & WP Putrajaya Total 41 70.69 17 29.31 58 WP Kuala Lumpur Public 3 100.00 0 0.00 3 WP Kuala Lumpur Private 17 54.84 14 45.16 31 WP Kuala Lumpur Total 20 58.82 14 41.18 34 Selangor & WP Putrajaya & WPKL Public 15 100.00 0 0.00 15 Selangor & WP Putrajaya & WPKL Private 46 59.74 31 40.26 77 Selangor & WP Putrajaya & WPKL Total 61 66.30 31 33.70 92 Negeri Sembilan Public 6 100.00 0 0.00 6 Negeri Sembilan Private 3 50.00 3 50.00 6 Negeri Sembilan Total 9 75.00 3 25.00 12 Melaka Public 3 100.00 0 0.00 3 Melaka Private 3 100.00 0 0.00 3 Melaka Total 6 100.00 0 0.00 6 Johor Public 11 100.00 0 0.00 11 Johor Private 15 53.57 13 46.43 28 Johor Total 26 66.67 13 33.33 39 Pahang Public 10 100.00 0 0.00 10 Pahang Private 7 77.78 2 22.22 9 Pahang Total 17 89.47 2 10.53 19 Terengganu Public 6 100.00 0 0.00 6 Terengganu Private 1 100.00 0 0.00 1 Terengganu Total 7 100.00 0 0.00 7 Kelantan Public 10 100.00 0 0.00 10 Kelantan Private 3 100.00 0 0.00 3 Kelantan Total 13 100.00 0 0.00 13 Sabah & WP Labuan Public 22 100.00 0 0.00 22 Sabah & WP Labuan Private 4 80.00 1 20.00 5 Sabah & WP Labuan Total 26 96.30 1 3.70 27 Sarawak Public 20 100.00 0 0.00 20 Sarawak Private 9 81.82 2 18.18 11 Sarawak Total 29 93.55 2 6.45 31 Abbreviation: na – not applicable 136 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 4: Surgical Services in Malaysian Hospitals

Table A5.5 Outcome Variables with Missing Data and Imputation Methods for Surgical Services, 2011 PERCENTAGE (%) with Outcome variable Imputation missing values Total Number of Dedicated Emergency/Trauma Theatres 0 - Total Number of Elective Operating Hours 0 - Total Number of Elective Cases 0 - Total Number of Elective Cases under GA 1 Yes Total Number of Elective Cases under LA 1 Yes Total number of Emergency Cases 0 - Total Number of Emergency Cases under GA 2 Yes Total Number of Emergency Cases under LA 2 Yes Total Number of Mastectomies Procedures 0 - Total Number of Hospital with Inguinal Hernia Surgery 0 - Total Number of Inguinal Hernia Surgery: Open Procedures 1 Yes Total Number of Inguinal Hernia Surgery: Laparascopic Procedures 7 Yes Total Number of Hospital with Cholecystectomies 0 - Total Number of Cholecystectomies: Open Procedures 2 Yes Total Number of Cholecystectomies: Laparascopic Procedures 1 Yes Total Number of Hospital with OGDS Endoscopy Procedures 0 - Total Number of OGDS Endoscopy Procedures 0 - Total Number of OGDS Endoscopy Procedures by Surgical Team 24 Yes Total Number of OGDS Endoscopy Procedures by Medical Team 26 Yes Total Number of Hospital with Colonoscopy Endoscopy Procedures 0 - Total Number of Colonoscopy Endoscopy Procedures 0 - Total Number of Colonoscopy Endoscopy Procedures by Surgical Team 26 Yes Total Number of Colonoscopy Endoscopy Procedures by Medical Team 27 Yes Total Number of Hospital with ERCP Endoscopy Procedures 0 - Total Number of ERCP Endoscopy Procedures 0 Yes Total Number of ERCP Endoscopy Procedures by Surgical Team 24 Yes Total Number of ERCP Endoscopy Procedures by Medical Team 24 Yes Total Number of Hospital with Surgeons 0 - Total Number of Permanent/Resident Surgeons 0 - Total Number of Visiting Surgeons 0 - Total Number of Theatre Scrub Nurses 0 - Total Number of Theatre Scrub Nurses with Periopreative Post Basic 0 - Total Number of Theatre Scrub Nurses without Periopreative Post Basic 0 - Total Number of OGDS Scope 2 Yes Total Number of Functioning OGDS Scope 0 - Total Number of Non Functioning OGDS Scope 0 - Total Number of Colonoscope 2 Yes Total Number of Functioning Colonoscope 0 - Total Number of Non Functioning Colonoscope 0 - Total Number of ERCP Scope 2 Yes

Total Number of Functioning ERCP Scope 0 - AND RESPONSE RATES SURVEY PROFILES Total Number of Non Functioning ERCP Scope 0 -

Abbreviation:; - – not available A pp x 5 137 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A5.6 Number and Rate of Respondents by State and Sector for Surgical Services, 2011 Respondent Non Respondent State Sector Total Number % Number % Malaysia Public 59 98.33 1 1.67 60 Malaysia Private 83 78.30 23 21.70 106 Malaysia Total 142 85.54 24 14.46 166 Perlis Public 1 100.00 0 0.00 1 Perlis Private na na na na na Perlis Total 1 100.00 0 0.00 1 Kedah Public 4 100.00 0 0.00 4 Kedah Private 5 100.00 0 0.00 5 Kedah Total 9 100.00 0 0.00 9 Kedah & Perlis Public 5 100.00 0 0.00 5 Kedah & Perlis Private 5 100.00 0 0.00 5 Kedah & Perlis Total 10 100.00 0 0.00 10 Pulau Pinang Public 4 100.00 0 0.00 4 Pulau Pinang Private 7 70.00 3 30.00 10 Pulau Pinang Total 11 78.57 3 21.43 14 Perak Public 5 100.00 0 0.00 5 Perak Private 8 72.73 3 27.27 11 Perak Total 13 81.25 3 18.75 16 Selangor & WP Putrajaya Public 7 100.00 0 0.00 7 Selangor & WP Putrajaya Private 17 73.91 6 26.09 23 Selangor & WP Putrajaya Total 24 80.00 6 20.00 30 WP Kuala Lumpur Public 2 66.67 1 33.33 3 WP Kuala Lumpur Private 14 77.78 4 22.22 18 WP Kuala Lumpur Total 16 76.19 5 23.81 21 Selangor & WP Putrajaya & WPKL Public 9 90.00 1 10.00 10 Selangor & WP Putrajaya & WPKL Private 31 75.61 10 24.39 41 Selangor & WP Putrajaya & WPKL Total 40 78.43 11 21.57 51 Negeri Sembilan Public 2 100.00 0 0.00 2 Negeri Sembilan Private 4 66.67 2 33.33 6 Negeri Sembilan Total 6 75.00 2 25.00 8 Melaka Public 1 100.00 0 0.00 1 Melaka Private 3 100.00 0 0.00 3 Melaka Total 4 100.00 0 0.00 4 Johor Public 7 100.00 0 0.00 7 Johor Private 6 54.55 5 45.45 11 Johor Total 13 72.22 5 27.78 18 Pahang Public 2 100.00 0 0.00 2 Pahang Private 4 100.00 0 0.00 4 Pahang Total 6 100.00 0 0.00 6 Terengganu Public 3 100.00 0 0.00 3 Terengganu Private 1 100.00 0 0.00 1 Terengganu Total 4 100.00 0 0.00 4 Kelantan Public 6 100.00 0 0.00 6 Kelantan Private 3 100.00 0 0.00 3 Kelantan Total 9 100.00 0 0.00 9 Sabah & WP Labuan Public 8 100.00 0 0.00 8 Sabah & WP Labuan Private 3 100.00 0 0.00 3 Sabah & WP Labuan Total 11 100.00 0 0.00 11 Sarawak Public 7 100.00 0 0.00 7 Sarawak Private 8 100.00 0 0.00 8 Sarawak Total 15 100.00 0 0.00 15 Abbreviation: na – not applicable

138 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 5: Oncology Services in Malaysian Hospitals

Table A5.7 Outcome Variables with Missing Data and Imputation Methods for Oncology Services, 2011 PERCENTAGE (%) Outcome variable with missing Imputation values Hospital with Oncology Services 0 - Hospital with Cleanrooms for Reconstruction of Cytotoxic Drugs 0 - Total Number of Cleanrooms for Reconstruction of Cytotoxic Drugs 0 - Hospital without Cleanrooms for Reconstruction of Cytotoxic Drugs (Outsource the Service) 0 - Hospital with Chemotherapy Daycare 0 - Number of Chemotherapy Beds 0 - Number of Chemotherapy Chairs 0 - Number of Hospital with for Cytotoxic Drugs Reconstruction CDR Isolators 0 - Total Number of Oncology Trained Nurse 0 - Total Number of Radiation Therapist 0 - Total Number of Physicists 0 - Total Number of CDR Pharmacist 0 - Total Number of Megavoltage Machine 0 - Total Number of Brachytherapy Machine 0 - Total Number of Simulators 0 - Total Number of Physics Equipment 0 - Total Number of Treatment Planning System 0 - Total Number of Equipment Capable of Carrying Out Intensity Modulated Radiotherapy 0 - Total Number of Equipment Capable of Carrying Out Image Guided Radiotherapy 0 - Total Number of Equipment Capable of Carrying Out Stereotactic RadioSurgery 0 - SURVEY PROFILES AND RESPONSE RATES SURVEY PROFILES A pp x 5

139 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A5.8 Number and Rate of Respondents by State and Sector for Oncology Services, 2011 Respondent Non Respondent State Sector Total Number % Number % Malaysia Public 31 100.00 0 0.00 31 Malaysia Private 27 100.00 0 0.00 27 Malaysia Total 58 100.00 0 0.00 58 Perlis Public na na na na na Perlis Private na na na na na Perlis Total na na na na na Kedah Public 2 100.00 0 0.00 2 Kedah Private na na na na na Kedah Total 2 100.00 0 0.00 2 Kedah & Perlis Public 2 100.00 0 0.00 2 Kedah & Perlis Private na na na na na Kedah & Perlis Total 2 100.00 0 0.00 2 Pulau Pinang Public 2 100.00 0 0.00 2 Pulau Pinang Private 7 100.00 0 0.00 7 Pulau Pinang Total 9 100.00 0 0.00 9 Perak Public 4 100.00 0 0.00 4 Perak Private 3 100.00 0 0.00 3 Perak Total 7 100.00 0 0.00 7 Selangor & WP Putrajaya Public 4 100.00 0 0.00 4 Selangor & WP Putrajaya Private 6 100.00 0 0.00 6 Selangor & WP Putrajaya Total 10 100.00 0 0.00 10 WP Kuala Lumpur Public 3 100.00 0 0.00 3 WP Kuala Lumpur Private 5 100.00 0 0.00 5 WP Kuala Lumpur Total 8 100.00 0 0.00 8 Selangor & WP Putrajaya & WPKL Public 7 100.00 0 0.00 7 Selangor & WP Putrajaya & WPKL Private 11 100.00 0 0.00 11 Selangor & WP Putrajaya & WPKL Total 18 100.00 0 0.00 18 Negeri Sembilan Public 1 100.00 0 0.00 1 Negeri Sembilan Private 1 100.00 0 0.00 1 Negeri Sembilan Total 2 100.00 0 0.00 2 Melaka Public 1 100.00 0 0.00 1 Melaka Private 2 100.00 0 0.00 2 Melaka Total 3 100.00 0 0.00 3 Johor Public 4 100.00 0 0.00 4 Johor Private 1 100.00 0 0.00 1 Johor Total 5 100.00 0 0.00 5 Pahang Public 1 100.00 0 0.00 1 Pahang Private na na na na na Pahang Total 1 100.00 0 0.00 1 Terengganu Public 1 100.00 0 0.00 1 Terengganu Private na na na na na Terengganu Total 1 100.00 0 0.00 1 Kelantan Public 2 100.00 0 0.00 2 Kelantan Private na na na na na Kelantan Total 2 100.00 0 0.00 2 Sabah & WP Labuan Public 3 100.00 0 0.00 3 Sabah & WP Labuan Private 1 100.00 0 0.00 1 Sabah & WP Labuan Total 4 100.00 0 0.00 4 Sarawak Public 3 100.00 0 0.00 3 Sarawak Private 1 100.00 0 0.00 1 Sarawak Total 4 100.00 0 0.00 4 Abbreviation: na - not applicable 140 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 6: Psychiatric Services in Malaysian Hospitals

Table A5.9 Outcome Variables with Missing Data and Imputation Methods for Psychiatric Services, 2011 PERCENTAGE (%) with Outcome variable Imputation missing values Hospital with Psychiatry Services 0 - Hospital with Gazetted Psychiatry Beds 0 - Total Number of Inpatient Psychiatry Dedicated Beds 0 - Total Number of Functioning Inpatient Psychiatry Dedicated Beds 0 - Inpatient Psychiatry Bed Occupancy Rate 0 - Average Length of Stay 0 - Total Number of Inpatient Psychiatry Admissions 7 Yes Total Number of Outpatient Psychiatry Follow up Patients Visits 16 Yes Total Number of Outpatient Psychiatry New Cases 18 Yes Hospital with Community & Rehabilitation Services 0 - Total Number of Community & Rehabilitation Services 0 - Hospital with Rehabilitation Services 0 - Total Number of Rehabilitation Services 1 Yes Hospital with Patients below 18 years old 4 Yes Total Number of Patients below 18 years old 15 Yes Hospital with Patients above 60 years old 3 Yes Total Number of Patients above 60 years old 16 Yes Hospital with Methadone Clinic Services 0 - Total Number of Methadone Clinic Patients 0 - Hospital with Referrals from Psychiatry Wards or Emergency Dept 0 - Total Number of Referrals from Psychiatry Wards or Emergency Dept 13 Yes Hospital with Psychiatrists 0 - Total Number of Permanent Psychiatrists 0 - Total Number of Visiting Psychiatrists 0 - Total Number of Permanent Clinical Psychologists 1 Yes Total Number of Visiting Clinical Psychologists 1 Yes Total Number of Counselors – Full Time 0 - Total Number of Counselors – Common User 0 - Total Number of Medical Social Worker – Full Time 0 - Total Number of Medical Social Worker – Common User 0 - Total Number of Nurses in Mental Health Facilities 0 - Total Number of Nurses with Post Basic Psychiatry Training 0 - Total Number of Community Nurses 0 - Total Number of Assistant Medical Officer in Mental Health Facilities 0 - Total Number of Assistant Medical Officer with Post Basic Psychiatry Training 0 - Total Number of Assistant Medical Officer without Post Basic Psychiatry Training 0 - Total Number of ECT Machines 0 -

Total Number of ECT Procedures - Outpatient 0 - AND RESPONSE RATES SURVEY PROFILES Total Number of ECT Procedures - Inpatient 0 - A pp x 5

141 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A5.10 Number and Rate of Respondents in Hospitals by State and Sector for Psychiatry Services, 2011 RESPONDENT NON RESPONDENT STATE SECTOR TOTAL NUMBER % NUMBER % Malaysia Public 49 100.00 0 0.00 49 Malaysia Private 41 91.11 4 8.89 45 Malaysia Total 90 95.74 4 4.26 94 Perlis Public 1 100.00 0 0.00 1 Perlis Private na na na na na Perlis Total 1 100.00 0 0.00 1 Kedah Public 3 100.00 0 0.00 3 Kedah Private 2 100.00 0 0.00 2 Kedah Total 5 100.00 0 0.00 5 Kedah & Perlis Public 4 100.00 0 0.00 4 Kedah & Perlis Private 2 100.00 0 0.00 2 Kedah & Perlis Total 6 100.00 0 0.00 6 Pulau Pinang Public 2 100.00 0 0.00 2 Pulau Pinang Private 5 100.00 0 0.00 5 Pulau Pinang Total 7 100.00 0 0.00 7 Perak Public 6 100.00 0 0.00 6 Perak Private 4 80.00 1 20.00 5 Perak Total 10 90.91 1 9.09 11 Selangor & WP Putrajaya Public 7 100.00 0 0.00 7 Selangor & WP Putrajaya Private 8 88.89 1 11.11 9 Selangor & WP Putrajaya Total 15 93.75 1 6.25 16 WP Kuala Lumpur Public 3 100.00 0 0.00 3 WP Kuala Lumpur Private 9 100.00 0 0.00 9 WP Kuala Lumpur Total 12 100.00 0 0.00 12 Selangor & WP Putrajaya & WPKL Public 10 100.00 0 0.00 10 Selangor & WP Putrajaya & WPKL Private 17 94.44 1 5.56 18 Selangor & WP Putrajaya & WPKL Total 27 96.43 1 3.57 28 Negeri Sembilan Public 2 100.00 0 0.00 2 Negeri Sembilan Private 2 100.00 0 0.00 2 Negeri Sembilan Total 4 100.00 0 0.00 4 Melaka Public 1 100.00 0 0.00 1 Melaka Private 2 66.67 1 33.33 3 Melaka Total 3 75.00 1 25.00 4 Johor Public 7 100.00 0 0.00 7 Johor Private 2 100.00 0 0.00 2 Johor Total 9 100.00 0 0.00 9 Pahang Public 3 100.00 0 0.00 3 Pahang Private na na na na na Pahang Total 3 100.00 0 0.00 3 Terengganu Public 3 100.00 0 0.00 3 Terengganu Private na na na na na Terengganu Total 3 100.00 0 0.00 3 Kelantan Public 4 100.00 0 0.00 4 Kelantan Private 1 100.00 0 0.00 1 Kelantan Total 5 100.00 0 0.00 5 Sabah & WP Labuan Public 3 100.00 0 0.00 3 Sabah & WP Labuan Private 1 100.00 0 0.00 1 Sabah & WP Labuan Total 4 100.00 0 0.00 4 Sarawak Public 4 100.00 0 0.00 4 Sarawak Private 5 83.33 1 16.67 6 Sarawak Total 9 90.00 1 10.00 10 Abbreviation: na – not applicable 142 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Chapter 7: Ophthalmology Services in Malaysian Hospitals

Table A5.11 Outcome Variables with Missing Data and Imputation Methods for Opthalmology Services, 2011 PERCENTAGE (%) Outcome variable with missing Imputation values Hospital with Dedicated Ophthalmology Operating Rooms, ORs 0 - Total Number of Dedicated Ophthalmology Operating Rooms, ORs 0 - Total Number of Functioning Dedicated Ophthalmology Operating Rooms, ORs 0 - Total Number of Elective Operating Hours (4 week month) 0 - Hospital with Cataract Surgery 0 - Total Number of Cataract Surgeries Done as Daycare 2 Yes Total Number of Cataract Surgeries Done as Inpatient 2 Yes Hospital with Glaucoma Surgery 2 Yes Total Number of Glaucoma Surgeries with Implant 3 Yes Total Number of Glaucoma Surgeries without Implant 3 Yes Hospital with Vitreoretinal Surgery 2 Yes Total Number of Vitreoretinal Surgeries 2 Yes Total Number of Vitreoretinal Surgeries for Diabetic Retinopathy 5 Yes Hospital with Ophthalmologists 0 - Total Number of Permanent Ophthalmologists 0 - Total Number of Visiting Ophthalmologists 0 - Total Number of Permanent Optometrists 0 - Total Number of Visiting Optometrists 0 - Total Number of Assistant Medical Officers with Post-Basic in Ophthalmology 0 - Total Number of Assistant Medical Officers without Post-Basic in Ophthalmology 0 - Total Number of Nurses with Post-Basic in Ophthalmology 0 - Total Number of Nurses without Post-Basic in Ophthalmology 0 - Total Number of Functioning Operating Microscope 0 - Total Number of Functioning Phacoemulsification Machine (Stand-Alone) 0 - Total Number of Functioning Posterior Vitrectomy Machine Combination 0 - Total Number of Functioning Posterior Vitrectomy Machine (Stand-Alone) 0 - Total Number of Automated Perimetry Devices 0 - SURVEY PROFILES AND RESPONSE RATES SURVEY PROFILES A pp x 5

143 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A5.12 Number and Rate of Respondents in Hospitals by State and Sector for Opthalmology Services, 2011 Respondent Non Respondent State Sector Total Number % Number % Malaysia Public 39 100.00 0 0.00 39 Malaysia Private 51 86.44 8 13.56 59 Malaysia Total 90 91.84 8 8.16 98 Perlis Public 1 100.00 0 0.00 1 Perlis Private na na na na na Perlis Total 1 100.00 0 0.00 1 Kedah Public 2 100.00 0 0.00 2 Kedah Private 3 75.00 1 25.00 4 Kedah Total 5 83.33 1 16.67 6 Kedah & Perlis Public 3 100.00 0 0.00 3 Kedah & Perlis Private 3 75.00 1 25.00 4 Kedah & Perlis Total 6 85.71 1 14.29 7 Pulau Pinang Public 2 100.00 0 0.00 2 Pulau Pinang Private 4 80.00 1 20.00 5 Pulau Pinang Total 6 85.71 1 14.29 7 Perak Public 4 100.00 0 0.00 4 Perak Private 4 80.00 1 20.00 5 Perak Total 8 88.89 1 11.11 9 Selangor & WP Putrajaya Public 6 100.00 0 0.00 6 Selangor & WP Putrajaya Private 13 92.86 1 7.14 14 Selangor & WP Putrajaya Total 19 95.00 1 5.00 20 WP Kuala Lumpur Public 3 100.00 0 0.00 3 WP Kuala Lumpur Private 11 84.62 2 15.38 13 WP Kuala Lumpur Total 14 87.50 2 12.50 16 Selangor & WP Putrajaya & WPKL Public 9 100.00 0 0.00 9 Selangor & WP Putrajaya & WPKL Private 24 88.89 3 11.11 27 Selangor & WP Putrajaya & WPKL Total 33 91.67 3 8.33 36 Negeri Sembilan Public 2 100.00 0 0.00 2 Negeri Sembilan Private 2 100.00 0 0.00 2 Negeri Sembilan Total 4 100.00 0 0.00 4 Melaka Public 1 100.00 0 0.00 1 Melaka Private 3 100.00 0 0.00 3 Melaka Total 4 100.00 0 0.00 4 Johor Public 4 100.00 0 0.00 4 Johor Private 3 75.00 1 25.00 4 Johor Total 7 87.50 1 12.50 8 Pahang Public 2 100.00 0 0.00 2 Pahang Private 1 100.00 0 0.00 1 Pahang Total 3 100.00 0 0.00 3 Terengganu Public 1 100.00 0 0.00 1 Terengganu Private na na na na na Terengganu Total 1 100.00 0 0.00 1 Kelantan Public 3 100.00 0 0.00 3 Kelantan Private na na na na na Kelantan Total 3 100.00 0 0.00 3 Sabah & WP Labuan Public 4 100.00 0 0.00 4 Sabah & WP Labuan Private 1 100.00 0 0.00 1 Sabah & WP Labuan Total 5 100.00 0 0.00 5 Sarawak Public 4 100.00 0 0.00 4 Sarawak Private 6 85.71 1 14.29 7 Sarawak Total 10 90.91 1 9.09 11 Abbreviation: na – not applicable 144 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

APPENDIX 6 | MEDICAL SUBSPECIALTIES

Table A6.1 Number and Density of Anaesthesiologists, Emergency Medicine Specialists and Paediatricians in Malaysia by State and Sector, 2011 Emergency Medicine Anaesthesiologists Paediatricians Specialists State Sector Per 10,000 Per 10,000 Per 10,000 No. No. No. Population Population Population Malaysia Public 381 - 101 - 377 - Malaysia Private 302 - 1 - 292 - Malaysia Total 683 0.24 102 0.04 669 0.23 Perlis Public 4 - 2 - 3 - Perlis Private na na na na na na Perlis Total 4 0.17 2 0.08 3 0.13 Kedah Public 17 - 5 - 17 - Kedah Private 10 - 0 - 10 - Kedah Total 27 0.14 5 0.03 27 0.14 Kedah & Perlis Public 21 - 7 - 20 - Kedah & Perlis Private 10 - 0 - 10 - Kedah & Perlis Total 31 0.14 7 0.03 30 0.14 Pulau Pinang Public 20 - 4 - 29 - Pulau Pinang Private 35 - 1 - 41 - Pulau Pinang Total 55 0.35 5 0.03 70 0.44 Perak Public 29 - 5 - 27 - Perak Private 23 - 0 - 20 - Perak Total 52 0.22 5 0.02 47 0.20 Selangor & WP Putrajaya Public 72 - 19 - 61 - Selangor & WP Putrajaya Private 85 - 0 - 88 - Selangor & WP Putrajaya Total 157 0.28 19 0.03 149 0.26 WP Kuala Lumpur Public 87 - 25 - 102 - WP Kuala Lumpur Private 70 - 0 - 56 - WP Kuala Lumpur Total 157 0.93 25 0.15 158 0.93 Selangor & WP Putrajaya & WPKL Public 159 - 44 - 163 - Selangor & WP Putrajaya & WPKL Private 155 - 0 - 144 - Selangor & WP Putrajaya & WPKL Total 314 0.43 44 0.06 307 0.42 Negeri Sembilan Public 11 - 3 - 13 - Negeri Sembilan Private 9 - 0 - 15 - Negeri Sembilan Total 20 0.19 3 0.03 28 0.27 Melaka Public 10 - 3 - 8 - Melaka Private 17 - 0 - 13 - Melaka Total 27 0.32 3 0.04 21 0.25 Johor Public 35 - 5 - 28 - Johor Private 25 - 0 - 17 - Johor Total 60 0.18 5 0.01 45 0.13 Pahang Public 17 - 3 - 13 - Pahang Private 6 - 0 - 6 - Pahang Total 23 0.15 3 0.02 19 0.12 Terengganu Public 12 - 4 - 7 - Terengganu Private 1 - 0 - 1 - Terengganu Total 13 0.12 4 0.04 8 0.07 Kelantan Public 27 - 15 - 26 - Kelantan Private 2 - 0 - 5 - Kelantan Total 29 0.18 15 0.09 31 0.19 Sabah & WP Labuan Public 22 - 5 - 20 - Sabah & WP Labuan Private 5 - 0 - 5 - Sabah & WP Labuan Total 27 0.08 5 0.01 25 0.07 Sarawak Public 18 - 3 - 23 - MEDICAL SUBSPECIALTIES Sarawak Private 14 - 0 - 15 - Sarawak Total 32 0.13 3 0.01 38 0.15 Abbreviation: na – not applicable; - – not available A pp x 6 145 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.2 Number and Density of Internal Medicine and Infectious Diseases Specialists in Malaysia by State and Sector, 2011 Internal Medicine Specialists Infectious Diseases Specialists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 327 - 15 - Malaysia Private 163 - 3 - Malaysia Total 490 0.17 18 0.01 Perlis Public 3 - 0 - Perlis Private na na na na Perlis Total 3 0.13 0 0.00 Kedah Public 26 - 0 - Kedah Private 5 - 0 - Kedah Total 31 0.16 0 0.00 Kedah & Perlis Public 29 - 0 - Kedah & Perlis Private 5 - 0 - Kedah & Perlis Total 34 0.15 0 0.00 Pulau Pinang Public 28 - 2 - Pulau Pinang Private 19 - 0 - Pulau Pinang Total 47 0.29 2 0.01 Perak Public 18 - 1 - Perak Private 15 - 0 - Perak Total 33 0.14 1 0.00 Selangor & WP Putrajaya Public 56 - 5 - Selangor & WP Putrajaya Private 26 - 2 - Selangor & WP Putrajaya Total 82 0.15 7 0.01 WP Kuala Lumpur Public 63 - 3 - WP Kuala Lumpur Private 29 - 0 - WP Kuala Lumpur Total 92 0.54 3 0.02 Selangor & WP Putrajaya & WPKL Public 119 - 8 - Selangor & WP Putrajaya & WPKL Private 55 - 2 - Selangor & WP Putrajaya & WPKL Total 174 0.24 10 0.01 Negeri Sembilan Public 10 - 0 - Negeri Sembilan Private 17 - 0 - Negeri Sembilan Total 27 0.26 0 0.00 Melaka Public 7 - 0 - Melaka Private 10 - 0 - Melaka Total 17 0.20 0 0.00 Johor Public 20 - 1 - Johor Private 14 - 0 - Johor Total 34 0.10 1 0.00 Pahang Public 22 - 0 - Pahang Private 7 - 0 - Pahang Total 29 0.19 0 0.00 Terengganu Public 15 - 1 - Terengganu Private 1 - 0 - Terengganu Total 16 0.15 1 0.01 Kelantan Public 14 - 1 - Kelantan Private 3 - 1 - Kelantan Total 17 0.11 2 0.01 Sabah & WP Labuan Public 22 - 1 - Sabah & WP Labuan Private 6 - 0 - Sabah & WP Labuan Total 28 0.08 1 0.00 Sarawak Public 23 - 0 - Sarawak Private 11 - 0 - Sarawak Total 34 0.14 0 0.00 Abbreviation: na – not applicable; - – not available

146 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.3 Number and Density of Nephrologists and Endocrinologists in Malaysia by State and Sector, 2011 Nephrologists Endocrinologists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 62 - 34 - Malaysia Private 50 - 17 - Malaysia Total 112 0.04 51 0.02 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 2 - 0 - Kedah Private 2 - 0 - Kedah Total 4 0.02 0 0.00 Kedah & Perlis Public 2 - 0 - Kedah & Perlis Private 2 - 0 - Kedah & Perlis Total 4 0.02 0 0.00 Pulau Pinang Public 6 - 2 - Pulau Pinang Private 8 - 3 - Pulau Pinang Total 14 0.09 5 0.03 Perak Public 1 - 1 - Perak Private 5 - 1 - Perak Total 6 0.03 2 0.01 Selangor & WP Putrajaya Public 12 - 10 - Selangor & WP Putrajaya Private 17 - 8 - Selangor & WP Putrajaya Total 29 0.05 18 0.03 WP Kuala Lumpur Public 20 - 13 - WP Kuala Lumpur Private 6 - 5 - WP Kuala Lumpur Total 26 0.15 18 0.11 Selangor & WP Putrajaya & WPKL Public 32 - 23 - Selangor & WP Putrajaya & WPKL Private 23 - 13 - Selangor & WP Putrajaya & WPKL Total 55 0.07 36 0.05 Negeri Sembilan Public 2 - 1 - Negeri Sembilan Private 2 - 0 - Negeri Sembilan Total 4 0.04 1 0.01 Melaka Public 1 - 1 - Melaka Private 4 - 0 - Melaka Total 5 0.06 1 0.01 Johor Public 3 - 0 - Johor Private 2 - 0 - Johor Total 5 0.01 0 0.00 Pahang Public 2 - 0 - Pahang Private 0 - 0 - Pahang Total 2 0.01 0 0.00 Terengganu Public 2 - 0 - Terengganu Private 0 - 0 - Terengganu Total 2 0.02 0 0.00 Kelantan Public 4 - 4 - Kelantan Private 1 - 0 - Kelantan Total 5 0.03 4 0.02 Sabah & WP Labuan Public 4 - 1 - Sabah & WP Labuan Private 1 - 0 - Sabah & WP Labuan Total 5 0.01 1 0.00 Sarawak Public 3 - 1 -

Sarawak Private 2 - 0 - MEDICAL SUBSPECIALTIES Sarawak Total 5 0.02 1 0.00

Abbreviation: na – not applicable; - – not available A pp x 6

147 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.4 Number and Density of Cardiologists and Respiratory Medicine Specialists in Malaysia by State and Sector, 2011 Respiratory Medicine Cardiologists Specialists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 39 - 32 - Malaysia Private 160 - 35 - Malaysia Total 199 0.07 67 0.02 Perlis Public 0 - 0 - Perlis Private 0 - 0 - Perlis Total 0 0.00 0 0.00 Kedah Public 1 - 2 - Kedah Private 6 - 1 - Kedah Total 7 0.04 3 0.02 Kedah & Perlis Public 1 - 2 - Kedah & Perlis Private 6 - 1 - Kedah & Perlis Total 7 0.03 3 0.01 Pulau Pinang Public 2 - 2 - Pulau Pinang Private 19 - 5 - Pulau Pinang Total 21 0.13 7 0.04 Perak Public 1 - 2 - Perak Private 10 - 3 - Perak Total 11 0.05 5 0.02 Selangor & WP Putrajaya Public 7 - 2 - Selangor & WP Putrajaya Private 33 - 14 - Selangor & WP Putrajaya Total 40 0.07 16 0.03 WP Kuala Lumpur Public 8 - 15 - WP Kuala Lumpur Private 52 - 9 - WP Kuala Lumpur Total 60 0.35 24 0.14 Selangor & WP Putrajaya & WPKL Public 15 - 17 - Selangor & WP Putrajaya & WPKL Private 85 - 23 - Selangor & WP Putrajaya & WPKL Total 100 0.14 40 0.05 Negeri Sembilan Public 0 - 0 - Negeri Sembilan Private 4 - 1 - Negeri Sembilan Total 4 0.04 1 0.01 Melaka Public 0 - 0 - Melaka Private 11 - 1 - Melaka Total 11 0.13 1 0.01 Johor Public 5 - 2 - Johor Private 8 - 0 - Johor Total 13 0.04 2 0.01 Pahang Public 2 - 1 - Pahang Private 2 - 1 - Pahang Total 4 0.03 2 0.01 Terengganu Public 0 - 0 - Terengganu Private 1 - 0 - Terengganu Total 1 0.01 0 0.00 Kelantan Public 3 - 2 - Kelantan Private 2 - 0 - Kelantan Total 5 0.03 2 0.01 Sabah & WP Labuan Public 4 - 4 - Sabah & WP Labuan Private 3 - 0 - Sabah & WP Labuan Total 7 0.02 4 0.01 Sarawak Public 6 - 0 - Sarawak Private 9 - 0 - Sarawak Total 15 0.06 0 0.00 Abbreviation: na – not applicable; - – not available 148 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.5 Number and Density of Hepatologists and Gastroenterologists in Malaysia by State and Sector, 2011 Hepatologists Gastroenterologists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 9 - 29 - Malaysia Private 0 - 76 - Malaysia Total 9 0.00 105 0.04 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 0 - 3 - Kedah Private 0 - 3 - Kedah Total 0 0.00 6 0.03 Kedah & Perlis Public 0 - 3 - Kedah & Perlis Private 0 - 3 - Kedah & Perlis Total 0 0.00 6 0.03 Pulau Pinang Public 0 - 1 - Pulau Pinang Private 0 - 9 - Pulau Pinang Total 0 0.00 10 0.06 Perak Public 0 - 0 - Perak Private 0 - 4 - Perak Total 0 0.00 4 0.02 Selangor & WP Putrajaya Public 7 - 4 - Selangor & WP Putrajaya Private 0 - 26 - Selangor & WP Putrajaya Total 7 0.01 30 0.05 WP Kuala Lumpur Public 2 - 12 - WP Kuala Lumpur Private 0 - 20 - WP Kuala Lumpur Total 2 0.01 32 0.19 Selangor & WP Putrajaya & WPKL Public 9 - 16 - Selangor & WP Putrajaya & WPKL Private 0 - 46 - Selangor & WP Putrajaya & WPKL Total 9 0.01 62 0.08 Negeri Sembilan Public 0 - 0 - Negeri Sembilan Private 0 - 1 - Negeri Sembilan Total 0 0.00 1 0.01 Melaka Public 0 - 0 - Melaka Private 0 - 6 - Melaka Total 0 0.00 6 0.07 Johor Public 0 - 0 - Johor Private 0 - 4 - Johor Total 0 0.00 4 0.01 Pahang Public 0 - 1 - Pahang Private 0 - 0 - Pahang Total 0 0.00 1 0.01 Terengganu Public 0 - 0 - Terengganu Private 0 - 0 - Terengganu Total 0 0.00 0 0.00 Kelantan Public 0 - 5 - Kelantan Private 0 - 0 - Kelantan Total 0 0.00 5 0.03 Sabah & WP Labuan Public 0 - 3 - Sabah & WP Labuan Private 0 - 1 - Sabah & WP Labuan Total 0 0.00 4 0.01 Sarawak Public 0 - 0 -

Sarawak Private 0 - 2 - MEDICAL SUBSPECIALTIES Sarawak Total 0 0.00 2 0.01

Abbreviation: na – not applicable; - – not available A pp x 6 149 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.6 Number and Density of Clinical Haematologists in Malaysia by State and Sector, 2011 Clinical Haematologists State Sector No. Per 10,000 Population Malaysia Public 35 - Malaysia Private 12 - Malaysia Total 47 0.02 Perlis Public 0 - Perlis Private na na Perlis Total 0 0.00 Kedah Public 0 - Kedah Private 0 - Kedah Total 0 0.00 Kedah & Perlis Public 0 - Kedah & Perlis Private 0 - Kedah & Perlis Total 0 0.00 Pulau Pinang Public 2 - Pulau Pinang Private 2 - Pulau Pinang Total 4 0.03 Perak Public 1 - Perak Private 1 - Perak Total 2 0.01 Selangor & WP Putrajaya Public 19 - Selangor & WP Putrajaya Private 3 - Selangor & WP Putrajaya Total 22 0.04 WP Kuala Lumpur Public 7 - WP Kuala Lumpur Private 3 - WP Kuala Lumpur Total 10 0.06 Selangor & WP Putrajaya & WPKL Public 26 - Selangor & WP Putrajaya & WPKL Private 6 - Selangor & WP Putrajaya & WPKL Total 32 0.04 Negeri Sembilan Public 0 - Negeri Sembilan Private 0 - Negeri Sembilan Total 0 0.00 Melaka Public 0 - Melaka Private 1 - Melaka Total 1 0.01 Johor Public 0 - Johor Private 0 - Johor Total 0 0.00 Pahang Public 0 - Pahang Private 0 - Pahang Total 0 0.00 Terengganu Public 0 - Terengganu Private 0 - Terengganu Total 0 0.00 Kelantan Public 3 - Kelantan Private 0 - Kelantan Total 3 0.02 Sabah & WP Labuan Public 2 - Sabah & WP Labuan Private 0 - Sabah & WP Labuan Total 2 0.01 Sarawak Public 1 - Sarawak Private 2 - Sarawak Total 3 0.01 Abbreviation: na – not applicable; - – not available 150 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.7 Number and Density of Neurologists and Rheumatologists in Malaysia by State and Sector, 2011 Neurologists Rheumatologists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 30 - 26 - Malaysia Private 36 - 14 - Malaysia Total 66 0.02 40 0.01 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 0 - 0 - Kedah Private 1 - 0 - Kedah Total 1 0.01 0 0.00 Kedah & Perlis Public 0 - 0 - Kedah & Perlis Private 1 - 0 - Kedah & Perlis Total 1 0.00 0 0.00 Pulau Pinang Public 3 - 0 - Pulau Pinang Private 5 - 1 - Pulau Pinang Total 8 0.05 1 0.01 Perak Public 1 - 1 - Perak Private 2 - 1 - Perak Total 3 0.01 2 0.01 Selangor & WP Putrajaya Public 0 - 11 - Selangor & WP Putrajaya Private 11 - 6 - Selangor & WP Putrajaya Total 11 0.02 17 0.03 WP Kuala Lumpur Public 20 - 3 - WP Kuala Lumpur Private 10 - 4 - WP Kuala Lumpur Total 30 0.18 7 0.04 Selangor & WP Putrajaya & WPKL Public 20 - 14 - Selangor & WP Putrajaya & WPKL Private 21 - 10 - Selangor & WP Putrajaya & WPKL Total 41 0.06 24 0.03 Negeri Sembilan Public 0 - 3 - Negeri Sembilan Private 1 - 1 - Negeri Sembilan Total 1 0.01 4 0.04 Melaka Public 1 - 1 - Melaka Private 3 - 0 - Melaka Total 4 0.05 1 0.01 Johor Public 0 - 1 - Johor Private 1 - 1 - Johor Total 1 0.00 2 0.01 Pahang Public 1 - 1 - Pahang Private 0 - 0 - Pahang Total 1 0.01 1 0.01 Terengganu Public 1 - 1 - Terengganu Private 0 - 0 - Terengganu Total 1 0.01 1 0.01 Kelantan Public 2 - 1 - Kelantan Private 0 - 0 - Kelantan Total 2 0.01 1 0.01 Sabah & WP Labuan Public 0 - 2 - Sabah & WP Labuan Private 1 - 0 - Sabah & WP Labuan Total 1 0.00 2 0.01 Sarawak Public 1 - 1 -

Sarawak Private 1 - 0 - MEDICAL SUBSPECIALTIES Sarawak Total 2 0.01 1 0.00

Abbreviation: na – not applicable; - – not available A pp x 6 151 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A6.8 Number and Density of Geriatric Medicine Specialists in Malaysia by State and Sector, 2011 Geriatric Medicine Specialists State Sector No. Per 10,000 Population Malaysia Public 7 - Malaysia Private 6 - Malaysia Total 13 0.00 Perlis Public 0 - Perlis Private na na Perlis Total 0 0.00 Kedah Public 0 - Kedah Private 0 - Kedah Total 0 0.00 Kedah & Perlis Public 0 - Kedah & Perlis Private 0 - Kedah & Perlis Total 0 0.00 Pulau Pinang Public 0 - Pulau Pinang Private 1 - Pulau Pinang Total 1 0.01 Perak Public 0 - Perak Private 2 - Perak Total 2 0.01 Selangor & WP Putrajaya Public 0 - Selangor & WP Putrajaya Private 0 - Selangor & WP Putrajaya Total 0 0.00 WP Kuala Lumpur Public 5 - WP Kuala Lumpur Private 2 - WP Kuala Lumpur Total 7 0.04 Selangor & WP Putrajaya & WPKL Public 5 - Selangor & WP Putrajaya & WPKL Private 2 - Selangor & WP Putrajaya & WPKL Total 7 0.01 Negeri Sembilan Public 0 - Negeri Sembilan Private 0 - Negeri Sembilan Total 0 0.00 Melaka Public 0 - Melaka Private 0 - Melaka Total 0 0.00 Johor Public 0 - Johor Private 0 - Johor Total 0 0.00 Pahang Public 0 - Pahang Private 0 - Pahang Total 0 0.00 Terengganu Public 0 - Terengganu Private 0 - Terengganu Total 0 0.00 Kelantan Public 0 - Kelantan Private 0 - Kelantan Total 0 0.00 Sabah & WP Labuan Public 1 - Sabah & WP Labuan Private 0 - Sabah & WP Labuan Total 1 0.00 Sarawak Public 1 - Sarawak Private 1 - Sarawak Total 2 0.01 Abbreviation: na – not applicable; - – not available 152 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

APPENDIX 7 | OTHER SPECIALTIES IN MEDICINE Table A7.1 Number and Density of Cardiothoracic and Paediatric Surgeons in Malaysia by State and Sector, 2011 Cardiothoracic Surgeons Paediatric Surgeons State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 24 - 19 - Malaysia Private 45 - 20 - Malaysia Total 69 0.02 39 0.01 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 0 - 2 - Kedah Private 0 - 0 - Kedah Total 0 0.00 2 0.01 Kedah & Perlis Public 0 - 2 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 0 0.00 2 0.01 Pulau Pinang Public 2 - 0 - Pulau Pinang Private 9 - 4 - Pulau Pinang Total 11 0.07 4 0.03 Perak Public 0 - 0 - Perak Private 1 - 1 - Perak Total 1 0.00 1 0.00 Selangor & WP Putrajaya Public 7 - 1 - Selangor & WP Putrajaya Private 8 - 6 - Selangor & WP Putrajaya Total 15 0.03 7 0.01 WP Kuala Lumpur Public 5 - 9 - WP Kuala Lumpur Private 22 - 6 - WP Kuala Lumpur Total 27 0.16 15 0.09 Selangor & WP Putrajaya & WPKL Public 12 - 10 - Selangor & WP Putrajaya & WPKL Private 30 - 12 - Selangor & WP Putrajaya & WPKL Total 42 0.06 22 0.03 Negeri Sembilan Public 0 - 0 - Negeri Sembilan Private 0 - 0 - Negeri Sembilan Total 0 0.00 0 0.00 Melaka Public 0 - 0 - Melaka Private 3 - 0 - Melaka Total 3 0.04 0 0.00 Johor Public 4 - 2 - Johor Private 1 - 1 - Johor Total 5 0.01 3 0.01 Pahang Public 0 - 1 - Pahang Private 0 - 0 - Pahang Total 0 0.00 1 0.01 Terengganu Public 0 - 0 - Terengganu Private 0 - 0 - Terengganu Total 0 0.00 0 0.00 Kelantan Public 2 - 2 - Kelantan Private 0 - 2 - Kelantan Total 2 0.01 4 0.02 Sabah & WP Labuan Public 2 - 1 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 2 0.01 1 0.00

Sarawak Public 2 - 1 - IN MEDICINE OTHER SPECIALTIES Sarawak Private 1 - 0 - Sarawak Total 3 0.01 1 0.00 A pp x 7 Abbreviation: na – not applicable; - – not available 153 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A7.2 Number and Density of Plastic and Reconstructive Surgeons in Malaysia by State and Sector, 2011 Plastic and Reconstructive Surgeons State Sector No. Per 10,000 Population Malaysia Public 34 - Malaysia Private 33 - Malaysia Total 67 0.02 Perlis Public 0 - Perlis Private na na Perlis Total 0 0.00 Kedah Public 1 - Kedah Private 0 - Kedah Total 1 0.01 Kedah & Perlis Public 1 - Kedah & Perlis Private 0 - Kedah & Perlis Total 1 0.00 Pulau Pinang Public 3 - Pulau Pinang Private 3 - Pulau Pinang Total 6 0.04 Perak Public 2 - Perak Private 3 - Perak Total 5 0.02 Selangor & WP Putrajaya Public 5 - Selangor & WP Putrajaya Private 10 - Selangor & WP Putrajaya Total 15 0.03 WP Kuala Lumpur Public 8 - WP Kuala Lumpur Private 12 - WP Kuala Lumpur Total 20 0.12 Selangor & WP Putrajaya & WPKL Public 13 - Selangor & WP Putrajaya & WPKL Private 22 - Selangor & WP Putrajaya & WPKL Total 35 0.05 Negeri Sembilan Public 0 - Negeri Sembilan Private 0 - Negeri Sembilan Total 0 0.00 Melaka Public 0 - Melaka Private 1 - Melaka Total 1 0.01 Johor Public 3 - Johor Private 2 - Johor Total 5 0.01 Pahang Public 0 - Pahang Private 0 - Pahang Total 0 0.00 Terengganu Public 1 - Terengganu Private 0 - Terengganu Total 1 0.01 Kelantan Public 7 - Kelantan Private 0 - Kelantan Total 7 0.04 Sabah & WP Labuan Public 4 - Sabah & WP Labuan Private 1 - Sabah & WP Labuan Total 5 0.01 Sarawak Public 0 - Sarawak Private 1 - Sarawak Total 1 0.00 Abbreviation: na – not applicable; - – not available

154 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A7.3 Number and Density of Neurosurgeons and Urologists in Malaysia by State and Sector, 2011 Neurosurgeons Urologists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 44 - 34 - Malaysia Private 33 - 63 - Malaysia Total 77 0.03 97 0.03 Perlis Public 0 - 0 - Perlis Private na na na na Perlis Total 0 0.00 0 0.00 Kedah Public 1 - 1 - Kedah Private 0 - 4 - Kedah Total 1 0.01 5 0.03 Kedah & Perlis Public 1 - 1 - Kedah & Perlis Private 0 - 4 - Kedah & Perlis Total 1 0.00 5 0.02 Pulau Pinang Public 3 - 2 - Pulau Pinang Private 7 - 8 - Pulau Pinang Total 10 0.06 10 0.06 Perak Public 1 - 0 - Perak Private 2 - 3 - Perak Total 3 0.01 3 0.01 Selangor & WP Putrajaya Public 4 - 5 - Selangor & WP Putrajaya Private 9 - 17 - Selangor & WP Putrajaya Total 13 0.02 22 0.04 WP Kuala Lumpur Public 16 - 16 - WP Kuala Lumpur Private 5 - 11 - WP Kuala Lumpur Total 21 0.12 27 0.16 Selangor & WP Putrajaya & WPKL Public 20 - 21 - Selangor & WP Putrajaya & WPKL Private 14 - 28 - Selangor & WP Putrajaya & WPKL Total 34 0.05 49 0.07 Negeri Sembilan Public 0 - 0 - Negeri Sembilan Private 0 - 2 - Negeri Sembilan Total 0 0.00 2 0.02 Melaka Public 0 - 0 - Melaka Private 6 - 7 - Melaka Total 6 0.07 7 0.08 Johor Public 5 - 2 - Johor Private 2 - 6 - Johor Total 7 0.02 8 0.02 Pahang Public 0 - 2 - Pahang Private 1 - 2 - Pahang Total 1 0.01 4 0.03 Terengganu Public 2 - 0 - Terengganu Private 0 - 0 - Terengganu Total 2 0.02 0 0.00 Kelantan Public 7 - 2 - Kelantan Private 0 - 1 - Kelantan Total 7 0.04 3 0.02 Sabah & WP Labuan Public 2 - 2 - Sabah & WP Labuan Private 0 - 1 - Sabah & WP Labuan Total 2 0.01 3 0.01 Sarawak Public 3 - 2 - Sarawak Private 1 - 1 - Sarawak Total 4 0.02 3 0.01 IN MEDICINE OTHER SPECIALTIES Abbreviation: na – not applicable; - – not available A pp x 7

155 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A7.4 Number and Density of Orthopaedic Surgeons and Sport Medicine Specialists in Malaysia by State and Sector, 2011 Orthopaedic Surgeons Sport Medicine Specialists State Sector Per 10,000 No. Per 10,000 Population No. Population Malaysia Public 279 - 10 - Malaysia Private 283 - 0 - Malaysia Total 562 0.19 10 0.00 Perlis Public 4 - 0 - Perlis Private na na na na Perlis Total 4 0.17 0 0.00 Kedah Public 15 - 0 - Kedah Private 14 - 0 - Kedah Total 29 0.15 0 0.00 Kedah & Perlis Public 19 - 0 - Kedah & Perlis Private 14 - 0 - Kedah & Perlis Total 33 0.15 0 0.00 Pulau Pinang Public 10 - 0 - Pulau Pinang Private 33 - 0 - Pulau Pinang Total 43 0.27 0 0.00 Perak Public 20 - 1 - Perak Private 24 - 0 - Perak Total 44 0.18 1 0.00 Selangor & WP Putrajaya Public 49 - 3 - Selangor & WP Putrajaya Private 67 - 0 - Selangor & WP Putrajaya Total 116 0.21 3 0.01 WP Kuala Lumpur Public 63 - 4 - WP Kuala Lumpur Private 57 - 0 - WP Kuala Lumpur Total 120 0.71 4 0.02 Selangor & WP Putrajaya & WPKL Public 112 - 7 - Selangor & WP Putrajaya & WPKL Private 124 - 0 - Selangor & WP Putrajaya & WPKL Total 236 0.32 7 0.01 Negeri Sembilan Public 8 - 1 - Negeri Sembilan Private 14 - 0 - Negeri Sembilan Total 22 0.21 1 0.01 Melaka Public 6 - 0 - Melaka Private 16 - 0 - Melaka Total 22 0.26 0 0.00 Johor Public 23 - 0 - Johor Private 25 - 0 - Johor Total 48 0.14 0 0.00 Pahang Public 14 - 0 - Pahang Private 9 - 0 - Pahang Total 23 0.15 0 0.00 Terengganu Public 9 - 0 - Terengganu Private 1 - 0 - Terengganu Total 10 0.09 0 0.00 Kelantan Public 30 - 0 - Kelantan Private 4 - 0 - Kelantan Total 34 0.21 0 0.00 Sabah & WP Labuan Public 13 - 1 - Sabah & WP Labuan Private 7 - 0 - Sabah & WP Labuan Total 20 0.06 1 0.00 Sarawak Public 15 - 0 - Sarawak Private 12 - 0 - Sarawak Total 27 0.11 0 0.00 Abbreviation: na – not applicable; - – not available 156 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A7.5 Number and Density of Radiologists and Nuclear Medicine Specialists in Malaysia by State and Sector, 2011 Radiologists Nuclear Medicine Specialists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 247 - 8 - Malaysia Private 166 - 7 - Malaysia Total 413 0.14 15 0.01 Perlis Public 2 - 0 - Perlis Private na na na na Perlis Total 2 0.08 0 0.00 Kedah Public 11 - 0 - Kedah Private 7 - 0 - Kedah Total 18 0.09 0 0.00 Kedah & Perlis Public 13 - 0 - Kedah & Perlis Private 7 - 0 - Kedah & Perlis Total 20 0.09 0 0.00 Pulau Pinang Public 13 - 2 - Pulau Pinang Private 23 - 1 - Pulau Pinang Total 36 0.23 3 0.02 Perak Public 13 - 0 - Perak Private 14 - 0 - Perak Total 27 0.11 0 0.00 Selangor & WP Putrajaya Public 47 - 0 - Selangor & WP Putrajaya Private 41 - 4 - Selangor & WP Putrajaya Total 88 0.16 4 0.01 WP Kuala Lumpur Public 65 - 3 - WP Kuala Lumpur Private 32 - 1 - WP Kuala Lumpur Total 97 0.57 4 0.02 Selangor & WP Putrajaya & WPKL Public 112 - 3 - Selangor & WP Putrajaya & WPKL Private 73 - 5 - Selangor & WP Putrajaya & WPKL Total 185 0.25 8 0.01 Negeri Sembilan Public 7 - 0 - Negeri Sembilan Private 8 - 0 - Negeri Sembilan Total 15 0.14 0 0.00 Melaka Public 5 - 0 - Melaka Private 9 - 0 - Melaka Total 14 0.17 0 0.00 Johor Public 19 - 1 - Johor Private 15 - 1 - Johor Total 34 0.10 2 0.01 Pahang Public 13 - 0 - Pahang Private 3 - 0 - Pahang Total 16 0.10 0 0.00 Terengganu Public 8 - 0 - Terengganu Private 0 - 0 - Terengganu Total 8 0.07 0 0.00 Kelantan Public 18 - 1 - Kelantan Private 1 - 0 - Kelantan Total 19 0.12 1 0.01 Sabah & WP Labuan Public 12 - 0 - Sabah & WP Labuan Private 2 - 0 - Sabah & WP Labuan Total 14 0.04 0 0.00 Sarawak Public 14 - 1 -

Sarawak Private 11 - 0 - IN MEDICINE OTHER SPECIALTIES Sarawak Total 25 0.10 1 0.00 Abbreviation: na – not applicable; - – not available A pp x 7

157 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A7.6 Number and Density of Pathologists and Forensic Pathologists in Malaysia by State and Sector, 2011 Pathologists Forensic Pathologists State Sector Per 10,000 Per 10,000 No. No. Population Population Malaysia Public 302 - 25 - Malaysia Private 42 - 0 - Malaysia Total 344 0.12 25 0.01 Perlis Public 3 - 0 - Perlis Private na na na na Perlis Total 3 0.13 0 0.00 Kedah Public 10 - 1 - Kedah Private 0 - 0 - Kedah Total 10 0.05 1 0.01 Kedah & Perlis Public 13 - 1 - Kedah & Perlis Private 0 - 0 - Kedah & Perlis Total 13 0.06 1 0.00 Pulau Pinang Public 11 - 2 - Pulau Pinang Private 2 - 0 - Pulau Pinang Total 13 0.08 2 0.01 Perak Public 14 - 1 - Perak Private 2 - 0 - Perak Total 16 0.07 1 0.00 Selangor & WP Putrajaya Public 44 - 5 - Selangor & WP Putrajaya Private 17 - 0 - Selangor & WP Putrajaya Total 61 0.11 5 0.01 WP Kuala Lumpur Public 100 - 8 - WP Kuala Lumpur Private 16 - 0 - WP Kuala Lumpur Total 116 0.68 8 0.05 Selangor & WP Putrajaya & WPKL Public 144 - 13 - Selangor & WP Putrajaya & WPKL Private 33 - 0 - Selangor & WP Putrajaya & WPKL Total 177 0.24 13 0.02 Negeri Sembilan Public 11 - 1 - Negeri Sembilan Private 0 - 0 - Negeri Sembilan Total 11 0.11 1 0.01 Melaka Public 8 - 1 - Melaka Private 3 - 0 - Melaka Total 11 0.13 1 0.01 Johor Public 15 - 2 - Johor Private 0 - 0 - Johor Total 15 0.04 2 0.01 Pahang Public 13 - 2 - Pahang Private 0 - 0 - Pahang Total 13 0.09 2 0.01 Terengganu Public 9 - 0 - Terengganu Private 0 - 0 - Terengganu Total 9 0.08 0 0.00 Kelantan Public 48 - 1 - Kelantan Private 0 - 0 - Kelantan Total 48 0.30 1 0.01 Sabah & WP Labuan Public 11 - 1 - Sabah & WP Labuan Private 0 - 0 - Sabah & WP Labuan Total 11 0.03 1 0.00 Sarawak Public 5 - 0 - Sarawak Private 2 - 0 - Sarawak Total 7 0.03 0 0.00 Abbreviation: na – not applicable; - – not available 158 NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2011 HOSPITAL

Table A7.7 Number and Density of Rehabilitation Medicine Specialists and Otorhinolaryngologists in Malaysia by State and Sector, 2011 Rehabilitation Medicine Specialists Otorhinolaryngologists State Sector Per 10,000 No. Per 10,000 Population No. Population Malaysia Public 34 - 153 - Malaysia Private 3 - 141 - Malaysia Total 37 0.01 294 0.10 Perlis Public 0 - 4 - Perlis Private na na na na Perlis Total 0 0.00 4 0.17 Kedah Public 0 - 9 - Kedah Private 0 - 6 - Kedah Total 0 0.00 15 0.08 Kedah & Perlis Public 0 - 13 - Kedah & Perlis Private 0 - 6 - Kedah & Perlis Total 0 0.00 19 0.09 Pulau Pinang Public 1 - 4 - Pulau Pinang Private 0 - 18 - Pulau Pinang Total 1 0.01 22 0.14 Perak Public 2 - 12 - Perak Private 0 - 10 - Perak Total 2 0.01 22 0.09 Selangor & WP Putrajaya Public 9 - 28 - Selangor & WP Putrajaya Private 1 - 40 - Selangor & WP Putrajaya Total 10 0.02 68 0.12 WP Kuala Lumpur Public 12 - 33 - WP Kuala Lumpur Private 2 - 29 - WP Kuala Lumpur Total 14 0.08 62 0.37 Selangor & WP Putrajaya & WPKL Public 21 - 61 - Selangor & WP Putrajaya & WPKL Private 3 - 69 - Selangor & WP Putrajaya & WPKL Total 24 0.03 130 0.18 Negeri Sembilan Public 5 - 4 - Negeri Sembilan Private 0 - 5 - Negeri Sembilan Total 5 0.05 9 0.09 Melaka Public 0 - 4 - Melaka Private 0 - 9 - Melaka Total 0 0.00 13 0.16 Johor Public 3 - 12 - Johor Private 0 - 11 - Johor Total 3 0.01 23 0.07 Pahang Public 0 - 10 - Pahang Private 0 - 4 - Pahang Total 0 0.00 14 0.09 Terengganu Public 0 - 5 - Terengganu Private 0 - 0 - Terengganu Total 0 0.00 5 0.05 Kelantan Public 1 - 15 - Kelantan Private 0 - 2 - Kelantan Total 1 0.01 17 0.11 Sabah & WP Labuan Public 1 - 7 - Sabah & WP Labuan Private 0 - 2 - Sabah & WP Labuan Total 1 0.00 9 0.03 Sarawak Public 0 - 6 - Sarawak Private 0 - 5 - IN MEDICINE OTHER SPECIALTIES Sarawak Total 0 0.00 11 0.04

Abbreviation: na – not applicable; - – not available A pp x 7 159

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