Abstract
Introduction: While Malaysian PHC has been cited as a progressive model in Maternal and Child Health services, it is under strain to respond to the epidemiological transition. In 2016, Malaysia participated in the development of the Primary Health Care Performance Initiative Framework and an innovative tool for comprehensive PHC measurement of financing, capacity, performance, and equity, enabling the production of its first VSP. The study objective was to measure the Malaysian PHC system performance, identify gaps in service delivery and propose improvement strategies.
Methodology: This was a mixed-methods study design, part of a multi-country initiative, carried out in two phases. The first was a quantitative study in 2018, utilising secondary data from multiple national and international sources to populate the three pillars of financing, performance, and equity. The second, which started in 2019, was a mixed quantitative-qualitative approach to assess functional capacity using metrics on (i) governance and leadership (ii) population health needs (iii) inputs (iv) population health management, and (v) facility organisation and management.
Results: PHC spending constituted 35% of overall health spending in the country, with a per capita PHC spending of $152. While the Malaysian government spent 2% of GDP on health, 26% was spent on PHC. The capacity of the PHC system in Malaysia was strong in the subdomains of governance & leadership, information system, and funds management but with low scores in drugs & supplies and facility organisation & management. The lowest scoring measure in population health management was the empanelment of the population. The PHC system in Malaysia had performed with an access index of 98%, quality index of 84% and service coverage index of 62%. It was equitable with little difference in the coverage of Reproductive Maternal Neonatal and Child Health services by mother's level of education and under-five childhood mortality between urban and rural areas.
Discussion: The approach of integrating health planning into the development plans of the country had contributed to the strong performance of Malaysian PHC in achieving universal health coverage, improving equity, with limited resources. The capacity was generally stronger in the public sector as compared to the private sector mainly due to a lack of information from the private sector, but also due to the different financing, organisational structures, and service delivery capacity in the two sectors. As the private sector provide 35% of PHC utilisation in the country, its capacity needs to be on par to enable both sectors to work in an integrated and cohesive partnership. Initiatives during the control of the COVID-19 pandemic have addressed data gaps and strengthened coordination between the two sectors. This tool could be applied across different country contexts, and while it has attempted to standardise measurements, interpretation of performance measures needs to consider the specific context.
Conclusion: The Malaysian VSP has showcased the achievement of its PHC system and provided evidence-based recommendations to address the gaps. In Malaysia's journey towards Universal Health Coverage, strengthening the PHC system must take the system approach, considering the parallel public and private delivery systems.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-36.pdf
- https://apcph.cphm.my/events/oral-session-2-ballroom-B/
BibTeX (Download)
@proceedings{APCPH2022-O-36,
title = {Malaysian 1st Primary Health Care (PHC) Vital Signs Profile (VSP): Fit for Purpose?},
author = {Kamaliah Mohamad Noh and Rachel Koshy and Nazrila Hairizan Nasir and Samsiah Awang},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-36.pdf
https://apcph.cphm.my/events/oral-session-2-ballroom-B/},
year = {2022},
date = {2022-08-01},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: While Malaysian PHC has been cited as a progressive model in Maternal and Child Health services, it is under strain to respond to the epidemiological transition. In 2016, Malaysia participated in the development of the Primary Health Care Performance Initiative Framework and an innovative tool for comprehensive PHC measurement of financing, capacity, performance, and equity, enabling the production of its first VSP. The study objective was to measure the Malaysian PHC system performance, identify gaps in service delivery and propose improvement strategies.
Methodology: This was a mixed-methods study design, part of a multi-country initiative, carried out in two phases. The first was a quantitative study in 2018, utilising secondary data from multiple national and international sources to populate the three pillars of financing, performance, and equity. The second, which started in 2019, was a mixed quantitative-qualitative approach to assess functional capacity using metrics on (i) governance and leadership (ii) population health needs (iii) inputs (iv) population health management, and (v) facility organisation and management.
Results: PHC spending constituted 35% of overall health spending in the country, with a per capita PHC spending of $152. While the Malaysian government spent 2% of GDP on health, 26% was spent on PHC. The capacity of the PHC system in Malaysia was strong in the subdomains of governance \& leadership, information system, and funds management but with low scores in drugs \& supplies and facility organisation \& management. The lowest scoring measure in population health management was the empanelment of the population. The PHC system in Malaysia had performed with an access index of 98%, quality index of 84% and service coverage index of 62%. It was equitable with little difference in the coverage of Reproductive Maternal Neonatal and Child Health services by mother's level of education and under-five childhood mortality between urban and rural areas.
Discussion: The approach of integrating health planning into the development plans of the country had contributed to the strong performance of Malaysian PHC in achieving universal health coverage, improving equity, with limited resources. The capacity was generally stronger in the public sector as compared to the private sector mainly due to a lack of information from the private sector, but also due to the different financing, organisational structures, and service delivery capacity in the two sectors. As the private sector provide 35% of PHC utilisation in the country, its capacity needs to be on par to enable both sectors to work in an integrated and cohesive partnership. Initiatives during the control of the COVID-19 pandemic have addressed data gaps and strengthened coordination between the two sectors. This tool could be applied across different country contexts, and while it has attempted to standardise measurements, interpretation of performance measures needs to consider the specific context.
Conclusion: The Malaysian VSP has showcased the achievement of its PHC system and provided evidence-based recommendations to address the gaps. In Malaysia's journey towards Universal Health Coverage, strengthening the PHC system must take the system approach, considering the parallel public and private delivery systems.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: ORAL PRESENTATION; Organisation: Independent Consultant; PHC Section, Family Health Development Division, Ministry of Health; Public Health Development Division, Ministry of Health; Institute for Health Systems Research, National Institutes of Health, Ministry of Health},
keywords = {},
pubstate = {published},
tppubtype = {proceedings}
}