EOH3402 Community

Health Programme
Management
Lecture 3

COMTEMPORARY COMMUNITY HEALTH

27 September 2017
Title

▶Threats and Challenges

▶The needs for new initiatives
Ministry of Health’s Vision for Health
Ministry of Health’s Vision for Health in which
“Malaysia is to be a nation of healthy individuals,
families, and communities, through a health system
that is equitable, affordable efficient, technologically
appropriate, environmentally adaptable and consumer-
friendly, with emphasis on quality, innovation health
promotion and respect for human dignity, and which
promotes individual responsibility and community
participation towards an enhanced quality of life”.
Challenges facing the public health
sector
▶ Overworked public health sector
▶ Brain-drain caused by the increase in private sector (which is
profit-driven)
▶ 1980s – 76% of the total health care expenditure was contributed
by the government; 2000s – private health care expenditure care
has increased to 40%
▶ This was the result of the government’s policy of letting the
private sector play a bigger role in areas such as healthcare and
education since the 1980s
▶ This rapid growth of private hospitals and clinics
has resulted in a “brain drain” of doctors and
other medical personnel from the public sector.
▶ About two third of surgeons and physicians now
work in private sectors, with the remaining one-
third in government hospitals .
▶ This is despite the fact that government hospitals
have ¾ (about 34000 beds) of total hospital beds
whereas private hospitals have only 9100 beds.
▶The consequence is a very
overworked public health sector
and a perceived decline in the
quality of healthcare in the public
sector. The fact is, despite the
heavy workload, Malaysian public
health sector is still functioning
well.
▶ Increasing proportion of older people in the
next few decades
▶Rising cost of medication and
equipment
▶Rising demand of quality healthcare
▶Sophisticated equipment
▶Changing patterns of diseases

will inevitably lead to a higher

healthcare cost in future.
In view of the expected increase in healthcare cost,
under the 6th Malaysia Plan,
▶ A number of public health facilities and related
services were corporatised and privatized.
▶ The National Heart Institute (IJN) was
corporatised in 1992.
▶ The general medical store was privatized in 1993.
▶ Hospital supportive services such as laundry and
cleaning, equipment maintenance, waste disposal
and facility maintenance services in all hospitals
were privatized on a regional basis in 1995.
Proposed National Health Financial
Scheme (NHFS)
In the Seventh Malaysia Plan (1996-2000), it was
stated that “the Government will gradually reduce
its role in the provision of health services and
increase its regulatory and enforcement functions. A
health financial scheme to meet health care costs
will also be implemented. However, for the low
income group, access to health services will be
assured through assistance from the government”
Ministry of Health’s proposal on NHFS
▶ The National Health Fund
▶ Mandatory Monthly Contributions
▶ Essential Health Benefit Package
▶ Restructured MOH Hospitals and Clinics
▶ The Private Sector
▶ Private Insurance for Extra Coverage
▶ The National Health Financing Authority
The setting up of this National
Health Financial Scheme will
have a very great impact on the
lives of everyone. It will
undoubtedly shift the burden of
healthcare from the government
to the ordinary citizens initially.
Health Care Challenges for Developing
Countries with Aging Populations
Populations in developing countries will
be aging rapidly in the coming decades:
The number of older persons (those age
65 or older) in less developed countries
is expected to increase from 249 million
to 690 million between 2000 and 2030. 
And because the elderly are at high risk
for disease and disability, this
population aging will place urgent
demands on developing-country health
care systems, most of which are ill-
prepared for such demands.
Chronic disease now makes up almost one-half
of the world's burden of disease, creating a
double burden of disease when coupled with
those infectious diseases that are still the major
cause of ill health in developing countries. The
challenge for developing countries is to reorient
health sectors toward managing chronic diseases
and the special needs of the elderly.
Policymakers must take two
steps:
1. Shift health-sector priorities
to include a chronic-disease
prevention approach; and
2. invest in formal systems of
old-age support 
More specifically, these countries
should institute prevention planning
and programming to delay the onset
of chronic diseases, enhance care
for the chronic diseases that plague
elderly populations, and improve
the functioning and daily life for the
expanding elderly population.
The Shift to Prevention
Population aging has been accompanied by an
epidemiological shift in the leading causes of
death from infectious and acute conditions
associated with childhood to chronic
conditions. A confluence of factors has
spawned this epidemiological transition:
modernization and urbanization (especially
improvements in standards of living and
education); and better nutrition, sanitation,
health practices, and medical care.
Projections made by the World Health
Organization (WHO) suggest that, by
2015, deaths from chronic diseases—
such as cancer, hypertension,
cardiovascular diseases, and diabetes
—will increase by 17 percent, from 35
million to 41 million. But few
developing countries have
implemented primary prevention
programs to encourage those healthy
lifestyle choices that would mitigate
chronic diseases or delay their onset.
Rarely do developing countries have
the appropriate medicines or
adequate clinical care necessary to
treat these diseases.
To encourage a prevention approach, WHO
launched in 2002 its Innovative Care for Chronic
Conditions Framework (ICCC), aimed at
policymakers in the health sector. This
framework takes the approach that non-
adherence to long-term treatment regimens is
fundamentally the failure of health systems to
provide appropriate information, support, and
ongoing surveillance to reduce the burden of
chronic disease. The framework also advises that
a prevention approach can mitigate these
problems and contribute to healthier lifestyles.
Delaying the onset of disability
through prevention approaches
can both alleviate the growing
demand for health care and,
more important, improve the
quality of life for the elderly.
Primary Prevention
A prevention approach can be undertaken
even where there are resource constraints
and age discrimination. Unfortunately, a
"negative aging paradigm" found in both
developed and developing countries assumes
that older people's health needs require high-
cost, long-term treatments.
Secondary Prevention
Whereas primary
prevention programs
target populations before
a disease develops,
secondary prevention
involves identifying
(through screening) and
treating those who are at
high risk or already have
a disease.
Secondary prevention is also necessary to
prevent recurrence of the disease. For
example, all developing-country health
sectors should use aspirin, beta blockers, and
statins as mechanisms for secondary
prevention of chronic diseases. Incorporating
such secondary prevention measures also
means providing the technical skills to
diagnose and care for patients as well as
providing the appropriate medication.
Tertiary Care
Once a chronic disease has been
diagnosed, tertiary care involves
treatment of the disease and
attempts to restore the individual
to her or his highest functioning.
However, WHO reports that
adherence to long-term therapy for
chronic illnesses is only 50 percent
in developed countries, and is
likely even lower in developing
countries. Such poor treatment
compliance could be bolstered by
cultivating better health awareness
through education and outreach
programs.
Disability and Quality Caregiving
Disability significantly affects quality of life
in old age. Types of disability frequently
considered among the elderly include
limitations in general functioning (such as
walking or climbing stairs); managing a
home; and personal care. In addition to being
consequences of the normal aging process,
disabilities are also often caused by chronic
diseases.
And population aging also
increases the prevalence of
mental health problems—
especially dementia, which
results in disability by
limiting the ability to live
independently. WHO
projects that Africa, Asia,
and Latin America will have
more than 55 million people
with senile dementia in
2020.
Caring for the elderly in a way that
addresses disability and maintains
good quality of life has become a
global challenge. Informal care—often
provided by spouses, adult children,
and other family members—accounts
for most of the care the elderly
currently receive in developing
countries. Care provided at home is
often considered the preference of the
elderly and, from a policy standpoint,
is essential for managing the cost of
long-term care. However, despite the
increasing demand for home-based
care due to population aging,
decreasing fertility rates means that
future cohorts of elderly will have
smaller networks of potential family
caregivers.
The need for public policies to address the
demand for caregivers is one of the priority
issues for long-term care and a guiding
principle for WHO's 2000 publication Towards
and International Consensus on Policy for
Long-Term Care of the Ageing. In it, WHO
urges developing countries to urgently train
more professional caregivers to focus on
elder care in order to meet current and
future demand.
According to WHO, future caregiving for
the elderly will also require models of both
formal and informal care and systems for
supporting caregivers. Although formal
long-term care programs are vastly
underdeveloped in poor countries, they
will be essential for complementing the
informal support system and sustaining the
major role that family caregivers currently
play.
Examples of formal long-term care programs that
assist informal caregivers include training, respite
care, visiting nurse services, and financial assistance
to cover care-related expenses. For instance, many
East Asian and Southeast Asian countries are
providing adult day care and counseling services to
help family caregivers. Singapore is providing home
help, nursing care at home, and priority in housing
assignments to family members who were willing to
live next door to their older relatives, and Malaysia
is offering tax benefits to adult children who live
with their parents.
Potential to Reduce the Impact of Aging
Exists
Policies and health promotion programs that
prevent chronic diseases and lessen the degree of
disability among the elderly have the potential to
reduce the impact of population aging on health
care costs. Research shows increasing health care
costs are attributable not just to population aging
but also to inefficiencies in health care systems such
as excessively long hospital stays, the number of
medical interventions, and the use of high cost
technologies.
Appropriate policies to address
health care challenges for aging
populations are crucial for
developing countries if they are to
simultaneously meet the health care
needs of their elderly populations
and continue their economic
development.
Other challenges
TFR (Total Fertility Rate) in Malaysia is on the decline.
Fertility decline would have an impact on the reduction of
young people that are foreseen as an investment in the
future human capital. This factor should be considered to
maintain the economic growth and to be a developed nation
by 2020. With the low fertility level, it can be predicted that
Malaysia need to rely on foreign workers. Despite to
decrease the dependency on foreign workers, bringing more
women into the workplace was a necessity; to fulfil the
labour demand and for both economic development and
global competition.
The problems that is associated with
decrease TFR:
1.Increasing cost of raising children
2.Balance between family and
career development
Thank you.