The Primary Health Care Performance Initiative (PHCPI): Issues and Challenges for Malaysia as a Trailblazer Country

Abstract

A strong and robust Primary Health Care system is essential to achieving universal health coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs Profiles (VSP). However, the VSP project requires an honest and transparent data collection and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in support of Primary Health Care reform. This is a huge commitment and can only be materialised if there is a collaborative partnership between Primary Care and Public Health providers. Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and ‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system. This review aims to differentiate between Primary Care, Primary Health Care and Public Health, describe the relationships between the three entities and redefine the role of Primary Care and Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care system.

Perceived quality of care among people with type 2 diabetes mellitus in the north east region of peninsular Malaysia

“…Each FDC clinic is responsible to care for 3000-15,000 people in their catchment area [4], giving the ratio of FMS to patients per FDC clinic of 1: 3000-15,000 people in our study. According to Ramli et al (2019), at least 16,000 FMS are needed to care for a population of 32 million people in Malaysia. Internationally, a ratio of FMS to patients of 1:2000 has been recommended to be at par with developed countries, with currently only 400 FMS serving in primary healthcare in Malaysia [20] at a ratio of 1:80,000.…”

“…According to Ramli et al (2019), at least 16,000 FMS are needed to care for a population of 32 million people in Malaysia. Internationally, a ratio of FMS to patients of 1:2000 has been recommended to be at par with developed countries, with currently only 400 FMS serving in primary healthcare in Malaysia [20] at a ratio of 1:80,000. To date, only 29 FMS are serving a population of 1.8 million people in Kelantan, and this is far from international standard.…”

“…The finding was comparable to a study conducted by Ku and Kegels (2014) in the Philippines, which reported the highest and similar score in the domain, and there was no difference between a facility with a specialist and that managed by a regular doctor. The similar score between both types of clinics reflected that every doctor was able to activate their patients during consultation even though an FMS was better trained for specific counseling skills to empower patients with knowledge and skills [ 20 , 27 ]. This finding could also be explained by the fact that there are insufficient FMS to deliver care in FDC clinics, as only one FMS is available per FDC clinic.…”

“…The current practice requires a family medicine specialist (FMS) to deliver diabetes care in both FDC and non-FDC clinics. However, the number of FMS is limited, and the sharing of expertise is needed [ 20 ]. Hence, diabetes cares heavily relies on the availability of medical officers who do not hold a postgraduate qualification in primary care [ 20 ].…”

“…However, the number of FMS is limited, and the sharing of expertise is needed [ 20 ]. Hence, diabetes cares heavily relies on the availability of medical officers who do not hold a postgraduate qualification in primary care [ 20 ]. In both clinic settings, people with T2DM are seen together with those presenting with acute minor ailments, and medical officers need to equip themselves with comprehensive medical knowledge for both acute and chronic illnesses.…”