The WHO overall health system performance score places Malaysia 49/191 countries. This composite measure of overall health system attainment¹⁷³ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.

In 2004, the total per capita expenditure on health care was Intl $402 (3.8% of GDP)¹⁷⁴. Figure 4 shows that among the countries of CSE Asia, this figure falls within a spending range of Intl $2,293 (in Japan, 7.8% of GDP) and Intl $38 (in Myanmar, 2.2% of GDP).

The Government has played an important role as the main provider of public health services through a national network of hospitals, clinics and other services. This is to ensure that the objective of universal access to essential health services is attained. The efficient use of limited resources has been achieved through an integrated national health care system that encompasses both preventive and curative services. Facilities provided by the Ministry of Health in 2005 are shown in Table 27.

Figure 4 Total expenditure on health per capita (intl $) shown also as a percentage of GDP

Source: World Health Statistics 2007

Table 27 Health facilities provided by the Ministry of Health, 2005

**1 Refers to dispensary services, village health teams, flying doctor service, mobile dental services
**2 Includes maternal and child health clinics
**3 Refers to dental chairs in government clinics
Source: Ninth Malaysia Plan

Health practitioners working in Malaysia in 2005 are shown in Table 28.

Table 28 Health personnel: number and population ratio, 2005

**1 Includes public and private sectors. All other details refer to Ministry of Health only.
Source: Ninth Malaysia Plan

In 2004, WHO reported:

The National Health Morbidity Survey (NHMS) II confirmed that 92% of urbanites were living within 3 kilometers of a health facility as compared with 69% for the rural populations. The study also showed that only 67% of the rural population in the State of Sabah and 50% of Sarawak is within 5 km to the nearest facility.

Local government complements the Ministry of Health in providing selective public health services in the major urban centres. The private medical sector and traditional and complementary medicine practitioners contribute significantly to the provision of health and curative care. Universities and nongovernmental organizations are also among the main players in the health system pyramid.

The combined rural and urban health care system has contributed to the increased coverage of immunization against childhood disease, namely tuberculosis, polio, tetanus, diphtheria to a level exceeding 85%. The country was certified polio-free in 2000 and has achieved elimination of neonatal tetanus.

Significant progress has been made to control other communicable diseases such as malaria, typhoid, hepatitis A, leprosy and tuberculosis through improved sanitation facilities, increased access to safe drinking water and improved dental health. The resurgence of some communicable disease, as a result of rural–urban and international transmigration and the spread of HIV/AIDS, has to be addressed.

New programmes are being initiated to address the challenges posed by increased incidence of noncommunicable disease like lifestyle-related illnesses, environmental health and occupational disease. Community participation and the involvement of nongovernmental organizations have contributed to the success of these programmes.¹⁷⁵

The government currently regards Malaysia as a developing country but has formulated plans to become a fully developed nation by 2020. Central to this ‘Vision 2020’ programme is the ‘Vision for Health’ which looks forward to a national community of healthy individuals and families. Here, the emphasis is on innovation and health promotion while acknowledging the place of individual responsibility and community participation in enhancing the quality of life. The Ninth Malaysia Plan summarises the next phase of development as follows:

During the Eighth Plan period, emphasis was given to further improve the quality of life. Priority was given to facility expansion and upgrading as well as expanding the scope of health care. During the Ninth Plan period, efforts will be undertaken to consolidate health care services, enhance human resource development and optimise resource ultilisation. Improvements in the delivery system will be undertaken with greater involvement of the private sector and NGOs. While efforts will be undertaken to protect the population from communicable and non-communicable diseases, the responsibility and cooperation of individuals, family and the community in disease prevention and control as well as practising a healthy lifestyle is crucial towards achieving better health and wellness.¹⁷⁶

In this structured and collaborative approach to progress, palliative care is an important element. Speaking in 2006, the Director General of Health Malaysia outlined the details of palliative care development in the Ninth Malaysia Plan.

Targets 2006 – 2010 include:

• Specialised palliative care services in six regional hospitals with palliative medicine and pain specialists.
• All medical schools to include palliative care education at undergraduate and postgraduate levels.
• Palliative care education to be integrated into nurse training programmes.
• The development of clinical practice guidelines for cancer pain management.
• Network building with palliative care providers in each region.

Action plans 2010 include:

• The establishment of specialised palliative medicine services in six regional centres: Hospital Penang, Hospital Selayang, Hospital Johor Bahru, Hospital Kota Bahru, Hospital Kuching, Hospital Queen Elizabeth Kota Kinabalu.
• The setting up of a specialist consultative palliative medicine service in the National Cancer Institute.
• The identification of eight individuals to be trained as specialists in palliative medicine.
• Identifying and training support staff in palliative care (nurses, physiotherapists, social workers, clinical psychologists).
• To network with and lobby all accredited medical schools to provide undergraduate and postgraduate palliative care curricula.
• To develop a post-basic palliative care nursing course.
• To conduct basic CME programmes in palliative medicine for doctors and nurses throughout the country.¹⁷⁷

While there is some way to go before all of these targets and plans are achieved, there are signs of progress. Three doctors are undergoing training in palliative medicine, two of which will return to PCUs – making a total of at least three specialist units operational by 2010. Reports indicate that steps are being taken to produce a post basic palliative care nursing course; that discussions have begun regarding a palliative care curriculum; and that clinical practice guidelines will be under development by April 2008. Regarding the Ministry’s relationship with NGOs, Richard Lim comments:

Any fragmentation is because there is a lack of open communication between NGOs and the Ministry units. There is not enough dialogue due to either lack of time or maybe a lack of bother and this is what I hope to talk to the Malaysian Hospice Council about soon. I have recently spoken to Dato’ Devaraj and explained my position and where I can help. As the national adviser, I hope that I might be able to link the NGOs better to the Ministry and that communication can be more frequent and smoother than it is now.¹⁷⁸