Saturday, March 20, 2010

One Malaysia Clinics -- by Dr. T Jayabalan


by Dr. T Jayabalan

The setting up of One Malaysia Clinics is presumably to help meet the health needs of the urban rakyat. Tan Sri Dr. Mohd Ismail Merican, the DG of health claims that the sole objective of this move is to ensure the delivery of equitable, quality healthcare to the public.

This is of course a laudable move and is very likely to be popular as well. But the issue at large is the quality of these clinics. According to Tan Sri Dr. Mohd Ismail Merican, there is a growing trend in most developing countries like Australia and the UK to delegate the routine follow-ups and monitoring of stable patients with chronic illnesses such as diabetes, hypertension and even stable heart failure to staff nurses. This may be possible in these developed countries as the nurses here are senior staff and degree holders in their profession but the same does not hold true for medical assistants in Malaysia who undergo a 3+1 nursing training programme. A study undertaken in 2009 in the Kampar district revealed that medical assistants at the government health clinics and government hospitals were found to be responsible for medication errors. A total of 1612 prescriptions were generated by medical assistants in a single week and of this, 421 were evaluated for medication errors. A total of 1169 errors were noted and some of these were critical errors. It was also noted that 39% of the 421 prescriptions by medical assistants involved the use of at least one medication categorized as Group B medicine (medicines that only medical officers are authorised to prescribe). It must be noted that medical assistants are trained to assist medical officers and not to provide treatment in the same manner as medical officers do. Furthermore, a study conducted in the US indicated that medication knowledge deficiency of the prescriber had accounted for 64% of the errors made.

Another issue that needs to be considered is the administrative cost involved in establishing these clinics. The administrative cost involved in running public health institutions have not been studied comprehensively and it is well-known that some district hospitals are underutilized mainly because patient attendance is poor. So setting up primary care organizations between ‘Kilinik Desa’, District Hospitals and other primary healthcare centres will incur further costs and may fail for want of attendance.

Apart from these issues, another consideration is that, access to healthcare cannot be provided in an ad-hoc manner. The views of all parties involved should be sought before any decisions are made and finalized. While it was claimed that senior officers from the relevant divisions of the Ministry were involved in drawing up comprehensive guidelines for the establishment and running of these clinics, but the fact remains that the view of other stakeholders, for example the MMA, and the NGOs were not solicited.

Despite these shortcomings, there are remedial measures that can be put in place to make these One Malaysia Clinics workable. There is no error-free system involving human intervention but it is possible to design a system to avoid or minimize the errors such as a primary healthcare team, made up of pharmacists, midwives, physiotherapists, senior nursing sisters, etc to run these clinics. For example, a patient coming in with minor sports injury can be treated by a physiotherapist; a pregnant lady can be assessed by a midwife; minor surgery by the medical assistant; and the pharmacists would be able to pick up prescription errors and correct them before any harm occurs. This will ensure that there will be a check and balance of prescriptions and different treatment options.

The government should consider the views of other stakeholders before embarking on this project because backpedaling after establishing these clinics would be a colossal waste of public funds.
[ Dr. T Jayabalan's study has been quoted by many writers and debated in the media, see Letters in Malaysiakini and other media. We published here the original letter first appeared in the Star. Editor.]


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