The Role of Public Health Professionals. Lessons from Malaysia. Prof Maznah Dahlui and Prof Awang Bulgiba University of Malaya

Transcription

1 The Role of Public Health Professionals in Health hdevelopment: Lessons from Malaysia Prof Maznah Dahlui and Prof Awang Bulgiba University of Malaya

2 Acknowledgement The following people have contributed tib t material l& slides: Dr Sirajoon Noor Ghani Associate Prof Ng Chiu Wan (SPM Dept, UM) Associate Prof Victor Hoe (SPM Dept, UM) Associate Prof Noran Hairi (SPM Dept, UM) Dr Maslinor Ismail (SPM Dept, UM) Dr Chan Chee Koon (Faculty of Economy) 2

3 Outline 1. Training of public health hcare professionals in Malaysia 2. What these Malaysian public health care workers do 3. Future of Malaysian public healthcare & its effect on training 3

4 Training of modern public health professionals in Malaysia 4

5 Development of PH Workforce definition of essential public health services (as opposed to specific public health professions) for the country & organisation is important workforce development requires assessment of national, local & organizational ability to implement training & other workforce development programs flexible and multi disciplinary public health workforce required for rapidly changing environment, including a changing health sector life long training is a critical component of any workforce development programme support required to ensure workforce that includes key cultural groups and cultural competence 5

6 Development of PH Workforce overall public health workforce development strategy that is coordinated & funded is fundamental to ensure competent public health workforce we need to facilitate establishment of organisational competencies anda a morecoherent programmeof of trainingopportunities systems approach required starts with core public health functions leading to organisational competencies leading to individual competencies provides useful framework for discussing workforce development workforce development needs to be linked to overall public health goals person & community centred approach consider needs of individual, d family or community rather than the perceived needs of practitioners 6

7 A combination of approaches most countries have used a combination of approaches to health workforce development In New Zealand, the Health hworkforce Advisory Committee (2001) outlined 3 major components of workforce development: planning for the quantity and configuration of the workforce educating and training to ensure the quality of the workforce managing to ensure the performance and retention of an appropriately trained workforce Malaysia also takes into account the following to plan its public health hcare Workforce to population ratio Student admissions Needs based planning Demand based planning Benchmarking Model of Care approach 7

8 Competency Competency dfi defined: da complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization (Ctr for PH Practice, Emory University) Knowledge, skills and attributes which are required to accomplish the desired outcomes. Generally accepted but may be exemptions for individual jobs depending on actual job requirements (CDC/ATSDR Master Development Plan) Source: Competencies to Curriculum Tool Kit: Developing Curricula for the Public Health Workforce 8

9 Competency Basics can be acquired through experience, performance support systems, and on the job training &not just formal training should be included in public health workforce development efforts individual competencies intersect with organizational performance standards & capacities competency sets may apply broadly to public health workers or bespecific to a small subset express a standard level of worker performance need to be routinely updated Source: Competencies to Curriculum Tool Kit: Developing Curricula for the Public Health Workforce 9

10 Competency Sets Core basic public health e.g. Council on Linkages Topical E.g. bioterrorism, law, genomics, informatics Functional E.g. technical, support staff, professional or leader Discipline specific E.g. environmental health, laboratory, nutrition, health education 10

11 3 levels of public health competency Basic Competency: a basic understanding of what public health is, what it does &how it is achieved Cross cutting (Core) Competencies: general knowledge, skill and ability in areas which enable performance of one or more essential services competence in epidemiology, policy development, health communications, communityneedsassessment needs & mobilisation & behavioural sciences Technical Competencies: defined programme areas require specific technical knowledge, skills & abilities represent unique application of skills to a particular health problem or issue may build upon basic and core competencies (e.g. control of communicable disease, chronic disease prevention, environmental health). 11

12 Process for Public Health Competency Integration Assessment Data Essential Public Health Services Validate Linked Competencies and Objectives Review Course Content Council on Linkages Competencies Competency Sets (discipline, functional or topic specific) Review Learner Objectives Course Implementation Performance Outcomes Evaluation Methods Demonstrate Competence 12

13 Health professionals in Malaysia 1. Basic competencies: Public Health hassistants, Assistant Environmental Health Officers, Public Health hnurses, Community Nurses, Medical Mdi Assistants 2. Cross cutting (Core) Competencies: Health Officers 3. Technical Competencies: Epidemiologists, Health Economists, Family Health Specialists, Health Services Management Specialists, Occupational Physicians, Environmental Health Specialists 13

14 Where they are trained Basic competencies: trained in colleges across Malaysia initially certificate level now diploma level Cross cutting (Core) Competencies: trained in universities MPH Master of Health Promotion Technical Competencies: trained in universities DrPH PhD Sub speciality training 14

15 What these Malaysian public health care workers do 15

16 Pre independence health care in Malaysia Not much is known about early health hcare Early health care provision concentrated around: Malay traditional medicine blend of folklore Hindu mythology Muslim orthodoxy Arab pharmacopoeia 16

17 Malaya history Melaka Sultanate 1400 Parameswara establishes sultanate Portuguese rule 1511 Portuguese captures Mlk Melaka Two hospitals built by Portuguese Dutch rule 1641 Dutch captures Melaka Surgery Clinic & Hospital for Dutch citizens British rule in Malaya 1786 British settlement in Penang 1795 British capture Melaka 1819 British purchase Singapore from local lruler built Garrisons with hospitals or infirmaries for care of European officials and families Modern public health as we know it was nonexistent 17

18 Pre independence Malaysia Work on providing public health care started in 1950s Rural Health Service Scheme ( ) 56) First Rural Health Centre built in 1953 Provided dmch services with minimal i curative services By the end of 1960s, the number grew to 8 main health centres (MHC), 8 health sub (HC) centres and 26 midwife clinic cum quarters (MCQ), with 18 maternal and child health clinics (MCHC) 18

19 Pyramid of Health Services Ministry of Health Secondary and Tertiary Car re Specialised National Institutes University Hospitals Regional Health Services lthm, now er rural hea ivery system district level Three ti care del called d District Health Services &Hospitals(first referral level) Community Health Centres (intermediate level) Community Dispensaries & Village Health Posts Ref: McMahan, R (Ed): On Being in Charge: A Guide to Management in Primary Health Care, 2 nd Ed. WHO, Geneva,

20 Public Healthcare in Malaysia There are public & private health care providers The Ministry of Health (MoH) is the main health care provider The ministry operates a wide network of hospitals and clinics sited throughout the country There are about 146 (MoH & non MoH) government hospitals throughout the country with 41,616 beds in 2011 These hospitals are supported by (2013 figures): 1039 Health Clinics 1,864 Community Clinics 5 Flying Doctor services 254 1Malaysia Health Clinics 8 1Malaysia Mobile Clinicsi 20

21 Public Health Facilities 21

22 Private Hospitals 22

23 From 1956 to 2011 Health facility Community clinics 26 1,864 Health clinics (1031 in 2013) Private clinics 6,589 Government hospital & institutions Private hospitals

24 Public Health Professionals 2013 MOH Non Private Total MOH Medical Officers :6 (M&HO 5%) Assistant Medical :2 Officers (50%) Community Nurses Assistant Health Environment Officers Gazetted PH Physicians

25 Organisation Chart for Ministry of Health, Malaysia MINISTER OF HEALTH DEPUTY MINISTER OF HEALTH PARLIAMENTARY SECRETARY SECRETARY GENERAL DIRECTOR GENERAL OF HEALTH PUBLIC RELATIONS OFFICER LEGAL ADVISOR INTERNAL AUDITOR DEPUTY DIRECTOR GEN. (PUBLIC HEALTH) Dental Services Disease Control Health ltheducation Food Quality Control Family Health Development DEPUTY DIRECTOR GEN. (MEDICAL) Medical Development Medical Practice DEPUTY DIRECTOR GEN. (RESEARCH & TECH. SUPPORT) Pharmaceutical Services Engineering Services Planning & Development Institute for Medical Research DEPUTY SECRETARY GEN. (Management) DEPUTY SECRETARY GEN. (Finance) 13 STATE HEALTH DIRECTORATES Kuala Lumpur Perlis Neg. Sembilan Management International Section Human Resource Establishment Section Promotion Section Finance Budget Revenue Procurement & Privatisation Accounts Sabah Penang Malacca Sarawak Kedah Pahang Kelantan Perak Terengganu Johore Selangor Manpower Planning & Training I.T Centre 25

26 Organization of State Health Department Director of Health Deputy Director (Mgt) Deputy Director (Med) Deputy Director (Dental) Deputy Director (PH) Deputy Director (Pharm) Director of Hospital District Medical Officer of Health 26

27 Organization Chart for District of Health District Health Office Health Services Administrative Support Family Health Nutrition Health Promotion and Education Food Quality Control Environmental Sanitation Water Quality Control Workers & Environmental Health Quality Assurance Human Resource Management Financial Management Resource and Supplies Management Health Management Information Budget Accounts Expenditure Income 27

28 1. Family Health Family Health Services Maternal Health Ante Natal Clinics Safe Deliveries Hospital Alternative Birthing Centres (ABC) Domiciliary delivery Post Natal Care Family Planning Screening Pap smear, etc. 28

29 Child Health Infant health Immunisation Toddler/Preschool School Health Nutrition Services 2. PrimaryHealth Care Outpatient Clinics Hospital Health Centres 29

30 Disease Control 1. Vector borne disease Malaria Dengue Filariasis, etc 2. AIDS/STD 30

31 3. Communicable Diseases Food & water borne Cholera Typhoid Dysentery etc. 4. Non communicable Diseases Cardiovascular Diseases Cancer Diabetes etc. 31

32 Workers & Environmental Health Health promotion in worksites Healthscreening ofworkers Worksite inspection with Dept. of Occupational Safety & Health Dept. of Environment 32

33 Food Quality Control Programme Surveillance programme Premises inspection Food sampling Enforcement Prosecution Health Education Programme Health Education activities for the above Healthy Lifestyle promotion 33

34 Environmental Sanitation & National Water Quality Programme Sanitary facilities in villages eg e.g. toilets Wt Water supply monitoring of water supply gravity feed system Sullageand and solidwaste disposal 34

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38 Current scope of services in health clinics Curative Services Family Health Dental Services Nutrition and Dietetics Health Education/Promotion Home Nursing, Care of the Elderly Rehabilitative Services Environmental Sanitation Well Women Clinics Adolescent Health Community Mental Services, etc 38

39 Health Status of Malaysians (2011) Ml Malaysian population lti of 28.9 million in 2011 (63% bt between 15 to 64 years old, 32% below 15 and 5% above 65) Life Expectancy: male71.9, female 77.0 Crude birth rate is 17.5 per 1000 population Crude death rate is 4.8 per 1000population Infant mortality rate is 6.8 per 1000 live births Mt Maternal mortality rate is 27.3 per 100, live births Total expenditure on health RM33.7 billion or USD10.8 billion Total lexpenditure for Health as a percentage of Gross Domestic Product (GDP) was 4.96% of GDP 39

40 The future of Malaysian public healthcare & its impact on training 40

41 The 3 Grand Challenges of the Future 1. Rise in lifestyle diseases 2. Ageing population 3. Rapidly spreading infectious diseases 41

42 Lifestyle diseases Rise in lifestyle diseases (heart disease, cancers) in tandem with sedentary lifestyles & environmental changes Preventive and promotive care is more cost effective than curative care The new healthcare model must take cognisance of this fact 42

43 Ageing population By 2035, >10% of Malaysia s s population will be 60 years or older Health care must recognise this fact and take steps to prepare for it The future healthcare system must cater for this group of people 43

44 Rapidly spreading infectious diseases Emerging and re emerging diseases pose a major threat to Ml Malaysians today Ability to harness all healthcare resources is key to controlling outbreaks Origin & spread of the Black Death in Asia 44

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46 Infectious diseases spread faster than ever before 46

47 Rising to the challenge Malaysia s Public Health training needs to prepare itself to meet these Grand dchallenges Staff capabilities will need to increase dramatically Lifestyle disease expertise Ageing issues expertise Real time spatio temporal infectious disease modelling Quick response se infectious ectousdisease seaseteam Health policy advisory roles Better working relationship with other agencies Interfacing of data from other agencies 47

48 Expertise The list of Public Health lhexperts needs to grow The depth of expertise also needs to grow Malaysia will need to invest heavily in these areas: Capacity building Building up selected resources & facilities Extending and strengthening collaborative networks 48

49 New roles for Malaysia s academic public health departments Advanced training for future public health professionals Advocacy for a better quality of life Advisory role to governments & NGOs Active involvement in niche areas 49

50 Some challenges will result from Technology Making IT the enabler for all this Environment Making the environment conducive for this to happen Cost of health care Making enough provision ii for public health hcare Getting all parties to agree Community participation Making g the community the driving force behind health care 50

51 I hope That the future Ml Malaysian public health care professional will have the following characteristics: 1. Be truly tech savvy 2. Be able to understand & exploit inter agency collaborations 3. Bea really strong advocate of preventive and promotive rather than curative care to address the epidemic of lifestyle diseases 4. Be able to address the problem of equitable access and care of an ageing gpopulationp 5. Be more prepared for better epidemiological control of emerging infectious diseases and non communicable diseases 51

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