Perkhidmatan disediakan mendapat sambutan rakyat pelbagai kaum dengan bayaran kos perubatan serendah RM1

KLINIK 1Malaysia yang beroperasi sejak 7 Januari lalu adalah permulaan baik dan memberangsangkan kepada seluruh rakyat khususnya berpendapatan rendah untuk mendapatkan rawatan pemeriksaan kesihatan asas dengan bayaran kos perubatan serendah RM1, sekali gus menggambarkan keprihatinan kerajaan terhadap kebajikan rakyat.
Ternyata selepas dua minggu pelancarannya, semua 44 Klinik 1Malaysia yang diwujudkan di seluruh negara di kawasan berkepadatan penduduk lebih 10,000 orang di sekitar bandar memberikan impak yang sungguh berkesan dan berjaya menarik perhatian rakyat pelbagai kaum mengunjungi premis disediakan.

Walaupun tumpuan pemeriksaan kesihatan biasa seperti memeriksa tekanan darah, dan kandungan gula, ia dianggap sebagai alternatif kepada orang ramai untuk mendapatkan rawatan mengesan penyakit awal dihadapi mereka.

Healthcare to benefit people

KUALA LUMPUR: The 1Malaysia Clinics to be launched throughout the country will serve to illustrate the “1Malaysia: People First, Performance Now” mantra, said Prime Minister Datuk Seri Najib Tun Razak.

He said the facility would benefit the rakyat and ensure that everyone, regardless of race, would have access to inexpensive treatment.
“Why 1Malaysia Clinic? Because health services must be the ownership of every Malaysia in a fair and just way.
“Access to healthcare is not only for the rich. The access is at minimal cost, which is RM1,” he said in his speech yesterday when opening the country’s first 1Malaysia Clinic in Lembah Pantai.

He also opened another one at Lembah Subang.
Najib said 50 1Malaysia Clinics would be up and running within a week to serve the lower-income groups and staffed by assistant medical officers and nurses with at least five years’ experience.
The clinics were approved under Budget 2010 and cost RM10mil to be set up.

According to a senior Health Ministry official, the Lembah Subang and Lembah Pantai 1Malaysia Clinics occupied spaces that were provided rent-free by the Petaling Jaya City Council and Kuala Lumpur City Hall respectively.

Najib also said dialogues would be held with the private medical sector to ensure that the livelihood of those doctors were not affected by the 1Malaysia clinics.
“It will not be a win-lose situation. The doctors will get their patients as usual,” he said.

Najib added that serious cases would be referred to the government or private clinics for further consultation.

By LESTER KONG
lester@thestar.com.my. The Star 8/1/2010

1MALAYSIA CLINICS: Urban poor need shot in the arm
2010/01/01 NST

TAN SRI DR MOHD ISMAIL MERICAN, Director-general of Health

SEVERAL letters have been published expressing concerns over the establishment of 1Malaysia clinics by the government.
The Malaysian Medical Association president wrote that it was being done in haste without due thought to the role these clinics will play.

He and another writer, a fourth-year medical student, felt that the Health Ministry was taking a step backwards by having paramedics and staff nurses run these clinics.

It saddens me to read their exhortations, one a presumably experienced clinician in the private sector and the other a student who has yet to earn his stripes as a doctor. While both mean well, they should have given some thought to what they are writing.

Suggesting that the ministry had acted in haste and is being retrogressive in its approach clearly reflects their lack of understanding of the role of the 1Malaysia clinics.

I would like to shed some light on the 1Malaysia clinics so that Malaysians will be assured that by establishing these clinics in urban settings, we are helping to meet the urgent health needs of the rakyat.

Rural Malaysians receive better healthcare than their poorer urban counterparts.
Malaysia has a dichotomous healthcare system. People have the option of either going to government-run clinics and hospitals or the private sector. Many throng our health clinics and almost all have to wait long hours to get served, even for minor ailments or simple procedures.

The ministry extended the hours of outpatient services until 9.30pm at selected busy clinics. We have also opened our clinics during lunch hour for patients' convenience.

One of the ministry's primary objectives is to ensure the delivery of equitable quality healthcare to the rakyat.

The establishment of the 1Malaysia clinics was certainly not done in haste. In nations throughout the world, there is a progressive migration from rural to urban areas. Malaysia is no exception. It is estimated that by 2015, more than 50 per cent of the population will be living in urban settings.

With the migration of people to urban areas, there is a growing concern for the plight and specific health needs of the urban poor. Many face various socio-economic problems, including access to quality healthcare.

Malaysia has often been cited by the World Health Organisation as having one of the best rural healthcare services, with strategically located rural clinics making quality healthcare accessible.

Many are managed by paramedics, that is, assistant medical officers (previously called medical assistants) and staff nurses, under the supervision of a doctor stationed at a larger nearby clinic. This doctor is responsible for ensuring that the care delivered by the paramedics is in accordance with good medical practice.

This system has stood the test of time and it was felt that a similar structure would now be appropriate to cater for the needs of the urban poor, many of whom do not have access to the services enjoyed by those in rural areas.

A task force comprising senior officers from the relevant divisions of the ministry, who are well versed in the current strengths and limitations of our existing healthcare delivery in urban areas, drew up comprehensive guidelines for the establishment and running of these clinics.


It was to address this need that the idea of 1Malaysia clinics was put forward. Such clinics will fulfil the government's social responsibility of delivering equitable healthcare to every Malaysian.



This proactive step to address the growing health needs of the urban poor will alleviate the suffering of those who require urgent attention for minor ailments.

The paramedics manning these clinics are experienced officers who know their limitations and are able to detect clinical conditions that would require urgent referral to doctors. We have enlisted a group of doctors, both in the public and private sectors, in the vicinity of these clinics, to see such patients where necessary.

In addition, a doctor will be held responsible for ensuring that the treatment provided by the paramedics is proper, in accordance with the established guidelines and procedures, and meets our standards.

To belittle the capability of the paramedics and staff nurses in handling minor illnesses is unfair and reflects ignorance of the role of these healthcare providers in our healthcare delivery system.

There are clear job descriptions for staff nurses and assistant medical officers. They are qualified to carry out minor surgical procedures and are allowed to use specific surgical instruments under the Medical Act 1971.

Their role in these clinics is within their current scope of work at hospitals and clinics. They will not be asked to take on more than they have been trained for and will adhere to the guidelines on the type of services that can be offered at all times.

With the setting up of these clinics, one need not take an elderly relative to a large clinic or hospital to change a bladder catheter or dress a minor injury sustained at home, school or at work.

A 1Malaysia clinic, which operates from 10am to 10pm daily, can get this done promptly without the hassle of looking for transport. These clinics will be situated in areas where there is a concentration of urban poor.

While some are questioning the use of paramedics, there is a growing trend in most developed countries such as Australia and the United Kingdom to delegate the routine follow- ups and monitoring of stable patients with chronic illness such as diabetes, asthma, hypertension and even stable heart failure to staff nurses.

Our 1Malaysia clinics will similarly be able to offer point-of-care tests to help monitor the status of patients with chronic illnesses and, when necessary, initiate a referral either to a family physician or to a hospital for definitive care. Of course, they have to be trained and supervised by a doctor in the course of their work.

Having staff nurses to help monitor these patients is not a move backwards, but a move forward in keeping with changing trends of medical care.

I would like to reassure the public and the medical fraternity that the ministry gave this a lot of thought.

It is not our intention to take the business of healthcare away from our primary care doctors. On the contrary, we have proposed that the government introduce an integrated primary healthcare system so the rakyat can seek treatment from doctors in both public and private sectors.

We hope to introduce the concept of a "family doctor" and have taken steps to encourage our primary care doctors to become effective "gatekeepers".

While waiting for that to materialise, we need to urgently address the health needs of the urban poor, and having the 1Malaysia clinics, just 50 of them throughout the country (three or four in each state) is not going to dent the purse of our doctors.

Let me reiterate that although we would like to provide convenience to the rakyat, we will not compromise on the standards of care.

Let us all give the 1Malaysia clinics a chance to prove their worth. Should there be any infringements of quality of care, we can always put in remedial measures. We are open to feedback from all.

Should any of you have good ideas on how we can provide better healthcare for you, please let us know. We are ready to serve you better.

Health D-G: 1Malaysia clinics to go mobile, too

KUALA LUMPUR: The government has approved an annual allocation of RM10 million to operate 50 1Malaysia static and mobile clinics nationwide.
The static clinics will be opened at shophouses or rented premises. The mobile clinics will operate in areas where it is difficult to set up static clinics. They may also operate from existing health centres.

Director-General of Health Tan Sri Dr Ismail Merican, in a circular dated Nov 6, stated that the state health director would identify the location and building for the clinics according to the needs of the area.

"The clinics must be near housing estates and easily accessible to residents," he said.

If the clinics have to be set up at rented premises, he said then it must be in accordance with the procedures stipulated by the ministry.

"As far as possible, we encourage getting a place which could be used free of charge," he added.

As a short-term strategy to kick-start the clinics in January, the state health departments have been asked to deploy staff from existing government clinics and recruit assistant medical officers, allied health staff and trained nurses on a contract basis.

Dr Ismail said the 1Malaysia clinics, which would operate from 10am to 10pm, would provide minor treatment to people in line with the government's "People First, Performance Now" policy.

The clinics will be closed on weekends and public holidays.

He said the service would help reduce the patient load at existing government clinics as it is hoped that patients will go to these clinics for minor treatments and procedures.

He said the assistant medical officers and trained nurses at the clinics would be able to provide treatment for minor ailments and perform minor procedures.

They would refer chronic cases to the nearest government clinics or hospitals, notify the authorities of communicable diseases, dispense medicine, conduct counselling and promote healthcare.

"If emergency cases come to these clinics, the assistant medical officer must stabilise the patients first before referring them to the nearest hospital," he added.

He said the ministry would extend its emergency call network system to these clinics.

The ministry has come out with a comprehensive guideline on the services that would be provided by the assistant medical officer and trained nurses.

Cases that are beyond their scope will be referred to the nearest government clinic or hospital. Dr Ismail said the 1Malaysia clinics would be supervised by a medical officer from the government clinic.

NST 12/11/2009

Urban folk to benefit but private doctors worry

KUALA LUMPUR: The government's move to expand community clinics, to be known as 1Malaysia Clinics, in urban areas similar to government clinics in rural areas got the thumbs up from the public and health ministry.

Director-General of Health Tan Sri Dr Ismail Merican said the 1Malaysia Clinics would ensure that the public gets prompt treatment for minor ailments, including wound dressings.

"Although the clinics will be manned by trained paramedics, we will also put in a mechanism for doctors to go on a regular basis to these clinics."

He said the 1Malaysia Clinics would have standard operating procedures to provide not only treatment for minor ailments, but also to handle emergencies and put in place a referral system.

Najib, in his 2010 Budget speech yesterday, said these clinics would be opened in rented shop lots at housing areas for the convenience of the community to seek treatment for fever, cough and flu.

He added that these clinics would be manned by medical assistants and would operate daily from 10am to 10pm.

For a start, an allocation of RM10 million would be provided to establish 50 clinics in selected areas.

Dr Ismail also welcomed the move by the government to allocate RM14.8 billion to manage, build and upgrade hospitals and clinics.

"With the hospitals and clinics upgraded, the rakyat can be assured of better services from doctors who will have a better environment to work in," he said.

Construction and upgrading of hospitals for next year would include those in Kluang, Bera, Shah Alam, Alor Gajah and Tampoi.

However, private general practitioners are worried that the setting up of the 1Malaysia Clinics in urban areas might affect their business.

Malaysian Medical Association president Dr David Quek Kwang Leng said it would definitely affect the income of general practitioners who were already hit by the economic recession, and having to compete with pharmacies.

"We are also worried about the task shifting, namely the medical assistants, being designated for non-critical services.

"It may be cost-effective in the short-term but the ministry must look into its implementation in the long term."

He said every year, some 2,500 doctors would be graduating and joining the employment field and they must be placed in remote and urban areas.

"We are not against the setting up of 1Malaysia Clinics in remote and rural areas. But, there are enough clinics to handle patients in urban areas," said Dr Quek.

Furthermore, he added, the association wondered whet-her the paramedics were trained well enough to handle patients with minor ailments.

Several people, when contacted, said that they welcomed the 1Malaysia Clinics as they no longer have to queue up at the hospital's outpatient clinics and emergency department for minor ailments.

Businessman S. Francis, 61, said the move was timely especially with many facing financial problems due to the economic crisis.

"There are many people who cannot afford to go to private hospitals and clinics to get treatment for minor ailments," he said.

NST 24/10/2009