Master of Public Health, Senior Principal Assistant Director, Primary Health Infrastructure Development Sector, Primary Healthcare Section Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
Master of Public Health, Master of Business Administration, Former Director Family Health Development Division, Ministry of Health Malaysia, Currently Professor Community Medicine, International Medical University Malaysia, Kuala Lumpur, Malaysia.
Prim Health Care Res Dev. 2020 Feb 24;21:e4. doi: 10.1017/S146342362000002X.
This paper illustrates the development of Primary Health Care (PHC) public sector in Malaysia, through a series of health reforms in addressing equitable access. Malaysia was a signatory to the Alma Ata Declaration in 1978. The opportunity provided the impetus to expand the Rural Health Services of the 1960s, guided by the principles of PHC which attempts to address the urban-rural divide to improve equity and accessibility. The review was made through several collation of literature searches from published and unpublished research papers, the Ministry of Health annual reports, the 5-year Malaysia Plans, National Statistics Department, on health systems programme and infrastructure developments in Malaysia. The Public Primary Care Health System has evolved progressively through five phases of organisational reforms and physical restructuring. It responded to growing needs over a 40-year period since the Alma Ata Declaration in 1978, keeping equity, accessibility, efficiency and universal health coverage consistently in the backdrop. There were improvements of maternal, infant mortality rates as well as accessibility to health services for the population. The PHC Reforms in Malaysia are the result of structured and strategic investment. However, there will be continuing dilemma between cost-effectiveness and equity. Hence, continuous efforts are required to look at opportunity costs of alternative strategies to provide the best available solution given the available resources and capacities. While recognising that health systems development is complex with several layers and influencing factors, this paper focuses on a small but crucial aspect that occupies much time and energies of front-line managers in the health.
本文通过马来西亚一系列公平获取的卫生改革，阐述了初级卫生保健（PHC）公共部门的发展。马来西亚于 1978 年签署了《阿拉木图宣言》。这一机会提供了动力，以扩大 20 世纪 60 年代的农村卫生服务，其指导原则是初级卫生保健，旨在解决城乡差距，提高公平性和可及性。通过对已发表和未发表的研究论文、卫生部年度报告、马来西亚五年计划、国家统计局关于卫生系统方案和基础设施发展的文献进行多次汇编，对卫生系统进行了审查。公共初级保健卫生系统通过五个阶段的组织改革和物理结构调整逐步发展。自 1978 年《阿拉木图宣言》以来的 40 多年里，它应对了不断增长的需求，始终将公平、可及性、效率和全民健康覆盖作为背景。孕产妇和婴儿死亡率有所改善，人口获得卫生服务的机会也有所增加。马来西亚的初级卫生保健改革是有计划和战略性投资的结果。然而，在成本效益和公平性之间将继续存在两难境地。因此，需要不断努力，考虑替代战略的机会成本，根据现有资源和能力提供最佳可行解决方案。虽然认识到卫生系统发展是一个复杂的过程，涉及多个层面和影响因素，但本文重点关注一个小但至关重要的方面，该方面占据了卫生前线管理人员的大量时间和精力。
