Pengenalan asas mengenai PRIMARY HEALTH CARE

1. PRIMARY HEALTHCARE
Disediakan Oleh : Nassruto

2. Introduction…
• At the International Conference on Primary Health Care in
1978 at Alma Atta, Primary Health Care has been
identified as a key to attaining Health For All

3. PRIMARY HEALTH CARE
Definition
The World Health Organisation (WHO) has
defined Primary Health care as :
Essential health care based on practical, scientifically
sound and socially acceptable methods and technology
made universally accessible to individuals and families in
the community through their full participation and at a
cost that the community and country can afford to
maintain at every stage of their development in the spirit
of self-reliance and self-determination.
(WHO, 1978)

4. PRIMARY HEALTH CARE
• It is intended to reach everybody, particularly
those in greatest need
• It is intended to reach to the home and the
family level, and not be limited to health
facilities
• It is intended to involve a continuing
relationship with persons and families

5. • - There are at least 8 essential services to be
provided to every individual in the community :
• Health education
• food supply and proper nutrition
• safe water and basic sanitation
• maternal and child care
• immunization
• prevention and control of endemic diseases
• basic treatment of health problem
• provision of essential drugs
PRIMARY HEALTH
CARE

6. PRIMARY HEALTH CARE in Malaysia
The Eight (+ One) Elements
Malaysia, even before 1978, has always had these at all
rural clinics, and additional ninth element, dental care.
• Maternal and Child Health, including family planning and childhood
immunization
• Out-patient Curative Care (inc dispensary)
• Dental Health
• Control of Communicable Diseases
• Environmental Sanitation
• Health Education for the public
• Clinical Laboratory
• School Health Program
• Nutrition

7. • In the 6 and 7th
MP:
To ensure adequate emphasis is given to Primary Health
Care (PHC) , it has been proclaimed as the “Thrust of
Health Services of the country” in the Seventh
Malaysia Plan.
It will provide comprehensive services : ---
Promotion
• Preventive
• Curative
• Rehabilitative

8. What we did in 7th
MP
• Plan and implement expanded and extended
scope of PHC services
• Transfer of outpatient service
• Upgrade PHC facilities and support services
• Develop ICT for health – Telehealth,
Teleprimary care, Lifetime Health Record
• Human resource planning and procurement
• Develop policy on Traditional/Complementary
Medicine

9. PHC Objectives in 8th
MP
• To provide PHC service to the population and to promote
wellness and facilitate maximum recovery from illness

10. PRIMARY HEALTH CARE
SECTION
• started as one unit in 1996,
• Became a section in 1997
• Now we have 12 staffs ,
• – take care of health services provided at first point of
contact, by health clinics and community clinics to all
clients.

11. Primary Health Care :
- policy planning and development related to health care
services at primary care level.

12. Objectives
• To plan and monitor programs implemented & integrated
at primary care level
• To plan human resource requirement and their
development
• To plan and monitor the infrastructure development –
layout plan, equipment, support services and ICT

13. Objectives ….
• To develop policy and operational policy at the clinic
level
• To monitor the traditional/complementary medicine
practices
• Others : NGO, Quality program, Health Technology
Assessment

14. ORGANISATION
Director General of Health
Deputy Director General of Health (Public Health)
Director of Family Health Development Division
Primary Health Care Section
Infrastructure Human Resource Policy/T/CM

15. RURAL HEALTH SERVICE – has always
been a major component of health facility
development
• It is provided by Ministry of Health, except in the
estate/Orang Asli settlement
• The services are provided at Health Clinics and
Midwife Clinic -cum- Quarters
• It practices the Primary Health Care Concept
• The initial structure was a three-tier system (each unit
for50,000) population)
• After 1971, it was upgraded by phases into two- tier
system (each unit for 15,000 – 20,000 populations) to
improve accessibility

16. Upgrading of health
facilities
• In 1971, there was a modification of the rural health unit
from a 3-tier system into a 2-tier system through the
upgrading of Sub-health Centres and Mid-wife Clinics
into Main Health Clinics and “Klinik Desa” (community
clinic)
• This Rural Health Clinic covers a population of 15,000 to
20,000 and the Klinik Desa provides services to a
population of 4,000-5,000

17. Healthcare providers at various
level of Primary Health Care
- Health Facility Level
Type of facility :
Dispensary, Community Clinic, Health Clinic or a consultation
room of a General Practitioner’s clinic
Category of Health Personel :
Medical Officer, Public Health Nurse, Community Nurse,
Medical Assistant, Public Health Inspector, Dispenser, Junior
Laboratory Assistant/Medical Laboratory Technologist/)
Supportive facilities: Clinical laboratory Services, Essential
drugs, no X-Ray facility, no ultrasound machine

18. URBAN HEALTH SERVICES
• It is provided by Local Authority, Ministry of
Health and private sector
• Service range:
• - Maternal & Child Health Services
- Out patient Care
• It is mainly curative services

19. PRIMARY HEALTH CARE
NOW & FUTURE
• Expand the scope of PHC services
• Human resource development
• New plan for Health Clinics and Rural Clinics
• Development of physical facilities (x-ray, labs)
• Emphasis to develop Urban Health Clinics
• Involving NGO’s and community in health care
• Involve local private primary care providers to
provide PHC
• Health Care Financing Options

20. Existing services
• Maternal health
• Child health
• Family planning
• Outpatient curative care
• Home delivery and nursing
• Dental health
• School health
• Disease Prevention & Control
• Environmental health
• Health education
• Pharmacy
• Clinical Laboratory
• New’ services
• Well Adult Clinic
• Workers’ health
• Adolescent health
• Care of the Elderly
• Community Mental Health
• Care of Children with Special
Needs
• Rehabilitation
• Diagnostic Imaging
(ultrasound, x-ray)
• Alternative Birthing Centre

21. PHC Elements …
In 7th
MP and on …
Health care for the Elderly
Adolescent health
Occupational health
Care for children with special needs
Rehabilitative service
Community mental health
Well adult clinic
Home care nursing

22. PRIMARY HEALTH CARE
Malaysian achievement
Number of health facilities and facility : population
ratio in Malaysia, 1970-1996Type of
facilities
1970 1980 1990 1995
MCQ/Rural
Clinics
26 703
(1:12200)
1977
(1:5380)
1987
(1: 4720)
Health
Clinics
16
(1:625000)
178
(1:73000)
611
(1:29100)
772
(1: 26800)
Source: Ministry of Health, Malaysia.
2001
1940
855
(1:25730)

23. Infrastructure Planning
and Development
For the 8th
Malaysia Plan, Standard Plan for
Health Clinics has been reviewed
Type 1 - > 800 patients per day
Type 2 - 500 – 800 patients per day
Type 3 - 300 – 500 patients per day
Type 4 Semenanjung - < 300 patients per day
Type 4 Sabah/Sarawak - 150- 300
Type 5 Sabah/Sarawak - < 150
Type 6 Sabah/Sarawak - < 50

24. • Lab facilities
• Radiological facilities
• Pharmaceuticals
• Rehabilitative facilities
• Health Promotion facilities
• IT and networking
• Training -CME/CEPH
• Technology - Teleprimarycare

25. Human Resource
Development
- Introduction of new categories of
staffs
• Family Medicine Specialist
• Radiographer
• Occupational Therapist
• Physiotherapist
• Medical Social Worker
• Audiologist
• Dietician
• Speech Therapist

26. FAMILY MEDICINE SPECIALIST (FMS)
- Will provide comprehensive and continuity of specialist
care at first point of contact, and takes responsibility for
providing the patient’s care , extended to their family and
community
- Currently, there are 95 Family Medicine Specialists
serving through out the country
•

27. Support Services
- Having FMS at the PHC level of care, the support services
also being upgraded
• - Specialist drugs (List A) are available and can be
prescribed by the specialist
- Laboratory services : Upgrading of laboratory services from
clinical to Level 1 (upgraded ) has been continuous effort
- Diagnostic imaging : Service has developed tremendously
since 1989, now 61 health clinic equipped with diagnostic
imaging services , which is run by radiographer
- Ultrasound : So far 83 health clinics equipped with
ultrasound machine

28. Future of Primary Health
Care Delivery
Home
testing &
monitoring
Medical
advice via
telephone
Coordinated &
integrated delivery of
care
Best practice
interactive
technology
Contemporay
education
media and
technology
Wellness &
prevention at work