Current Issue - 2008, Volume 3 Number 1

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MANAGING CHRONIC DISEASES IN THE MALAYSIAN PRIMARY HEALTH CARE – A NEED FOR CHANGE

CONCLUSION

It is imperative that the increasing magnitude of chronic disease burden is anticipated, understood and acted upon urgently. Chronic disease prevention and control can no longer be ignored as an important means of economic development. Primary health care with its defining features of continuity, comprehensiveness and coordination, is the cornerstone to provide high quality and cost-effective chronic disease care to the population. Despite significant progress made in developing the infrastructure, primary health care service in Malaysia, be it in the public or private sector, is still oriented to react to acute, episodic illnesses as well as maternal and child health. The system largely remains that way despite the increased prevalence of chronic diseases. Major impediments to execute successful chronic disease management programmes in the current system are the lack of high quality research to study barriers of implementation of the various policies made pertaining to chronic diseases, slow expansion of electronic clinical information systems to achieve the goal of coordinated care, lack of universal funding mechanism to ensure equitable access to healthcare, fragmentation of primary health care services into public and private sectors, lack of compulsory formal postgraduate training for the majority of primary care doctors and shortage of trained allied health care personnel to care for chronic conditions.

We need a top-down stewardship and strong commitment by national leaders, policy makers, health care organisations, community leaders, health care personnel, and patients and families, on quality primary health care that focus on prevention and control of chronic diseases. The solution lies in every person at all levels to become an agent of change by embracing a new way of thinking regarding chronic disease care and to take serious actions on each of the problems highlighted. As long as the acute care model dominates health care systems, health care expenditure will continue to escalate without meaningful improvements in populations’ health status.23 Through innovative application of the ICCC Framework as advocated by the WHO, primary health care system in Malaysia can potentially maximise its returns from limited resources by shifting from an acute to chronic care model. The health of our future generation will depend on our ability to successfully redesign our primary health care system that can meet the needs of a growing population of patients with chronic conditions.

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