Abstract
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 The review was made through several collation of literature searches from published and unpublished research papers, the Ministry of Health annual reports, the 5-year Malaysia Plans, National Statistics Department, on health systems programme and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.
Highlights
Equity and access through Primary Health Care (PHC) have been the main agenda of many countries after the PHC Declaration made in Kazakhstan in 1978
The focus was on reducing the urban–rural divide, while more recently the focus is on equity, quality, efficiency and universal health coverage
Progressive physical re-structuring and organisational evolution were central to continuing improvement of access and equity
Summary
Equity and access through Primary Health Care (PHC) have been the main agenda of many countries after the PHC Declaration made in Kazakhstan in 1978. Development of physical infrastructure such as transport and communication, educational and health facilities have provided the platform to support the provision and use of health-care services that in turn have been influenced by the interplay of resources including equipment, logistics, transport, supplies, manpower, management and information. Health care requires the establishment of a comprehensive variety of buildings, to cater for different functions that are needed during the life span of man ‘from womb to tomb’ (Mohd Nawawi et al, 2012). It requires appropriate best match between requirements of space, patient and information flow and clinic services to function in harmony. Each facility would need to fit with the social development of the local area, and not be under- or over-utilised during a specified period
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