Besides providing basic medical care for low-income earners, the 1Malaysia clinics will ease the workload of doctors at government hospitals and clinics in urban areas.
IN the past, when Mariamah Saravanan, 73, did not feel well, she would take a bus to the Klinik Kesihatan (Government Outpatient Clinic) in Plaza Pantai located next to the Putra LRT Kerinchi Station. To get there, she had to wait for a bus that arrived every half an hour. She could go to a private clinic near her place but she would have to pay up to RM40 for a simple consultation.
Now, if Mariamah has a cough or cold, she just walks to the 1Malaysia clinic near her home in Kampung Kerinchi, Kuala Lumpur to get treatment.
“We trust the medical assistants. Government medicines are just as good,” she says.
For the urban poor: The 1Malaysia clinics will be located in areas where there is a high concentration of low-income earners in an urban setting. Last week, Prime Minister Datuk Seri Najib Tun Razak launched the Kampung Kerinchi and Lembah Subang 1Malaysia clinics, which are meant for those seeking treatment of minor ailments such as coughs, colds and fever.
At these clinics, Malaysians are charged RM1 but Government servants and students will be given free treatment. Refugees with UNHCR cards and foreigners are charged RM7.50 and RM15 respectively.
The clinics, which will operate daily from 10am to 10pm, will be manned by an assistant medical officer (AMO), a staff nurse and an assistant health officer.
Altogether, 50 such clinics will be opened throughout the country – five each in Penang, Johor, Federal Territory and Selangor; four each in Perak, Sabah and Sarawak; three each in Terengganu, Pahang, Malacca, Negri Sembilan and Kelantan; two in Kedah and one in Perlis.
The clinics are located in areas where there is a high concentration of low-income earners in an urban setting. The Kampung Kerinchi and Lembah Subang 1Malaysia clinics, for example, are located near low-cost housing schemes.
The Government has spent RM10mil to set up the 50 clinics and Najib says it would evaluate the success of these clinics before deciding whether to set up more.
The clinics have a basic layout with a registration and waiting area, consultation room and treatment room.
Family Health Development director Dr Safurah Jaafar, who coordinated the design and set-up of the clinics, says the premises vary in size and some are rented while others are provided by the local authorities for free.
The clinics are equipped with basic facilities such as a set to read blood pressure, emergency trolley, examination couch, nebuliser and ECG (electrocardiogram) machine. Educational materials covering many health subjects are also available there.
Dr Safurah says the AMOs and staff nurses manning the clinics would have at least five years experience. They will work in shifts and will be rotated according to the resources available locally, including at the Klinik Kesihatan.
Their role in the 1Malaysia clinics would be within their current scope at hospitals or clinics, for example, changing a bladder catheter (which has to be changed fortnightly) or dressing minor wounds.
The AMOs also have the credentials to perform minor surgical procedures and are allowed to use specific surgical instruments under the Medical Act 1971.
Cases that are not within the scope of the AMOs will be referred to the nearest health clinic or hospital.
Dr Safurah says the AMOs can dispense Class C drugs such as Paracetamol, anti-histamines or anti-fungal creams, among others.
The “privileged” AMOs who have received the required training can prescribe hypertensive and diabetes drugs.
The scope of the AMOs depend on the training they have undergone, she says. “They would have gone for a course and would have been clinically audited. We have to ensure that standards are maintained.”
The Health Ministry has also enlisted the services of doctors both in the public and private sectors in the vicinity of the 1Malaysia clinics to attend to patients who require urgent referrals.
Government doctors are more than supportive of the move, believing the clinics will play a complementary role to Government hospitals.
“The patients don’t have to clog up the hospitals for simple things like wound dressings,” says a doctor who declined to be named.
The Consumers Association of Penang (CAP) has also lauded the 1Malaysia clinics initiative. According to CAP, a random survey on the number of private clinics within a 500m radius in an urban area in Penang showed not less than 15 clinics were in operation.
“Most people living in the area are from lower and middle income groups who, if given a choice, preferred to seek treatment from a public healthcare facility instead of these clinics due to the high cost of treatments,” says CAP President S. M. Mohd Idris.
Idris says the idea of community-based primary healthcare is not new in Malaysia, citing the rural clinics that have been in existence since the 1960s and which have mainly been staffed by AMOs. These clinics are usually under the supervision of a doctor stationed at a larger clinic nearby.
“They have done the poor and rural-based rakyat a great service by taking care of their primary healthcare needs,” he says.
But the 1Malaysia clinics have detractors too. According to Malaysian Medical Association (MMA) president Dr David Quek, the clinics have been hurriedly put together. “Healthcare must be planned properly,” he states.
His primary concern is the fact that the clinics are not going to be manned by doctors. The World Medical Association (WMA) had expressed a series of concerns about the global development of “task shifting”, where a task normally performed by a physician is transferred to a health worker who is less qualified, he says.
“It won’t impact the GPs much. If doctors are involved in running it then we have no issue at all,” he says, referring to suggestions that general practitioners (GPs) are opposed to the clinics because they would impact negatively on their earnings.
Dr Safurah understands the MMA’s concerns and says that as proponents of standards, the Health Minsitry wants to make sure that everything is put in place properly.
It would be perfect if the Government could appoint doctors to the clinics but we are short of doctors, she says.
“We are thankful the MMA raised the issue. Their concerns are our concerns as well. We have put all the checks and balances in place and made sure the AMOs are trained. We have to maintain standards so we will not be accused of providing poor standard services.”
The suggestion that most GPs are opposed to the 1Malaysia clinics because they fear their earnings might be affected is also refuted by medical practitioner Dr Milton Lum.
“It is unlikely that the urban poor who visit the 1Malaysia clinics will be disposed to consulting a GP,” says Dr Lum who is also a health columnist for The Star.
Lum says the poor, government servants and people who do not want to pay more for medical treatment make up the majority of patients at government clinics and hospitals.
“It appears that the objective of the 1Malaysia clinic is to get medical assistants and nurses to deal with some of the self-limiting and not serious cases. If that’s the case, is there any strong reason to object?”
Dr Jayabalan Thambyappa, a GP in Butterworth, says he is unsure about the AMO’s ability in running the clinics.
“They need more training in primary healthcare. Are these medical assistants trained sufficiently to handle everyone’s ailments? If someone is having a heart attack, are they capable of handling it? If a pregnant lady comes in, can they assess if she’s having real pains or false pains?”
Dr Lum says medical assistants, nurses and midwives in government clinics and hospitals provide care to more patients compared to doctors.
“Some of the medical assistants, nurses and midwives today are degree holders. To say that they are not trained or unqualified is unfair,” he says.
Between the 1950s and 70s when there was a high mortality rate among mothers during childbirth, the Government had midwives from all over the country trained and this reduced the mortality to the present rate, he adds.
Dr Lum also believes the 1Malaysia clinics will have standard operating procedures to ensure that patient care and safety are not compromised.
From feedback, he says, the medical officers at the outpatient clinics in the hospitals see between 100 and 140 patients in an eight-hour shift.
“Many of these cases are self-limiting and not serious. I am informed that these cases can make up 50% to 75% of cases seen daily,” he says.
Dr Lum hopes the 1Malaysia clinics will release the medical officers from these duties so that they can deal with the more complex and serious cases in government clinics and hospitals.
In any case, the clinics should be given a chance to operate before they are judged, he says. “The jury is still out (on the 1Malaysia clinics). We have to see how it works. If they work outside their scope, then it’s a different ball game.”
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