Letter to Editor, The Star, Thursday January 7, 2010
Seek views of all parties firstTHE setting up of 1Malaysia clinics is presumably to help meet the needs of the urban people.
Tan Sri Dr Ismail Merican, the director-general of health, claims that the sole objective of this move is to ensure the delivery of equitable, quality healthcare to the public. This is of course a laudable move but the issue at large is the quality of these clinics.
According to him, there is a growing trend in most developed countries, like Australia and the UK, to delegate routine follow-ups and monitoring of stable patients with chronic illnesses such as diabetes, hypertension and even stable heart disease to staff nurses.
This may be possible in these countries as the nurses there are senior staff and degree holders in their profession, but the same does not hold true for medical assistants in Malaysia who undergo a 3+1 nursing training programme.
A study in 2009 revealed that medical assistants at government health clinics and government hospitals were found to be responsible for many medication errors. Of the 1,612 prescriptions generated by medical assistants in a single week, 1169 errors were noted and some were critical errors, involving the use of at least one medication categorised as Group B medicine, which only medical officers are authorised to prescribe. It must be noted that medical assistants are trained to assist medical officers and not to provide treatment in the same manner as medical officers.
Another issue that needs to be considered is the administrative cost involved in establishing these clinics. The cost involved in running public health institutions has not been studied comprehensively and it is well-known that some district hospitals are under-utilised, mainly because patient attendance is poor.
So setting up primary care organisations among klinik desa, district hospitals and other primary healthcare centres will incur further costs and may fail for want of attendance.
Another consideration is that access to healthcare cannot be provided in an ad hoc manner. It is not clear how the system will operate and the supervisory roles of medical officers are ill-defined. This will be especially critical in an emergency as well as when there is a need to seek a second opinion.
The views of all parties involved should be sought before any decisions are made and finalised. While it was claimed that senior officers from the relevant divisions of the ministry were involved in drawing up comprehensive guidelines for the establishment and running of these clinics, the fact remains that the views of other stakeholders, for example the MMA, and the NGOs were not solicited.
Despite these shortcomings, there are remedial measures that can be put in place to make these 1Malaysia clinics workable. There is no error-free system involving human intervention but it is possible to design a system to avoid or minimise the errors, such as a primary healthcare team made up of pharmacists, midwives, physiotherapists, senior nursing sisters, etc, to run these clinics.
For example, a patient coming in with a minor sports injury can be treated by a physiotherapist; a pregnant lady can be assessed by a midwife; minor surgery by the medical assistant; and the pharmacists would be able to pick up prescription errors and correct them before any harm occurs. This will ensure a check-and-balance of prescriptions and different treatment options.
The Government should consider the views of other stakeholders before embarking on this project because backpedalling after establishing these clinics would be a colossal waste of public funds.
The KPI of 1Malaysia clinics to provide equitable and quality healthcare can never be fulfilled if the clinics themselves are plagued with potential medical and system errors.
Dr Jayabalan T,
Dr Mohamed Azmi Ahmad Hassali and
Dr Asrul Akmal Shafie,