NST Letter: Healthcare services: Need to work together... by Dr Md Azmi Ahmad Hassali & Dr Jayabalan Thambyappa

Healthcare services: Need to work together

2011/03/16
ASSOCIATE PROFESSOR DR MOHAMED AZMI AHMAD HASSALI and DR JAYABALAN THAMBYAPPA, Discipline of Social and Administrative Pharmacy,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang

letters@nst.com.my

OVER the last 10 years, national statistics on health have indicated a significant increase in the number of non-communicable diseases such as diabetes and cardiovascular-related diseases among the population.

The main reasons for this increase include the lack of awareness and lackadaisical attitude towards leading a healthy lifestyle.

It is also interesting to note that despite the numerous health campaigns and activities nationwide by the government or non-governmental organisations, the impact and outcomes of these programmes have been minimal in reducing the disease burden.

The time has come for healthcare providers to ask themselves: "What has gone wrong and who is to blame?"

The lack of interprofessional collaboration among partners in healthcare delivery in pushing health promotion agenda is to blame.

It cannot be denied that in the public sector, the government through the Health Ministry, has done a tremendous job in ensuring the delivery of preventive services via the provision of primary healthcare services.

However, one of the setbacks is that the current public demand has resulted in manpower and the cost of running such programmes stretched to the limits because of extreme focus on one group of healthcare professionals -- the medical doctors.

Therefore, it's time to engage a broader group of healthcare professionals in such an activity.

With the importance of primary care services emphasised by international health bodies such as the World Health Organisation, the current training of health professionals has also been transformed.

Subjects such as public health and epidemiology, which were traditionally taught only to medical students, have now been made compulsory subjects in all health professional undergraduate training.

For example, public health and epidemiology are core subjects in the curriculum of most pharmacy courses in the country. Similarly, public health subjects are also incorporated into the curriculum of nursing programmes and other allied health science courses.

In the private sector, primary healthcare providers, comprising general practitioners, dentists and pharmacists, are in the best position to take the health promotion agenda further.

Unfortunately, although it is mandated that health promotion activities are to be provided by primary healthcare workers, the uptake among practitioners is very low and interest in providing such intervention is minimal because of the non-profitable nature of such interventions.

The problem in our country is that nearly all relevant healthcare professionals in the private primary care services work with a silo mentality.

Primary care services can only be enhanced when there is coordinated effort. But most healthcare providers do not complement each other's roles and tend to put their interest in business first rather than patient care.

Feedback from colleagues in both the medical and pharmaceutical fraternity shows that most of them blame the existing out-of-pocket services as the main obstacle towards working in close collaboration with each other.

Consequently, business interests and survival in the healthcare market become top priority for healthcare providers.

In the long term, this is unhealthy as consumers are the ones who will be victimised.

One may argue that by having too many health professionals, our primary healthcare will become too expensive.

But this is unlikely as health promotion advice and counselling from community pharmacies for instance, are free of charge or at a very minimal cost.

Furthermore, community pharmacists are very well trained to deal with minor illnesses, which can be easily managed with over-the-counter preparations.

Besides, by forging interprofessional collaboration, pharmacists will refer their patients to general practitioners or other allied health personnel if the patients need further diagnosis or out-of-prescription treatment.

This has been successfully implemented in many developed nations and it is our belief that this model can be implemented here.

It is hoped that both professional bodies and individual practitioners can exchange ideas and discuss the creation of a model for successful interprofessional care.

Once a model has been created, it is crucial to study its effectiveness in preventive care. This is to ensure that there is sufficient evidence to institute policy changes for the benefit of society.

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