MINISTRY OF HEALTH MALAYSIA
NCRC/HSU/2013.2
EDITED BY:
HWONG WY, SIVASAMPU S,
AISYAH A, SHANTHA KUMAR C,
GOH PP, HISHAM AN
NATIONAL HEALTHCARE
E S TA B L I S H M E N T &
WORKFORCE STATISTICS
PRIMARY CARE
2012
N AT I O N A L H E A LT H C A R E S TAT I S T I C S I N I T I AT I V E
National Healthcare Establishment and Workforce Statistics (Primary Care) 2012
March 2014
© Ministry of Health Malaysia
Published by:
The National Healthcare Statistics Initiative (NHSI)
National Clinical Research Centre
National Institutes of Health
3rd Floor, MMA House
124, Jalan Pahang
53000 Kuala Lumpur
Malaysia
Tel.
: (603) 40439300
Fax
: (603) 40439400
e-mail
: [email protected]
Website : http://www.crc.gov.my/nhsi
This report is copyrighted. Reproduction and dissemination of its contents in part or in whole for research, educational or
non-commercial purposes is authorised without any prior written permission provided the source is fully acknowledged.
Suggested citation:
Hwong WY, Sivasampu S, Aisyah A, Shantha Kumar C, Goh PP, Hisham AN. National Clinical Research Centre.
National Healthcare Establishment & Workforce Statistics (Primary Care) 2012.
Kuala Lumpur 2014.
This report is also available electronically on the website of the National Healthcare Statistics Initiative at:
http://www.crc.gov.my/nhsi/
Funding:
The National Healthcare Statistics Initiative was funded by a grant from the Ministry of Health Malaysia
(MRG Grant No. NMRR-09-842-4718)
Please note that there is potential for minor corrections of data in this report. Please check the online version at
www.crc.gov.my for any amendments
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
TABLE OF CONTENTS
ACKNOWLEDGEMENTS
iii
PROJECT TEAM
iv
ABBREVIATIONS AND SYMBOLS
v
INTRODUCTION
Background
vi
vi
Objectives
vi
METHODOLOGY
Sampling Frame and Sample Size Calculation
Data Collection and Follow-Up
Data Entry
Data Cleaning and Verification
Statistical Analysis
Ethical Issues
Limitations
Consort Diagrams
RESPONSE RATE
vii
vii
viii
ix
ix
ix
ix
x
xi
xiii
CHAPTER 1 | OVERVIEW
1
CHAPTER 2 | PRIMARY HEALTHCARE ESTABLISHMENTS
3
4
4
5
8
Types of Private Practice
Attendances
Electronic Healthcare Computer System
Tables for Figures
CHAPTER 3 | PRIMARY HEALTHCARE FACILITIES
Tables for Figures
11
13
CHAPTER 4 | PRIMARY HEALTHCARE SERVICES
15
15
16
16
17
20
Types of Services
Antenatal Care
Laboratory Services
Operating Days and Operating Hours
Tables for Figures
CHAPTER 5 | PRIMARY HEALTHCARE WORKFORCE
Characteristics of Healthcare Providers: Age, Gender and Years of Experience
Working Hours and Full-Time Equivalence
Family Medicine Specialists
Other Healthcare Professionals
Tables for Figures
CHAPTER 6 | PRIMARY HEALTHCARE MEDICAL DEVICES
Tables for Figures
23
23
25
26
27
29
31
35
APPENDICES
APPENDIX 1 | ADDITIONAL TABLES
37
APPENDIX 2 | PARTICIPANTS OF NHEWS PRIMARY CARE 2012
39
APPENDIX 3 | LIST OF DEFINITIONS
43
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List of Tables
Table 2.1.
Percent of Clinics with Electronic Healthcare Computer System in 2012
5
Table 2.2.
Number of Malaysian Primary Care Clinics per 10,000 Population in 2011
8
Table 2.3.
Types of Private Practice by State/Region in 2012
8
Table 2.4.
Median Attendances per Clinic per Day by State/Region and Sector in 2011
8
Table 2.5.
Percent of Fully Computerised Clinics by Sector in 2012
9
Table 2.6.
Types of Computer Usage by Sector in 2012
9
Table 3.1.
Types of Facilities by State/Region and Sector in 2012
11
Table 3.2.
Distribution of Functioning Ambulances in Public Clinics by State/Region in 2012
12
Table 3.3.
Percent of Public Clinics with Laboratory Space and Ambulance Services by State/Region in 2012
13
Table 4.1.
Percent of Clinics providing Antenatal Services by State/Region and Sector in 2012
16
Table 4.2.
Types of Services Available by Sector in 2012
20
Table 4.3.
Types of Laboratory Services by State/Region and Sector in 2012
20
Table 4.4.
Number of Operating Days per Week in Private Clinics by State/Region in 2012
20
Table 4.5.
Number of Operating Hours per Day in Private Clinics by State/Region in 2012
21
Table 4.6.
Types of Operating Hours per Day in Public Clinics by State/Region in 2012
21
Table 5.1.
Distribution of Medical Doctors by State/Region and Sector in 2012
23
Table 5.2.
Types of Post-Graduate Qualifications for Family Medicine Specialists by Sector in 2012
27
Table 5.3.
Distribution of Other Healthcare Professionals by State/Region and Sector in 2012
28
Table 5.4.
Age Distribution of Medical Doctors by State/Region and Sector in 2012
29
Table 5.5.
Years of Experience of Medical Doctors by State/Region and Sector in 2012
29
Table 5.6.
Gender Distribution of Medical Doctors by Sector In 2012
29
Table 5.7.
Median Working Hours per Week per Doctor by State/Region and Sector In 2012
30
Table 5.8.
Number of Patients Seen per Day per FTE Private Clinic Doctor by State/Region in 2012
30
Table 5.9.
Distribution of Family Medicine Specialists by State/Region and Sector in 2012
30
Table 6.1.
Distribution of Functioning Medical Devices per Clinic by State/ Region and Sector in 2012
Table 6.2.
Percent of Clinics with Functioning Medical Devices by Sector in 2012
35
Table A1.1.
Median Number of Attendances per clinic per year by State/Region and Sector in 2011
37
Table A1.2.
Median Number of Attendances (Outpatient, Home Visit, Antenatal Visit) per clinic per year by
State/Region and Sector in 2011
37
Table A1.3.
Types of Computer Usage by State/Region and Sector in 2012
37
Table A1.4.
Types of Services Available by State/Region and Sector in 2012
38
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ACKNOWLEDGEMENTS
The National Healthcare Statistics Initiative Primary Care team would like to thank the Director General of Health
Malaysia for his continuous support towards this survey and the permission to publish this report.
We would also like to express our sincere appreciation to the following for their participation, assistance, support and
contribution:
● Deputy Director General of Health (Research and Technical Support), MOH
●
Deputy Director General of Health (Public Health), MOH
●
Deputy Director General of Health (Medical), MOH
●
Director, National Clinical Research Centre (NCRC), National Institutes of Health (NIH)
●
Director, Family Health Development Division, MOH
●
Director, Medical Practice Division, MOH
●
State level Private Medical Practice Control Units (Unit Kawalan Amalan Perubatan Swasta, UKAPS) of Kelantan, Sabah,
Sarawak, Selangor and Wilayah Persekutuan Kuala Lumpur.
●
Malaysian Medical Council, Malaysian Medical Association, Academy of Family Physicians Malaysia, National
Specialist Register
Our special thanks and gratitude also goes to
●
All medical doctors and support personnel from the participating public and private clinics whom have kindly provided
data on their respective establishment and workforce
● The team from Family Health Development Division, MOH whom have generously shared data on public primary
care establishment and workforce
And all those who have supported or contributed to the success of the NHEWS Primary Care Survey 2012 and the
publication of this report
Thank you.
National Healthcare Statistics Initiative (NHSI) Primary Care Team
Healthcare Statistics Unit
National Clinical Research Centre (NCRC)
Ministry of Health, Malaysia
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PROJECT TEAM
Principal Investigator
Principal Co-Investigators
Datuk Dr. Noor Hisham Abdullah
Dr Sheamini Sivasampu
Dr. Goh Pik Pin
Dr Kamaliah Mohd. Noh
Dr. Kaviyarasan Sailin
Research Evaluation Committee
Professor Dr. Khoo Ee Ming
Associate Professor Dr. Ng Chirk Jenn
Professor Dr. Taufik Teng Cheong Lieng
Associate Professor Dr. Jamaluddin Abdul Rahman
Project Manager
Dr. Hwong Wen Yea, Amy
Survey Coordinator
Ms. Aisyah Ali
Research Officers
Ms. Sharmini Chandran
Ms. Hanan Hamimi Wahid
Dr. Hwong Wen Yea, Amy
Data Analysts
Ms. Norazida Ab Rahman
Mr. Shanthakumar Chandrasekaran
Database Developer/Administrator
Altus Solutions Sdn. Bhd.
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NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
ABBREVIATIONS AND SYMBOLS
CKAPS
Cawangan Kawalan Amalan Perubatan Swasta
CI
Confidence Interval
CRF
Case Report Form
df
Degree of Freedom
DG
Director General of Health, Ministry of Health Malaysia
e-CRF
Electronic Case Report Form
FAFP
Florida Academy of Family Physician
FMS
Family Medicine Specialist
FRACGP
FRCGP
Fellowship of the Royal Australian College of General Practitioners
Fellowship of Royal College of General Practitioners
FTE
Full Time Equivalence
GP
General Practitioner
IQR
Interquartile Range
KK
Klinik Kesihatan
MOH
MRCGP
MREC
NA
NCRC
NHEWS
NHSI
Ministry of Health
Member of Royal College of General Practitioners
Medical Research Ethics Committee
Not Available
National Clinical Research Centre
National Healthcare Establishment and Workforce Survey
National Healthcare Statistics Initiative
NIH
National Institutes of Health
NMCS
National Medical Care Survey
No.
Number
SD
Standard Deviation
UKAPS
WHO
WP
-
Unit Kawalan Amalan Perubatan Swasta
World Health Organisation
Wilayah Persekutuan
Not Applicable
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INTRODUCTION
Background
The National Healthcare Statistics Initiative (NHSI) is a family of surveys looking into services, healthcare workforce,
processes of care as well as some medical technologies of our dual healthcare system.This initiative is part of the Ministry
of Health Malaysia’s (MOH) move towards the availability of better health statistics. Healthcare statistics is a key element
of any country’s policymaking, monitoring and evaluation system. NHSI was initiated in 2009 by the National Clinical
Research Centre (NCRC) in collaboration with relevant MOH and private sector stakeholders. The Healthcare Statistics
Unit (HSU) in NCRC is the program coordinator of this initiative. Over the past 4 years, the NHSI has managed to
gain recognition as a reliable source of healthcare statistics providing useful and timely data which fills the gap between
research and policy.
It is well established that primary care services act as the gatekeeper of any healthcare system. The development of both
National Healthcare Establishment and Workforce Primary Care Survey (NHEWS) and National Medical Care Survey
(NMCS) was mooted when it was realised that there was very little known at large about the primary care system in
Malaysia; especially on the resources and contribution of the private primary care clinics and their providers. Being one
of the four surveys in NHSI, the NHEWS Primary Care Survey is in its third year of inception with two prior surveys
conducted in 2009 and 2010 respectively. In 2012, the project team had decided to pilot test the revised version of NMCS;
hence downsizing NHEWS Primary Care 2012 in terms of national representation.
Objectives
General Objectives
NHEWS Primary Care aims to:
1. determine the availability and distribution of primary healthcare services, facilities and healthcare workforce
2. compare the services, facilities and workforce in primary care between the public and private
3. monitor the trends of the services, facilities and workforce in primary care
4. provide reliable data for the purpose of healthcare planning, policy making and healthcare expenditure
Specific Objectives
NHEWS 2012 collects primary care data on:
1.
the total number and density of primary care clinics at national level by states and sector
2.
the availability and distribution of primary care facilities and services in the chosen states (Selangor & Wilayah
Persekutuan (WP) Putrajaya,WP Kuala Lumpur and Kelantan) and regions (Kota Kinabalu and Kuching) by sector
3.
the socio-demographics and characteristics of medical doctors and allied healthcare personnel in the chosen
states (Selangor & WP Putrajaya, WP Kuala Lumpur and Kelantan) and regions (Kota Kinabalu and Kuching) by
sector
4.
the distribution of selected medical devices in the chosen states (Selangor & WP Putrajaya,WP Kuala Lumpur and
Kelantan) and regions (Kota Kinabalu and Kuching) by sector
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METHODOLOGY
General
NHEWS 2012 was a cross-sectional study. Random sampling was performed on the primary care clinics in 5 selected
regions which include:
• Kelantan to reflect East Coast of Peninsular Malaysia
•
WP Kuala Lumpur, WP Putrajaya and Selangor to reflect West Coast of Peninsular Malaysia
•
Kuching and Kota Kinabalu to reflect East Malaysia
Approval for NHEWS Primary Care protocol was granted by MOH Medical Research and Ethics Committee (MREC) in 2010.
Sampling Frame and Sample Size Calculation
The determination of total population for the survey was finalised prior to the initiation of data collection. This involved
record matching of clinics from the NHEWS Primary Care 2010 list against independent databases from Ministry of Health’s
Private Medical Practice Control Section (CKAPS) and Family Health Development Division. Checking of duplicates and
matching were done by the Information Technology (IT) department. Both matched and unmatched records were then
reviewed by NHEWS Primary Care team and subsequent verification was conducted by contacting each site to confirm
their operational status. The review and verification processes were repeated and closed clinics were removed from the
sampling frame.
The inclusion and exclusion criteria for the survey were as stated below:
INCLUSION
CRITERIA
EXCLUSION
CRITERIA
•
All private medical clinics registered with the Medical Practice Control Section or Cawangan
Kawalan Amalan Perubatan Swasta (CKAPS) providing primary care (up to 31st December 2011)
•
All MOH Health Clinics (Klinik Kesihatan) delivering outpatient services by medical doctors. (up to
31st December 2011)
•
Government clinics which fell into the categories of:
- Outpatient departments within public hospitals
- Klinik Kesihatan without medical doctors
-
-
-
-
•
Clinics providing maternal and child health services only (Klinik Kesihatan Ibu dan Anak)
Rural Clinics (Klinik Desa)
1 Malaysia Clinics
Primary care clinics in universities
Private Clinics which fell into the categories of:
• In-house clinics /company clinics
• Clinics providing specialised care/ Specialist clinics e.g. paediatric, cardiology, occupational therapy
• Diagnostic centres
• Aesthetic clinics
• Charity clinics
The random sampling method used for sample size calculation was a complex multistage stratified random sampling.
Stages for the sampling involved:
Stage 1: Selection of Sampling Regions (Convenience / Purposive Sampling)
• WP Kuala Lumpur, Selangor and WP Putrajaya, Kelantan, Kuching and Kota Kinabalu
Stage 2: Stratification by Sector
• Each region was stratified to both public and private sector.
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Stage 3: Sampling of Clinics
• Random sampling was done based on random numbers generated from Microsoft Excel. During the sampling, the
inclusion and exclusion criteria for both public and private sectors were accounted for.
The table below shows the final calculated sample size:
Sample Size for NHEWS Primary Care 2012
State/Region
No. of clinics
Public
Private
Selangor & WP Putrajaya
39
187
WP Kuala Lumpur
8
107
Kelantan
20
57
Kuching
4
21
Kota Kinabalu
4
11
75
383
Total
Data Collection and Follow-Up
These sampled clinics were sent an official invitation letter to attend a briefing. Briefings for government doctors were held on
weekdays whereas for private doctors, briefings were conducted on the weekends between June and July 2012.
During the briefings, doctors who attended were given a research pack which contained:
•
Call letter for participation of the survey signed by State Director of Health
•
Case report form (CRF)
•
Username and password for the option of completing the survey form online
•
Prepaid envelope
•
NHEWS Primary Care 2008-2009 report
Clinics which did not send any representatives for the briefings were contacted by phone in an attempt to persuade them
to participate. Many strategies were carried out to increase the response rate of the sampled private clinics.
These included:
• Establishing buy in from senior management of the chain clinics
•
Close cooperation with the state Malaysian Medical Association (MMA) to encourage their members to participate
•
Conducting private briefings to the doctor/nurse-in-charge of primary care clinics around KL/Selangor region
•
Establishing a close rapport with medical enforcements’ officers of the respective states and regions. At times, the
project team followed the enforcement officers during their scheduled visits and conducted a private briefing to the
sampled clinics.
•
Contacting clinics via phone. If the doctor agreed to participate, a research pack was sent by express post. This was
followed by a telephone call to confirm that the research pack had been received and a briefing over the phone was
then conducted.
Respondents to this survey had 2 options for modes of data submission which were:
• Paper data submission via hardcopy of the Case Report Form (CRF)
• Electronic data submission via web application (eCRF)
For clinics which failed to return their forms, they were reminded via phone calls. Such reminders were made for both
surveys (NMCS 2012 and NHEWS Primary Care 2012) simultaneously in two stages, ie at 3 weeks and at 5 weeks
after their respective survey dates for NMCS 2012. All participants were encouraged to contact the research team with
questions, at any time during office hours by phone.
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Once the survey forms were received either by postage or online, two certificates and a copy of the NMCS 2010 report
were sent to the participants as a token of appreciation.
Data Entry
Data received via paper submission were thoroughly reviewed for completeness and consistency prior to data entry
into the NHEWS Primary Care database. Data entry was then performed by trained NHEWS Primary Care members.
Data entry from participant’s site through eCRF was submitted directly into the NHEWS Primary Care database and
monitored in real-time basis by the members of the team. Quality of data entry was constantly checked and maintained
by several built-in features in the data entry module such as a compulsory data checking function, inconsistency checks,
auto calculations and auto default data from previous year’s survey. Every activity in the database was recorded in a realtime tracking system.
Data Cleaning and Verification
Data cleaning was performed in parallel with data entry based on the results of edit checks. An edit check is a data
checking procedure for tracing doubtful data being entered and was performed by NHEWS Primary Care team members
who are familiar with primary care settings. A built in data query feature was also created in the web application to cross
check data from the same variables in 2010 and 2012. Queries that arose were then attended to by contacting the stated
person-in-charge in the form or other authorised representatives to seek further clarification.
All queries were resolved before the database was locked to maintain data quality and integrity. A final checking was
performed prior to database locking to ensure that the data was acceptable for statistical analysis. The dataset was
then standardised by performing data deduplication procedure for removing duplicate records and checking of range
and consistency to detect outliers. A protocol with validation rules for cleaning as well as data inconsistency rules have
been created for data cleaning. Cross-checking with other relevant data sources such as the Malaysian Medical Council
database, National Specialist Register of Malaysia and list of registered family medicine specialists from the Academy of
Family Physician Malaysia was performed. Most of the missing or out-of-range mandatory variables and auxiliary variables
were resolved during data cleaning stage.
Statistical Analysis
Findings of the survey were primarily reported as descriptive statistics. Statistical analyses were conducted using the
IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp). Categorical data were reported in rates and
proportions but their respective confidence intervals were not reported as the requirements for inferential statistics
were not met.1 Proportions may not always add up to exactly 100.0% due to rounding of figures. Continuous data were
reported in median and interquartile range (IQR). An analysis to determine if there were any significant differences
between the characteristics of the respondents and non-respondents from the private general practitioners (GPs) namely
age, gender and years of practice was also conducted. Categorical variables were compared using the χ2-test whereas for
continuous variables; a simple logistic regression.
Ethical Issues
As mentioned above, the survey received ethics approval from Medical Research and Ethics Committee (MREC) of the
MOH. As participation in this study was on voluntary-basis, respondents had the right to decline to participate at any
point of time throughout the study.
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Limitations
1. Only 3 states (Selangor and WP Putrajaya,WP Kuala Lumpur and Kelantan) and 2 regions (Kota Kinabalu and Kuching)
were selected in the survey. The results of this study do not reflect national or state representation for Sabah and
Sarawak.
2. The same sample size calculation was used for both NHEWS Primary Care 2012 and NMCS 2012. Further details of
the calculation can be found in the NMCS 2012 report2.
3. The sample was not calculated to represent each type of (Type I to Type VI) clinics in the public sector.
4. The survey was rolled out in July 2012 and hence, data on the number of clinics and total attendances could only be
reported as of the year 2011 as those variables were collected yearly. The rest of the variables were reported as of
30th of June 2012.
5. The results could not be inferred to the population because to our best knowledge, there was a lack of a reliable
national representation of both health sectors for the purpose of applying survey weights.
References
1.
Naing L. Inferential Statistics. Power point presentation. Research Methodology and Basic Biostatistics Workshop, Kuala Lumpur. 23rd-25th
August 2013.
2.
Sivasampu S, Yvonne Lim, Hwong WY, Norazida AR, Goh PP, Hisham AN. National Clinical Research Centre. National Medical Care
Statistics 2012. (unpublished report)
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CONSORT DIAGRAM: PUBLIC PRIMARY CARE CLINICS 2012 (KLINIK KESIHATAN)
Excluded
*Kuching and Kota Kinabalu regions were taken to represent Sarawak and Sabah respectively
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NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
CONSORT DIAGRAM: PRIVATE PRIMARY CARE CLINICS 2012
*Kuching and Kota Kinabalu regions were taken to represent Sarawak and Sabah respectively
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RESPONSE RATE
The table below shows the response rate for NHEWS Primary Care 2012 Survey:
Response Rate for NHEWS Primary Care 2012 Survey
State/Region
Sector
Sample size
No. of respondents
Response rate (%)
Selangor & WP Putrajaya
Public
39
34
87.2
Private
187
52
27.8
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Overall
Public
8
8
100.0
Private
107
30
28.0
Public
20
18
90.0
Private
57
25
43.9
Public
4
4
100.0
Private
21
9
42.9
Public
4
4
100.0
Private
11
4
36.4
Public
75
68
90.7
Private
383
120
31.3
The low response rate from private clinics had already been anticipated and accounted for. A few studies which previously
surveyed private clinics in Malaysia had also reported similar response rates ranging from 26.3% to 33.0%.1,2 Low response
rates in national surveys when physicians were the responders had been associated with many factors such as apathy, lack
of incentives and resistant to healthcare surveys especially those conducted by the government.3,4
In view of this, the sampling matrix calculation had included an estimation of a 30.0% drop-out rate from the public and a
70.0% drop-out rate from the private sector.
A subsequent analysis comparing the respondents and non-respondents from private clinics was performed to ensure
that the low response rate has not introduced any form of bias into the findings. As seen from the tables below, no
significant differences in terms of age, gender and years of practice between these two GP groups were observed.
Comparison of age between the respondents and non-respondents in the private sector
Characteristics
Odds ratio
95% CI for
odds ratio
χ2 statistics (df)
P value
1.01
(0.99, 1.03)
0.27 (1)
0.604
Age
*10 missing variables for non respondents
Comparison of gender between the respondents and non-respondents in the private sector
Characteristics
n
Respondents
n (%)
Non respondents
n (%)
χ2 statistic (df)
P value
0.04(1)
0.837
Gender
Male
239
76 (31.8)
163 (68.2)
Female
134
44 (32.8)
90 (67.2)
*10 missing variables for non respondents
Comparison of years of practice between the respondents and non-respondents in the private sector
Characteristics
Odds ratio
95% CI for
Odds ratio
Years of Practice
1.00
(0.98, 1.03)
χ2 statistics (df)
0.15 (1)
P value
0.699
*4 missing variables for respondents and 14 missing variables for non respondents
Having this analysis also increased the validity of the study. As the non-respondents were mainly from the private sector,
the team has kept the comparison between the two groups to private sector only.
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References
1.
Teng CL,Tong SF, Khoo EM, Lee V, Zailinawati AH, Mimi O, Chen WS, Nordin S.Antibiotics for URTI and UTI – prescribing in Malaysian
primary care settings. Aust Fam Physician. 2011; 40(5):325-9.
2.
Mimi O,Tong SF, Nordin S,Teng CL, Khoo EM, Abdul-Rahman A, Zailinawati AH, Chen WS, Shihabudin WM, Noridah MS, Fauziah ZE. A
comparison of morbidity patterns in public and private primary care clinics in Malaysia. Malaysian Family Physician. 2011; 6(1):19-25
3.
Parsons J, Warnecke R, Czaja R, Barnsley J, Kaluzny A. Factors associated with response rates in a national survey of primary care
physicians. Eval Rev. 1994; 18: 756-66.
4.
Cartwright, A. Professionals as responders: variations in and effects of response rates to questionnaires. BMJ. 1978; 2: 1419-21
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CHAPTER 1
PRIMARY CARE
| OVERVIEW
Primary care provides essential functions for individual patients, health systems and populations. Apart from managing
and triaging undifferentiated symptoms and delivering treatment for acute and chronic illnesses, primary care providers
also manage many different services which include health promotion, disease prevention, health maintenance, counselling,
patient education and many more.1
The Malaysian primary care is of no exception.The two tiered healthcare system i.e. public and private holds an extremely
important position in the delivery of primary care services in Malaysia. This chapter summarises the key findings of
NHEWS Primary Care Survey 2012 by chapters:
Chapter 2: Primary Healthcare Establishments
• There were 5,198 private clinics and 871 public clinics in Malaysia as of 31st December 2011.
•
Overall, there were 2.1 clinics per 10,000 population in Malaysia.
•
75.0% of the private clinics were solo practices.
•
On average, public clinics had a higher total attendances per day compared to the private.The highest ratio was 12:1 (public
versus private).
•
Only 29.3% of the primary care clinics were fully computerised with the majority coming from private sector.
Chapter 3: Primary Healthcare Facilities
•
55 out of 68 public clinics sampled had a triage system implemented in their clinics.
•
None of the private clinics sampled in East Malaysia had a diagnostic imaging/X-ray room in their premises.
•
All public clinics with an exception of WP Kuala Lumpur (62.5%) had a designated laboratory space.
•
The median for functioning ambulances per public clinic in the states/regions sampled is 1.0 (IQR 0.0).
Chapter 4: Primary Healthcare Services
• Only 16.7% of the private clinics offered smoking cessation programmes as compared to 75.0% in the public.
•
More than 90.0% of public clinics provided preventive and health promotion services such as obstetric and
gynaecological services, family planning services and clinical breast examinations. On the other hand, private clinics
performed more minor surgeries (91.7%) and medical check-ups (98.3%).
•
All states and regions sampled had a higher percentage (range: 51.9% - 75.0%) of clinics opening 7 days in a week
except for WP Kuala Lumpur where 73.3% of the clinics had less than 7 operating days in a week.
•
Only 5.0% of the private clinics in the states/regions sampled were functioning as 24-hour clinics.
Chapter 5: Primary Healthcare Workforce
• The median number of doctors per public clinic was 4.5 doctors (IQR 5.0) and 1.0 doctor (IQR 1.0) per private clinic.
•
The majority of doctors (61.1%) practising in the public clinics were between the ages of 25-34 years old. By
comparison, 72.1% of the private clinics’ doctors were ≥ 45 years old.
•
75.5% of the doctors in the private sector had more than 10 years of experience in primary care.
•
Overall, two-third of the doctors in primary care were females.
•
Medical doctors from private clinics worked a median of 47.5 (IQR 21.0) hours per week while public clinic doctors
had shorter working hours per week with a median of 40.0 (IQR 5.0) hours.
•
Kuching region recorded the highest number of patients seen per day per full time equivalence (FTE) doctor (44 patients).
•
Overall, there was a ratio of 1 Family Medicine Specialist to 5 primary care clinics.
1
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Chapter 6: Primary Healthcare Medical Devices
• Only 51.5% of the public clinics had functioning defibrillators in their premises.
•
Less than 15.0% of the private clinics had laboratory equipments such as bilirubinometer or full blood count analysers.
•
Public clinics had a median of four or more functioning peak flow meters per clinic for every state/region while the
private sector had only a median of one functioning peak flow meter per clinic.
•
71 out of 73 resuscitation trolleys were functioning in the public clinics. Clinics in both public and private sectors
had at least one resuscitation trolley per clinic except for private clinics in Kelantan which only had a median of 0.6
(IQR 1.0) resuscitation trolley per clinic.
•
About 5.0% of the glucometers in the public clinics were reported to be non-functioning.
Although the survey was restricted to only 3 states and 2 regions sampled, the findings have provided a better understanding
of the primary care services as well as the socio-demographic characteristics of the primary healthcare workforce. These
results, together with the findings of morbidity pattern and processes of care from the National Medical Care Survey
(NMCS) 2012 are hoped to form a clearer picture on the current primary healthcare system in Malaysia.
References
1.
Primary Care. American Academy of Family Physicians, 2013. [Viewed 17th October 2013]. Available from: http://www.aafp.org/about/
policies/all/primary-care.html.
2
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
CHAPTER 2
PRIMARY CARE
| PRIMARY HEALTHCARE ESTABLISHMENTS
Primary healthcare is the foundation of a comprehensive healthcare system for the nation. Its framework is detailed in
the 1978 Declaration of Alma-Ata.This includes at least the following 8 areas: identifying, controlling and preventing health
conditions through education, adequate nutrition, maternal and child healthcare, immunisation against major infectious
diseases, family planning, prevention and control of local endemic conditions, management of common ailments and
injuries and provision of essential drugs.1 Primary care serves as the first-contact point and as a gatekeeper to secondary
and tertiary health care.2 This highlights the importance of collecting information on the present workforce and health
services in primary care for evaluation of the current system as well as in drafting and implementation of future health
policies.
The two-tiered healthcare system for primary care in Malaysia; the public and private sectors have provided accessibility
to Malaysians for many years. While the public health system is heavily subsidised by the government, the private clinics
charge fee-for-service. As of 31st December 2011, there were 5,198 private primary care clinics and 871 public primary
care clinics in Malaysia. The ratio of private clinics to public clinics was 6:1. This difference has not changed much from the
6.3:1 ratio reported in 2008-2009.3
In summary there were 2.1 clinics per 10,000 population in Malaysia in 2011 (Figure 2.1). Figure 2.1 also shows a consistently
higher number of clinics per 10,000 population in the urban states of which WP Kuala Lumpur had the highest density; 3.7
clinics per 10,000 population.This density however is still low compared to Australia which recorded an average of 6.1 GP
practices per 10,000 population in 2002.4
Figure 2.1. Number of Malaysian Primary Care Clinics per 10,000 Population in 2011
3
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Types of Private Practice
The majority of practices (75.0%) in 2012 were still individual practices. However, there has been an increase in private
group practices in all states sampled over the two year period.5 Clinics in WP Kuala Lumpur recorded the highest
proportion of group practice at 33.3%. A study in 2003 on physician workforce in Canada reported that the trend
of having group practice was more popular among the younger generation of the general practitioners with the aim
to achieve a more balanced lifestyle in terms of workload distribution.6 The changing trend towards group practice is
also hoped to reduce medical error and negligence in primary care when GPs with different skills and knowledge are
brought together for a more comprehensive diagnosis and treatment of patients. Moreover economics wise, forming
group practices would allow better equipments and facilities to be built and shared.7
Figure 2.2.Types of Private Practice by State/Region in 2012
Attendances
Despite being outnumbered in terms of quantity of clinics, the public sector is seeing the bulk of primary care patients
compared to the private clinics. Our results showed that overall, public clinics had higher attendances compared to clinics
in the private sector (Appendix 1 Table A1.1).The difference was obvious in Kota Kinabalu where the number of attendees
to the public clinics per day was approximately 12 times more than that of the private clinics (Figure 2.3).The public clinics
in Kuching region recorded the highest number of attendees in a day with a median of 463.7(IQR 699.3) attendances per
clinic per day.
The breakdown by types of attendances such as antenatal and home visits can be found in the Appendix 1 Table A1.2.
4
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 2.3. Median Attendances per Clinic per Day by State/Region and Sector in 2011
Electronic Health Care Computer System
Implementation of a computer system and incorporating information technology in healthcare practices is expected
to play a vital role in the near future especially to acquire, manage and disseminate knowledge and information.8
Among the benefits of using electronic patient record include more efficient transferability of the records, systematic
record keeping where all results and patient notes are kept together, increasing safety of the records and most
importantly, enabling involved GP practitioners to have immediate access to full records.9 Our findings indicate that
more than half (52.7%) of the respondents were already using computers in their establishments (Table 2.1). Out of
these, only 29.3% of these clinics were fully computerised (patient records, dispensing, billing and registration); most
of them from the private sector (Figure 2.4).
Table 2.1. Percent of Clinics with Electronic Healthcare Computer System in 2012
State/Region
Sector
No. of clinics
Selangor & WP Putrajaya
Public
34
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Overall
Clinics with computer system
No.
Percent (%)
9
26.5
Private
52
41
78.8
Total
86
50
58.1
50.0
Public
8
4
Private
30
20
66.7
Total
38
24
63.2
11.1
Public
18
2
Private
25
12
48.0
Total
43
14
32.6
Public
4
0
0.0
Private
9
6
66.7
Total
13
6
46.2
Public
4
2
50.0
Private
4
3
75.0
Total
8
5
62.5
Public
68
17
25.0
Private
120
82
68.3
Total
188
99
52.7
5
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 2.4. Percent of Fully Computerised Clinics by Sector in 2012
Source: Table 2.5
In the public clinics, overall computer usage was 25.0%, which was lower compared with the private clinics (68.3%). Khoo
and Tan in 1998 recorded 43.0% of the private clinics having a computer in their premises for a variety of usage including
word processing, accounting, recording drug stocks, patient record and research.10 Results from this study show that most
of the computers were used for billing purposes (81.7%) and patient’s registration (80.5%) in private clinics (Figure 2.5).
Figure 2.5 also shows that public clinics with computers were using the technology mostly for registration (82.4%), keeping
patient records and dispensing (both at 76.5%). Despite the implementation of Teleprimary Care (TPC) in the government
clinics for the past 7 years, only 88 public primary healthcare facilities were equipped with this system in 2011.TPC allows
tele-consultation in real time within the same state, and has the function for electronic health record keeping.11
Findings on types of computer usage by states and sector can be found in Appendix 1 Table A1.3.
Figure 2.5.Types of Computer Usage by Sector in 2012
6
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
References
1. Declaration of Alma-Ata. The International Conference on Primary Health Care. Alma-Ata, USSR: World Health Organization, 6-12 September
1978.
2. Starfield B. Primary care: balancing health needs, services, and technology. Revised edition. USA: Oxford University Press, 1998.
3. Clinical Research Centre. National Healthcare Establishment & Workforce Statistics (Primary Care) 2008-2009. Kuala Lumpur 2011.
4. Australian Bureau of Statistics. 8865.0 - Private medical practices, Australia 2001-02. Australia. 18th December 2003.
5. Clinical Research Centre. National Healthcare Establishment & Workforce Statistics (Primary Care) 2010. [unpublished report].
6. Canadian Labour and Business Centre for Task Force Two: A Physician Human Resource Strategy for Canada. Physician workforce in Canada:
Literature Review and Gap Analysis. Ottawa, Canada: January 2003. [viewed 18th September 2013] Available from: http://www.effectifsmedicaux.ca/
reports/literatureReviewGapAnalysis-e.pdf
7. Rorem CR. Economics of private group practice. Can Med Assoc J. 1954;70(4):462-6.
8. Stead WW, Lin HS. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. National Research Council of the
National Academies, Washington, DC: The National Academies Press,2009. [pre publication copy] [viewed 18th September 2013]. Available from http://
www.nlm.nih.gov/pubs/reports/comptech_prepub.pdf
9. Electronic Patient Record. NHS Institute for Innovation and Improvement, 2013. [ viewed 19th September 2013]. Available from: http://www.
institute.nhs.uk/building_capability/technology_and_product_innovation/electronic_patient_record.html.
10. Khoo EM, Tan PL. Profile of general practices in Malaysia. Asia Pac J Public Health. 1998;10(2): 81-87
11. Ministry of Health Malaysia. Annual Report Ministry of Health 2011. Malaysia:Ministry of Health, 2011.
7
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Tables for Figures
Table 2.2. Number of Malaysian Primary Care Clinics per 10,000 Population in 2011
State
No. of clinics
Population
Per 10,000 population
Malaysia
6,069
2,89,64,300
2.1
635
16,94,500
3.7
WP Kuala Lumpur
Selangor
1,448
55,77,400
2.6
Negeri Sembilan
267
10,42,900
2.6
Pulau Pinang
400
15,93,600
2.5
Melaka
193
8,33,000
2.3
Perak
554
23,97,600
2.3
Johor
753
34,01,800
2.2
Pahang
270
15,24,800
1.8
Kedah
337
19,73,100
1.7
Terengganu
174
10,74,000
1.6
Perlis
38
2,37,500
1.6
Sarawak
402
25,16,200
1.6
Kelantan
240
16,15,200
1.5
WP Putrajaya
10
76,400
1.3
WP Labuan
10
89,800
1.1
Sabah
338
33,16,400
1.0
Table 2.3.Types of Private Practice by State/Region in 2012
State/Region
No. of clinics
Group practice
Solo practice
No.
Percent (%)
No.
Percent (%)
Selangor & WP Putrajaya
52
15
28.8
37
71.2
WP Kuala Lumpur
30
10
33.3
20
66.7
Kelantan
25
4
16.0
21
84.0
Kota Kinabalu
9
1
11.1
8
88.9
Kuching
4
0
0.0
4
100.0
Overall
120
30
25.0
90
75.0
Table 2.4. Median Attendances per Clinic per Day by State/Region and Sector in 2011
State/Region
Selangor & WP Putrajaya
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Attendances per day
Sector
Total attendances per day
No. of clinics
Median *(IQR)
Public
12,174
34
248.1 (236.2)
Private
2,265
52
40.0 (28.0)
Public
2,611
8
264.6 (119.5)
Private
948
30
30.0 (21.0)
Public
3,271
18
169.9 (112.9)
Private
1,006
25
40.0 (30.0)
Public
1,657
4
390.7 (388.4)
Private
260
8
32.5 (16.0)
Public
2,078
4
463.7 (699.3)
Private
190
4
50.0(43.0)
*Median attendances per day
8
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table 2.5. Percent of Fully Computerised Clinics by Sector in 2012
Fully computerised clinics
No. of clinics with
computers
No.
Percent (%)
Public
17
2
11.8
Private
82
27
32.9
Total
99
29
29.3
Sector
*the denominator is the total number of clinics with computer system in our sample (n=99)
Table 2.6.Types of Computer Usage by Sector in 2012
Types of computer usage
No. of
clinics with
computer
system
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
Public
17
14
82.4
13
76.5
3
17.6
13
76.5
Private
82
66
80.5
49
59.8
67
81.7
37
45.1
Total
99
80
80.8
62
62.6
70
70.7
50
50.5
Sector
Registration
Patient record
9
Billing
Dispensing
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
CHAPTER 3
PRIMARY CARE
| PRIMARY healthCARE FACILITIES
This chapter examines the availability of facilities in our primary care clinics. There are five variables which are reported
in this chapter; triage system, pharmacy space, imaging and diagnostic room, laboratory space and ambulance services.
Triage system is described as the process of sorting out clients according to their clinical or healthcare needs.1 This is
a system which assesses how quickly a patient needs to be treated while ensuring every patient is given a chance for
appropriate level of care. Triaging patients was previously done only in hospital emergency departments but of late, the
primary care clinics have also implemented this system. One example of effective triaging could be observed in Putrajaya
Health Clinic.1 Currently 55 out of 68 public clinics (80.1%) were observed to practise triaging in their clinics. However,
this study revealed that Kuching had the least number of public clinics set up with facilities to triage patients (50.0%). As
for private sector, the number of clinics offering triaging was even lesser. The highest percentage reported was 34.6% in
Selangor & WP Putrajaya (Table 3.1).
In terms of pharmacy space, it is apparent from Table 3.1 that all public clinics had a pharmacy space in their establishments.
In the public sector, the supplies of medicines are under the responsibility of the pharmacy department. The general
operational policies state that outpatient pharmacy services should be available in public clinics in accordance to the
guidelines on the requirement for the pharmacy facilities.2 As for the private sector, almost all the clinics had a dedicated
pharmacy space in their clinics (Table 3.1).
Having a diagnostic imaging room would usually mean the clinic provides X-ray services. These X-ray facilities require a
specific room to be built according to the standard requirements.3 The results obtained from the study show that except
for public clinics in Kuching, less than 50.0% of the clinics had this facility (Table 3.1). Similarly, very few private clinics
reported the availability of this facility. None of the private clinics in East Malaysia had this facility.
Table 3.1. Types of Facilities by State/Region and Sector in 2012
State/Region
Selangor &
WP Putrajaya
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Sector
No. of clinics
Triage system
Pharmacy space
Diagnostic/
imaging room
No facilities*
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
Public
34
25
73.5
34
100.0
12
35.3
0
0.0
Private
52
18
34.6
49
94.2
15
28.8
1
1.9
Total
86
43
50.0
83
96.5
27
31.4
1
1.2
Public
8
8
100.0
8
100.0
3
37.5
0
0.0
Private
30
7
23.3
27
90.0
7
23.3
3
10.0
Total
38
15
39.5
35
92.1
10
26.3
3
7.9
Public
18
16
88.9
18
100.0
4
22.2
0
0.0
Private
25
6
24.0
25
100.0
2
8.0
0
0.0
Total
43
22
51.2
43
100.0
6
14.0
0
0.0
Public
4
4
100.0
4
100.0
1
25.0
0
0.0
Private
9
3
33.3
9
100.0
0
0.0
0
0.0
Total
13
7
53.8
13
100.0
1
7.7
0
0.0
Public
4
2
50.0
4
100.0
4
100.0
0
0.0
Private
4
0
0.0
4
100.0
0
0.0
0
0.0
Total
8
2
25.0
8
100.0
4
50.0
0
0.0
*No facilities refer to clinics having none of the mentioned facilities.
11
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
The availability of laboratory space and functioning ambulance services were captured only in public clinics as most of
the private clinics do not offer these services. All public clinics with an exception of WP Kuala Lumpur (62.5%) had a
specific laboratory space (Figure 3.1). As for ambulance services, WP Kuala Lumpur has implemented call centre services
which provide ambulance services to clinics based on the distance of the primary care clinic to the call centre; hence
explaining the low reporting of ambulance services. In addition, two of the states sampled in this survey reported not
having fully functioning ambulances. Overall, there was a median of 1.0 (IQR 0.0) functioning ambulances per clinic in the
states/regions sampled (Table 3.2). Similarly, the MOH Annual Report has also reported that only 71.0% ambulances were
functioning in 2011.4
Figure 3.1. Percent of Public Clinics with Laboratory Space and Ambulance Services by State/Region in 2012
Table 3.2. Distribution of Functioning Ambulances in Public Clinics by State/Region in 2012
No. of clinics with
ambulances
No. of functional
ambulances
Median*(IQR)
Selangor & WP Putrajaya
32
33
1.0 (0.0)
WP Kuala Lumpur
3
3
1.0 (0.0)
Kelantan
17
21
1.0 (0.5)
Kota Kinabalu
4
6
1.0 (1.5)
State/Region
Kuching
Total
4
4
1.0 (0.0)
60
67
1.0 (0.0)
*median ambulances per clinic
References
1.
Nora’i MS, Jumiatin O, Farizah H. Effective triaging in Putrajaya Health Clinic. Malaysian Journal of Public Health Medicine. 2002;2(2):58-62.
2.
Pharmaceutical Services Division, Ministry of Health Malaysia. Requirement for the Development of Pharmacy Facilities in Hospitals, Health Clinics and
Other Health Facilities, Ministry of Health, Malaysia. 3rd ed. Pharmaceutical Services Division, Ministry of Health, Malaysia, 2009.
3.
Guidelines to Obtain Class C License under the Atomic Energy Licensing Act (Act 304) from the Ministry of Health Malaysia. Engineering Services Division,
Ministry of Health Malaysia, November 2000. [ viewed 18th September 2013] Available from: http://www.radiologymalaysia.org/Archive/file%20downloads/
Class%20C%20License%20Guideline_Part2.pdf
4.
Ministry of Health Malaysia. Annual Report Ministry of Health 2011. Malaysia: Ministry of Health, 2011.
12
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table for Figures
Table 3.3. Percent of Public Clinics with Laboratory Space and Ambulance Services by State/Region in 2012
State/Region
No. of clinics
Laboratory space
Ambulance services
No.
Percent (%)
No.
Percent (%)
Selangor & WP Putrajaya
34
34
100.0
32
94.1
WP Kuala Lumpur
8
5
62.5
3
37.5
Kelantan
18
18
100.0
17
94.4
Kota Kinabalu
4
4
100.0
4
100.0
Kuching
4
4
100.0
4
100.0
68
65
95.6
60
88.2
Total
13
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
CHAPTER 4
PRIMARY CARE
| PRIMARY healthCARE SERVICES
The scope of primary care services has expanded over the years and has been attributed to advancement of technology,
increasing burden of disease and greater demands from the public. The Malaysian primary care is of no exception. Khoo
et al reported that a comprehensive range of curative, preventive, promotive and rehabilitative services were provided by
private general practitioners in Malaysia.1 This chapter will report the type of services provided by both sectors.
Types of Services
Figure 4.1 shows some of the services available in both sectors in Malaysia. The full range of services as per reported in
the survey form can be found in Table 4.2. Overall, public clinics provided majority of the services.
The International Tobacco Control Policy Evaluation Project in Malaysia reported that more than 3/4 of the smoking adults
in Malaysia had plans to quit smoking.2 Only 16.7% of the private clinics however, offered smoking cessation programmes
in their clinics. The public sector reported a higher proportion (75.0%) of their clinics providing quit smoking services.
Apart from that, the availability of occupational health services in our primary care setting was limited; 4 % in public and
40.0% in the private clinics.
It was also observed that more public clinics provided obstetrics and gynaecological services such as antenatal and
postnatal care, and Pap smear compared to the private (91.2% versus 67.5% and 100.0% versus 73.3% respectively).
Preventive services like clinical breast examination were available in almost all public clinics (98.5%) but only in 74.2% of
the private clinics.
Instead, the reverse was seen in services such as minor surgery and medical check-ups. More private clinics (98.3%)
offered medical check-ups as opposed to 89.7% of the public clinics. Minor surgery was performed in 91.7% of the private
clinics compared to only 70.6% in the public clinics.
Figure 4.1.Types of Services Available by Sector in 2012
A further analysis on the types of services by states and regions sampled in both sectors is in Appendix 1 Table 1.4
15
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Antenatal Care
All public clinics in the selected states/regions except for WP Kuala Lumpur recorded a complete pregnancy care services
(Table 4.1). By comparison, private clinics had different level of antenatal services ranging from 1st trimester only to a 3rd
trimester care. None of the private clinics in Kuching offered antenatal services.
Table 4.1 Percent of Clinics providing Antenatal Services by State/Region and Sector in 2012
Antenatal care
Up to 1st trimester
Up to 2nd trimester
Up to 3rd trimester
No.
No.
Percent (%)
No.
Percent (%)
100.0
State/Region
Sector
Selangor &
WP Putrajaya
Public
34
0
0.0
0
0.0
34
Private
37
6
16.2
11
29.7
20
54.1
Total
71
6
8.5
11
15.5
54
76.1
66.7
WP Kuala Lumpur Public
Kelantan
Kota Kinabalu
Kuching
No. of clinics*
Percent (%)
3
1
33.3
0
0.0
2
Private
20
7
35.0
6
30.0
7
35.0
Total
23
8
34.8
6
26.1
9
39.1
Public
18
0
0.0
0
0.0
18
100.0
Private
16
0
0.0
2
12.5
14
87.5
Total
34
0
0.0
2
5.9
32
94.1
Public
4
0
0.0
0
0.0
4
100.0
Private
8
0
0.0
2
25.0
6
75.0
Total
12
0
0.0
2
16.7
10
83.3
Public
3
0
0.0
0
0.0
3
100.0
Private
0
-
-
-
-
-
-
Total
3
0
0.0
0
0.0
3
100.0
Note: The Maternal and Child Health services in WP Kuala Lumpur is offered by the Local Municipality (DBKL); hence the low availability of the number of
MOH clinics in this region.
*Total number of clinics offering antenatal services only
Laboratory Services
As for laboratory services, 37.5% of the public clinics in WP Kuala Lumpur fully out-sourced their laboratory services.The
laboratory services for public clinics in Kota Kinabalu region were noted to be in-house only. The distribution of different
types of laboratory services offered in public clinics from other states and regions is shown in Figure 4.2.
Majority of the laboratory services in the private clinics were out-sourced; the highest percentage (79.3%) was in WP
Kuala Lumpur (Figure 4.3).
Figure 4.2 Types of Laboratory Services in Public Clinics by State/Region in 2012
16
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 4.3 Types of Laboratory Services in Private Clinics by State/Region in 2012
Operating Days and Operating Hours
In terms of operating days per week for private clinics, majority of the clinics operated for seven days per week.
Interestingly, 22 out of 30 clinics (73.3%) from WP Kuala Lumpur opened for less than seven days per week (Figure 4.4).
Figure 4.4. Number of Operating Days per week in Public Clinics by State/Region in 2012
17
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
In addition to operating days, this study also looks into operating hours per day. Results from this study reflect a preference
of the private clinics to operate for less than 24 hours (Figure 4.5). All private clinics in WP Kuala Lumpur and Kuching
reported operational hours of less than 24 hours. In summary, only 5.0% of private clinics in the sample were opened for
24 hours. It has been observed in developed countries that doctors especially the younger ones are opting to work fewer
hours compared to the past.3
As for the public clinics, the operating hours were separated into three categories; office hours, after hours on-call
services and extended hours. The extended hours and after hours on-call services were introduced with the intention to
decongest the hospital emergency department.4 In Selangor & WP Putrajaya and Kelantan, 61.8% and 72.2% of the public
clinics were opened not only during office hours but also offered after hours on-call services (Figure 4.6). Majority of the
public clinics in WP Kuala Lumpur, Kuching and Kota Kinabalu however, were only opened during office hours; the highest
proportion seen in WP Kuala Lumpur (87.5%).
Figure 4.5. Number of Operating Hours per Day in Private Clinics by State/Region in 2012
Private
Figure 4.6.Types of Operating Hours per Day in Public Clinics by State/Region in 2012
18
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
References
1.
Khoo EM, Tan PL. Profile of general practices in Malaysia. Asia Pac J Public Health. 1998;10(2): 81-87
2.
ITC Project (March 2012). ITC Malaysia National Report. Findings from Wave 1 to 4 Surveys (2005–2009). University of Waterloo,
Waterloo, Ontario, Canada; Universiti Sains Malaysia, Pulau Pinang, Malaysia; and Ministry of Health, Putrajaya, Malaysia.
3.
Canadian Labour and Business Centre for Task Force Two: A Physician Human Resource Strategy for Canada. Physician workforce in
Canada: Literature Review and Gap Analysis. Ottawa, Canada: January 2003. [viewed 18th September 2013] Available from: http://www.
effectifsmedicaux.ca/r eports/literatureReviewGapAnalysis-e.pdf
4.
Ministry of Health Malaysia. Malaysia’s Health 2008. Malaysia: Ministry of Health, 2008.
19
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
TABLES FOR FIGURES
Table 4.2.Types of Services Available by Sector in 2012
Public clinics
Services
Private clinics
No.
Percent (%)
No.
Percent (%)
(n= 68)
(n=120)
Acute Illnesses
68
100.0
120
100.0
Chronic Diseases
67
98.5
116
96.7
Antenatal and Postnatal Care
62
91.2
81
67.5
Family Planning
64
94.1
101
84.2
Pap Smear
68
100.0
88
73.3
Minor Surgery
48
70.6
110
91.7
Laboratory Services
66
97.1
107
89.2
Clinical Breast Examination
67
98.5
89
74.2
Occupational Health
30
44.1
48
40.0
Smoking Cessation Programmes
51
75.0
20
16.7
Dispensing
0
0.0
120
100.0
Medical Checkup
61
89.7
118
98.3
Table 4.3.Types of Laboratory Services by State/Region and Sector in 2012
Laboratory services
State/Region
Sector
No. of
clinics**
Selangor &
WP Putrajaya
Public
34
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
In-house only
Out-sourced only
In house and out-sourced
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
12
35.3
0
0.0
22
64.7
Private
51
4
7.8
38
74.5
9
17.6
Total
86
16
18.6
38
44.2
31
36.0
Public
8
2
25.0
3
37.5
3
37.5
Private
29
1
3.4
23
79.3
5
17.2
Total
38
3
7.9
26
68.4
8
21.1
Public
18
9
50.0
0
0.0
9
50.0
Private
23
2
8.7
15
65.2
6
26.1
Total
43
11
25.6
15
34.9
15
34.9
Public
4
4
100.0
0
0.0
0
0.0
Private
9
0
0.0
7
77.8
2
22.2
Total
13
4
30.8
7
53.8
2
15.4
Public
4
2
50.0
0
0.0
2
50.0
Private
3
1
33.3
2
66.7
0
0.0
Total
8
3
37.5
2
25.0
2
25.0
*percentages for WP Kuala Lumpur and Kelantan do not equal to 100.0% because there were clinics with no laboratory services at all.
** total number of clinics with laboratory services only.
Table 4.4. Number of Operating Days per Week in Private Clinics by State/Region in 2012
Operating days per week
State/Region
No. of clinics
< 7 days
7 days
No.
Percent (%)
No.
Percent (%)
Selangor & WP Putrajaya
52
25
48.1
27
51.9
WP Kuala Lumpur
30
22
73.3
8
26.7
Kelantan
25
11
44.0
14
56.0
Kota Kinabalu
9
4
44.4
5
55.6
Kuching
4
1
25.0
3
75.0
20
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table 4.5. Number of Operating Hours per Day in Private Clinics by State/Region in 2012
State/Region
Operating hours
Less than 24 hours
No.
Percent (%)
No.
No. of clinics
24 hours
Percent (%)
Selangor & WP Putrajaya
52
48
92.3
4
7.7
WP Kuala Lumpur
30
30
100.0
0
0.0
Kelantan
25
24
96.0
1
4.0
Kota Kinabalu
9
8
88.9
1
11.1
Kuching
4
4
100.0
0
0.0
Table 4.6.Types of Operating Hours per Day in Public Clinics by State/Region in 2012
Operating hours
State/Region
No. of
clinics
Office hours only
Office hours
and after
hours on-call
Office hours and
extended hours
Office hours, after
hours on-call and
extended hours
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
Selangor &
WP Putrajaya
34
5
14.7
21
61.8
4
11.8
4
11.8
WP Kuala Lumpur
8
7
87.5
0
0.0
1
12.5
0
0.0
Kelantan
18
2
11.1
13
72.2
0
0.0
3
16.7
Kota Kinabalu
4
2
50.0
1
25.0
1
25.0
0
0.0
Kuching
4
2
50.0
1
25.0
1
25.0
0
0.0
21
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
CHAPTER 5
PRIMARY CARE
| PRIMARY HEALTHCARE WORKFORCE
Healthcare workforce is a vital building block in the delivery of an efficient primary care system. This chapter reports the
number of healthcare workforce which includes the medical doctors, specialists, nurses and allied healthcare personnel
working in the primary care. In addition, we will able to show the demographic characteristics and individual workload of
the primary care doctors.
A total of 554 doctors in public and private clinics were reported.Three hundred and seventy doctors were working in 68
public clinics; a median of 4.5 (IQR 5.0) doctors per clinic. Amongst all public clinics, Kelantan registered the least number
of doctors per clinic [median: 2.0 (IQR 2.0)] (Table 5.1). As for the private sector, the median was 1.0 (IQR 1.0) doctor
per clinic. This distribution was similar across the states and regions. This correlates with our findings in Chapter 2 that
75.0% of the private clinics were individual practices.
Table 5.1. Distribution of Medical Doctors by State/Region and Sector in 2012
State/Region
Sector
Selangor & WP Putrajaya
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Overall
Medical doctors
No.
Median*(IQR)
Public
220
6.0 (6.0)
Private
86
1.0 (1.0)
Total
306
2.0 (3.0)
Public
62
6.5 (5.0)
Private
46
1.0 (1.0)
Total
108
1.5 (2.0)
Public
40
2.0 (2.0)
Private
33
1.0 (1.0)
Total
73
1.0 (1.0)
Public
28
5.5 (10.0)
Private
13
1.0 (1.0)
Total
41
2.0 (3.0)
Public
20
5.5 (3.0)
Private
6
1.0 (2.0)
Total
26
3.0 (5.0)
Public
370
4.5(5.0)
Private
184
1.0(1.0)
Total
554
2.0(2.0)
*median doctor per clinic
Characteristics of the Healthcare Providers: Age, Gender and Years of Experience
In terms of age distribution, the number of doctors in public clinics was highest at the range of 25-34 years of age
and showed a declining trend as the age increased (Figure 5.1). Besides that, the proportion of medical doctors in
the age category of 55-64 years old in some states had increased compared to the findings in NHEWS Primary
Care 2010. In 2010, only clinics in WP Kuala Lumpur had doctors in the age category of 55-64 years (8.3%)1. In 2012
however, 3 states were noted to have doctors between the ages of 55-64 years old. The highest proportion (9.7%)
was still seen in WP Kuala Lumpur (Figure 5.1).
23
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 5.1. Age Distribution of Medical Doctors in Public Clinics by State/Region in 2012
On the other hand, the private clinics reported having medical doctors of an older age. Majority of the doctors in the
private clinics were between the ages of 45-54 years old (Figure 5.2).
Figure 5.2. Age Distribution of Medical Doctors in Private Clinics by State/Region in 2012
These findings are in tandem with the reported duration of the doctors’ experience in primary care. More than 75.0%
of doctors in the private sector had more than 10 years of experience in primary care. Instead, 62.4% of the doctors in
public clinics had less than 5 years of experience in primary care. The disproportion in years of experience is a worrying
situation and needs to be addressed.
24
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 5.3.Years of Experience of Medical Doctors by State/Region and Sector in 2012
Worldwide, there has been an increase in the number of women in the medical workforce. The proportion of female
physicians in Canada for example has risen from only 7.0% in 1961 to 28.0% in 2000.2 Similarly, this phenomenon was
observed in this study. In summary, two third of the primary care doctors were females. Seventy eight point nine percent
of the doctors working in public clinics were females. On the other hand, a reverse situation was seen in the private where
59.2% of the doctors were male doctors (Figure 5.4 and 5.5).
Figure 5.4 and 5.5. Gender Distribution of Medical Doctors by Sector in 2012
Working Hours and Full-Time Equivalence (FTE)
This study also captured details on the working hours per week in both public and private clinics.When compared against
the Canadian family physicians who worked an average of 52.6 hours per week, Malaysian general practitioners seemed to
work lesser hours.3 Overall, a Malaysian public primary care doctor worked a median of 40.0 (IQR 5.0) hours per week.
By comparison, a private primary care doctor’s median working hours was 47.5 (IQR 21.0) hours per week. Apart from
Kuching, private clinics’ doctors from other states/regions sampled had longer working hours than their colleagues from
the public clinics. Figure 5.6 shows that doctors from private clinics in Kota Kinabalu reported the longest working hours
per week with a median of 50.0 (IQR 24.0) hours. The public clinic doctors meanwhile, was observed to have relatively
similar working hours per week.
25
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 5.6. Median Working Hours per Week per Doctor by State/Region and Sector in 2012
The number of patients seen per day per full time equivalence (FTE)* of doctors from the private clinics is displayed in
Figure 5.7. FTE for doctors in the public clinics was not analysed as the data for total attendances in the public clinics
were not specific to patients being seen by the doctors. The highest number of patients seen per day per FTE doctor was
44 patients in Kuching region. As observed from Figure 5.7, doctors in WP Kuala Lumpur and Kota Kinabalu saw less than
half of the patients compared to their colleagues in Kuching.
Figure 5.7. Number of Patients Seen per Day per FTE Private Clinic Doctor by State/Region in 2012
*1 FTE doctor is equivalent to 1 doctor working 8 hours per day
Family Medicine Specialists
In addition, this survey has also captured the distribution of Family Medicine Specialists (FMS). To qualify as an FMS in Malaysia,
the postgraduate degree in family medicine obtained by the doctors must be gazetted by the Ministry of Health. Results from
this survey revealed that there were a total of 33 FMS in 68 public clinics and only 5 FMS in 120 private clinics (Figure 5.8 and
5.9). In summary, the public sector had a ratio of 1 FMS to 2 clinics whereas the private clinics had a ratio of 1 FMS to 24 clinics.
Qualification wise, majority of the FMS had local post graduate degrees for family medicine (Table 5.1).
26
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Figure 5.8. & 5.9 Distribution of Family Medicine Specialists by State/Region and Sector in 2012
Public
Private
*2 specialists from other specialties apart from FMS were excluded from the analysis
** number of FMS per all clinics
Table 5.2.Types of Post-Graduate Qualifications for Family Medicine Specialists by Sector in 2012
Sector
Qualifications
Public
Private
No.
Percent (%)
No.
Family Medicine UM/UKM/USM*
31
93.9
0
0.0
FRACGP
2
6.1
5
100.0
FRCGP/MRCGP
0
0.0
2
40.0
Others*
Total
Percent (%)
0
0.0
2
40.0
33
100.0
5**
100.0
* Others: MAFP/FAFP
** The sum of all is not equivalent to the total because there were 2 specialists who had both FRACGP/FRCGP and MAFP/FAFP qualifications
Other Healthcare Professionals
Table 5.2 and Table 5.3 show the distribution of the staff nurses, community nurses, nursing aides, pharmacists and assistant
medical officers in the states/regions sampled. The number of qualified staff nurses [median: 13.5 (IQR 2.0)] and assistant
medical officers (AMOs) [median: 8.0 (IQR 4.0)] were the highest in the public clinics in Kuching. Kota Kinabalu reported
the highest number of community nurses in the public clinics with a median of 22.0 (IQR 11.0) nurses while WP Kuala
Lumpur had the highest number of pharmacists with a median of 4.0 (IQR 4.0) pharmacists. The distribution of nursing
aides in the private clinics across the states/regions sampled however, were quite similar [median: 3.0 (IQR 2.0)].
There is an apparent maldistribution of our healthcare workforce. Re-organisation of the current healthcare workforce
needs to be reviewed to ensure there are no over-burdened sectors which will hopefully lead to better quality of care
for our patients.
27
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table 5.3. Distribution of Other Healthcare Professionals by State/Region and Sector in 2012
State/
Region
Selangor &
WP Putrajaya
Staff nurses
Sector
Kota Kinabalu
Kuching
Nursing aides
Pharmacists
Assistant medical
officers
No.
Median*
(IQR)
No.
Median*
(IQR)
No.
Median*
(IQR)
No.
Median*
(IQR)
No.
Median*
(IQR)
Public
293
8.0 (4.5)
443
11.5 (11.3)
-
-
81.0
2.0 (2.3)
98.0
3.0 (1.0)
Private
19
0.0 (0.0)
0
0.0 (0.0)
184.0
3.0 (2.0)
0.0
0.0 (0.0)
0.0
0.0 (0.0)
75
8.0 (8.5)
114
14.5 (13.0)
-
-
39.0
4.0 (4.0)
37.0
5.0 (2.8)
Private
8
0.0 (0.0)
1
0.0 (0.0)
95.0
3.0 (2.0)
0.0
0.0 (0.0)
0.0
0.0 (0.0)
Public
135
6.5 (2.5)
209
11.5 (8.3)
-
-
22.0
1.0 (1.0)
57.0
3.0 (2.0)
Private
2
0.0 (0.0)
0
0.0 (0.0)
81.0
3.0 (2.0)
0.0
0.0 (0.0)
0.0
0.0 (0.0)
Public
75
7.5 (37.8)
88
22.0 (11.0)
-
-
12.0
1.5 (5.5)
24.0
5.0 (4.5)
Private
15
0.0 (3.0)
0
0.0 (0.0)
26.0
3.0 (2.5)
0.0
0.0 (0.0)
0.0
0.0 (0.0)
Public
53
13.5 (1.8)
72
17.0 (9.5)
-
-
13.0
3.0 (2.3)
34.0
8.0 (3.5)
Private
0
0.0 (0.0)
0
0.0 (0.0)
13.0
3.5 (3.3)
0.0
0.0 (0.0)
0.0
0.0 (0.0)
WP Kuala Lumpur Public
Kelantan
Community nurses
*median staff per clinic
References
1. Clinical Research Centre. National Healthcare Establishment & Workforce Statistics (Primary Care) 2010. [unpublished report].
2. Canadian Labour and Business Centre for Task Force Two: A Physician Human Resource Strategy for Canada. Physician workforce in Canada: Literature
Review and Gap Analysis. Ottawa, Canada: January 2003. [viewed 18th September 2013] Available from: http://www.effectifsmedicaux.ca/reports/
literatureReviewGapAnalysis-e.pdf
3. Chan BT. The declining comprehensiveness of primary care. CMAJ. 19th February 2002,166(4):429-434
28
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Tables for Figures
Table 5.4. Age Distribution of Medical Doctors by State/Region and Sector in 2012
State/Region
Selangor &
WP Putrajaya
No.of
doctors
Sector
Public
220
Kota Kinabalu
Kuching
25-34
35-44
45-54
55-64
≥65
No.
Percent (%)
No.
Percent(%)
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
144
65.5
58
26.4
16
7.3
2
0.9
0
0.0
Private
85*
7
8.2
23
27.1
24
28.2
23
27.1
8
9.4
Total
305
151
49.5
81
26.6
40
13.1
25
8.2
8
9.4
WP Kuala Lumpur Public
Kelantan
Age category
62
33
53.2
18
29.0
5
8.1
6
9.7
0
0.0
Private
46
1
2.2
6
13.0
10
21.7
17
37.0
12
26.1
Total
108
34
31.5
24
22.2
15
13.9
23
21.3
12
11.1
Public
40
24
60.0
13
32.5
2
5.0
1
2.5
0
0.0
Private
33
2
6.1
6
18.2
13
39.4
11
33.3
1
3.0
Total
73
26
35.6
19
26.0
15
20.5
12
16.4
1
1.4
Public
28
16
57.1
6
21.4
6
21.4
0
0.0
0
0.0
Private
13
1
7.7
3
23.1
7
53.8
2
15.4
0
0.0
Total
41
17
41.5
9
22.0
13
31.7
2
4.9
0
0.0
Public
20
9
45.0
8
40.0
2
10.0
0
0.0
1
5.0
Private
6
1
16.7
1
16.7
3
50.0
0
0.0
1
16.7
Total
26
10
38.5
9
34.6
5
19.2
0
0.0
2
7.7
*subtotal due to missing value
Table 5.5. Years of Experience of Medical Doctors by State/Region and Sector in 2012
State/Region
Selangor &
WP Putrajaya
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Sector
Public
No. of
doctors
220
Years of experience in primary care
< 5 years
5-10 years
>10 years
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
145
65.9
52
23.6
23
10.5
Private
86
8
9.3
22
25.6
56
65.1
Total
306
153
50.0
74
24.2
79
25.8
Public
62
35
56.5
17
27.4
10
16.1
Private
46
2
4.3
4
8.7
40
87.0
Total
108
37
34.3
21
19.4
50
46.3
Public
40
25
62.5
9
22.5
6
15.0
Private
33
0
0.0
6
18.2
27
81.8
Total
73
25
34.2
15
20.5
33
45.2
Public
28
21
75.0
5
17.9
2
7.1
Private
13
0
0.0
1
7.7
12
92.3
Total
41
21
51.2
6
14.6
14
34.1
Public
20
5
25.0
10
50.0
5
25.0
Private
6
2
33.3
0
0.0
4
66.7
Total
26
7
26.9
10
38.5
9
34.6
Table 5.6. Gender Distribution of Medical Doctors by Sector In 2012
Sector
No. of
doctors
Gender
Female
Male
No.
Percent (%)
No.
Percent (%)
Public
370
292
78.9
78
21.1
Private
184
75
40.8
109
59.2
Total
554
367
66.2
187
33.8
29
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table 5.7. Median Working Hours per Week per Doctor by State/Region and Sector in 2012
State/Region
Sector
Selangor & WP Putrajaya
Public
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Overall
No. of doctors
220
Total working
hours per week
9,502
Median*(IQR)
45.0(5.0)
Private
86
3,763
47.0(25.0)
Total
306
13,265
45.0(5.0)
Public
62
2,579
40.0(5.0)
Private
46
2,200
44.0(20.0)
Total
108
4,779
42.5(5.0)
Public
40
1,664
40.0(0.0)
Private
33
1,596
48.0(22.0)
Total
73
3,260
40.0(9.0)
Public
28
1,120
40.0(0.0)
Private
13
677
50.0(24.0)
40.0(3.0)
Total
41
1,797
Public
20
848
40.0(7.0)
Private
6
230
36.0(22.0)
Total
26
1,078
40.0(8.0)
Public
370
15,713
40.0(5.0)
Private
184
8,466
47.5(21.0)
Total
554
24,179
41.0 (5.0)
*median working hours per week per doctor
Table 5.8. Number of Patients Seen per Day per FTE Private Clinic Doctor by State/Region in 2012
Total attendances
per day
Total working
hours per week
No. of working
hours per day
No. of patients
per FTE doctor
2,265
3,763
578.55
31.3
948
2,200
368.18
20.6
1,006
1,596
246.05
32.7
Kota Kinabalu
260
677
101.26
20.5
Kuching
190
230
34.86
43.6
State/Region
Selangor & WP Putrajaya
WP Kuala Lumpur
Kelantan
Note: 1 FTE doctor is equivalent to 1 doctor working 8 hours per day
Table 5.9. Distribution of Family Medicine Specialists by State/Region and Sector in 2012
Sector
No.
Median*(IQR)
Selangor & WP Putrajaya
Public
34
17
0.0(1.0)
Private
52
1
0.0(0.0)
Total
86
18
0.0(0.0)
Public
8
6
1.0(1.0)
Private
30
4
0.0(1.0)
Total
38
10
0.0(0.0)
Public
18
4
0.0(0.0)
Private
25
0
0.0(0.0)
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Overall
No. of clinics
Family medicine specialist
State/Region
Total
43
4
0.0(0.0)
Public
4
3
0.5(2.0)
Private
9
0
0.0(0.0)
Total
13
3
0.0(0.0)
Public
4
3
1.0(1.0)
Private
4
0
0.0(0.0)
Total
8
3
0.0(1.0)
Public
68
33
0.0(1.0)
Private
120
5
0.0(0.0)
Total
188
38
0.0(0.0)
*2 specialists from other specialties apart from FMS were excluded from the analysis
30
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
CHAPTER 6
PRIMARY CARE
| PRIMARY HEALTHCARE MEDICAL DEVICES
Medical devices reported in this chapter are those commonly available in primary care setting and part of the integral component
in the process of care. Overall the results (Figure 6.1 and 6.2) show that clinics from the public sector recorded higher
percentages in the availability of the surveyed medical devices as compared to the private.Amongst all equipments in the public
clinics, defibrillators were the least available. The proportion of public clinics with defibrillators was 51.5%. Looking into the
private sector, clinics with laboratory equipments such as bilirubinometer and full blood count analysers were especially low in
numbers (5.8% and 8.3% respectively). Devices like peak flow meters were found in only 45.0% of the private clinics in a paper
by Khoo and Tan in 19981 whereas in this survey, it was slightly higher at 65.0%.
Figure 6.1 Percent of Public Clinics with Functioning Medical Devices in 2012
Figure 6.2 Percent of Private Clinics with Functioning Medical Devices in 2012
Breaking down further by states/regions and sector, the number of medical devices per clinic as well as the proportion of
functioning devices are as reported in Table 6.1.
31
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
The peak flow meter and nebuliser are indispensable devices in a primary care setting given that asthma has been reported
as one of the top 10 diseases seen in both public and private clinics.2 The administration of short acting bronchodilators
by means of a nebuliser or metered-dose inhaler and monitoring of peak expiratory flow using peak flow meter is the
mainstay of management in acute asthma.3 For every state/region sampled, all respective public clinics had a median of
four or more functioning peak flow meters per clinic (Table 6.1). By comparison, the private sector had only a median
of one functioning peak flow meter per clinic. As for nebulisers, all clinics in both sectors except public clinics in Kuching
recorded a proportion of more than 80.0% of functioning nebulisers.
Prevalence of cardiovascular diseases is on the rise in Malaysia and hence, cardiovascular diagnostic and monitoring
equipments are essential items in the primary care setting.4 Almost all the electrocardiograms (ECG) in both sectors were
reported to be functioning with a median of 1.0 functioning ECG per clinic except for public clinics in Kuching region
[median 2.0(IQR 1.5)].
Resuscitation trolley and defibrillators are deemed necessities in all clinics. Our survey has recorded 71 out of 73
resuscitation trolleys to be functioning in the public clinics. All clinics had at least one resuscitation trolley per clinic.
Similar observation was observed in the private clinics except for Kelantan which fell short with only a median of 0.6(IQR
1.0) resuscitation trolley per private clinic.As for defibrillators, none of the public clinics in Kota Kinabalu had a functioning
defibrillator in their premises. On the other hand, there were only 5 defibrillators reported available in all 120 private
clinics of which only 3 were functioning.
Glucometers are widely used in the primary care setting to obtain quick results for screening and monitoring of blood
sugar.5 While this device is available in almost all of the public clinics, about 5.0% of the glucometers reported in these
clinics were non-functioning. The private clinics meanwhile, had a median of 1.0(IQR 1.0) glucometer per clinic.
The use of ultrasound machine for diagnostic purposes is on the rise at present in many countries.6 Public clinics in
Selangor and WP Putrajaya recorded 92.9% of functioning ultrasound machines whereas clinics in Kelantan had a slightly
lower percentage (87.5%). Ultrasound machines in the rest of the states/regions sampled were all operating well. Looking
at the private sector however, clinics in Kuching region reported only 66.7% of functioning ultrasound machines while the
rest of the states/regions had more than 90.0% functioning ultrasound machines.
Similar to the usage of ultrasound machines, X-ray machines are introduced to quicken the process of diagnosis. Table 6.1
shows that all public clinics except two located in Selangor/WP Putrajaya and Kuching had functioning X-ray machines.
None of the private clinics in Kuching and Kota Kinabalu regions reported the availability of this machine in their premises.
The availability of these devices fastens diagnostic process and hence increases productivity.7 Besides ensuring that the
primary care clinics have these devices, it is also important for the healthcare personnel to make sure that the devices are
in a good condition and functions well.
Table 6.1. Distribution of Functioning Medical Devices per Clinic by State/ Region and Sector in 2012
Peak flow meter
No. of
functioning Percent (%)
devices
161
99.4
Nebuliser
State/Region
Sector
Selangor &
WP Putrajaya
Public
162
Private
38
34
89.5
WP Kuala Lumpur
Public
36
35
97.2
Private
25
25
100.0
1.0 (0.0)
Public
79
74
93.7
4.0 (4.0)
Private
13
13
100.0
1.0 (1.0)
Public
16
16
100.0
Private
11
11
Public
23
Private
4
Kelantan
Kota Kinabalu
Kuching
No. of
devices
No. of
functioning Percent (%)
devices
Median*
(IQR)
No. of
devices
4.0 (5.0)
78
64
82.1
2.0 (1.0)
1.0 (1.0)
70
68
97.1
1.0 (1.0)
4.0 (1.0)
26
23
88.5
2.0 (2.3)
32
32
100.0
1.0 (0.0)
30
29
96.7
2.0 (1.0)
32
29
90.6
1.0 (0.0)
4.5 (4.0)
11
11
100.0
3.0 (0.8)
100.0
1.0 (0.5)
14
13
92.9
1.0 (1.0)
23
100.0
5.0 (5.8)
19
15
78.9
4.0 (2.3)
4
100.0
1.0 (0.0)
7
7
100.0
1.0 (2.3)
*Median functioning devices per clinic.
32
Median*
(IQR)
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table 6.1. (continued) Distribution of Functioning Medical Devices by State/ Region and Sector in 2012
Resuscitation trolley
Defibrillator
No. of
functioning Percent (%)
devices
35
94.6
No. of
functioning Percent (%)
devices
21
84.0
State/Region
Sector
Selangor &
WP Putrajaya
Public
37
Private
36
36
9
Private
Median*
(IQR)
No. of
devices
1.0 (0.0)
25
100.0
1.0 (1.0)
3
2
66.7
0.0 (0.0)
9
100.0
1.0 (0.0)
7
7
100.0
1.0 (0.8)
23
23
100.0
1.0 (0.0)
2
1
50.0
0.0 (0.0)
Public
19
19
100.0
1.0 (0.0)
7
7
100.0
0.0 (1.0)
Private
15
15
100.0
0.6 (1.0)
0
0
0.00
0.0 (0.0)
Public
4
4
100.0
1.0 (0.0)
2
0
0.0
0.0 (0.0)
Private
6
6
100.0
1.0 (1.0)
0
0
0.0
0.0 (0.0)
Public
4
4
100.0
1.0 (0.0)
4
4
100.0
1.0 (0.0)
Private
3
3
100.0
1.0 (0.8)
0
0
0.0
0.0 (0.0)
WP Kuala Lumpur Public
Kelantan
Kota Kinabalu
Kuching
No. of
devices
Median*
(IQR)
1.0 (1.0)
*Median functioning devices per clinic.
Table 6.1. (continued) Distribution of Functioning Medical Devices by State/ Region and Sector in 2012
Electrocardiogram
Glucometer
No. of
functioning Percent (%)
devices
No. of
functioning Percent (%)
devices
State/Region
Sector
No. of
devices
Selangor &
WP Putrajaya
Public
46
Private
52
50
96.2
1.0 (0.0)
80
78
97.5
1.0 (1.0)
WP Kuala Lumpur
Public
13
10
76.9
1.0 (0.0)
34
34
100.0
4.0 (2.5)
Private
29
28
96.6
1.0 (0.0)
33
32
97.0
1.0 (0.0)
Public
22
21
95.5
1.0 (0.0)
56
55
98.2
2.5 (3.0)
Private
20
19
95.0
1.0 (0.5)
44
44
100.0
2.0 (1.0)
Public
4
4
100.0
1.0 (0.0)
11
9
81.8
2.0 (0.8)
Private
11
9
81.8
1.0 (0.8)
18
18
100.0
2.0 (1.0)
Public
10
8
80.0
2.0 (1.5)
64
54
84.4
13.0 (10.0)
Private
4
3
75.0
1.0 (0.8)
7
7
100.0
1.0 (2.3)
Kelantan
Kota Kinabalu
Kuching
38
82.6
Median*
(IQR)
No. of
devices
1.0 (0.0)
132
130
98.5
Median*
(IQR)
3.5 (2.3 )
*Median functioning devices per clinic.
Table 6.1. (continued) Distribution of Functioning Medical Devices by State/Region and Sector in 2012
Ultrasound machine
State/Region
Sector
Selangor &
WP Putrajaya
Public
42
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
No. of
devices
No. of
functioning Percent (%)
devices
39
92.9
General radiology unit (X-ray machine)
Median*
(IQR)
No. of
devices
1.0 (0.0)
13
No. of
functioning Percent (%)
devices
11
84.6
Median*
(IQR)
0.0 (1.0)
Private
33
31
93.9
1.0 (1.0)
13
12
92.3
0.0 (0.0)
Public
5
5
100.0
0.5 (1.0)
3
3
100.0
0.0 (1.0)
Private
11
10
90.9
0.0 (1.0)
7
6
85.7
0.0 (0.0)
Public
24
21
87.5
1.0 (1.0)
4
4
100.0
0.0 (0.0)
Private
20
20
100.0
1.0 (0.5)
2
2
100.0
0.0 (0.0)
Public
4
4
100.0
1.0 (0.0)
1
1
100.0
0.0 (0.8)
Private
10
10
100.0
1.0 (0.0)
0
0
0.0
0.0 (0.0)
Public
4
4
100.0
1.0 (0.0)
4
3
75.0
1.0 (0.8)
Private
3
2
66.7
0.5 (1.0)
0
0
0.0
0.0 (0.0)
*Median functioning devices per clinic.
33
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table 6.1. (continued) Distribution of Functioning Medical Devices by State/Region and Sector in 2012
Bilirubinometer
Full blood count machine
No. of
devices
No. of
functioning
devices
Percent (%)
Median*
(IQR)
No. of
devices
No. of
functioning
devices
Percent (%)
Median*
(IQR)
State/Region
Sector
Selangor &
WP Putrajaya
Public
33
31
93.9
1.0 (0.0)
45
43
95.6
1.0 (1.0)
Private
2
0
0.0
0.0 (0.0)
8
5
62.5
0.0 (0.0)
WP Kuala
Lumpur
Public
4
4
100.0
0.5 (1.0)
7
7
100.0
1.0 (1.8)
Private
4
3
75.0
0.0 (0.0)
3
2
66.7
0.0 (0.0)
Kelantan
Public
19
16
84.2
1.0 (0.0)
18
18
100.0
1.0 (0.0)
Private
2
2
100.0
0.0 (0.0)
2
2
100.0
0.0 (0.0)
Public
5
4
80.0
1.0 (0.0)
5
4
80.0
1.0 (1.5)
Private
2
2
100.0
0.0 (0.5)
1
1
100.0
0.0 (0.0)
Public
6
5
83.3
1.0 (0.8)
6
5
83.3
1.0 (0.8)
Private
0
0
0.0
0.0 (0.0)
0
0
0.0
0.0 (0.0)
Kota Kinabalu
Kuching
*Median functioning devices per clinic.
Table 6.1. (continued) Distribution of Functioning Medical Devices by State/ Region and Sector in 2012
Doppler foetal monitor
No. of
functioning Percent (%)
devices
Median*
(IQR)
No. of
devices
No. of
functioning
devices
Percent (%)
Median*
(IQR)
73.9
2.0 (2.3)
126
113
89.7
3.0 (2.3)
8
88.9
0.0 (0.0)
60
57
95.0
1.0 (0.0)
13
92.9
0.0 (3.5)
34
33
97.1
2.5 (4.8)
State/Region
Sector
Selangor &
WP Putrajaya
Public
115
85
Private
9
WP Kuala Lumpur
Public
14
Kelantan
Kota Kinabalu
Kuching
No. of
devices
Wheelchair
Private
6
5
83.3
0.0 (0.0)
28
28
100.0
1.0 (0.0)
Public
36
32
88.9
2.0 (1.0)
47
44
93.6
2.0 (1.0)
Private
4
3
75.0
0.0 (0.0)
27
27
100.0
1.0 (0.0)
Public
2
1
50.0
0.0 (0.8)
14
12
85.7
2.5 (4.0)
Private
1
1
100.0
0.0 (0.0)
7
7
100.0
1.0 (0.5)
Public
12
10
83.3
2.0 (5.0)
19
16
84.2
3.0 (8.0)
Private
2
2
100.0
0.5 (1.0)
5
5
100.0
1.0 (0.8)
*Median functioning devices per clinic.
References
1.
Khoo EM, Tan PL. Profile of general practices in Malaysia. Asia Pac J Public Health. 1998;10(2): 81-87
2.
Mimi O, Tong SF, Nordin S, Teng CL, Khoo EM, Abdul-Rahman A, Zailinawati AH, Chen WS, Shihabudin WM, Noridah MS, Fauziah ZE. A comparison of
morbidity patterns in public and private primary care clinics in Malaysia. Malaysian Family Physician. 2011; 6(1):19-25
3.
Guidelines on Management of Adult Asthma – A Consensus Statement of the Malaysian Thoraci Society. Malaysian Thoracic Society, 1996. [viewed 23rd
September 2013] Available from: http://www.mts.org.my/Guidelines_BronchialAsthma.html.
4.
Institute of Public Health (IPH) 2011. National Health and Morbidity Survey 2011 (NHMS 2011).Vol. II: Non-Communicable Diseases;2011: 188 pages.
5.
Ministry of Health Malaysia, Malaysian Diabetes Association, Academy of Medicine of Malaysia, Malaysian Endocrine and Metabolic Society. Clinical Practice
Guidelines on Management of Type 2 Diabetes Mellitus 4th Edition. Ministry of Health Malaysia, May 2009.
6.
Khoo EM. A comparative study on the service profiles and practice facilities among urban general practices in East and West Malaysia. Med J Malaysia. Sept
2000;55(3).
7.
Canadian Labour and Business Centre for Task Force Two: A Physician Human Resource Strategy for Canada. Physician workforce in Canada: Literature
Review and Gap Analysis. Ottawa, Canada: January 2003. [viewed 18th September 2013] Available from: http://www.effectifsmedicaux.ca/reports/
literatureReviewGapAnalysis-e.pdf
34
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table for Figures
Table 6.2. Percent of Clinics with Functioning Medical Devices by Sector in 2012
Public
Medical Devices
Private
No. of clinics with
functioning devices
Percent (%)
No. of clinics with
functioning devices
Percent (%)
n=(68)
n=(120)
Peak flow meter
66
97.1
78
65.0
Nebuliser
67
98.5
119
99.2
Glucometer
66
97.1
117
97.5
Electrocardiogram (ECG)
66
97.1
107
89.2
Resuscitation trolley
65
95.6
83
69.2
Defibrillator
35
51.5
3
2.5
Doppler Fetal Monitor/Daptone
52
76.5
19
15.8
Wheel chair
64
94.1
108
90.0
Full blood count machine
63
92.6
10
8.3
Bilirubinometer
58
85.3
7
5.8
Ultrasound machine
61
89.7
69
57.5
General radiology unit
22
32.4
20
16.7
35
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
|
APPENDIX 1 ADDITIONAL TABLES
Table A1.1. Median Number of Attendances per clinic per year by State/Region and Sector in 2011
Attendances per year
State/Region
Selangor & WP Putrajaya
WP Kuala Lumpur
Kelantan
Kota Kinabalu
Kuching
Sector
Total attendances
per day
No. of clinics
Median* (IQR)
Public
Private
Public
Private
Public
Private
Public
Private
Public
Private
30,07,058
7,76,464
6,44,806
3,01,860
8,07,960
3,41,796
4,09,208
90,480
5,13,146
68,120
34
52
8
30
18
25
4
8
4
4
61,278.5 (58,328.3)
13,260.0 (9,763.0)
65,350.0 (29,521.3)
9,230.0 (6,669.0)
41,957.0 (27,894.3)
13,104.0 (10,790.0)
96,502.5 (95,932.5)
11,050.0 (6,305.0)
1,14,539.5 (1,72,738.0)
18,200.0 (16,250.0)
*median attendances per clinic per year
Table A1.2. Median Number of Attendances (Outpatient, Home Visit, Antenatal Visit) per clinic per year by State/Region and
Sector in 2011
Outpatient
State/Region
Sector
Total
attendances
19,56,624
5,53,376
5,31,991
Private
Total
Public
Private
Total
Public
Private
Total
Selangor &
WP Putrajaya
Public
Private
Total
WP Kuala Lumpur Public
Private
Total
Kelantan
Public
Kota Kinabalu
Kuching
Home Visit
37,222.5 (41245.0)
64,859.5 (27830.0)
25,981.0(17699.0)
Total
attendances
1,87,536
411
1,87,947
5,020
139
5,159
76,489
3,19,250
-
70,809.0(101569.0)
-
4,62,899
-
1,00,610 (185686.0)
-
Median* (IQR)
Antenatal
4,393.5 (5,393.0)
3.5 (6.0)
138.0 (4,390.0)
375.0 (2,323.0)
5.0 (9.0)
5.0 (10.0)
3,688.0 (2,741.0)
Total
attendances
3,43,347
4,762
3,48,109
16,385
9,789
26,174
84,133
7,634.0 (10,078.0)
27.0 (85.0)
1,163.0 (8,317.0)
5,096.0 (-)
14.0 (40.0)
17.5 (50.0)
4,152.0 (4,419.0)
561
77,050
15,427
25
20.0 (50.0)
69.0 (3,634.0)
3391.5 (2,985.0)
2.0 (5.0)
2,733
86,866
53,744
514
60.0 (180.0)
1,138.0 (4,863.0)
7,037.0 (2,7833.0)
60.0 (80.0)
15,452
1,968
0
1,968
5.0 (3,077.0)
730.0 (-)
0.0 (0.0)
-
54,258
19,016
0
19,016
100.0 (6,944.0)
6,277.0 (0.0)
0.0 (0.0)
-
Median *(IQR)
Median* (IQR)
*median attendances per clinic per year, - -not available
Table A1.3.Types of Computer Usage by State/Region and Sector in 2012
State/Region
Sector
Selangor &
WP Putrajaya
Public
Private
Total
Public
Private
Total
Public
Private
Total
Public
Private
Total
Public
Private
Total
WP Kuala
Lumpur
Kelantan
Kota Kinabalu
Kuching
Registration
No. of
clinics with
computer No.
Percent (%)
system
9
41
50
4
20
24
2
12
14
0
6
6
2
3
5
9
32
41
2
15
17
1
12
13
0
4
4
2
3
5
100.0
78.0
82.0
50.0
75.0
70.8
50.0
100.0
92.9
0.0
66.7
66.7
100.0
100.0
100.0
Patient Record
Billing
Dispensing
No.
Percent (%)
No.
Percent (%)
No.
Percent (%)
8
25
33
3
11
14
0
10
10
0
2
2
2
1
3
88.9
61.0
66.0
75.0
55.0
58.3
0.0
83.3
71.4
0.0
33.3
33.3
100.0
33.3
60.0
2
34
36
1
17
18
0
10
10
0
4
4
0
2
2
22.2
82.9
72.0
25.0
85.0
75.0
0.0
83.3
71.4
0.0
66.7
66.7
0.0
66.7
40.0
6
17
23
3
9
12
2
7
9
0
3
3
2
1
3
66.7
41.5
46.0
75.0
45.0
50.0
100.0
58.3
64.3
0.0
50.0
50.0
100.0
33.3
60.0
37
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
Table A1.4.Types of Services Available by State/Region and Sector in 2012
State/Region
Types of
services
Selangor &
WP Putrajaya
WP Kuala Lumpur
No.
Percent (%)
No.
Percent (%)
Public,
n=(34)
Private,
n=(52)
Public
34
Private
Sector
Kelantan
Kota Kinabalu
No.
Percent (%)
No.
Percent (%)
Public,
n=(18)
Private,
n=(25)
Public,
n=(4)
Private,
n=(9)
Public,
n=(4)
Private,
n=(4)
100.0
18
100.0
4
100.0
4
100.0
30
100.0
25
100.0
9
100.0
4
100.0
100.0
38
100.0
43
100.0
13
100.0
8
100.0
33
97.1
8
100.0
18
100.0
4
100.0
4
100.0
Private
52
100.0
30
100.0
25
100.0
9
100.0
3
75.0
Total
85
98.8
38
100.0
43
100.0
13
100.0
7
87.5
Family Planning Public
34
100.0
4
50.0
18
100.0
4
100.0
4
100.0
Private
42
80.8
24
80.0
24
96.0
9
100.0
2
50.0
Total
76
88.4
28
73.7
42
97.7
13
100.0
6
75.0
34
100.0
8
100.0
17
94.4
4
100.0
4
100.0
40
76.9
26
86.7
13
52.0
8
88.9
2
50.0
74
86.0
34
89.5
30
69.8
12
92.3
6
75.0
32
94.1
8
100.0
17
94.4
1
25.0
3
75.0
52
100.0
30
100.0
24
96.0
9
100.0
3
75.0
Total
84
97.7
38
100.0
41
95.3
10
76.9
6
75.0
Public
17
50.0
3
37.5
9
50.0
0
0.0
1
25.0
Private
21
40.4
13
43.3
7
28.0
6
66.7
1
25.0
Total
38
44.2
16
42.1
16
37.2
6
46.2
2
25.0
Public
22
64.7
8
100.0
15
83.3
3
75.0
3
75.0
Private
10
19.2
5
16.7
3
12.0
2
22.2
0
0.0
Total
32
37.2
13
34.2
18
41.9
5
38.5
3
37.5
Public
34
100.0
8
100.0
18
100.0
4
100.0
4
100.0
Private
40
76.9
24
80.0
15
60.0
7
77.8
2
50.0
Total
74
86.0
32
84.2
33
76.7
11
84.6
6
75.0
Public
22
64.7
7
87.5
12
66.7
3
75.0
4
100.0
Private
48
92.3
28
93.3
22
88.0
9
100.0
3
75.0
Total
70
81.4
35
92.1
34
79.1
12
92.3
7
87.5
Public
-
-
-
-
-
-
-
-
-
-
Private
52
100.0
30
100.0
25
100.0
9
100.0
4
100.0
Total
-
-
-
-
-
-
-
-
-
-
Antenatal care Public
34
100.0
3
37.5
18
100.0
4
100.0
3
75.0
Private
37
71.2
20
66.7
16
64.0
8
88.9
0
0.0
Total
71
82.6
23
60.5
34
79.1
12
92.3
3
37.5
Public
34
100.0
8
100.0
18
100.0
4
100.0
4
100.0
Private
51
98.1
29
96.7
23
92.0
9
100.0
3
75.0
Total
85
98.8
37
97.4
41
95.3
13
100.0
7
87.5
Management
of Acute
Illnesses
Management
of Chronic
Diseases
No.
Percent (%)
Public,
n=(8)
Private,
n=(30)
100.0
8
52
100.0
Total
86
Public
Kuching
Clinical Breast Public
Examination
Private
Total
Medical Check Public
Up
Private
Occupational
Health
Smoking
Cessation
Programme
Pap Smear
Minor
Surgeries
Dispensing
Laboratory
Services
--not available
38
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
|
APPENDIX 2 PARTICIPANTS OF THE NHEWS PRIMARY CARE SURVEY 2012
The participants comprised of primary care establishments from both the public and private sectors in Malaysia. A total of 68
Klinik Kesihatans and 120 private GP clinics have participated in NHEWS Primary Care 2012. The clinics are listed below:
PUBLIC CLINICS
SELANGOR
1
Klinik Kesihatan Bagan Terap
17 Klinik Kesihatan Rawang
2
Klinik Kesihatan Batu 14, Hulu Langat
18 Klinik Kesihatan Salak
3
Klinik Kesihatan Batu 9
19 Klinik Kesihatan Selayang Baru
4
Klinik Kesihatan Batu Arang
20 Klinik Kesihatan Semenyih
5
Klinik Kesihatan Bestari Jaya
21 Klinik Kesihatan Serendah
6
Klinik Kesihatan Bukit Changgang
22 Klinik Kesihatan Sungai Besar
7
Klinik Kesihatan Bukit Kuda
23 Klinik Kesihatan Sungai Buloh
8
Klinik Kesihatan Dengkil
24 Klinik Kesihatan Sungai Selisek
9
Klinik Kesihatan Gombak Setia
25 Klinik Kesihatan Taman Ehsan
10 Klinik Kesihatan Ijok
26 Klinik Kesihatan Telok Datok
11 Klinik Kesihatan Jeram
27 Klinik Kesihatan Telok Panglima Garang
12 Klinik Kesihatan Kajang
28 Klinik Kesihatan Ulu Yam Bharu
13 Klinik Kesihatan Pandamaran
29 Poliklinik Komuniti Kapar
14 Klinik Kesihatan Parit Baru
30 Poliklinik Komuniti Meru
15 Klinik Kesihatan Pelabuhan Klang
31 Poliklinik Komuniti Sekinchan
16 Klinik Kesihatan Rasa
32 Poliklinik Komuniti Sungai Air Tawar
WP PUTRAJAYA
1
Klinik Kesihatan Putrajaya
2
Klinik Kesihatan Putrajaya Presint 3
WP KUALA LUMPUR
1
Klinik Kesihatan Bandar Tun Razak
5
Klinik Kesihatan Pantai
2
Klinik Kesihatan Batu
6
Klinik Kesihatan Petaling Bahagia
3
Klinik Kesihatan Cheras
7
Klinik Kesihatan Sungai Besi
4
Klinik Kesihatan Jinjang
8
Poliklinik Komuniti Tanglin
KELANTAN
1
Klinik Kesihatan Aring 2
10
Klinik Kesihatan Kedai Lalat
2
Klinik Kesihatan Bachok
11
Klinik Kesihatan Kemahang
3
Klinik Kesihatan Badang
12
Klinik Kesihatan Lundang Paku
4
Klinik Kesihatan Balai
13
Klinik Kesihatan Penambang
5
Klinik Kesihatan Bandar Gua Musang
14
Klinik Kesihatan Selising
6
Klinik Kesihatan Bandar Kuala Krai
15
Klinik Kesihatan Temangan
7
Klinik Kesihatan Beris Panchor
16
Klinik Kesihatan Tendong
8
Klinik Kesihatan Bunohan
17
Klinik Kesihatan Wakaf Bharu
9
Klinik Kesihatan Jeram Tekoh
18
Klinik Kesihatan Wakaf Che Yeh
KOTA KINABALU
1
Klinik Kesihatan Inanam
3
Klinik Kesihatan Menggatal
2
Klinik Kesihatan Luyang
4
Klinik Kesihatan Telipok
KUCHING
1
Klinik Kesihatan Batu Kawa
3
Klinik Kesihatan Kota Sentosa
2
Klinik Kesihatan Jalan Masjid
4
Klinik Kesihatan Tanah Puteh
39
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
PRIVATE CLINICS
SELANGOR
1
Dr Leela Ratos Dan Rakan-Rakan, Klang
27 Klinik Dr Shamsuddin, Sg Buloh
2
Drs Young Newton & Rakan-Rakan, Petaling Jaya
28 Klinik Dr Suraya
3
Kelinik Lim, Jln Berangan
29 Klinik Dr. Fauziah
4
Kelinik Mohan, Jln Kg Jawa
30 Klinik Dr. I. Chin
5
Klinik & Surgeri Bukit Rimau
31 Klinik Dr. Suhaida
6
Klinik & Surgeri Chuah
32 Klinik Famili Bandar Puteri
7
Klinik & Surgeri Sidhu
33 Klinik Famili Dr Wan Kamariah Sdn. Bhd, Batu Caves
8
Klinik Abd Hamid
34 Klinik Famili Shah Alam, Kota Kemuning
9
Klinik Alam Medic, Taman Tasik Prima
35 Klinik Famili Shah Alam, Taman Bunga Negara
10 Klinik Alam Medic (Kota Kemuning)
36 Klinik Famili Sofia
11 Klinik Alam Medic, Taman Sri Muda
37 Klinik Faridah & Dr Rashid
12 Klinik Alam Medic, Tmn Puchong Perdana
38 Klinik Fatimah, Batu Caves
13 Klinik Alam Megah
39 Klinik Fauziah Dan Rakan-Rakan
14 Klinik Amardev & Surgery
40 Klinik Guan Sdn. Bhd
15 Klinik Anis, Jalan Usahawan
41 Klinik Hamzah, Kpg Sungai Udang
16 Klinik Antarabangsa, Ampang
42 Klinik Hanita, Kajang
17 Klinik Aspalela, Pinggiran Subang
43 Klinik Hasniah Elani
18 Klinik Azlina & Sharifah
44 Klinik Hayati, Taman Sri Gombak
19 Klinik Bahari, Shah Alam
45 Klinik Hooi, Taman Megah Cheras
20 Klinik Bandaran, Jalan SS15/4
46 Klinik Idzham (Tmn Wangsa Ukay)
21 Klinik Bandaran, Bandar Baru Klang
47 Klinik Johari Dan Anita
22 Klinik Bandaran, Shah Alam
48 Klinik Kathy Am
23 Klinik C J Kwek
49 Klinik Keluarga Jugra
24 Klinik Chieng, Taman Sri Sentosa
50 Klinik Keluarga Lee
25 Klinik Chin, Puchong
51 Klinik Lana, Jalan PJS 1/50
26 Klinik Dan Surgeri Jaspal
52 Klinik Mediviron (Formerly Kelinik Bina), Banting
WP KUALA LUMPUR
1
Drs.Young, Newton & Rakan-Rakan, Damansara Heights
16
Klinik Leela Ratos & Rakan-Rakan
2
Drs.Young, Newton Dan Rakan-Rakan, Capital Square
17
Klinik Medi Al Hilmi
3
Klinik Ahmad-Shan Dan Surgeri
18
Klinik Medic Bestari, Kpg Pantai Dalam
4
Klinik Ashvini
19
Klinik Medica, Bukit OUG
5
Klinik Catterall, Khoo And Raja Malek, Jalan Bukit Nanas
20
Klinik Reddy Setapak
6
Klinik Chin Chee Yeong
21
Klinik Salma, PWTC
7
Klinik Chong & Rakan-Rakan
22
Klinik Senan, Jalan Senan
8
Klinik Dan Surgeri Sridamansara
23
Klinik Sharani, Bangsar
9
Klinik Dr Shashikala Sdn Bhd
24
Klinik Tan & Mano, Jalan Sultan Ismail
10
Klinik Dr. Rahim Omar & Rakan-Rakan
25
Klinik Yong, Jalan Imbi
11
Klinik Famili Seri Petaling
26
Kumpulan Medic, Jalan Raja Chulan
12
Klinik Genting Unimed
27
Poliklinik & Surgeri Kong
13
Klinik Harun, Kpg Baru
28
Poliklinik Connaught & Surgeri
14
Klinik K.H.Ong
29
Poliklinik Lourdes
15
Klinik Kee, Taman Melawati
30
Poliklinik Meranti
40
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
KELANTAN
1
Klinik Perdana Pengkalan Chepa
14
Klinik Chong
2
Klinik Nik
15
Klinik Keluarga
3
Klinik Rosdan & Hafidzah
16
Klinik Dr.Roslan
4
Klinik Shafee
17
Klinik Penawar
5
Klinik Mardhiah
18
Klinik Murni
6
Klinik Dr. Wan Abdul Kadir
19
Klinik Wakaf Siku 3
7
Klinik Dr Che Ku
20
Klinik Lee
8
Klinik Pancho
21
Klinik Dr Azhar
9
Klinik Perdana Cawangan Islah
22
Klinik Mahmood (Cawangan Wakaf Bharu)
10
Klinik Sayyida Sdn.Bhd.
23
Klinik Lua
11
Klinik Raju
24
Klinik Dr. Wan
12
Klinik A Wahab
25
Klinik Dr.Yasiman Perdana
13
Klinik Dr. Ramli
KOTA KINABALU
1
Klinik & Surgeri Dr C. F. Pang Sdn. Bhd
6
Klinik Malaysia (Cawangan Centre Point)
2
Klinik & Surgeri Dr Harvinder
7
Klinik Sihat
3
Klinik & Surgeri Lau & Choong
8
Permai Polyclinics Lintas Plaza
4
Klinik Aslam
9
Poliklinik Rakyat - Cawangan Kota Kinabalu
5
Klinik Dr. Baharin
KUCHING
1
Klinik Bina
3
Klinik Sharifah Ihsan
2
Klinik Cyril Songan
4
Klinik Waqaf An-Nur Samariang
41
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
|
APPENDIX 3 LIST OF DEFINITIONS
CHAPTER 2: Primary Healthcare ESTABLISHMENTs
VARIABLE
DEFINITION
Individual practice
Clinic practice run by one permanent doctor.
Group practice
Clinic practice run by more than one permanent doctor or more than one visiting doctor.
Total attendance
Number of visits (a visit here refers to an encounter between a patient but with or without a doctor’s
consultation).
Outpatient attendances
Number of patient attending outpatient department.
Home visits / House call
Encounter between a patient and a healthcare professional that occurs where the patient lives.
CHAPTER 3: Primary Healthcare Facilities
VARIABLE
Triage system
DEFINITION
A system that is dedicated to sort patients into groups based on their needs or those who are most likely
to benefit from immediate medical treatment. It is the first clinic workstation encountered by patients
upon arrival for medical review.
Pharmacy space
The work area within the clinic where dispensing, packing and storing of medication are carried out.
Laboratory space
The work area within the clinic where laboratory support services are carried out. It usually consists of a
“clean area” (for clerical, post analytical and validation work) and a dirty area (for pre analytical, analytical
and sample buffering area).
Diagnostic/Imaging room
Designated room for X-ray device(s).
Ambulance services
Emergency transport services that are run by staff that belong to the same management as the clinic.
CHAPTER 4: PRIMARY HEALTHCARE SERVICES
VARIABLE
DEFINITION
Office hours
From 8am to 5pm on weekdays and non-public holidays.
Extended hours
The clinic opens and provides services after office hours.
After hours on call
services
The clinic is closed; however staffs are on standby to provide medical services if required after office hours.
CHAPTER 5: Primary Healthcare Workforce
VARIABLE
DEFINITION
Medical doctors
Any medical practitioner registered with the Malaysian Medical Council.
Family Medicine
Specialist
A registered medical practitioner with post graduate qualification specialising in family medicine which is
recognised by both the Ministry of Health and the Public Service Department of Malaysia.
Staff nurses
Any registered nurse with a degree or diploma in nursing.
Community nurses
Any registered nurse with a certificate in nursing.
Nursing aides
Any personnel (other than trained nurses) who assist in the daily operations of the clinic
Assistant medical
officers (MA)
An assistant medical officer registered with the Medical Assistant Board.
43
NATIONAL HEALTHCARE ESTABLISHMENT & WORKFORCE STATISTICS 2012
PRIMARY CARE
CHAPTER 6: Primary Healthcare Medical Devices
VARIABLE
DEFINITION
Peak flow meter
A device used to measure air flow out of the lungs called the peak expiratory flow rate (PEFR), as a person
forcefully blows into the device.
Nebuliser
A device used to reduce a liquid medication to extremely fine cloudlike particles; useful in delivering
medication to deeper parts of the respiratory tract.
Glucometer
A battery-operated point-of-care device for determining the approximate blood glucose concentration.
Doppler foetal
monitor/Daptone
Hand-held ultrasound transducer used to detect the heart beat of a foetus.
Electrocardiogram
machine (ECG)
An electrical device intended for studying the activity of the heart based on changes in the voltage between
pairs of electrodes placed at certain points on the skin.
Resuscitation
(emergency) trolley
A portable trolley containing the necessary equipment and drugs required in cardiopulmonary resuscitation
and emergency care of patients.
Defibrillator
A medical electrical device intended to defibrillate the heart by electrical pulses via electrodes when the
heart’s own conduction slows dangerously or stops. It may or may not have transcutaneous pacing capabilities
of electrically stimulating the heart externally.
Full blood count
machine
A machine that analyses the number and types of cells in the blood to generate the commonly used test
known as the full blood count (FBC)/complete blood count (CBC).
Bilirubinometer
(total bilirubin)
A device to measure the amount of bilirubin in the blood. The bilirubinometer is designed primarily to
determine serum bilirubin levels in infants.
Ultrasound machine
Imaging equipment, which uses high-frequency sound waves to create images of internal structures.
General radiology
unit (X-ray machine)
A device used to acquire an X-ray image to visualise structures within the body.
44
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