Embracing system-wide reforms for equitable, sustainable health services through strengthening primary health care delivery and enhanced governance in Malaysia

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Since gaining independence, Malaysia has made strides in healthcare, achieving broad coverage and commendable health outcomes. However, the past two decades have introduced new challenges such as urbanization, lifestyle changes, an aging population, and increasing income disparities, all of which have exerted significant pressure on the healthcare system. The onset of the COVID-19 pandemic further exposed these vulnerabilities. In response, the World Health Organization (WHO) has lent its technical expertise to support the Malaysian government in crafting the Health White Paper (HWP), a document that proposes comprehensive healthcare reforms for the next fifteen years.[1] The HWP aims to improve preventive services, guarantee equitable healthcare access by strengthening primary health care, enhance resilience against emerging health threats, and encourage the development of innovative health ecosystems. In 2023, the approval of the HWP by the Malaysian Parliament represented a pivotal step in the nation's health reform journey, showcasing Malaysia's strong dedication to health policy reforms.[2] Initiatives have been set in motion through the formation of working groups focused on bolstering primary healthcare, refining health financing, and facilitating multisectoral collaboration. These reforms are in harmony with the goals of the GPW 13 and the pursuit of universal health care (UHC) access, underscoring Malaysia's commitment to advancing its healthcare system to meet contemporary challenges.

Key WHO Contributions

• Collaborated closely with Malaysia's Ministry of Health to develop the Health White Paper by offering high-level advice and strategic guidance on healthcare reforms.
• Shared relevant experiences from other countries in planning and executing successful health reforms.
• Facilitated dialogues across different sectors, helping to crystalize the policy framework of the HWP.
• Collaborated with Malaysia's Ministry of Health to create a comprehensive communication strategy. This included forming a technical working group to oversee strategic communications and public engagement.
• Established/led/participated an independent monitoring body to oversee the implementation process of the health reforms.

How did Malaysia, with the support of WHO, achieve this?

The Ministry of Health (MoH) in Malaysia initiated a significant health reform by leading the creation of the Health White Paper (HWP), in collaboration with a wide array of stakeholders including ministries, agencies, the private sector, and civil society organizations. This initiative was grounded in a comprehensive evaluation of existing health system studies, policy documents, and international benchmarks, establishing a solid base for the proposed reforms.

WHO was pivotal from the outset, providing strategic guidance on healthcare reforms, conducting a situational analysis of Malaysia's health system, and contributing to the HWP's development. This partnership capitalized on WHO's extensive experience in global health reforms, affording the MoH access to a wealth of relevant insights and best practices. Furthermore, WHO played a crucial role in orchestrating multisectoral dialogues among a wide array of stakeholders, crucial for tailoring the HWP's policy framework to be inclusive, reflect Malaysia's unique needs, and align with international standards.

“The development of the paper received advice and technical input from the Health White Paper Advisory Council and experts from the World Health Organisation.”

– Dr Zaliha Mustafa, former Malaysian Minister of Health

The HWP outlines ambitious reforms across Malaysia's healthcare system, focusing on delivering high-quality, equitable, and sustainable care. It highlights the enhancement of primary healthcare and community-based services, backed by a competent workforce, and calls for multi-sectoral collaboration to advance preventive and promotive health services, with a special emphasis on youth engagement in health awareness.

Key goals of the HWP include ensuring equitable healthcare access, promoting a patient-centric model, building a resilient health system ready for future challenges, incorporating innovative health solutions, and developing a health system that earns public trust. The document underscores the importance of making healthcare more affordable and accessible, aiming to create a proactive health system equipped to address future health needs.

In 2023, the HWP received bipartisan approval from the Malaysian Parliament, a significant milestone in the country's healthcare transformation journey. This approval triggered a series of comprehensive policy reforms focused on enhancing data systems for informed decision-making and strengthening primary healthcare centers, thus adopting a holistic approach to health improvement.

In response, WHO and Malaysia's MoH developed a Strategic Communication Plan to promote widespread acceptance of the HWP. A technical working group, leveraging WHO's expertise, was established to boost public awareness and garner stakeholder support for the HWP. This involved regularly sharing insights into the public's healthcare expectations through media monitoring, social listening, and sentiment analysis; targeted communications to address public concerns and foster HWP acceptance; and securing backing from a diverse set of stakeholders, including those both internal and external to the Ministry of Health, such as private healthcare service providers, consumer associations, academics, NGOs, international organizations, parliament members, and allied health associations.

An independent monitoring body will oversee, analyze, and report on the health reform implementation for continuous improvement and adaptation, offering necessary recommendations. Anticipated policy changes are directed towards improving decision-support data systems and bolstering primary healthcare centers (PHC). WHO continues to work closely with the MoH as the implementation of reforms advances. Moreover, the Malaysian Government has announced a policy decision to increase healthcare financing in line with the HWP's reforms.

This collaboration between Malaysia and WHO serves as a model for successful health governance partnership. By exchanging expertise and facilitating multisectoral discussions, WHO has been instrumental in steering Malaysia towards a health system that not only meets current needs but is also prepared for future challenges, highlighting Malaysia's commitment to securing a healthier future for all its citizens.

References

1. Malaysia Ministry of Health. Health White Paper for Malaysia [report]. Health White Paper for Malaysia, accessed 20 February 2024.
2. United States of America Department of Commerce. Malaysia Healthcare Government Plan [news]. Malaysia Healthcare Government Plan, accessed 20 February 2024.