SPEECH BY YB DATO’ DR. CHUA SOI LEK, MINISTER OF HEALTH MALAYSIA,
AT THE OFFICIAL OPENING OF THE 3RD ANNUAL DIALYSIS MEETING ON
“NUTRITION IN END STAGE RENAL DISEASE”, LEGEND HOTEL, KUALA
LUMPUR, 26 MARCH 2005 AT 10.00 AM
Y Bhg Tan Sri Dato’ Dr. Abu Bakar bin Suleiman,
President of the Board of Governors, National Kidney Foundation of Malaysia,
Dr. S.S. Gill, Chairman of the Board of Managers,
Mr Goh Seng Chuan, Chief Executive Officer,
Members of the Board of Governors and Board of Managers,
National Kidney Foundation of Malaysia (NKF),
Ladies and Gentleman,
1.
Thank you for inviting me to your function today. As you are aware, the
provision of dialysis treatment for kidney failure patients has come a long way in
Malaysia since 1964 when Hospital Kuala Lumpur purchased its first haemodialysis
machine. By 2004, some 12,000 patients were undergoing dialysis treatment in the
country. If the current annual patient growth rate of 10 to 15 percent continues, there
will be 20,000 kidney failure patients undergoing treatment by 2008. Indeed, I
understand that our dialysis prevalence rate of 406 patients per million population as
recorded in 2003 is one of the highest in the region. At the same time, the number of
nephrologists practising in the country has also increased from a mere four or five 25
years ago to more than 50 today. All these augur well for kidney patients in the
country.
2.
In the early 1980s, the Ministry of Health was the major provider of dialysis
with about 90% of patients dialysing at government centres. By 2003, this had fallen
to 40%, with another 35% dialysing at NGO-run centres and 25% at private centres.
3.
According to data from the National Renal Registry, there were 316 dialysis
centres in the country by 2004. Of these, 112 were government-owned and 91 run
by NGOs. The remaining 113 centres were operated by the private sector. In 2002
and 2003 alone, 35 new dialysis centres were opened by NGOs and the private
sector.
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4.
This rapid proliferation of dialysis centres in both the public and private
sectors accounted for the impressive treatment rates seen in recent years. However,
this rapid increase is also a cause of concern for the Ministry of Health, particularly
with regard to the distribution, monitoring and control of the sprouting centres.
5.
For instance, dialysis provision rates in the various states are presently
unequal. States on the western belt have a high level of dialysis provision (with more
than 100 patients per million population) while states like Kelantan, Pahang and
Sabah have a low provision rate of less than 50 patients per million population. While
it is understandable that, being profit-oriented, the private sector tends to set up
dialysis centres in areas of economic wealth, the same should not be the case for
NGO-run centres that are eligible for Government aid in the form of treatment
subsidies and matching grants. It may therefore not be a bad idea for the Ministry to
start nudging NGOs into setting up dialysis centres in states with low provision rates,
by according such centres priority in financial assistance.
6.
The Ministry is also concerned about the quality of care and staffing at NGO
and private dialysis centres. While we would like to see the continued participation
of all sectors, particularly the NGOs, in providing dialysis treatment, I must
emphasise that the Ministry has a responsibility to ensure that all sectors maintain
the highest standards of dialysis care. I have therefore set up a Committee headed
by the Ministry’s Parliamentary Secretary to look into how these centres may be
audited, monitored and controlled more effectively, pending implementation of the
Private Healthcare Facilities and Services Act 1998 and its Regulations which are
currently still being deliberated with the AG’s Chambers.
7.
I understand that among the measures being considered by the Committee
are:
i.
Requiring NGO-run centres that are receiving financial assistance from
the Government to sign MOUs with the Ministry that will require them to
continuously comply with quality standards and terms set by the
Ministry;
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ii.
Requesting help from the Local Authorities to refer licensing
applications from NGO and private dialysis centres to the district health
offices for technical evaluation and comments before approval; and
iii.
Regular technical and medical audits of these centres to ensure that
quality standards are maintained.
8.
The Ministry has developed a standard evaluation and technical report format
for auditing teams to use when they visit dialysis centres. The audits, based on the
Ministry’s “Guidelines on Standards for Haemodialysis Treatment”, will cover the
physical facilities at the centres, the equipment and consumables, the professional
staffing, the adequacy of haemodialysis treatment, the monitoring of dialysis
patients, the adequacy of cross-infection control measures, the submission of returns
to the National Dialysis and Transplant Registry, and remarks on deficiencies noted.
9.
I understand that our staff have already made inspections or audits on 3
dialysis centres in Sri Manjung and one in Seremban this month, and I am gratified
to learn that all four centres have complied with most of the requirements stipulated
under the Ministry’s guidelines. Some of the deficiencies noted at these centres are:

Inadequate floor space for patients undergoing dialysis;

Not doing the required 3-monthly blood screen on patients for HIV and
hepatitis;

Not setting aside specific machines for the use of HIV, hepatitis and
infectious patients, on the excuse that there are no such patients under
treatment;

Not having adequate provision for handling medical emergencies, for
instance by having a treatment room, defibrillator or emergency trolley on
each floor of the centre; and

Not maintaining a record on the use of dialysers (to prove that they are not
being recycled as a cost-cutting measure).
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Ladies and Gentlemen,
10.
Continuing Medical Education is an integral part of a good dialysis
programme, and it is crucial for staff at dialysis centres to continue upgrading their
knowledge in order to be better informed of the latest dialysis and nephrology
procedures. In this respect, I am pleased to note that NKF has designed, developed
and run a Dialysis Assistant Training Course meant specifically for dialysis assistants
working at private and NGO-run centres. I understand that NKF is also currently
developing a second course for non-renal trained staff nurses and medical assistants
employed at these centres. I would therefore encourage dialysis centres to send
their staff to these NKF-run courses which are specially designed for them. This is
one way to ensure higher standards.
11.
The care provided to dialysis patients should not be limited to the provision of
dialysis treatment. Kidney failure patients can now live for 30 years or more on
dialysis. Hence, we must be just as concerned about providing patients with holistic
care. In doing so, long term complications must be anticipated and pre-empted
where possible. Preventing medical complications will reduce the cost of care, apart
from improving the patients’ quality of life.
12.
Rehabilitation is another important area that needs to be addressed. Studies
have shown that patients who are well rehabilitated tend to enjoy a better quality of
life, especially so when they suffer from chronic diseases that require long-term
treatment. In addition, studies indicate that patients who are actively involved in their
own dialysis and rehabilitation process are less prone to depression compared to
those who are totally dependent on care-givers.
13.
With good rehabilitation, including nutritional considerations, a significant
number of patients can return to normal and gratifying lifestyles despite being on
dialysis. This is especially true for young patients. Data shows that 90% of Malaysian
kidney failure patients between 21-35 years of age are able to return to full or part
time work. However this figure drops to about 64% in the 46 to 55 years age group.
Proper rehabilitation programmes therefore need to be in place to enable a greater
proportion of patients to return to gainful employment and become productive
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citizens. The time has come for renal-care workers to recognise this and strive for
better outcomes for their patients. In fact, this should be your never-ending goal.
14.
On that note, ladies and gentlemen, I have pleasure in declaring open your 3rd
Annual Dialysis Meeting on “Nutrition in End Stage Renal Disease”. Thank you.
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