Proceedings
of the
Sixth National Paediatricians
Conference
“Future of Paediatrics and Child Health”
30-31st July 2001
Paediatric Institute
Hospital Kuala Lumpur
Edited by
TB Khoo
YN Lim
KEMENTERIAN KESIHATAN MALAYSIA
TABLE OF CONTENTS
Page
1. Organising Committee
2
2. List of Participants
3
3. Programme
8
4. Opening Remarks by Chairperson of 6th National Paediatricians Conference
10
5. Presentations and Discussion From Divisions of Ministry of Health
5.1. Bahagian Perancangan & Pembangunan
17
5.2. Bahagian Perkembangan Perubatan
20
5.3. Family Health Development
25
5.4. Bahagian Sumber Manusia
30
5.5. Bahagian Perancangan Tenaga Manusia & Latihan
33
6. Workshop Presentations and Recommendations
6.1 Future of Child Health
37
6.2 The Underserved Population
46
6.3 Panel Discussions
50
7. Closing Remarks by The Director General of Health Malaysia
53
8. Post-conference follow-up and Workgroups
57
9. List of Paediatricians in the MOH Hospitals
58
1
Organising Committee
Chairman:
Dr. Wong Swee Lan
Members:
Dato’ Dr. Jai Mohan
Dr. Hussein Imam
Dato’ Dr. Lim Nyok Ling
Dr. HSS Amar Singh
Dr. Lim Yam Ngo
Dr. Mardziah Alias
Dr. Irene Cheah
Dr. Wan Jazilah Wan Ismail
Dr. Kamarul Azahar
Dr. Mahfuzah Mohamed
Dr. Sheila Marimuthu
Dr. Khoo Teik Beng
2
LIST OF PARTICIPANTS
Paediatric Institute, Kuala Lumpur
1. Dr. Wong Swee Lan
2. Dr. Lim Yam Ngo
3. Dr. Mardziah bt. Alias
4. Dr. Irene Cheah Guat Sim
5. Dr. Hung Liang Choo
6. Dr. Lim Chooi Bee
7. Dr. Anna Padmavathy Soosai
8. Dr. Eni Juraida bt. Abd. Rahman
9. Dr. Norzila bt. Mohamed Zainudin
10. Dr. Hishamshah bin Mohd. Ibrahim
11. Dr. Kamarul Azahar bin Md. Razali
12. Dr. Sofiah bt. Ali
13. Dr. Wan Jazilah bt. Wan Ismail
14. Dr. Shamini a/p Vijayan
15. Dr. Rosnah bt. Taha
16. Dr. Sanjiva J. Woodhull
17. Dr. Chee Seok Chiong
18. Dr. Sheila Marimuthu
19. Dr. Mahfuzah bt. Mohamed
20. Dr. Khoo Teik Beng
21. Dr. Padmini a/p Shanmuganathan
22. Dr. Sharmila a/p Kylasam
23. Dr. Rus Anida bt. Awang
24. Dr. Lim Poi Geok
25. Dr. Selva Kumar
26. Dr. Sabeera Begum binti Kader Ibrahim
27. Dr. Sushila Siva Subramaniam
Hospital Selayang
1.
2.
3.
4.
5.
6.
7.
8.
9.
Dato’ Dr. Jai Mohan
Dato’ Dr. Lim Nyok Ling
Dr. Malinee Thambyayah
Dr. Norashidah Abd Wahab
Dr. Ismail Haron
Dr. Tang Swee Ping
Dr. Mary Regina Peter
Dr. Harjeet Kaur
Dr. Ananda Dharmalingam
3
Hospital Tengku Ampuan Rahimah, Kelang
1.
2.
3.
4.
Dr. S Yogeswary
Dr. Foo Lai sin
Dr. Nachal Nachiappan
Dr. Ooi May Sin
Hospital Alor Setar, Kedah
1. Dr. Teh Kheng Hwang
2. Dr. Thiyager Nadarajah
3. Dr. Lim Choo Hau
Hospital Sungei Petani, Kedah
1. Dr. Choo Chong Ming
Hospital Pulau Pinang
1. Dr. Hussain Imam Muhammad Ismail
2. Dr. Balveer Kaur
3. Dr. Lynster Liaw
Hospital Seberang Jaya, Pulau Pining
2. Dr. Angeline Yeoh Aing Chee
Hospital Ipoh, Perak
1.
2.
3.
4.
5.
6.
7.
Dr. HSS Amar Singh
Dr. Tharam a/p Sadananthan
Dr. Prema a/p Subramaniam
Dr. Hajjah Noor Khatijah bt Nurani
Dr. Jeyaseelan a/l Nachiappan
Dr. Akhbar Ali Hatim Ali
Dr. Syham Ishta Puthucheary
Hospital Taiping
1. Dr. Neoh Siew Hong
Hospital Manjung, Perak
1. Dr. Chan Sow Keng
Hospital Queen Elizabeth, Kota Kinabalu, Sabah
1. Dr. Soo Thian Lian
2. Dr. Fong Siew Moy
3. Dr. Fauziah Zainal Abidin
4
Hospital Sandakan, Sabah
1. Dr. Rajan Duda
Hospital Kuching, Sarawak
1. Dr. Kok Juan Wong
2. Dr. Ng Hoong Phak
Hospital Sibu, Sarawak
1. Dr. Wong See Chang
Hospital Kota Bharu, Kelantan
1. Dr. Hasmawati bt. Hassan
Hospital Kuala Terengganu, Terengganu
1. Dr. Jimmy Lee Kok Foo
2. Dr. Suryati bt. Adnan
Hospital Kemaman, Terengganu
1. Dr. Zulaikha bt. Muda
Hospital Tengku Ampuan Afzam, Kuantan
1. Dr. Amir bin Hamzah
Hospital Sultanah Aminah, Johor
1.
2.
3.
4.
Dr. Chan Chin Foo
Dr. Susan Pee
Dr. Tam Pui Ying
Dr. Choong Tek Choo
Hospital Muar, Johor
1. Dr. Angeline Wan Seng Lian
Hospital Batu Pahat, Johor
1. Dr. Tay Yng Yng
Hospital Melaka
1. Dr. Kuan Geok Lan
2. Dr. Gan Yoke Cheng
Hospital Seremban, Negeri Sembilan
1. Dr. Lee Ming Lee
2. Dr. Liu Chian Boon
5
Hospital Kuala Pilah, Negeri Sembilan
1. Dr. Leow Puay Lee
Universiti Kebangsaan Malaysia (UKM)
1. Prof. Madya Dr. Rahmah Rasat
2. Prof. Dr. Ong Lai Choo
Universiti Malaya (UM)
1.
2.
3.
4.
5.
6.
Prof. Dr. Asma bt. Omar
Prof Dr. Lin Hai Peng
Prof. Madya Dr. Lucy Lum
Prof. Madya Dr. Adnan Adrian Goh
Prof. Madya Patrick Chan
Dr. R. Krishnan
Universiti Sains Malaysia (USM)
1. Col. (B) Dr. Wan Fauzi W. Ibrahim
2. Dr. Ariffin Nasir
Universiti Putra Malaysia (UPM)
1.
2.
3.
4.
5.
6.
7.
Prof. Madya Dr. Norlijah Othman
Prof. Datuk Dr. Mohd. Sham Kassim
Prof. Madya Dr. Nur Atiqah
Prof. Madya Dr. Bina Sharine Menon
Dr. Ng Sui Yin
Dr. Stella Kit Yin Chu
Dr. Rosalie Yip Cheng Wan
Perak College of Medicine
1. Dr. Jacqueline Ho
Malaysian Paediatric Association
1. Prof. Dr. Zulkifli bin Ismail
2. Dr. Tang Swee Fong
Perinatal Society of Malaysia
1. Dr. Jamiyah bt. Hassan
Chapter of Paediatrics, Academy of Medicine
1. Prof. Dr. Boo Nem Yum
Private Paediatrician
1. Dr. Kok Chin Leong, Puteri Specialist Hospital
6
Ministry of Health
Bahagian Perkembangan Perubatan
1. Dr. NKS Sathiaseelan
2. Datin Dr. Rosnah Hussein
3. Dr. Noor Aziah bt. Zainal Abidin
Bahagian Pembangunan Kesihatan Keluarga
1. Dr. Rohana bt. Ismail
2. Dr. Aminah Bee Kassim
3. Dr. Rosnah Sutan
Bahagian Perancangan Tenaga Manusia & Latihan
1. Encik Deva Manoheran
2. Encik Muhammad Syafiq Teoh
Bahagian Sumber Manusia
1. Encik Razak bin Rahman
Bahagian Perancangan & Pembangunan
1. Dr. Supathiratheavy Rasiah
7
3. Programme
Monday 30th July 2001
8.00 – 8.30 am ………Registration
8.30 – 9.00 am ………Welcome address by Dr. Wong Swee Lan
9.00 – 1.00 pm
Workshop’s Discussion
Group one: Changing Trends in Paediatric Morbidity and Practices
Facilitator:
Dr. HSS Amar Singh
Rapporteurs:
Dr. Hung Liang Choo
Dr. Fauziah Zainal Abidin
Dr. Lim Chooi Bee
Group two: Restructuring Paediatric Services
Facilitator:
Dr. Lim Yam Ngo
Rapporteurs:
Dr. Neoh Siew Hong
Dr. Leow Puay Lee
Dr. Fong Siew Moi
Dr. Rus Anida
Group three: Addressing the Needs of the Underserved Populations
Facilitator:
Dr. Soo Thian Lian
Rapporteurs:
Dr. Balveer Kaur
Dr. S. Selva Kumar
Dr. Nachal Nachiappan
Dr. Noor Khatijah Nurani
Group four: Continuous Professional Development
Facilitator:
Dr. Hussain Imam Mohamad Ismail
Rapporteurs:
Dr. Chan Sow Keng
Dr. Thiyager Nadarajah
Dr. Tang Swee Peng
Dr. Sabeera Begum
1.00 – 2.00 pm
Lunch
8
2.00 – 5.30 pm
Workshop’s Presentation
Group 1
Dr. HSS Amar Singh
Group 2
Dr. Lee Ming Lee
Group 3
Dr. Soo Thian Lian
Group 4
Dr. Hussain Imam
4.00 – 4.30 pm
Afternoon Tea
5.30 – 6.30 pm
Free Dialogue Session with Young Paediatricians
Tuesday 31st July 2001
9.30 –1200 am Presentations and Dialogue with MOH Representatives
Bahagian Perancangan & Pembangunan
Dr. Supathiratheavy Rasiah
Bahagian Perkembangan Perubatan
Dr. NKS Sathiaseelan
Bahagian Pembangunan Kesihatan Keluarga
Dr. Rohana bt. Ismail
Bahagian Sumber Manusia
Encik Razak bin Rahman
Bahagian Perancangan Tenaga Manusia &
Latihan
Encik Deva Manoheran
12.00 – 2.30 pm
Lunch
2.30 – 4.30 pm
Presentation of Conference’s Recommendations
to Panelists from MOH
Presenters:
Dr. HSS Amar Singh
Dr. Soo Thian Lian
Panelists:
1. Dato’ Dr. Ahmad Tajuddin bin Mohd Jaafar
– Timbalan Ketua Pengarah Kesihatan (Perubatan)
2. Dr. Narimah Awin – Pengarah, Bahagian Pembangunan
Kesihatan Keluarga
3. Dr. Yao Sik King – Pengarah, Bahagian Perancangan &
Pembangunan
4. Dr. Ramlee bin Rahmat - Pengarah Hospital Kuala Lumpur
4.30 pm Closing Remarks by Y. Bhg. Datu Ketua Pengarah Kesihatan
9
OPENING ADDRESS AND OVERVIEW OF CONFERENCE
Dr. Wong Swee Lan
Head of Department of Paediatrics
Kuala Lumpur Hospital
The Ministry of Health Paediatricians Conference is an important event for us. We try to
hold this meeting every two years, to discuss issues related to the paediatric discipline
and the services we provide. This is the sixth meeting. We organize this meeting
differently from previous ones because we would like to have wider participation and
contribution of ideas from as many paediatricians as possible. We especially would like
to hear from the junior paeditricians, as the theme for this year’s meeting is the Future of
Paediatrics and Child Health in this country.
The objectives of this meeting are for us to discuss our role as paediatricians in the
further improvement of the health of our children, and to identify the changes that may be
required in the provision of services and in training in order for us to fulfil this role.
We asked the States to send as many paediatricians as they could to this meeting, and we
are grateful to the Heads of Paediatric Departments for their support. We have with us
today about 80 MOH Paediatricians. We are happy to have with us colleagues from the
universities, the private sector, the Malaysian Paediatric Association, the Academy of
Medicine and the Perinatal Society. Also present at this meeting are colleagues from five
divisions of the Ministry of Health: Medical Development, Planning and Development,
Family Health Development, Manpower, Human Resource Development and Training.
About 2 months ago, when we planned for this meeting, we created a webpage (Death
Paediatrics-Birth Childhealth) for paediatricians to discuss issues related to paediatrics
and child health. I will not go into the controversial name of this webpage. The ideas
generated in these discussions on the webpage are used as input for the workshop
discussions. Also used as input for the discussions are verbal and written comments we
received from a number of paediatricians.
We begin the meeting not with paper presentations but with group discussions, again
because we would like to hear from you. We have identified four areas for the workshop
discussions.
What are the changing trends in paediatric problems and diseases and what are the
changes we need to make in our services and the delivery of health care to the children
and their parents, because of these changing trends? What new systems of delivery of
health care do we propose, for emergency and intensive case, chronic disease
management, ambulatory, community, preventive and promotive paediatrics? How do we
integrate the services in these 5 areas, so that the care we provide is seamless and
continuous? How do we address the needs of the underserved population? The poor, the
aborigines, the migrants, adolescents, school children and children with handicap? And
10
finally how do we address our needs as health care providers so that we can effectively
and efficiently provide these services? What is the place of general paediatrics in the
future?
We have workshop discussions in the morning. At 2.00 pm, we meet here for
presentation from each workshop group. We hope for a lot of discussion. Tomorrow
afternoon, we will present the resolutions of the meeting to a panel, chaired by the
Director General of Health. The other members of the panel are the Deputy DG
(Hospital), Deputy DG (Research & Technical support), Director of Planning &
Development and Director of Family Health Development.
After the meeting, the recommendations will not sit on shelves to collect dust. A number
of working committees will be formed to follow up on the issues till the
recommendations are implemented. We hope we do not have to wait too long.
For tomorrow morning we have invited the Directors of 5 Divisions of the Ministry to
speak to us on issues related to child health from the perspective of their divisions. I am
sure the speakers will be happy to answer questions we have for them and we can discuss
how we can work together for the benefit of everyone.
Some of us may ask the question, have we achieved anything from the previous
conferences? I reviewed the proceedings of the last 4 conferences and was pleasantly
surprised to find that many of the recommendations have been implemented. These
conferences identify issues for program directors to take up at national level. They also
identify areas that the paediatricians can work on at local level. We will now look at
some of the recommendations from the previous conferences and the progress we have
made.
Not many of you will know that one of the recommendations at the first conference was
to raise the paediatric age from 6 to 12 years. I remember Dr. Mahinder Singh telling us
to go to the adult wards to take care of these older children. We must have done a good
job, because by the time we had the second conference, we had the patients as well as the
wards. Maybe we should ask ourselves the question; do we want to raise the paediatric
age from 12 to 18 in the same way?
I see the same scenario with paediatric intensive care services. A survey done by Teh
Keng Hwang for the 3rd conference in 1994 showed only 2 hospitals had PICU. Today we
have PICU’s in 9 hospitals and at a workshop on Future Hospitals early this year, it was
agreed that the bigger hospitals could have PICU separate from general ICU. We should
now train paediatricians to manage these PICU’s.
The development of neonatal services was a recommendation of the 2nd conference when
it was noted that it contributed to 50% of the workload of paediatricians. Today we have
more paediatricians trained in neonatology than any of the other paediatric subspecialties.
For years, practically, all the equipment purchased was for neonatal services. Last year
11
1.74 million ringgit were allocated to set up retrieval systems in the states of Perak and
Sabah.
The concept of Child Friendly Hospital was introduced to us at the 3rd meeting in 1994.
Today all paediatric wards have paintings on the walls and have play areas. We should
use the 12 guidelines of the Child Friendly Healthcare Society to increase the child
friendliness of our facilities. I was told the new ambulatory care centers that are being
planned have dedicated areas for children. We would like to see the same for A&E, OPD
and ICU where there isn’t a separate PICU.
In 1986, there were only 23 paediatricians in the Ministry of Health. Today there are
about140. However the increase in number in the last 5 years from 1996 to now is only
28. This figure shows the distribution, I should say the maldistribution of the
paediatricians in the 3 sectors in the country. Using the Ministry ‘s norm of 1
paediatrician to 50,000 population only 3 places, Wilayah, Penang, and Kelantan fulfill
this norm. 30% of the paediatricians are with the MOH, 17% with the universities and
53% in the private sector. In the private sector, half are office based and half hospital
based.
In 1992, only 4 paediatric subspecialty services were available and they were all in Kuala
Lumpur Hospital. The conference then recommended that 17 subspecialty services be
developed. Today we have 12 subspecialty services and some of these services are
available outside Kuala Lumpur. We should now work towards regionalization of these
services.
The Family Health Development Division took up our recommendations for a national
congenital hypothyroid screening program. This was implemented in stages starting from
Oct 1997. By next year, the program will be in place in the whole country.
The Family Health Development Division also worked with us on the Childhood
Immunization Schedule. Using a health technology assessment on childhood vaccines,
we recommended a revised schedule and the addition of 2 vaccines, Hib and MMR. The
recommendations have recently been accepted and we have been given RM15 million to
buy the new vaccines.
I would like to end by reminding you of the vision and mission of the Ministry of Health
and the 8 goals of the Healthcare System. The recommendations we make should be
guided by the principles and philosophy of the vision, mission and goals.
12
Table 1: MOH Paediatricians’ Conference
No
Year
Venue
No of participants
1
1986
IMR, KL
23
2
1992
Port Dickson
32
3.
1994
Cameron Highlands
29
4.
1996
Kundasang, Sabah
32
5.
1998
Paediatric Inst, HKL
44
6.
2001
Paediatric Inst, HKL
120
Table 2: Paediatricians in MOH
Year
No. of MOH Paediatricians
1986
23
1992
53
1994
74
1996
111
1998
120
st
2001 (31 May 2001)
139
No. of paediatricians per 100000 population
Figure 1: Number of Paediatricians to 100 000 state population by Sector
9
8
Private
7
6
5
MOH
Total
4
3
2
1
Year
Source: MPSU 1999
13
W
P
ak
a
Ke
la
nt
an
P.
Pi
na
ng
M
el
N
S
Pe
ra
k
Sa
ra
w
ak
Se
la
ng
or
Jo
ho
r
Pe
rli
s
Te
re
ng
ga
nu
Sa
ba
h
Pa
ha
ng
Ke
da
h
0
Table 3: Proportion of Paediatricians by Sector, Malaysia 1999
Private officebased
paediatricians
Private Hosp
based
paediatricians
MOH
University
Total
99
99
112
63
370
Percent
26.8%
25.9%
30.3%
17.0%
100%
USA*
87.4%
No.
Source: MPSU 1999
* AMA 1991
Table 4: Status of Paediatric Subspecialty Services 2001.
No. Paediatric Sub-specialty
Consultants
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Neonatology
Oncology/Hematology
Nephrology
Infectious Disease
Neurology
Cardiology
Respiratory
Gastroenterology
Dermatology
Genetics
Paediatric Intensive Care
Community Paediatric
Immunology
Endocrinology
Adolescent medicine
Rheumatology
Metabolic Diseases
TOTAL
12
5
5
5
3
1
2
1
1
1
1
1
Trainees
6
2
1
2
2
1
1
1
1
1
1
1
38
14
20
VISION OF THE MINISTRY OF HEALTH
Malaysia is to be a nation of healthy individuals, families and communities,
through a health care system that is:
 equitable
 affordable
 efficient
 technologically appropriate
 environmentally appropriate
 consumer friendly
MISSION OF THE MINISTRY OF HEALTH
The Ministry of Health is dedicated to build partnerships for health to
facilitate and support the people to:
 attain fully their potential in health
 motivate them to appreciate health as a valuable asset
 take positive action to improve further and sustain their health status
to enjoy a better quality of life.
GOALS OF THE HEALTHCARE SYSTEM








Wellness focus
Person focus
Informed person
Self help
Care provided at home or close to home
Seamless, continuous care
Services tailored to individual or group need
Effective, efficient and affordable services
15
Presentations
and
Dialogue
with MOH Representatives
16
HEALTH FACILITY PLANNING
Dr. Supathiratheavy Rasiah
Bahagian Perancangan dan Pembangunan,
Kementerian Kesihatan Malaysia
Health Facility Planning
Facility Planning – Form follows function
Identify functional requirements (brief)

Organisational aspects

Service delivery aspects based on
 Requirements depending on catchment population, workload and any special
pre-requisites
 Norms
 Policies such as future directions and expansion of services
Characteristics

Family friendly and welcoming environment

Functional – user friendly to enable delivery of a range of services that have to be
provided to meet all health needs.

Support environment for
 Parents and patients/ cases with special needs (e.g. quiet room for oncology
ward)
 To provide patient privacy, dignity and belief (e.g. prayer room)
 Day lounges
 Environment plays a big role in providing reassurance, which in turn is one
of the key factors contributing to provision of effective treatment.
Current Scenario of Facility Planning

New hospitals (turn-key)

Upgrading – Masterplan hospitals

Upgrading, expansion or addition of new facilities for health care.

Paediatric Wards – need to take into consideration mother-accompanying child
facilities, play areas and facilities for parents.

Day-care Facilities – need to include treatment areas and play areas.

Neonatal intensive care unit – divided into intensive care, intermediate care and
convalescent care areas.

Rooming in facilities and dorms for mothers

Parent’s lounge
In new psychiatric hospitals

Child and adolescent facilities

Separate facilities with dedicated support areas in the wards
17
Staff residential accommodation

Some have been provided with crèches.
Paediatric Intensive Care Unit

Proven needs identified during a workshop on “Planning of Future Hospital” in
December,2000.

Some norms have already been identified.
Example : More than 200 admissions per year to ICU.

Principle of networking of hospitals at various levels planned and policy paper
being finalized.
 Level 1 – Super-tertiary
 Level 2
 Level 3
Paediatric Wards

Toilets – paediatric or normal toilet with adapter ?

Baby bath – should it be provided in the support area of the ward or should it be on
a mobile trolley and performed by the bedside ?

Phototherapy units – should it be located in the ward or nursery ?
Nursery in District Hospital without Specialist

Are babies admitted here counted as admissions and part of the census?

Cots – Do they constitute part of the bed number ?
New Women’s and Children’s Hospital

Centre of Excellence – regional or Asean ?

THIS hospital

Independent. A separate entity within the same premises of current Hospital Kuala
Lumpur.

Networking with HKL for some support services such as
 Pathology services
 ? Imaging services – some justification required
 ? CSSD services
 ? Dietary services

Support elements in reproductive medicine

Neonatology

Paediatric medical and surgical units including all subspecialties

Adolescent unit – Adolescent needs special requirements

Facilitate ambulatory care expansion
Guiding Principles for Comprehensive Facilities
1. Facilitate child-centred, seamless care across a continuum of primary, secondary and
tertiary care
18
2.
3.
4.
5.
6.
Integration with community care and child health programme.
Promotive and preventive programmes such as injury prevention and management.
Training and research requirements
Quality assurance, audit and outcome measures
Facility requirements (scope, networking and sharing of resources, justification for
duplication of facilities)
Issue That Need To Be Clarified :- Emergency Department

It was recognized that the Emergency Department should have an on-site
paediatric unit.

NHS review of acute services

Current A&E in Paediatric Institute ? What is its role, function and operational
policy ?

What is the role of current A&E Department in providing paediatric emergency
services in HKL ?
Question(Q) & Answer(A) Session
Q : What are the bare minimum requirements for facilities providing child health services
from primary level clinics to tertiary centers ?
A : Guidelines will have to be provided by the Specialists / Hospital Division to the
Planning Division
Comments:
1. There is a need to ensure equity of services at all levels of health care.
2. All child-friendly facilities must provide educational opportunities with
teachers. These is necessary for long staying patients e.g. oncology patients.
3. We need to think about “Family-friendly” rather than just “Mother-child
friendly” concept.
Q : Are we going to have dedicated day care facilities for paediatrics ?
A : Plans have been approved for dedicated Day Care Services for Paediatrics for
HSAJB, Seremban and Muar Hospitals.
Comments:
There is a need to incorporate paediatric ambulatory care in new and upcoming
ambulatory care facilities in Ipoh, Melaka and Penang Hospitals.
Q : Will Alor Setar and Queen Elizabeth Hospital(QEH) get their Paediatric Intensive
Care Units ?
A : Yes for QEH, not certain for Alor Setar
19
DEVELOPMENT OF PAEDIATRIC AND PAEDIATRIC SUBSPECIALITY
SERVICES
Dr. N.K.S. Sathiaseelan
Timbalan Pengarah Perkembangan Perubatan
Bahagian Perkembangan Perubatan,
Kementerian Kesihatan Malaysia.
1. 7th MALAYSIA PLAN (1996-2000)
1.1 Two patient care activities identified in the Medical Programme
- Secondary Medical Care
- Tertiary Medical Care
1.2 Secondary Medical Care – defined as :
- first basic specialty services
- provided up to the level of larger district hospitals with specialists.
- Total of 41 hospitals to be provided with basic paediatric service (HKL, 13 other
state hospitals, 27 district hospitals)
1.3 Tertiary Medical Care – defined as :
- subspecialty services or specialized procedures
- requires sophisticated equipment and specialized training
- provided only in national and regional level hospitals
1.4 Paediatric Subspecialty Services. 17 subspecialties identified as follows :
- Neonatology
- Oncology / Haematology
- Intensive Care
- Traumatology / A&E
- Dermatology
- Rheumatology
- Infectious Diseases
- Endocrinology
- Cardiology
- Genetics
- Neurology
- Metabolic Immunology
- Nephrology
- Adolescent Health
- Respiratory Medicine
- Social and Preventive Paediatrics
- Gastroenterology
1.5 Status of Development of Services – see Appendix 11, and 15 of Dr. Wong’s Report
- 12 of27 identified district hospitals are still without paediatricians
- Only 12 of 17 subspecialty services being developed. Mainly in neonatology.
- Achievement not equitable. Mainly in Klang Valley. None or minimal in East
Coast and East Malaysia.
2. 8th MALAYSIA PLAN (2001-2005)
2.1 Patient care activities replaced by Hospital Medical Care and Extended Medical Care.
Hospital Medical Care covers both secondary and tertiary medical care.
20
2.2 Focus on priority areas for development – national health problems and key areas that
will provide impact on improvement to national health. Priority areas identified for
development include:
Disease Conditions
Population Groups
i) Heart diseases
i) Maternal and Perinatal Health
ii) Cerebrovascular diseases
ii) Mental Health
iii) Trauma
iii) Geriatric Care
iv) Cancers
v) Diabetes Mellitus
vi) Renal disease – Renal failure
vii) Respiratory disease – asthma & chronic lung diseases
viii) Gastro-intestinal diseases
2.3 Supportive Services to be strengthened – intensive care, pathology and diagnostic
imaging services.
3. DASAR BARU AS A MEANS FOR DEVELOPMENT OF SERVICES
-
This has been the main source of funding for development of services prior to
year 2001.
-
Covers both development of new services and expansion of existing services
including provision of basic equipment and replacement of old equipment.
-
Allocations for Paediatric Services in the last 5 years – see Appendix 2
-
Inefficient means of funding. Problem of tender process.
-
1999 Specialist Conference – it was recommended that development of services
that require substantial funding for equipment and training should be funded
under the development budget. This was agreed and incorporated into the 8th
Malaysia Plan.
-
Another major change in the provision of Dasar Baru funding for the 2002/2003
Dasar Baru. A certain amount of funding is to be approved and incorporated as
ET in the annual operating budget – recurrent fund for purchase of basic
equipment and development of basic specialist services. ‘Dasar Baru’s are to be
provided for specific services as well.
4. PROVISIONS UNDER 8TH MALAYSIA PLAN
-
Under 8th Malaysia Plan, a budget line has been created under BP 301 – Naik
Taraf Perkhidmatan Perubatan, Pelbagai Negeri.
21
-
Amount approved for Development of Medical Services has not been finalized.
-
So far, submission has been confined to perinatal services.
-
Need to identify paediatric specialty and subspecialty services to be developed
under this funding.
5. DEVELOPMENT OF PAEDIATRIC SERVICES – need for review
5.1 Must be realistic. Approach of 1995 Specialist Conference is not achievable.
5.2 What are the areas of high morbidity and mortality in the Paediatric subgroup ?
5.3 What are the areas that affect the quality of life of paediatric patients most ?
5.4 What are the strategies for development in terms of source of funding ?
- need to identify areas of development under ET or Dasar Baru, new Dasar Barus,
services to be developed under RMKe-8.
Note : Refer to findings of DHLL Study 1997 and other evidences – HMIS admissions.
And Appendix 5 & 6 of Report “Paediatric Health Services in Malaysia, 2000”
22
Funding Approved Under “Dasar Baru” – 1990-2001
Year
1990
1991
1992
1994
1995
1996
Total
Approved
332,000.00
16,001,300.00
10,035,100.00
46,207,300.00
90,272,816.00
106,691,700.00
1997*
123,200,000.00
1998
1999
2000
2001*
51,492,500.00
104,821,344.00
49,962,000.00
Amount
Approved
Note
5,323,000.00
800,000.00
* not inclusive of RM 96 million under
4,563,200.00 drugs(price review) and RM 6.8 million for
SUKOM
- Economic downtown 1997/1998
2,450,000.00
4,700,000.00
3,400,000.00 *not inclusive of about RM 90 million for
drugs(price review)
List of Dasar Baru Projects Approved
900,000.00 Meningkatkan rawatan BMT, Institut Pediatrik
2001
2000
1999
1998
1997
1,000,000.00 Meningkatkan perkhidmatan pediatrik (bawah ET- recurrent)
1,500,000.00 Meningkatkan perkhidmatan HDU/NICU (bawah peruntukan
pembangunan)
600,000.00 Mewujudkan perkhidmatan rawatan rapi pediatrik di Hospital Alor
Setar dan Kuala Terengganu.
1,900,000.00 Memulakan “neonatal retrieval system” di Perak dan Sabah
(4 hospital/negeri)
2,200,000.00 Meningkatkan perkhidmatan pediatrik/neonatal di hospitalhospital.
2,050,000.00 Meningkatkan perkhidmatan. Pediatrik/neonatal di hospitalhospital.
1,300,000.00 Menubuhkan Unit PHDU di Hosp. Ipoh dan HTAR Klang.
450,000.00 Membangunkan perkhid. “Paed. Gastro.” Di Inst. Paed. HKL
400,000.00 Membangunkan perkhid. Onkologi/hematology di Inst. Paed. HKL
115,000.00 Meningkatkan perkhid. “Paediatric Day Care” di HUS, Kuching
Tiada
peruntukan
4,563,200.00 Meningkatkan perkhidmatan pediatrik di hospital-hospital.
23
Q & A Session
Q : Why specialist registry takes so long to be instituted ?
A : Need time to set up as it involves the ACT.
C: Subspecialist should be promoted at their regional center and should not be tied to a
transfer.
A : MOH tries to minimize transfer but sometimes the post is not available. No special
promotional posts for subspecialists. They are in the common pool.
Q: Two cardiology centers in Penang and JB but no paediatric cardiac surgeons
available, therefore paediatric cardiology could not be developed in those centers.
A : At the moment there are only three cardiothoracic surgeons, two in Penang and one
in JB. Training in paediatric cardiac surgery is long. MOH is facilitating their
training. Every discipline must promote its own discipline. Get the people to be
interested to take up the specialty.
Q: Is there any way in which different aspects of Perinatal care (e.g. NICU, Retrieval,
Breastfeeding, Good Data) be coordinated to improve Perinatal care ?
A : The MOH has identified, allocated and planned services to improve perinatal care for
approval under 8th Malaysian Plan.
C: There is only minimal equipment for Paediatric oncology services in Kuching
Hospital.
A: Papers have been put up under 8th Malaysia Plan for this purpose.
24
OVERVIEW OF FAMILY AND CHILD HEALTH SERVICES
Dr. Rohana bt. Ismail
Bahagian Pembangunan Kesihatan Keluarga ,
Kementerian Kesihatan Malaysia
Family Health Development Division caters for
- Maternal and Perinatal Health
- Child, School and Adolescent Health
- Mental Health and Care for the Disabled
- Women Health
- Health for the Elderly
Perinatal Health
Reporting of stillbirth and neonatal death in Malaysia
- Started in January 1998
- Revised in June 2000
- Using Wiggleworth pathophysiology classification
- Aim is to collect data based on place of death to facilitate auditing of Perinatal
health.
Guidelines
Definition of Perinatal health
Management of NNJ
Plan of action and integration in NNJ management
Perinatal health committee – district, state
Perinatal care manual – pilot study (Selangor, Malacca, Pahang)
Annual report on stillbirth & neonatal deaths –1998
Perinatal bulletin – 1998, 1999, 2000
Two committees at national level :
- National Perinatal Health Committee
- National Technical Committee on Perinatal Health
Child Health Unit
Immunisation
G6PD screening
Early Childhood Development and Stimulation
National Congenital Hypothyroidim Screening
Integrated Management of Childhood Illness
ARI/ CDD
Thalassemia Screening
Under 5 mortality reporting format
25
Child Health Home-based Card
- Is given to all newborn delivered at government hospitals
- To be used at all levels – hospital and health clinic
- Private hospital is encouraged to use
Immunisation
Immunisation coverage
Recommended New Immunisation Schedule for Infants and Children
BCG : At birth, Standard 1, 6
Hepatitis B : At birth, 1 month, 5 month
DPT : 2, 3, 5 months, 18 month, DT : Standard 1 and Form 3
OPV : 2, 3, 5 months, 18 month, Standard 1
Hib : 2, 3, 5 months
Measles (monovalent) : 9 month ( for Sabah only)
MMR : 12 month and Standard 1
Early Childhood Development and Stimulation
- Senarai Semak
- Manual Latihan
Perkembangan dan Panduan Stimulasi Awal Kanak-kanak bawah 1 tahun
- Started since June 2001
- Objective : To screen any developmental delay as early as possible so as to
provide early appropriate intervention programme
- Implementation at all health clinics
National Congenital Hypothyroidism Screening
- Objective : All newborn with congenital hypothyroidism will be detected early
and manage appropriately to prevent mental disability
- Started in 1998
- Test Strategy
- Serum cord blood at birth
- TSH for screening
- T4 and TSH for confirmation
Integrated Management of Childhood Illness
Strategy
- To reduce childhood mortality and significantly improves children’s health
- Ensure the combined treatment of the major childhood illness, speeds urgent
treatment of seriously ill children, involves parents in the effective care of their
children at home wherever possible and emphasizes prevention of diseases
through immunization, improved nutrition and exclusive breastfeeding.
26
Main focuses – Pneumonia, Diarrhoea, Malaria, Measles, Malnutrition, Breastfeeding.,
ARI / CDD.
Module has been prepared – modified from WHO
Training will be carried out
- facilitators – September 2001
- core-trainers – October, 2001
Future Plan
- Thalassemia Screening
- Under 5 mortality reporting format
Health Care for the Disabled
Health care for children with special needs
Activities
- Screening, confirmation and appropriate referral
- Rehabilitation and follow up at 72 centres
- Guidelines – Fine motor delay, gross motor delay, and ADL.
- Prevention and control of Deafness
o National Plan of Action for the Prevention and Management of Deafness
and Hearing Impairment
- Prevention and Control of Blindness
o Manual on Eye Care for Primary Health Workers
Health Promoting School (Program Bersepadu Sekolah Sihat)
Aim : To produce a safe, healthy and quality school environment and citizen
Six main components
- School Health Policies
- Healthy and Safe Physical Environment
- Healthy and Safe Social Environment
- Community Involvement
- Personal Health Skills
- School Health Services
School Health Services
- Assessing the health status, treatment and referral
- Minor treatment
- Health Education
- Immunisation
- Dental Services
27
Adolescent Health
Adolescent Clinic – pilot project
Standard approach(SOP)
Adolescent Health Policy
WHO Program - study to identify protective factors
Nutrition
Food Basket
IDD supplement and water iodinisation
Breastfeeding Promotion
- Baby Friendly Hospital Initiative
- Code of ethics
Quality Assurance Programme
Severe Neonatal Jaundice
- Introduced in 1993
- Replace kernicterus with serum bilirubin > 20 mg% or 340 umol/L
- Target is < 100 cases for every 10,000 live birth
Tetanus Neonatorum
- Sentinel event
DPT(3)
- To achieve target coverage of 90%
Visual defect among Standard 1 children
- Target: to achieve detection rate > 2%
Health Technology Assessment
-
Childhood Immunisation
Congenital Hypothyroidism Screening
Home visiting
Preconception use of folic acid supplementation
Vit. K injection for Newborn
Maternal screening in detection of birth defect
28
Health Education
-
Technical expert from various discipline
HECC
Telehealth
- Wellness
- Maternal and Perinatal
- Nutrition
- Lifetime Health Record
Q & A Session
Q : Please elaborate on IMCI ( Integrated Management of Childhood Illnesses) and why
accidents and injuries are not included.
A : IMCI is a WHO programme that addresses the most common causes of admission to
paediatric wards. Accidents and injuries are not included because they are not one of
the top five causes of death in developing countries. However, they can be
incorporated in our IMCI programme if paediatricians think it is necessary.
Q: The incidence of kernicterus and tetanus are increasing.
A : Our investigations have shown that the main cause is due to poor coordination
between the hospital and health authorities.
Q: What is the extent of day-to-day interaction at ground level between Family Health
Development Division and paediatricians ?
A : Good. Many paediatricians have been involved and worked closely with the Family
Health Division. Their input has been taken very seriously. At State level, the MCH
committee meets every 2 to 3 monthly. Paediatricians are also encouraged to go and
visit the health centres.
C: There is a need for greater involvement of young paediatricians in the Family Health
programmes.
Q : Has the Family Health Adolescent Programme incorporate issues on lifestyle
disorders such as alcohol / drug abuse, smoking and HIV ?
A : Health talks on these issues were given on ad-hoc basis only at the moment because
of lack of staff.
C : There is a need to incorporate them into the School Programme early as the
Adolescent Programme is a relatively new one.
29
ISU-ISU NAIK PANGKAT UNTUK PAKAR PEDIATRIK
Encik Razak bin Rahman
Bahagian Sumber Manusia,
Kementerian Kesihatan Malaysia
Carta Aliran Kerja Urusan
Memangku
- Menerima gaji sama seperti jawatan yang disahkan
- Layak untuk disahkan dalam jawatan selepas 6 bulan
Naik Pangkat
Syarat-Syarat Kelayakan
1. Telah disahkan dalam perkhidmatan
2. Menerima SKT yang cemerlang
3. Telah membuat laporan harta
4. Telah diwartakan sebagai seorang pakar
Lembaga Naik Pangkat
- Bukan di bawah KKM
- Menentukan kenaikan pangkat untuk U2 dan ke atas
- Bersidang dua kali setahun untuk kenaikan pangkat pakar
Penyediaan Maklumat
- Pengisian Borang
- Semak Syarat-syarat naik pangkat
Dapatkan Dokumentasi
- Keluarkan surat edaran
- Dokumen diperlukan
- LNPT
- Kenyataan Perkhidmatan
- Borang T (BPR) untuk mereka yang menjalankan kursus di luar negara
Terima dan Proses Maklumat
Semak Penyata Perkhidmatan
- Tarikh lantik
- Tarikh sah jawatan
- Tarikh naik pangkat
- Tarikh kelulusan laporan harta
- Tindakan tatatertib
- Tarikh warta pakar
30
Penjumlahan Markah
- 40% dari prestasi pakar
} untuk naik pangkat dari U2 ke atas
- 60% dari laporan prestasi
}
- 100% dari laporan prestasi – untuk naik pangkat dari U3 ke U2
Penyediaan Kertas Perakuan Untuk Jawatankuasa Naik Pangkat, KKM (JNP)
Semua senarai calon yang dipertimbangkan
Perakuan kepada JPA, selepas senarai calon diluluskan oleh BPR
Terima keputusan Lembaga Naik Pangkat Perkhidmatan Awam
Senarai berjaya dikemukakan kepada Cawangan P&P untuk penempatan
Dimaklumkan kepada calon
Rayuan Kenaikan Pangkat
Surat Rayuan (daripada individu melalui Ketua Jabatan)
Maklumat berdasarkan Format B
Kenyataan Perkhidmatan yang dikemaskini
Kemukakan ke JPA
Keputusan Lembaga Rayuan
Memaklumkan kepada calon
Pengwartaan
-
Calon yang berjaga dalam pemangkuan dan kenaikan pangkat
Di bawah warta kerajaan
31
Q & A Session:Q : What remedial actions / steps are taken if the hospital has left out the names of
specialist (gazetted) when they send up the names to JPA for promotion exercise ?
A : The names will be submitted by the MOH to JPA once the names are sent to them.
The MOH may appeal for their promotion to be backdated.
Q : Why does a candidate need to “memangku” on a post before confirmation ?
A : This is to avoid refusal of transfer.
Q : Does the “Jawatan Kenaikan Pangkat” get input from the “Bahagian Perkembangan”
to ensure that the promotion exercise does not result in transfer of a subspecialist
out of the regional centre when the subspecialty service is provided ?
A : As far as possible, yes.
32
PAEDIATRIC SUBSPECIALTY TRAINING
Mr. Deva Manoheran
Bahagian Perancangan Tenaga Manusia & Latihan
Kementerian Kesihatan Malaysia
Introduction
The trend in the training of specialists today is towards a definitive structured program
with a formal exit examination.
In the US, a candidate who wishes to be board certified is usually required to pass an
examination set by a relevant specialty body.
In the UK, the implementation of the Calman report on higher specialist training has
radically reorganised training of doctors working in hospitals.
The GMC now awards the Certificate of Completion of Specialist Training (CCST).
In Malaysia, the MOH has been conducting training in a number of subspecialty areas.
These training programs are drawn up by the individual subspecialties. Now, we are
moving towards a formalized training programme.
Subspecialty Training Committees
Success and effectiveness of training depends on quality of organization and supervision.
There is a need for formal committees to plan, organise and supervise the programme at
the various levels :i)
MOH
ii)
Specialty
iii)
Subspecialty
i)
MOH Subspecialty Training Committee
Chairman :
Secretariat :
Members :
TKPK (P)
Pengarah Perkembangan Perubatan
Discipline Representatives
4 Subspecialty Representatives
Sub Bah. PTM & Latihan
Kiv Representatives from AM / Universities
33
Terms of Reference
- Overall planning of subspecialty training
- Accreditation of training centres and trainers
- Policy on selection and placement
- Review of training program
- Transfer policy vis-à-vis placement of candidates in various training centres
- Policy on exit certification and gazettement
ii)
Paediatric Subspecialty Training Committee
Members :
Head of Paediatrics (Chairman)
Representatives from all paediatric subspecialties
Kiv representatives from AM / University / Paediatric Society
Terms of Reference
- To implement the terms of reference of the main committee at MOH i.e.
- Overall planning of subspecialty training
- Accreditation of training centres and trainers
- Policy on selection of candidates
- Policy on exit certification
iii)
Individual Subspecialty Training Committee
Members :
Head of Subspecialty (Chairman)
3 other senior members of the subspecialty including
representatives from AM /Universities / Society
Terms of Reference
- Recommend candidates for selection into training program
- Accreditation of training centres and trainers
- Review program contents and mode of training
- Plan training schedule of trainees
- Review progress of trainees
- Exit evaluation
General Requirements For Subspecialty Training
Entry Criteria
- A recognised postgraduate qualification
- Have at least 2 years of supervised training after postgraduate qualification
- Report from supervisors pertaining to the suitability of candidates
- Availability of recognised training posts for subspecialty training
34
Duration of Training
- At least 3 years
- Be conducted in accredited training centres locally either in MOH,
Universities or private sector.
- It is encourage that the final year be spent in recognised centre(s) overseas
(specialised areas)
Progress Assessment
- Trainer must submit a special report to STC after the first six months of
training. It should address the suitability of the candidate.
- This is to allow unsuitable candidate to be identified early.
- Subsequent to this, six monthly assessment reports should be submitted to the
STC. Areas to be covered include the attitude, clinical skills, progress with
research project, organisational and leadership skills of the candidate.
- A logbook of training / procedures undertaken should be maintained.
Exit Certification
- Specialty to establish Board / Assessors to certify completion of training.
- Candidate may be required to undergo viva voce / examination as part of the
assessment.
Post-Training
- Upon completion, the successful trainee should spend the following year at an
existing local sub-specialist centre or at a hospital which has been identified
for the development of that particular sub-specialty.
……………………………………………………………………………………………
Q &A Session:Q : How was it decided what scholarships were given for each subspecialty ?
A : Regional subspecialty heads were consulted to see if there were trainees available
and these trainees must already be doing local training. Only five slots were given
to paediatrics for this year, i.e. neonatology, intensive care, cardiology, infectious
disease and neurology.
35
WORKSHOP
PRESENTATIONS
36
WORKSHOP PRESENTATION 1
The Future of Child Health
National Paediatricians Meeting 30-31 July 2001
Introduction
Significant changes have taken place in the health of children and families. This
brief document attempts to identify the key changes and suggest how
pediatricians can work with the MOH to improve further child health.
I. Paediatric Mortality Data
Mortality rates have begun to level off (see table 1). This is an expected outcome
as initial dramatic changes were due to improved socio-economic status of the
population, immunisation programmes, better living conditions, etc. Our current
challenges in reducing paediatric mortality are as described in table 2. There is a
need to address the top 5 causes of mortality.
Table 1: Perinatal & Paediatric Mortality Data 1975-1998
Year
1975#
Total Births
1980#
1985#
1990
1995
2000
289,644
411,322
440,273
523,205
487,641
PMR
32
26.2
19.34
15.76
10.62
10.4
SBR
17.1
15.8
11
9.22
6.32
6.4
ENMR
15.4
12.6
10.7
6.54
4.3
4
NMR
19.1
15.6
10.65
8.53
5.45
5.2
10.3
8.9
8.2
8
8.8*
% of infants with
low birth weight
(<2.5 kg)
IMR
33
24.87
16.95
12.98
8.22
7.5
TMR
3
2.04
1.4
0.71
0.46
0.3
Population under 5
years (mil)
1.48
11.82
2.3
2.53
2.63*
Under 5 mortality
rate
25.7
17.9
14.1
11.2
10.2*
# Data refers to Peninsular Malaya, * Refers to 1997 data
Source: Vital Statistics, Peninsular Malaysia, Department of Statistics Malaysia, 1980-1998 and
KKM annual reports, IDS KL.
37
Table 2: Annual leading causes+ of death for children# aged 1-19 years of age,
in order of frequency
Rank
1997@
1970
1980
1985
1990
1995
1
Perinatal
causes
Perinatal
causes
Perinatal
causes
Perinatal
causes
Perinatal
causes
2
Pneumonia
Pneumonia
Septicaemia Congenital Congenital Congenital
abnormalitie abnormalitie abnormalitie
s
s
s
3
Birth Injuries Congenital Congenital Septicaemia Septicaemia Septicaemia
abnormalitie abnormalitie
s
s
4
Diarrhoea
Injuries
Pneumonia
Injuries
Injuries
Injuries
5
Injuries
Diarrhoea
Injuries
Pneumonia
Pneumonia
Pneumonia
Perinatal
causes
+ Only the first 5 causes are presented to focus discussion. Number become small lower down,
which limit meaningful comparison.
# Data only represents medically certified deaths. In 1997 73.3% were certified in children under 20
years of age.
@ If data were to include uncertified deaths, injuries would rank as the 3rd cause of death, after
perinatal & congenital abnormalities.
Source: Vital Statistics Reports (from: IDS, Ministry of Health), Malaysia
II. Selected Data on In-Patient Care and Ambulatory Care (Day-care)
The data in the table below is from selected regional hospitals (see table 3 in the
Appendix). Some inferences from the data:
 Admissions are rising in 3 major paediatric departments and decreasing in the
third (this decrease is off set by a larger ambulatory workload).
 For available data, between 9.0% and 16.3% of all paediatric admission
(including neonates) were offered ICU care (includes HDU care).
 Specialist clinic visits have grown considerably.
 Ambulatory care is growing and different departments are using it differently.
 There is no mechanism to capture or recognize ambulatory workload.
Presently, data on ambulatory care is captured as inpatients or not captured
at all.
 Urgent need to develop norms for staffing and structure of ambulatory care
areas. The paediatric community will come up with norms for MOH
consideration.
These changes are in line with the “MOH’s direction” and the needs of children:
 one third of all paediatric beds into NICU, PICU or HDU beds
 one third of all paediatric beds into general paediatric and neonatal beds
 one third of all paediatric beds as ambulatory (daycare) “beds”
38
III. Paediatric Morbidity Data
Table 4 presents 4 sets of data (3 local) that compares the needs of children
from various perspectives. Note that the private paediatricians is largely doing
child health related issues and that few of us are ready to face the needs and
concerns of parents.
Table 4: Comparison of Health Needs, Services & Perceptions
Health Needs
Most Frequent
Most Frequent
Common Health
(Based on
Reasons Children
Reasons Children Problems or
Mortality Figures are Seen at Private are Seen at
Concern to Parents
0-12 years of age) GP or Specialists
Government
Clinic
Specialists Clinic
Perinatal causes Well care (including Chronic severe
Behaviour related
immunisation)
illnesses (e.g.
asthma, renal,
cardiac)
Congenital
Upper Respiratory
Disability related
School performance
abnormalities
Tract Illnesses
related
Septicaemia
Other mild illnesses Follow-up cases
Developmental
(e.g. fever, diarrhoea) (e.g. prematurity,
delay
acute illness)
Unintentional
Some severe
Other mild illnesses Mild recurrent
injuries
illnesses
illnesses
Table 5 presents the “new” health morbidities. These pose as challenges and
most are best addressed in the ambulatory setting. Innovative strategies need to
be developed on a local level to address these issues.
TABLE 5: Health Care Challenges in Malaysian Children
1. The "New" Morbidities (secondary to emotional, social, economic and
demographic factors)
 Injuries (Road Traffic Accidents & Child Abuse)
 Mental health & Behaviour-related problems (e.g. adolescent, substance
abuse & sexuality
 related)
 Disability & learning problems
2. Perinatal health (Extreme prematurity)
3. Genetic & metabolic disorders
4. Chronic illnesses
5. New Viral epidemics (e.g. HIV/AIDS, Enterovirus)
6. Malignancy
7. Underserved Populations
39
IV. Implementing the MOH Policies in Paediatrics
Vision:
“ a nation of healthy individuals, families and communities”
We should focus of the quality of child health rather than just the quality or scope
of child health services which is part of the strategy to improve the quality of child
health.
Mission:
“to develop partnerships in health”
Paediatricians should work in partnership with obstetricians, public health
specialists, family physicians, allied health professionals, professional bodies,
NGOs, etc to achieve the highest possible state of child health. This is necessary
at all levels of health care from policy setting to implementation at ground level.
Both government and private sector should be involved.
Goals:
Wellness, Person-focused, Self-help, Informed, etc.
These need to be translated into specific targets for child health and appropriate
strategies and activities developed.
(The Healthy People 2010 provides a good example of the use of nationally
agreed targets which are utilized by all to work in teamwork. Targets relevant to
child health identified in the 8th Malaysia Plan are a good starting point for
Malaysia. Good statistics are necessary to monitor success of strategies and
should be captured.)
Evidence-Based Child Health
Management of child health and illness should be evidence-based. CPGs need
to be developed in those areas of child health where such are lacking. These
CPGs should be operationalised as critical pathways and incorporated into
medical information systems so that the right actions are taken at the right times
by the right persons. In paediatrics, these are especially required to ensure
continuous seamless quality care in the management of child health
maintenance and the management of chronic diseases where multiple health
care practitioners are involved.
40
Supporting Self-Care and Self-Management
Self-care is the norm for most acute conditions in childhood. In chronic disease,
parents have access to health care practitioners only intermittently and have to
manage their child’s condition on their own most of the time. There is a need to
support parents and children to ensure self-care is safe and appropriate, and
health care practitioners are accessible when self-care is not appropriate e.g. via
call centre.
Paediatricians need to work to develop reliable sources of information to support
self-care and self-management as well as to access to paediatric services when
required.
Continuous Professional Development (CPD)
There is a need to move from a ‘training’ environment which benefits 1-10% of
health care professionals to a ‘learning’ environment where 100% of health care
professionals are receiving continuous and just-in-time information that would
contribute to the development of a skilled and informed paediatric work force. All
are trainers and trainees in this system. Learning activities at all levels should be
recorded and made available online to reduce duplication of activity and reduce
inequity of access to learning. A national coordinating committee for Paediatrics
should be set up to support these CPD activities.
41
RECOMMENDATIONS
In view of these trends, there is a need for paediatricians to review their role and
direction in child health. Some recommendations for change include:
1. Paediatricians are challenged to adopt a wider role that encompasses
ambulatory and community needs of children and the family.
2. Changes to ambulatory care:
 Reorganise existing ambulatory services – proper structure or
dedicated area for ambulatory care, dedicated staff
 Obtain data on service workload for anticipated ambulatory care
 Task force to determine recommendations for implementation.
3. Community initiatives that promote wellness and reduce the disease
burden due to genetic disorders and congenital birth defects, child abuse,
disability, injury, chronic illnesses, etc
 This should include an increased involvement in health of all
children, prevention programs, immunization, parental and health
education, advocacy, and adolescent issues
 This promotion of wellness can be enhanced by utilizing existing
telehealth services, especially with the use of PLHP, community
nursing, etc
 Paediatricians should be more proactive in promoting self-help in
families by empowering parents
 As a policy, paediatricians are encouraged to allocate dedicated
time to be involved in the community regularly
 Paediatricians should be posted at Family Health Division MOH as
resource persons to assist in program development.
4. Training requirements to address changing needs:
 More paediatricians trained in both general paediatric care and in
the new morbidity
 Restructure training of undergraduates and future paediatricians to
include community & adolescent health care
 Training of allied health personnel involved in community care
(health promotion & disease detection)
5. General Paediatrics will remain the backbone/core of Paediatric services
in Malaysia.
 During the pre-gazettement period, paediatricians who are unable
to travel to centers with subspecialties for exposure during general
paediatric training, should be offered distance learning modules
(online). This can be supplemented by short intensive attachments
at selected centers.
42




Exposure to community paediatrics for those planning a career in
general paediatrics
Peripheral service in a district hospital for one year as a compulsory
rotation
Young paediatricians should be encouraged to take up general
paediatrics as a career
Create avenues for continued training in general paediatrics.
6. Continued development of subspecialties is necessary.
 Candidates for subspecialty will be selected from those who have
had adequate general paediatric training and exposure.
 Subspecialty training should only be allowed after completion of
gazettement and peripheral service for one year in a district
hospital (compulsory).
 Promotion of specific training of allied health personnel so that they
are specialized in selected areas.
7. Continuing renewal of competence is required for all paediatricians. This
can be facilitated by online CME, maintaining a CPD diary, protected time
for CME.
8. Regionalisation of subspecialty care
 Development and support for regional tertiary service with special
emphasis on networking between hospitals in the region
 Different tertiary care services can be located in various hospitals
within one region.
9. Paediatric and neonatal intensive care - dependent on population birth
rate and needs. The development of transport and retrieval services are
fundamental to proper use of expensive tertiary services and to
appropriate changes of working patterns in smaller hospitals.
10. To promote continuous and seamless health care between private and
government health agencies and between different sectors and different
levels of health care
 Reduce borders, flexi-training and working practices
 To integrate services and enhance networking utilising telehealth
functionalities e.g. LHR, TC, PLHP.
11. Promotion in MOH
 Automatic promotion to U2 on gazettement
 Promotion beyond U2 will be time based
 Promotion should not be discipline based
 Promotions should be duly given irrespective of subspecialisation.
12. All hospitals with paediatric services should have at least 2 paediatricians.
43
"Our role in preventive paediatrics and public health is not only obvious but a
reality. There should be no doubt in the minds of Paediatricians that there should
be a deliberate attempt to move out of hospitals into field of preventive
paediatrics."
"The Paediatric Challenge", Sam Abraham
Editorial of the Malaysian Medical Journal in 1970
Presented by Dr Amar Singh
44
Appendix
Table 3: Selected Data on In-Patient and Ambulatory Care
Sarawak GH
Hospital
Sultanah
Aminah
Ipoh
Hospital
Seremban
Hospital
7396
Up 28.6%
10134
Up 35.4%
6652
Up 60.4%
2318
5038
1:2.2
3460
6674
1:1.9
909
524
463
385
203
6545
Down
13.0%
2901
3644
1:1.3
1065
383
172
782*
177
N=11452
N=11549
N=3473
40.2%
31.2%
28.6%
16.4%
10.8%
18.8%
38.0%
9.9%
Year: 2000
Admissions
a. Total admissions
Change in admission from 1995
b. Neonatal admissions
c. Paediatric admissions
NN:Paeds ratio
d. Total ICU care
e. Neonatal ICU
f. Neonatal IPPV
g. Paediatric ICU
h. Paediatric IPPV
* includes all admission to HDU
Paediatric admissions by age
group (%)
a. Infant (post neonatal) (>28 days -<1 yr)
b. Toddler (>1 yrs -- < 4yrs)
c. Pre school (>4 yrs -- < 7yrs)
251
145
3029
3623
1:1.2
203
67
17.9%
d. School age (>7yrs--<12yrs)
e. Adolescent >12 yrs--- <18yrs
Specialist Clinic Visits
Total visits (numbers)
Change in visits from 1995
Ambulatory visits
Total (number)
14.4%
18.2%
32.1%
27.7%
NA
8640
Up 14.8%
8122
Up 12.4%
11855
Up 37.7%
13543
Up 70.2%
1200
2490
5124
Ambulatory visits by Type
a. Sedation for procedures
215
387
b. Radiology
b. Venepuncture (blood taking)
243
700
c. Other Procedures
d. Treatment (nebuliser, IV antibiotics,
etc)
e. Reviews
f. Thalassemia
g. Oncology
h. Haemophilia
3867
1782
115
117
45
WORKSHOP PRESENTATION 2
THE UNDERSERVED POPULATION
Groups of Underserved Children
1. Remote rural
2. Urban poor
3. Orang Asli & other Indigenous groups
4. Illegal immigrants
5. Estate poor
Reasons for Underserved or "Hard to Reach" populations:
1. Geographical isolation
2. Poverty
3. Ignorance
4. Failure of provision
5. Refusal of services
Areas of concern
1. Immunisation
coverage
2. Nutrition
assessment, breastfeeding promotion, good feeding practices
3. Common causes of mortality
accurate diagnosis and timely/appropriate management of disease:
diarrhoeal disease, respiratory infections, measles, malaria, CNS
infections
5. Perinatal/neonatal services
6. Transport of the Severely Ill Child
7. Adequate secondary care facilities
8. Inter-agency collaboration
Authorities involved
i.
Ministry of Health
ii.
Town/city councils
iii.
Estate Health Authority
iv.
Jabatan Hal Ehwal Orang Asli
v.
NGO's
The bigger picture
a. socio-economic development
b. infrastructure development
c. improvement in literacy rate: children, and also the adult female population
EQUITY IS THE NAME OF THE GAME !!
46
ISSUES
1.
RECOMMENDATIONS
Malnutrition
58.1% Orang Asli aged 1-4 years of
age were found to be stunted and
underweight in one study of
resettlement villages – Rancangan
Pengumpulan Semula in a 1996
study;
78% of Semai children between 4-15
years of age were malnourished in
another 1996 study.
Approximately 80% of inpatients in
Queen Elizabeth Hospital are
malnourished.
a. Food Basket Program for the
underweight and hard core pore
needs to be further strengthened in
terms of
 distribution
 monitoring and
 follow-up of the involved children.
b. Improve nutritional practice in estate
crèches where children of the estate
workers spend a large proportion of
their time
c. Increased awareness and use of
growth monitoring. Detection of
growth failure and appropriate
action.
d. Improve feeding and nutritional
advice by health center staff.
Emphasis on locally available foods,
and also the mode of preparation
(“cookery classes”).
e. Appropriate breastfeeding practices
(not too short/not too long)
47
ISSUES
2.
RECOMMENDATION
Immunisation
a. Perceived poor coverage in urban
areas where a large proportion use
the private sector
Only 30% coverage of measles
immunization in urban areas
Only 40% Oral Polio coverage in
an AFP survey
B. Rural/illegal immigrant populations
with poor uptake of immunisation
3.
i) Compulsory documentation and
returns to the MOH from private
practitioners.
ii) Education/sensitization of private
practitioners on immunization
programme.
b. Extend the outreach
programme
- subsidiary clinics in the
orang asli community
- “mopping up” immunization of
outbreaks in illegal immigrant
communities
- Train the MA’s of the estate
clinics to do immunization
- ? outreach to the illegal
immigrant community
Accessibility of Health Care
Infant Mortality Rate(per 1000
livebirth):- National 7.5
- Sabah
11.1
- Kelantan 8.1
1. Telemedicine
As a means to bring
Appropriate medical/specialist
services to the periphery
-development of effective
protocols and work processes
2. Decentralisation of subspecialty
paediatric services.
3. Safe transport of the ill child
(initial project in two states, Perak
and Sabah)
48
ISSUES
4
5.
RECOMMENDATION
Infectious Disease
High morbidity and mortality due to
infectious disease especially among
Orang Asli, rural poor and illegal
immigrant groups
(respiratory infections, diarrhoeal
disease, CNS disease)
a. Implementation of the WHO
IMCI (integrated management of
childhood illness) program for
children under 5 years
in selected states
Specific problem of malaria –
75% of the national malaria cases
used to be from Sabah;
of the malaria cases in Pen. Malaysia,
69% were in Orang Asli
b. Re-introduction of impregnated
mosquito nets in Orang Asli
populations
Interagency Cooperation
a. with Jabatan Hal Ehwal Orang Asli
(to have a paediatrician included in
the joint committee Jawatankuasa
Mengkukuhkan Kesihatan Ibu dan
Kanak-Kanak Orang Asli)
b. with Estate Managers’ Association
and Ministry of Labour (for training
programmes, immunisation and
supervision of care)
c. with DBKL on specific issues like
postnatal visits,
d. with the Army/Air Force for improved
access to interior areas for the
delivery of outreach for Orang Asli
e. with Non-Governmental
Organisations: e.g. ORBIS – eye
cataract operations in rural areas
Presented by Dr. Soo Thian Lian
49
Panel Discussion on Workshop Presentations and Recommendations
Panelists:1. Dato’ Dr. Ahmad Tajuddin bin Mohd Jaafar
Timbalan Ketua Pengarah Kesihatan (Perubatan), - Chairman
2. Dr. Narimah Mat Awin
Pengarah, Bahagian Pembangunan Kesihatan Keluarga
3. Dr. Yao Sik King
Pengarah, Bahagian Perancangan & Pembangunan
4. Dr. Ramlee bin Rahmat
Pengarah, Hospital Kuala Lumpur
ISSUES AND COMMENTS:1. Data Collection
Dr. Narimah emphasised the need to decide on how to capture the data for
ambulatory cases. She also pointed out that more data sharing is necessary. Dr. Yao
mentioned that there will be a reorganisation of the IDS Unit in the Planning
Division. It will most probably be an independent body, outside MOH whereby health
data and technical planning unit will be made accessible to MOH and private
practitioners.
2. Paediatric Age Group and Adolescent Health
Dr. Narimah brought out the point on how do we classify adolescents and who should
look after them. Dr. Yao echoed that there is an urgent need to address this issue as it
will determine the bed numbers in the health facilities. The physical facilities suitable
to the needs of adolescents need to be developed. Dr. Narimah mentioned that the
Adolescence Policy will be launched soon.
3. Ambulatory Care
Dr. Yao wanted a clearer definition of ambulatory care. Currently, Day Care serves
all age groups and is divided into medical and surgical only. However, the division
has a plan to provide a Child-friendly Corner in the Ambulatory Care Centres. She
also welcomed paediatricians’ commitment to set up a Task Force to work on this
issue.
4. Self Care / Self Management / Continued Professional Development
Dr. Yao pointed out that the allocation for ICT is from the Development Fund,
however there is not much money / rooms for ICT. Eventually, it will involve all the
50
hospitals. However, at the moment, the Total Hospital Information System (THIS)
will be implemented at various levels in hospitals e.g. ‘basic’, ‘intermediate’ or ‘total’
as in Selayang Hospital. Eight new hospitals, five of them in Klang Valley will be
included.
5. The Challenge: From Hospital Paediatrics to Child Health in the Community
Dr. Tajuddin commented that it is timely for paediatricians to play a pivotal role in
the community and contribute to the family health as a whole. Dr. Yao added that
MOH had the responsibility to provide the necessary facilities for paediatricians who
wish to extend their services into the community.
Dr. Narimah pointed out there is also a need to put emphasis on the mental health of
women and children. She also mentioned that secondment of a paediatrician to the
Family Health Division is possible and welcomed the idea.
6. Neonatal and Paediatric Intensive Care
Dr. Tajuddin pointed out that ICU beds are very expensive though the paediatric
component is still very small in terms of overall ICU bed numbers. Despite being
very expensive, there is a need to have the ICU beds for children.
Dr. Yao agreed but questioned the necessity to have PICU beds in certain hospitals
once the issues on regionalization and transport services are addressed.
7. The Underserved Children
Dr. Narimah emphasized that issues on availability, accessibility and equity need to
be addressed. She opined that in this respect, the behaviour of the health care provider
is also very important. The Family Health Division is aware of the high incidence of
malnutrition among the underserved children. She reiterated that food baskets can be
given to Orang Asli in the interior and a study has been carried out to evaluate its
impact.
With regards to immunisation, she agreed that the coverage is low among the
underserved children. She mentioned that KPK has reminded GPs to give the
immunisation returns to MOH. Vaccination is free for the illegal immigrants but other
aspect of child health is chargeable. She also commented that to improve
immunisation coverage, at times, the estate clinic hours was extended.
Dr. Ramlee pointed out the use of impregnated mosquito net for the Orang Asli is not
new. It only needs to be reinforced. He also agreed that the Jabatan Kesihatan
Wilayah needs to address the issue on postnatal checkup.
Dr. Tajuddin commented that estate medical assistants are trained to do very basic
care only. However, the council can look into their curriculum and add a component
on promotive and preventive health care. As for the Jabatan Kesihatan Wilayah, he
51
mentioned that it will be equivalent to the State Pengarah’s office and hope that the
scope of services will be much wider than that currently provided by DBKL.
8. Shortage of Paediatrician in District Hospital
Dr. Tajuddin urged local Universities to consider providing or complementing the
services in some of these District Hospital e.g. Batu Pahat, Segamat and Kluang
Hospital. With this effort, these hospitals can then be re-accredited for house officer
training. He also urged senior paediatricians to encourage the junior ones to go to
these hospitals at least for a short stint.
9. The New Women and Children’s Hospital.
Dr. Yao mentioned that it will be built in the vicinity of HKL. However, the
outstanding issues include networking within the disciplines and with other
disciplines need to be ironed out. There is also a need to address the transport of ill
patients around the hospital.
52
CLOSING REMARKS
BY THE DIRECTOR GENERAL OF HEALTH MALAYSIA
- Datu Dr. Mohamad Taha Arif
Asalamualaikum warahmatullah hiwabarakatuh and a very good afternoon to our host for
this Conference, Dr. Wong Swee Lan and the organising committee, Senior officers from
the Ministry of Health, Representatives from the government and private hospitals,
universities, Malaysian Paediatric Association, ladies and gentlemen.
It gives me great pleasure to be here today for the official closing ceremony of the 6th
Biennial National Paediatrician Conference here at the Paediatric Institute. I would like to
thank the organising committee for inviting me to this auspicious occasion. Being a
biennial event, I am made to understand that diverse and far-reaching issues were
discussed by fellow paediatricians during this two-day conference.
Ladies and gentlemen,
We are witnessing changing trends in the disease spectrum of our children signaling our
coming of age, with trend progressing to a pattern more akin to the developed nations of
the world. And of late, the non-communicable diseases related to injuries and
malignancies are also becoming increasingly more prominent. Diseases related to the
gastrointestinal, respiratory and central nervous systems are also important, as are chronic
diseases with special and chronic rehabilitative needs.
Our childhood morbidity and mortality pattern is in a transitional stage between that of a
developing country and a developed one. Therefore the health services provided to our
children should address the whole spectrum of diseases ranging from perinatal period,
infections, injuries, malignancy to chronic diseases of the respiratory, cardiovascular and
central nervous system. Due to changing morbidity and changing trends in diseases, we
are moving towards restructuring the delivery of health care for the future health of our
children.
Just what are the challenges that our hospitals will be facing in the coming century?
Hospitals have an important role in the delivery of health care. The rapid escalation of
healthcare costs poses certain questions on the future role of hospitals. As such it may be
timely for us to look at the health care system in total with a view to restructure itself in
preparation for the challenges ahead without neglecting our social obligations.
The hospital of tomorrow will have to be much more closely integrated with the larger
health care system, and must support and service community-based services with both
outreach and referral, linked into collaborative regional networks with sharing of
information and resources.
53
The characteristics of the health system of the future should include:
 Improvement in health status
 Promote equity
 Responsive to the needs and concerns of the community
 Promote social justice in the delivery and financing of healthcare
Hospitals of the future must incorporate all the goals mentioned above.
Currently, among the major issues of paediatric health in Malaysia is in perinatal and
neonatal services, where the bulk of our mortality comes from. Others that need attention
are infectious diseases, chronic diseases and children with special needs. Perinatal-related
diseases and infections however continue to be major contributors of morbidity and
mortality to our children. Our perinatal mortality rate in 1997 is 9.1 per 1000 livebirths
compared to a dismal rate of 18.0 in 1985. However our figures are still inferior
compared to more developed nations elsewhere.
In 1995, about 30% of outpatient attendances and 20% inpatient admissions were from
among children below 12 years of age. From the health point of view, the largest
proportion of public hospital admissions is for pregnancy and childbirth including pre and
perinatal complications (32%)
[ IDS, MOH 1996]
From these, it can be concluded that hospital resources are used largely to solve problems
that could be dealt with outside of hospitals – as an outpatient basis and primary health
care, preventive measures, health promotion and environmental control.
With the growing complexity of paediatric care, there is an increasing need for
paediatricians to collaborate with other health care professionals and with health care
institutions. We have to move towards the development of integrated networks that link
primary, secondary and tertiary centres that share information and resources and are
responsive to social needs as well as to advances in technology. This will be important, as
the management of health risks of individuals in the district need to be pooled to look at
the risks in the community.
In order to ensure efficiency and affordability, the policies of promoting ambulatory care,
day care centers, and other innovations will be important. The use of the hospital as a
resource for teaching must be taken into account in the planning. Indeed in planning for
the hospital of the future, one cannot successfully do this by looking at issues of today,
instead we need to project the needs of tomorrow.
The hospitals will be dealing with more ill and critically ill patients, and will require a
much higher percentage of intensive care and high dependency beds. More and more of
surgeries would be performed in a less invasive manner. More and more high tech
equipment would be used in the operating rooms and in the wards. As more of the
54
severely ill patients can be treated, greater demands will be made for rehabilitation
services, in the hospitals as well as in the community.
As home and community services and virtual services expand, hospitals will become
smaller, more technological and more integrated with the rest of the healthcare system.
Hospitals will remain an essential component of the healthcare system, however its
operations must be restructured and redesigned to be much more patient focused,
wellness oriented and integrated with the rest of the healthcare system if they are to
promote continuity of care. The financial burden placed on the Ministry of Health in
order to establish these facilities would be enormous. Much as we would like to have all
of these facilities in every specialty, a much closer evaluation is needed due to the high
costs associated with it.
The Ministry of Health welcomes the move by the conference to address the issues
pertaining to the needs of the under-served populations. We are moving towards a more
caring society and civil society which will not only provide basic requirements for
children but also ensure protection, development, and the opportunity to be heard through
their participation in certain decision-making processes.
The under-served children and families need imaginative strategies to meet their needs.
These are the urban poor, rural poor, aboriginal, migrants and they are those with the
largest need having the least access to health care.
Equity has always been the basis of our national development and has been extremely
important in health and will continue to be so in the future. In considering equity, the
emphasis should be universal access and care according to need. While the concerns of
geographical access have largely been overcome, the issue of cost access will remain a
major challenge to health care providers in order to be more equitable.
The health demands of a young Malaysia requires a comprehensive health care initiative
able to meet our current, evolving and also future needs. Although expansion and
upgrading of infrastructure are important, more vital however are issues relating to
manpower procurement and training, the perennial forces of supply and demand, and also
the perpetual brain-drain.
The shortage of specialists in the MOH is most felt for paediatricians. Using a
requirement of one paediatrician for 50,000 population, it is estimated the number
required in 2001 is 476. However there are now only 351 paediatricians and this gives a
shortage of 125.
The projected deficit of paediatricians for the whole country is also amongst the highest
compared to that of other medical specialties. These calculations were based on an
arbitrarily set ratio of 1 paediatrician per 50,000 population which is below the
recommended American Academy of Paediatrics ratio of 1 paediatrician per 2500
children. With only 20 – 30 doctors qualifying as paediatricians each year, we will not
achieve this need. The perception of less attractive career opportunities in MOH is among
55
the many reasons why paediatrics is not very popular amongst post-graduate doctors.
However efforts are being made within the MOH to rectify this anomaly. More paediatric
subspecialties are being developed and more U1 posts are being created in the Ministry.
Currently there are at least 12 major paediatric subspecialty services in the country.
Efforts are also underway to develop other important subspecialty like endocrinology and
adolescent medicine. Apart from that, due recognition is also being given to the general
paediatricians who provide the backbone of any paediatric healthcare service. It is hoped
that these efforts would help slow down the brain drain to the private sector.
Based on 1998 figures, the Malaysian population is still predominantly young with an
estimated 34% of the population of children being less than 15 years of age. How well a
country manages its population is often reflected by how well it manages the health of the
children. It is therefore not surprising to note that major childhood health indices are
being used as a yardstick to a nation’s progress and its international stature. As we
progress towards Vision 2020, in becoming an industrialised nation, children of today
will be our leaders tomorrow. The need in protecting and promoting the health of this
valuable young generation will ensure a healthy development for our country. The
paediatric health services in Malaysia would therefore remain an integral component
within our national health programme.
In the coming years, Paediatric healthcare need to reinvent itself, making it more relevant
with the changing times. It is therefore timely that this year’s biennial meeting is
addressing important issues like ‘changing trend in paediatric practice, restructuring
paediatric healthcare, continued professional development and addressing the needs of
the underserved population’. I’m sure the deliberations from this meeting would be of
great value towards the planning and delivery of a more efficient healthcare system in the
near future.
Lastly, I would like to call upon all parties to come together and help promote the health
of our children in meeting the challenge of becoming a resilient, robust and healthy
nation. Thank you.
56
Post-Conference Follow Up and Work Groups
Areas
Suggested Scope
Ambulatory Care
1. Definition of paediatric ambulatory
care
2. Scope of work
3. Data set – to circulate a draft for
opinion & then collect data
4. Use data to make recommendation
to MOH on physical structure
(equipment, space), anticipated
workload, staffing norms
Basic Needs for
Children in Hospital
Paediatrician
Responsible
1. To set standards for the basic
requirements that any new health
facility caring for children should
have.
2. This should include physical
structure (equipment, space),
staffing norms, child-friendly
outlook, etc.
Dr. Balveer Kaur
Dato’ Dr. Lim Nyok
Ling
Community
Involvement
Practical suggestions for involvement
of paediatricians in the community
Dr. Amar Singh
General Paediatrics
1.
2.
3.
1.
2.
Dr. Kuan Geok Lan
Pre-gazettement
Scope
Credentialing
Training, etc
Log book revision
Process after MRCP & Masters
training (notification to national
paediatrician, posting preference,
training direction, etc)
Dr. Chin Wai Seong
Dr. Thiyager
Nadarajah
On-line Training
Set up of on-line training material by
various sub-specialties
Family Health
To identify a paediatrician to work with Dr. Wong Swee Lan
Family Health.
57
Dr. Hussain Imam
LIST OF PAEDIATRICIANS IN THE MOH HOSPITALS
Institut Pediatrik, Hospital Kuala Lumpur
1. Dr. Wong Swee Lan
2. Dr. Lim Yam Ngo
3. Dr. Mardziah Alias
4. Dr. Irene Cheah Guat Sim
5. Dr. Hung Liang Choo
6. Dr. Caroline Ho Mei Li
7. Dr. Eni Juraida Abd Rahman
8. Dr. Hishamshah Mohd Ibrahim
9. Dr. Norzila Mohd Zainudin
10. Dr. Lim Chooi Bee
11. Dr. Anna Padmavathy
12. Dr. Sofiah Ali
13. Dr. Choy Yew Sing
14. Dr. Kamarul Azahar bin Mohd Razali
15. Dr. Wan Jazilah Wan Ismail
16. Dr. Vigneswari a/p Ganesan
(Study Leave)
17. Dr. Rosnah bt. Taha
18. Dr. Rus Anida bt. Awang
19. Dr. Chee Seok Chiong
20. Dr. Selva Kumar Sivapunniam
21. Dr. Mahfuzah bt. Mohamed
22. Dr. Sheila Marimuthu
23. Dr. Shamini a/p Vijayan
24. Dr. Zuraidah Hj Abdul Latif
(Study Leave)
25. Dr. Amir Hamzah Abdul Latif
(Study Leave)
26. Dr. Sharmila a/p Kylasam (awaiting gazettement)
27. Dr. Lim Poi Geok (awaiting gazettement)
28. Dr. Noor Aziah bt. Mohd. Shaari (awaiting gazettement)
29. Dr. Sabeera Begum binti Kader Ibrahim (awaiting gazettement)
Hospital Kangar
1. Dr. Jamaluddin b. Hj Mohamed
2. Dr. Abd Nasir b. Mohd Abd Kadher
Hospital Alor Setar
1.
2.
3.
4.
5.
Dr. Teh Keng Hwang
Dr. Lim Choo Hau
Dr. Choong Phaik Sim (awaiting gazettement)
Dr. Ida Shahnaz (awaiting gazettement)
Dr. Liew San Foi
(Attachment, IJN)
58
Hospital Sungai Petani
1. Dr. Choo Chong Ming
2. Dr. Thiyagar Nadarajan
Hospital Kulim
1. Dr. Keng Wee Teik
(Study Leave)
Hospital Pulau Pinang
1. Dr. Hussain Imam Hj Muhammad Ismail
2. Dr. Revathy a/p Nallusamy
3. Dr. Balveer Kaur
4. Dr. Lynster Liaw Chiew Tung
5. Dr. Cheah Yee Ping
6. Dr. Khoo Teik Beng
7. Dr. Hasanah Ishak
8. Dr. Chan Kwai Cheng
9. Dr. Lee Lean See (awaiting gazettement)
10.Dr. Terrence Thomas (awaiting gazettement)
11.Dr. Indra Ganesan (awaiting gazettement)
(Attachment, HKL)
Hospital Seberang Jaya
1. Dr. Angeline Yeoh Aing Chiee
2. Dr. Yeoh Seoh Leng (awaiting gazettement)
3. Dr. Toong Siew Wai (awaiting gazettement)
Hospital Ipoh
1.
2.
3.
4.
5.
6.
7.
8.
Dr. Amar Singh a/l Surjan Singh
Dr. Tharam a/p Sadananthan
Dr. Prema a/p Subramaniam
Dr. Hajjah Noor Khatijah bt Nurani
Dr. Jeyaseelan a/l Nachiappan
Dr. Akhbar Ali Hatim Ali
Dr. Wong Yoke Peng (awaiting gazettement)
Dr. Eddie Chan Seng Hung (awaiting gazettement)
Hospital Taiping
1. Dr. Neoh Siew Hong
2. Dr. Cheong Soo Tow
59
Hospital Teluk Intan
1. Dr. Chen Yih Siang
2. Dr. Lee Hak Teong (awaiting gazettement)
Hospital Manjung
1. Dr. Chan Sow Keng
Hospital Melaka
1.
2.
3.
4.
Dr. Kuan Geok Lan
Dr. Gan Yoke Cheng
Dr. Zainah Shaikh Hedra
Dr. Chan Tee Ling (awaiting gazettement)
Hospital Seremban
1.
2.
3.
4.
5.
6.
7.
8.
9.
Dr. Tan Kah Kee
Dr. Lee Ming Lee
Dr. Cheah Yee Keat
Dr. Umathevi a/p Paramasivam
Dr. Vimaljit Kaur
Dr. Pria Darshini Somasundram
Dr. Ye Pek Ai
Dr. Lim Chian Boon (awaiting gazettement)
Dr. Aina Mariana (awaiting gazettement)
Hospital Kuala Pilah
1. Dr. Leow Poy Lee
Hospital Tengku Ampuan Rahimah, Klang
1.
2.
3.
4.
5.
6.
Dr. Yogeswary a/p Sithamparanatham
Dr. Foo Lai Sin
Dr. Nachal a/p Nachiappan
Dr. Jessie Shannmugan
Dr. Vinojini Nadarajah
Dr. Ooi May Sim
Hospital Kajang
1. Dr. Soo Ming Hong
60
Hospital Selayang
1. Dato’ Dr. Jai Mohan
2. Dato’ Dr. Lim Nyok Ling
3. Dr. Malinee Thambyayah
4. Dr. Norashidah Abd Wahab
5. Dr. Ismail Haron
6. Dr. Tang Swee Ping
7. Dr. Mary Regina Peter
8. Dr. Harjeet Kaur
9. Dr. Ananda Dharmalingam
10. Dr. Chew Thean Meng
Hospital Putrajaya
1. Dr. Siti Mazliah Hj. Kasim
Hospital Sultanah Aminah, Johor Bahru
1.
2.
3.
4.
5.
6.
7.
8.
Dr. Chan Chin Foo
Dr. Susan Pee
Dr. Tam Pui Ying
Dr. Choong Tek Choo
Dr. Lim Bee Yoo
Dr. Yap Yok Chin
Dr. Loh Eam Chong
Dr. Nizam bin Mat Baci
Hospital Muar
1. Dr. Angeline Wan Seng Lian
2. Dr. Mariana Md. Noh
Hospital Batu Pahat
1. Dr. Tan Yng Yng
Hospital Kluang
1. Dr. Noor Azmi Abdullah
Hospital Tengku Ampuan Afzan Kuantan
1. Dr. Chin Choy Nyok
2. Dr. Lim Zek Sen
3. Dr. Choo Kok Kuan
61
Hospital Mentakab
1. Dr. Amir Hamzah Abd Rahman
Hospital Kuala Terengganu
1. Dr. Jimmy Lee Kok Foo
2. Dr. Suryati bt. Adnan
3. Dr. Sharifah Huda bt. Engku Alwi
4. Dr. Christopher Lim Lean Chai
Hospital Kuala Krai
1.
Dr. Nik Khairuldin
Hospital Kemaman, Terengganu
1. Dr. Zulaikha bt. Muda
Hospital Kota Bharu
1. Dr. Mohd Hanifah Mohd Jamil
2. Dr. Hasmawati bt. Hassan
3. Dr. Wan Hanifah bt. Wan Hussin
4. Dr. Yeu Boon Kian
Hospital Umum Sarawak, Kuching
1.
2.
3.
4.
5.
6.
7.
Dr. Chan Lee Gaik
Dr. Ng Hoong Phak
Dr. Kok Juan Loong
Dr. Ong Gek Bee
Dr. Shirley Wong
Dr. Ngu Hock Lock (awaiting gazettement)
Dr. Chieng Siik Kong (awaiting gazettement)
Hospital Sibu
1. Dr. Wong See Chang
2. Dr. Ooi Mong How
3. Dr. Chieng Chae Hae
Hospital Miri
1. Dr. Cheah Lee Ping (awaiting gazettement)
2. Dr. Janet Hong Yeow Hua (awaiting gazettement)
62
Hospital Queen Elizabeth, Kota Kinabalu
1.
2.
3.
4.
5.
6.
7.
Dr. Soo Thian Lian
Dr. Fong Siew Moy
Dr. Fauziah Zainal Abidin
Dr. Yogavijayan a/l Kandasamy
Dr. Bina Gopinath
Dr. Terry Huang Loon Ger (awaiting gazettement)
Dr. Sharon Chan (awaiting gazettement)
Hospital Sandakan
1. Dr. Rajan Duda
Total Number of Paediatricians
Total awaiting gazettement
= 118
= 23
GRAND TOTAL NUMBER
= 141
63