How can we improve our healthcare infrastructure?


The pandemic has emphasised the need for physical infrastructure to be improved, including in rural areas, like this clinic in interior highlands of Sarawak. — Filepic

A friend of mine recently opined that the worst thing that could happen after the year that we have had (2020), is for things to remain the same.

The adage that “no crisis should go to waste” is often used in political and economic circles, but one of its earliest uses was by Dr M.F. Weiner.

His article Don’t Waste a Crisis – Your Patient’s or Your Own, was published in the journal Medical Economics back in 1976.

Dr Weiner was referring to the fact that a medical crisis can be used to improve aspects of personality, mental health or lifestyle.

For example, a heart attack is as good a reason as any to be more active, eat a healthier diet and quit smoking.

In a similar vein, it is worth exploring the challenges that our healthcare system faced in 2020, as well as prepare ourselves for the year ahead.

However, a single article is not going to be able to cover all the aspects of healthcare in Malaysia.

With that in mind, I would like to focus on the need to build our healthcare infrastructure.

Building capacity

Should we build more hospitals? Or clinics or polyclinics?

If so, where?

Is it better to have multiple small hospitals and single tertiary centres with good connectivity?

Then again, if it is possible to receive quality care at home, would you not want to bypass visiting a busy healthcare facility, thus avoiding the queues and risks of contracting an infection?

There is no easy answer, or rather, there is no one answer that is applicable to everyone.

Improving connectivity to patients can include allowing professional access to their health signs via wearables like smartwatches. — Photos: AFPImproving connectivity to patients can include allowing professional access to their health signs via wearables like smartwatches. — Photos: AFP

The Covid-19 pandemic has highlighted the importance of physical space.

This ranges from intensive care units (ICUs) to secondary care hospitals and isolation facilities that provide basic necessities without the need for close health monitoring.

The availability, or lack thereof, depends very much on where you live – chances are that people in Kuala Lumpur do not face the same challenges as those in Kudat.

The high number of cases in Sabah highlighted the need for more development in healthcare facilities there.

Just as importantly, this needs to be coupled with an investment in human resources.

Buying a ventilator for intensive care use without ensuring that there are sufficiently-trained doctors and nurses is akin to buying a Formula 1 car and handing over its keys to me (just in case there is any doubt, I do not moonlight as a Formula 1 driver).

Digital infrastructure

It seems almost laughable that we talk about telemedicine, Big Data analytics and artificial intelligence (AI) when we still have students having to climb trees to get a decent connection to the Internet.

However, it once again boils down to context and geographical location.

To avoid further increasing the digital divide, there must be a holistic approach to providing adequate connectivity to patients.

This means not just focusing on 5G technology, but also expanding fibre optic connectivity and opening up Television White Space (unused broadcasting frequencies).

An ideal scenario involves patients using wearables that can measure various physiological parameters, e.g. blood pressure.

This can be connected to a cloud-based database that analyses the data, which can then be monitored by healthcare professionals.

The same set-up can involve telemedicine, whereby the patient logs online to have a conversation and review with a doctor, rather than braving traffic (or in some rural areas, navigating rivers and valleys).

The necessary medication can be prescribed or adjusted virtually, after which arrangements for delivery can be made.

Utilising technology

Areas with good access can benefit from technology such as drones to deliver medicine.

In the United States, delivery company UPS and pharmacy chain CVS have teamed up to deliver prescription medicines.

The same concept can be explored in the Drone and Robotic Zone in Iskandar Puteri, Johor, which is part of our National Technology and Innovation Sandbox.

For both rural and urban areas, access to medical specialists remains a problem.

Drones can be used to deliver medications to a patient’s doorstep, as seen in this case of a customer getting a Covid-19 test kit delivered to her in the US.Drones can be used to deliver medications to a patient’s doorstep, as seen in this case of a customer getting a Covid-19 test kit delivered to her in the US.

Just as there is a lack of specialists in more rural regions, those in urban centres may not have access to these very same specialists due to excessive demand and capacity overload.

Here lies yet more opportunities to utilise technology, but again with the caveat that basic infrastructure is put in place.

The potential for teleconsultation is high, especially with the impetus provided by the Covid-19 pandemic.

A McKinsey report noted that consumer adoption of teleconsultation in the US has skyrocketed, from 11% in 2019 to 46% earlier this year.

This points to a willingness to try something novel, as well as the willingness to share more personal data.

This can only happen if the benefits are demonstrated to patients, as well as ensuring that safety mechanisms are put in place.

The more data that is available – across systems and providers – the more we can analyse and capitalise on AI-driven prediction.

This can work to the benefit of the individual, as well as the community.

Improving mental health

Anecdotally, one of the biggest users of telemedicine in Malaysia are those with mental health ailments.

Mental health disorders have been on the rise even before the Covid-19 pandemic.

The 2019 National Health and Morbidity Survey (NHMS) reported that half a million Malaysians suffer from depression, with the highest numbers recorded in Putrajaya, Negri Sembilan and Perlis.

Children were not excluded: A total of 424,000 children were reported to have mental health problems.

Online consultations allow for timely interventions, which can be very crucial.

It also allows patients to seek help at their own convenience.

For many, the privacy afforded is also essential as unfortunately, there still remains a great amount of stigma attached to those who are seen to visit the office of a mental health expert.

The added privacy afforded by telemedicine might encourage Malaysian children (and adults) who suffer from mental health problems, along with their parents, to seek help. — Positive ParentingThe added privacy afforded by telemedicine might encourage Malaysian children (and adults) who suffer from mental health problems, along with their parents, to seek help. — Positive Parenting

Space for improvement

It is obvious that as much as we have done well in terms of controlling the pandemic, there are many opportunities for us to improve healthcare outcomes for all.

As much as there are needs for physical and human capital development, the Government must not neglect developing the infrastructure necessary to improve digital connectivity.

It is only with a holistic multi-ministry approach that we will be able to ensure that patients receive the necessary interventions in a timely and efficacious manner.

Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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