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Govt urged to strengthen healthcare workforce and resources as demand rises
PETALING JAYA: With the population getting older and living well into advanced ages, the pressure to improve palliative and hospice care is piling by the day.
Longer life expectancy and the growing burden caused by chronic and degenerative illnesses are compounding the problem for health authorities, who are faced with a shortage of trained personnel, limited funding and uneven access.
National Cancer Society Malaysia (NCSM) managing director Dr Murallitharan Munisamy said hospice care is provided when curative treatment is no longer effective, with the focus shifting from fighting disease to preserving comfort and dignity.
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“There comes a point in many serious illnesses where treatment can no longer heal the disease.
“At that stage, the priority becomes comfort, symptom control and, most importantly, freedom from pain, so patients can live the final chapter of their lives with dignity,” he said in an interview.
While hospice care is often associated with cancer, he said many other conditions also require palliative support, such as those suffering from stroke, dementia, Parkinson’s disease, and other neurological and psychiatric illnesses.
“People with dementia may suffer from sleep disturbances and palliative care can help manage these symptoms,” he said.
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Contrary to common belief, palliative care does not begin only at the final stages of illness.
Dr Murallitharan said it can be introduced early and run alongside curative treatment.
“In the past, palliative care was offered very late. Today, it can be part of a planned approach from the point of diagnosis, especially if treatment outcomes are uncertain,” he said.
However, access remains a major challenge.
Palliative care is still a relatively new specialty in Malaysia, with few trained professionals.
While services are available in government and private hospitals, costs in the private sector can be prohibitive.
This gap is often filled by hospice NGOs, which provide free home-based care across several states. Yet these organisations are underfunded, he said.
“They rely on donations and partial government support. There is a serious manpower shortage, and services are sustained largely because of volunteers who sacrifice their time,” Dr Murallitharan said, adding that NCSM has about 7,000 volunteers who include 3,000 medical personnel.
Even so, he estimated that the number of hospice staff nationwide would need to increase several-fold to meet existing needs.
Accessibility poses another barrier, particularly for patients in smaller towns and rural areas.
“How do patients who are immobile or severely ill travel long distances for hospice care?” he asked.
Social stigma also played a role, with some families regarding hospice care as taboo, he said.
Yet another obstacle is insurance coverage.
Dr Murallitharan said many end-stage patients faced limitations because palliative care was not recognised as essential treatment under most medical insurance policies.
Without sustained funding, stronger policy support and specialised workforce development, he cautioned that caring for terminally ill patients would become an even greater challenge in the years ahead.
Health Minister Datuk Seri Dr Dzulkefly Ahmad previously said that Malaysia aimed to increase the number of palliative care specialists to 50 in the next two years, up from the current 34, to meet growing demand for end-of-life care.
He said an estimated 180,000 Malaysians required palliative care last year.
However, Malaysia faces a shortage of specialists at government hospitals, supported by experts from universities and the private sector.
Hospis Malaysia chief executive officer Dr Ednin Hamzah, who shared the concerns, said hospice and palliative care extended far beyond end-of-life care.
“Hospice grew out of care for the dying, but today it supports people at many stages of serious illness, including conditions that one may or may not recover from.
“Globally, non-cancer patients now make up the majority of those needing hospice care, including children,” he said.
Despite rising demand, access remains severely limited, with Dr Ednin estimating that Malaysia currently meets only about 10% of its hospice care needs.
“While the numbers are not exact, it suggests that the vast majority of patients, possibly more than 75%, go without hospice care,” he said.
Capacity constraints affect patients across all income levels, he said, but lower health literacy and the absence of services in rural areas further worsen access.
Late referrals are another persistent problem.
“Patients are often referred very late due to the misconception that hospice care is only for the terminally ill.
“Early intervention is crucial. It is like watching a movie from the beginning rather than the last five minutes,” he said, pointing out that without timely care, thousands of Malaysians continue to suffer daily from pain, anxiety and emotional distress.
With an ageing population and rising non-communicable diseases, Dr Ednin said demand for such services would grow exponentially.
“Malaysia is an upper-middle-income country, yet some lower-income nations have already adopted practical solutions to address this issue. We can cope with future demands, but it requires national engagement and coordinated policies,” he said.
To sum things up, Dr Ednin said there were two ways to respond to a health crisis – a top-down approach focusing on building hospitals and training specialists or a bottom-up approach that empowered communities.
The government announced last August that Malaysia was projected to become an “aged nation” by 2048, when the proportion of citizens aged 65 and above reaches 14% the total population.
It said Malaysia officially became an ageing nation in 2021, when the proportion of those aged 65 and above reached 7% of the total population.
