FOR many Malaysians living in urban low-income communities, maintaining good health is not simply a matter of making healthy lifestyle choices; it is a daily struggle shaped by financial limitations, demanding work schedules, inadequate health information and difficulties navigating an increasingly complex healthcare system.
A person living with diabetes may understand the importance of regular follow-up appointments but struggle to take time off work. An older adult with hypertension may receive medication without fully understanding how to manage the condition at home. A family may know that preventive screening is important but postpone it because immediate household expenses take priority.
These situations raise an important question: Are we doing enough to help vulnerable communities become active participants in managing their own health?
We believe Malaysia must move beyond conventional health education and adopt a more coordinated, community-centred approach that strengthens health self-reliance.
Health inequality goes beyond access to clinics
Malaysia has made considerable progress in expanding healthcare services. Nevertheless, the
availability of health facilities does not automatically guarantee equitable access to meaningful healthcare.
For urban B40 households, health-related decisions are frequently influenced by competing
financial and social responsibilities. Transport costs, lost working hours, caregiving obligations, limited health literacy and fragmented information about available services may discourage individuals from seeking timely care.
These barriers are particularly concerning for people living with non-communicable diseases such as diabetes, hypertension and cardiovascular conditions, which often require sustained monitoring, treatment adherence and lifestyle modifications.
The consequences extend beyond individual health. Poorly-managed chronic conditions can affect employment, household income, family responsibilities and long-term economic security.
Health and poverty should therefore not be treated as separate policy concerns. They are interconnected challenges that require coordinated solutions.
Why community health navigation matters
Community health navigation offers a promising approach to addressing the gap between healthcare availability and the ability of individuals to use services effectively.
Rather than expecting patients to navigate healthcare systems independently, community health navigation provides structured guidance, education and support to help them identify their health needs, access appropriate services and participate in managing their conditions.
For example, community health navigation may help an individual understand medical instructions, identify available screening programmes, arrange appropriate referrals or connect with community-based support services.
Importantly, health navigation should not replace professional medical assessment or treatment. Instead, it should complement existing healthcare services by improving communication, coordination and continuity of care.
The ultimate objective is not to create long-term dependence on health navigators but to equip individuals and families with the knowledge, confidence and practical skills needed to make informed health decisions. This is the foundation of health self-reliance.
Inter-professional collaboration is essential
The health challenges experienced by urban B40 communities rarely fall within the responsibility of a single health profession. A patient with poorly controlled diabetes, for instance, may require medical treatment, nursing education, medication counselling, nutritional guidance and assistance with social or financial barriers. Addressing these needs independently can lead to fragmented care.
An inter-professional approach brings together health professionals, community organisations and other relevant stakeholders to support individuals more comprehensively.
Nurses can contribute significantly through health education, chronic disease monitoring, preventive care and patient empowerment. Medical practitioners provide clinical assessment and treatment while pharmacists, allied health professionals, social workers and community representatives contribute expertise according to individual needs.
Effective collaboration must also involve the communities themselves. Residents should not be regarded merely as recipients of health programmes. Their experiences, priorities, cultural practices and everyday challenges should inform how services are designed and delivered.
When communities participate meaningfully, health interventions are more likely to be practical, acceptable and responsive to local needs.
Introducing HealthNAV, a community-centred approach
Recognising the importance of integrated community health support, our multidisciplinary research team at Universiti Malaya is undertaking a project titled HealthNAV™, an Inter-professional community health navigation implementation model to strengthen health self-reliance for sustainable livelihoods among urban B40 communities in Malaysia.
The project is supported by the Poverty Research Lab UAC 4.0 research grant under the Ungku Aziz Centre for Development Studies, Universiti Malaya.
HealthNAV is intended to explore how an inter-professional community health navigation model can strengthen individuals' ability to understand health information, access appropriate services and take greater responsibility for their health.
The initiative places particular emphasis on the relationship between health self-reliance and
sustainable livelihoods among urban B40 communities.
Its underlying principle is straightforward: improving health outcomes requires more than providing information. Communities also need accessible support systems that help translate health knowledge into practical action.
As the project enters its implementation period, it is important to emphasise that its effectiveness has yet to be established. The initiative represents an opportunity to examine the feasibility and potential contribution of a structured community health navigation approach within Malaysia's urban low-income context.
Any future recommendations for wider implementation should be guided by evidence, community feedback and careful evaluation.
Promoting health self-reliance must never mean shifting responsibility for health inequalities entirely onto vulnerable individuals. It would be unreasonable to expect families experiencing financial insecurity to overcome structural barriers through motivation and education alone.
A person cannot consistently adopt healthier dietary practices if affordable nutritious food is inaccessible. Similarly, health knowledge cannot eliminate difficulties associated with transportation, employment insecurity or inadequate community support.
Health self-reliance must therefore be understood as empowerment supported by an enabling environment.
Health systems, policymakers, local authorities, educational institutions and community organisations share responsibility for ensuring that individuals have realistic opportunities to maintain their health.
What Malaysia should prioritise
To strengthen community-based healthcare for urban low-income populations, Malaysia should consider several priorities.
First, integrate community health navigation into primary healthcare and community outreach initiatives. Navigation support should complement existing services rather than create another disconnected programme.
Second, strengthen inter-professional training and collaboration. Health professionals need opportunities to develop competencies in communication, health literacy, community engagement and coordinated care.
Third, involve communities in programme development. Residents must have meaningful opportunities to identify barriers, propose solutions and evaluate whether interventions meet their needs.
Fourth, measure outcomes beyond programme participation. Evaluation should consider improvements in health understanding, self-management confidence, service utilisation, continuity of care and, where feasible, household well-being.
Finally, develop sustainable partnerships. Universities, healthcare providers, local authorities, non-governmental organisations and community leaders can contribute to models that remain viable beyond short-term research funding.
Good health is more than the absence of disease. It influences an individual's ability to work, care for family members, participate in community activities and maintain economic stability.
For Malaysia's urban B40 communities, strengthening health self-reliance may contribute to improved well-being while supporting more sustainable livelihoods.
However, meaningful progress requires us to recognise that health empowerment cannot occur in isolation from social and economic realities.
HealthNAV represents one research-driven effort to examine how community health navigation and inter-professional collaboration might address these interconnected challenges.
Malaysia should view community health navigation not simply as another health promotion activity but as a potential component of a more inclusive and responsive health system.
DR TAN WOEI LING and DR NOOR HASLIZA CHE SEMAN
Senior Lecturer, Faculty of Nursing, Universiti Malaya
DR NORSYAZMI MOHD
Senior Lecturer, Faculty of Sports and Exercise Science, Universiti Malaya
DR AIDA SYAFINAZ MOKHTAR
Senior Lecturer, Department of Parasitology, Faculty of Medicine, Universiti Malaya
and DR WONG KWOK KHUEN
Medical Consultant, Ministry of Health Malaysia
