COVID-19: Primary Health Care Initiatives in Malaysia

As COVID-19 spread worldwide, the importance of early action to reduce transmission became more and more clear. In Malaysia, the Ministry of Health initiated its preparedness plan on January 7, a full two weeks before the first case was reported in the country, and well ahead of the WHO declaring a pandemic. The government imposed a strict Movement Control Order (MCO) to slow the spread, which, while effective, created significant challenges for both the health and economic sectors. 

The Ministry of Health of Malaysia led a rapid, coordinated effort to adapt the entire health sector in response to the COVID-19 pandemic and the MCO, particularly at the primary care level. These adaptations were intended to ensure adequate resourcing for the pandemic response effort while continuing essential health services and protecting the safety and well-being of both patients and providers. Much of this was made possible by the country’s early investment in and commitment to building a strong and coordinated primary health care system.  

At the facility level, new triage and screening practices were implemented to reduce possible transmission of COVID-19 between patients. Waiting areas were organized such that patients with respiratory symptoms were kept separate from other patients, and all waiting areas were equipped with sanitary equipment and arranged according to social distancing best practices. Facilities with low patient volume re-deployed their staff to higher-volume facilities to help manage the influx of patients. 

A key element of the MOH’s efforts to promote the continued utilization of services while maintaining social distancing was a series of new and adapted initiatives that allowed people to seek information, medicines, and routine care through low- or no-contact means. The MOH quickly established a Virtual Health Advisory through which patients with symptoms or even just concerns could access rapid, credible information. Through a collaboration with a private-sector, online medical consultation company, the MOH established a custom web portal that allowed patients to engage in free audio, video, or text chats with family medicine specialists. In another private-sector partnership, the MOH implemented a new, online appointment system for public health clinic visits, significantly reducing in-clinic wait times and allowing people to schedule visits according to their availability. 

The MOH also initiated five virtual public health clinics, which they plan to expand to an additional 35 sites during the pandemic. These clinics reduce the need for travel to health facilities, while also making care more accessible and cheaper to provide. 

Promoting access to medicines while maintaining social distancing is a crucial component of reducing the overall burden of the pandemic. Without adequate access to pharmaceuticals, we would be sure to see a surge in morbidity and mortality due to non-communicable diseases and infectious diseases unrelated to COVID-19. To mitigate this, the MOH instituted or expanded a number of services to safeguard access to pharmaceuticals without the need for patients to travel to clinics. Patients can now access their prescriptions via mail, contactless pickup lockers, and drive-thru pharmacies. The expansion of the Integrated Drug Distribution System and pharmacy appointment systems allow patients to plan their pickups at a time and location most convenient to them, reducing the need to travel and wait to collect their prescriptions. 

Unfortunately, there have been a number of health services offered at the country’s public health facilities that have been reprioritized and thus deferred during the pandemic. The majority of these services are group-based, including health camps, cooking demonstrations, and health education activities, which would have caused difficulty in practicing social distancing. Counseling, rehabilitation, and in-person health screenings have all been deferred as well. While these are all considered important health services, this unprecedented situation necessitated difficult decisions that prioritized patient and provider safety, while ensuring that resources are directed where they are needed most. 

Despite these efforts, Malaysia was hard hit over the first few months of the COVID-19 pandemic. A large, dense, and mobile population made containment immensely difficult. The relative success of the Malaysian MOH at limiting COVID-19 cases and deaths and achieving steady improvement was due to the Ministry’s swift mobilization of the health sector, which would not have been possible without the strong foundation of PHC that Malaysia has worked hard to build over the years. 

Click here to read the full report on the Malaysian MOH’s response to the COVID-19 crisis.