ABOUT

ABOUT SARAWAK HEALTH DEPARTMENT

INTRODUCTION

The health services provided by the Sarawak Health Department are delivered through a network of static and mobile facilities that provide promotive, preventive, curative and rehabilitative care.

VISION

Sarawak Health Department is committed towards realising the Vision of Health for Malaysia that "by the year 2020, Malaysia is to be a nation of healthy individuals, families and communities, through developing a health system that is equitable, affordable, efficient, technologically appropriate and consumer-friendly, with emphasis on quality, innovation, health promotion and respect for human dignity, and which promotes individual responsibility and community participation towards an enhanced quality of life".

STRATEGIES

The strategies to achieve these objectives are based on the basic principles of health promotion, prevention of disease, early treatment/referral and rehabilitation.

These strategies are implemented under the Medical Care (Hospital), Public Health, Dental and Pharmacy Programmes. The technical programmes are supported by the Management Programme.

ORGANISATION

Sarawak Health Department is organised into three levels. They are as follows:

State-level

The State Director of Health is assisted by five Deputy Directors who are in charge of Public Health, Medical Care, Dental, Pharmacy and Management programmes respectively. The main functions of the State-level management team are:

  • Policy-making and planning
  • Development of programmes and facilities (identification/introduction and implementation of new programmes;)
  • Acquisition and deployment of resources: manpower, financial, equipment;
  • Setting quality standards and targets;
  • Provision of technical advice to peripheral units and other agencies;
  • Monitoring and evaluation of existing programmes; and
  • Training
  • Planning for upgrading of or new facilities and services

Divisional-level

Sarawak is divided into eleven administrative Divisions. Each Divisional-level management team comprises a Divisional Health Officer, Divisional Dental Officer, Divisional Pharmacist and a Hospital Director. The main functions of the management team at this level are:

  • Implementation and monitoring of all programmes;
  • Monitoring of quality standards;
  • Assisting in the identification and introduction of new programmes; and
  • Training.
  • Planning for upgrading of or new facilities and services

District-level

Each Division is further divided into administrative districts. The management team at this level comprises the District Health Officer, District Dental Officer and a Hospital Director and their respective sectional heads. Their main functions are to:

  • Implement and monitor health programmes at district level;
  • Ensure that quality standards are maintained;
  • Identify and implement quality improvement projects; and
  • Training
  • Planning for upgrading of or new facilities and services

All hospitals are headed by a Hospital Director. Except for Sarawak General Hospital, Kuching, and two special institutions (a mental hospital and a leprosorium), that are directly responsible to the State Health Office, all other hospitals are responsible to their respective Divisional Health Officers.

HUMAN RESOURCE

As of 31 December 2001, 10,062 (82%) out of 12,236 posts in the Department were filled. Of the filled posts, only about 6% are in the professional group, while the rest are allied health professionals and other support staff. There are about 773 medical officer posts in Sarawak but only about 54.3% of them are filled. In 2001, the doctor:population ratio was 1:2,838 ; the dental officer:population ratio was 1:16,668; the nurse:population ratio was 1:1,1081 ; the medical assistant:population ratio was 1:2,695 ; and the community nurse and midwife:population ratio was 1:1,244

FINANCE

The State's operating expenditure for health care has been increasing steadily from RM239 million in 1995 to RM472 million in 2001. Almost 65% of the allocation is utilised by the Medical Care Programme and about 25%, by the Public Health Programme. About half of the total allocation is for emoluments.

HEALTH SERVICE DELIVERY SYSTEM

Sarawak Health Department provides health services through a network of 290 health facilities located throughout the State. In urban areas, the static facilities comprise hospitals(21), polyclinics(12), outpatient clinics (12), maternal and child health clinics(23) and dental clinics(28). Health centers(173) and community clinics(21) serve the rural communities.

These static facilities cover about 70% of the population but mobile units like Village Health Teams and the Flying Doctor Service have increased access to almost 90%. The rural facilities alone cover about 680,000 people, while the Flying Doctor Service serves around 70,000 people. In addition, the Sarawak Health Department has also introduced a village health volunteer scheme known as the Village Health Promoter Programme, to enable basic health care to be provided to remote areas on a more continual basis.

Sarawak has a two-tier referral system where cases requiring further treatment are referred from clinics to hospitals. Only those who need specialist care are referred to specialist clinics in the larger hospitals.

The type of health facility in an area depends on the size of the population to be served.

Hospitals

There are three types of hospitals in the Sarawak. The district hospitals without specialists are the smallest and are managed by medical officers. Next are district hospitals with specialists (previously known as divisional hospitals) The Sarawak General Hospital in Kuching is a referral centre for the State as it is able to provide subspeciality services.

Polyclinics

These are large urban clinics managed by medical officers. They provide general out-patient care, maternal and child care and dental care. In addition, they also provide laboratory and radiological services. Larger polyclinics are managed by Family Medicine Specialists.

Rural Health Centres

Sarawak has 194 rural health clinics that function as "one-stop" family health centres, providing an integrated service comprising maternal & child care, general outpatient care and environmental sanitation. All clinics have rest beds and birthing facilities to encourage safe delivery among rural mothers. Community clinics are smaller versions of health centres and serve between 1,500 - 3,000 people. Except for a few larger clinics with medical officers, all rural health facilities are managed by allied health personnel.

Mobile Health Services

In addition to static facilities,Sarawak Health Department also has mobile clinics in the form of Village Health Teams and Flying Doctor Service, to serve people in less accessible areas. These teams either travel by road, river, on foot or by helicopter, depending on the accessibility of the areas they serve. In rural areas, Village Health Teams are based in rural health centres, while those serving peri-urban areas, are based at the Divisional or District Health Offices.

Flying Doctor Service

The Flying Doctor Service was introduced in 1973 to provide basic health services to people living in remote areas. The service operates 3 helicopters that are rented under a contract with a private company. The helicopters are based in Kuching, Sibu and Miri and together, they cover 175 locations throughout the State with a population of about 70,000. The Flying Doctor team comprises a medical officer, a medical assistant and two community nurses who visit the locations once a month or once in two months.

Village Health Promoter Programme

As the mobile health teams can only visit remote villages once a month, Sarawak Health Department introduced a village health volunteer programme to provide basic health care to these communities on a more continual basis.

Under this programme, two volunteers from each participating village are given three weeks' training on a fairly wide-range of health-related topics. Upon returning to their respective villages, these volunteers give first aid, do health promotion, make blood slides for detection of malaria parasites and sputum slides for detection of tuberculosis. The volunteers give regular feedback on their activities, and are regularly supervised by staff from the Sarawak Health Department.

The Village Health Promoter (VHP)programme started in 1981 and up till the end of 2001, there were 2,956 VHP throughout the State, serving a total of 271,182 people from 1,664 villages.

"Home-based" Health Records

Another unique feature in the Sarawak Health Service is the use of "home-based" medical records. The system was introduced in the 1970's for the child-health card, the 1980's for the antenatal card and in 1992, for the outpatient card. The main advantage of this system is that it ensures continuity of care for the patient, especially in children, where immunisation records are concerned.

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e-mail us at shd@sarawak.health.gov.my