Management of Diabetes in Malaysia:Issues & Challenges

Hilmi YahayaDeputy Minister of Health, Malaysia

International Diabetes Leadership Forum15 November 2013

Istanbul, Turkey]

Ministry of Health Malaysia

Population of Malaysia

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• 2000: 23.3 mil• 2010: 28.3 mil• Life expectancy:

• Total pop : 70.83 (2000), 73.79 (2011).• Male: 71.05• Female: 76.73

• Average annual population growth • 1996 to 2000: 2.65%• 2000 to2010: 2.0%

• Fertility rate :• 2000: 3%• 2010: 2.6%

• .

Burden of Diabetes in Malaysia: Trends & Projections by 2020 (Adults age 18 years and above)

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Sources: NHMS I (1986), NHMS II (1996), NHMS III (2006) and NHMS 2011

National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2010-2014

• Presented and approved by the Cabinet on 17 December 2010.• Provides the framework for strengthening NCD prevention & control

program in Malaysia.• Adopts the “whole-of-government” and “whole-of-society approach”.• Diabetes & obesity are used as the entry points.

Seven Strategies:1. Prevention and Promotion

2. Clinical Management

3. Increasing Patient Compliance

4. Action with NGOs, Professional

Bodies & Other Stakeholders

5. Monitoring, Research and

Surveillance

6. Capacity Building

7. Policy and Regulatory

interventions

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Strengthening Chronic Disease Management at the primary care level

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MANAGEMENT OF NCD (Including Diabetes): 7 BASIC PRINCIPLES TO BE INTRODUCED AT THE COMMUNITY LEVELS (KOSPEN with KEMAS)

1. SCREENING2. REGISTER3. CLINICAL MANAGEMENT4. COMPLICATIONS5. REHABILITATION6. DEFAULTER TRACING7. SELFCARE – Patient’s empowerment

Initiatives to Improve Clinical Outcome:• The formation of Diabetes Team which consists of Diabetic Educator, Medical Officer,

Family Medicine Specialist (FMS), Nutritionist and Pharmacist in every clinic as appropriate to their burden of diabetes patients.

• FMS or senior Medical Officer in the clinic to do regular audits on green book.• Intensify and more frequent supervision especially by FMS of clinical staff to ensure

compliance to CPGs and related guidelines.

• Regular training and CMEs on diabetes care for all clinic staffs, and the state office to monitor the numbers of training sessions conducted.

• Availability of module for health education for patients and a set of pre- and post-test for patients, as published by Disease Control Division, MOH.

• The usage of the Diabetes Conversation Map.

• Further development of a Peer Support Group.

• Personalized care by Medical Officer in clinics with low to moderate burden of loads, as appropriate in the individual clinic settings.

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National Diabetes Registry

• Web-based application.• Went live on 1 January 2011.• Supports the implementation of the

annual “Diabetes Clinical Audit” and the “Diabetes Quality Assurance Programme” amongst Type 2 Diabetes patients in MOH Health Clinics.

• First report, “NDR Report, Volume 1, 2009-2012” was published in August 2013, available at the MOH website http://www.moh.gov.my/v/NCDs.

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Challenges:1. The prevalence of diabetes has increased 31.0% in 5 years,

from 11.6% in 2006 to the current 15.2%.• Mostly contributed by increase of “undiagnosed”.• Increase in prevalence occurring across all age-groups.

2. Increasing challenge in providing satisfactory quality of care to patients with diabetes.• Number of patients in MOH health clinics will continue to

increase.• Referrals for specialists management will also continue to

increase due to late diagnosis and sub-optimal control.• Need to address “patient-related factors” i.e. patient

empowerment. 9

Challenges for Malaysia

3. The main challenge in policy and regulatory interventions remain that they are mostly under the responsibilities of ministries and departments other than Ministry of Health• Ministry of Health needs to take leadership role.• Need to find a win-win solution – “mutuality of interest”.• Economic and “political” consideration remains paramount and

needs to be acknowledged.• For Malaysia, the establishment of the Cabinet Committee was

an important initial step to achieve the “whole-of-government approach”.

• The health sector needs to play a strong advocacy role.10

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Thank you