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Awang S, Agins B, Mohd Ujang IR, Narayanan DN, Zulkifli NW, Hamidi N. Development of the National Policy for Quality in Healthcare for Malaysia. Health Res Policy Syst 2023; 21:119. [PMID: 37964336 PMCID: PMC10644427 DOI: 10.1186/s12961-023-01063-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Quality in healthcare is a fundamental pillar of health systems performance, leading to improved health outcomes and reduced waste. The World Health Organization recommends that countries establish a national quality policy and strategy (NQPS) to steer the provision of safe and high-performing healthcare services and foster a quality culture. This paper describes the development process and key content of Malaysia's new 5-year National Policy for Quality in Healthcare. METHODS The development process was managed by a technical working group led by the Institute for Health Systems Research in the Ministry of Health. Situational analysis was conducted through a multi-pronged approach, underpinned by a review of the past and present healthcare sectoral and quality plans and guided by the WHO NQPS framework. This approach involved: (i) review of quality-related policy documents, (ii) online surveys of healthcare providers and the public, (iii) key-informant facilitated discussions and (iv) mapping of existing quality improvement initiatives (QIIs). Data gathered from these approaches informed the content of the new policy. Following thematic analysis, the findings were grouped into specific domains, which were then organized into a strengths, weaknesses, opportunities, and threats (SWOT) framework. RESULTS Ten key areas of concern identified were (i) a people-centred holistic approach, (ii) governance for quality, (iii) resources, (iv) quality culture, (v) stakeholder engagement, (vi) health management information system, (vii) workforce competency, (viii) knowledge exchange, (ix) quality indicators and (x) monitoring and evaluation of quality activities. These led to the formulation of seven strategic priorities for the planning of improvements aimed at addressing the key areas of concern. The national definition of quality was affirmed. A total of 40 QIIs were mapped and grouped into three broad categories, namely (i) regulatory, (ii) domain-specific QIIs and (iii) Quality Improvement (QI) method. CONCLUSIONS The National Policy for Quality in Healthcare for Malaysia was developed through a comprehensive situational analysis using a multi-method approach that identified priorities across national, state, institutional and community levels. This evidence-informed approach led to meaningful contextual adaptation of the NQPS framework to shape the strategic direction to advance quality and achieve effective and safe outcomes for all Malaysians.
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Affiliation(s)
- Samsiah Awang
- Centre for Healthcare Quality Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Setia Alam, 40170, Shah Alam, Selangor, Malaysia.
| | - Bruce Agins
- Institute for Global Health Sciences, Division of Epidemiology, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA
| | - Izzatur Rahmi Mohd Ujang
- Centre for Healthcare Quality Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Divya Nair Narayanan
- Centre for Healthcare Quality Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
| | - Nur Wahida Zulkifli
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, FF1, Level 11, Bandar Puncak Alam, 42300 Puncak Alam, Selangor, Malaysia
| | - Normaizira Hamidi
- Centre for Healthcare Quality Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Block B2, NIH Complex, No. 1, Jalan Setia Murni U13/52, Setia Alam, 40170, Shah Alam, Selangor, Malaysia
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Mohd Ujang IR, Hamidi N, Ab Hamid J, Awang S, Zulkifli NW, Supadi R, Mohamed NE, Sooryanarayana R. The COVID-19 pandemic and disruptions to maternal and child health services in public primary care Malaysia: a retrospective time-series analysis. BMJ Glob Health 2023; 8:e013397. [PMID: 37949498 PMCID: PMC10649372 DOI: 10.1136/bmjgh-2023-013397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This study aimed to assess the impact of the COVID-19 pandemic on the utilisation of MCH services in Malaysian public primary care. METHODS A retrospective analysis was conducted using national administrative data from 1124 public primary care clinics. Eight indicators were selected to measure service utilisation covering antenatal, postnatal, women's health, child health, and immunisation services. Interrupted time-series analysis was used to evaluate changes in levels and trends of indicators during four different periods: pre-pandemic (January 2019-February 2020), during pandemic and first lockdown (March-May 2020), after the first lockdown was lifted (June-December 2020) and after the second lockdown was implemented (January-June 2021). RESULTS Most indicators showed no significant trend in monthly utilisation prior to the pandemic. The onset of the pandemic and first lockdown implementation were associated with significant decreasing trends in child health (-19.23%), women's health (-10.12%), antenatal care (-8.10%), contraception (-6.50%), postnatal care (-4.85%) and postnatal care 1-week (-3.52%) indicators. These indicators showed varying degrees of recovery after the first lockdown was lifted. The implementation of the second lockdown caused transient reduction ranging from -11.29% to -25.92% in women's health, contraception, child and two postnatal indicators, but no sustained reducing trend was seen afterwards. Two immunisation indicators appeared unaffected throughout the study period. CONCLUSION The COVID-19 pandemic significantly impacted MCH services utilisation in Malaysia. While most MCH services were negatively affected by the lockdown implementation with varying degrees of recovery, infant immunisation showed resilience throughout. This highlights the need for a targeted preparedness plan to ensure the resilience of MCH services in future crises.
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Affiliation(s)
- Izzatur Rahmi Mohd Ujang
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Normaizira Hamidi
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Jabrullah Ab Hamid
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Samsiah Awang
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | | | - Roslina Supadi
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Nur Ezdiani Mohamed
- Centre for Healthcare Quality Research, Institute for Health Systems Research, Ministry of Health, Shah Alam, Malaysia
| | - Rajini Sooryanarayana
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
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Muhamad NA, Abdullah NA, Ujang N, Elias A, Ho JJ, Awang S. Community based interventions for reducing dengue incidence. Hippokratia 2016. [DOI: 10.1002/14651858.cd010184.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nor Asiah Muhamad
- Ministry of Health Malaysia; Disease Control Division; Putrajaya Malaysia 62590
| | - Nor Aini Abdullah
- Institute for Medical Research; Jalan Pahang Kuala Lumpur Malaysia 50588
| | - Noorhaida Ujang
- Institute for Health Systems Research; Jalan Rumah Sakit Bangsar Kuala Lumpur Malaysia 59000
| | - Anza Elias
- Institute for Medical Research; Jalan Pahang Kuala Lumpur Malaysia 50588
| | - Jacqueline J Ho
- Penang Medical College; Department of Paediatrics; 4 Sepoy Lines Penang Malaysia 10450
| | - Samsiah Awang
- Institute for Health Systems Research; Jalan Rumah Sakit Bangsar Kuala Lumpur Malaysia 59000
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Regunath K, Awang S, Siti SB, Premananda MR, Tan WM, Haron RH. Penetrating injury to the head: case reviews. Med J Malaysia 2012; 67:622-624. [PMID: 23770960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Penetrating injury to the head is considered a form of severe traumatic brain injury. Although uncommon, most neurosurgical centres would have experienced treating patients with such an injury. Despite the presence of well written guidelines for managing these cases, surgical treatment requires an individualized approach tailored to the situation at hand. We describe a collection of three cases of non-missile penetrating head injury which were managed in two main Neurosurgical centres within Malaysia and the unique management approaches for each of these cases.
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Affiliation(s)
- K Regunath
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan Malaysia.
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Idris Z, Ghani ARI, Idris B, Muzaimi M, Awang S, Pal HK, Abdullah JM. Neuronavigation-Guided Endoscopic Management of a Pineal Region Tumour with Obscured Floor of the Third Ventricle: Case Report. ACTA ACUST UNITED AC 2011; 54:125-7. [DOI: 10.1055/s-0031-1277198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ghani ARI, Ariff AR, Romzi AR, Sayuthi S, Hasnan J, Kaur G, Awang S, Zamzuri I, Ghazali MM, Abdullah J. Giant nerve sheath tumour: report of six cases. Clin Neurol Neurosurg 2005; 107:318-24. [PMID: 15885392 DOI: 10.1016/j.clineuro.2004.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 06/02/2004] [Accepted: 07/07/2004] [Indexed: 10/26/2022]
Abstract
Giant nerve sheath tumour is a rare tumour originating from the nerve sheath. It differs from the conventional nerve sheath tumour only by the size these tumours can reach. There are two main type of tumours that occur in the nerve sheath which include neurofibroma and schwannoma. The current views are that schwannomas arise from the progenitor of the schwann cell. Whereas the neurofibroma series probably arise from a mesenchymal origin closer to a fibroblast. We report on six cases of nerve sheath tumour that occur in the spinal and paraspinal region that presented to us over a 5 year period.
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Affiliation(s)
- A R I Ghani
- Department of Neurosciences, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Abdullah J, Zamzuri I, Awang S, Sayuthi S, Ghani A, Tahir A, Naing NN. Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy. Acta Neurochir Suppl 2005; 95:311-4. [PMID: 16463872 DOI: 10.1007/3-211-32318-x_64] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.2 ml) made into a double lumen intraventricular balloon catheter. The objective of this study was thus to determine the effectiveness of the decompressive craniectomy done on the worst brain site with regard to compliance (Cl), pressure volume index (PVI), jugular oximetry (SjVo2), autoregulation abnormalties, brain tissue oxygen (TiO2) and cerebral blood flow (CBF). This is a prospective cohort study of 17 patients who were enrolled after consent and approval of the ethics committee between the beginning of the year 2001 and end of the year 2002. For pre and post assessment on compliance and PVI, all 12 patients who survived were reported to become normal after decompressive craniectomy. There is no significant association between pre and post craniectomy assessment in jugular oxymetry (p > 0.05), autoregulation (p > 0.05), intracranial brain oxymetry (p = 0.125) and cerebral blood flow (p = 0.375). Compliance and PVI improved dramatically in all alive patients who received decompressive craniectomy. Compliance and PVI monitoring may be crucial in improving the outcome of severe head injured patients after decompressive craniectomy.
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Affiliation(s)
- J Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
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