Health and development are inextricably linked. Countries require robust health systems to enable the delivery of quality health services and to ensure access to health as a public good while both balancing national budgets and providing protection against individual catastrophic spending on healthcare. Getting this balance right remains a problem for most countries and particularly in resource-poor settings.
The need to focus on the structure of health systems was first promoted globally through the 1978 Alma Ata Declaration. The Declaration called for a comprehensive primary health care system that would link communities with health services through a system of close to client services, relieving the pressure from poorly resourced, over-used tertiary facilities, and increasing preventative strategies. For most low-income countries, the adoption of this comprehensive strategy was derailed by development funding for selective primary health care programs, focusing on identified priority diseases. Other strategies attempted health sector reform through a range of financing mechanisms. The culmination of the last 40 years of health systems development is the promotion of Universal Health Coverage as a values-based system, that attempts to combine equity and universal access, with contextual realities of national budgets.
This series of country case studies is an attempt to explore and analyse how low and middle-income countries have navigated the complexities of health systems development. The purpose is to highlight critical lessons for South-South learning that acknowledge the similarities and differences in the historical, political, social, economic and cultural contexts of countries in Asia and Africa.
Malaysia is selected for the first (index) case study, acknowledged as one of the few middle-income countries in the region that has achieved significant progress in health outcomes and to a large extent, to have achieved universal health coverage. Since its independence in 1957, Malaysia has progressed from low-income status, with the concomitant poor health outcomes, to near high-income status and a health profile that rivals many, including high-income countries. This achievement reflects a combination of strategic decisions both within the health system and other sectors that link health to other areas of economic development. This book presents a critical analysis of the development of the health system in Malaysia using systems thinking approach to explore interactions between the health system building blocks and contextual factors that have influenced its development. The book provides a candid discussion, using systems perspectives to understand historical events that have catalysed decisions resulting in the current Malaysian health system – one with strong foundations to address current global health challenges.