1. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 1 Framework for Development of Specialty & Subspecialty Services under 10MP Dr Teng Seng Chong Senior Deputy Director Medical Development Division

2. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 2 Purpose of Paper To outline how we will: build upon the Specialty & Subspecialty Services Development Blueprint for the 9MP build upon the Specialty & Subspecialty Services Development Blueprint for the 9MP in laying the framework for further development under the 10MP in laying the framework for further development under the 10MP

3. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 3 Why do we need this framework Basis for infrastructural planning & development under 10MP Basis for infrastructural planning & development under 10MP New projects, upgrading works, equipmentNew projects, upgrading works, equipment Basis for manpower planning, recruitment, deployment and development Basis for manpower planning, recruitment, deployment and development Appropriate mix and numbers to deliver the services needed by 2015 / 2020Appropriate mix and numbers to deliver the services needed by 2015 / 2020 Basis for resource planning & allocation over next few years Basis for resource planning & allocation over next few years One-offs / Dasar BaruOne-offs / Dasar Baru

4. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 4 Quick Review of Specialty & Subspecialty Services Development 6MP – 8MP

5. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 5 6 th Malaysia Plan (1991-1995) 7 basic secondary level specialty services  General medicine  General surgery  Paediatrics  Obstetrics and Gynaecology  Anaesthesiology  Pathology  Radiology 7 th Malaysia Plan (1996-2000) 15 specialty / subspecialty services The 7 above, plus:  Orthopaedics  ENT  Ophthalmology  Psychiatry  Emergency Medicine  Rehabilitative Medicine  Dermatology  Geriatrics 6 th – 7 th Malaysia Plan (1991-2000)

6. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 6 8 th Malaysia Plan (2001- 2005) Continue with the 15 specialty / subspecialty services:  General medicine  General surgery  Paediatric  Obstetrics and Gynaecology  Anaesthesiology  Orthopaedic  Radiology  Pathology  ENT  Ophthalmology  Psychiatry  Emergency Medicine  Rehabilitative Medicine  Dermatology  Geriatrics TargetsAchievement 19 hospitals identified to provide all 15 secondary specialties. 1 (5.2%) achieved Rest of 18 hospitals provided at least 12 specialties. Geriatrics available in only 1 hospital and rehabilitative medicine in 2 hospitals 45 hospitals identified to provide 5 basic specialties 42 hospitals (95.5%) achieved 8th Malaysia Plan (2001-2005)

7. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 7 9 th Malaysia Plan (2006-2010) Development of resident specialty / subspecialty services reviewed, based on realistic, achievable targetsrealistic, achievable targets equityequity accessibilityaccessibility human resource availabilityhuman resource availability

8. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 8 Guiding Principles 1.Where there are enough specialists / subspecialists in a particular clinical discipline, resident specialist / sub- specialist services will be developed in every state at identified hospitals.

9. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 9 2.Where there are not enough specialists / subspecialists in a particular clinical discipline, resident specialist / subspecialist services will be developed in stages on a regional basis: 6 care-network zones North - Perlis, Kedah, P. Pinang, Northern PerakNorth - Perlis, Kedah, P. Pinang, Northern Perak Central - Southern Perak, Selangor, KL /Putrajaya, N.S Central - Southern Perak, Selangor, KL /Putrajaya, N.S South - Johor, Melaka South - Johor, Melaka East - Kelantan, Trengganu, Pahang East - Kelantan, Trengganu, Pahang Sabah Sabah Sarawak Sarawak Guiding Principles

10. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 10 Guiding Principles 3.Where a particular service is urgently needed but there is no resident specialist / sub-specialist available, such services may be procured from the non-MOH and private sectors on an outsourced, contract, sessional or honorarium basis. The MAC of the respective hospital will identify the need for such procurement and approvals should be obtained from the respective State Health Department / MOH. The MAC of the respective hospital will identify the need for such procurement and approvals should be obtained from the respective State Health Department / MOH. Guiding Principles

11. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 11 4.Relevant training in subspecialty areas shall be given to general specialists to enable them to provide the necessary services in places where there are no sub-specialists, and they will be privileged to do so. Guiding Principles

12. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 12 5. The Blueprint will not preclude flexibility of the MOH to deviate from the general plan in order to accommodate specific needs that may arise from time to time 6.The development of a subspecialty within a specialty or further sub-specialisation within a subspecialty will only be considered when sufficient numbers of specialists or sub-specialists are available in that discipline. Guiding Principles

13. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 13 Specialist Hospitals & InstitutionsNon-Specialist Hospitals HKL+ State Hosp. Major Specialist Hospitals Minor Specialist Hospitals Special Medical Institutions 142120775 Kangar Alor Setar P.Pinang Ipoh Klang HKL Seremban Melaka J.Bahru Kuantan K.T’ganu K.Bahru QE Kuching Sg.Petani Sbg Jaya Taiping T. Intan Kajang Sg.Buloh Selayang Ampang Serdang Putrajaya K. Pilah S.I. Pandan Muar B. Pahat Temerloh Kemaman K. Krai Sandakan Tawau Sibu Miri Kulim Langkawi K.Batas Slim River Sri Manjung Banting P.Dickson Kluang Segamat K.Lipis T.Merah Keningau Lahad Datu Labuan Sri Aman Sarikei Kapit Bintulu Likas (3) B.Mtjam (4) IPR Bahagia Permai Mesra Sentosa PDN PKKN Baling Yan Jitra Sik Kuala Nerang Sg Bakap Balik Pulau Parit Buntar Kuala Kangsar Batu Gajah Kampar Tapah Gerik Selama Cht Melintang Sg Siput K Kubu Baru Tg.Karang S.Bernam Tampin Jelebu Jempol A. Gajah Jasin K. Tinggi Kulai Mersing Tangkak Pontian Pekan Bentong Raub Jerantut Mdzm Shah Jengka Cameron H Dungun Besut H. Trggu Setiu Machang Tumpat Pasir Mas Gua Musang Pasir Puteh Jeli Kudat Kota Belud Papar Beaufort Ranau Tambunan Tenom Beluran Semporna Sipitang Kota Marudu Kinabatangan Kunak K. Penyu Pitas Limbang Serian Lundu Saratok Mukah Kanowit Marudi Lawas Bau Simunjan Betong Daro RCBM Dalat Minimum 15 resident specialties/subspecialties Minimum 6 resident specialties Specific resident specialties Visting specialist services

14. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 14 HospitalsSpecialties State & Major Specialist Hospitals (35) – minimum 15 specialties / sub-sp. Gen Medicine Gen Surgery Pediatrics Orthopedics O&G Anesthesiology Radiology Pathology Opthalmology ENT Emergency Med Psychiatry Dental Dermatology Nephrology Minor Specialist Hospitals (18) - minimum 6 specialties Gen Medicine Gen Surgery Pediatrics Orthopedics O&G Anesthesiology Resident Sp / Sub-sp Services Dev 9MP 13 (37%) 2 (11%)

15. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 15 For the regionalized services, focus will be given to 26 specialty / subspecialty services: 1.RESPIRATORY MED. 2.INFECT. DISEASES 3.RHEUMATOLOGY 4.HEPATOLOGY 5.PALLIATIVE MEDICINE 6.HAEMATOLOGY 7.GASTROENTERO. 8.CARDIOLOGY 9.GERIATRIC 10. NEUROLOGY 11. ENDOCRINOLOGY 12. ONCOLOGY 13.UPPER GI SURG. 14.COLORECTAL SURG. 15.HEPATOBILIARY SURG. 16.BREAST/ ENDOC SURG. 17.VASCULAR SURGERY 18.NEUROSURGERY 19.CARDIOTHORACIC SURG 20.UROLOGY 21.PAEDIATRIC SURGERY 22.PLASTIC SURGERY 23.CARDIAC PERFUSION ANAES. 24.NUCLEAR MEDICINE 25.REHABILITATION MEDICINE 26.FORENSIC MEDICINE Other sub-specializations and areas of competence will continue to be developed. 7 (27%)

16. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 16 Moving Forward to 10MP Continuity of services from previous plans Weak areas that need strengthening New needs based on available data, considering: Disease burden Aging population Epidemiologic transition Probability of achieving success, considering: Resources available, including manpower Health technology available Political interest and support New facilities coming on-stream

17. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 17 HKL & State Hospitals Major Specialist Hospitals Minor Specialist Hospitals Non- specialist hospitals Inst RMK-914 Hosp21 Hosp20 Hosp75 Hosp7 Inst RMK-1014 Hosp25 Hosp22 Hosp73 Hosp10 Inst New Additions NilSegamat Bintulu Kulim Shah Alam K Kangsar Bentong Limbang Kota Tinggi K K Bharu Rompin Bera Tuaran NCI Rehab Hosp W&C Hosp A total of 144 Hospitals and Institutions under RMK-10 Expected Functional Facilities, 10MP

18. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 18 Specialist Hospitals & InstitutionsNon-Specialist Hospitals HKL+ State Hosp. Major Specialist Hospitals Minor Specialist Hospitals Special Medical Institutions 1425221073 Kangar Alor Setar P.Pinang Ipoh Klang HKL Seremban Melaka J.Bahru Kuantan K.T’ganu K.Bahru QE Kuching Sg.Petani Kulim Sbg Jaya Taiping T. Intan Kajang Sg.Buloh Selayang Ampang Serdang Shah Alam Putrajaya K. Pilah S.I. Pandan Muar B. Pahat Segamat Temerloh K. Krai Kemaman Sandakan Tawau Sibu Miri Bintulu Langkawi K.Batas Slim River Sri Manjung K.Kangsar Banting K Kubu Baru P.Dickson Kluang K. Tinggi K.Lipis Bentong T.Merah Keningau Lahad Datu Labuan Sri Aman Sarikei Kapit Limbang Likas (3) B.Mtjam (4) IPR Bahagia Permai Mesra Sentosa PDN PKKN Rehab Hosp NCI W&C Hosp Baling Yan Jitra Sik Kuala Nerang Sg Bakap Balik Pulau Parit Buntar Batu Gajah Kampar Tapah Gerik Selama Cht Melintang Sg Siput Tg.Karang S.Bernam Tampin Jelebu Jempol A. Gajah Jasin Kulai Mersing Tangkak Pontian Pekan Raub Jerantut Mdzm Shah Jengka Cameron H Rompin Bera Dungun Besut H. Trggu Setiu Machang Tumpat Pasir Mas Gua Musang Pasir Puteh Jeli Kudat Kota Belud Papar Beaufort Ranau Tambunan Tenom Beluran Semporna Sipitang Kota Marudu Kinabatangan Kunak K. Penyu Pitas Tuaran Serian Lundu Saratok Mukah Kanowit Marudi Lawas Bau Simunjan Betong Daro RCBM Dalat Minimum 33 / 18 resident specialty / subspecialties Minimum 9 resident specialties Specific resident specialties Visting specialist services

19. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 19 12 hospitals planned in RMK-9, pushed to RMK-10 due to lack of funds Hospital Bachok Hospital Pendang Hospital Rembau Hospital Padang Besar Hospital Sri Iskandar Hospital Bera Hospital Petrajaya Hospital Kinarut Hospital Tuaran (Phase 2) Hospital Rompin Hospital Kota Samarahan Hospital Kuala Selangor Hospitals, expected under construction 10 MP

20. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 20 RegionalState Hospitals & HKL Major Specialist Hospitals Minor Specialist Hospitals Institu- tions RMK-926 services 15 services 6 servicesSpecific services RMK-1030 services 33 services 18 services 9 servicesSpecific services Minimum under RMK-10 One hosp/ zone TBD Specific services

21. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 21 Minor Specialist Hospitals (22) Major Specialist Hospitals (25) Min: 9 spMin: 18 sp / subsp 1. Gen Medicine 2. Gen Surgery 3. Pediatrics 4. Orthopedics 5. O&G 6. Emergency Medicine 7. Anesthesiology 8. Radiology 9. Clinical Pathology 1. Gen Medicine 2. Gen Surgery 3. Pediatrics 4. Orthopedics 5. O&G 6. Emergency Medicine 7. Anesthesiology 8. Radiology 9. Clinical Pathology 10. Opthalmology 11. ENT 12. Psychiatry 13. Dermatology 14. Oral Surgery 15. Pediatric Dental 16. Nephrology 17. Maternal Foetal (O&G) 18. Neonatology Development of Services

22. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 22 State Hospitals &HKL (14) Min: 33 sp / subsp 1. Gen Medicine 2. Gen Surgery 3. Pediatrics 4. Orthopedics 5. O&G 6. Emergency Medicine 7. Anesthesiology 8. Radiology 9. Anatomical Pathology 10. Clinical Pathology 11. Opthalmology 12. ENT 13. Psychiatry 14. Dermatology 15. Rehab Medicine 16. Neurosurgery 17. Plastic Surgery 18. Forensic Med 19. Oral Surgery 20. Pediatric Dental 21. Nephrology 22. Resp Medicine 23. Gastroenterology 24. Urology 25. Paed Surgery 26. Maternal Foetal (O&G) 27. Spine (Ortho) 28. Joint arthroplasty 29. Adult Intensive Care 30. Paed Intensive Care 31. Neonatology 32. Vitreo-Retinal (Opth) 33. Glaucoma Development of Services

23. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 23 Regional Services(30 sp / subsp) Min: 1 hosp / zone 1. Infectious Diseases 2. Rheumatology 3. Hepatology 4. Palliative Medicine 5. Hematology (Med) 6. Cardiology 7. Geriatrics 8. Neurology 9. Endocrinology 10. Oncology 11. Hepatobiliary Surg 12. Breast & Endo Surg 13. Vascular Surgery 14. Cardiothoracic Surg 15. Reproductive Med 16. Gynae-Oncology 17. Uro-Gynaecology 18. Sports Med 19. Paed Cardiology 20. Paed Endocrinology 21. Paed Haem / Onco 22. Paed Nephrology 23. Paed Neurology 24. Genetics 25. Cardiac Anes & Perf 26. Nuclear Medicine 27. Interventional Radio 28. Oral Path / Med 29. Forensic Dental 30. Dental Special Care Development of Services

24. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 24 RMK-9 RMK-10 1. Cardiology services 2. Cardiothoracic surgery 3. Intensive care services 4. Emergency services 5. Oncology & Radiotherapy 6. Ambulatory care 7. Neurosurgery 8. Neonatal/perinatal diseases 9. Rehabilitation medicine 10. Infectious diseases 11. Mental Health 1. Cardiothoracic surgery 2. Cardiology services 3. Intensive care services 4. Emergency care services 5. Oncology & Radiotherapy 6. Ambulatory care services 7. Trauma care 8. Stroke management 24 Key Areas for secondary & tertiary care

25. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 25 Case mix Pilot project in 6 hospitals, scheduled 2009-2010 Roll out to other hospitals during RMK- 10 Medical records Electronic medical records (digitization) Medical records centre Information technology

26. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 26 1. 1. HIS of 12 hospitals Upgrade and maintenance 2. 2. SPPD Upgrade identified hospitals 3. 3. SPP Upgrade at 4 identified hospitals Expansion of SPP 4. 4. New system Pharmacy Information system Lab Information system Radiology Information system Blood Bank Information System 26 Information Technology

27. What next? Briefing to states Briefing to states explain framework to State / Hosp directors and state technical advisorsexplain framework to State / Hosp directors and state technical advisors Ketua-Ketua Unit at CPPP, BPP Ketua-Ketua Unit at CPPP, BPP Workshops / discussions on priority areas, e.g. Trauma, Ambulatory Care – dev plans of actionWorkshops / discussions on priority areas, e.g. Trauma, Ambulatory Care – dev plans of action Identify physical projects for RMK-10 – input to state / hosp directorsIdentify physical projects for RMK-10 – input to state / hosp directors Program write-ups for RMK-10Program write-ups for RMK-10 Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 27

28. What next? National Tech Advisors National Tech Advisors Decide which hosp for regionalised services – input to states thru BPPDecide which hosp for regionalised services – input to states thru BPP Discuss with state tech advisors: nature of infrastructure, equipment & resources needed – input to state/hosp directorsDiscuss with state tech advisors: nature of infrastructure, equipment & resources needed – input to state/hosp directors Caw Pemb Profesion, Nursing, Allied Hlth Caw Pemb Profesion, Nursing, Allied Hlth Work out manpower needs, training priorities, and deploymentWork out manpower needs, training priorities, and deployment Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 28

29. What next? State / Hospital Directors State / Hospital Directors Conduct echo-briefing in stateConduct echo-briefing in state confer with state tech advisorsconfer with state tech advisors Determine capacity of identified hosp for expected roles – feedback to BPPDetermine capacity of identified hosp for expected roles – feedback to BPP plan & propose projects under RMK-10 – project write-ups.plan & propose projects under RMK-10 – project write-ups. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 29

30. Taklimat Kpd JKN / Hosp, Putrajaya, 30.7.09 30 Thank you