FROM TRADITION TOWARDS PROFESSIONALISM
The role of the Ministry of Health in Traditional & Complementary Medicine
Text for Keynote Address by Datuk Dr. Noor Hisham Bin Abdullah,
Director General of Health Malaysia
Thank you Ms Chairperson. A very good morning to our distinguished speakers, honoured guests, ladies and gentlemen. I am pleased to be here to deliver this Keynote Address at the 8thIntracom titled ‘FROM TRADITION TOWARDS PROFESSIONALISM: The role of the Ministry of Health in Traditional & Complementary Medicine’
I would now like to take you on a brief journey to look back upon the origins of Traditional & Complementary medicine (also known as T&CM) in Malaysia.
As the pictures indicate, there has been a change in the nation’s landscape from the time of the Malacca Sultanate, to the colonial edifices that dot our countryside; and the modern skyscrapers that embody the progress this country has made since Independence more than a half a century ago.
Prior to the 15th century, Indigenous/ traditional native medicine practised by Orang Asli of the Malay Peninsula (Negrito, Senoi and Proto-Malays) and Pribumi of Sabah and Sarawak. During this period, traditional Malay medicine was strongly influenced by the cultures from the Indian sub-continent.
From the 15th century onwards, Islam was introduced by traders and missionaries from India and Arab who came to Malacca, the maritime empire. Islam influenced the traditional medicinal system, with the incorporation of recitation of verses from the Quran. Moving forward to the 19th century, Traditional Chinese medicine began to make its presence felt in the country when the Chinese population increased rapidly in Penang and Singapore. Traditional Indian Medicine commenced at the same time, introduced by traders from India. Modern medicine was also introduced by the colonial British during this period.
From the 20th century onwards, to where we are today, modern medicine is the mainstream practice in Malaysia with Traditional & Complementary Medicine (T&CM) treatment available to complement it. T&CM in Malaysia has evolved over centuries. Despite advances in science and technology, Malaysians are ever mindful of their heritage; a common thread for example would be traditional postnatal care that cuts across all major ethnic groups in that it differs in style, not substance.
These are some of the milestones in the initial phase of the chronology of T&CM via the efforts of the Ministry of Health (MOH) Malaysia:
i. Formation of T&CM Unit under the Family Health Development Division, MOH in 1996
ii. Establishment of T&CM Standing Committee which is the precursor of the soon to be established T&CM Council, in 1998
iii. Formation of 5 T&CM umbrella bodies in 1999
iiii. Launch of the Herbal Medicine Research Centre in 2000
v. Launch of the National Policy on T&CM in 2001, updated in 2007
vi. Establishment of the Global Information Hub and National Committee in R&D on Herbal Medicine in 2002
vii. Establishment of the T&CM Division in MOH in 2004
viii. Establishment of the 1st T&CM unit in at a public health care facility at Kepala Batas Hospital, Penang in 2007
Our National Policy on T&CM, which was formulated in 2001 and updated in 2007, states that Traditional & Complementary Medicine system shall be an important component of the health care system. It will co-exist with modern medicine and contribute towards enhancing the health and quality of life of all Malaysians.Our vision is the optimal integration of T&CM into the Malaysian health care system to achieve a holistic approach towards enhancing health and the quality of life. We also aim to ensure quality and safe use of T&CM practices and products to attain optimal potential in health care delivery.
The 4 main thrusts of our National Policy on T&CM cover the following areas:
ii. Education & Training
iii. Raw Materials & Products; and
The Traditional & Complementary Medicine Division of the MOH takes the lead in practice related issues by focusing on the following activities:
i. Regulating the practice of T&CM practitioners by having regular engagement with practitioner bodies and relevant stakeholders
ii. Ensuring all T&CM practitioners undergo formalised system of education and training
iii. Establishing a registry of all T&CM practitioners
iiii. Facilitating the development of standards and criteria in T&CM
v. Regulation and monitoring of accredited learning centres as well as helping to set the quality and standards of T&CM programmes
vi. Facilitating and collaborating in research and scientific evaluation of T&CM
From available statistics of those who have voluntarily registered with the Ministry, there are currently more than 12 thousand practitioners in our database. It is anticipated that once registration becomes mandatory upon the enforcement of the T&CM Act 2013, the numbers will increase significantly.
With regard to Education & Training, the MOH views this from 2 broad perspectives where T&CM is concerned. First is the Therapeutic concept which incorporates the curative process. Here we focus on the Academic pathway which involves education at diploma level and higher. To this end, we work closely with the Malaysian Qualifications Agency in the formulation of the necessary Standards &Criteriae.At present diploma and degree level programmes with provisional accreditation by the MQA have been offered by 8 Institutions of Higher Learning in Malaysia. These include the first Bachelor’s degree programme in Chiropractic in South East Asia, as well as courses in Traditional Chinese Medicine and Homeopathy.
For those not too academically inclined, we also advocate a Wellness concept for would be practitioners to venture into. They can use the Skills pathway to equip themselves with skills certificates in the relevant practice areas. These skills courses are based on the National Occupational Skills Standards which we have jointly developed with the Department of Skills Development under the Ministry of Human Resources.
It is mandatory for Traditional Medicine products to be registered for the purpose of manufacturing, selling, supplying or importing them. The National Pharmaceutical Control Bureau (NPCB) looks into all aspects related to the registration of Traditional Medicine products, and approval from the Drug Control Authority, Ministry of Health is required before such products can enter the market.Up to last year, we have almost 12 thousand registered T&CM products in Malaysia. This number is expected to increase as consumers become more aware of product safety issues and increased vigilance on products entering the market.
Research in T&CM in Malaysia is coordinated by Institute for Medical Research (IMR), through Herbal Medicine Research Centre (HMRC). It is in collaboration with other governmental agencies & NGOs as well as local & international researchers. The objective is to provide scientific data on safety & efficacy of herbal products. An innovation by the IMRto assist in the dissemination of information regarding T&CM is the Global Information Hub on Integrated Medicine.This website hosts comprehensive scientifically proven information on Traditional and Herbal Medicine. To date we have published 2 volumes of Compendium of Medicinal Plants used in Malaysia and 3 volumes of Malaysian Herbal Monograph with cooperation from other agencies.
In order to better serve the needs of our public, the Government of Malaysia agreed to the incorporation of T&CM into the public health care system. The Cabinet paper to establish T&CM Units at public health care facilities was passed by Parliament in January 2006 and the first T&CM unit was incorporated into a public hospital in October 2007. From 2007 to date, 16 T&CM Units have been set up in public health care facilities in almost all states in Malaysia.
Currently 5 modalities are available at these T&CM Units. They are;
i. Malay/ Traditional massage for chronic pain & post stroke
ii. Acupuncture for chronic pain & post stroke
iii. Traditional post natal care
iiii. Herbal Therapy as an Adjunct Treatment for Cancer Patients; and
v. Shirodhara for insomnia, headache, stress or mental fatigue, anxiety & mild depression
From the statistics available, the response from the public to T&CM services at our Units have been quite good, with an ever-increasing number of treatments being provided year-on-year.
After the initial efforts at providing T&CM services at our public hospitals, it was felt that due attention should also be paid to primary health care (PHC). A pilot programme by the MOH was successfully conducted at the Masai Health Clinic in Johore in 2012, utilising a value added, pay per service model which facilitates provision of T&CM services with minimal cost to the Government. Initial services offered include Traditional Postnatal Care & Acupuncture. To formalise and standardise this service extension, the Strategy of T&CM in PHC was developed by MOH and launched in 2013. We are now looking to expand this model to other primary health care clinics nationwide.
The MOH was also involved in a pioneering venture, namely acupuncture assisted anaesthesia. Minor surgery to remove a thyroid nodule from a patient was successfully done at the Raja PermaisuriBainun Hospital Ipoh in June 2013, with only acupuncture and minimal local anaesthesia administered. Acupuncture assisted anaesthesia is also in line with the pain-free hospital concept introduced by the MOH. As I have stated before, “A pain-free hospital encourages minimally-invasive procedures, optimum or adequate analgesics, and acupuncture to achieve better pain control”.
The Ministry of Health engages with the relevant stakeholders, including various agencies and organisations locally as well as international collaborators. At the regional level, Malaysia contributes expertise to further the agenda of research and training with regards to Traditional Medicine and participates actively during the annual ASEAN Task Force on Traditional Medicine (ATFTM) meetings and ASEAN TM Conferences. Malaysia assumed Chairmanship of ATFTM from November 2012 to October 2013.
In November 2012, Malaysia organised the 4th Conference on TM in ASEAN Countries themed ‘Towards Harmonisation of TM Practices’. Key Outputs of this conference included the:
i. Kuala Lumpur Declaration – which outlined the consensus reached by AMS on the way forward with regards to TM in ASEAN; and the
ii. Launch of GlobinMed – an information sharing online platformspearheaded by Malaysia; includes content on TM after being launched at this conference
We have close cooperation with the Government of India, in particular the Department of AYUSH (Ayurveda, Yoga, Unani, Siddha& Homeopathy) of the Ministry of Health & Family Welfare. We signed a Memorandum of Understanding (MoU) on Cooperation in the field of Traditional Systems of Medicine on 27th October 2010. The 1st bilateral technical meeting was held in November 2012 in New Delhi, India and I also co-chaired the 2nd bilateral technical meeting in March 2014 in Kuala Lumpur, Malaysia. There has been deputation of Shirodhara experts under the Indian Technical and Economic Cooperation (ITEC) scheme to serve in Malaysian public health care facilities, at present we have 1 practitioner and 2 therapists providing services at Cheras Rehabilitation Hospital and Port Dickson Hospital. There has also been deputation of experts to Malaysia in Siddha Medicine for training purposes and collaboration in hosting the 1st International Conference on Siddha Medicine in Kuala Lumpur, November 2013.
Our collaboration with the People’s Republic of China goes back to the deputation of Chinese Medicine experts during the initial provision of T&CM Services at Malaysian public health care facilities in 2007-2008. Recently, the First Bilateral Technical Meeting on Cooperation in TM Between the Government of Malaysia and the PRC was held on 14th August 2014 in Beijing. It was co-chaired by the Honourable Minister of Health, Malaysia and 5 Areas of collaboration were identified as follows:
1. Acupuncture assisted anaesthesia
2. TCM in autism management
3. Herbal medication in cancer management
4. Health Preservation and preventive care management
5. Research and development of medicinal plants
Besides that, we have also collaborated with the WHO Western Pacific Regional Office (WPRO) on the ‘Workshop on Policy of Traditional Medicine in Primary Health Care’ in November 2012, Kuala Lumpur; involving all ASEAN Member States. WHO WPRO also sponsored the recent ‘Workshop on Outcome Measurement of Clinical Pathway for T&CM Practices in Malaysia’ held in September 2014 led by an expert facilitator from South Korea. The MOH also organised a Herbal Dispensing Course conducted by experts from Hong Kong, Taiwan and USA in November 2013.
Looking forward, the future planning of the MOH with respect to the development of T&CM in Malaysia includes the following:
i. We are now in the process of transformation from self-regulation to statutory regulation. We are preparing for enforcement of the T&CM Act 2013 as well as finalising the T&CM Regulations to support the Act. We are also preparing Residency training modules for fresh graduates as stipulated in the legislation.
ii. We aim to grow continuously, via the expansion of number of T&CM Units in public hospitals and are looking forward to the expansion of services at the primary health care level
iii. We also aim to enhance research on integrated medicine with a focus on evidence-based practices
iiii. We shall continue to collaborate with relevant stakeholders to professionalise and upgrade T&CM
v. Consumer education shall also be part of our activities to bring about greater awareness to the public on matters related to T&CM.
The Traditional & Complementary Medicine Act 2013 is an Act:
i. to provide for the establishment of the T&CM Council;
ii. to regulate the T&CM services in Malaysia; and
iii. to provide for the matters connected therewith.
Its objectives are to regulate T&CM practices and practitioners as well as to ensure safe and quality services to the public. It is also a formal recognition of T&CM practices in the country. The underlying aspiration is to develop and professionalise T&CM practices and practitioners.
Where consumer education is concerned, we shall focus on increasing awareness to make informed decisions as we consider the consumer to be an important stakeholder. We shall continue with consumer education programmes via roadshows, talks and exhibitions; use of pamphlets, brochures and guidelines. Dissemination of adequate information is important so that the patient / client is well aware of the treatment they will receive. The importance of a complaint channel is emphasised by an online as well as off-line avenue to immediately report adverse drug reactions, including for traditional medicine, via the NPCB website.
This brings us to where we are at this current point in time; where all of you have come together to join us at the 8th INTRACOM with our theme ‘From Tradition Towards Professionalism’.
The Oxford Advanced Learner’s Dictionary defines ‘Tradition’ as the transmission of customs or beliefs from generation to generation, or the fact of being passed on this way. Meanwhile, the Merriam-Webster’s Dictionary tells us that ‘Professionalism’ is the skill, good judgment, and polite behaviour that is expected from a person who is trained to do a job well.
Based on the theme, the following objectives have been formulated for the 8th INTRACOM, namely:
i. To understand the influence of tradition and culture in the development of T&CM;
ii. To share knowledge and experiences in formalising, standardising and regulating T&CM;
iii. To encourage individual empowerment by promoting and increasing awareness on quality and safety of T&CM; and
iiii. To enhance professionalism among T&CM practitioners.
8th INTRACOM is a platform for ALL stakeholders. The Conference aims to engage in the sharing of updates and advances in the vast arena of T&CM by a distinguished panel of experts. The Exhibition & Carnival will be an exciting avenue to increase awareness among consumers regarding T&CM. The Oral & poster presentations will provide a window into the latest in T&CM research.
With this I would like to say ‘SelamatDatang’ and a warm welcome to all of you who have come to attend the 8th INTRACOM and I wish you an exciting, informative and pleasant programme ahead.