Cancer prevention and control: Which policies and programmes have best driven progress?

Talking Points for Director General of Health, Malaysia at the WHO Technical Briefing on the occasion of the 68th World Health Assembly

 “Cancer prevention and control: Which policies and programmes have best driven progress?”

1230-1415, Friday, 22 May 2015
Venue: Room XII (12) at the Palais des Nations in Geneva

  
Mr. Chair, Madam DG, esteemed fellow panelists, ladies and gentlemen.

First and foremost, I would like to thank the Secretariat for inviting Malaysia to share her experience in cancer prevention and control. Our given topic today entitled “How Malaysia is progressing in healthcare system strengthening to improve access to cancer management.” Access means differently to different people. 

The Institute of Medicine defined “access” as the “timely use of health services to achieve the best possible health outcomes.” Hence “access” is the ability to get healthcare that is timely, appropriate, of high quality, culturally relevant, affordable, well coordinated and comprehensive. In addition, access is not only confined to cancer treatment but also includes cancer prevention, screening, and diagnostic services.

Malaysia has a total population of 30.3 million, with an average life expectancy of 74.4 years. Our total health expenditure in Malaysia is only 4.4% of the GDP, of which 53% coming from the public expenditure. Our urban population reaching to 72.3% and the elderly population, age 60 and above is expected to reach 15% by year 2030. Malaysia has a dual healthcare system comprising the public and private sectors. The Ministry of Health is the primary public agency responsible for the development and maintenance of all government healthcare services throughout the nation, providing universal health care since the 1980s in an equitable manner. The funding of Ministry of Health is mainly from the tax-based Federal Government budget. 

Ladies and gentlemen,

Because of the time limitation, I would focus on prevention of cancer through vaccination and highlight our National Strategic Plan for the Cancer Control Program 2015-2020.

We are at a transition period, where cardiovascular diseases and cancers have progressively become more prevalent. Cancer is now the second highest cause of mortality for Malaysians. With the ageing population and the increasing prevalence of NCD risk factors, we project that the incidence will continue to rise in the coming years.

  
The HPV vaccination Programme was introduced in 2010 as a national programme targeted to adolescent girls age 13 years for prevention of cervical cancer. There are four learning points that I would like to share with you on the implementation. 

The first point is on evidence-based policy decision. Based on a mathematical modelling methodology, the introduction of HPV vaccination was projected to potentially prevent 89% of cervical cancer and save substantial annual cost for HPV-related treatments. Our Government approved it because of the convincing data of the cost effectiveness of the strategy. Prevention cost per person, is much lower as compared to treatment cost of cervical cancer.

My second point is the importance of engagement and mass communication to ensure success of HPV vaccination. We achieved an acceptance far beyond expectations, despite several negative campaigns in social media about the ill-effects of HPV vaccine, Acceptance rate had increased from 95% in the first year to 98% in the third year and sustained until today.

My third point is that implementation in Malaysia is based on the strategy of building on existing infrastructure, that is under the school health program. Enhancing the intersectoral cooperation and shared responsibility with other stakeholders especially the Ministry of Education.

My last point is the declining costs of the HPV vaccine and opportunity for other countries. Riding on volume of scale and time, if more countries in the region participate in the mass vaccination program, we certainly can expect the cost to be much cheaper. 
  
Ladies and gentlemen,

One unique feature of our National Strategic Plan for the Cancer Control was the incorporation of “Traditional and Complementary Medicine” as one of the eight goals. The objective of TCM is to relieve pain and suffering by acupuncture, massage or the use of herbal preparations that have undergone clinical trials. 

In the implementation, one of our strategies was the formation of smart partnerships between the government and civil societies, through a multi-sectoral approach. We have presented this at a palliative care side event, at the 67th WHA last year and have published a paper elaborating the two smart partnership models adopted in palliative care management.

To improve performance of service delivery with the increasing demand and congestion, we have embarked on “lean healthcare initiatives” since 2013, through modification and reengineering of existing work processes, cut leakages and wastage, focus on patient centred approach and the creation of a value matrix. One example of the successful implementation in oncology department was the reduction of waiting time for radical radiotherapy from 120 days to 80 days initially, and further reduced to 28 days as of December 2014.

In conclusion ladies and gentlemen, the strengthening of healthcare in Malaysia is to improve access to cancer management, focusing on the quality of care, to be better, faster, smarter and cheaper, embracing the concept of value for money, and value for many. 

Thank you Mr Chair.

Datuk Dr Noor Hisham Abdullah, 

Director General of Health Malaysia 

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