The International Conference on Maternal and Child Health, 3-4 March 2016 with the theme “Reaffirming the Women’s and Children’s Right to Health” was held in Sibu, Sarawak with more than 800 local and international participants and speakers from Malaysia, UK, USA, India, Australia and Thailand. This was the keynote address from the Director-General of Health Malaysia

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• The human rights-based approach to health specifically aims at realising the rights to health and other health-related human rights
• Health policy and programmes under the human rights principles should aim at developing capacity of health provider to meet their obligation and empower the right-holders (our clients) to effectively claim their rights
• In summary, the human right-based approach to health is based on these 7 key principles. Namely; availability, accessibility, acceptability, quality of facilities & services, community participation, equality and non-discrimination and accountability that is shared by provider and recipient
• Ministry of Health is committed to mainstream human rights into health care programmes and policies
• Applying human rights to women’s and children’s health interventions not only helps us to comply with our obligations, but also contributes to improving the health of women and children

• A study on human rights-based approach to women’s and children’s health in Nepal, Brazil, Malawi and Italy showed that countries have begun to apply elements human rights in policies and implementations
• In all four countries, human rights appear to have shaped laws, policies and programmes related to women’s and children’s health to one degree or another.
• In some it is explicit as stated in the constitution, while in others it is implicit where the human rights-based approach is embedded in the programmes and implementation

• Although the rights to health of women and children is not explicitly stated in our constitution, there is provision in the constitution under Article 8 that talks about equality and the prohibition of discrimination on basis of gender or age
• Furthermore, Article 74 of the Federal Constitution is the overarching rule which empowers the Federal Government to make laws for the rakyat (i.e. all Act/Regulations relating to health)
• However the rights to health are well defined in the national policies and laws and regulations

• Malaysia recognised the rights to health of women and children even before Independence
• The First Malaysia Plan (1950-1955) focused on the Rural Health Development, where the maternal and child health services was given the priority

• From then on, the programmes for both women and children has expanded over the years
• In 1967, the school health programme was initiated to cater the health need of the child in school.
• Early intervention for children with special needs began implementation in clinics and at home in 1986, followed by programmes focused on adolescent and elderly in 1996
• Over the years, Ministry of health has worked closely with other related agencies to ensure all health issues are addressed holistically

• The commitment continues as manifested in the 11th Malaysia Plan where all relevant Ministries are involved in providing the social aspect of health
• The right to highest attainable standard of healthcare has expanded to include all individuals, not at the expense of women and children but in an inclusive manner

Mapping our healthcare services for women and children based on the seven principles of human right approach, shows a clear picture if we have applied it in our system

• Mapping the 1st principle of availability we see that maternal and child health are basic services provided in all health facilities
• Specialized support services, such as rehab services, dietitian services etc. are available to women and children through referral to health clinics with FMS

• Accessibility is measured in terms of physical access, economic as well as information access
• Primary health care services at public health clinics are delivered almost free of charge, whereby each patient is charged a nominal fee of RM 1 (equivalent to US$0.31 in 2007) for each outpatient visit and RM5 (USD1.55) for specialist consultation. Service also includes investigation and drugs
• The Fees (Medical) Order 1976 also provides an exemption clause such that those who cannot afford to pay will be given free treatment whether at primary care, secondary and tertiary care levels
• Access to information is made available through conventional and web-based media to cater to all age groups and the different preferences

• Physical accessibility to health services, includes static and mobile services
• Number of health facilities have increased over the years both in public and private sectors

Mobile services has further increase the access of the population in the rural area

To increase coverage of accessibility to safe obstetrics services, different facilities were made available. For example transit houses were built to cater women especially from the remote areas

• Among the web based media available to public:
  • MOH national and state webpage, Facebook
  • Infosihat
  • Myhealth Portal Webpage and phone applications
  • My own Facebook and Twitter
• Other than utilizing the web to disperse information, MOH still continues to use conventional methods to ensure information is well disseminated

• Measurement of acceptability of the service focuses on sensitivity to culture, age and gender as well as compliance to medical ethics. Health services offered are gender sensitive and takes into account all age groups
• Religious bodies are consulted during policy making especially on sensitive issues such as reproductive health issues. E.g. JAKIM, Malaysian consultative council of Buddhism, Christianity, Hinduism and Taoism (MCCBCHT). Such is evidenced by the development of manual of Adolescent Health services in primary care
• We have professional bodies to ensure the highest standards of medical ethics, education and practice, in the interest of patients, public and the profession

• When Quality Assurance Programme was introduced in the early 90s, maternal and child health programme was the focus. Among the QAP indicators were incidence rates of eclampsia, peuperal sepsis, kernicterus, and tetanus neonatorum
• Before a new service is implemented or a new equipment is utilize a HTA evaluation and assessment is now the norm
• Clinical practice guidelines are also based on evidence based medicine

• Participation and inclusion means that people are entitled to active, free and meaningful participation in decisions that directly affect them. Such as the design, implementation and monitoring of health interventions
• Participation increases ownership and help ensure that policies and programmes are responsive to the needs of the people they are intended to benefit

Community participation in providing healthcare services to the community

Community participation was further enhanced under the NBOS 7, where Ministry of Health and Ministry of Women, Family and Community Development together with NGOs provide holistic health and social support to the Elderly, Persons with Disabilities (PWD) and Single Mothers

• Eliminating discrimination is core to human-rights approach. Strategies include gender main streaming and provision of services to marginalized groups
• Commonly marginalized groups are children, women, person with disabilities, indigenous people, migrants, and person living with HIV or AIDS
• MOH has strived to provide equality of care for women and children across the country, by addressing vulnerable group e.g.:
  • Orang Asli: improving the healthcare service and ensuring proper monitoring and surveillance through the establishment of a specific Orang Asli unit
  • Urban poor: by establishing Klinik 1 Malaysia
  • Persons with disability: decentralizing rehabilitation services to primary care, bringing the rehab services closer to home

• Information sharing is a critical component of accountability
• We have ratified to international treaties that bind us for eg. Convention on the Rights of the Child (CRC) and Convention on the Elimination of Discrimination Against Women (CEDAW)
• Not only international accountability but at the national level, MOH is accounted to the parliament
• At the national level, we have Acts and Regulations / Policy that govern the rights of the child and women e.g. Child Act
• For all our programmes, we have a monitoring system, whereby the District reports to the State, and the states report to the National agency. Our progress/achievements are also reported to International Organisations such as WHO

• Maternal mortality rate has decline even before Independence and has been stable at 22/100,000 for the past 15 years
• Improvement along the mile stone was due to better resource distributions, quality in training, new strategies and initiatives with improved accessibility.
• The dramatic decline before the Independence, was following the initiation of The Midwifery Legislation in 1920’s
• Further improvement was seen after 1957, with the implementation of the rural health services, followed by the introduction of Family Planning in 1960’s.
• Other initiatives include:
  • registration of traditional birth attendants and initiation of investigation of maternal death (1970)
  • colour coding and Home based Maternal Health Card (1980)
  • confidential enquiry of maternal death, QA programme, Alternative birthing centres (1990)
  • training manuals of PPH, HPT in pregnancy and heart disease (2000)

Over the years we can see the increase in the community acceptance to our services, through the increasing attendance for antenatal checkup and the high coverage for safe delivery methods

• Life expectancy of both male and female has improved over the years. However the gap between life expectancy for the male and female is increasing, possibly attributed to better health and health related services targeted to women
• This leads to the feminisation of ageing, where many older women face inequities related to health. Ministry of health has develop programmes for elderly in the primary care setting. Among the recent initiatives is the National Blue Ocean Strategy  (NBOS 7) 1 Malaysia Family Care where services for elderly are provided in institutions and at home

• Malaysia health system has done well in reducing under 5 mortality rates, where our under 5 mortality rate is now 7.6/1000 live birth
• WHO has defined countries with under 5 mortality rate of < 10/1000 as having attained very low mortality rates

Good immunisation coverage of > 95% show the availability, accessibility and acceptance to the health services provided

• National polio vaccination programme started in 1972 led to the decrease of poliomyelitis cases
• Polio vaccination coverage was maintained > 95% since the year 2000 and we have been polio free since the year 2000

Trend of cervical cancer incidence in Malaysia has reduce with the implementation of specific screening programmes for women of reproductive age group

Number of cases reported has reduced over the years

United Nations studies have highlighted the magnitude of the problem posed by violence against women and children has increased

• We cannot be too complacent with all the success thus far because the modernization and urbanization is creating an environment that is ever changing
• This is now a challenge for us as providers to ensure that women and children achieve the highest attainable health
• Among the emerging and remerging issue are:
  • Vaccine refusal
  • Problems of caring child for working mothers
  • Information explosion
  • Teenage pregnancies
  • increasing non-communicable disease among women and children

• The exercise of rights is not absolute
• Misuse of rights can be detrimental to the individual and community health. For example, vaccine refusal groups are emphasizing on their rights as parents to refuse vaccination, freedom of speech can lead to spread of misinformation. Both situations can bring harm to others and in fact impede other’s rights.
• Thus, there should be limits on rights:
  • Individuals should not harm others when exercising their rights
  • Rights should be exercised responsibly
  • Rights should be exercised with respect for the reciprocal rights of others
  • Society rights supercedes individual rights

• The social determinants of health are mostly responsible for health inequities such as the unfair and avoidable differences in health status seen within and between countries
• Globally, we are now moving towards universal health coverage as suggested by WHO in the SDG
• The 17 goals in SDG is inline with the human rights approach to achieve the highest standard of attainable health
• Right to health is at the heart of Goal 3

• In fact, Ministry of Health Vision is inline with SDG goals where the aim is to achieve better health which can only be realized if the nation works together
• And in doing so, Ministry of Health Malaysia had earlier on in 2009, incorporated the essences of the human rights approach through the 7 principles as stated in the Mission

• The rights to highest attainable standard of health is wider and requires a nation working together for better health as stated in MOH vision statement
• Human rights to health may be explicit or implicit, but what is important is the political will power to ensure that health is made available to all
• Malaysia has done its best to attain the highest standard of healthcare for women and children and it this is proven by the improvement in the health indicators
• However, we must continue to strive to maintain highest standard of healthcare for women and children, as more challenges are emerging