The New Straits Times, January 30, 2000
By Prof Dzulkifli Abdul Razak
BARELY a week apart, the Ministry of Health has made two important points in the development of the nation's health care delivery system. One relates to the introduction of the National Essential Drug List (NEDL) on January 27, and another was the launching of the MSC Telemedicine flagship on January 20.
Both are landmarks, since each can serve as an entry point for a more equitable, accessible and affordable healthcare system aimed at the majority of Malaysians.
The former is based on a time-tested concept in existence for more than 20 years. It first gained international acceptance in 1978, at a conference held in Alma Ata. To date, about 150 of the 191 member-states in the World Health Organisation have implemented it.
Since Malaysia participated in this conference, the recent move to adopt a national "essential" drug list is significant. This is in line with the Alma Ata declaration. It specifies the provision of "essential drugs" as one of the key principles in achieving Health for All.
Thus, it recognises that access to some selected drugs is essential. Through an "essential drugs" concept it seeks to ensure that all people , wherever they may be, are able to obtain get the drugs they need at the lowest possible price; that they are safe, effective, and of high quality; and prescribed and used rationally.
To support this concept, a WHO Model List of Essential Drugs was introduced, and last year saw the publication of the latest edition, of about 300 drugs. In addition, WHO established the Action Programme on Essential Drugs to ensure that the essential drug concept is properly understood and implemented.
Essential drugs are among the most cost-effective elements in modern healthcare. They are vital for preventing and treating disease. Each country is encouraged to define its own NEDL, based on the model list.
Telemedicine, or more appropriately tele-health, which will become a foundation of future healthcare initiatives in the country", could also be charged with the same mission. It is expected to be completed by the year 2005.
Quoting the Minister of Health: "Most importantly, telemedicine and tele-health facilities must be affordable for the people." This underscores the whole purpose of the project, seamless (that is, greater equity and access), affordable, high quality healthcare.
Tele-health is information and knowledge-driven. This is apparent in the four main modules that make up tele-health _ the Lifetime Health Plan (LHP), Mass Customised Personalised Health Information and Education (MCPHIE), Continuing Medical Education (CME) and Tele-consultation.
They are information and knowledge-rich modules which allow for greater latitude in decision making and more informed action by professional and patient alike. For this to happen, technology must be affordable and accessible, as well as the informational content. Like drugs, some aspects of drug information are indeed "essential" for preventing and treating diseases.
Taken together, therefore, essential drugs and tele-health are complementary concepts important to the development of Malaysia"s healthcare delivery.
It would be ironic if despite substantial spending on drugs and the development of tele-health, there are still people who lack access to essential drugs or even the relevant information on them. Such shortfalls have given rise to a number of concerns locally as well as globally.
For example:
- The inappropriate use of drugs, antibiotics in particular. Globally up to 75 per cent of antibiotics are prescribed inappropriately, even in teaching hospitals in some countries.
- Patient awareness about drugs due to the absence of appropriate information. Worldwide, an average of only 50 per cent of patients take their drugs correctly.
Some 16 years ago, Malaysia created history when it promulgated the Drug and Cosmetic Regulation, 1984. It strengthened the pharmaceutical sector by ensuring that only quality, safe and efficacious drugs were available.
The implementation of NEDL is yet another historic event as in that it further ensures that equity, accessibility and affordability for those drugs through the adoption of the essential drug concept.
The potential impact of tele-health is overwhelming since information is an integral part of drugs. Without it no drug can be used optimally.
