Partners in health: WHO's continuing journey in Malaysia
Malaysians are so used to being part of the South-East Asian region that we naturally expect to be placed in any group called “South-East Asia” when it comes to international classifications.

However, for the World Health Organization (WHO), Malaysia actually comes under the Western Pacific region, even though the United Nations health body also has a South-East Asian region.

WHO Representative to Malaysia, Brunei Darussalam and Singapore Dr Rabindra Abeyasinghe explains that the region a country is placed in is influenced by the geopolitical situation at the time they join the WHO.

So three of our Asean neighbours – Indonesia, Myanmar and Thailand – come under the WHO South-East Asian region, which was the first WHO regional office to be established in 1948 and is headquartered in India.

And the rest of the Asean nations are with us in the Western Pacific region, which was established in 1950 and is now headquartered in the Philippines.

Malaysia has been part of the WHO ever since our country’s formation in 1963.

This was a natural progression as the Federation of Malaya had joined the WHO on April 24, 1958, after Independence.

Vast improvements

In that time, Malaysia has seen great progress and change in our health and healthcare system.

According to Dr Rabindra, the most pressing issue Malaya faced in the early days was malaria.

Today, the WHO is poised to grant Malaysia “malaria free” status, which means that the country has had no locally- transmitted cases of the mosquito-borne disease for at least three years.

The only barrier standing in the way of this status is our cases of monkey malaria, where Anopheles mosquitoes bite infected macaques and then transfer the Plasmodium knowlesi parasite that causes malaria to humans via another bite.

“We salute the Malaysian government for the progress on malaria,” says Dr Rabindra.

“Malaysia has met the requirements to say human malaria is at the end, but we are not in a position to certify that accomplishment because of the zoonotic malaria.

“So we are working with Malaysia to see how we can resolve that issue.”

Another similar accomplishment of our public health system is the near-elimination of lymphatic filariasis.

Also known as elephantiasis, this painful and disfiguring parasitic disease is caused by roundworms, which are transmitted through infected mosquitoes.

Says Dr Rabindra: “Malaysia has also made incredible progress in the battle against lymphatic filariasis.

“I know there are a few kampung (villages) in Sabah which are still faced with the challenge, but largely, the country has eliminated lymphatic filariasis.”

The greatest achievement that WHO has helped facilitate in Malaysia, he notes, is the elimination of the transmission of the sexually-transmitted infections (STIs) syphilis and HIV (human immunodeficiency virus) from pregnant women to their unborn child.

“That is a huge accomplishment; Malaysia was the first Asian country to achieve that back in 2018.

“I think it’s a testament to the efforts and the strength of the Malaysian system to achieve that,” he says.

Congenital syphilis can cause stillbirths or death soon after birth, as well as developmental delay, seizures, severe anaemia, jaundice, and enlarged livers and spleens, among other symptoms.

While penicillin can cure syphilis and some cases of congenital syphilis, some babies with this STI will continue to require treatment for the complications of the disease.

Meanwhile, around 15% to 45% of untreated pregnant women with HIV will pass the incurable infection to their baby, according to WHO estimates.

However, adequate antiretroviral treatment for such women can suppress HIV levels enough to prevent this.

Malaysia’s Klinik Katarak-Kementerian Kesihatan Malaysia project was also the first to be highlighted in WHO’s Innovation for Health series, which aims to spotlight case studies on health innovation in the Western Pacific region.

Comprising one-stop cataract service centres and mobile cataract clinics, this initiative has significantly increased accessibility, affordability, patient outcomes and follow-up rates, as well as reduced waiting time, for cataract care around the country, especially for patients in rural regions.

A child getting vaccinated through an immunisation programme for communities in hard-to-reach areas of Sabah as part of preventive care at Klinik Kesihatan Pagalungan in Nabawan, Sabah.

Continued challenges

However, we still have many challenges to face.

As Dr Rabindra says: “Malaysia made very significant strides in improving the health situation of their population over the last 50 years.

“But if you look carefully, many of those indicators have plateaued around 15 years ago, and there has been little progression.”

One of the most important areas that we need to tackle is the financing of the healthcare system.

“The financing of the health system has not kept pace with the development and growth of Malaysia,” he points out.

“And because of that, the health sector has not developed at the same time – it has not made the shift necessary to address the evolving challenges of the increasing burden of non-communicable diseases (NCDs); it has not recognised and catered well enough for the larger number of people who are now surviving into older age.”

Indeed, tackling the risk factors for NCDs is another big challenge that Malaysia faces.

With obesity and hypertension (high blood pressure) affecting so many Malaysians, Dr Rabindra notes that there is a need for a lifestyle change to one that is more active and which consumes less carbohydrates, sugar and salt.

“This is a dialogue we are having with the Malaysian government to see how we can do that,” he says.

“This is a mindset shift that cannot be done in a day or two.

“But we need to start working with our younger generations now so that they are better prepared for that future.”

Dr Rabindra points out that it is not just about empowering people with knowledge, but also about providing them with a variety of choices.

“I often cite the situation where you go to the supermarket; what you see at eye level is the highest sugar-containing drinks.

“If you want to find something with low sugar, you have to bend down and look for it because it is hidden somewhere.”

We need the system itself to be predisposed towards healthier choices, e.g. ensuring that the first choice that catches your attention when you enter the supermarket is the healthy option, not the unhealthy one, he says.

This, however, requires changes beyond the health system.

But Malaysia need not reinvent the wheel as it were; Dr Rabindra points out that there are examples around the world that we can adapt.

One such example is how the salt content in half the sliced packaged breads sold in the United Kingdom has been reduced through a voluntary nationwide salt reduction programme involving bread manufacturers.

Bread is the largest contributor to daily salt intake for the UK population.

In addition, tobacco, vaping and alcohol control and regulation are also important issues for Malaysia to tackle, he notes.

The Klinik Katarak-Kementerian Kesihatan Malaysia initiative, which includes mobile cataract clinics to reach out to patients in rural areas (including this one in Simunjan, Sarawak), was the first case study in health innovation to be highlighted in the WHO Western Pacific's Innovation in Health series.

Current priorities

Many of these challenges are not unique to Malaysia though, as many other countries in our region and around the world are also facing them.

And indeed, our government has recognised these problems, as reflected in the Health White Paper passed by Parliament last June (2023).

“We are proud to say that we worked with the Malaysian government on that White Paper.

“And we are now continuing to work with the Health Ministry and the government to ensure that those reforms are implemented in a step-by-step manner, so that all of them can be realised,” says Dr Rabindra.

For now, the most immediate priority, he thinks, is the continued recovery of our health system from the Covid-19 pandemic.

This includes catching up on ground lost during that period, e.g. in terms of vaccinations, and tuberculosis and dengue control, among others.

Other priorities include encouraging a shift to digital health and promoting a preventive care system.

Both of these moves will help to strengthen our universal health coverage and primary care system, as well as reduce congestion at our hospitals.

He notes: “If we just try to invest only in improving hospitals, we’re going to fail somewhere along the way, because if people don’t make that mindset shift, our systems are going to buckle.”
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The World Health Organization (WHO) works closely with the government to improve the health of our population.