International Journal of Public Health Research Special Issue 2011, pp (50-56) 50 Primary Health Care Reform in 1CARE for 1 Malaysia Dr. Kamaliah Mohamad Noh Family Health Development Division, Ministry of Health Malaysia ABSTRACT Primary health care is an approach to health and a spectrum of services beyond the traditional health care system while primary care is just one element within PHC that focuses on health care services. The present status of PHC in Malaysia and the strides it has made in uplifting the health status of the nation is described. The challenges that the Malaysia health system are facing have necessitated a review of the structure of the whole health system and reforms in PHC will ensue in due course. The concept of 1Care, the proposed re-structuring of the health system, is discussed with emphasis on the reform in the PHC delivery system. The reforms are aimed at addressing three main concerns on seamless integration of care especially for the management of chronic diseases, ensuring universal coverage and responsiveness of the health system in the face of increasing client expectations and patient safety. The opportunity for macro reform to improve the health of Malaysians by developing a sustainable and high performing health care system is being seized by the Ministry of Health in 1Care. The micro reforms are discussed as regards to increasing access to services, development of primary health care teams to deliver comprehensive PHC, the application of ICT, the renewed emphasis on health promotion & prevention activities and a renewed focus on community empowerment and participation. Support in terms of human resource, governance & funding models, capacity building in monitoring & evaluation as well as change management to affect the reforms are identified. The paper concludes with lessons learnt from other countries and the importance of systemic reform for a well functioning health delivery system. INTRODUCTION Primary Health Care refers to an approach to health and a spectrum of services beyond the traditional health care system while primary care is the element within primary health care that focuses on health care services including health promotion, management of illness, injury prevention and personal care. Healthcare services in PHC has a dual function of directly providing services at point of first contact and a coordinating function to ensure continuity of care and ease of movement across the system for individuals in developing their health. Primary health care providers consist of a team of physicians, assistant medical officers (AMOs), nurses and community nurses, pharmacists, medical laboratory technologists, pharmacist assistants, physiotherapist and the listing grows longer as the scope of services at PHC becomes more comprehensive. PRESENT HEALTH STATUS The Malaysian PHC delivery system provides population-based services using a life-course approach in delivering services from womb to tomb. The health of Malaysia’s population has benefited from a well-developed primary health care system, together with improved access to clean water and sanitation, and reinforced by programs to reduce poverty, increase literacy, and build a modern infrastructure. Malaysia has made great gains in life expectancy for its people. Life expectancy at birth rose between 1970 and 2008 for men from 61.6 to 71.6 years, and for women from 65.6 to 76.4 years (Table 1): similar to the average life expectancy of 72 and 76 years for men and women respectively in 2006 in the Western Pacific Region of the World Health Organization. Infant mortality dropped substantially between 1970 and 2008 from 39.4 to 6.4 deaths per 1000 live births: just above Australia with 5 per 1000 and Singapore with 3.2 per 1000. Maternal mortality in that period dropped from 1.4 to 0.3 deaths per 1000 live births. Table 1 Mortality and health indicators 1970 1980 1990 2000 2008 Life expectancy at birth, female (years) 65.6 70.5 73.5 74.7 76.4 Life expectancy at birth, male (years) 61.6 66.4 68.9 70.0 71.6