Although in the previous century, Malaysia - an “Asian tiger” - used to be an over-performer in the arena of child health, Malaysia’s performance in recent years has been less flattering.
Critical indicators for child health have stagnated. Deaths among newborns, infants and children made no discernible progress for the last two decades.
Malaysia is increasingly trailing behind comparator countries such as South Korea, Japan, Singapore and Taiwan.
The low number of intensive care facilities per capita is a pervasive problem in our Health Ministry’s critical care services.
One of the critical success factors (CSF) of healthcare in children is the availability and accessibility to neonatal intensive care.
It has been associated with significant improvements in the survival rates of newborns, especially those with low birth weight or gestational age.
The flattening of our child mortality rates in the 2000s is partly yet significantly contributed by the lack of neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU) beds.
Our intensive care norms are, unfortunately, stuck in a time zone, utilising the intensive care norms of the 20th century.
A conservative increase of the intensive care norms to two NICU beds per 1,000 live births will require an additional 95 NICU beds in 2024 in the Health Ministry and Higher Education Ministry.
There are presently 74 NICU beds in the private health sector.
In the spirit of Public Private Partnership (PPP), these should be better utilised by the Health Ministry and Higher Education Ministry to outsource neonatal intensive care services to private hospitals, considering that NICUs in the public sector are virtually always full to the brim.
If this option is seriously considered, it must be included in Budget 2024.
A nominal increase to three PICU beds per 100,000 children will require an additional:
32 PICU beds in 2024 for paediatric intensive care of children less than 15 years old in the Health Ministry and Higher Education Ministry.
78 PICU beds in 2024 for paediatric intensive care of children less than 18 years old in the Health Ministry and Higher Education Ministry.
There are only 11 PICUs in the private healthcare sector and there must be a genuine effort to boost the numbers of PICUs in both ministries-run healthcare facilities.
The provision of paediatric intensive care is likely responsible for a five-fold reduction in infant and child mortality rates.
Furthermore, centralised paediatric intensive care has been associated with a two-fold reduction in the length of stay in the intensive care unit and a 50 percent reduction in mortality.
The increase in NICU and PICU beds needs to come with the corresponding step down of the number of Special Care Nursery (SCN) and Pediatric High Dependency Unit (PHDU) beds in both ministries.
Apart from the quantity of NICUs and PICUs, of equal importance is the need to ensure the development of high-quality intensive care services in children which among others, constitute the following characteristics and sophistication:
Regional neonatal and paediatric networks.
Appropriate staffing levels of neonatologists, paediatric intensivists, intensive care nurses and others as laid down by the Health Ministry and professional bodies.
Training of more intensivists and intensive care nurses.
Best practice guidelines and benchmarking exercises.
Data sharing infrastructures.
Communications and administration systems.
Retrieval systems.
A critical care ambience to embrace better family-centred care.
A separate budget beyond that for the paediatric departments needs to be provided to ensure the delivery of optimal neonatal and paediatric intensive care services.
And it’s not too much to ask from Budget 2024. This is for the protection and preservation of our children’s lives and for improving their long-term health prospects and quality of life.
It is indeed one of the true key performance indicators (KPI) of how genuine is our love for our children. - Mkini
Signatories:
Dr Musa Mohd Nordin, past president, Perinatal Society Malaysia (PSM)
Dr Selva Kumar Sivapunniam, president, Malaysian Paediatric Association
Dr Amar-Singh HSS, adviser, National Early Childhood Intervention Council (NECIC)
Dr Tang Swee Fong, assistant secretary, Malaysian Society of Intensive Care (MSIC)
The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.
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