Rural communities living in remote areas have an additional worry to factor in when planning visits to the clinic or hospital. Road conditions, transportation options and current weather conditions become determinants of whether they make it to the hospital or not. In the case of a medical emergency, this could mean life or death.
While Malaysia takes pride in being universally accessible when it comes to healthcare, the experience between urban and rural communities are still considerably different. Here are four reasons why.
#1 – Access To Healthcare A Real Issue
92% of Malaysia’s urban population live within three kilometres of a clinic or hospital. It takes them only about 20 minutes to get to the nearest clinic or hospital.
Only 69% of the rural population have the same privilege of access to the nearest clinic or hospital. The remaining 30% need to travel a minimum of three kilometres, some up to five kilometres to reach a basic healthcare facility[1].
Distance is only one factor. Road condition and mobile coverage is another. The states of Labuan, Sabah and Sarawak are much more rural, with terrain that is difficult to navigate, making it difficult to develop proper infrastructure to accommodate medical needs. Therefore, residents in rural areas typically travel long distances through rugged terrain to reach medical facilities.
Khazanah Research Institute found that 6.5% of Malaysia’s population were more than 5km away from any healthcare facility, with no mobile alternatives that they could turn to[2].
Private healthcare facilities are highly concentrated in urban areas for economic reasons, however, the disparity is stark when comparing private and public healthcare options in small towns and rural areas. The rural population are largely denied access to private healthcare, regardless of whether they can afford to pay for it or not.
Although the government claims to evenly distribute resources based on need, the deployment of facilities and human resources for health remains uneven, with particular disparities in rural areas[3].
#2 – Lack Of Proper Equipment
Rural clinics and health services are only equipped to provide basic healthcare. Smaller district hospitals do not have hi-tech facilities for investigation or treatment.
In Sarawak, 39% of the state’s public health clinics do not have pharmacists. 70.7% of the clinics do not have laboratory services and 88.9% do not have x-ray services[3].
As a result of limited resources and medical supplies, more complex health issues need to be referred to larger hospitals located in town centres which are a distance away.
Government-managed ambulances and airlift capacities for remote sites are provided for medical and surgical emergencies. Otherwise, it is up to the patient to make the long journey for any of their non-urgent appointments.
#3 – Shortage of Medical Personnel
While it is clear that urban areas are more densely populated, the distribution of doctors and specialists throughout the nation may be disproportionate. Many healthcare facilities in the rural areas lack proper medical personnel.
A study released by the Ministry of Health Malaysia shows the distributions of General Practise (GP) doctors according to states and categorised under urban and rural areas.
More rural states like Sabah and Sarawak still had more GPs in urban areas compared to rural areas. The state that had the most GPs in rural areas is Negeri Sembilan[4].
Bandar Kuching MP Dr Kelvin Yii cited statistics from the Sarawak state government saying that 98 out of 215 rural clinics in Sarawak did not have a doctor. The majority were run on medical assistants and nurses. Overall, the state of Sarawak had one doctor for every 682 patients last year[3].
In Sabah and Sarawak, the two rural states in East Malaysia, the doctor-to-patient ratios are, respectively, 1:1357 and 1:957, whereas the average doctor-to-patient ratio in all of Malaysia is 1:633[5].
It is evident that states like Sabah and Sarawak are lacking in healthcare experts. They are also the two largest states in terms of geographical landscape. Access to healthcare and the quality of healthcare provided to the rural population must be improved.
#4 – Undiagnosed Diseases
Rural settings have a much higher risk of undiagnosed cases. For example, the prevalence of high cholesterol levels is 34.3% in the urban population and 37.0% in the rural population. However, only 6.6% of rural cases were diagnosed.
Every 3 out of 10 rural patients had an undiagnosed medical problem[1].
This number was only 25% for urban dwellers. Undiagnosed health problems have a huge potential of snowballing into other more significant health issues in the future.
Poverty does not automatically determine a person’s health status, although it can significantly influence it. Access and affordability to good healthcare, especially to the low-income groups, is a necessity and paramount to improving the overall well-being and health of this group.
Explore Our Sources:
- Falcon, D. J. (2019). The Health Care Gap in Rural Malaysia. Lehigh University. Link.
- Khazanah Research Institute. (2020). Social Inequalities and Health in Malaysia: The State of Households 2020 Part III. Link.
- Batumalai, K. (2020). 57 Years Later, Do Sarawak, Sabah Enjoy Equal Health Care To Peninsula? Code Blue. Link.
- Sivasampu, S. et al. (2013). A Comparative Study of Urban and Rural General Practices in Malaysia. Ministry of Health Malaysia. Link.
- Bahardin, A. (2016, June 17). Suturing the gap – the urban-rural health dilemma. Malaysiakini. Link.
