Summary:

Malaysia has made considerable improvement both in the socio-economic and health care aspects of her people. A long-established rural health care system provides preventive and curative health services to a large proportion of the rural population. However, studies in
1979 indicated that 41.2% of the people in Sabah remained underserved. One of the least served and poverty-stricken areas is the Keningau Area.

Engaging in shifting cultivation, the Muruts continue to live in remote and sometimes inaccessible areas and consequently, many lack basic amenities resulting in poor health and high morbidity and mortality.

In order to meet the health needs of the people, an action-research primary health care project was started in 1987 with full community participation and integration with the existing
health care system. Several discussions were held with the leaders and influential members of each village and the communities were given time to deliberate on their participation in the programme. The health staff were re-orientated to their new role which emphasized health promotion and disease prevention rather than curative care. As a result, 44 village health promoters were chosen and given two weeks of intensive full-time training in the essential elements of primary health care with an emphasis on health promotion and disease prevention. These VHPs form the link between the community and health services, acting as facilitators of community activities as well as agents of change in their respective & villages. A comprehensive supervisory system was also developed and mechanisms for supervision were established to ensure quality and success.

Generally, evaluations carried out indicate improvements in all participating communities.
Village development and security committees have given strong support to the project and the selected VHPs, many of whom are members of these committees. The communities too have been supportive as evidenced by their participation in various development projects such as the construction of sanitary utilities, cleanliness campaigns and agricultural projects. Environmental sanitation, safe deliveries, immunization coverage, nutritional status and agricultural activities have improved while the infant mortality rates have been reduced.

The primary health care project has not only served to bring essential health services to
the disadvantaged Mu ruts in Keningau, but it has also helped to develop and sustain a sense of self-reliance. They have been stimulated to achieve and visibly improve their level of health and economic status through community participation. Although much has been achieved and emulated for other areas, much remains to be accomplished. Nevertheless, it cannot be denied that the primary health care project has benefitted the people of Keningau.

Authors: Siew Tin Chen, Paul Chieh Yee Chen, Mechiel KC Chan, Hasan Abdul Rahman, Mee Lan Wong.
Publisher: The Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur.
Details: Year: 1989, No of chapters: 6, No of pages: 67

Authors’ details:

ASSOC. PROF. S.T. CHEN, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.(Principal Investigator 1988-1989)
PROF. P.C.Y. CHEN, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. (Principal Investigator 1987)
DATUK (DR.) MECHIEL K.C. CHAN, Director of Medicine & Health Services, Sabah.
DR. HASAN ABDUL RAHMAN, Area Medical Officer of Health, Keningau, Sabah.
DR. MEE LIAN WONG, Department of Social & Preventive Medicine, Faculty of Medicine, Universty of Malaya, Kuala Lumpur, Malaysia.