• Infant mortality was 10 per 1,000 live births in 2004 (by comparison the U.S. infant mortality rate was about 6 per 1,000 live births) (World Health Organization, 2006), down from 73 per 1,000 in 1960.

  • The under-5 mortality rate has dropped from 105 per 1,000 in 1960 to 13 per 1,000 in 2004 (World Health Organization, 2006).

  • For adults, the age-standardized mortality rate was 200 per 1,000 for males and 109 per 1,000 for females in 2004 (World Health Organization, 2006). In 1999, the leading causes of adult mortality in medically certified deaths were cardiovascular diseases, cancers, septicemia, motor vehicle accidents, and pneumonia.

  • The maternal mortality rate in 2000 was 41 per 100,000 live births, down from 500 per 100,000 live births before independence (World Health Organization, 2006).

Undernutrition and malnutrition are now rare, and the prevalence of diet-related noncommunicable diseases (cardiovascular disease, diabetes) is increasing. These issues are recognized by the health authorities and are being addressed.

THE HEALTH CARE SYSTEM

The Ministry of Health (MOH) runs health care facilities. There is also an active private sector and a presence of traditional healers. The government health service provides practically free medical care for all, but facilities and personnel are overworked, and waiting lists can be very long. Private health services have no waiting lists, but are expensive. Patients in the private sector are covered by insurance, or care is provided by their employer, or they pay out of pocket. Only about 10 percent of the population has health insurance. A rapidly expanding private sector, coupled with unsatisfactory working conditions in the government services, has drained away skilled personnel from the public sector, which is chronically understaffed (Lim, 2002).

In the public sector, primary care (immunization, family planning, maternity care, communicable disease prevention, and accident and emergency services) is provided in a range of institutions. Secondary and tertiary care are available at the district and general hospitals, but with variable staffing and services offered. Complex tests (e.g., immunological studies, tumor markers) and complex radiological investigations (e.g., mammography, CT scans, and MRI scans) are available only in larger hospitals (Ministry of Health Malaysia, 2006).

Health clinics, staffed by health assistants, are easily accessible in every village and town, with the exception of the interior jungle of East Malaysia,



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