Malaysia has done well in achieving health of its population, especially in the reduction of both maternal and child mortality rates.

When it gained independence in 1957, the maternal mortality was more than 500 per 100,000 live births. In the 1970’s this came down appreciably to between 100 and 200. This rate is less than 30 maternal deaths per 100,000 live births in 2002.

The infant and perinatal mortality has come down to a single digit that is less than 10 per 1,000 live births. Under-five child mortality is less than 8 deaths per 1,000.

What has contributed to Malaysia’s success story?

• The clear and deliberate policy of providing more to those whose needs are more (eg. disadvantaged and vulnerable) has played a major role. Women of childbearing age and children have always been accorded highest priority in the government policies, and indeed the maternal and child health services were essentially the forerunner and foundation of health care in the country.

• This focus on maternal and child health gets translated into resource allocation to strengthen the infrastructure for service delivery. If there is a single most significant contributor to the reduction in mortality rates, it is the continuous improvement in safe deliveries. Safe deliveries have increased from 86.7 per cent in 1990 to 98 per cent in 2005. Malaysians are fortunate to have a health system in the public sector that constantly undergoes improvement in terms of both quantity and quality of health infrastructure, better equipment and transport facilities

• Besides improving infrastructure and access, human resource development in terms of quantity, quality and distribution also plays a vital role. The new clinical specialties and sub-specialties that have been developed include family medicine specialists at primary care level and perinatologists, neonatologists and feto-maternal specialists at tertiary level. Although the number of traditional birth attendants has dwindled, it stills plays a ositive ‘social role’.

• The other specific maternal and newborn health strategies that Malaysia adopted which led to reduction in maternal and child mortality are:

• The high risk approach since the mid 1970’s, putting in place a reliable referral and feedback system including incorporating elements of colour coding system, emergency obstetrics care and providing empowerment to primary health care providers.

• Establishment of an enquiry system whereby every maternal death is investigated and audited.

• Increasing access to quality family planning services and information. It has led to lower fertility levels among women at the youngest and oldest childbearing ages as well as among those of high parity groups known to have relatively higher risk of maternal mortality.

• The creation of alternative and low risk birthing centres that either decongests high level hospital care for more resources to high risk cases, or to provide safe delivery at the clinic level.

• Attempts in improving newborn health include better transport for referral, better facilities in hospitals for neonates, identifying and putting in place a system for classifying perinatal deaths (the Wigglesworth classification) that lends itself for a national reporting system and thorough reporting, training in neonatal resuscitation, and neonatal retrieval.

• Infant and child health has improved with specific initiatives such as promotion of breastfeeding, growth monitoring, oral dehydration for diarrhea, screening of newborns for selected conditions, early detection and management of disabilities, immunization including the introduction of newer vaccines into the EPI such as the vaccine against Hib disease.

Sustaining the maternal and child mortality at current low level, and reducing it even further, requires maintaining commitment, human and financial resources, and more innovative programme strategies.