Ubat Melalui Pos 1Malaysia (UMP1M)
Ministry of Health Malaysia

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
In Malaysia, the public healthcare services provided by the Ministry of Health (MOH) are almost fully subsidized by the government whereby all Malaysians can have access to healthcare services with as low as MYR 1.00 (USD 0.30). Due to this fact, MOH health facilities attract a large number of patients. This is one of the main contributing factors for the 10-15% annual increase in MOH’s pharmaceutical expenditure from RM 891 million in In MOH healthcare settings, patients with chronic diseases are scheduled for appointments with their doctors at intervals of between 3 – 6 months whereby they will be given prescriptions for their medicines for the same duration. However these medicines are only supplied on a monthly basis. This policy, which is similar to the practice in most other countries, was implemented to ensure medicines are used appropriately and to reduce wastage. This policy has resulted in congestion and longer waiting time in the pharmacies as the pharmacy personnel need to refill prescriptions for these chronic cases as well as for those with prescriptions for acute conditions and other emergency cases. Statistics showed that the number of prescriptions received by public health facilities has increased by almost 10% annually. For the year 2012, we received 47.5 million prescriptions as compared to 43.4 million prescriptions in year 2011. From MOH data, approximately 30-40% of the total number of prescriptions received are repeat prescriptions for patients with chronic illnesses. These patients make regular visits to the pharmacy on a monthly basis to get their prescriptions filled. As patients with chronic illnesses are often the elderly, they may be unable to collect the medicines themselves and may have to rely on family and friends to get their prescriptions filled and this again may add to their problems. Besides the inconvenience to patients, repeat prescriptions also incur additional travelling costs, parking woes and stress as patients may not be able to come at the appointed collection day. These factors invariably may lead to non-compliance of these patients to their medicines regimen and resulting in sub-optimal management of their health conditions. Such a situation can lead to poor health outcomes and escalating healthcare costs both to the individual as well as to the nation. Based on MOH Malaysia’s data in 2012, Non-Communicable Diseases (NCD) are on the rise and approximately 17 million Malaysians which constitutes 60.7% of the population are currently suffering from NCD. As poor compliance to medicines regimen could be one of the contributing factors for this increase, it is important to ensure that this category of patients have equitable and easy access to their medicines. Pharmaceutical Services Division (PSD) under the MOH since 2004 had introduced several initiatives whereby patients can refill their repeat prescriptions easily, at their own convenience and without much hassle. The initiatives include collecting medicines from any MOH facilities nearer to their homes through an integrated supply system known as Sistem Pendispensan Ubat Bersepadu (SPUB) and appointment system via the Short Message System (SMS)/telephone/e-mail/fax or Drive-Through Pharmacy. However, all these options still require patients to come to the pharmacy to collect their medicines and thus have minimal impact on reducing the congestion and waiting time.

B. Strategic Approach

 2. What was the solution?
The dire need to decongest the pharmacies and in tandem with one of Malaysia’s Health Services goals of bringing ‘care close to home’ led to the initiative of having a medicine home delivery service whilst improving patients’ access to medicines. With this, instead of patients coming to the pharmacy to get their medicines supply, medicines will be delivered right to their doorstep. A series of discussions were held with Pos Malaysia Berhad (PMB), a Malaysian National Courier Company, to engage them in this project. PSD explained the background of the problem, the need for their social contribution and emphasised that the medicines to be sent by their courier service called PosLaju need to be handled with care, delivered in a timely manner and at a minimal delivery charge. A questionnaire survey was also conducted in Putrajaya Hospital to gauge willingness of the patients to pay for this service with a minimal charge of MYR 5.00 per parcel. The survey results showed that most patients (74.7%) welcomed the new service with 60.2% patients indicating willingness to pay for the service . Based on the positive response from the patients and also good co-operation from PMB, Putrajaya Hospital took the pro-active action by implementing this service in 2010 by naming it Pharmacy Home Delivery Service. With the acceptance by the patients and good response for the pioneer project in Putrajaya Hospital, in 2011 PSD decided to expand this service to other facilities throughout Malaysia. This service was rebranded “Ubat Melalui Pos 1Malaysia” or UMP 1M in short which means “Medicines by Post 1Malaysia” as it reflects the delivery of medicines by post throughout Malaysia. UMP1M initiative is also in tandem with Malaysia’s National Blue Ocean Strategy (NBOS) that was adopted by the government with the aim of delivering services to the public that are of high-impact, low cost, and timely-executed. Therefore this initiative creates opportunities for the public to have an easy access to their medicines with less hassle and at minimal cost. The two-pronged main objectives of UMP 1M are: a) For patients: • To ensure continuity of patient’s medicines supply at their convenience with no waiting time at the pharmacy; • To ensure patients receives uncompromised quality medicines; • To promote good compliance to their medication therapy; • To reduce the monthly burden of cost and time of travelling to the health facility b) For Pharmacy • To reduce congestion at the pharmacy by decreasing the number of patients coming to collect their repeat medicines supply; • To promote a Public-Private-Partnership with PMB. The target population that will benefit from this initiative are: • Patients with chronic illnesses; • Patients who are elderly; • Patients who are living far from any health facilities; • Working patients/ caregivers.

 3. How did the initiative solve the problem and improve people’s lives?
The Ubat Melalui Pos 1Malaysia (UMP1M) is a creative and innovative approach because: 1. It’s a unique concept of delivering medicines to patients through mutual public-private partnership (PSD,MOH and PMB) to ensure the continuity of pharmacotherapy for patient’s health benefit; 2. In line with the Goals of Malaysia's Health Services, to bring the service close to home, medicines will be delivered right to the patients’ doorstep instead of coming to the pharmacy to get their medicines supply; 3. It uses the existing delivery service by PMB; 4. Hospital with electronic information system has the ability to receive patient’s request to use UMP1M via online provided their prescription is valid. The IT system is linked with PMB and the payment can be made via online banking service so that patients or their caregiver can do the transaction at their own convenience; 5. The delivery initiative eliminates the waiting time at the pharmacy and provides convenience for those who are unable to travel constantly due to lack of time, ill health or other limiting situations; 6. It is unique and innovative in a way that patients can use various modes of communication such as SMS, telephone, email or fax to inform the pharmacy as a reminder to send their medicines before the collection due date.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
a) Planning Phase (2009 – 2010) 1. Idea of creating a new pharmacy service of care close to home was proposed due to a lack of impact in the current strategy to reduce the congestion at the pharmacy. 2. Engaging into a smart partnership with PMB with a sense of social responsibility willing to deliver medicines to patients at a reasonable cost. 3. Conducting a survey amongst patients to assess their acceptance and their willingness to pay on such a service. 4. Implementing the pioneer project at Putrajaya Hospital which is a tertiary care hospital in Malaysia. 5. Based on the outcome of the initial pioneer project, setting up a taskforce which included representatives from all the public hospitals where the service will likely to be provided. Issues addressed were as follows: a. Discuss possible pitfalls and their solutions; b. Develop Standard Operating Procedures (SOP) for the service - Garis Panduan Perkhidmatan Ubat Melalui Pos 1Malaysia; c. Design promotional materials such as bunting and pamphlet for patients; d. Post some possible “Frequently Asked Questions” to educate patients and also address their concerns on UMP 1M service on the PSD website. 6. As the service involved a third party for the delivery of the medicines, a Service Agreement in the form of a Memorandum of Understanding (MoU) was prepared by the legal divisions of both MOH and PMB. The MoU which has 3 years tenure was signed between representatives from the MOH and PMB (as the parent company for PosLaju). As a corporate social responsibility, a 5% contribution from the gross income of UMP1M will be donated by PMB into a Cancer Trust Fund managed by PSD, MOH. b) Implementation Phase (2011-2013) 1. An official launching by the MOH was held at Putrajaya Hospital where the service was first implemented and simultaneously throughout the country. The publicity received during the launch served very well in promoting the service and led to many patients requesting for the service. 2. The taskforce under the PSD continued to meet frequently during the initial phase of the service to resolve some issues which were encountered initially such as getting patients to pay for a service. 3. The PSD then extended the service in a phase wise manner to include other smaller government hospitals as well as health clinics 4. Nationwide promotion done together by PSD, MOH and PMB through mass media (TV, radio) and kiosk. 5. Monitoring and analysis of the service by using standard monthly data collection form by PSD, MOH. c) Future Plan (2014) 1. A Patient Satisfaction Survey is planned to be conducted in 2014; 2. Renewal of MoU with PMB; 3. Engaging other courier companies in this medicines delivery services especially for delivery to remote areas in Peninsular and East Malaysia.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
1. Putrajaya Hospital, a tertiary government hospital a. Implementing the pioneer project 2. Pharmaceutical Services Division (PSD), Ministry of Health Malaysia a. Conducting series of follow up discussion and signing of MoU with PMB b. Expanding the service nationwide c. Develop Standard Operating Procedures (SOP) - Garis Panduan Perkhidmatan Ubat Melalui Pos 1Malaysia d. Design promotional materials e. Monitoring and analysis of the service 3. Pos Malaysia Berhad a. Delivery of medicines b. Contributes to the Cancer Trust Fund as part of Corporate Social Responsibility (CSR) 4. All state pharmacy department a. Coordinate the Implementation of UMP1M at all health facilities under their supervision b. Promoting UMP1M to patients c. Coordinate relevant data collection for submission to PSD,MOH 5. All pharmacy department at health facilities a. Implement UMP1M b. Relevant data collection c. Promoting UMP1M to patients 6. Legal Advisor Office, MOH Malaysia a. Provide advices on legal matters
 6. How was the strategy implemented and what resources were mobilized?
Financial The implementation of UMP 1M has incurred minimal cost of MYR 48,000.00 to the government for nationwide promotion which includes preparation of buntings, pamphlet and promotional video. PMB also contributed in promoting UMP1M in the mass media. The preparation of the medicine packages consisting of packaging materials and labeling machine did not incur any cost to the government as it’s borne by PMB. Nonetheless, cost of delivery is paid by patient upon receiving the medicine package at MYR 5.00 per parcel. Technical Technical aspect such as IT system that involved in the implementation did not incur any cost as it uses existing amenities. Human Resources Human resource was mainly needed to pack the medicine parcels without compromising the medicines quality and patient’s safety. All the facilities implementing UMP1M used the existing human resources by deploying them to pack the packages during non-peak hours.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The main outputs of UMP1M are: a) Number of facilities In the initial phase (2010), only one facility offered UMP1M. The number of facilities offering this service has been increasing yearly and throughout the years 2011, 2012 to 2013 (until June) with 53, 102 and 108 facilities offering it respectively. b) Number of parcels In 2011, number of medicines parcels delivered to patients were 14,062. By 2012, it increased 366.6% to 51,553. As for 2013, data collected until June recorded 33,480 parcel deliveries and the number is expected to double by the end of December. c) Decongestion improved pharmacy waiting time From the data above, it can be assumed that the congestion in the pharmacy was reduced by 51,553 patient’s visits in 2012 as 1 parcel sent is equivalent to 1 patient visit. A reduction in congestion also improves the waiting time at the pharmacy. This was evident from the implementation of UMP1M which has ensured that waiting time target of at least 95% patients received their medicines within 30 minutes was achieved and maintained.

 8. What were the most successful outputs and why was the initiative effective?
The implementation of this medicine delivery service is something new to Malaysian healthcare scene. Therefore, to ensure continous and successful operation of this service, periodic monitoring is done by PSD through biannual committee meetings and standard monthly data collection. Apart from that, dialogue sessions are held with PMB to discuss and resolve issues related to UMP1M. By year 2013, UMP1M which is part of the Value Added Services (VAS) was chosen to be monitored at national level as one of the Director General of Health’s Key Performance Indicators (KPI). A set target for this KPI will ensure that UMP1M is the preferable VAS of choice among patients to collect their repeat prescription.

 9. What were the main obstacles encountered and how were they overcome?
In Malaysia, patients pay MYR 1.00 (USD 0.30) registration fee for out-patient treatment and MYR 5.00 (USD1.70) at the specialist clinics (e.g orthopedic clinic etc) and all medicines are supplied free of charge at the government hospitals and health clinics. As patients are accustomed to obtaining medicines free of charge, there was some resistance from patients to use this service as they would have to pay the courier company a minimal fee of MYR5.00 (USD1.70) to have their repeat medicines delivered to their homes. However, as this service is optional, it was not a major issue as patients who were unwilling to pay could still use any of the other appointment system to collect their repeat prescriptions. Acceptance of this service has increased mainly through the patients themselves. Patients who have used this service have realized that the delivery charges is very much less compared to their travelling expenses and time spent in coming to the hospitals and clinics to collect medicines themselves. PSD has also doubled the efforts to promote UMP1M as the preferable VAS of choice. Coverage of PMB via Poslaju service is limited in certain area especially in the rural areas of East Malaysia. This issue was addressed to PMB and continuous discussions were held to improve their coverage.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Through the introduction of UMP1M, 5 key benefits have been identified as follow: a) Reduction of time spent by patients to collect their medicines. The conventional way of collecting medicines requires the patient to come to the pharmacy which consumes a considerable amount of their time. For example, a patient travelling to and fro his house in Shah Alam to Putrajaya Hospital which is a distance of 80 kilometers: • Travelling time (to & from) : ~ 80 minutes (with normal traffic) • Time taken to find parking (as parking is limited in hospital compound) : 15 minutes • Average waiting time during busy hour at the pharmacy: 30 minutes Total time spent by patient to just collect his medicine supply: 125 minutes or 2 hours 5 minutes Thus, by using UMP1M, patient can spend their spare 125 minutes for other activities. b) Travelling cost saving For example, a patient travelling to and fro his house in Shah Alam to Putrajaya Hospital which is a distance of 80 kilometers: • Travelling cost (to & from) with average cost of MYR0.30 per km : 80km x MYR0.30 = MYR24.00 • Toll: RM 3.90 x 2 = MYR 7.80 per travel. • Total cost spent by patient to just collect his medicine supply: MYR 31.80 per travel By using UMP1M, patient only spends MYR5.00 per parcel with saving of MYR26.80. In addition to the example above, the cost saved by patients can be illustrated by the following example: • With estimation cost of MYR0.30 per km, the fees per parcel (MYR5.00) covers the radius of 8km. Thus this delivery initiative will greatly benefit patients who live outside the radius of 8km. c) Patient’s satisfaction From 2011 until November 2013, PSD only received 3 unofficial complaints from patients regarding UMP1M which is only 0.003% from the total parcels (99,095) sent. d) Generate income From 2011 up till June 2013, a total number of 99,095 parcels were successfully delivered by PMB to the patient with a gross income of MYR 527,629.00 where MYR 19,025.00 was donated to Cancer Trust Fund managed by MOH. By implementing this iniative, UMP1M generated income for the stakeholders. The implementation of UMP 1M has not incurred any implementation cost to the government as the packaging material and pick up costs are all borne by the courier company. e) Public-Private Partnership (PPP) Implementation of UMP1M provided an opportunity for smart partnership between MOH Malaysia and PMB while fulfilling the NBOS target of providing services to the public that are of high-impact, low cost, and timely-executed. This partnership also provides a win-win situation which is beneficial for both parties whereby a Cancer Trust Fund is established for patients benefit and PMB offer their corporate social responsibility by contributing to this trust fund for cancer patients in the nation.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
This UMP 1M service is very sustainable as financially it does not involve high cost for setting up and its continuous maintainance. Secondly, this service is very beneficial to patients as it is a hassle-free way for obtaining their medicines. This in turn helps ensure continuity of their medicines supply and can lead to better medication compliance and improved health outcomes. Eventually it will also benefit the nation’s health status as health conditions of its people are properly maintained. This service is also transferable, and steps to expand it to more government health facilities in Malaysia have been taken since it received encouraging feedback from its users i.e. patients. Since its commencement, a total of 108 health facilities have offered this service for patients use compared to only 1 in 2010. Several non-MOH hospitals such as the University Hospitals under the Minstry of Education have also used the same model to send medicines to patient’s home using a courier service. This shows that the concept of providing care close to home i.e. delivering repeat medicines direct to patients is applicable everywhere since the service is very beneficial to all (patients and providers) and is easy to put into practice without involving huge start-up costs on the part of the government.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Ministry of Health Malaysia understands patients’ needs and in line with our motto, ‘Kami Sedia Membantu’ which means ‘We Are Ready to Help’. By implementing this service, we have proven our endeavor to offer better healthcare accessibility for the people. UMP 1M has served to help patients with chronic illnesses to obtain their repeat prescription with ease in a hassle-free manner. This in turn helped to improve patient’s compliance towards their medication regimen and ultimately, better disease control. Pharmaceutical Services Division always strives to reduce the congestion at the pharmacy for shorter waiting time for patients by implementing various strategies. This has been proven by the fact that the waiting time at the pharmacy was maintained above 95% patients received their medications within 30 minutes after the implementation of the strategies. The initial resistance by patients to pay for UMP1M was overcome through detailed explanations on the benefits they will gain from this service. This project also demonstrated that there are opportunities for the government to engage in smart partnerships with the private sector with a win-win situation for the benefits of the patients towards attaining better health outcome for the nation. Also by adopting the National Blue Ocean Strategy in implementing UMP1M , a rapidly executed, low-cost initiative with high impact outcome for the public shows that the Blue Ocean Strategy is achievable in government setting with cooperation from private sector.

Contact Information

Institution Name:   Ministry of Health Malaysia
Institution Type:   Government Agency  
Contact Person:   Noor Hisham Abdullah
Title:   Datuk Dr  
Telephone/ Fax:   +603-88832545/ 603-88895542
Institution's / Project's Website:  
E-mail:   pej.kpk@gmail.com  
Address:   Ministry of Health Malaysia, Level 12, Block E7, Complex E
Postal Code:   62590
City:   Putrajaya
State/Province:   PUTRAJAYA

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