| 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?
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 aspect such as IT system that involved in the implementation did not incur any cost as it uses existing amenities.
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.