Social Security Transformation For Health And Wellbeing of Malaysian Employees
Social Security Organization

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Health and wellbeing of workers in Malaysia is paramount to the nation. The role of Social Security Organization of Malaysia (SOCSO) is to provide comprehensive social protection for workers arising from injury or disease. This is based on three pillars, namely compensation, prevention and rehabilitation. In the past, SOCSO’s main focus was on compensation. However, SOCSO learnt that the root cause of its high compensation was due to road traffic accidents, non-communicable diseases (NCDs) and lack of proactive measures in prevention and rehabilitation. These have led to the rise in health concerns, therein increasing vulnerability towards poverty hence affecting economic growth and decent work. SOCSO statistics show that between 2000 and 2010, the number of commuting accidents has increased by 12.31% from 19,620 to 22,306 which contributes to an average of 57 people suffering from the impact of disability every day. This has resulted in a loss of productivity of up to 2.8 million man-hours per annum, causing an enormous loss of productivity for the nation and a burden on social security funds. In 2010, a total of 10,409 workers have claimed to be invalid or died due to NCDs. These had continued to increase, parallel to the worsening health of the population as reported by the Malaysian National Health Morbidity Surveys. These alarming numbers have become a public concern because most of the workers are the breadwinners of their families and if they are unable to work, their earning capacity is reduced and their dependents would be financially affected. A high number of less affluent households would have an impact on the general society as well as the nation’s economic growth and a possible collapse of the social system. In the past, health promotion and rehabilitation are seen as an exclusive realm of health authorities, conducted through general community approach. As a result, a gap is seen in the health promotion and rehabilitation outreach by not utilizing workplaces as healthy settings. SOCSO, meanwhile, was seen as being reactive by providing compensation and benefits to workers following the loss of their health or earning capacity due to injury or diseases. That is why change is required for SOCSO to be dynamic in supporting all aspects of prevention through its close links with the employers and workers. This includes primary prevention initiatives such as injury prevention and health promotion, and tertiary prevention initiative such as Disability Management through the Return to Work Program (RTW).

B. Strategic Approach

 2. What was the solution?
SOCSO introduced a transformation on the delivery of its services by restructuring the pillars of social security in Malaysia to look into ‘prevention before rehabilitation’ and ‘rehabilitation before compensation’. SOCSO began to introduce focus-based and dynamic programs in the area of injury prevention through its Workplace & Commuting Safety Program, health promotion through its Health Screening Program (HSP) and rehabilitation through its Disability Management Program to ensure no one is left behind. The solutions are driven to address the crux of the problem which is to ensure safe and healthy employees, minimize disability durations, prevent further disability as well as improve the general health and wellbeing of workers.

 3. How did the initiative solve the problem and improve people’s lives?
Given that the main cause of disability and death among workers is due to workplace and commuting accidents, SOCSO developed workplace and commuting safety programs, targeted to all employees in the country. The aim of these programs is to prevent death or injuries by raising awareness on safety at work, safe commuting to or for work, improving safe work practices and ultimately, create a safe work culture among Malaysians. The initiatives include the implementation of outreach programs which are targeted at not only the working population but also the general public, specific safe riding programs for targeted workers and research and development (R&D). SOCSO had also spearheaded the development of the first guidelines on commuting safety. All programs have its uniqueness and utilize a variety of measures to enable maximum outreach. These initiatives have contributed towards the reduction in the rate of workplace and commuting accidents in the country, which is part of the objectives of the SOCSO Prevention Plan (2011-2015) and the National OSH Master Plan (2011-2015). Promoting healthy lifestyle among workers is a challenge in a country where the prevalence of NCD risk factors such as obesity, diabetes, hypertension and hypercholesterolaemia is among the highest in Asia. The SOCSO HSP is an initiative that provides health promotion beyond awareness campaign. It also provides a facility to enable the workers to be in charge of their own health. This is implemented by offering a free comprehensive health screening that they can obtain at general practice clinics throughout the country. The target group of this annual program is workers aged 40 and above. Through this program, workers are given the opportunity to identify their health risk, seek early treatment and prevent disability that renders them unable to work. Almost half a million people underwent the health screening and it was found that 67% of them went for a health check for the very first time. SOCSO discovered that 73% were obese or overweight , 37% with hypertension, 62% with high cholesterol, 9% with diabetes and over 1,000 women detected with breast cancer while 460 with cervical cancer. Meanwhile, the objective of SOCSO’s Disability Management Program that consists of physical and vocational rehabilitation interventions, is to restore and increase the functional and cognitive capacity of workers with injuries or illnesses to enable them to return to work as soon as possible and in the safest possible manner. This program, which is a tertiary prevention approach, utilizes the biopsychosocial, multidisciplinary and case management concepts to assist workers with injuries and illnesses through appropriate interventions that are geared towards decent work and economic growth. SOCSO was providing passive rehabilitation services in the past. However, with this initiative, proactive and active rehabilitation measures are provided through case management to ensure interventions are dynamic and person-centered, which are more effective towards sustainable return to work. With these interventions, workers with disabilities are able to continue earning an income and become productive members of society, which will further reduce their vulnerability to poverty. This program does not only have a positive impact on the physical recovery but also a positive influence on the morale of the workers concerned. Being economically empowered allows for minimum disruption to the family as well as the social and working life of the injured or ill workers. Building on to the success of this program, a one-stop integrated rehabilitation services consisting of physical and vocational rehabilitation facilities was established through SOCSO’s Rehabilitation Centre as well as the a one-stop online inventory system (PIMS) to provide immediate rehabilitation and medical devices for workers in need.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
In the implementation of these initiatives, SOCSO employs a range of innovative approaches to maximize visibility and utilization of programs. [Embracing Technology] The HSP Program is conducted using an online system which enables seamless doctor-patient consultations and allows SOCSO to perform further analyses. The Disability Management Program uses technology for predictive modeling and employs data centric measures for efficient Disability Management services. In prevention, SOCSO leverages on digital and electronic media to raise public awareness by producing TV series, a rare medium used for safety promotion activities. [Individualized Support] SOCSO’s Disability Management Program embeds individual support through its Disability Managers to facilitate each worker to return to work to the same employer or secure another job. The prevention and health promotion program provides for innovative measures by providing extensive support to companies with high risk of accidents or diseases through support and compliance programs. [Bringing everyone on board] The HSP is the first free mass health screening program in the country. With the HSP, SOCSO brought health screening to vulnerable groups with free consultations on their health and disease prevention. The RTW is also the only disability management program focusing on workers with disabilities in a structured and systematic manner.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
On a yearly basis, SOCSO organizes 400 road safety advocacy programs in the targeted workplaces; distributes more than 10,000 helmets, road safety vests, and stickers; and has supported 400 workplace safety programs conducted by Non-Governmental Organizations (NGOs). Annually, SOCSO reaches out to over 20,000 workers through the Workplace & Commuting Safety Program; and 5,450 workers trained in 218 defensive driving and safe riding programs. SOCSO has also developed fourteen workplace and commuting safety videos and conducted annual academic research on safety and health in collaboration with international and national universities. The Disability Management Program has benefitted 23,850 workers with injuries or illnesses, who have been given physical and vocational rehabilitation interventions. From this number, 75% have been successfully rehabilitated and have returned to and retained at the workplace, assisted by SOCSO Disability Managers. The SOCSO Rehabilitation Centre has so far assisted 1,266 workers with comprehensive rehabilitation through a one-stop integrated rehabilitation center which aim to improve their quality of life, functional improvements as well as enabling return to work. The PIMS, on the other hand, has efficiently distributed 35,000 items to workers with injuries or illnesses throughout Malaysia. The HSP program specifically covers men and women above 40 years of age, who are potentially at risk of NCDs whereas the Disability Management Program covers workers with injuries or illnesses. The Workplace & Commuting Safety Program covers all workers, employers and the general public where this preventive efforts are focused at minimizing premature deaths due to NCDs as well as preventing disabilities due to injuries or illnesses. Some 2.4 million users are eligible for the HSP Program. On the whole, these initiatives cover 16 million registered workers and close to 1 million employers who contribute to the social security system under SOCSO.
 6. How was the strategy implemented and what resources were mobilized?
The rollout started with the prevention activities in 2009, followed by the nationwide implementation of the disability management program in 2010 and the health screening program in 2013. All three (3) initiatives, which is are funded entirely by SOCSO, had similar strategies in their implementations namely the design of policy and framework, capacity and infrastructure building, pilot projects, awareness campaign, implementation, governance and evaluation of the program. [Tripartite engagement between government, trade unions and employers federation] In line with the national social security strategic plan of the Ministry of Human Resources of Malaysia and SOCSO’s strategic plan in the area of prevention and rehabilitation, plenty of discussions and involvement with all key stakeholders were held. Discussions with trade unions and employers federation on each of the initiatives, its scopes, objectives and expected outcomes are presented to this group prior to implementation. [Pilot projects with evaluation reporting to the board] Both prevention and rehabilitation initiatives commenced with a pilot project on a smaller scale at the beginning. When the outcome yielded positive results, and after reporting to the SOCSO board and at the ministerial level, programs were expanded nationwide covering a larger target market while enhancing its capacity building through human resources and infrastructure. Prevention activities took on a paradigm shift in 2009 by implementing more sophisticated and active preventive program where today, it spearheads prevention together with the Royal Malaysian Police and many NGOs as well as other stakeholders. Meanwhile, the Disability Management Program commenced with a pilot project with 5 Case Managers and 1 Job Placement Officer. With regular reporting and program enhancement, it expanded progressively and in 2016, the program was driven by 40 Case Managers and 10 Job Placement Officers. The program now is not only one of SOCSO’s primary KPI but also a ministerial KPI where the outcome and success of the project is made available to the general public. [ICT System – automation in service delivery ] The HSP and the Disability Management ICT system was developed in-house with a very minimal cost. This system connects not only doctors but also service providers which can be centrally monitored by SOCSO. Technology has further strengthened all initiatives not only through practice but also by allowing SOCSO to capitalize on a lot of data which has been gathered since 2010, by using predictive modeling to make more informed decisions. The generous amount of data generated through this system has made it possible for a lot of R&D to be conducted with international and national academic institutions. [Capacity Building and Professional Certification] Parallel to the enhancement of service delivery, enhancement of the professionalism of the human resource aspect is also given key consideration by SOCSO’s top management. Since 2010, SOCSO established a partnership with the National Institute of Disability Management and Research, Canada to provide Disability Management Certification and Return to Work Coordinator Certification to all practicing prevention and rehabilitation services related employees. SOCSO employees are also sent for formal safety and health training courses locally and abroad to become leaders and experts in this field. This is the focus in SOCSO’s strategic plan on the human resource development potential. [Financial Resources] Since these initiatives were implemented, approximately USD2.2 million a year was allocated for prevention, USD9.4 million a year for disability management and USD45 million allocated to kick start the HSP program. These programs were funded entirely by SOCSO.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
All initiatives involved engagements with relevant stakeholders such as SOCSO’s Board, Malaysian Employers Federation, Malaysian Trades Union Congress, Ministry of Health, Ministry of Human Resources, Ministry of Finance, Malaysian Medical Association, National Council of Safety and Health, National Council for Persons with Disabilities, academic institutions, various NGOs and the public. This broad range of stakeholders has a legitimate interest in prevention, rehabilitation and health promotion interventions in the workplace. Respective stakeholders were involved from the beginning of discussions until the evaluation process was completed. Apart from regular discussions, the HSP Program has established a steering committee to formulate policies and procedures of the program including in determining screening parameters, health screening charges as well as program delivery methods. The committee comprises representatives from the Ministry of Health, Malaysia Medical Association and Malaysia Laboratory Services. SOCSO has also collaborated with the Ministry of Health to ensure the scope of the program is relevant and medical evidence based. The proposals for all prevention programs are based on inputs from stakeholders, which are then endorsed by SOCSO Accident Prevention Committee. The implementation of the approved prevention program will then be carried out by the SOCSO in collaboration with relevant accident prevention stakeholders. The outcome is then reviewed by this same committee for the planning and improvement of future programs. The design of the Disability Management Program on the other hand was discussed with key stakeholders including the trade union and the employers’ federation, Ministry of Health, Ministry of Human Resources and various NGOs besides SOCSO Board Members. The Ministry of Human Resources also played an integral role in monitoring of this program during the infancy stage.

 8. What were the most successful outputs and why was the initiative effective?
The unemployment among workers with disabilities contributes to the loss of valuable manpower to the economy. Since the start of the pilot project, SOCSO has assisted 15,479 workers with injuries or illnesses to return to and retain at work. With their inclusion into the workforce, they play an integral role as part of the nation’s human resources, enabling ‘decent work and economic growth’. The inclusion of persons with disabilities (PWDs) into the workforce also promotes diversity and encourages equality as per the recommendations by the United Nations Conventions on the Rights of Persons with Disabilities (UNCRPD). This program is effective because it also applies a holistic, biopsychosocial and multidisciplinary approach. These are facilitated by Case Managers who work with various parties including clinical services, workplace involvement, social and community support while looking into the spiritual aspects. By returning them to work, the ‘reduction of poverty among workers with disabilities’ can be achieved. By being employed, workers with disabilities are able to meet their families’ expenses, make purchases, save and invest, thus strengthening their social and economic independence. ‘A large number of people are able to undergo health screening’. This will support the government’s agenda in reducing premature mortality from NCD by one-third through the promotion of good health, wellbeing and quality of life for workers as indicated in the SDG. Road traffic and workplace safety promotion program had ‘halted the continuous exponential rise of in the number of injured workers’ in the country including those commuting to work. This outcome is most relevant in reducing global death rate due to road traffic injury. These initiatives are also in line with the strengthening of partnership and institutional coherence. ‘The transformation initiatives capitalize on existing and new international collaborations between SOCSO and other global players’. Close linkage with international players is formed through partnerships with the International Labour Organisation (ILO), the International Social Security Organisation (ISSA) and the ASEAN Social Security Organisation (ASSA) in the involvement in various technical committees and advisory roles, in the areas of prevention, compliance, disability management and specific guidelines. These initiatives are regularly featured on the global level through these organizations. The linkage also allows SOCSO to assist other developing countries to implement similar initiatives such as Disability Management Program which has been introduced Namibia, Botswana, Singapore and Indonesia.

 9. What were the main obstacles encountered and how were they overcome?
There are several obstacles encountered in the implementation of the programs under the transformation initiative. The first being lack of awareness towards safety and healthy lifestyle promotions, hence the response from employees in the country is a challenge. The second major obstacle is the readiness and buy-in from the employers into the implementation of the programs, which is essential to ensure the success of the advocated intervention programs. In order to overcome these, SOCSO embarked on multi-pronged strategies. Promotional activities were conducted in various ways including breakthrough media approaches such as television series, short films and utilization of social media. Mass campaigns for workplace and road safety, health campaigns and job fairs specifically targeting the disabled were carried out to raise public awareness on the available facilities and programs. In order to enhance employer participation, direct engagement with employers was conducted through workplace and road safety advocacy programs, mobile-health screening programs and workplace RTW coordinator programs. Adequate number of service providers is needed for all the initiatives either to reach out to the target workers or to meet the needs of the workers involved. To draw support from service providers, SOCSO conducted initial discussions and then engagement of third party providers so that they were able to fulfil demands throughout the country. This has facilitated easy access of workers to the services of panel clinics and rehabilitation providers, improved efficiency and in the case of RTW program, reduced the disability period. Now, the initiatives had drawn support from 3,500 clinic, 258 laboratories, 126 mammogram centers, and 122 rehabilitation centers to provide services throughout the whole nation.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The transformation initiatives have changed the landscape of social security providence in Malaysia and enhanced healthcare delivery in the country. With these initiatives, the roles and expectations of the Social Security Organization also change, therefore improving service delivery. The combination of the different components of health screening program, disability management, injury and road accident prevention had reached more than 500,000 workers, and over a thousand employers annually. The outreach is many-folds than the number of workers reached through compensation for injury or illness. The health screening program had been utilized by more than 460,000 users, and met the needs of at least 66% of them who had undergone their first comprehensive health screening, previously hindered by their unaffordability. Another 1.9 million workers are currently eligible and have yet to undergo the health screening program. The disability management program is unique in meeting the needs of workers who became disabled from injury or disease. Without a proper support, they will be drawn into a vicious circle of poverty, and possibly, social ill. The program managed to return 15,479 workers with injuries or illnesses back to work. Given the limitation in mobility and social circumstances, the services are planned to be as near to the workers as possible. The geographical needs are met through establishment of return to work clinics at General Hospitals throughout Malaysia, Rehab Community Clinics and the establishment of SOCSO’s own state-of-the-art Rehabilitation Centre for a more comprehensive management of cases. The program is also responding to the needs of employers and employees alike, being the catalyst for workplace-based return to work coordinators. Meeting the needs of the workers is achieved through another innovative strategy in prevention of work injury and road accidents, by engaging NGOs and providing direct safety training to workers at their workplaces. The strategy has enabled NGOs to conduct workplace safety and health training annually, many of which had not included workplace safety and health in their activities previously. More than 20,000 employees are involved in road safety and workplace safety training annually through workplace advocacy programs nationwide. These programs are implemented outside the purview of services provided by the government, therefore generating positive impact on public services as they complement the existing programs. The health screening program adds on to the primary health care services, especially to the lower income group who forms the majority of SOCSO insured persons. The disability management program addresses the complexity of tertiary care and provides rehabilitation services beyond hospital stay. The work injury prevention and road safety programs are essential elements in the National Workplace Safety and Health Master Plan heading towards the year 2020. The impact of the initiatives are measured based on the program achievements and milestones, claimant rates and compensation values; while at the same time, are also viewed through the national statistics on health, workplace injuries and road injuries.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Not Applicable

 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)
In general, the initiatives are accessible to all workers, regardless of gender. However, workers with disabilities and women workers benefit the most from the programs on offer. In response to the high incidence of breast and cervical cancers among women in the country, the HSP provides for free mammogram and pap smear screening for female workers. This increases the value of the screening by more than a 100% compared to their male counterpart. Considering women with disabilities are more vulnerable to poverty, this program further strengthens the economic empowerment of women where close to 30% benefitted from the program.

Contact Information

Institution Name:   Social Security Organization
Institution Type:   Government Department  
Contact Person:   Azlan Darus
Title:   Prevention & Heath Promotion  
Telephone/ Fax:   +603-42645399/+603-42510100
Institution's / Project's Website:  
Address:   281 Jalan Ampang
Postal Code:   50538
City:   Kuala Lumpur
State/Province:   Wilayah Persekutuan

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