Malaysia is a heterogenous, multi-ethnic society with a population of 30
million, of which 74% reside in urban areas. Since gaining independence, the
main priority of health policy makers is to provide and enhance the delivery of
health care for the disadvantaged communities, namely the rural populations:
women, children and the disabled. The Ministry of Health is the main healthcare
provider in Malaysia. There has been much development in the healthcare system
of Malaysia from the time of independence; starting from the development of the
two-tier system and its subsequent transformation to a three-tier system, as well
as the extension of healthcare delivery into rural areas in Sabah and Sarawak
through the implementation of mobile teams and the Flying Doctor Service (FDS).
The improvement in health status of the general population, particularly in
rural settings is remarkable and in line with the Tenth Malaysian Plan on the
road to Vision 2020. However, the current shift in disease burden from
communicable to chronic non-communicable conditions continues to undermine
these efforts. As a result, deficiencies in healthcare delivery and the health
status of populations still exist, albeit more rampant in rural populations. We
propose the implementation of Advanced Practice Nursing (APN) in the community
as a solution to bridge gaps in health care provision in rural areas in line
with Vision 2020. An advanced practice nurse is a specialty-specific registered
nurse with an expert knowledge base and clinical competencies for extended
practice. Modelled on Australian and Norwegian systems, advanced practice
nurses are recruited directly from rural communities, with a better understanding
of the population, and access to the local cultural norms, such as traditional
healers. APN training is still in its infancy in many developing countries.
Evidence from other similar models has proven that the care provided by
specialised nurses results in higher patient satisfaction, greater access to
health care, improved outcomes and cost effectiveness. APN compliment the care
provided by physicians; reducing doctors’ workload, patient waiting times and
providing care in the convenience of the patients’ homes. To succeed in
improving health care outcomes by APN, the utilisation of evidence based
practice, audits, guidelines, and escalation of specialist care at hospitals
and continuous medical education are essential.