More on the PHCFS

We spent more then 3 hours at the Ministry of Health (29th June 2006) negotiating with Dr Khairi (Director of Medical Services) and Dr Radzi, his subordinate. It looked like these two were the main workers formulating the regulations. They were very receptive but they did caution us that they were in no position to make decisions and would have to check everything with the minister. They also made it a point to tell us that our meeting was sanctioned by the Minister who is indeed interested in our input. That was a very good start.

We went thought the regulations, virtually line by line, starting with the registration forms. They were very receptive and shared with us the reasons certain regulations were written. They are obviously very concerned about the GATT timetable when we must open our borders to foreigners coming in to run healthcare services here. Looks like certain of the regulations were written with that in mind. I was very pleasantly surprise when they conceded that the regulations on the exact sizes of the clinic physical structures like doors and ceiling, were not practical, and that the whole section may have to be re-done. It's not often that anyone is willing to be so open about being wrong. Two thumbs up here.

The next section gave me a great headache. That was the "resus equipment" bit. I had prepared to advise only Basic Life Support aid for emergencies. That means that the GP only have to stock oxygen, mask and oro-pharyngeal airway. Khairi remarked that in his opinion, that is not adequate, as the GP is then no better than the common bystander. He wanted IV drips and defib to be included. I compromised by saying that this regulations should be introduced gradually. For now teach 90% GPs basic life support in 1-2 years, while the MOH place defibs and train firefighter and ambulance drivers to resus. In two years time, then the doctors should go into advance life support with advance CPR and defib/ECG.

He did not look too convinced, but promised to convey our recommendations to the minister. Of course, we went with all our flow charts and diagrams. The rest of the discussions were easier. The grievance mechanism, the case disease reporting, the registration forms, and the fees schedule were all accepted. In fact they were keen to fasttrack the fees schedule. We still have to write standard operating policy (part 4 of regulations) for them, for clinic policies, billings, patients rights, etc.

All in all, things went well. The tone of the meeting was positive where we were prepared to best serve the community and the ministry was prepared to accept input on how this would be best achieved. None of our goals were particularly conflicting in nature so it was easy to work together. I hope that we have made a difference. Time will tell whether this turns out into a "win-win-win"(for the community, the ministry and the doctors) but we are off to a good start.