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Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls

Section Two - Nine AUICK Associate City (AAC) Reports

6. Kuantan, Malaysia


Historical Background

Views of Administrators and NGO Service Providers

Objective RH Services Data


Dr. Marlia Mohammad Salleh 

Director, Pahang State Hospital (Participant of AUICK Second 2007 Workshop) Dr. Nurly Zahureen 
Public Health Specialist, Pahang 
Dr. Selva Kumar Sivapunniam
Pediatrician, Mentakab Hospital, Pahang 

Kuantan Map

Reproductive health In Kuantan Municipality falls under the jurisdiction of the Department Of Health, Kuantan, at the district level, and the Ministry Of Health, Malaysia, at the national level. 

Historical Background

Reproductive health services initially became operational with their main component, maternal and child care, as early as the year 1956. At that time maternal and child health evolved as an essential component of the National Rural Health Development Programme. Services were delivered through a system of rural health facilities, in the form of midwife clinics and health centres. This is a tier system of the Rural Health Unit, comprising of one main health centre, four health sub centres and 20 midwife clinics, to cater for a population of 50,000. A review undertaken in 1972 recommended the conversion to a two tier system by upgrading existing health sub centres to health centres, and midwife clinics to community clinics (Klinik Desa). This revised Rural Health Unit serves a population of 15,000 – 20,000, bringing the community closer to the health establishment. 

In recent years the coverage of these services was increased to include the urban areas, and they were delivered through polyclinics and MCH clinics. 

Reproductive health services in Kuantan are provided through the following facilities: 

- One Government General Hospital Centre
- One maternal and child health clinic 
- 20 community clinics 
- Four private hospitals and 66 general practitioner’s clinics (private clinics) 
- One National Population and Family Development Board Facility (NP FDB) 
- The Fertility Centre at the International Islamic University Malaysia (IIUM) 
- NGOs, including the Federation of Family Planning Association (FFPAM) 

Programmes and services for reproductive health In Kuantan include (1) maternal and child education and services including antenatal, postnatal and safe delivery, (2) family planning (3) an adolescent health programme (4) infertility clinics (5) the Women’s Health Programme and (6) prevention of HIV/AIDS and STDs. 

Views of Administrators and Non-Government Organization (NGO) Service Providers

Note: Since reproductive health is under the jurisdiction of the Ministry of Health at the national level and the Kuantan Health Department at the district/city level, thus interviews with the Mayor and Deputy Mayor were not conducted. However, we have included interviews with the Director of the National Population and Family Development Board (NPFDB), Kuantan City. 

These are question areas on which we requested administrators to comment in as much detail as possible. We requested first a selection of one of the response categories listed, then a narrative description. 

1. City Health Director 

1. What are considered the most important RH issues and conditions? 

The answer is family planning for health of mothers. 

Discussion and Analysis 

The family planning programme which initially started as part of the maternal and child health programme in the Ministry of Health Malaysia has contributed to the decline in the average fertility rate, and improved the health and quality of families in Malaysia. There is an increasing trend of new acceptors over the years, as shown by data collected by HMIS. However, the practice of effective family planning among high risk groups does not show much improvement. 

Looking at the Millennium Development Goals set for the country, Malaysia had achieved all targets set, except for Goal 5, which is on the Maternal Mortality Rate. Malaysia and Kuantan are to achieve the target set for the Maternal Mortality Rate which is 11/100,000 population by the year 2015. 

Currently the achievements of Kuantan City are as follows: 

- In the year 2008, there were five maternal deaths in the city. If we convert this to the Maternal Mortality Rate, it will be 74 per 100,000. 
- In the year 2010, by June there had already been four deaths, giving the MMR as 83 per 100,000. So, the city has to improve a lot on strategies for the reduction of maternal mortality if MDG no. 5 is to be achieved by the year 2015. One of the strategies is to identify high risk women and prevent or plan pregnancies for them. 

Other strategies include: 

- Making sure doctors and paramedics handling obstetric cases are experienced, adequately trained and privileged. 
- There should be adequate numbers of staff taking care of mothers. Especially in the categories of midwives, they should be sufficient in number. 
- There is a need for the pre conception clinic to identify high risk women and give counseling to them. 
- Antenatal care needs to be strengthened and more focused. 
- Training in emergency obstetric skills needs to be integrated into the training of all personnel handling maternity cases. 

The next issue which is of importance is the fact that Malaysia is undergoing a change in its socio-economic status, as well as a cultural transition. Changing attitudes to sexuality and availability of contraception promote promiscuity in the community. Adolescents in the age group 10-19 years are not excluded, as changes in lifestyle, family structure and moral and ethical values have contributed to social problems like abandoned babies, illegal abortions or unwanted pregnancies seen in the city. The number of unmarried pregnant mothers (or single parents) for Kuantan City for the year 2009 is 93 cases. The Maternal and Child Clinic at Jln Gambut Kuantan alone handled 50 unmarried pregnant mothers, including adolescent pregnancies. 

With the upward trend of HIV/AIDS since the first case in Malaysia in 1986, and considering the age group, appropriate strategies for healthy lifestyles among young people should be a priority. 

2. Overall how is the level of the city’s reproductive health condition? 

The answer is very good but could be improved. 

Malaysia has witnessed a significant reduction in the Maternal Mortality Rate (MMR) from 148 per 100,000 live births in 1970, to 63 per 100,000 in 1980, and 30 per 100,000 live births in 1998. From then onwards, it is noted that there is a relatively slow decline in maternal mortality compared to other indicators. On the other hand, it is of course to be noted that for maternal mortality, since the country as a whole has begun to attain low rates, further reduction becomes more challenging. Thus, bearing this in mind, even though the MMR in Kuantan is high, as mentioned earlier, this definitely could be improved if specific strategies are implemented. The other components of reproductive health services, like adolescent health, which was introduced in the 1990s as part of an expanded scope of reproductive health, are actually an achievement. 

3. Overall what priority does the city give to RH services? 

The answer is high. 

The problem of reproductive health in Kuantan is somewhat serious .This is why in terms of priority, it is high. Most of the unmet needs and demands in reproductive health services are concentrated amongst the high risk women, i.e. those aged 35 years and above, and those with a parity of more than five or multipara. Also, Kuantan Health Department is putting focus on the poor and those living in the urban slums of Kuantan. These marginalized groups are to be given attention under the five year development plan already in action. 

4. Overall how do you feel about the resources available for RH services? 

The answer is quite good. 

In terms of human resources, the issue of shortage of man power and expertise has always been given high priority. The expansion in scope for primary health care services has been compromised by inadequate numbers and mixes of personnel. The vacancy rate for medical and health officers is high, and for the community nurses it is also high. The existing norms for manpower requirement in the Ministry of Health at the national level have not been in keeping with new challenges in health care. 

New categories of primary care providers have been identified to accommodate the expanded scope in primary health care services, e.g. psychotherapists etc. 

5. Overall what are the specific needs of the City to improve RH services? 

The answer is less than adequate services; more is needed in funds and personnel. 

- To address the human resource issue, it is recommended to work with central agencies e.g. the Public Service Department, to implement the proposed manpower projection and norms, including needs in tandem with the expanded scope of services. 

It is also necessary to do the following: 

- Continue to upgrade existing skills to meet special demands. Every health clinic to be manned by a family physician as well as paramedics trained in specialized functions. 
-Develop relevant standard operating procedures, procedure manuals, clinical practice guidelines and consensus statement. 
- Strengthen continuous education in primary health. Develop criteria for credentialing of staff and accreditation of facilities and relevant training institutions. 
- Promote the use of information technology for career enhancement. 

Financial Constraints 

While the total budget allocation for the Ministry of Health in proportion to the National Budget has increased, the operating allocation given to the Public Health Programme, especially primary health care which is primarily preventive and promotive, has always been an average of 25.0% of the total budget, an amount which is half or less than that of the medical care programme. This does not take into consideration the medical care contributed by the private sector. It can be seen that the expenditure in improving curative medicine has increased steadily over the years, due to an explosive increase in new medical technologies, the rising demand for the medical interventions and the expectations of the public for technologies for solutions to all health problems. In an effort to address these rising health care costs, the government should invest more resources in prevention and promotion activities. 

6. What is the size of the city’s slum or below poverty level population? 

The slum population in Kuantan based on 2009 data is 1,705 people. The below poverty level population for Kuantan is 241 people. There should not be future projection because the policy of the government, either the central government or the state government, is zero slum dwellers and zero for those below the poverty level by the year 2015. Efforts are being made towards policies and towards achieving this by the year 2015. 

7. To what extent are city RH/Family Planning (FP) services available to the slum dwellers? 

Yes, in line with the policy for provision of a comprehensive health service in urban areas, through greater collaboration with local authorities and private doctors, Kuantan Health Department provides RH services to the slum dwellers. 

8. Are there special programs to increase RH services to slum dwellers? If so, please describe them. 

Actually, the services provided to the slum dwellers are not really special programs. These are under the activities to be carried out by community nurses and public health nurses that are working in the community clinics (klinik desa) or health centres that are located close to or nearby the slum areas. The nurses must conduct routine home visits, as planned, or others will cover if they are on leave or attending training for emergencies. 

Staff size and categories designated:

-Public health nurses -2 
-Community nurses - 4 

Special features: 
- No special features 

Size of budget: 
- No special budget allocated. The budget is absorbed into the main budget for reproductive health. 

9. What is the estimated size of the city’s new immigrant population (the new floating population)? 

The data for the city’s new immigrant population is still not available, even for recent years, i.e. 2009 and 2010. Data for 2000 and 2005 is also quite difficult to trace. 

10. To what extent are city RH services regularly available to the migrants? Does this represent a problem for the city? Are there any special health and social programs to deal with the new floating population?

For the Malaysian Government there is a specific policy for immigrants. Clinic charges or hospital charges for immigrants will be double in amount if they use government facilities. The employers of immigrants are responsible for the health of the immigrants. Normally, the employers will use private clinics or private hospitals. Kuantan Health Department does not have specific programs for immigrants. 

11. What is the breakdown of the total budget for RH services in terms of the following? 

a) Percentage of cost covered by city government 
-The actual cost is RM 1,444,300.00 - estimate. 

b) Percentage of cost covered by national / state government 
- Unavailable 

2. City Deputy Health Director 

1. What are considered the most important RH issues and conditions? 

The answer given is family planning for the health of mothers. 

Discussion and analysis 

Family planning services are an integral component of the maternal and child health services of the Ministry of Health Malaysia. In early 1987, the Family Planning Information System (HMIS) was implemented nationwide. This system is relevant and necessary to managers at different levels to monitor the programme, as well as to plan for future development. The system is developed to provide timely and relevant information to the managers at various levels for management decision making. 

The Family planning services have the main objective to promote the development of a healthy family, especially in the rural areas. Amongst the strategies that have been developed are: 

- To promote community involvement in health programmes, especially in coordinating and implementing the Family Planning Integration Programme in rural health services. 
- To ensure that trained health personnel provide family planning services. 
- To ensure that adequate supply of contraceptives is made available.
- Priority is given to married women in the rural areas. 
- Giving advisory services on effective methods of contraceptives to eligible couples, so that awareness is created on the importance of child spacing. 

The activities carried out in the family planning facilities/areas are:

- Recruitment of family planning acceptors. 
- Examinations of acceptors for high risk factors. 
- Supply of contraceptives. 
- Family planning education/advice. 
- Annual follow-up of all acceptors. 
- Pap smear services for acceptors and non acceptors. 
- Referral when indicated. 

Thus the family planning programme on the whole for the population in Kuantan City is an established programme, already integrated in the existing maternal and child health services. However, the only issue that we are faced with now is that of implementing family planning for the health of mothers, especially those mothers in high risk groups, like grandmultipara mothers, mothers with heart disease or any chronic deliberating disease, and young/adolescent single mothers. 

These groups of high risk mothers later end up with mortality if not managed properly. At the present moment, Kuantan has a very high mortality rate, i.e. until September, 2010, the MMR is 83 per 100,000. This is outside of the Ministry Of Health or Kuantan Health Department target. 

Under the Millennium Development Goal (MDG) No. 5, by 2015 the MMR should be 11/100,000 for Kuantan City, but we really feel that to reach this status, there is a lot to be done. The strategies to be taken up include the following:

- The need for pre conception clinics to identify high risk women and prevent/plan pregnancies for them. 
- Family planning services must be strengthened. 
- There is a need for special programmes for single pregnant mothers or unmarried adolescent pregnant mothers. 

At the Kuantan Health Department, efforts to reduce maternal mortality were focused on detailed analysis of each fatality, to identify preventable and contributory factors. 

A Quality Assurance has been introduced to Kuantan Health Department by the State Director to be implemented. The indicators used are related to family planning services i.e. “the percentage of high risk family planning acceptors practicing effective family planning methods for two years". The indicators will be monitored closely by the health personnel conducting family planning clinics. 

Beside this, for women already pregnant, the “risk approach strategy” and the team problem solving approach will be used, and the process and progress of pregnancy closely monitored. 

2. Overall how is the level of the city’s reproductive health condition? 

The answer is very good but could be improved. 

Discussion 

Malaysians as a whole and the citizens of Kuantan City in specific are generally healthier and live longer, as shown by the life expectancy at birth. Good health enables Malaysians to lead productive lives. For the past 40 years, the mortality rates in Malaysia have also been decreasing, as shown in the crude death rate. 

Reproductive health conditions in Kuantan, as shown by the indicators such as percentage of safe deliveries (which is 100%), immunization (which is almost 100%), as well as other indictors, are very good. The only shortfall is in terms of the Maternal Mortality Rate (MMR), which has fluctuated, and at times reached a ratio which is beyond the targeted ratio. But efforts are being made to overcome this, so that the target set under the Millennium Development Goal can be achieved. 

The other aspect of reproductive health that could be improved is the adolescent group with their special social and health needs, including HIV/AIDS. 

3. Overall what priority does the city give to RH services? 

The answer is high. 

Discussion 

Kuantan gives high priority to RH services because there are problems, even though they are not so serious as to give the very highest priority. 

As discussed earlier, we need to pay our attention to the Maternal Mortality Rate, single pregnant mothers or unmarried pregnant mothers, and the problem of HIV/AIDS. 

4. Overall how do you feel about the resources available for RH services? 

The answer is quite good. 

Discussion and Analysis 

Reproductive health services required the most budget when compared to other services available. This is because reproductive health services cover the widest scope, i.e. from the time women get pregnant until delivery. If we take the population as a whole, the coverage of the adolescence age group, i.e. young people, is also high. At the same time, over recent years, there was an expansion of scope within the reproductive health services. 

As government funds are limited, health care on the whole must compete for its share with other worthy programmes, such as economic development units, roads and transport, and education. At the same time, expectations and the demand for health care have steadily risen, adding to the strain. A more long term concern is that the rapid development in expensive medical technology and new drugs has inflated health care costs beyond what even affluent nations can afford. 

Human resource is the most important asset to any organization or department. With the increase in scope in reproductive health, the services have been compromised by inadequate number and mix of personnel. New categories of reproductive health providers have been identified to cater for the expanded programme. There is also a need not only to produce a sufficient number, but also to have adequately trained staff. 

5. What are the specific needs of the City to improve RH services? 

The answer is less than adequate services; more is needed in funds and personnel. 

Discussion 

As mentioned earlier, funding is not sufficient. At times, especially towards the end of the year, there will be shortages of contraceptives. However, this will be overcome by referring patients to the National Population and Family Development Board clinic, where they will be charged some nominal fee. As for human resources, actually the expansion of services at health clinics where reproductive health services are delivered has progressed more rapidly with the support of improved and upgraded infrastructure, clear operational policies and implementation guidelines. 

However, we continue to face human resource problems due to this rapid expansion in the range of services provided at the operational level. A gross inadequacy of staff, or human resource shortage, has always been the main constraint in implementing the expanded scope. It is difficult to run the service without enough doctors, nurses or dispensers to handle the vast variety of problems faced, and carry out the function of follow-up care, which is the main factor which hinders the speed of implementing reproductive health services. The problem of man power or human resources is further added to by the need for staff with better competence and skills, with the expansion of the scope of services. This shortage requires stretching the skills of the existing staff to cater for the expanded scope, which inevitably affects the overall coverage and quality. New categories, such as clinical psychologists, counselors and medical social workers are highly needed to carry out the function of follow-up care in the community. 

6. What is the size of the city’s slum or below poverty level ($2 per day) population? 

Note: It is not possible at this time to get data on the city’s slum or below poverty level population for the years 2000 and 2005. The respective department (not under the Ministry of Health) is able to provide data for 2009 only. At the time of writing, the data for 2010 has not yet been analyzed. The number of houses in the slum area in the year 2009 is 341. The number of people in the houses is 1,705. The number of poor people in Kuantan City is 241. 

7. To what extent are city RH/Family Planning (FP) services available to the slum dwellers? 

Discussion 

Kuantan Health Department provides reproductive health services to all the slum dwellers. This is in line with the policy of provision of comprehensive and integrated primary health care delivery. The strategies for this policy are as follows: 

a) Provision of health care services that is equitable and accessible to the community at all levels. 
b) Increased participation and improved collaborative approach amongst the health, health related agencies and the community in primary health care delivery. 

Thus the city slum dwellers that are considered the marginalized group of the population have actually been given priority in assessment of health care provision. 

The public health nurses and community nurses went for home visits to the slum areas to follow-up on defaulter cases, as well as to do routine antenatal or postnatal check ups. During these home visits, staff also check on immunization schedules for slum dwellers’ children. This activity is done monthly by the community nurse in charge of the slum dwellers, or in accordance to the follow-up appointment date. 

8. Are there special programs to increase RH services to slum dwellers? Is so, please describe them. 

See answer given by City Deputy Health Director

9. What is the estimated size of the city’s new immigrant population (the new floating population)? 

See answer given by City Deputy Health Director

10. To what extent are city RH services regularly available to the migrants? Does this represent a problem for the city? Are there any special health and social programs to deal with this new floating population? 

See answer given by City Deputy Health Director

11. What is the breakdown of the total budget for RH services in terms of the following: 

See answer given by City Deputy Health Director

3. City Director, National Population and Development Board 

1. What are considered the most important RH issues and conditions? 

The answer is family planning for the health of mothers. 

Discussion 

Family planning services in Malaysia are provided by three main agencies, namely the Ministry of Health, the Federation of Family Planning Associations (FFPAM) or the Federation of Reproductive Health Association of Malaysia (FRHAM), and the National Population and Family Development Board (NPFDB). However, data collected from the 1970s to the present time show that >77.5% of new acceptors received family planning services from the Ministry of Health, hence making it the main agency providing family planning services in Malaysia. 

The National Population and Family Development Board (NPFDB) contributed to about 10% of the new acceptors of family planning services yearly. In the early years, i.e. in the 1950s, 1960s and 1970s, family planning for population growth was the aim of the reproductive health programme. Currently, that stage is basically solved, and family planning now is mainly for the health of mothers. 

2. Overall, how is the level of the city’s reproductive health condition? 

The answer is very good but could be improved. 

Discussion 

The Ministry of Health, being the main agency providing family planning services in Malaysia, has certainly done a good job and helped the city achieve a good level. 

The National Population and Family Development Board is only providing about 10% of the overall coverage. Currently NPFDB charges people who require contraceptive pills or devices. The step taken to charge patients or clients who need contraception is actually not a good decision, because the clients who are not willing to pay will just turn back and walk away. 

3. Overall, what priority does the city give to RH services? 

The answer is the very highest. 

Discussion 

Obviously, being the corporate body that is responsible fully for the family planning services in Malaysia, NPFDB has to give the very highest priority to reproductive health services. 

4. Overall how do you feel about the resources available for the services? 

The answer is quite good. 

5. What are the specific needs of the City to improve its RH services? 

The answer is that there are less than adequate services, more is needed in personnel. 

NPFDB does not have enough personnel, especially doctors. The doctors that provide services at NPFDB clinics are doctors that work part time. They are from the University, or from the Ministry of Health. 

6. What is the size of the city’s slum or below poverty level (2$ a day) population?

See data given above. 

7. To what extent are city RH/Family Planning (FP) services available to the slum dwellers? 

NPFDB do not routinely provide any RH services to slum dwellers. However, if a person comes from a slum dwelling and brings an identification card from the Social Welfare Department that acknowledges the patient’s condition, then the patient can be given any form of contraceptive device on a free basis. 

8. Are there special programs to increase RH services to slum dwellers? 

There are no special programmes provided by NPFDB to slum dwellers. 

Questions 9, 10 and 11 are not relevant to NPFDB. 

4. City NGOs 

1. What are considered the most important RH issues and conditions? 

Before answering the question, a little background information on RHAP. The Family Planning Association of Pahang, as it was previously known, and which is now known as the Reproductive Health Association Pahang (RHAP), is a voluntary charity formed with the objective of promoting family planning services in the State of Pahang. Its sources of revenue arise from donations by the International Planned Parenthood Federation (IPPF), of which the Association is an affiliate member, donations from the Malaysian Government, and income from contraceptive sales, clinics and fund raising activities. 

In order to carry out its task, the association provides the following services: 

a) Formulation and development of information, education and training programmes, including the application of audio visual and mass media medical services. 
b) The provision of medical and clinical services, advice on family planning technology and maintenance of clinical service statistics. 
c) The promotion of national and local fund raising campaigns. 
d) The assessment of the conduct and effect of the programs undertaken. 

The answer for question 1 is family planning for the health of mothers. 

Discussion 

At the national level, the Association is known as the Federation of Reproductive Health Associations, Malaysia (FRHAM). The Federation has 13 state branches, including the Association in Kuantan which is known as Reproductive Health Association Pahang (RHAP). For Reproductive Health Association Pahang, they will continue to advocate for the provision of accessible, comprehensive and gender sensitized family planning services to all communities for further reduction in the Child Mortality Rate and improvements in maternal health. At present, most of the unmet needs and demands in family planning are concentrated among high risk women (aged 35 years and above, and a parity of more than five) and also those who have difficulty in accessing acceptable and affordable family planning services. The Association complements the governments in the provision of family planning services, using IPPF’s Charter on Sexual and Reproductive Rights (1996) as a guiding document. Hence, the Association will play an increasingly significant role as an advocate on the right-based approach, being one of the three main national family planning implementing agencies. 

Besides the above issue, RHAP is also responding to the social problems faced, as a result of the rapid pace of development and urbanization, as well as changes in lifestyle, moral and ethical values that have contributed to social problems related to unwanted pregnancies, abortion, abandoned babies and rape. In response to this problem, RHAP, through its youth-friendly clinics, will strategize to expand appropriate services to adolescents and young people. 

2. Overall, how is the level of the city’s reproductive health condition? 

The answer is very good but could be improved. 

The level of the City’s reproductive health condition is very good already but could be improved in certain aspects, as mentioned earlier, like by focusing on high risk women to accept family planning, focusing on social problems related to unwanted pregnancies, abortion, abandoned babies and rape, and also continuing to create awareness on prevention of reproductive tract infection, including HIV/AIDS. The Association, at both the national and state levels, continues to take the lead among the NGOs in the country, especially in the area of family planning and sexual and reproductive health and rights. This role firmly places the Association as one of the three main agencies in the country to have the resources and infrastructure to provide a comprehensive range of services to women, men, young people and the marginalized communities. 

3. Overall what priority does the city give to RH services? 

The answer is high. The reasons for this are as mentioned in the answer to question no.2. 

4. Overall how do you feel about the resources available for RH services? 

The answer is that they are somewhat deficient. 

Discussion 

The Association relies on volunteers to run its services. The volunteers are doctors with special interest in reproductive health, who run clinic sessions. Family planning services are provided at one state static clinic in Kuantan, located at B 1582 Jln Beserah Kuantan. 

Twelve volunteers, mainly retired government staff, provide services at the static clinic. Due to shortages in volunteers and funds, the Association is not able to do outreach programmes, or to keep those poor or living in urban slums. The sexual reproductive health services are available at state static clinics, and also at outreach localities during campaigns. 

Currently about six specialists offer their services and six medical officers also do so. 

5. What are the specific needs of the city to improve its RH service? 

The answer is funds are the most important needs of the Association, as well as personnel. 

Discussion 

A continuous decline in funding (cash and in kind) from the IPPF and other agencies in recent years, including competition amongst NGOs for donor funds, has affected the implementation of FRHAM and RHAP programmes and activities, in particular resources, required for institutional support. Recognizing such trends, resource generation initiatives created and established would thus need to take into consideration developing and implementing programmes and activities that meet with the criteria set by donors/ funding agencies targeting selected communities and beneficiates, but in consonance with national policies and programmes. Sustainability in today’s ever changing environment requires the Association to build synergistic partnerships and alliances with both international and national level organizations in the provision and promotion of sexual and reproductive health programmes and services. Organizational mobilization amongst NGOs and GOs in resource generation, including mobilization of community resources, will further strengthen the capacity of all involved to achieve common goals and objectives. 

To contribute to the above initiatives, the Association has taken the initiatives to relook at different approaches to generate funds, such as the re-packaging of the technical expertise via fee charging training courses, targeting external agencies to tap this source of income generation. Volunteers will be mobilized to play a crucial role as resource speakers as well as consultants in their various areas of expertise, especially in the field of sexual and reproductive health. In addition, the Association raises funds through traditional methods like food fairs, dinners, and film premieres. 

Another way is to reduce operational costs through cost-sharing amongst agencies sharing common goals and aims. 

As for personnel, the Association has taken appropriate steps to enhance the competency level and capability of its staff and volunteers via the conduct of relevant training courses for upgrading technical and managerial skills, in order to effectively carry out their expected duties and tasks. 

Organizational policy on human resource development is already in place. 

6. What is the size of the city’s slum or below poverty level ($2 per day) population? 

See answer given by the City Health Director

7. To what extent are city RH/Family Planning (FP) services available to the slum dwellers? 

The answer is that there are no outreach services for slum dwellers, as the Association does not have enough resources to implement these. 

8. Are there special programs to increase RH services to slum dwellers? 

There are no special routine programmes to increase RH services to slum dwellers, but once in a while collaboration with other NGOs provides such services to slum dwellers. 

Questions 9 and 10 are not relevant to the Association. 

11. What is the breakdown of the total budget for RH services? 

The budget for the Kuantan branch is RM 221,609.00 for the year 2008, and RM 173,074.00 for the year 2009.

Kuantan Objective RH Services DataKuantan Objective RH Services Data (Continued)

CONTENTS

Top

Foreword

Section One

The New Urban Challenge for Primary and Reproductive Health Care

Executive Summary

1. Background: Urban Growth and Urban Primary / Reproductive Health (RH) Services

2. An AUICK Research Project Report

3. Regional Findings

4. Individual City Findings

5. Summary and Implications

Section Two

Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls:

Nine AUICK Associate City (AAC) Reports

6. Kuantan, Malaysia

7. Khon Kaen, Thailand

8. Weihai, China

9. Surabaya, Indonesia

10. Olongapo, Philippines

11. Chennai, India

12. Faisalabad, Pakistan

13. Danang, Vietnam

14. Chittagong, Bangladesh

Annex I.
Research Instrument: AUICK Research Project Outline

Annex II.
AUICK Research Project Participants


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