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At the beginning of the 1990s, the main issue in Malaysia’s public health and medical
sector was the shortage of human resources (doctors and nurses). There were 2,500
persons per doctor in 1990, or nearly three times the level of Singapore and over five
times the level of Japan. Extreme disparities existed among regions in Malaysia, and the
doctor shortage in rural areas was particularly severe.
At that time, although medical education was indispensable for resolving the problem,
there were only three universities with medical schools in Malaysia: the University of
Malaya (UM), Universiti Sains Malaysia (USM), and Universiti Kebangsaan Malaysia
(UKM). Of these, UKM was the only one without a teaching hospital attached to its
medical school. The UKM Medical School was conducting education and training at
Hospital Kuala Lumpur (HKL), but due to the heavy demand for healthcare services at
HKL, education and training could not be adequately carried out.
UKM is a national university founded in 1970, and currently it has 10 departments,
including the medical school (total students: approximately 24,000; staff: approximately
8,000; graduates: approximately 120,000). The university hospital which is the subject of
this project was built in Cheras, located on the outskirts of Kuala Lumpur (about 15 to 20
minutes by car from central Kuala Lumpur).
1.2 Objective
The objective of this project is to promote (i) improvement of medical techniques and
knowledge among UKM medical students and graduates (through retraining after
プロジェクトサイト Project Site
Malaysia
Kuala Lumpur
Map of the project area Exterior view of UKM Medical School’s
hospital ward
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graduation) and training of nurses, (ii) acceleration of research and development in the
clinical fields, and (iii) provision of healthcare services, through new construction of a
medical education facility equipped with the latest medical equipment at UKM, which is
the only medical school among the three in Malaysia without a university hospital;
thereby contributing to the improvement of health in the surrounding area and in rural
areas.
1.3 Borrower / Executing Agency
Government of Malaysia / Ministry of Education (currently the Ministry of Higher
Education)
1.4 Outline of Loan Agreement
Copied from materials provided by JBIC
Loan Amount / Loan Disbursed Amount 10,215 million yen / 8,203 million yen
Exchange of Notes / Loan Agreement August 1993 / September 1993
Terms and Conditions
- Interest Rate
- Repayment Period (Grace Period)
- Procurement
3.0%
25 years (7 years)
General untied
Date of Disbursement Completion January 2001
Main Contractors E&A Letrik (M) Sdn. Bhd.(Malaysia)
Consulting Services None
2. Evaluation Result (rating: A)
2.1 Relevance (rating: a)
This project was wholly consistent with the national plans, both at the time of appraisal
and at the time of ex-post evaluation. Thus, the relevance of the project implementation is
extremely high.
2.1.1 Relevance at the time of appraisal
The government of Malaysia formed and implemented many policies in its 5th and 6th
five-year plans under the slogan of “Health for all by the year 2000” with the aim of
enabling all people in Malaysia to receive every healthcare service so that they could lead
high-quality lives. In the 6th plan in particular, improvement of healthcare facilities and
healthcare services as well as rectification of the disparity in healthcare services between
urban and rural areas were upheld as the most important issues and were allocated 2.4
times the budget allocated in the 5th plan.
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The specific content of the 6th plan may be considered from the perspective of the three
functions of a university hospital, i.e., “human resources development,” “research,” and
“healthcare services.” First, for human resources development, in order to rectify the
chronic doctor shortage and regional inequality in public regional hospitals, steps were
planned to implement the rehiring of retirees, invitation of foreign doctors, human
resources development and retraining of doctors, improvement of the employment terms
of public healthcare workers, boosting of the capacity of nurse training institutions, and
expansion of the hiring of foreign nurses. One of the specific measures clearly stated in
the 6th plan is new construction of a university hospital for UKM, which is the purpose of
this project. Furthermore, for research, advancement of research related to malaria and
dengue fever was planned, and for healthcare services, expansion of healthcare facilities
(primary, secondary, and tertiary) was planned.
Thus, it may be reasonably concluded that the project was relevant at the time of the
appraisal.
2.1.2 Relevance at the time of evaluation
At the time of this evaluation, the government of Malaysia is placing importance on
policies for the public health and medical sector. Specifically, the public health and
medical sector is clearly positioned in the 7th plan (1996–2000), 8th plan (2001–2005), and
the 9th plan (2006–2010) as an important element for boosting the quality of life (QOL) of
the Malaysian people, on par with education and housing. Budget allocations to the public
health and medical sector are also increasing, and in the 8th and 9th plans, the budget
allocations are 4.5 to 5 times larger than that in the 6th plan. Particularly for “expansion
and improvement of healthcare facilities,” “health improvement in rural areas,” and
“healthcare-related training,” the budget allocation in the 9th plan is over 10 times greater
than that in the 6th plan.
The recent five-year plans are examined specifically from the perspective of the
above-mentioned three functions filled by university hospitals as follows. Beginning with
human resources development, the 9th plan places importance on the enhancement of
services through collaboration between and integration of medical institutions and
enhancement of primary healthcare. For research, from the 7th through the 9th plan,
emphasis is placed on the acceleration of research and development to improve
prevention, diagnosis, and treatment, and for that purpose, emphasis is also placed on the
strengthening of research and development capabilities. For healthcare services,
importance is placed on the continued strengthening of specialized education
(post-graduation) and improving the employment terms of doctors, in conjunction with
strengthening measures to deal with the healthcare human resources shortage.
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Thus, the project is relevant at the time of evaluation as well.
2.2 Efficiency (rating: b)
Although the project cost is estimated as being basically as planned, the project period
significantly exceeded the planned period. For this reason, the efficiency is rated as being
moderate.
2.2.1 Outputs
In the planning stage, the project was to construct a university hospital to conduct
specialized education and treatment in seven departments (internal medicine, obstetrics
and gynecology, surgery, orthopedics, ophthalmology, otorhinolaryngology, and
pediatrics). The project consisted of three components, specifically (i) construction of
medical office, education, and residential facilities, (ii) installation of service facilities,
and (iii) procurement of other medical and office equipment (not affixed to the building).
Of these, it was assumed that the component (i) would be implemented using Malaysian
funds and that approximately half the funds for the component (iii) would be supplied by
the government of Malaysia.
