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