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PUBLIC RECORD OFFICE
Reference -
C.O.882/12
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH-NOT TO
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He shall not be concerned in the actual execution of public works or the disbursement of money, except by special direction of the Chief Secretary.
He shall yearly inspect all the principal works being carried out in every district reporting when considered advisable by him, to the Chief Secretary or the respective British Residents.
He shall not call for or let contracts except under special instructions from the Chief Secretary.
4. The only material difference is that the Director-Adviser is not responsible for all services entered in the annual Estimates of the Malay States.
5. The smooth working of this scheme depends almost entirely on the goodwill and co-operation of all concerned. After 2 months as Director-Adviser, in which time I have made a tour (lasting 37 days) of the Colony and of the States of Perak, Selangor, Negri Sembilan, and Pahang, I have no hesitation in saying that the scheme as outlined in the despatch is perfectly sound and workable. I might perhaps mention that as a result of my tour I estimate a saving of $1,500,000 in the four States; I went into the question of economy very minutely with each State Engineer, and I am now arranging for similar economies in the Colony. This is but an instance, the first fruits of the scheme, but such saving could never have been effected under two different administrations.
G. STURROCK, M.Inst.C.E.,
Director of Public Works, Straits Settlements,
and Adviser, Public Works, Malay States.
Enclosure 2 in No. 26.
MEMORANDUM ON THE ADMINISTRATION OF Medical and Health SerVICES IN MALAYA as affected BY PRESENT PROPOSALS FOR DECENTRALIZATION,
THE organization of medical and health services in Malaya was fully described two years ago by the Principal Civil Medical Officer, Straits Settlements, and the Prin- cipal Medical Officer, Federated Malay States, in memoranda prepared for the infor- mation of the Colonial Office Conference of 1930. It is not now necessary, therefore, to discuss the organization which has heretofore existed; it is only necessary to indicate the changes which will result from present proposals.
2. Control of the personnel of the Malayan Medical Service will be merged in one officer, who will assume the title of Director of Medical and Health Services, Straits Settlements, and Adviser, Medical and Health Services, Malay States; dual control, by the Principal Civil Medical Officer, Straits Settlements, and the Principal Medical Officer, Federated Malay States, will disappear.
3. Administration of medical and health services in the Straits Settlements will remain as before, except that the title of the head of the Medical Department of the Colony will be altered from Principal Civil Medical Officer to Director of Medical and Health Services, and there will be a Deputy Director to assist.
4. Administration of medical and health services in each of the four Federated States will devolve upon the State Medical and Health Officer. Unified control will thereby be established in the State, in place of the dual control heretofore existing, Previously there were in each State:-
(a) A Senior Medical Officer responsible for hospital services, acting in consul- tation with the Principal Medical Officer, Federated Malay States, but not under the orders of the Principal Medical Officer.
(b) A Senior Health Officer controlling health services, having no relation with the Senior Medical Officer, but acting under the order of the Chief Health Officer, Federated Malay States, who, in turn, was under the orders of the Principal Medical Officer.
5. The organization in each State of the Federation will, consequently, resemble the already existing organization in the Colony and in each of the Unfederated States, in that there will be one officer responsible for both medical and health services.
6. The position in the Unfederated States will be altered to this extent, that, whereas formerly the Principal Civil Medical Officer was only occasionally consulted and only visited any of the States by special invitation on rare occasions, under the proposed scheme the Director of Medical and Health Services, in his capacity as Adviser, Medical and Health Services, Malay States, would be available for advice as
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a matter of course on any medical or health question on which edvice is required, and would make such periodical visits to each State as the High Commissioner and the Ruler of the State shall require.
7. The proposed changes will effect a definite improvement in the administration of medical and health services in Malaya. There will be unity in place of variance; unity in the Malayan Medical Service, instead of the previous division between the officers of the Straits Settlements under the Principal Civil Medical Officer and the officers of the Federated Malay States under the Principal Medical Officer; union between curative and preventive services, instead of an ever-widening divergence. It will be possible to follow a uniform policy in health and hospital services throughout. Malaya, and it will be possible to co-ordinate health and hospital services in mutually beneficial co-operation.
8. The independence allowed to the State Medical and Health Officers of the Federated States will encourage initiative and enterprise. All that is necessary to ensure efficiency is to select the right officers for these posts. Essential uniformity in policy, in both preventive and curative services, will be secured by the controlling influence and authority of the Adviser. Local problems will be dealt with by the State Medical and Health Officers all the more effectively, on account of the responsi- bility and freedom allowed to them.
9. The government of the component parts of British Malaya is so complex that it would be difficult to devise any other system of medical administration likely to secure greater efficiency throughout the country. Were the whole of Malaya under one central government, then single executive control of medical and health services throughout Malaya would be practicable; under existing conditions this executive union would appear to present insuperable difficulties.
10. A scheme for the unification of medical and health services, based on a central executive authority for the Straits Settlements and the Federated Malay States, wra recently put forward. The proposal met with sufficient opposition to suggest that
V.
J.
scheme, however attractive in principle, would have proved disappointing in prac- It is unlikely that any scheme giving greater executive control of local services than that now proposed would prove satisfactory.
11. This present scheme allows such a measure of self-government, while retain- ing so much central advisory control, as to afford, in my opinion, the best solution of the very complex problem of medical and health administration in Malaya. I do not believe that the adoption of this scheme will result in loss of efficiency; on the contrary I believe that it will effect a substantial improvement of the present state of affairs.
12. In conclusion it may be well to add a word of explanation with regard to the position of health services in particular, under this proposed organization. There is no intention whatever to relegate health services to a secondary position; the proposal is exactly the contrary. In the past the "health branch has been developing as an offshoot of the Department; the branch has grown to such " of the Medical Department an extent as to threaten to break away from the parent stem. Such a rupture would be a disaster. It must be obvious that preventive and curative medicine should be combined and contained in one corporate organization. It is impossible to keep the "health branch "in a position of subordination, but it is not impossible to constitute a health service of which a hospital branch" is an integral part. Such should be the result of this scheme for Malaya. It should not be long before the predominant factor will be the preventive rather than the curative interest. The change from the old order, in which hospitals were all-important and health services comparatively neglected, cannot be effected instantaneously; the development of health services has been too recent for there to be a sufficient number of senior officers of that branch to assume general control. But at least a step will have been made in the right direction by opening the way for officers trained in public health to assume control of a unified service in each State, and so emancipating health services from their position of subordination. The eventual result will be supremacy of the public health interest, in a unified service of which the curative element will be an important, but accessory, part.
C. J. WILSON,
19th March, 1932.
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