This paper illustrates the development of Primary Health Care (PHC) public sector in Malaysia, through a series of health reforms in addressing equitable access. Malaysia was a signatory to the Alma Ata Declaration in 1978. The opportunity provided the impetus to expand the Rural Health Services of the 1960s, guided by the principles of PHC which attempts to address the urban–rural divide to improve equity and accessibility. The review was made through several collation of literature searches from published and unpublished research papers, the Ministry of Health annual reports, the 5-year Malaysia Plans, National Statistics Department, on health systems programme and infrastructure developments in Malaysia. The Public Primary Care Health System has evolved progressively through five phases of organisational reforms and physical restructuring. It responded to growing needs over a 40-year period since the Alma Ata Declaration in 1978, keeping equity, accessibility, efficiency and universal health coverage consistently in the backdrop. There were improvements of maternal, infant mortality rates as well as accessibility to health services for the population. The PHC Reforms in Malaysia are the result of structured and strategic investment. However, there will be continuing dilemma between cost-effectiveness and equity. Hence, continuous efforts are required to look at opportunity costs of alternative strategies to provide the best available solution given the available resources and capacities. While recognising that health systems development is complex with several layers and influencing factors, this paper focuses on a small but crucial aspect that occupies much time and energies of front-line managers in the health.

Background: Urut Melayu, the traditional Malay massage, had been introduced into three pioneer hospitals in Malaysia, as part of the integrated hospital program. It was introduced primarily for the rehabilitation of poststroke patients. After almost 3 years since it was first implemented, there are currently plans to extend it to other hospitals in the country. Information from this study will contribute toward a better future implementation plan. Objectives: This study was conducted to gain an insight into the experiences and views of poststroke patients and their urut Melayu practitioners. Methods: A qualitative study design was adopted. A total of 17 semistructured in-depth interviews were carried out with poststroke patients who were undergoing urut Melayu treatment at one of the three integrated hospitals. Information was solicited from their accompanying caregivers whenever necessary. The 2 urut Melayu practitioners at the hospital were also interviewed. All the interviews were carried out in Malay by the authors, at the Traditional and Complementary Medicine unit of the relevant hospital. The interviews were audiotaped, transcribed, and coded into categories through a constant-comparison method of data analysis. Illustrative quotations were identified to supplement the narrative descriptions of the themes. Results: It was found that urut Melayu was sought by patients who had experienced stroke brought about by hypertension and postdelivery complications. They reported the unique characteristics of urut Melayu and their positive experiences with it. Conclusions: Urut Melayu has potential as a complementary therapy for poststroke patients. It is recommended that the number of practitioners at the Traditional and Complementary Medicine unit be increased to provide the optimum care for poststroke patients.

Background: The case of a 32-year-old Malay woman who developed postpartum stroke is reported. Methods: The patient received a series of urut Melayu, the traditional Malay massage, sessions at one of the newly established integrated hospitals in the country. Results: After 14 urut Melayu sessions, she improved tremendously in her speech and fine motor skills and regained her activities of daily living. Conclusions: This use of urut Melayu to complement rehabilitation care in patients poststroke is promising.

Urut Melayu is a unique form of massage carried out for various purposes. Although it is common belief that there are vast differences in the way it is performed from one practitioner to another, this study revealed that similarities do exist and there is potential to develop a standard framework for urut Melayu for regulation and training purposes.

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