This is in response to the article 2 Malaysia in Health Services by Sim Kwang Yang: The health ministry expresses our appreciation of your concern regarding the health care provision for the people of Sarawak, especially those living in the interior.

Sarawak has never been left out. However, due to geographical constraints, the remote interior of Sarawak is not as easily accessible as one would wish.

The examples narrated in your article are of concern to us and the ministry will do the necessary to improve health provisions for this group of people.

There are currently 22 hospitals, of which seven are providing specialist services, and 226 health clinics providing services in Sarawak.

Mobile clinics are also available to serve communities in remote areas accessible only by non-gazetted roads and rivers.

There are currently 99 mobile clinics to provide basic health care like immunisation, maternal and child health care, nutrition and follow-up for patients with chronic diseases.

In addition, the village health team, comprising assistant medical officers and community nurses operates from the nearest health clinic delivering mobile health services, maternal and child health services and curative care.

Action has been taken to improve this service by including health education and promotion as well as dental services. This integrated service was started in 2007 through a project known as 'Reaching the Unreachable'.

Realising that the number of doctors and medical staff available will not be able to provide services as required, we have enlisted volunteers.

From the village, they assist the health department in giving health education, simple medical aid and identify cases that need further medical attention.

As of 2008, a total of 3,416 Wakil Kesihatan Kampung (village health representatives) have been trained covering 1972 villages including 74 Penan Villages.

Doctors and nurses of the health ministry posted to the rural hospitals and clinics in Sarawak have displayed dedication and commitment to the profession and have travelled to areas deep in the interior to provide services.

The ministry is aware of the overcrowding in hospitals in the urban setting, especially in Sarawak general hospitals. Effort is being made to expand services and facilities in Kuching.

We thank you for raising the matter on the halfway houses for patients' families. Although it is not a policy of the Ministry of Health to provide halfway houses in all hospitals, we take note that it is most beneficial in the specialist/referral hospitals.

Many hospitals, on their own initiative, have been able to provide halfway homes within or outside the hospital compound.

Public hospitals in the country do not deny patients treatment and if the clinical condition of patient warrants an admission, the patient will be admitted. This would include even rural Sarawakians who do not have an identity card!

As for hospital bills, this should not be of great concern, as the hospital has the mechanism to waiver hospital charges to patients who are genuinely poor.

In relation to the flying doctor service, the earlier contractor had failed to fulfil their contract in providing the service and for that, the contract was terminated in December 2007.

Although a new contract has not been made, the Flying Doctor Service was not interrupted as other helicopter companies were assigned to provide the Flying Doctor service.

Visits to 93 locations were made every month since February 2008 till date. The performance of the Flying Doctor service in the state of Sarawak since February 2008 till now is maintained at about 80 percent.

The ministry spends approximately RM1.3mil monthly on this service.

Taking into consideration all the limitations faced, the health ministry has proven to be committed to providing and improving health care provisions to all Malaysians.

Dr Mohd Ismail Merican is Director General of Health, Malaysia