One of the steps taken by the government to break the cycle of poverty and ill-health in rural Malaysia is the establishment of a rural health service. Initially, the health unit served 50,000 people; it consisted of 1 main health center; 4 health subcenters, and 20 midwife stations. By the end of 1970, 44 main health centers, 180 health subcenters, and 943 midwife stations were in operation, creating a great demand for all types of health personnel: professional, paramedical, and auxiliary. Doctors are unevenly distributed in West Malaysia: in urban areas, the ratio of doctors to population is 1 to 1500; in rural areas, the ratio is 1 to 25,000. Paramedicals are unevenly distributed too. The scarcity of professionals in rural areas is attributed to professionals' demand for high salaries and the corresponding requirement of professional and social settings which rural areas cannot provide. The rural health unit utilized the tiered pyramidal system for staffing, with heavy reliance on auxiliary personnel. This system enabled the rapid expansion of rural health services, helping reach over a third of the population in just 15 years. As a consequence, infant, toddler and maternal mortality rates declined substantially. Traditional birth attendants, or kampong bidans, are currently being trained, on an experimental basis, simple principles of hygiene and family planning. With the enforcement of the Midwives Act in 1971, indigenous midwives have not been permitted to register as legitimate midwives and are now subject to supervision by health authorities. Future plans include retraining single-purpose midwives in child health and nursing, and giving all assistant nurses midwifery training. The aim is to make these 2 auxiliaries multipurpose community nurse-midwives. Experiences of developed countries show that demand for auxiliaries will continue to increase with the growth of professional personnel.
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