Two linked components share one entry point — PeKa Health Screening. Diabetes and hypertension (with or without comorbidities) route into continuous NCD management, while pre‑diabetes routes into a 6‑month preventive cohort that re‑enters new beneficiaries every cycle.
Comprehensive primary health screening at empanelled GP clinics, covering diabetes mellitus, hyperlipidaemia, hypertension and pre‑diabetes.
GP reviews lab results and clinical findings, then routes the beneficiary to the pathway that matches their diagnosis.
Diabetes mellitus and/or hypertension, with or without comorbidities/dyslipidaemia, identified at HS2.
Beneficiary agrees to join the PeKa Pilot NCD Management Programme; enrolment starts immediately at the panel clinic.
Additional tests covered by the programme are done at the panel clinic. GP explains programme criteria, reviews clinical condition and evidence, and initiates treatment from the covered medication list.
GP refers the patient to any panel ophthalmologist or optometrist, to be completed within the next 3 months.
Patient proceeds to the fundus photography appointment at any panel provider — before or after the next GP visit, as long as it falls within the first 3 months.
Patient continues attending GP appointments per the programme's follow‑up schedule.
GP and patient jointly decide whether to continue treatment at the GP clinic, or refer out to a Klinik Kesihatan (KK) / MOH facility.
Not‑yet‑screened beneficiaries get PeKa Health Screening (labs + CVD risk stratification); previously screened beneficiaries (after 1 Jan 2025) get the PeKa Rescreening Package (labs + clinical review).
Pre‑diabetes confirmed, with or without obesity/overweight, and beneficiary opts in.
3 nutrition sessions at months 1, 3 and 6 → HbA1c & FBS checkpoint at month 6 → GP consultation reviews the clinical outcome.
Based on HbA1c, FBS and GP review at month 6, the beneficiary's result determines the next step.
Enrols into the NCD Management Track.
Package completed; returns to the annual (12‑month) rescreening cycle.
Package completed.
Two linked components share one entry point — PeKa Health Screening. Diabetes and hypertension (with or without comorbidities) route into continuous NCD management, while pre‑diabetes routes into a 6‑month preventive cohort that re‑enters new beneficiaries every cycle.
At empanelled GP clinics
GP routes by diagnosis
DM / HTN confirmed
Immediate, at panel clinic
GP starts covered meds
Any panel provider
Photo done within 3 mths
Per GP schedule
Continue with GP or refer to KK/MOH
Labs + risk check
Voluntary entry
Nutrition + HbA1c/FBS
Month 6 review
→ Management track
→ Annual rescreen
Package complete