KUALA LUMPUR, July 9 — The change of administration impacted the 11th Malaysia Plan and will likely also affect the upcoming government plan amid vague policy direction, health advocates said.
International Medical University (IMU) pro-vice chancellor (research) Dr Lokman Hakim Sulaiman and Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib told radio station BFM last month that they were unsure how the 11th Malaysia Plan 2016 to 2020 mid-term review, released in October 2018, was conducted by the then-Pakatan Harapan (PH) government that wrested power from Barisan Nasional (BN) in the May 2018 general election.
“I thought there was some major change in terms of direction of government, so that will affect implementation on what has been agreed upon in the 11th Malaysia Plan,” Dr Lokman said.
Azrul said a mid-term review is meant to monitor progress and to identify any changes to the five-year plan of Malaysia’s overall development that need to be made.
“Whether Pakatan Harapan managed to do that, is something we’re all asking. We’re ending the 11th Malaysia Plan and we’re going to the next one. The next one is supposed to be informed by the lessons learned and gaps identified in the previous Malaysia Plan, before we can go to the new one.
“Many of us are putting in recommendations for items in the Malaysia Plan, but because the review was not really shared or conducted even, we don’t know where we are or were in the 11th Malaysia Plan. I think that’s a major problem in itself,” the health advocate said, adding that stakeholders were unsure how the published mid-term review for the 11th Malaysia Plan was put together.
Some of the revised health care targets in the mid-term review of the 11th Malaysia Plan include 2.0 hospital beds per 1,000 population and 1:450 doctor-to-population ratio. The review also stated that the rising trend of non-communicable diseases, infectious diseases, maternal mortality, and inadequate public health facilities “posed challenges to public health and health care service delivery”.
The new Perikatan Nasional (PN) government — which ousted the federal PH administration in March this year — has postponed the tabling of the 12th Malaysia Plan 2021 to 2025 in Parliament to an unspecified date after its initial August schedule, amid the Covid-19 outbreak that hit Malaysia’s economy.
Dr Lokman said the five-year Malaysia Plans outlined the structure and goals for the development of the country’s health care sector.
“But what I foresee for this 11th Plan and 12th Plan, we’re confuscated by a magic change of government. What policy are we following now? Which policy for development planners to follow? Like it or not, the politicians from the government are setting up the policy direction, then we follow and plan according to what the policy is,” he said.
“What’s the policy direction in terms of where the country is moving now?”Dr Lokman Hakim Sulaiman, International Medical University (IMU) pro-vice chancellor (research)
He noted that the biggest challenge in planning Malaysia’s development is always finance and that half-way through five-year plans, priorities may sometimes be reviewed, as the budget of the government plans is based on the country’s projected economic performance.
When asked about the role of civil servants in implementing the Malaysia Plan, Dr Lokman stressed that the political leadership decides on the government budget and the direction of the country, though Azrul believed civil servants had some influence on the direction of development plans as policymakers.
“Only a legitimate government can put aside funding for all the development funding. That’s how the system works,” Dr Lokman said.
Azrul said health financing reform is one of the areas stakeholders are looking into, which goes beyond the next five years or decade. The government has yet to change the main method of financing the public health care system through general taxation revenue, which critics charge is insufficient. Previous administrations toyed with the idea of social health insurance, including BN that once proposed a voluntary form of it.
A disruption in the administration, Azrul noted, could affect major reforms that need serious political will.
“When the change of government happened, it introduced an element of uncertainty which also put into mind, into question, those who are the policymakers, the implementers in the different ministries, as to whether or not the commitment made previously will continue on,” Azrul told BFM.
“Now that we have another change of government, we come back to the same question again. Where is the policy there? Where is our position on this? We’re entering the next Malaysia Plan; there’s a lot of uncertainty,” he added, citing the Covid-19 public health emergency that would affect costing in other sectors.
This, as a result, may affect reforms outlined in the upcoming Malaysia Plan.
“It’s going to be very difficult to introduce reform that could introduce more hardship. It’ll be quite hard for any government to put through and pass in Parliament, so it poses a huge problem for professionals like Dr Lokman who worked in the Ministry of Health (MOH) to be able to recommend to the government,” Azrul said.
“The uncertainty is quite harmful.”
What Needs To Be Addressed In The 12th Malaysia Plan
Dr Lokman, previously the Health deputy director-general (public health), called for the 12th Malaysia Plan to address the rising problem of NCDs, after the National Health and Morbidity Survey (NHMS) 2019 showed that about one in five adults in Malaysia were living with diabetes, while half of the adult population were either overweight or obese.
He also urged the government to focus on primary care and health promotion in the upcoming Malaysia Plan to tackle NCDs.
Dr Lokman noted that 90 per cent of doctors were serving in the private sector but only saw about 40 per cent of total outpatient load, compared to 10 per cent of doctors in the public sector that treat the majority of outpatients.
“If only these two systems, these doctors in primary care can be brought together in a very integrated and comprehensive manner,” he said.
“We have enough doctors, but we’ve not been able to utilise the resources very efficiently, with the health care financing system that has been existing all these years. It’s very important to address this issue of health care financing because it has an impact on how we can manage the national resources that we have.”
Dr Lokman said Malaysia’s primary health care system is “quite weak”, as MOH mainly focuses on curative care. He added that MOH had not been able to get enough funding for community empowerment programmes when he left government service.
Azrul similarly called for greater investment into health promotion and preventive health measures, which he noted was not “sexy stuff” compared to the Covid-19 pandemic that yielded immediate results from public health measures.
“When you talk about NCDs, you talk about investment of time and years, and certainly a lot of money. We’re dealing with one of the hardest things you can ever do in public health — changing health behaviour, ensure people are literate when it comes to health,” he said.
“I hope the upcoming 12th Malaysia Plan will not only see some renewed hope, but also some oomph in the health component, which has more emphasis and more realisation that health should not be taken for granted. And we need to put in more investment, rather than less investment in the coming years.”