Government Slashes 2021 Medical, Public Health Budgets Amid Covid Crisis

Under MOH’s Budget 2021, nephrology received a 78% budget cut with an RM56 million allocation for next year, while the allocation for cancer treatment was slashed by 10 times to about RM21 million.

KUALA LUMPUR, Nov 6 — The government has decreased next year’s budgets for curative care and public health, including deep cuts for cancer and kidney disease treatments, even as Malaysia is facing the greatest public health crisis in history with Covid-19.

Despite a slight 4 per cent increase of the Ministry of Health’s (MOH) allocation from last year to RM31.9 billion in Budget 2021, MOH reduced its medical budget by 20.5 per cent from RM14.2 billion in 2020 to RM11.3 billion in 2021, making wide-ranging cuts across almost all health care services, including a massive 74 per cent decrease for pharmacy and supplies, according to the Estimated Federal Expenditure 2021 document. Pharmacy and supplies refer to drugs and other non-pharmaceutical items like personal protective equipment, IV drips, and syringes, among others.

Amid a surge in the number of Covid-19 cases nationwide, hitting a record 1,755 infections today, there has been an 11.70 per cent decrease in MOH’s public health budget from RM5.7 billion in 2020 to about RM5 billion in 2021. Disease control under public health — which includes infectious diseases like Covid-19 and dengue — suffered a 0.95 per cent cut from RM843.7 million in 2020 to RM835.7 million in 2021.

Dental health was also reduced from about RM990 million in 2020 to RM978.2 million in 2021, while pharmacy services were cut from RM212 million this year to RM209.3 million next year. Research and technical services suffered budget cuts from RM426.9 million in 2020 to RM411.8 million in 2021, although research under the sector received a slightly increased allocation from RM141.9 million in 2020 to RM146.9 million in 2021.

MOH’s budget for administration was cut from RM2.4 billion in 2020 to RM2.3 billion for 2021. Under administration, the budget for human resources received a slight increase from RM15 million in 2020 to RM15.4 million in 2021, besides other budget hikes for administration of headquarters and state offices, data management, and competency development.

Budget increases were made for food safety and quality from RM94.4 million in 2020 to RM98.2 million in 2021, as well as a RM1.6 billion increase in specific programmes, which includes emoluments for contract staff, from RM3.9 billion in 2020 to RM5.5 billion in 2021.

After Finance Minister Tengku Zafrul Aziz tabled Budget 2021 in Parliament today, Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib said it was shocking that the public health budget has been reduced.

“Public health is the most important aspect of our health care system right now and we need it to be strengthened,” Azrul said in a statement.

“More than ever before, we need to protect the public health care system which provides high quality, accessible and affordable services. We cannot take it for granted.”

Budgets for respiratory medicine and general medicine departments have been cut by 10.46 per cent and 14.28 per cent respectively. Respiratory diseases like Covid-19 fall under general medicine and respiratory medicine.

MOH’s budget for anesthesiology and intensive care has also been slashed by 10.03 per cent, despite the rise in the number of Covid-19 patients being treated in intensive care units (ICU) as well as on ventilators.

Today, there are 83 Covid-19 patients being treated in the ICU, including 32 of them on ventilator support. These are not including non-Covid-19 patients in the ICU or on ventilator support. An ICU bed is different compared to a normal ward bed, as it is equipped with monitors to provide higher levels of care for critically ill patients.

Hospital support services under MOH’s specific programmes has also been cut from RM1.93 billion to RM98.36 million by 94.91 per cent.

Budget Cuts For Non-Communicable Diseases (NCDs)

Budgets have also been cut for treatment of non-communicable diseases (NCDs) — cancer, as well as cardiovascular and kidney diseases.

The highest cut was made for nephrology with a budget cut of 77.61 per cent as compared to Budget 2020, as nephrology received RM56.5 million for 2021, compared to RM252.1 million for 2020. The entire RM56.5 million allocated next year was for emoluments, with nothing allocated for services and supplies (ie: treatment).

Meanwhile, there has been a 66.70 per cent cut for cardiothoracic (RM180.5 million in 2020 to RM60.1 million for 2021) and a 58.49 per cent cut for radiotherapy and oncology (RM328.7 million in 2020 to RM136.4 million in 2021).

The 2021 budget for cardiothoracic went entirely to emoluments, with nothing allocated for services and supplies, while next year’s allocation for cancer treatment was slashed by 10 times to about RM21 million from RM216.9 million in 2020.

Although Budget 2021 states zero allocations for services and supplies for nephrology and cardiothoracic, the allocations for treatments may have been placed somewhere else in the budget. Tengku Zafrul told Parliament during the tabling of Budget 2021 that the government was allocating RM25 million on peritoneal dialysis home treatment.

Azrul said the diversion of resources and cuts to fund the Covid-19 response now threatens to have a significant negative impact on Malaysia’s response towards NCDs like cancer, kidney disease, and cardiovascular diseases.

“We cannot afford to look at one crisis at a time. Telling ourselves that we will deal with cancer and chronic kidney disease some other day after we are done with Covid-19, is not an option. Suffering could increase and lives will be lost due to insufficient resources for treatment and care.”

Azrul pointed out that the National Health and Morbidity Survey 2019 had clearly highlighted the risk of NCDs causing a catastrophic impact on the Malaysian health care system and society as a whole.

“We call on the government to review the allocations for health under the 2021 federal budget.”

Azrul Mohd Khalib, CEO of the Galen Centre for Health and Social Policy

Budget 2021 Increases For Food Safety, Contract Staff

Meanwhile, there has been an increase in allocation for certain aspects in health care under MOH for Budget 2021. For instance, there has been an increase of the allocation for the management of food safety and quality at headquarters/ state under the food safety and quality budget by 11.41 per cent. MOH’s food safety and quality budget rose by about 4 per cent from RM94.4 million in 2020 to RM98.2 million in 2021.

This was followed by increases in the allocation for general inpatient treatment and hospital management under the medical budget at 3.64 per cent and 0.76 per cent respectively.

The government further allocated money for new items in Budget 2021 that were not previously included in Budget 2020, such as health facilities’ medical supply and a concession on the privatisation of medical laboratories and stores, both of which are under MOH’s specific programmes.

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