It has been a whirlwind of a year and yet 2020 seemed like one of the longest years of our lives. The Covid-19 pandemic, which started in January 2020 for Malaysia, tore through our country with three waves and we are still battling to contain the third outbreak.
At the front of this fight, the Ministry of Health (MOH) of Malaysia has the hero, the victim and at times, the villain.
Looking forward, 2021 will be crucial for MOH. To untangle the country out of the pandemic, which seems intent on wrapping itself on us, MOH needs an equally unprecedented response. An immediate, middle term and a long term response, to be specific.
The Immediate Response
Without a doubt, the immediate response is to try and contain this current outbreak. MOH will need to scale up both inpatient hospital facilities for the more ill Covid-19 patients, as well as low-risk facilities for the less ill patients.
We cannot afford to let the disease overburden our hospitals, which will lead us to a spiral of complications and likely, deaths too. Every day that passes will make it harder for us to get out of this rabbit hole.
Second immediate response is our vaccination strategy. The news of the vaccine procurement in December was very welcomed but it is only the beginning. MOH must now craft out a mass vaccination exercise which is arguably the largest and most complex in the history of the nation.
Trying to build vaccine confidence and vaccinate 70 per cent of the population, which is about every adult in Malaysia, is no easy feat. Coupled with logistics and geographical variation, MOH will have its hands full.
Middle Term Response
The middle term response will start when the current outbreak stops or at least slows down significantly. This is the time to build capacity for future, inevitable outbreaks. We had a good period between the second and third wave but the window was mostly wasted.
The containment of the first and second wave was successful but we were complacent by the time the third wave arrived.
I would even say we were a little lucky that the first two waves were mostly in urban areas where access to health care was good, but the third wave struck us like a hammer to the knees. Trying to contain an outbreak in East Malaysia is a completely different exercise than in Klang Valley.
And when it did reach Klang Valley, the disease found itself a Petri dish: the cramped living conditions of migrant workers. We are now consistently seeing 4-figure new cases compared to double figures earlier in the year.
Learning from this current wave, we need to scale up our testing, contact tracing and inpatient care facilities tenfold. Testing and contact tracing is crucial to stop outbreaks from getting out of control and hospital care is needed to keep complications and death rates low.
The last piece of the jigsaw is manpower. MOH must accept the reality that the contract system for housemen and medical officers is not doing the service any good and there needs to be a serious discussion with all stakeholders on how to begin rectifying this manpower problem. If not, we will be looking at a gap of specialists in our hospital in the near future.
Apart from Covid-19 patients, MOH must sort of the backlog of non-Covid-19 patients. We know during the pandemic, healthcare services are disrupted and many avoid seeking health care. This will affect the long term health and economic productivity of our population. And the country cannot be caught off-guard by this.
Long Term Response
The long term response is perhaps the hardest pill to swallow. As health care costs increase every year, MOH needs to face the reality that “RM1 health care” is not sustainable. The health care budget may be the highest every year, but it is far from being able to elevate the service to the next level.
Instead, we hang by a thread, delivering good quality but inconsistent health care services to the people.
Considering other forms of funding for MOH such as co-payments, social health insurance is inevitable. And is it better for MOH to start putting the pieces in place before the system truly collapses. All three responses need not be compartmentalised but instead should work simultaneously to ensure continuity and sustainability.
MOH has always been the steady ship of the government, almost on autopilot. Whatever the budget is every year, MOH somehow will pull through and continue to provide much-needed health care services to the people of Malaysia.
This is not a testament to the system and its policies but a testament to the dedication of the staff, who almost always put duty above self. And it is time for the government to repay back the decades of hard work by ensuring they are adequately remunerated, securing employment by making positions permanent and provide them with a healthy, conducive and productive working environment.
Health care is now in the spotlight due to the pandemic, there is even talk about a bipartisan approach to enhance it. Therefore I believe the good people in MOH must take this opportunity to spearhead a change and move away from old practices. A nation’s foundation must be rooted in an efficient, accessible and sustainable health care system. This should be the focus of MOH in 2021.
Dr Khoo Yoong Khean is a health care administrator and the managing editor of The Malaysian Medical Gazette.
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