Sabah entered its third Movement Control Order (MCO) period on 13 January, 2021, since the first nationwide MCO was declared ten months ago due to the Covid-19 pandemic.
Being one of the poorest states in Malaysia with major health care facilities sometimes taking hours or even days to reach from certain remote locations of the state, access to health care has always been a challenge for a significant proportion of the state’s population.
Infrastructure, in particular road connectivity in many parts of the state, may involve long narrow mountain roads or deep ravines interrupted by landslides or non-tarred roads. Night travel is particularly hazardous, with many of these roads mostly unlit.
Certain villages are only accessible by rivers and some may need access by helicopter. Internet connectivity remains a significant problem for many remote or deep interior locations.
In addition, the large immigrant population in the state, documented and undocumented, has been part of Sabah’s health care challenges for decades.
Ethics, human rights, health care cost issues and their relationships with the general health of Sabahans have always been contentious concerns that remains largely unresolved.
Covid-19 has a predeliction to disproportionately affect the most vulnerable communities, and the statistics for Sabah reflect that exact nature.
More than half of the total Covid-19 deaths in Malaysia in 2020 were from Sabah alone.
The death rate per million population and the number of those brought in dead was the highest in the nation. The fatality rate continues unabated.
Human resources, equipments, personal protective Equipment (PPE), army hospitals and modular labs have been set up in Sabah as the pandemic unfolds. Government grants, public donations and community assistance have poured in. However, Sabah has never really managed to contain the pandemic since its resurgence after the Sabah state election, and today, hospitals in the state are being overwhelmed with near-capacity occupancy rates and health care staff are working around the clock and trying to fight a virus that seems incapable of being defeated.
The current MCO might ease the pressure on Sabah’s health care system, but the various lockdowns have exacted severe economic pressures on many Sabahans who are already vulnerable from the start. Many have lost their jobs, suffer from ill-health, and permanent business closures and bankruptcies are not uncommon.
The mental toll and economic devastation are deeply entrenched in many local communities, and recovery will be very slow, painful and prolonged. The permanent solutions remains elusive so far.
What is essential now are radical policy changes, massive investments to strengthen Sabah’s health care system, the uplift of household economic statuses and the tackling of the long-standing illegal immigrant issue. The need for increases in hospital capacities and number of health care staff members are at the top of the list.
Public health has now emerged as an important element in our fight against the Covid-19 pandemic. Its ability to test and trace patients has been severely stretched during this pandemic, and massively increasing the availability of expertise and human resources will greatly enhance our current strengths and prepare us for future crises. Collaborating with private practitioners, especially general practitioners, will also be of importance in fighting Covid-19.
Immigrant health care issues need to be addressed with strategic planning integrated into the national and state health policies. Sidelining this critical issue will only serve to put the health of all Sabahans at risk.
Working collaboratively with local industries in providing safe housing needs for many of their foreign workers can bring us one step further in our fight against the pandemic.
And last but not least, permanent reforms in the prison system and detention centres that address the issue of overcrowding and enable effective preventive health care measures will be of urgent priority.
There is a dire need to institute clear vaccination plans, and all stakeholders must work collaboratively to ensure a high and rapid vaccine uptake in Sabah. Only by doing so may we see some light at the end of the tunnel, making the effective control of the Covid-19 pandemic a possibility.
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