The Government should consider reviewing the strategies outlined under Priority Area B (Enhancing Healthcare Service Delivery) of the 12th Malaysian Plan (12MP) tabled today in Parliament by the prime minister.
The fact that a number of key areas are either lacking in substance or missing altogether from the national strategic plan, could signal or be interpreted as a lack of recognition, support and commitment on the part of the government to address these issues.
Considering what the country and people have gone through over the past 18 months, sacrifices made by thousands of frontline health and non-health essential workers, the many strengths and gaps identified, and the hard-won lessons from the Covid19 response, the health component of the 12th Malaysia Plan feels a bit underwhelming.
There are several problems in what was outlined, and likely only one real game changer in this section.
We often overlook that the health care sector is and has been a leader and driver of economic progress in Malaysia. Prior to the Covid-19 pandemic, the past several years saw an increase of 11 per cent annually for this sector, which was frequently double the country’s GDP growth rate. There is so much untapped potential. The 12MP does not reflect that.
It is surprising that yet another study is being proposed to put together a Malaysia Healthcare System Reform blueprint. We have done at least half a dozen studies over the past two decades, looking at the same issue of national health care reforms.
The latest one was done in 2016, which was commissioned by the Ministry of Health (MOH) and conducted by the Harvard TH Chan School of Public Health.
Let us not continuously reinvent the wheel. Look at the findings and conclusions from that Harvard report, and we will already see many of the reforms which are needed and can be done today. What is needed are courage and political will to implement the recommendations from that study.
Despite being identified in the document as a gap contributing to the problem of double burden of disease, the issue of managing non-communicable diseases (NCDs) such as cancer, diabetes and cardiovascular diseases was barely addressed, beyond increasing awareness and screening.
Before the Covid-19 crisis hit, Malaysia was already going through a national NCD crisis. Half of the adult population are either overweight or obese.
Data from 2012-2016 found that nearly 30 per cent more Malaysians died from cancer during that period. 3.9 million aged 18 and above are currently suffering from diabetes.
Increasingly, more people are being diagnosed with these conditions at later stages, especially after the disruption caused by the coronavirus. If we do not acknowledge and commit at a national level that increased investment in effective treatments and care are needed to tackle these diseases, people will be left behind.
More patients will die due to suboptimal treatment. The urgency to combat NCDs goes beyond the health sector and requires multisectoral effort. We will be living with this problem for decades to come. There should have been a stronger emphasis on dealing with the NCD crisis.
As part of reforms to ensure sustainable healthcare financing, we support the application of means testing to provide targeted subsidisation for healthcare services for those who most need it.
Those who can afford to pay more for government medical services should be able to do so in order to help support those who are less privileged. This reform is overdue and will help reduce the government’s financial burden which is steadily increasing each year. The current situation is not sustainable.
However, we believe that the government should have also announced its intent to introduce a compulsory national insurance scheme which would spread risk, pool revenues and risk, improve treatment options and provide sustainability during times of crisis. That would have been a true game changer.
Oddly, the establishment of a Malaysia Institute of Infectious Diseases was announced by the prime minister, but not stated in the 12MP document. Rather than construct yet another new building, the millions in funding should go towards support of the National Institutes of Health under the MOH, specifically the research work of the Institute for Medical Research and the Institute for Public Health, which already houses the Centre for Communicable Diseases Research.
The renewed and intense interest and commitment in infectious diseases is welcome, but we should really use that money to strengthen the capacity of our existing institutions by recruiting the best and brightest people and researchers in infectious diseases.
Also missing was any recognition or commitment to solving the problems related to human resources such as contract doctors and the retention of specialists and experts in the public sector, which will require a structured framework of deliberate policies, increases of millions in operational funding, and a time frame of several years to implement; addressing the safety of health care facilities and services (e.g. fire safety in hospitals); and strengthening the role and capacity of teaching hospitals in health emergency preparedness and disease research.
Unless the government reviews what it proposes in the health section of the 12MP, this could be a lost opportunity to rebuild, reform and transform our health system into a service that is fit for purpose and future-proofed to meet the challenges of a population facing rising health burdens due to an ongoing crisis of non-communicable diseases, an ageing population, and demands for better quality healthcare. It will also help us prepare for the next pandemic.
Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.