KUALA LUMPUR, Oct 8 — Malaysia’s health care system was unprepared to face the Delta outbreak that overwhelmed many Klang Valley hospitals in July and August as a result of years of chronic underinvestment, said infectious disease expert Prof Dr Adeeba Kamarulzaman.
Dr Adeeba, who is also a member of the World Health Organization (WHO) Science Council, said as infections of the highly contagious Covid-19 variant surged, with Klang Valley cases hitting a record high 11,397 on August 6, it was clear that public health systems were not able to cope.
Soaring Covid-19 caseloads and deaths were also seen in several other states soon after, such as in Penang, Johor, Kedah, Sabah, Kelantan, and Perak, as the Klang Valley crisis consumed federal attention and vaccines. Recently, an anonymous doctor in Sibu Hospital in Sarawak wrote to CodeBlue, highlighting an overwhelming number of sick Covid-19 cases in the facility.
“We need to make our political masters and our financial leaders understand the importance of investing in health, and that 3.8 per cent of gross domestic product (GDP) is totally inadequate. Hopefully, we have all realised that investing in health has a significant economic payoff.
“Because you know, when we didn’t invest in health, the disaster that we’ve had to live with in the last two years has just been tremendous,” Dr Adeeba said at the Sir John Monash Lecture webinar organised by Monash University Malaysia yesterday.
Citing data from the United Nations Human Development Report, Dr Adeeba said Malaysia’s health expenditure in relation to GDP at 3.8 per cent in 2016 is still “well below” what it should be although the figure has seen a marginal increase in recent years.
To compare, Singapore’s health expenditure stood at 4.5 per cent to GDP, while South Korea’s health expenditure was at 7.3% to GDP in 2016. Thailand’s health spending stood at 3.7 per cent to GDP, just below Malaysia.
Finance Minister Tengku Zafrul Aziz previously told Parliament that Malaysia’s health spending is expected to reach 5 per cent of GDP or RM72.7 billion in 2021, which covers both public and private spending. Advocates want public allocations alone to reach 4 per cent of the GDP.
“This is something I think we’ve known for a very long time. This is from 2016 and, I think, the percentage of health expenditure to GDP has increased somewhat but it’s still well below what it should be. So, in a way, it’s no wonder that we struggled to respond to the pandemic as the Delta surged. Even countries with GDPs much higher than us had troubles,” Dr Adeeba said.
“The collision of high burden of non-communicable diseases, particularly obesity and diabetes, hypertension and end-stage renal failure, with a highly infectious disease, unfortunately, triggered the hyper inflammation that led to severe disease,” she further noted.
Dr Adeeba said investments need to go into automation and digitisation of the health care system. “It’s no longer a ‘nice to have’ (kind of situation), but it is imperative that we have it. One of the reasons (for the overwhelming caseload problem) is because things were done manually.
“Some of you may have experienced, the PKDs (district health offices) were not able to call you in time to tell you to isolate and much less to contact trace, and that was because everything was done manually.
“And this is by no means faulting my colleagues in the PKDs — it’s just not humanly possible to do it when there were just so many cases. So, if we do not want a repeat of this, that’s where the investment needs to go into — proper surveillance systems, you know, automation and digitisation,” Dr Adeeba said.
The Ministry of Health (MOH) formed a virtual Covid-19 assessment centre (CAC) last July to manage mild and asymptomatic patients requiring self-quarantine amid Klang Valley’s surging epidemic then.
Dr Jemilah Mahmood, former special advisor to former Prime Minister Muhyiddin Yassin on public health, previously told CodeBlue that Malaysia’s tracing methodology needs to be more automated so that persons who come into close contact with those who tested positive for Covid-19 can be quickly identified.
In addition to automated tracing, Dr Jemilah said a national Covid-19 testing strategy must also include comprehensive yet practical isolation and surveillance plans.
Health Minister Khairy Jamaluddin last month announced that a national testing strategy will be introduced to ensure that regular testing is conducted, especially among unvaccinated people, to curb the spread of the virus as the country treats Covid-19 as endemic.