The Health Budget 2022 Is Inadequate — Malaysian Health Coalition

Budget 2022 must over-invest in health care, while focusing on long-term strategies, by being tied to 12th Malaysia Plan strategies and subsequent Budgets. 

The Malaysian Health Coalition is dissatisfied with the meagre 1.5 per cent increase in allocation for the Ministry of Health (MOH) in Budget 2022.

The RM32.4 billion allocation remains inadequate, even if we include the additional RM2 billion allocation for Covid-19 equipment and consumables and RM6 billion for vaccines.

We urge greater spending to manage an endemic Covid-19 while simultaneously strengthening our public health care system for non-Covid-19 care like non-communicable diseases (NCDs), an ageing population, and routine maternal and child health.

We stress that this health budget is not expansionary (as proposed by us on October 20, 2021), but the contrary. 

Therefore, we urge the following: 

1. Increase The Allocation For The Public Health Care System 

Budget 2022 must be the first budget that over-invests in our health care system, to compensate for decades of under-investment. This will enable the public health care system to cope with amplified responsibilities without jeopardising quality of care.

We note that Budget 2021 provided a 4 per cent increase versus 2020, while Budget 2022 only provides a 1.5 per cent increase over 2021.

The increase in mental health allocation is also not proportional to the rise in mental health issues caused by Covid-19 stressors. It remains lower than upper middle-income and high-income countries who spend 1.6 per cent and 3.8 per cent of government health expenditure on mental health respectively.

This sets a dangerous precedent and a backwards trajectory which may prevent us from building a robust public health infrastructure as imagined in the 12th Malaysia Plan, and as required by a larger, older and sicker population.

Finally, we insist on greater accountability, monitoring and scrutiny to avoid fraud, wastage, corruption and abuse. 

2. Focus On Durable Strategies For Long-Term Health Development 

Budget 2022 proposes many temporary stopgap measures that must be part of longer-term strategies. We would like to highlight two examples.

Firstly, while social provisions and cash transfer allocations for older adults in Budget 2021 were necessary, there must be a change in philosophy to encourage older adults to have more active participation in their own health care.

Without active participation, even exponential increases in the social care budget for the elderly will create the reality or perception that older people are constantly dependent on support.

Secondly, the allocation of RM100 million for doctors, dentists and pharmacists to pursue specialist training is welcome, but must be accompanied with an increase in permanent posts.

This lack of long-term solutions may cause dissatisfaction among health care professionals, and there is already the possibility of a second strike by health care professionals.

We propose additional investment in district hospitals and the cluster hospital system, to create more permanent and training positions for house officers and specialist trainees and to redistribute staff.

This can retain specialists in the public health care system and train more doctors and health care professionals for the future. 

3. Emphasise The Social Determinants Of Health 

Budget 2022 has a clear allocation for MOH to deliver health care, but there must be an equal emphasis on the social determinants of health delivered by non-MOH agencies. We would like to highlight two examples.

Firstly, there must be more expenditure for the non-health care determinants of health such as health literacy, living and working conditions, adequate income and wage, food security and physical activity.

This can be achieved through investment in public health services and engagement with various stakeholders such as other ministries and community leaders to form a whole-of-society approach.

Secondly, we object to the excise duty that has been imposed on vaping and e-cigarettes. This is as though we are approving vaping and e-cigarettes in Malaysia, which were previously not explicitly approved or explicitly banned.

We propose an outright ban on vaping and e-cigarettes in Malaysia, while increasing tobacco control including passing a Tobacco Control Act. 

4. Address Missed Opportunities 

The lessons from Covid-19 pandemic allows us to rethink the structure and components of our health care system and lay the groundwork for long-term health reform. We would like to underscore three significant missed opportunities.

Firstly, we must emphasise telemedicine, automation and digitising health care. This requires smart regulations that protect patients, help health professionals, and promote innovation.

Secondly, we must strengthen primary care, especially for the 8,000 private general practitioners (GPs), 3,000 community pharmacies, and the thousands of allied health care professionals such as nutritionists, optometrists and physiotherapists.

They play a crucial and under-appreciated role in our health care system through disease prevention, vaccinations, screening and health promotion.

Thirdly, we recommend the gradual introduction of compulsory social health insurance (SHI), to reduce the high out-of-pocket costs of ordinary Malaysians. 

As we enter the third year of Covid-19, Malaysia must not miss the opportunity to build a robust and resilient health care infrastructure. More Malaysians are poorer after Covid-19, and this makes them more likely to use public health care facilities, which makes it crucial for us to over-invest in our public health care system.

Budget 2022 must over-invest in health care, while focusing on long-term strategies, by being tied to 12th Malaysia Plan strategies and subsequent Budgets. 

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