KUALA LUMPUR, Sept 15 — Non-governmental organisations in health care have taken it upon themselves to adopt independent data collection mechanisms, said the National Cancer Society Malaysia (NCSM).
NCSM managing director Dr Murallitharan Munisamy made this statement at a health financing forum last September 6 organised by the Asia-Pacific Economic Cooperation (Apec) and the Pharmaceutical Association of Malaysia (PhAMA), in response to a purported lack of data by the government.
“So for a lot of us, we’ve just now started putting in our own data collection mechanisms, our own kind of tracking, our own kind of building of interventions. And perhaps that kind of also signals a little bit of an independence away from needing to always rely on government reporting mechanisms,” Dr Murallitharan told the APEC Health Financing Forum.
NCSM recently published its own research study that estimated that more than 560,000 teenage girls across Malaysia missed out on their HPV vaccination, which prevents cervical cancer, from 2020 to 2022 due to school closures during the Covid-19 pandemic.
Health Minister Khairy Jamaluddin said in response last September 7 that the Ministry of Health (MOH) would budget for a catch-up programme next year, including procuring sufficient vaccine doses, to cover girls who missed their HPV shots.
He, however, disputed NCSM’s finding that linked poor HPV vaccine coverage last year to the pandemic, saying instead that this was due to a global HPV vaccine shortage.
In a panel at the APEC Health Financing Forum that focused on describing the Malaysian health care system and its problems and challenges, Dr Murallitharan took a rather innovative and economical approach to characterise the system.
Instead of dividing the system into the vast primary, secondary, and tertiary spheres across the private and public sectors, he looked at the system through a microeconomics microscope and held that the three main areas which should be focused on are the “maternal child health services pocket, the communicable disease care services pocket, and the NCD kind of pocket.”
This micro approach to viewing the health care system is a view that Dr Murallitharan drew from the 2019 Nobel Prize-winning economists Abhijit Banerjee and Esther Duflo.
Duflo and Banerjee were awarded the Nobel Prize for work in utilising microeconomics to analyse the determinants of poverty and channels of poverty alleviation. They then used those methods alongside empirical research to create specific mechanisms to alleviate poverty.
By focusing on microeconomic studies, Banerjee and Duflo created a pathway that governments and nations can use to solve broad developmental problems.
By extension, Dr Murallitharan proposed that health care reform should begin by focusing on these small areas to ensure broad systemic change that will bring Malaysia a step closer to universal health coverage (UHC).
“So rather than broadly pushing across the entire spectrum in the entire space of the health care system, we should be looking at micro-interventions at each different level of our each different care space. Plus, each of that is a different health system with these kinds of small solutions in place.”
UHC is a World Health Organization (WHO) target to ensure that all people have access to the health services they need without suffering financial hardship.
It also requires nations to provide a full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course of a person.
Despite describing UHC as an unachievable utopian ideal, Dr Murallitharan emphasised the need to strive for such a dream, as it ensures that more people have access to care while decreasing the financial burden placed on individuals and households.
“So, this is an utopian ideal that we will never reach ever in existence, but this is the utopian ideal. And this is what every single kind of health system reform change transformation it needs to drive towards expanding the box for them.
“For the getting of more and more people covered, getting more and more services covered, less burdens on two kind of out of pocket expenditure for households, for individuals.”
When it came to health financing, Professor Dr Syed Mohamed Aljunid, professor of health policy and management at the faculty of public health at Kuwait University, held that out of the 48 per cent of total health expenditure that comes from private funding sources, 39 per cent is out-of-pocket payments, “which is quite significantly high compared to many other countries.”
Dr Syed holds that, apart from the high out-of-pocket payments, reform needs to happen because the lack of funding prevents MOH from hiring more staff. This not only results in a shortage of staff, but it also adds to the staff shortages faced by the private health care sector.
“We can see there is a long waiting time in the public procedures mostly because of a lack of funding to provide adequate human resources to manage the services, shortage of gap, especially for treatment of chronic non-communicable diseases.”
This shortage, partly stemming from the brain drain of the public health care sector, has also resulted in the “maldistribution of doctors and nurses.”
Many of these health care professionals have switched to the private sector or gone abroad, causing “problems in terms of planning for the human resources and also to get adequate health and also support staff.”
Deputy Health Minister Dr Noor Azmi Ghazali told Parliament in September last year that out of the 13,000 specialists currently in the country, 6,012 specialists (46 per cent) are serving in government, while 948 specialists resigned from the public sector between 2016 and 2021.
With respect to the above reasons, numerous attempts have been made to reform the system, but all have failed due to the lack of information, infighting amongst various groups, and a lack of transparency that resulted in public mistrust, said Dr Syed.
“We know that certain agencies feel that they are more responsible to manage the financing aspect. At the same time, there are also potential losers. For example, the private insurance [industry] might lobby against the reform.
“Lack of transparency and public consultation might be another important factor, and also loss of public confidence and trust on the government in managing a large fund because of the recent and also past related issues to cronyism and also corruption.”
Notwithstanding the above, Dr Syed held that the most important reason for the failure of past efforts at health care reform was the “lack of political will,” stating that strong political will, coupled with stakeholder consultations, will give Khairy’s attempts a better chance of success.
“I think something has to be done. People have to change, but I think in the current initiative on the Health White Paper, this is trying to be solved to a certain extent. Multiple stakeholders are now being engaged. I think this is a good start, but still we need to actually move this in a more concrete way.”
In addressing a statement from the floor on political will, Dr Murallitharan stated that his hope for the Health White Paper’s success stems from the fact that Khairy is a minister who kicked off the reforms with a long-term plan that will continue long after his time as health minister.
“So, this is a minister who started off saying that, ‘Look, this is not going to be done in my time. And, what I’m going to do is kind of lay the foundations, and hopefully, those foundations are enough to kind of carry this through this transformative process’.”
In a recent press conference, Khairy stated that he has tasked the Health White Paper Advisory Council and the senior management at the MOH to brief the new health minister to ensure a “buy-in,” in the event he is no longer health minister following the 15th general election.