The health allocation under the Federal Budget 2023 tabled in Parliament today is arguably not a game changer for health care, despite the significant increase in allocation. However, it seeks to begin to address long and teething institutional problems caused by previous underinvestment such as aging infrastructure and retaining skilled health care workers.
In terms of allocation, at RM36.14 billion, the health allocation under the proposed budget is 11.5 per cent higher than this year’s portion, and is both the highest increase in percentage and absolute amounts in the past five years. It is 9.8 per cent of the total federal budget of RM369.34 billion.
When the budget 2023 document is reviewed, the breakdown for that allocation gives a mixed impression of being part of a responsive budget and being business as usual.
There are positive elements which focus on investing in modernising Malaysia’s health care infrastructure and services and increasing its capacity and coverage especially in East Malaysia, and the resiliency to respond to issues such as mental health. Retaining staff is also a main priority.
It is encouraging that though the government has allocated RM1.8 billion towards the building of new hospitals, clinics, and health care facilities, it has also provided RM420 million towards the repair, maintenance, and upgrading of existing structures.
This is an important point, as over the past five years, there have been several fires at ageing facilities, including one at the Sultanah Aminah Hospital in Johor, which saw six fatalities due to a fire in 2016. Out of Malaysia’s 156 public hospitals, 45 are over 100 years old.
The government also wants to address the contract doctor issue by increasing the line item for contract recruitments, but seems to not have increased permanent positions, despite large increases in emoluments across the board.
This is obviously intended to fund the promotion of existing staff and increase salaries to support retention of skilled health care workers.
However, what does not appear is clearly of concern.
While the establishment of the National Centre of Excellence for Mental Health is welcome, it would have been better for the allocation to go fully towards investing in ensuring that we have more psychiatrists, psychologists, and other mental health professionals.
We need to increase the availability and coverage of mental health services, which are currently inadequate. We need more service providers, or at least means for people to access both public and private mental health services. This will require long-term investment and commitment.
Despite the finance minister recognising that Malaysia is still in pole position among countries in this region with a high population who are obese or living with non-communicable diseases, there seems to be little to address this situation.
The National Health and Morbidity Survey (NHMS) 2019 highlighted that one in five people live with diabetes; three in 10 with hypertension; 3.4 million currently live with at least two NCDs; and half of the adult population are either overweight or obese.
Yet allocations for health education and Peka B40 have been reduced, while Agenda Nasional Malaysia Sihat was provided with RM16 million.
While the government is willing to give RM150 for kids regardless of household income under the Bantuan Awal Persekolahan (BAP) programme, it is still unwilling to introduce a nutritious food programme in schools for all children to address child malnutrition.
Stunting and obesity are both affecting a significant proportion of Malaysia’s children, regardless of economic backgrounds. When are we going to invest in addressing the problem of childhood malnutrition?
We are still unable to see what the allocations for drugs and treatments are under specific disease areas, as they continue to be clumped together under broad line items which prevent an understanding and transparency of funding priorities for therapies.
Finally, it is disappointing that there is no mention of any commitment to address the issue of health care financing and investing in a sustainable long-term solution.
In order to ensure that Malaysia’s health care system is able to continue to provide quality, affordable, and accessible health services for all in the decades to come and tackle the challenges of preventing and treating NCDs, of mental health and an ageing population, the government must summon the will and commitment to invest now in a new sustainable approach to funding health. We did not hear that today.
Now more than ever, we need to invest in futureproofing and increasing the resilience and sustainability of the public health care system. We cannot take it for granted.
Azrul Mohd Khalib is 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.