After many months of speculation, the elections are upon us. We have an opportunity to elect leaders who will not just represent all the people but also champion the important issues and needs of the country.
As we evaluate those who are hoping to represent us, it is important that we ask them what their plans are for the most important issues that our nation faces. Health, education, economy and social support are, and should be, the pillars of any political manifesto.
Any party that plans to field candidates as elected Members of Parliament, and who hopes to be the government of the day, must be prepared to lay out in clear terms what is the agenda for the development of health services in the country, the plan to transform our education services, the strategy to revive and sustain our economy, and the growth of the safety net for the poor in our country.
This article deals with the key health issues and policies that all political parties need to have in their 15th general election (GE15) manifesto as well as commit to achieving, if elected.
Committed to Bipartisan and Civil Society Health Care Reform
Health care reform is not a transient or static process. By right, it should transcend the changing wishes and fashions of each new government.
It must be a process where all the people have a say and share in deciding. It should be altruistic, comprehensive, seamless and one which leaves no one behind.
As such, a primary policy by all political parties should be their commitment that the national health services planning, funding, and direction should be bipartisan, involving all political parties, with a significant, meaningful and real involvement from civil society.
The process should be transparent, not based on favouritism, and be open to continual public scrutiny at all stages.
Inadequate Health Spending
Currently, there are so many health issues that require our attention. This is because our health service has been chronically underfunded and relatively neglected for decades.
Hence, any political party that does not commit to spending at least six percent of Malaysia’s gross domestic product (GDP) on health is not to be supported.
It is important to note that this should be government spending and not out-of-pocket spending by the people.
This needs to happen quickly and not in some 10-year projected plan.
Much of the increased health budget should be targeted at marginalised communities to reverse the existing ‘inverse health care law’ and improve their poor health outcomes.
We do not need to spend large sums on more “centres of excellence” when we have not even established quality health care for a significant portion of our population.
Commitment to Upgrade Health Human Resource and Infrastructure
We have expanded the scope of our health services without the necessary human resource and infrastructure development to support it.
Our hospitals are aging, with many a fire hazard, having outdated facilities, and often using equipment beyond economic repair (BER).
Our limited national expenditure on health infrastructure has meant that many cannot receive intensive care in our public hospitals, unless they can afford the exorbitant private hospital fees.
It is time that we stop having to struggle every single working day to find an intensive care bed for a baby or child.
In addition, health staff burnout has become a critical problem.
Almost every major state capital city in the nation needs a new, well equipped general hospital. Intensive care services for children should be doubled.
We need to retain our doctors, pharmacists, and allied health staff by giving them permanent jobs, as well as work to double or triple our nursing numbers both in primary care and hospitals.
In particular, the entire health services in Sabah require an urgent upgrade.
Evidence and Data-Based Approach to Identifying and Meeting Health Needs
We have so many pressing health issues, which include disability (including rare diseases), aging; cancer; non-communicable diseases (NCDs) like diabetes, hypertension, coronary artery disease, chronic respiratory illness; injuries (road and drowning); mental health; adolescent health; child health; women’s health, climate change related health issues etc.
Hence, it is hard to decide where to place our health resources and time. Very often, what happens is that priorities are determined not by need, but by who has the loudest voices or which VIP influences the process.
This kind of health planning and decision making needs to stop.
We need an evidence and data-based approach to health needs so that areas with significant health burdens are not neglected, but given the resources needed.
It is important that the voices of lived experiences on the ground are listened to and given value, rather than that of foreign or ivory-tower experts who do not understand our situation.
A Focus on Preventative Health and Primary Care
We need to reverse the illness-centric-driven health care services in the Ministry of Health (MOH) and the private sector. We need to shift the emphasis from disease management to health and wellness.
The growth of big business in the private health industry has meant that it is now predominantly profit driven; hence there is no major incentive to promote preventative health.
We need to reject greed and excessive financial gain in health care that has grown, especially via private hospital chains. In essence, the private-public divide worsens our health services.
Health is a basic human right.
Any elected government must work to reverse the commercialisation of health care. It is time perhaps to nationalise the health services in the nation.
We need to have a national emphasis on preventative health and primary care, not just in MOH but also in the private sector.
We require imaginative strategies to get our public to grow their well-being and our doctors to become wellness focused.
One way is to encourage all specialists (MOH and private) to spend time on the ground in the community doing prevention work.
We need to move away from a mindset of delivery of health care to the community and work towards the development of capability within the community for self-care using trans-disciplinary community health care workers.
Mitigating and Reversing the Impact of the Climate Emergency on Health
The climate emergency is a worsening reality often ignored or downplayed by the government. This growing problem threatens to engulf and reverse all prior health gains.
Even now, it is estimated that air pollution alone has had a sizeable and significant impact on adult and childhood morbidity and mortality.
Health cannot be viewed in isolation and the environmental change we are experiencing has to be acknowledged as perhaps the single largest health issue.
We call on all political parties to have a clear mandate in their GE15 manifesto to recognise we are in a climate emergency and spell out the dramatic changes to improve air quality, reduce CO2 emissions and have contingency plans for rising water levels.
One critical measure is to move to clean energy and a meaningful, efficient, cost-reasonable, bus-based electrical public transport system nationwide.
Political aspirants (MP hopefuls) should commit to a personal usage of public transport (or bicycles) a few days a week for this reality to happen.
Conclusion
If we are serious about health in our country, then we require a radical change in approach and not “more of the same”.
We must achieve health for ALL, not as an average or for a segment of the community. We require a transformative approach that focuses on inclusive growth with good access to achieve equality.
Any political party that does not support such an approach is not for the people.
We urge the people to make health a critical election issue for GE15 and beyond.
We must hold our governments accountable for this vital and basic right for all those living in Malaysia.
Dr Amar-Singh HSS is a consultant paediatrician and an Honorary Senior Fellow with 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.
