KUALA LUMPUR, Dec 29 – This year marks a tumultuous period of health care issues in Malaysia, after Covid-19 restrictions were finally lifted following the Omicron wave in the first quarter of 2022.
Most politicians, policymakers, and the public appear eager to put health in the rear view after over two years of Covid that killed more than 36,000 people in Malaysia.
However, systemic issues continue to plague Malaysia’s ailing health care system, including insufficient health care professionals like doctors and nurses, linked to the contract system; lacking infrastructure; inadequate and unsustainable health care financing; and the high prevalence of chronic disease in Malaysia.
Plus, China’s Covid wave may spawn new variants that threaten the rest of the world. Several countries have already imposed travel restrictions on arrivals from China, such as the United States, Japan, Italy, India, South Korea, and Taiwan. China has decided to drop quarantine for overseas visitors as well as resume issuing visas to foreigners and passports to Chinese citizens from January 8.
Instead of less health in 2023, Prime Minister Anwar Ibrahim’s administration needs to focus on health care reform and boldly take on policy and legislation of eye-watering political difficulty to ensure a year of true recovery.
Here, CodeBlue lists the top 10 health issues that popped up in Malaysia in 2022.
MySejahtera: Developed Without A Contract, Expanded Use For 2023 Despite Unclear Procurement
MySejahtera turned into a national scandal after the powerful Public Accounts Committee (PAC) in the 14th Parliament revealed that the Covid-19 contact tracing mobile application had been developed for the government without a contract with the app developers.
Further public outrage ensued when court documents from two lawsuits against MySJ Sdn Bhd, the company currently operating the MySejahtera app, disclosed that the app developer, Entomo Malaysia Sdn Bhd, had sold MySejahtera’s intellectual property and software licence to MySJ for RM338.6 million in a deal until end 2025.
The previous Ismail Sabri Yaakob government did not announce that any payment has been made to MySJ, even as the PAC said in its inquiry into the development and procurement of MySejahtera that the then-Cabinet had authorised a cap of RM196 million in two annual payments of RM98 million each to MySJ from April 1, 2021 to March 31, 2023.
New Health Minister Dr Zaliha Mustafa announced yesterday the expansion of MySejahtera into an appointment system at public primary care facilities, amid lack of clarity over whether the unity government has signed a contract with MySJ to procure the app, and how much payment has or will be made to the company.
Housemen Bullying, Toxic Working Culture In Public Hospitals
The death of a house officer attached to Penang Hospital last April triggered multiple personal anecdotes and reports of bullying of housemen and junior doctors.
Then-Health Minister Khairy Jamaluddin created a Healthcare Work Culture Improvement Task Force (HWCITF) to examine the purportedly toxic working culture in public hospitals.
Strangely, the HWCITF failed to disclose basic findings from its survey across all 30 service schemes in the Ministry of Health (MOH), such as the statistical prevalence or personal testimonies of workplace bullying suffered by housemen and junior doctors specifically.
Khairy launched a new online complaints mechanism called MyHelp for doctors and other staff to report workplace bullying, but without more wide-ranging plans to revamp MOH’s workplace culture, the bullying and harassment of junior doctors will likely continue to persist.
Medicine Shortages From China Lockdowns, Russia-Ukraine War
Private general practitioner (GP) clinics, pharmacies, and hospitals in Malaysia suffered major shortages of various prescription and over-the-counter medications since last May, due to Covid lockdowns in Shanghai, China, and Russia’s war in Ukraine.
The drug shortages forced MOH to open up its federal medicine stockpile for loan to private health care facilities.
More than an acute problem, the extraordinarily severe drug shortage in Malaysia this year revealed the need to boost the country’s medicine security for future international issues in the global pharmaceutical supply chain, as Malaysia is a net importer of pharmaceutical products.
Controversial Smoking Generational End Game In Tobacco Bill
The Control of Tobacco Product and Smoking Bill 2022 was engulfed in controversy – chiefly among legislators, civil rights activists, and even a former chief justice – due to its proposed ban on tobacco and vape products for the next generation born from 2007.
Known as the generational end game (GEG), Khairy had modelled his proposed generational smoking and vaping prohibition after New Zealand that recently passed a world-first tobacco law to ban the sale and supply of smoked tobacco products to anyone born from 2009.
However, wide discretionary enforcement powers under Malaysia’s tobacco bill – which would be the country’s first ever tobacco control Act – sparked major concerns among MPs from both sides of the aisle, preventing a vote and passage of the bill before the 14th Parliament was dissolved.
Ipoh General Hospital’s Ambulance Service Withholds CPR
Perhaps one of the most shocking health issues to emerge this year was the case of a 43-year-old man in Ipoh, Perak, who died from a heart attack last April after Raja Permaisuri Bainun Hospital’s (HRPB) ambulance service withheld cardiopulmonary resuscitation (CPR) from him.
Dr Thiru Terpari, coincidentally a doctor from HRPB, had access to the prehospital care form by the paramedic who attended to his late brother, Kumaraveloo, that documented the lack of CPR intervention and the paramedic’s claims that Kumaraveloo’s body had turned cold and showed algor mortis, a “clear sign of death”.
This was despite the Ipoh general hospital’s ambulance arriving within 20 minutes from the time of Kumaraveloo’s collapse in his car during a traffic jam.
An independent inquiry into the case, involving experts from public hospitals outside HRPB, was held last July, but Khairy never published the findings of the investigation or disclosed if similar lapses have occurred in other public ambulance services nationwide.
Emergency Department Overcrowding Crisis: Worse Than Pre-Pandemic
HRPB’s emergency department (ED) is severely overcrowded, where critically ill patients, including ventilated cases, are stranded for up to six days for ward admission, due to insufficient critical care beds and staff.
HRPB doctors said most of the seriously sick patients coming into the ED are presenting with advanced non-communicable diseases (NCDs) – such as heart disease, kidney failure, and stroke – after the disruption of care from two years of Covid lockdowns.
They also said the situation in HRPB’s emergency room this year has worsened from pre-pandemic days, when patients back then waited one and a half days at the most for a bed in a ward.
CodeBlue’s 5,000-word report sparked discussions among doctors and medical experts about similar problems in other congested EDs across the country that may cause patient harm from substandard care. Emergency doctors in Kuala Lumpur complained about the lack of improvement since overcrowded, understaffed, and underfunded EDs in public hospitals were first highlighted by the Auditor-General’s 2018 report.
NCD Crisis: RM9.65 Billion Annual Health Care Costs From Diabetes, Cardiovascular Disease, Cancer
A report by MOH and the World Health Organization (WHO) revealed that the direct health care costs from diabetes, cardiovascular disease, and cancer in Malaysia exceed RM9.65 billion yearly, based on 2017 data.
Diabetes topped spending at about RM4.4 billion, 227 per cent higher than cancer (RM1.3 billion) and 11 per cent higher than cardiovascular disease (RM3.9 billion). A diabetic patient stressed the need to catch diabetes before it’s too late, noting that the condition doesn’t make you feel sick – until something drastic happens.
End-stage kidney disease (ESRD), or kidney failure, has also been rising in Malaysia, with a consultant nephrologist estimating a whopping 106,000 patients by 2040 from the current over 49,000 in 2020. Yet, only a few dozen deceased organ donor transplants are performed annually, as thousands of ESRD patients on dialysis die every year.
Prepping For HIV/ AIDS, China’s Covid Wave
HIV prevention medication PrEP will be available in January 2023 for free at selected public health clinics (Klinik Kesihatan) in the Klang Valley, Johor, Penang, and Sabah.
According to the UNAIDS’ “In Danger” 2022 report released last July, HIV infections have now increased since 2015 in 38 countries, including Malaysia and the Philippines, the only two Asean nations listed. The report cited Malaysia and the Philippines as being among the countries with rising HIV epidemics among key populations.
As for the Covid-19 pandemic, infections are surging in China, overwhelming hospitals and causing medicine shortages, after the Chinese government abruptly abandoned its strict “zero Covid” lockdown strategy earlier this month.
More than half of passengers on a flight from China to Milan, Italy, tested positive for Covid-19, international media reported earlier today. Italy now imposes mandatory Covid-19 tests and virus sequencing for all arrivals from China to detect possible variants. US officials reportedly criticised the lack of genomic sequencing data of the SARS-CoV-2 virus being reported from China.
The Malaysian government has yet to announce any travel restrictions or testing requirements for arrivals from China.
Health White Paper: Reform In Health Care Financing, Among Others
Khairy spent much of his time in his short tenure as health minister to promote health care reform, saying that he hoped to table a Health White Paper in Parliament by year-end on long-term health care reforms spanning a period of 15 years.
Both Pakatan Harapan (PH) and Barisan Nasional (BN), who are now part of the Anwar administration, pledged in their GE15 election manifestos to double public health care expenditure to 5 per cent of Malaysia’s gross domestic product (GDP) in five years. The federal government’s 2023 budget will be tabled in February.
The Galen Centre for Health and Social Policy listed health care financing reform as one of the key health priorities for the new government, suggesting a payroll-funded social health insurance scheme to boost funding, on top of existing allocations from general taxation revenue.
First 100 Days, New MPs On Health Issues
The general election ushered in a new PH-led unity government, while Khairy failed to enter the 15th Parliament as MP after losing the Sungai Buloh race to PKR’s R. Ramanan.
Khairy’s successor Dr Zaliha has yet to outline her key priorities for either her first 100 days of office or the government’s entire term, amid the ongoing ED overcrowding crisis across public and private hospitals, and the potential threat of new outbreaks from the Covid wave in China.
The 15th Parliament sees the entry of new federal lawmakers who talk about or may have an interest in health and social or aged care issues, such as Ipoh Timor MP Howard Lee Chuan How, Bukit Bendera MP Syerleena Abdul Rashid, Bangi MP Syahredzan Johan, and Sungai Petani MP Dr Taufiq Johari.
Former Health Minister Dzulkefly Ahmad and former head of the parliamentary special select committee on health, science and innovation Dr Kelvin Yii also successfully defended their respective Kuala Selangor and Bandar Kuching seats.