Health under the 13th Malaysian Plan (13MP) tabled yesterday in Parliament by the prime minister was underwhelming.
Bold reforms are urgently needed, but the 13MP falls short in the areas of health care financing, health workforce, outbreak preparedness and response, and non-communicable diseases.
The gaps, fragility and reality of the healthcare system revealed during the Covid-19 pandemic years were supposed to help inform, guide and prepare the strategic vision of the 13MP. Instead, the 13MP does not acknowledge the rebuilding still needed, and the hard-won lessons bought at so much cost to lives and national wealth.
For health, the 13MP proposed vision and reforms are simply not bold enough.
The current tax-funded health care system is not sustainable. Reforming health care financing is critical and must be done now.
Rakan KKM, and the introduction of a basic medical health insurance and takaful (MHIT) product and national health fund are insufficient measures to address this issue.
What is needed is a compulsory National Health and Social Insurance to provide complementary funding to support health and aged care. Adopting a rate similar to Socso contributions, we could raise at least RM6 billion annually to complement the annual health allocation under the federal budget.
With more of the population becoming older and needing specialised services, a portion could ensure that aged care is properly funded and sustained. It can provide a means to improve treatment options and a resource during times of crisis.
Meeting the need for sufficient health care workers is an existential concern. Malaysia continues to experience severe shortages of specialists, medical officers, nurses and medical assistants to properly staff hospitals and clinics. High workloads, low morale, and inadequate career progression opportunities are causing people to leave.
The 13MP should have provided a positive vision for health care workforce reform to train, recruit and retain. Forming a committee is not the end.
The 13MP could have announced the intention of forming a Health Services Commission, separate from the Public Services Department (JPA), with the authority to oversee the placement, salary scales, and working conditions of government health care professionals.
This commission would potentially enhance governance, improve accountability, and better manage human resources, leading to improved service delivery, and stronger confidence by the public and health care workers.
Legislation would have to be enacted or amended, but this would be real and meaningful reform to a longstanding problem contributing to the loss of our public health care workers to the public sector and other countries.
Other than a mention of compliance with International Health Regulations 2005, the lack of emphasis on infectious disease preparedness and response measures in the 13MP is worrying. With the experience of the Covid-19 public health emergency and with the threat of future global pandemics, the nation requires a systematic and resilient infrastructure for rapid disease detection, response coordination, and resource allocation.
We need a Health Security Agency which takes the lead, and is able to marshal the resources of the government, non-government, academia, and private sector to respond to future threats of infectious diseases. We need a framework that is able to plan and prepare better, is more agile, proactive, flexible, and reactive to challenges such as combating misinformation and pseudoscience.
Despite being identified in the 13MP as a major concern, managing non-communicable diseases (NCDs) such as diabetes, chronic kidney disease, cardiovascular diseases and obesity, was barely addressed. Treating these conditions consumes around 70 per cent of health expenditure and billions annually.
Malaysia is already in a national NCD crisis. More than half of the adult population are either overweight or obese. 3.9 million adults are currently suffering from diabetes. More than 100,000 people are going to need dialysis by 2030.
Combined with an aging population, if we do not acknowledge and commit at a national level that increased investment in effective treatments and care are needed to tackle these diseases, people will be left behind. More patients will die due to suboptimal treatment.
While the intention to increase taxes on tobacco, vape and alcohol are welcomed, you cannot tax your way out of a NCD crisis. There should have been a clear vision and outcome on dealing with the NCD crisis.
In conclusion, the 13th Malaysia Plan should represent a bold and ambitious vision to ensure that the country’s health care system continues to be fit for purpose. Strategic actions in strengthening the health care workforce, reforming national health financing mechanisms, enhancing infectious disease preparedness, and dealing with NCDs remain imperative for the well-being and resilience of Malaysia’s health care system.
We cannot afford to be timid.
The 13MP should not be a lost opportunity for health. Malaysia needs real and meaningful reforms which are sustainable, equitable, and help prepare it to meet future challenges. This would be a fitting long lasting legacy for the Madani government.
Azrul Mohd Khalib is the 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.
