Monday, January 08, 2018

Responses to a journalist's questions on stunting kids in Malaysia

The editor asked me questions at the very end of last year, and I could not make it to respond to all 5 questions from him before he went on publishing the article this morning. The questions he put to me, are not easy though. I tried to do it with my best knowledge and accuracy as a health policy researcher.
Question 1. The NHMS 2016 says national prevalence of stunting for kids below 5 years old is some 20%. In 2015, it was 17.7%. Why the increase? Supposedly we are slamming on the macroeconomic indicators and we've tackled poverty to 0.4% of the population?
Let’s start with the dry part (introduction) first: The NHMS 2016 methodology has stated how they define stunting according to the WHO Growth Standard 2006: Height-for-age (HAZ) smaller than 2SD (standard deviation). The reference/definition for ‘stunting’ is therefore statistical, not based on medical evidence. This is very crucial for your understanding.
If the sample given fell perfectly in the normal distribution pattern (in this case, it is not), there will always be at least 5% will be smaller than 2SD<-2sd 2006="" a="" african="" against="" also="" any="" applying="" are="" as="" average="" be="" by="" could="" countries="" country="" deviation="" example="" for="" growth="" in="" individuals="" is="" it="" just="" korea="" mean="" measurement="" might="" misleading.="" north="" or="" p="" point="" poor="" significant.="" some="" standard="" statistics.="" stunted="" such="" the="" therefore="" who="">, just by statistics. For any measurement against standard deviation, the mean/average point is the significant. For example, in a poor country such as North Korea or some African countries, it could be the mean point individuals are also stunted, therefore by applying WHO Growth Standard 2006 might be misleading.
In 2016, the NHMS findings indicated the stunting children (younger than 5 years old) is 20.7%, while it was 17.7% in the preceding year, thus a 3% increase within a year. Notwithstanding the difference could be just fall within 5% standard error of survey (note that this is typically stated when media/pollsters performing polling during general election/ campaign).
Let’s just discuss theoretically by putting aside all the points raised above.

20.7% of stunting children at nationwide in 2016, it is still much higher than normal. Besides, percentage of children who are underweight and wasting are 13.7% and 11.5% respectively. This indicates rather significantly that some children suffer from malnutrition, despite Malaysia is right now at the upper-middle income nation category (and sooner graduating to high income nation).
Children are stunting and wasting for many reasons. Financial difficulty to obtain/purchase nutritious/healthy food could be one factor. In fact, in the NHMS 2016 Table, it shows that children living in the family with monthly household income less than RM1000 suffer the most from stunting (29.8%), as compared to wealthier family (more than RM5000, 17.4%). Other low household income brackets (less than RM3000) also have more than 20% stunting kids.
However, household income has been steadily increased and since the introduction of minimum wage, the financial situation for many families should be improving. In 2016, household with monthly income less than RM2000 is 8.8% while less than RM960 (poverty line in Peninsular Malaysia) is only 0.4%. So, even if you take out the proportion of children living in these financially poor households (assuming that they would be all stunting or wasting—actually not, just about 20-30%), there are still many more children outside these households to make up the difference. Thus, we can safely assume that there must be more than just economic reasons.
Since these kids are so young (smaller than 5 years old) to decide food for themselves (and before school age), therefore it must be almost totally the responsibility of parents to make sure their kids are on good health. It has something to do with the parents’ knowledge of nutrition and well-being, family lifestyle as well as parent's culinary skills.
I disagree that nutritious food are expensive. Plenty of affordable vegetables, beans, eggs and meat are in the Pasar (Marketplace) and grocery shops throughout the country, especially affordable for those families with household monthly income greater than RM2000. But that would take one’s effort to cook the food they bought.
Increasingly more people in our society, especially the younger generations, do not practice cooking at home, thus they are totally dependent on the food provision outside. In this case, if they do not equip with knowledge to purchase outside food with balanced diet and nutrition values, then the health of their children (and themselves!) would be affected. Eat junk and fast food very often in lieu of healthy nutritious food, can result in stunting kids (and they are not necessary underweight though). Parents' attention to children’s development and health growth is paramount to ensure stunting and wasting do not happen to their children.
In the NHMS 2016 report, if you flip to page 173 on Table (Prevalence of minimum meal frequency, minimum dietary diversity, minimum acceptable diversity among children aged 6-23 months by socio-demographic characteristics) you would find out partially why there is a case for stunting or wasting kids in Malaysia. Only 80.8% of children population fulfilled the minimum meal frequency, 66.4% have obtained minimum dietary diversity (at least 4 food groups per day), 53.1% received minimum acceptable food diversity (combine minimum meal frequency and dietary diversity). If you look at the survey statistics by household income at the bottom, you would be surprised to actually found survey respondents with lower household income (RM5000), consistently. Some degree of parental negligence must be happening in the wealthier families too, at least to the children below 2 years old (as evidenced in this survey).
Question 2. The bumiputera are the majority. Of course the NHMS divides this into Other Bumis and Malays. Yet even on its own, these groups make the top 3. What's going on here? Aren't they the target of affirmative action policies? Also what about the Bumi Empowerment Agenda? Or even BR1M? A case of the Orang Asli being left out?

Economic status of bumiputera households might still be a factor which makes some differences.
If we refer to the Household Income and Basic Amenities 2016 survey, generally Bumiputera households have bigger average household size (4.3) compared to Chinese (3.5) and Indian (4.0). In terms of families with household monthly income less than RM2000, 10% of Bumiputera households (and 16% of ‘others’) fall into this category, while only 5.9% Chinese and 6.6% Indians. That means, poor Bumiputera households in general has more mouths to feed. In addition, the fact is that young families (which is usually sexually reproducing kids) tend to make less monthly income than households with older age breadwinner, the financial situation of these family might be more stressful.
However, as mentioned earlier, it might not entirely has something to do with financial resources, as affirmative action policies and Bumi Empowerment Agenda and even BR1M have not taught the parents how to deal with children nutrition, and I have previously argued the case that nutritious food might not be expensive.
Orang Asal should fall under the category of ‘other Bumiputera’.
Question 3. Interestingly in NHMS, Putrajaya ranks no.4 in terms of location. Any explanation why?

From the NHMS 2016 Table on the children minimum meal frequency and dietary diversity, children in Putrajaya actually did not do too badly, thus it is puzzling why Putrajaya performed badly in terms of stunting children. Granted the target group of the survey (for that table) is kids only up till 2 years old, probably those 2-5 years old children in Putrajaya did poorly on dietary intake and lifestyle due to urban planning of Putrajaya might not be encouraging healthy children development. Could civil servants be lacking time to cook? Or is there lack of healthy food outlets in Putrajaya?
(the less ‘sexy’ answer could be… Putrajaya’s respondent sample size is small, thus big error margin is reported)
Question 4. How does this increase inequality and in the long-term affect economic performance?
Stunting kids could have some irreversible health impact to their physical well-being in their later adult life. This could have considerable impact to their education learning ability and work productivity. For the government, this will be a laden cost to public healthcare, as these individuals would be more likely to have health complications and seeking medical attentions. Thus, in the long run, these would negatively affect our national economic performance. In addition, when these stunted kids grow up, they might already be disadvantageous to compete with similar age peers. In this way, inequality might persist (if the stunted kids come from poor family).
Question 5. What current policies need to be reviewed and what needs to be implemented quickly? And should we fail to deal with this properly, what are the long-term effects?

Primary care have to be strengthened, better via community-level family doctor system. Should certain high risk kids are monitored, then the danger of stunting or wasting could be averted via proper health screening and dietary advice through the community nurses or/and doctor.
Education or awareness on nutritious/healthy food need to be raised and put in practice. Probably younger generations should learn COMPULSORY cooking skills as part of their Kemahiran Hidup syllabus.
Nutrition/dietary knowledge and advice should be given to pregnant mothers too during ante-natal care medical check up. Better, if these first-time mothers could be arranged an ante-natal class to learn all the necessary information to prevent stunting or wasting child development problem.
As partially mentioned above in (4), if Ministry of Health and the larger society fail to deal with this issue, MOH has to fork out bigger budget (that they DON’T readily have) to treat more patients in years to come, and the affected families or individuals would have to commit more time in seeking medical care. It is a LOSE-LOSE situation for everyone.

Review of 2017 - Part III (Myself)

Last March I sprained my ankle badly during a badminton training session. It was a terrible sport accident. Unfortunately until today I have not gained back my full fitness for intense sport (like Badminton). It is partly due to not undergoing physiotherapy to regain fitness (after the initial 2 months of TCM treatments). In fact, this issue bothers me, I might still seek to solve it this year, because I cannot imagine I am out of badminton forever.
I managed to control my weight for the first time since my years in Germany– not only I did not gain weight but lose 2-3kg compared to the previous year. I cooked rather often, and spent time doing house chores (as usual) as part of responsibility. I regret that I did not cycle as often as I imagined to be, most of the times due to my busy work schedule. So, to ‘earn’ back the value of my bike, it is going to be this year! I had good time with my hiking kaki, hope to keep up with at least a hike once a month. Oh ya, last year I did not even go into a cinema once (performing arts theatre is excluded)!
To my own dismay, I did not read as much as I would like to have (mostly restricted to the reading time when I was in the LRT train), therefore my books keep accumulating. I also have horror at the number of unselected and unprocessed photos I took using my DSLR during many trips last year, wish I could have some personal time to do this. But sadly, I always lack time.
‘Priority’ is like a spell always sticks to me, compelling me to make certain decisions on how to distribute my time. I am already a different man with more responsibilities and commitments, gone are those days when I could simply go out anytime at night or weekends to meet friends or get involved in (social activist) activities and meetings. I cannot complain.
Therefore, I hope that my friends already rather understand. There are times when I need to take longer time to respond to WA or FB message or email, please bear with me. At home, I do have different priorities.
At this age, I treasure those ‘old-time’ friendships even more. I would try to meet and catch up with them as often as possible. I do wish all my friends lots of happiness this year, and may they have best of luck in the goals they want to achieve.
Mine is simple, just improvement in all the aforementioned points, hehe.
P/s: oh yes, these days I've got some interest in Korean language, might just casually learn it 

Review of 2017 - Part II (Family)

On family, looking back at 2017, I owe heartfelt gratitude to my dear wife Xiao Hui. Due to her decision to move in with me to Penang (from Singapore) in 2016, and moved again to Subang Jaya by the end of 2016, we were in a more stable situation in 2017. Tirelessly, Xiao Hui took good care of Yee Chern at home when I went to work, watching our boy growing up fast. We are in good agreement on how to raise a child, and we have been very patient and loving with Yee Chern.
Yee Chern is now 19 months old. His intelligence and learning ability simply keep amazing us as parents. He seems to understand quite a great deal of words and phrases, learned to execute our instructions perfectly and even picked up our conversation sometimes (therefore xh and I have to be careful when talking about him). We are more delighted that he picked up reading habit from the resources and environment we built for him. We regularly bought him good books and read together with him. We bought and install a kid’s bookshelf in the living room, put all his books there so that he could access to those anytime he wants. Now he can pick any book, flip and read by himself. At the recent Big Bad Wolf book sale, we managed to visit the venue 2 times scanning through the children book sections carefully, filtered and acquired 40 very interesting and inspiring books for him (spent about RM400, super worth it).
Yee Chern was definitely not early in some of the milestones of child development. He could only walk independently when he just crossed into his 18 months old. Both of us were thrilled when he finally discovered his own ability (Xiao Hui screamed out loud in the video recording at that moment, just to show me who was at work). Actually he could have walked by himself a month or two earlier but he took more conservative and careful approach not letting go his grip on our hand (or even finger/s). Therefore when he first walked, he did with good balance and barely fell down. Now he is still considered slow in speech (according to MOH guideline), and is arranged a session with a MOH specialist. Actually he is found rather often talking to himself in baby babble. We can somehow imagine that once he could talk, he could be rather talkative.
Last year 2017, as a family, we had been travelling to many places, including Jogjakarta (Indonesia), east-coast United States, and Seoul (South Korea). Xiao Hui and Yee Chern had also followed me to Penang and Johor a few times for work trips. Yee Chern had to endure/adapt to changes in eating-sleeping schedule, sometimes it was difficult for him (and his mum). His behaviour and preference changes on dietary type and timing, and his bed/nap timing, are sometimes hard to predict. There were meltdowns at times, luckily most of the times those happened at home. He usually behaves rather well in the presence of guests, friends or family (thus they often only see the cute and mild side of him). To my pleasure of unique achievement, last year finally I could put him to sleep alone without mum’s presence for 3 times (although it would still be 10,000x his preference to have mum instead).
After Yee Chern turned 1 year old, Xiao Hui has been on the hunt for a job. We are mulling to send him to a daycare centre should one day Xiao Hui secures a job. Until the end of 2017, XH had no such luck. We hope that 2018 could be the year of breakthrough for Xiao Hui and our family. (If you wanted to ask about the second addition to the family, we couldn’t tell you about any plan yet).
In 2017, it is heart-warming to see Yee Chern becomes more charming to both sides of our family members as well as our friends with higher level of self-awareness, responses and interactions. Particularly he has improved relationship with his cousins Jayden, Jazzra, Brayden and Leann; they happily accepted him and played more with him.
We are delighted to see the return of Soo Leng from the US, and look forward to see bro How and her in our neighbourhood soon this year 

Review of 2017 - Part I

First week of the new year 2018 comes to an end soon, and only until now I find good time to summarise my year 2017.
2017 was quite a productive but very busy-action-packed year for myself. Looking back now, I feel contented and delighted at what I had achieved. Moving back from Penang to the Klang Valley might be the turning point of career development as a health policy researcher, turns out to be one of crucial life decisions that I’ve got it right. (However, given that the top management of my institute had changed rather significantly months later, who knows it could also go well for me if I had stayed? But it doesn’t matter now… I am happy for my research colleagues in Penang too)
In terms of work output, since I am part of the KL office team, I can’t believe myself that I had :
- attended 32 events (including workshops, conferences, forums and talks);
- contributed 7 The Malaysia Insight (TMI) articles, 5 Oriental Daily articles, 1 Contemporary Review article;
- published 1 research report on the Housemanship issue in Malaysia;
- co-author & research on the Market review of the Malaysia’s pharmaceutical sector;
- helped organise (with major intellectual inputs) the inaugural Penang Medical Expo and Conference 2017;
- made appearance on 3 presentations in public (one in Penang, one in Seoul, South Korea, and another one recorded live in the press conference for the launch of my Housemanship issue report), and quite a number of presentations in close-door workshops and meetings.
2018 would be equally if not more challenging for myself. I still have 3 outstanding major research projects to complete/clear (all almost there) and a few new ones about to start. It was obvious to me that the decision at that time to relocate back to KL would help me concentrating on policy research on health(care), and it did work out very well. I do have my general manager YB Dr Ong Kian Ming to thank, for the trust and confidence he has in my works. I am glad that he sees values in health policy research, at the same time gives me freedom to explore the topics beyond health.
I would like to thank my dear beloved colleagues in KL and Penang. Esther, she is the dai ga jie in the KL office, deserves her credits for her incredibly organised administrative work. I am happy that she built up her researcher profile too, and has improved tremendously in her skills and knowledge (and most importantly, her confidence and motivation). Su Lin is our office unofficial MO1 (Media Officer 1), for her excellent English proficiency and brilliant copyediting works (service only available for us, ok?!). Her recently upgraded car (we dubbed it as the “PI-van”) is always very useful and meaningful to us. We often love to make her our leader so that we could ‘follow’ her car (to lunch place, function, or to LRT station).
I also enjoyed working briefly with Dr Lyana Khairuddin as she worked as our visiting fellow, surely we had good time together (besides some intensive discussion and arguments). Of course, I didn't forget my wonderful colleagues + friends in Penang, too many names I cannot spell out one-by-one (scare whoever got left out perasan), thank you for keeping the friendship (and comradeship) as well as keeping in touch mostly via Whatsapp , emails and sometimes in person. I feel hard to see Evelyn and Kok Hin leaving to further their study at overseas, I do wish them well and happy for them (the former will return soon). Ya, over the ‘summer’ period we have a bunch of very good and bright interns who are studying in the UK and Canada, I enjoyed their company too.

Sunday, January 07, 2018



Sunday, December 24, 2017

2018年大選前夕 - 個人聲明

近來在我社運朋友圈子里沸沸騰騰辯論著下屆大選的投票態度和動向。一邊大力鼓吹選民出來投票並且投票給希望聯盟(Pakatan Harapan)以保住國會至少三分之一的在野陣線議席;另一邊廂則批評前者的策略和注重結果的功利主義,同時對老馬加入後的希聯深感懷疑并大力抨擊。他們未必鼓勵人投廢票,但堅持投票是個人的自由,以目前的局勢現況若有人要不出來投票、投廢票或投第三黨,也不能怪他們。
1. 我不再相信人治政治。政壇上哪個陣線或政黨即使有再多的‘好人’或/和‘有能力’的人,不等同於該政黨的政綱方針。如果他們沒有推出體制上明顯的政治和司法改革,我很難被說服哪個更好(或足夠好),縱使我相信在最好的情況希聯上台執政會有小幅度的修改式改革。我有讀書,所以更有要求,不要騙我。
2. 目前希聯仍是權宜之幫,沒有明顯的政治方向,甚至沒端出值得期許的體制改革藍圖。他們代表什麼?我不清楚。我不能接受希聯的現狀,除非未來有新的正面變化。如果有人叫我為目前的希聯背書叫大家都投票給他們,對不起,我不願意。
3. 我仍會呼籲大家出來投票支持那些他們認為表現良好和有理想原則分寸的議員和政治人物。我不會投廢票(雖然我的票在梳邦再也其實一點都不‘值錢’),因為我仍滿意目前我的國和州議員。假設我的選區出現極具爭議性或負面的希聯議員,我本身很有可能就會把票投給第三黨或不投票(投給國陣目前仍難以想象...因為少有非常傑出值得支持的人選)。
4. 假設希聯執意要推薦有問題(或‘yes (wo)man’)的候選人,如果在當地不受歡迎而被懲罰落選了,那不是民意嗎?政黨難辭其咎,選民不需覺得自己為他們不認同的候選人和政黨負責。
5. 現在的球是在希聯的腳下,到底他們還要繼續分化公民社會的支持,還是能代表一個真正的希望和選擇團結凝聚各階層各社區的支持(而不是純粹是累積‘反對(國陣)票’的情緒票)。很多社運份子甚至上屆大選的民聯中堅支持者失望洩氣了。我認為其中一邊的社運者能明白另一邊的苦衷和想法,更重要的是,促使希聯在下屆大選來臨之前大力改進,把reform agenda(政改方案)拿出來。希聯的現狀是飽受另一邊社運份子批判的重點,無論你要他們怎樣改觀都不簡單,畢竟解鈴人還需繫鈴人。








6)我也看到Jeremy Corbyn對年輕人的政治動員和競選運動的興論影響力。雖然Jeremy Corbyn不是年輕人,但他的想法絕對符合年輕人的期待和要求。所以,領袖的年齡不一定是個問題,而是他說了和做了什麼,許我們這一代和下一代什麼未來?




Saturday, December 23, 2017



上屆大選創下了大馬史上最高投票率的記錄。年輕人曾對政改和政黨輪替滿懷熱忱和期待,“505換政府”和“Ini kali lah(就是這一次)的口號喊得特別響亮,造就在野黨聯盟取得歷來最高的得票率(51%)。可惜,由於選舉制度的不公,結果在野黨斬獲的議席席次不成正比,與‘改朝換代’擦肩而過。接下來的幾年,政局瞬息萬變:卡巴星和聶阿茲相續過世、安華入獄、民聯瓦解、希望聯盟(希聯)和誠信黨誕生、馬哈迪退出巫統成立土團黨再到政治版圖重組由馬哈迪領導在野陣線。凈選盟大集會也辦了多兩次。





環顧近年來的國際政治,不少較為年輕的政治人物成功勝選擔任國內最高民選領導人。舉例來說,今年上任的就有37歲來自工黨的新西蘭總理傑辛達·凱特(Jacinda Kate Laurell Ardern)41歲來自左派綠色聯盟的冰島總理卡特琳·雅克思(Katrín Jakobsdóttir)39歲來自‘共和前進’黨的法國總統埃馬紐埃爾·馬克龍(Emmanual Macron),以及2015年勝選時才43歲來自自由黨的加拿大總理賈斯丁·杜魯道(Justin Trudeau)。這些年輕領袖的冒現也順勢回應了當前選民欲看到政治新氣象和改變的渴望。同時,這也符合當地年輕人的政治想象和要求,期望他們的聲音更能貼近政治主流。

當然,年輕人不一定要支持較年輕的政治領袖。英國的工黨領袖傑里米·科爾賓(Jeremy Corbyn)就是一個好例子。他積極遊走全國聆聽并貼近大眾特別是年輕一輩,多次現身在年輕人為主的場合(比如說搖滾演唱會)。這種雙向和坦然的政見溝通能賦權選民,然後政治人物所提的想法和政策才會踏實接地以及與人民日常生活有關聯(relevance)。這不正彰顯民主的可貴嗎?





Monday, December 18, 2017

The appeal of Islamic Democrats in Malaysia

TWO weeks ago, I participated in an international conference in Kuala Lumpur organised by the Istanbul Network, a group of think-tank leaders from Muslim majority countries.
During the Q& A session, I posed the following question to the panel: Why should non-Muslims support an Islamist party, whether in a Muslim-majority country such as Malaysia or in a country where Muslims are in the minority, if the party in question only has an exclusively religious agenda for the Muslim community? I did not get a direct response to the question, and this still lingers in my mind after the conference.
To be fair, many distinguished speakers presented many good papers which examined the history of democratic transitions, outlining the relationship between Islam and democracy and further looking at the socio-economic undercurrents behind such transitions.
Case studies on Islamic political parties and movements in different countries were also discussed. I appreciate the evolution in certain countries such as Tunisia and Turkey that witnessed political transitions from an Islamist party to a party of Islamic Democrats, in Ennahda and the Justice and Development Party (AKP) respectively.
One fundamental difference between many Islamist parties around the world and Malaysian ones, is that Malaysia has a large proportion of non-Muslims in the population which the Islamist parties, like it or not, need to interact with.
If an Islamist party only appeals to the Muslim community in Malaysia, it would restrict its political influence to parts of the country with very few non-Muslims.
This was the situation faced by PAS in the past when its influence was mostly limited to the northern and east coast states in Peninsular Malaysia.
For a party to win elections at the federal level in Malaysia, it has to be part of a coalition which has a broad support across all ethnic groups. Even if an Islamist party like PAS only wants to appeal to the Muslim community, its views and positions must be acceptable to other parties within the coalition, some of whom will definitely represent the views and aspirations of non-Muslims in the country.
Unless an Islamist party wants to stand apart from any political coalition, it has to take into account the perspective of non-Muslim voters. This is one important yardstick of democratic transitions, which is the consideration of the diverse voices of the people, even from those who do not support the party / coalition in power.
Given that the Muslim community does not live in isolation, the positive and negative impact of policy difference and public opinion have to be resolved by ‘Ijma’ or the consensus of the masses.
The concept itself already has ‘bottom-up’ democratic elements and it does not imply majority rule but a need to consider as well as respect minority rights. However, consensus building often needs reference to some form of common denominator among different community groups.
Thus, it is not an issue when an Islamist party brings in Islamic values in policy discussion, if the values are a common denominator shared and understood among all the communities. For that, the doctrine of Maqasid al-Shari’a has been well-received and applied in some places in the Muslim world as the guiding principle in response to multiple issues concerning public interest, ranging from economy, environment, health and even human rights.
This shows that religion could be a big part of the political discourse if it stays aligned and relevant to people’s daily life and societal functions, be it Islam, Christianity, Hinduism, Buddhism or other religions. No religious practices or values should be forcefully imposed on the people, whether they are believers or not.
In my opinion, what sows distrust among communities in Malaysia in present day, is the allegation or perception that one gets differential or preferential treatment over others. If an Islamist party is going to pit Muslims against non-Muslims, and in doing so, creates a siege mentality among the former, the ensuing result is a negative campaign which is based on fear and discrimination. This cannot go
far in winning over the middle ground which includes a sizeable non-Muslim population.
Worse still, this reinforces the negative perception that an Islamist party tries to divide the people based on religion and treat them differently. Thus, such appeals which are premised on religious exclusivism and exerting obligations and values on others, could prove to be detrimental to social cohesion and nation building.
However, this really needs not to be the case. Political Islam, as any other movement, has plenty of diverse ideas and means to achieve its goals. Post-Islamism is emerging as a reaction to the perceived failure of many ruling Islamist politics in the Muslim world at addressing fundamental citizen needs and expectations such as jobs, education and the provision of basic public services including rubbish collection and access to clean water.
Given that the world has liberalised through recent decades via the information technology revolution, any attempt to control thoughts and ideas by using the religious monopolist, puritan and statist approach will surely be meet with strong resistance. The changing trend in the socio-demographics of many of these Muslim countries will raise more questions on the views and roles of an Islamist party, especially among the younger generation who are growing up in an environment where information and networking is much more accessible compared to before.
Presently in Malaysia, Parti Amanah Negara represents the mainstream political variant of Islamic Democrats. I see the vast potential and the positive impact that their political movement can bring to Malaysia. Hopefully they will present and bring out a more wide-ranging and progressive political Islam discourse in Malaysia, to showcase that Islamic values could be universal, inclusive and meaningful to all.
After all, Christian Democrats in the western world have proved to be able to command broad support and govern in fairness to all citizens, why not Islamic Democrats? In that sense, why should non-Muslims NOT vote for such ideals from Islamic Democrats who can truly represent them?

Friday, December 15, 2017

Health check on the 2018 Budget

LAST Friday after prime minister and finance minister Najib Razak tabled the 2018 Budget, which he dubbed ‘the Mother of all Budgets’, my friends asked me what I thought about the budget allocation given to the Ministry of Health (MOH).
In my previous column article, I justified the reasons why the MOH should be given a larger budget allocation amounting to over RM28.5 billion (or >15% growth rate). The good news is that under the 2018 Budget, the MOH budget allocation has indeed increased to RM26.6 billion, albeit at slower growth rate of 7.2%.
As is the case with the Budget itself, this year’s Health allocation is historically largest and takes the highest share (9.5%) relative to the total Budget since 2009. In response to the announcement, both the health minister Dr S. Subramaniam and the health director-general Dr Noor Hisham Abdullah publicly expressed their satisfaction with the budget allocation. On a personal note, I was disappointed by the shortfall of about RM2 billion or half of the growth rate that I was expecting to see. As the saying goes: ‘the devil is in the details’, it is worthwhile to see if the government has genuinely put the Rakyat’s money where its mouth is. 
New development, bigger budget
From a first glance at the headlined items, it appears that the government is heeding the call to allocate more funds towards development expenditure. About half a billion ringgit, or a 37.9% increase in budget allocation, has been channelled to development, of which RM212 million was added to the budget for upgrade and expansion hospital facilities. Purchase of medical equipment and vehicles was topped up by RM244 million (Figure 1). It is certainly a welcome move and necessary action after the tragic fire incident at the Sultanah Aminah Hospital that took six lives last year.

In his Budget speech, Najib mentioned the fix for the wiring systems and even ambitiously announced plans to build new hospitals and wards (including one for the Pulau Pinang Hospital). Strangely, merely RM2.7 million in additional funding has been allocated to achieve these plans.
By right, we should be placing more emphasis on the operating budget, since it takes up 93.1% (RM 24.7 billion), a lion’s share of the total MOH budget. Over half, or 60.9%, of the operating budget is reserved for the salaries and wages for a workforce of 268,014 in total. The number of positions in the Health Ministry has increased by 30.2% from 2010-2018, while the amount paid for emoluments in 2018 has risen 144.6% compared to 2010. The health workforce is crucial in ensuring high standards of healthcare delivery, but this rise is only justifiable if the emolument rise converts to higher pay to retain quality talent.
Cut back on funding for supplies and services
Departments under the Medical Care (Perubatan) category will receive the largest amount RM13.2 billion, or a 53.4% of the total operating budget, followed by the Public Health (Kesihatan Awam) category (RM4.7 billion or 19.1%) (Figure 2). Worryingly, although the total sum of allocations for these two categories has increased compared to 2017, most of it is channelled towards emolument. Despite the functional importance of these two categories, the government has opted to cut back on funding for supplies and services for both categories (Figure 3). For Medical Care, the allocation for supplies and services shrank from RM5.17 billion in 2015 to RM3.92 billion in 2018, a difference of RM1.26 billion!

MP for Kampar Dr Ko Chung Sen rightly criticised the government on the RM65 million reduction in the allocation for the pharmacy and supplies division. It is a peculiar decision, given that many members of the public who engage the services of MOH hospitals or health clinics have long complained about the frequency of drug shortages. A reduced allocation certainly does not help to alleviate the drug demand burden. Therefore, when Najib announced that a sum of RM2.5 billion would be allocated for medical supplies and RM1.6 billion for consumable and medical support items, was he actually referring to an increased or reduced allocation?
Public health concerns
The other worrying budget reduction is related to the Disease Control and Public Health Pharmacy and Supplies divisions, which will receive RM22.4 million and RM35.6 million less respectively in 2018 for services and supplies, compared to this year.
This reduction is especially worrying for the Disease Control division, which has seen a declining share of allocations from RM402 million in 2011 to RM159 million in 2018. Unless one can prove that the services provided by this division have become substantially cost-effective, the decision to slash funding is controversial, in the backdrop of dengue and malaria outbreaks as well as the re-emerging threat of various vaccine-preventable infectious diseases.
Lastly, it is definitely timely to tackle the non-communicable diseases (NCD) via the KOSPEN programme, and the RM30 million allocation will prove useful to carry out a nationwide campaign. On the other hand, the Malaysia Health Promotion Board (MySihat) is a statutory body under the MOH that is also focused on health promotion, however it has received RM5.5 million annual budget for the past 3 years and past campaigns have been criticised for being rather ineffective.
It would make sense for KOSPEN to collaborate with MySihat for the NCD campaign and in doing so, hopefully they will be able to live up the programme name: ‘Healthy Community Empowers the Nation’.