The night after the Budget 2021 was tabled in Parliament, messages were going around in social media with many expressing shock and anger that the government even contemplated ‘slashing budget’ heavily on many medical programmes.
People
thought that this was a ‘compromise’ in order to shift resources more to
fighting COVID-19 (since these endeavors were read out loudly and clearly in
the Budget speech), as well as to development expenditure. For the latter, it
is not surprising that the general public feels this way, since they looked at
the numbers and saw that the total Ministry of Health (MOH) budget increased by
RM1.3bil: an additional RM2.1bil goes to development expenditure but RM718
million seemed to have been reduced for the operating budget.
Patient
groups, including those who suffer from kidney, heart or cancer health
problems, were terrified to be told that the budget of programmes of concern to
them had been cut by more than 50%. In fact, some of them went to see the
extract of the estimated expenditure themselves, and were convinced that those
allocations for “services and supplies” (which carry the budget line item code
20000) that bought them medicines are all mysteriously zero-ed.
I
did find those anomalies but at the same time I also managed to locate two new budget
allocation items, one under the section “Specific Programmes” which is entitled
“Medical Supply for Health Facilities” (worth RM2.89 billion) and another one
under the new section “Financial Commitment” which is entitled “Private
Concession for Medical & Laboratory supplies” (worth RM1.4 billion) (Figure 1). When I added them
up and compared it with the Budget 2020 total amount, it suggests that the
Ministry of Finance probably has given RM300 million more for the purpose of
purchasing medical products and laboratory supplies.
Figure 1:
On Saturday night Finance Minister Tengku Zafrul Abdul Aziz issued a clarification statement confirming my suspicion that the budget item reclassification is the main culprit for the great confusion, anxiety and outrage expressed by the general public. I would not blame the average rakyat for the misunderstanding and misreading, as the government should remember well the mantra: “if it ain’t broke, don’t fix it”.
Yes,
central procurement by the government has been a practice for a long time, and the
private concession given to procure the Approved Product Purchase List of drugs
is also not new. However, this should not be the reason for reclassification.
Those ‘affected’ programmes should be restored and given an allocation (on the
code 20000 line item) for the sake of budget clarity, transparency and
accountability so that the public can track and understand the constraint of
resources in each programme.
A centralized
and pooled figure, although it may serve the MOH well for the flexibility of
allocating according to immediate needs, could have unintended consequences of
causing unnecessary anxiety and stress to the doctors and management officers
in various medical departments as well as the patients, worrying if the common
pool has been dried up or if their request is in competition with other medical
programmes for the scarce resource – the more unknown, the more insecure one becomes.
However,
given that MOH is currently enjoying high public confidence and approval, and on
many occasions we have heard Director-General of Health Dr. Noor Hisham championing
the strengthening of public health, my hope was high to expect that MOH could
secure a much improved and significantly higher budget than normal projections.
I am disappointed to find the % growth (4.4%) and absolute increase amount (RM1.3bil) is
the smallest since 2017. I find it a bit disturbing to see the total operating
budget allocation for “services and supplies” reduced by nearly RM1.3bil even
if the medical supplies component is not affected. For the disease control
division under the Public Health department, not only is the allocation amount
for “services and supplies” reduced, the number of positions in that division
does not grow too (but is effectively deducted by one). This might send the
wrong signal to the public, that the MOH does not invest more into disease
control given what has happened not just with COVID-19, but the good old dengue
problem and the ever rising non-communicable diseases in the country. Rabies
and polio outbreak threats are coming back to haunt too.
Not
all is gloomy, I am particularly pleased that this time the government has heeded
many calls to invest more into maintaining and expanding the health infrastructure.
It may well be because this has been a long overdue action. Public attention
has always been given to the physical
capacity of the facilities attending to so many patients; some concern arose over
the state of maintenance of the buildings especially after the frustration
vented by a doctor in Sabah last May highlighting the dilapidated state of health
facilities in Sabah. Make no mistake, the development expenditure (DevEx)
budget for 2021 is a historic high at RM4.7bil. Whether this decision was made due
to the economic impacts of COVID-19 and benefits that construction projects would
bring to the local community, is something that perhaps the Finance Minister
could help clarify, but such investment is never too late.
Budget
allocation for upgrading and expanding hospital facilities is by far the
largest, it took 60.7% of the DevEx, or RM2.86bil (Figure 2). During the COVID-19
pandemic period, it is good to see the government planning ahead and thinking
about the future capacity to meet the expected surge in public healthcare
demand. Allocating more resources for vehicles and equipment purchase is also a
wise decision, given that the district health offices might need more mobility
for COVID-19 screening and monitoring related activities at the community level.
Figure 2:
After the government pledge of another RM20bil to the COVID-19 Fund, this makes a total of RM65bil for the special carved out fund for tackling the epidemic all around the country. Currently, the third wave epidemic is still at its peak infection power, perhaps people are concerned if the budget allocated for fighting COVID-19 is sufficient.
First,
we were told that the government has reserved more than RM3bil
for vaccine procurement, planning to immunize at
least 70% of the population. After calculation, for a vaccine course of 2
doses per person, the government would have a working budget of RM131 per person,
which is higher than the average estimate made by the COVAX Facility for a
person. Alternatively, the government could even simply purchase more and go
beyond the 70% coverage.
RM1bil
budget allocation was announced for various COVID-19 fighting purposes, such as
purchase of Personal Protective Equipment (PPE) (RM318mil) and COVID-19 test kits
(RM475mil). For the former (PPE), if the amount is divided by 100,000 medical
frontliners in this country, then one would have an average personal annual
budget worth of RM3,180 or about RM10 per work day; depending on the medical specialization
or expertise of the person, it could well be sufficient. For the COVID-19 test
kits, let’s say next year the same number of persons undergoing screening is
about 2.26million as of 7 November: if the cost can be kept at RM100 per person
or lower, the current budget allocation should allow Malaysia to weather
through twice the current screening amount. Perhaps with the large reserve of
RM65bil COVID-19 fund, we should worry less about the financial implication of the
government’s effort, but more for getting enough helping hands (e.g. expertise
or volunteers) to address the current epidemic situation.
All in
all, not many candies were tendered out during this Budget 2021 presentation
sweet enough to call it an Election Budget. Even if this is just a MOH Budget
without a ‘Wow’ factor, I wish everyone good health in the coming year. It is
not too bad, because (election) candies may not be good for your health.
*This write up also appeared in The Malaysian Insight and Malaysiakini
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