Download the CSO analysis report here.
Below are the text drafted by myself, vetted by Dr Sharuna Verghis, representing the health cluster.
Introduction:
The “Health”
cluster paid courtesy visits to the then Health Minister Dr Dzulkefly Ahmad and
Deputy Minister Dr Lee Boon Chye. The cluster did not make any explicit
demands. However, some members did call for more financial
allocation for the public health
sector, the spotlight on brain
drain and an urgent solution to the lack of permanent positions for housemen,
and ensuring non-discriminatory and universal access to healthcare for migrant communities.
The 4% gross
domestic product (GDP) allocation from the government budget for the MOH was a
major promise, and it was badly required, but the minister caved in and did not
push for it after just one year in office, blaming it on the current economic
situation, as well as the debt and liabilities from the previous government.35 That was a major disappointment.
There was some progress in other major promises in the Buku Harapan, though still far from addressing the core issues, the biggest of which was support (not just financially) for the measures to tackle non-communicable diseases, rare diseases and mental health issues.
Demands proposed to the Pakatan Harapan government based on the Buku Harapan:
There was no
concrete demand or proposal to the PH government on this issue, though the CSOs
could broadly agree with some of the policy directions/ideas proposed in the
Buku Harapan, e.g. higher budget allocation for the MOH, more (but careful)
public-private partnership, and seriously tackling non-communicable diseases
and mental health issues in the community.
Pakatan Harapan’s achievements and shortcomings
PH’s performance as government with regard to health should
be evaluated by looking at not
only the Buku Harapan manifesto promises but also the policies implemented and
practices cultivated by the Minister and Deputy Minister concerned.
On the Buku Harapan,
observations are summarised in the following table:
|
Promise |
Status |
Remark/Comment |
1. |
Ensure that financial allocation for the
Ministry of Health is increased to 4% of GDP by the first term of
administration. |
F |
The 2019 and 2020 Budgets tabled for the
MOH are equivalent to an (estimated) 1.89% and a (forecast) 1.90% of GDP,
respectively. Though the real sum has increased for both years, the magnitude
of the percentage increase was marginal. Even if PH had continued to be the
government, given the magnitude of increase for the subsequent three
financial years, it is quite unlikely that it would have been able to uphold
its promise. |
2 |
Introduce the healthcare scheme, "Skim
Peduli Sihat". |
F? |
The government did not implement the model
as stipulated in the Buku Harapan and was in practice in Selangor. However,
it rolled out “MySalam”130 and “PekaB40”131 programmes, which were
rather different in design and purpose. |
3 |
Pursue
closer collaboration between government health centres with private clinics. |
A/ I |
Yes, evidently through the PekaB40
health screening programme, two-thirds132 of the participating clinics were
in the private sector. |
4 |
Increase budget allocation and provide
incentives to tackle rare diseases. |
A/ I |
The government set aside RM50 million133 for treating rare diseases
and other health conditions in the 2019 Budget. Since the sum is shared with
other disease |
128 Berita Harian. (2019, Sept 11). 21 IPG disyor tutup mulai tahun depan.
https://www.bharian.com.my/berita/nasional/2019/09/605989/21-ipg-disyor-tutup-mulai-tahun- depan
129 Malaysiakini. (2020, Jan 5). Laporan: Mahathir utus surat minta Maszlee
undur. https://www.malaysiakini.com/news/505951
130 MySalam official portal.
(Accessed: 31 Aug 2020). https://www.mysalam.com.my/b40/info/
131 PeKaB40 official portal.
(Accessed: 31 Aug 2020). https://www.pekab40.com.my/eng
132 Bernama. (2020, Jan 11). Health care scheme for B40 group a 'game
changer' – Dzulkefly. https://www.malaysiakini.com/news/506734
133 New Straits Times. (2018,
Nov 2). 2019 Budget: RM50m allocated to treat rare diseases, Hepatitis
B. https://www.nst.com.my/news/nation/2018/11/427586/2019-budget-rm50m-allocated-treat- rare-diseases-hepatitis-c
|
|
|
areas, the amount for rare diseases is
smaller and never sufficient. |
5 |
Focus on non-communicable diseases. |
A/ I |
The
government carried on and implemented some items in the policy proposal134 planned under the previous
administration on non-communicable diseases: i) excise tax on
sugar-sweetened beverages135 ii) health screening service
for B40 under PekaB40 136 programme iii) designating
all food and beverage outlets in
Malaysia as smoke-free areas.137 |
6 |
More government resources will be channelled to mental health care. |
A/ I |
A higher
budget allocation for mental health was allocated in both 2019 and 2020,138 though the sum was still small.139 |
7 |
Provide compulsory pneumococcal vaccination
for all children under the age of two years. |
A/ I |
Announced in the 2020 Budget speech, the
government would provide free pneumococcal vaccines140 for children. Toward this
end, a budget had been allocated. The program was supposed to have been
implemented in June. |
8 |
Provide incentives for the establishment of
the palliative care centres across the country. |
F |
There is no easily accessible published
evidence to suggest that the government has done this. However, by the Health
Minister’s own indirect ‘open admission’ in his speech,141 he seemed to suggest that
the available palliative care in the country was insufficient. |
134 MIMS Today. (2018, Jan 18). Malaysia implements 13 health policies,
sparking national debate.
https://today.mims.com/malaysia-implements-13-health-policies-sparking-national-debate
135 Official portal of Royal Malaysian Customs Department. (Accessed: 31 Aug
2020). Sugar sweetened beverages. http://www.customs.gov.my/en/pg/Pages/pg_mainssb.aspx
136 PeKaB40 official portal.
(Accessed: 31 Aug 2020). https://www.pekab40.com.my/eng
137 New Straits Times. (2019, Dec 30). Smoking ban at all eateries comes
into force on Wednesday. https://www.nst.com.my/news/nation/2019/12/551849/smoking-ban-all-eateries-comes-force- wednesday
138 Code Blue. (2019, Oct 25). MOH gets tiny mental health 2020 Budget
raise.
https://codeblue.galencentre.org/2019/10/25/moh-gets-tiny-mental-health-2020-budget-raise/
139 New Straits Times. (2020, Feb 17). Mental health costs Malaysia RM14.46bil
or over one per cent of its GDP. https://www.nst.com.my/news/nation/2020/02/566428/mental-health-costs-malaysia- rm1446bil-or-over-one-cent-its-gdp
140 Malay Mail. (2020, Jan 3). Pneumococcal vaccination starts in June with
2020 babies, says deputy minister. https://www.malaymail.com/news/malaysia/2020/01/03/pneumococcal-vaccination-starts- in-june-with-2020-babies/1824316
141 Borneo Post. (2020, Jan 12). Country’s palliative care less than
satisfactory—Dr Dzulkefly. https://www.theborneopost.com/2020/01/12/countrys-palliative-care-less-than-satisfactory-dr- dzulkefly/
9 |
MOH to solve the problems faced by younger doctors or
"housemen". |
A/ I |
Fewer
working hours142 at one stretch to reduce overwork;
shorter training programme143 (the compulsory service had been
reduced from 24 months to 18 months) and more positions created144 to reduce the waiting period for
housemanship. |
Indicator: Achieved (A), Started and (was) In progress (I),
Failed (F)
Both the Health
Minister and the Deputy Health
Minister were actively
engaging with health- related stakeholders and media,
issued statements or held press conferences frequently to clarify policies
and/or incidents. Examples of various town-hall meetings (but not exhaustive)
with the stakeholders included: private general practitioners, pharmacists,
Muslim groups (Maqasid Syariah) and
the pharmaceutical industry sector145 (twice).
The then Health Minister Dr Dzulkefly Ahmad also set up a
seven-member Health Advisory Council146 on 27 March 2019, which consisted of
academics, private hospital specialists and public health experts, to advise
the MOH on healthcare delivery, performance and reform. This led to the presentation of the “National
health reform: Impetus,
principles and pillars”
at the National Institutes of Health (NIH) on 15 Aug 2019, and the
incorporation of the ideas in the Sihat Bersama
2030 proposal,147 which had been ready
for Cabinet approval.
The proposal is a policy to
revamp the health financing system, it was highly controversial and the details
of the proposal are not available in the public domain.
However, PH’s medicine price-regulation policy proposal was (and is still) a challenging one for the ministry, which engaged in more than 40 closed-door meetings with various stakeholders. There is huge resistance, especially from the pharmaceutical industry, private hospitals and some pharmacist organisations. The intention of the medicine price-regulation policy is a matter of public interest—to ensure fair and affordable pricing for medicine required by patients. The disagreement between the MOH and the private sector can be also
142 The Sun Daily. (2019, Apr 22). Fewer work hours for housemen. https://www.thesundaily.my/local/fewer-work-hours-for-housemen-BY809245
143 The Star. (2018, Sept 22). Excellent trainee doctors to have shorter
course to reduce wait for housemanship training. https://www.thestar.com.my/news/nation/2018/09/22/excellent-trainee-
doctors-to-have-shorter-course-to-reduce-wait-for-housemanship-training
144 The Malay Mail. (2019, Nov
8). Health Ministry pushing for 10,000 additional slots for medical officers,
says minister. https://www.malaymail.com/news/malaysia/2019/11/08/health-ministry- pushing-for-10000-additional-slots-for-medical-officers-say/1808220
145 Information Department. (2019, Aug 7). Jemputan media ke "sesi
town hall YB Datuk Seri Dr. Dzulkefly Ahmad Menteri Kesihatan Malaysia bersama
industri farmaseutikal siri II". http://epress.penerangan.gov.my/epress/epress/view_acara.php?evt=14553
146 The Star. (2019, Mar 27).
Health Advisory Council set up with seven panellists to advise ministry. https://www.thestar.com.my/news/nation/2019/03/27/health-advisory-council-set-up-with-seven- panellists-to-advise-ministry
147 Malaysiakini. (2020, Jan 1). Cabinet to get healthcare reform proposal by
month-end: Dzulkefly. https://www.malaysiakini.com/news/505543
observed in other policy proposals such as the separation of
dispensary148 and the reimbursement
amount149 for the private general
practitioners in the PeKaB40 programme. Political will from both the minister
and deputy minister
was strong to withstand the pressure,
especially when the smoke-free zone in eateries was first implemented. In
addition, Dr Dzulkefly Ahmad had a strong conviction for setting up a national
electronic medical records (EMR)150 system in
all MOH hospitals and clinics in different phases.
On the Pharmaniaga concession issue,151 the
minister initially made the tough call of not extending the contract with the
pharmaceutical company, and this won applause from the public. However, those
who are long-term observers of the medical supply distribution operation deemed
that this decision could be too drastic and implicate Pharmaniaga in engaging in inefficiencies, whereas
the latter had actually performed well to meet the MOH’s expectations.152 In the following week, the minister
announced that the concession will be extended
for another 25 months153 to allow a soft landing
for both sides,
as the MOH was also too reliant on the Pharmaniaga set-up.
The credit to controlling the first wave of the COVID-19 pandemic
in Malaysia has to be given
to both the Health Minister and Deputy Health Minister of the PH government,
although the professional and competent bureaucrats in the MOH brought strong
leadership to the government’s response to the pandemic. However, the same
cannot be said about the handling of the influenza outbreak
at end-2019 (and beginning of 2020). The government was reacting too slow, too little, and it could
have ended up a more costly
affair. On 30 December
2019, the health director-general denied154 the gravity of the outbreak, and it
took another two weeks before the situation stabilised.155
148 Free Malaysia Today. (2019,
June 13). Raise doctors’ fees before taking out dispensary, says think tank.
https://www.freemalaysiatoday.com/category/nation/2019/06/13/raise-doctors-fees-before- taking-out-dispensary-says-think-tank/
149 The Malay Mail. (2019, Jan 30). Doctors shun Health Ministry’s ‘take it
or leave it’ health screening scheme. https://www.malaymail.com/news/malaysia/2019/01/30/doctors-shun-health-ministrys- take-it-or-leave-it-health-screening-scheme/1717833
150 The Edge Markets. (2019, July 2). Electronic medical record system for
all M'sian hospitals, clinics to cost up to RM1.5b, says minister. https://www.theedgemarkets.com/article/electronic-medical- record-system-all-msian-hospitals-clinics-cost-rm15b-says-minister
151 The Star. (2019, Oct 31). Dzulkefly: Health Ministry ending
Pharmaniaga's concession for medical supply distribution. https://www.thestar.com.my/news/nation/2019/10/31/dzulkefly-health-
ministry-ending-pharmaniaga039s-concession-for-medical-supply-distribution
152 Loh Foon Fong. (2019, Nov 1). Mixed views over medicine prices. The
Star. https://www.thestar.com.my/news/nation/2019/11/01/mixed-views-over-medicine-prices
153 The Star. (2019, Nov 8). Pharmaniaga's concession to end in the next 25
months, says minister. https://www.thestar.com.my/news/nation/2019/11/08/pharmaniaga039s-concession-to-end-in-the- next-25-months-says-minister
154 New Straits Times. (2019, 31 Dec). Influenza infections still within
normal parameters, says Health DG. https://www.nst.com.my/news/nation/2019/12/552217/influenza-infections-still-within-normal- parameters-says-health-dg
155 New Straits Times. (2020, 13 Jan). Influenza situation under control. https://www.nst.com.my/news/nation/2020/01/556067/influenza-situation-under-control
Observations and
critical analysis of the PN governance:
As the PN government is new, a major period
of its governance has been under the Movement
Control Order. In general, the new Health
Minister, Dr Adham Baba, and two deputy ministers,
Dr Noor Azmi Ghazali and Aaron Ago Dagang, could have shown stronger leadership
during this health crisis. However, the MOH, under director-general Dr Noor
Hisham Abdullah, continues to excel, although he attributes the success to the MOH team and the leadership of the Prime Minister who acted on the professional advice given
by MOH. Within the unique circumstances of this period of crisis, the success that can be credited solely to the PN political leaders in managing the pandemic is unclear. Notably,
the government took the advice
of the MOH and
director-general of health seriously210 and implemented and coordinated various
measures.
Measures related to migrant workers or
undocumented persons were less coherent. The crackdown, arrest211 and deportation of these groups of
people are not aligned with good
210 The Star.
(2020, Jul 22). PM played key role, says Health DG. https://www.thestar.com.my/news/nation/2020/07/22/pm-played-key-role-says-health-dg
211 South China Morning Post. (2020, May 1). Coronavirus: hundreds arrested as
Malaysia cracks down on migrants in Covid-19 red zones. https://www.scmp.com/week- asia/politics/article/3082529/coronavirus-hundreds-arrested-malaysia-cracks-down-migrants
public health practice and policy. The manifestation of eight clusters212 in the immigration detention depots (DTIs), including a few large clusters (such as the Bukit Jalil DTI213), could be attributed to the lack of adherence to good public health practice, which was in contrast to many countries that suspended immigration detention in the wake of the pandemic214. These measures led to many undocumented migrants going into hiding and going hungry.215
The Health Minister also made a few
unsubstantiated remarks, such as “drinking warm
water216 can kill the virus,” while his deputy
was caught for violating the
MCO SOP.217
212 New Straits
Times. (2020, July 12). 8 immigration detainees test positive for Covid-19.
https://www.nst.com.my/news/nation/2020/07/607997/8-immigration-detainees-test-positive-covid- 19
213 Malaysiakini. (2020, May 26). 187 new cases; Bukit Jalil depot is second-largest
Covid-19 cluster. https://www.malaysiakini.com/news/527348
214 Magda Majkowska-Tomkin. (2020, Apr 29). Countries are suspending immigration
detention due to coronavirus. Let’s keep it that way. Euronews. https://www.euronews.com/2020/04/29/countries- suspending-immigration-detention-due-to-coronavirus-let-s-keep-it-that-way-view
215 Free Malaysia Today. (2020, Apr 22). With no help from embassy,
thousands of Rohingya to go hungry in Selayang. https://www.freemalaysiatoday.com/category/nation/2020/04/22/with-no-help- from-embassy-thousands-of-rohingya-to-go-hungry-in-selayang/
216 The Star. (2020, Mar 20). Health Minister's 'warm water method' to kill
coronavirus questioned. https://www.thestar.com.my/news/nation/2020/03/20/health-minister039s-039warm-water- method039-to-kill-coronavirus-questioned
217 The Star. (2020, Apr 28). Noor Azmi, Razman plead guilty to violating
MCO. https://www.thestar.com.my/news/nation/2020/04/28/noor-azmi-and-razman-arrive-at-gerik- magistrate039s-court
Recommendations
COVID-19 has shown that the public healthcare
sector plays the most crucial role in protecting people’s health, especially during a crisis.
The deteriorating economic
situation in the country
has also led to many members of the public’s
resorting to public
healthcare, and demand is expected to rise in the coming months and
years. Therefore, it is crucial that the government of the day provides a
significant increase in financial resources to the MOH in the 2021 Budget.
As for
reforming the health sector, the PH government ticked many promises laid out in
the Buku Harapan although these promises did not address the structural issues.
However, it still scored poorly for not allocating sorely needed funds to the
Ministry of Health--funding being the biggest indicator of political will.
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