5 crucial points on the PN govt's health performance

Short speech prelude:

17 months of PN govt on health performance, many would judge significantly on the pandemic control outcomes. If we take the final outcome as when they left the office, the public perception is most probably not good. In fact, whether the assessment claim is true or not, certainly their pandemic control policies and measures were largely criticised and these are made good excuses or reasons to pressure their exit. Their first and early successes before the third wave of pandemic were already in the distant past, many would argue the credits may not pass entirely or largely to the political leadership but the competent health department civil servants.

Yes, political leadership is problematic, because during the pandemic, health ministry is probably the most important portfolio in the government, but the person held the minister position is Dr Adham Baba. People yearn for leadership to get them out of this mess of double jeopardy in public health and economic, but the health ministry seems to keep afloat and autopilot by the civil servants under the leadership of Director General Dr Noor Hisham. The latter even was made the national hero and superstar in early days of COVID-19 pandemic. This shouldn’t happen if the health minister were competent enough. One even can have doubt about Dr Adham Baba, how effective he could articulate and defend the MOH positions in the cabinet and the MKN meetings? MOSTI minister Khairy Jamaluddin is the complete opposite to Dr Adham Baba, he shows what a competent and effective leader can make the difference and impact. He ran the National COVID-19 immunisation programme so well until no one among the general public knows who is DG or KSU in his ministry.

One thing is about fighting the covid-19, another is to deal with non-covid health issues. Since the beginning of the pandemic, many among the public start to appreciate the importance of health policies. Many health advocate groups, opposition members and even DG himself called for strengthening public health, by allocating more resources for the health ministry. In the end, Budget 2021 was a big disappointment, because it failed to show the political will and strong intent from the government investing in public health. MOH operating budget was cut, allocation for services and supplies for the ministry were also slashed, even the budget for the Public Health department was also shrunk by 12%. They would do themselves a lot of good deeds and save troubles if they had allocated significantly more for creating many more permanent positions in the Medical department, this was the prelude to the Code Black and Hartal Doktor Kontrak movements.

Although the housemanship and contract doctor issue have a long history passing through many governments including Pakatan Harapan, they may also be complicated. What the Prime Minister offered to the contract doctors prior to their nationwide strike was just another temporary stop gap measure. Only when push comes to shove, then the government responded, before that they seemed to be just sitting on the issue.

Vaccination is traditionally a health matter implemented by the MOH, but on COVID-19 vaccination, it becomes joint-effort, perhaps under the leadership of the PICK coordinating minister Khairy, it is the only exemplary health performance under the PN government. But even that, home ministry often sabotage by initiating campaigns to arrest undocumented migrants. This complicates the pandemic control measures, including getting them to be vaccinated.

In short, under the eventful 17 months under the PN govt, their political leadership in the MOH is shambolic and, some argue, almost non-existence. The then Prime Minister Muhyiddin even had to appoint a special advisor on public health in Dr Jemilah Mahmood to show the internal deficit. 

5 crucial points on the PN govt's health performance

1. Incompetent and doubtful political leadership in health matters

 

PN government had selected Dr Adham Baba as the health minister, and stuck with him throughout the 17 months in governance. Despite being a medical doctor listed in the Medical Register, Dr Adham Baba’s deficiencies in ability to comprehend many complex issues, make good judgement as well as take timely and appropriate actions to remedy the situations and solve surging number of problems emerged due to the pandemic, are too obvious for the whole nation to see. His public unscripted appearance and speech delivery at times were disastrous and left him being a laughing stock for the nation. This is not helpful when the nation needs a capable and convincing leader to lead the people out of the pandemic, while his personal qualities were questioned and his reputation had been taken enormous hits. The people are not sure what were his contributions in the health ministry and how effectively he defended the MOH positions in the MKN and cabinet. The health ministry seemed kept afloat simply by the excellent support and deliveries from the competent civil servants. 

 

The public shifted their attention and yearned for leadership, giving rise to the stardom profile of Director General of Health, Dr Noor Hisham. This should not happen if the health minister were competent enough to handle the communications and deliveries in terms of health policies and measures. The NIP Coordinating minister Khairy Jamaluddin is the total opposite case to Dr Adham Baba, he is a prime example showing how much difference and impact a competent and effective leader can make.

2.              Failure to contain the pandemic due to political and external interest interference and not based on prevailing evidence

 

2 critical mistakes at the early third wave of pandemic paved the way for the subsequent  failures to suppress the COVID-19 disease transmission in 2021: i) Slow response in closing the Sabah state borders during the early outbreak of the third wave pandemic. The outbreak was exacerbated by the Sabah state election campaigns, which was unnecessary if not for the political actions by certain leaders to grab power via  defections. ii) Premature reopening of all state borders in early December, just when the pandemic situation was in control and improving. This intervention decided at the MKN resulted in widespread seeding of the virus throughout the country and caused the high peak in February. As a consequence, the viral load in the local communities became so high until it became entrenched as endemic, this sets the prelude to the series of subsequent failures of the disease containment strategies. MITI’s allowance for many firms and factories to continue operating as ‘essential services’ during the FMCO period helped sustain the disease transmission at the localities.

3.              Failed in investing more in public health under the Budget 2021

 

Despite the repeated calls by the health advocate groups, political parties and even the DG Health to increase the financial resources for the MOH, Budget 2021 was a disappointment. The MOH operating budget was reduced by about RM718 million, particularly the allocation for services and supplies was shrunk by RM1.3 billion. The government significantly cut back the budget on the Public Health overall programme by 12%, this is not a good message of intent to show that the government wants to strengthen public health, even though it is true that the government had allocated a lot more in a separate pool of funding only for COVID-19 pandemic.

4.              Temporary but unconvincing solutions for the contract doctors

 

To be fair, the housemanship & contract doctor issue has been a long standing issue, dated back to more than 10 years ago. Moratorium on new medical schools and programmes first imposed in 2011, pushed more desperate students to seek opportunities in overseas medical institutions, and they came back wanting to serve.

 

The contract system adopted in 2016, only served as a delay tactic to overcome the Public Services Department (JPA) bottleneck for appointing house officers as well as medical officers to the permanent civil servant positions. But the subsequent governments did not have the political will to significantly increase the number of positions to absorb the contract doctors. 

 

On the Hartal Doktor Kontrak movement, the then Prime Minister Muhyiddin Yassin finally responded on 23 July 2021 by offering another temporary stop gap measure with a 2 year contract to those who had completed mandatory service (or 4 years if accepted for specialist studies), as well as upgrading the contract benefits. He promised to fix the system. 

 

Although the systemic issue is complicated and hardly one can expect the government with such a short tenure to solve it, the government did not seem to deal much on the issue but only when push comes to shove (CodeBlack and Hartal Doktor Kontrak movement).

5.              Effective vaccine rollout campaign, held back by obsession to arrest undocumented migrants

 

The rapid pace of vaccine rollout under the National COVID-19 Immunisation Programme after June 2021 is one of the best performing acts and effective policy implementation by the PN government. The inclusiveness of the vaccination campaign (eg. multilingual official website, vaccination plan to include migrant workers and undocumented migrants, invited opposition lawmaker to be one of the coordinating officers), effective and clear public communication (eg. regular press conferences, statements, and public talk appearances), willingness to share more data in public, and spot-on strategic decision (eg. allowing the public to go for an opt-in option for AZ vaccine when the initial doubt raised about the vaccine) -- all these exemplary records  boosted public confidence in registering and getting the vaccine. The vaccine rollout rate during Jun-Aug saw Malaysia being one of the fastest immunised nations in the world, and it could have already protected many people from COVID-19 harm if only the pandemic were less severe.

 

However, the Home Ministry had a different idea. They were adamant in arresting undocumented migrants under the disguise of protecting the citizens from infection. Human rights aside, even if it were just about public health, that was obviously a wrong approach. These gave rise to multiple clusters in the immigration detention centres with a high number of positive cases. The policy also causes many undocumented migrants went hiding for the fear of arrest. This complicates the COVID-19 pandemic control management and interventions, and helps sustain a certain viral burden in some unreachable communities which were forced to hide.