This document is intended to gauge the Pakatan Harapan government’s stewardship of the health agenda and commitment to reforms. It is important to note from the onset that these grades reflect a work in progress. Implementation of reforms is the responsibility of many individuals, not just the Minister of Health. The intersectionality of health means that other Ministries are mentioned. Reference is not limited to the Pakatan Harapan Manifesto (i.e pledges contained within Promise 9: Improve access to and quality of health services & Promise 44: Improve the quality of education and healthcare). These can be seen in the pale blue boxes. However, other related issues are also included to reflect ongoing developments and concerns. The inputs consolidated here are based on published statements and public documents.
The full report card can be downloaded here.
The introduction and upcoming enforcement of the smoke-free air regulation in eateries is arguably, the most prominent health-related achievement for the Pakatan Harapan government in its first year. Considering that at least 40% of Malaysians are exposed to second-hand smoke and an estimated RM 2.9b is attributed to the treatment of tobacco-related diseases such as lung cancer, cardiovascular disease and chronic obstructive pulmonary disease, this move will be seen as a watershed moment. If the government stays firm in the face of criticism, this move will pay dividends in reduction in airborne nicotine, better respiratory symptoms, better air quality, increased well-being, and massive drops in societal healthcare costs.
Doctors doing their housemenship will see long-awaited reforms. They are no longer permitted to work more than 14 continuous hours, no back-to-back shifts, work hours reduced from 65 to 75 hours per week, to 60 to 62 hours a week, and term reduced from two years to 18 months. Though placement continues to be a problem, these changes will improve the overall conditions for this group of healthcare professionals.
The development of the Peka B40 programme, aimed at tackling the rise of non-communicable diseases (NCDs) such as diabetes, high blood pressure, and high cholesterol, through strengthening of primary care services is a significant achievement. Combining medical and non-medical interventions intended to improve health-seeking behaviour and early prevention and control of NCDs, the plan has the potential to succeed where other similar initiatives have failed. However, it needs to be better funded, include people below the age of 50, and have clear mechanisms linking people with treatment.
The state of healthcare in Sarawak and Sabah, particularly the remote and rural population, remains generally basic and underserved in terms of access to healthcare facilities and meeting community needs. More than a third of the population continue to live beyond 5km of any kind of health facility and may have to travel for hours to seek treatment. Long standing issues such as maternal health remain unresolved. There needs to be a separate action plan to upgrade the healthcare infrastructure in these two states which is fully funded and has political support.
Despite 1 in 3 persons in Malaysia suffering from depression and anxiety disorders, the framework to respond to mental health needs continues to be dependent on private sector players including for profit, not-for-profit and non-governmental organisations. The allocation comprises only 1.17% of the total health budget. Budget allocation for MOH’s psychiatric and mental health department was actually reduced by RM7.93 million this year, compared to 2018. By 2020, mental illness is expected to be the second biggest health problem affecting Malaysians.
High price mark-ups for treatment related costs and services by private hospitals (a large number are owned by government linked corporations) have contributed towards double digit medical inflation. Public perception has been that the cost of private healthcare has gone up in the past year.
Too Soon To Tell
The mySalam insurance scheme, introduced by the Ministry of Finance, assisting individuals struck by critical illness, is a critical step in the right direction towards eventually introducing a national social health insurance scheme. However, it is too soon to tell whether this income replacement assistance plan will actually help the intended beneficiaries, the B40 group, at the intended scale. The exclusions and lack of customisation to reflect the actual needs of this population, potentially compromises its value and impact.
Introducing cost containment measures such as central pool procurement and a price control mechanism for medicines will contribute towards managing healthcare cost, particularly for the public health sector. The stated objective is to ensure access to medicine at an appropriate price, as well as to encourage innovation and healthy competition for industry growth. Though it is too soon to tell whether these actions will actual lead to cheaper drugs and improved coverage for diseases, it is a major initiative.