Kuala Lumpur, 24 February 2023 — The health allocation under the Federal Budget 2023 tabled in Parliament today sets an optimistic tone towards tackling teething problems in recruiting and retaining healthcare workers, modernising ageing infrastructure, decongesting public health facilities, and address emerging public health threats such as vape and e-cigarettes. However, it falls short on issues such as sustainable healthcare financing.

“In terms of allocation, at RM 36.3 billion, this Budget signals a slightly greater commitment to health compared to the previous budget proposed by the Ismail Sabri administration at RM 36.1 billion,” said Azrul Mohd Khalib, Chief Executive of the Galen Centre for Health & Social Policy, when commenting on the tabling of the federal budget bill this evening.

“At 12 percent, it is by far the biggest percentage of increase for the Ministry of Health’s budget in the past five years. It is also the highest in absolute terms and is 9.4 percent of the total budget of RM 388.1 billion.”

“From the total of RM36.3 billion allocated, MOH will have RM31.5 billion for its operating expenditure and RM4.827 billion for development expenditure. It is sobering to note that the allocation for operational expenditure alone now exceeds the total allocation for health in the 2020 budget which was RM 30.84 billion. This was just two years ago,” Azrul pointed out.

“It is particularly encouraging to see the Government’s commitment to addressing the healthcare worker shortage crisis with an allocation of RM 3 billion for new permanent and contract positions inclusive of more than 1,500 medical officers, dental and pharmacy officers. We hope that this will also include nurses, allied health workers and supporting staff who are critical to the health system.”

“The Government must also demonstrate commitment to not only recruit new personnel but fund the promotion of existing staff and increase salaries to support retention of skilled healthcare workers.”

“It was heartening to hear the Government confirm its commitment to the Generational Endgame objective for tobacco and vape. The fact that it has announced the earmarking for health of half of the future revenue to be collected from the regulation and taxation of e-cigarettes and vape containing nicotine is certainly welcome,” Azrul highlighted.

“The Galen Centre has been a strong advocate of earmarking such revenue from tobacco and alcohol excise duties for the purposes of health. However, we note that this proposal does not include vape without nicotine. The Malaysian vape industry estimated to be worth more than RM 2 billion is largely made up of no nicotine vape. Regulating and taxing only nicotine vape and e-cigarettes will produce less than what the Government expects. All vape and e-cigarette products should be taxed.”

“When will the revised version of the Tobacco and Smoking Control Bill which was worked on by a Parliamentary Select Committee last year, be tabled? We hope that with this declared intent to tax vape, it will be followed by the passing of the legislation. It is overdue,” Azrul emphasised.

“The Skim Perubatan Madani or Madani Medical Scheme is potentially a game changer. We have seen the proven public-private partnership models from Selangor and ProtectHealth. By providing those who qualify to be enrolled in the scheme particularly those from lower income households, with subsidised access to private general practitioners (GP) clinics at a national level, this scheme could significantly relieve the pressure and burden on congested Emergency departments at public hospitals across the country.”

“There is also a massive increase in investment amounting to hundreds of millions of ringgit in critical infrastructure. This represents a strong and clear recognition that the repair, maintenance and upgrading of existing and aging structures and facilities including modernisation and digitalisation of health information systems, is long overdue. This will potentially translate to improved efficiency, shorter patient waiting times, and better delivery of health services. Out of Malaysia’s more than 156 public hospitals, 45 are over 100 years old.”

“Unfortunately, for the first time, non-communicable diseases (NCDs) have not been mentioned in the tabling of the federal budget. Previous speeches have recognised that this country is struggling through a NCD crisis, with 1 in 5 people living with diabetes; 3 in 10 with hypertension; 3.4 million currently live with at least two NCDs; and half of the adult population are either overweight or obese. The increasing usage and burden on the public healthcare structure is symptomatic of this crisis. More must be done to help prevent the onset of non-communicable diseases,” Azrul emphasised.

“As it was in the budget of the previous administration, it is disappointing that there is no mention of any commitment to addressing the issue of sustainable healthcare financing and investing in a sustainable long-term solution. In order to ensure that Malaysia’s healthcare system is able to continue to provide quality, affordable and accessible health services for all in the decades to come and tackle the challenges of preventing and treating NCDs, of mental health and an aging population, the government must commit itself to finding a way forward on this question.”

“Finally, teaching hospitals under the Ministry of Higher Education were again shortchanged when their allocations remained relatively similar to what they had received in previous years. Despite playing a major role in responding to the COVID-19 crisis and still managing caseloads across the country, our teaching hospitals appear to be forgotten. Besides carrying out their core function of educating future healthcare workers including nurses and doctors, we need to ensure that such facilities are prepared and equipped to handle a future infectious disease outbreak as part of Malaysia’s epidemic preparedness and response strategy,” Azrul emphasised.