Malaysia has not met its own goal for the MMR, although we are well within the SDG target for neonatal and under-five mortality rates. — Photos: Filepic
The Sustainable Development Goals (SDGs) were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure all people enjoy peace and prosperity by 2030.
SDG3, which is “Good health and well-being”, has 13 targets and 28 indicators.
What is the Malaysian data for this SDG like?
Some information can be found in publications from the Economic Planning Unit’s Voluntary National Review (VNR) 2021, the Department of Statistics (DOSM) and other sources.
Some of the targets are discussed below.
Unless otherwise stated, the numbers are from the VNR.
Mothers and children
The maternal mortality ratio (MMR) is the number of women who die from pregnancy-related causes during pregnancy or within 42 days of the end of pregnancy.
It is counted per 100,000 live births.
This indicator reflects the capacity of the country’s health system in addressing and preventing complications during pregnancy and childbirth.
However, in Malaysia, only maternal deaths of citizens and non-citizens with legal documents are reported.
Undocumented migrants are excluded from the data reported.
The national MMR has been hovering around 23 per 100,000 live births (24.4 in 2000, 23.8 in 2015, and 21.1 in 2019).
Perak, Negri Sembilan, Perlis, Sabah and Penang had MMRs higher than the national average in 2019.
This was despite the fact that 99.4% of births were attended by trained health personnel.
Many may have forgotten that Malaysia in 1994, set itself a Millennium Development Goal (MDG) target at the International Conference on Population and Development of an MMR of 15 per 100,000 live births by 2015.
The birth rate in the 10–14-years-old age group did not change between 2017 and 2019, and remained at 0.1 per 1,000 girls.
Meanwhile, the birth rate in the 15–19-years-old age group was 8.2 per 1,000 girls in 2019, compared to 9.1 in 2017.
The proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods was 47.7% in 2014.
The target to end all preventable deaths for children under five years of age has two indicators: neonatal and under-five mortality (death) rates.
The neonatal mortality rate is the number of infants dying within the first 28 completed days of life per 1,000 live births in a year.
This indicator reflects the adequacy of nutrition, receipt of timely vaccinations, and accessibility to treatment for preventable infectious diseases in neonates.
The national neonatal mortality rate for 2019 was 4.1 per 1,000 live births – an improvement from 4.4 in 2017.
The under-five mortality rate for 2019 was 7.7 per 1,000 live births – an improvement from 8.4 in 2017.
Both the neonatal and under-five mortality rates are within the 2030 global SDG target of at least 12 per 1,000 live births and at least 25 per 1,000 live births respectively.
Diseases and death
Unfortunately, we do not seem to be on track to eliminate HIV transmission by 2030.
The number of new HIV (human immunodeficiency virus) infections in uninfected persons aged 15-49 years, and the incidence of malaria has not changed between 2017 and 2019.
They remain at 0.2 and 0.1 per 1,000 population respectively.
At this rate, Malaysia is not on track to ending HIV by 2030, while the risk of imported malaria continues.
The incidence of tuberculosis and hepatitis B has also not changed between 2017 and 2019, and remain at about 81 and 15.3 per 100,000 population respectively.
The probability of premature death between the ages of 30 to 70 years from cardiovascular (heart) disease, cancer, diabetes and chronic respiratory disease in 2019 were 11.3%, 5.7%, 1.5% and 1.3% respectively.
There was no data from 2017.
This is not surprising as one in five persons have diabetes and three in 10 persons have high blood pressure.
There have been about 250,000 cancer cases in the past decade, with about 150,000 deaths.
It is expected that these numbers will increase by half by 2030.
More than 70% of cancers were diagnosed in the late stages of three and four.
Coverage for treatment interventions for amphetamine-type stimulants – many of which, like ecstasy and MDMA, are used illegally – had decreased from 20.4% in 2017 to to 14.9% in 2019.
Coverage of essential health services in 2017 was 73%.
Out-of-pocket payments for health increased from RM16.78 billion in 2015 to RM22.49 billion in 2019.
The mortality rate attributed to unsafe water, sanitation and hygiene per 100,000 population was 0.5 in 2017 and 0.7 in 2019 respectively.
Gaps in data
The DOSM states that it is the lead agency coordinating SDG data collection in Malaysia.
However, it has reported only proxy data for:
- Hepatitis B incidence
- The number of people requiring interventions against neglected tropical diseases
- Alcohol consumption per capita
- The proportion of women who have their need for family planning satisfied with modern methods
- The mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene, and
- The mortality rate attributed to unintentional poisoning.
The department also reported it only has partial data on the number of new HIV infections per 1,000 uninfected population, and the proportion of health facilities that have a core set of relevant and essential medicines available and affordable on a sustainable basis.
It did not have data for the mortality rate attributed to household and ambient air pollution; and the total net official development assistance to medical research and basic health sectors.
The lack of sufficient data makes it difficult to measure progress, or the lack of it, within these areas.
Going forward
The VNR outlined five areas for the “attention, commitment and improvement” of the Government, civil society and private sector. They are:
- Enhancing existing healthcare coverage and system delivery for better health outcomes.
- Intensifying efforts to control both communicable diseases and non-communicable diseases.
- Exploring healthcare financing alternatives for improved affordability and sustainability.
- Prioritising preventive healthcare approach towards improved health outcomes.
- Strengthening well-being and inclusivity.
The devil, however, is in the details, which every healthcare professional awaits with bated breath.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
