Dear Prime Minister, suggestions for our next Health Minister


  • Vital Signs
  • Wednesday, 04 Mar 2020

It’s clear that Malaysia is now under strain, with the epidemic, the economy and the electorate all under stress.

But we have rallied together before and we can unite again.

In his first public address as the current Prime Minister, Tan Sri Muhyiddin Yassin made a welcome promise to “be PM for all races”, to “prioritise efforts to increase integrity and good governance”, to appoint ministers “who are clean, with integrity and of high calibre” and to deliver “high quality and affordable healthcare”.

Please allow me to provide some input on your choice of Health Minister, Prime Minister, for it is my duty as a citizen and a health professional to support your promises.

Our shared intention is to stabilise Malaysia generally and protect the health of citizens specifically.

Crucial, yet less visible

Health is a paradoxical portfolio.

On one hand, it’s big and important, with the second-highest number of civil servants delivering a most fundamental public service with the second-highest budget allocation.

Everyone can agree that the basic legitimacy of any government relies on protecting its citizen's health.

Even if politicians vehemently disagree on khat or highway concessions, everyone can agree to support health for all Malaysians, regardless of race or religion.

Health is not only a human right; it can unite Malaysia.

On the other hand, health is not high on the political agenda and the Health Minister is not generally as powerful as the Finance or Home Affairs ministers.

Except during outbreaks or unfortunate sensational deaths, the media and the public generally do not discuss health policies.

This “avoidance” of health is partially because people are not comfortable with scientific jargon or life-and-death decisions.

Health also relies on measurable science, evidence-based guidelines and established professional ethics, making it less ideological or controversial than other portfolios.

Therefore, health remains less visible on the public agenda or less exciting as a topic to discuss.

A specific skillset

Prime Minister, the health portfolio could be your first results-driven, non-partisan, non-ideological and technocratic appointment. This will help meet all the promises in your speech.

You need someone you, the Rakyat and the health professions can trust, who can immediately deliver results (and legitimacy), especially during the current Covid-19 outbreak.

Historically, most of our health ministers have been appointed because they have a medical, science or health background, and are usually party leaders.

Since 1955, we’ve had 20 health ministers, averaging one every 3.3 years, due to elections or Cabinet reshuffles – many of us don’t change jobs that often.

Choosing science-minded ministers is laudable, although they carry additional duties to their constituencies and parties, and are subject to party politics and vested interests.

In the Barisan Nasional era, politics were contained within the coalition, for better and for worse.

Right now, we have to manage an unstable political landscape on top of the sheer complexities of running a gargantuan health system.

It becomes more challenging when multi-year reforms are needed to make healthcare more sustainable and fair.

Health is a portfolio that is too important to be left to a career politician or a leader of a component political party, chosen simply because coalition politics require keeping people happy.

We simply must have the best person in the job.

There are several reasons for this.

One, the skillset in the health portfolio is different from the politician’s skillset suitable for other portfolios.

Two, health systems are too large and too complex to be quickly appreciated.

Three, you need someone to be fully functional on Day One itself in our current situation as outbreaks don’t wait for political transitions to finish.

A results-driven, neutral technocrat

Therefore, Malaysia needs a minister who is results-driven, non-partisan, non-ideological and technocratic.

Malaysia needs a non-politician who can rise above politics, keep the country safe and implement the long-term reforms needed to keep Malaysians healthy.

This person should be an expert in multiple health sectors, with a track record of successful delivery, is capable of building bridges and consensus, has general administration experience (bonus if international), can rely on instant networks (bonus if international), can unite the health sector, and is committed to serving everyone in Malaysia.

Preferably, this person has no political affiliation and should not stay in the role permanently.

This person could come from the Dewan Rakyat, but could equally come via the Dewan Negara.

While this has never occurred before, unprecedented times require unprecedented solutions.

There are benefits to this results-driven, non-partisan, non-ideological and technocratic minister.

One, there could be more cohesion between the political leadership and the health technocracy.

Two, this could lead to a pragmatic hyper-focus on results, rather than politics or ideology.

Three, effective results translate into legitimacy for any government.

Four, appropriate ring-fencing from politics allows multi-year reforms to be implemented and systems to be built.

This should be free from political transitions and unnecessary interference, while preserving the necessary ideological, governance and social contract discussions on issues like government-owned private hospitals and health-financing reform.

Of course, such a non-partisan minister could have disadvantages, but these can be mitigated.

Party lines are helpful, although much of health can be done via policies, rather than laws. Major health reforms need bipartisan support anyway and we now have party-hopping.

There is an initial issue of legitimacy, but legitimacy from results is as powerful as legitimacy from elections.

Many decisions are made outside the Health Ministry (MOH), such as privatisation of services, so this non-partisan minister must build strong bridges to other agencies.

Our current system of selecting ministers based on coalition politics has its own severe disadvantages, such as instability or a lack of political will to implement reforms (see the recent push-back on a simple smoking ban, not to mention stalled reforms dating back to 1990s).

Malaysia’s game plan for health isn’t working well and worsening instability is changing the game; it’s time to change game plans.

A nation-building tool

In an alternate world, maybe we don’t even need a health minister. It’s really a credit to the MOH that Malaysia can continue to fight Covid-19 without one.

The health professions have also recently united to issue joint statements supporting the smoking ban, against profiteering from disease, reinstating the critical service allowance, and urging that the Rakyat’s health be protected during any political transitions.

As health professions unite and support our MOH, perhaps our systems and institutions are resilient enough to survive any political vacuum. Belgium, after all, famously had no government for 541 days.

Imagine though, that we had a stable, results-driven, non-partisan and non-ideological minister, appropriately insulated from politics, held accountable to ambitious performance metrics and given the mandate to build health as a Malaysian institution.

Health really is more than just hospitals and doctors. It is a nation-building tool, because an effective health service can unite a country through a shared lived experience.

Our fellow citizens and the 270,000 MOH civil servants deserve a new type of leader who can lead the complex health service ring-fenced from politics.

This stabilising, competent and uniting presence is precisely the medicine that Malaysia needs right now.

Health is always a political choice. We pray and hope that our nation will make the right ones.

Dr Khor Swee Kheng has postgraduate degrees in internal medicine and public health, and has worked in five health sectors across three continents. He is currently reading Public Policy at the University of Oxford. The views expressed here are entirely his own.

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Health Minister , Covid-19 , governance

   

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