Dear Health Minister, please attend to these priorities

  • Vital Signs
  • Wednesday, 11 Mar 2020

All Malaysians should live up to our fifth Rukun Negara “Kesopanan dan Kesusilaan”.

However, our culture’s politeness, decency and morality should never be mistaken for weakness; rather, they often indicate strength, courage and resilience.

In that spirit, we should congratulate the newly appointed Cabinet.

We hope that they will demonstrate leadership, competence and integrity to assure Malaysia’s safety during the Covid-19 outbreak and prosperity during the economic crisis. The fate of our nation depends partly on their skill.

I say “partly” because Malaysians must find solutions ourselves, instead of relying on politicians to save us.

We must continue fulfilling our duty as citizens and voters, hold the government accountable for our rights and change the rules of our democracy to make it fairer.

In that spirit, please allow me to fulfil my duty in two parts: some general reflections on the new Cabinet and some thoughts specific to health.

Reflections on the Cabinet

The first impression about this Cabinet is its size as the second biggest in Malaysia’s history.

Its size is necessary to accommodate unstable politics in a large and new coalition, but size increases decision-making complexity and carries a larger salary and pensions bill.

Secondly, women, minorities, Sabahans, Sarawakians and youths are under-represented in this Cabinet, which is a shame because Malaysia really could demonstrate our soft power as an inclusive, modern and progressive nation.

Thirdly, this Cabinet unfortunately rewards party-hopping and coalition-switching, which sends the wrong message to today’s 15-year-olds who will be eligible to vote in 2023 and may join politics in the future.

Fourthly, many are unknown career politicians without much experience in non-political areas of life, which understandably cause Malaysians to worry about their breadth and depth of leadership or governance capabilities.

Finally, there are some structural missed opportunities.

Climate change should be an explicit part of the Environment Ministry and the National Unity Ministry should perhaps be led by a Senior Minister, given its importance.

Two highly respected and highly qualified technocrats were appointed to the Finance and Religious Affairs portfolios through the Senator route.

This could be the path in the future for health technocrats to be appointed as ministers, without being subject to the unpredictability, messiness and unfairness of party and coalition politics.

Leaving aside the personalities appointed, the experiment of four Senior Ministers and no Deputy Prime Minister is ambitious.

Several countries are already appointing “coordinating ministers” because traditional portfolios are too narrow and need inter-ministry collaboration to be effective.

For example, Singapore has Coordinating Ministers for National Security, Social Policies and Infrastructure.

If Malaysia’s experiment works, there could be a Coordinating Minister for Health in the future, given that health is everywhere in all policies.

From my experience in Fortune 100 companies, differentiating Senior Ministers from Ministers allows talent to be appropriately promoted and recognised.

If this works, future administrations can consider institutionalising this format to incentivise better ministerial performance.

Prime Minister Tan Sri Muhyiddin Yassin wants a “Cabinet that delivers”, and so do all Malaysians.

Issues of legitimacy aside, we can help this Cabinet deliver by fulfilling our duty to fiercely hold it accountable through a vibrant media, civil society and citizenry, a strong opposition and shadow Cabinet, and elections.

To our new Health Minister

Congratulations, Datuk Seri Dr Adham Baba, Datuk Dr Noor Azmi Ghazali and Datuk Aaron Ago Dagang.

We all hope that you’ll lead Malaysia safely past the Covid-19 outbreak, ensure routine healthcare is not compromised and implement crucial multi-year reforms to strengthen our system.

In turn, we will fulfil our duty to support you in achieving the Prime Minister’s desire to provide “quality healthcare at affordable cost” to the Rakyat.

Your success is the Rakyat’s success and that represents our success in the health professions.

In the short term, there is a necessary emphasis on Covid-19.

We must ensure effective risk communications and a calm, sensible response to the outbreak.

We must protect our frontline health professionals, including from fatigue.

As the Health Minister, we expect that you will lead an all-of-society response to Covid-19, because the Health Ministry (MOH) alone cannot manage this.

We expect that you will marshal the necessary human, political, financial, economic and social resources necessary to overcome this crisis, especially because we don’t know when it will peak or how long it will last.

In this all-of-society response, we expect that you will lead efforts to provide forward guidance to employers, schools, religious authorities, glove manufacturers and so on, to ensure effective risk management, a sustainable response and adequate supplies to protect ourselves.

Simultaneously, the Rakyat expects that routine healthcare continues to be delivered.

As you well know from your decades of practice, the MOH must manage long waiting lines, increasingly expensive healthcare and a demand for higher quality care.

Three other tectonic trends for your attention are our under-spending on preventive care, our ageing population, and our growing inability to provide universal health coverage to the urban poor, to rural communities, in Sabah and Sarawak, and among marginalised communities.

To meet these demands in the long term, the health professions and the Rakyat are expecting meaningful structural reforms in our health system.

This should focus on three aspects: how healthcare is financed, how MOH hospitals are organised and how health professionals are treated.

The Sihat Bersama 2030 vision is a good reform blueprint to build on; we should use the excellent work of the senior leaders in the Health Advisory Council.

This would show your generosity and open-mindedness, while preserving some necessary continuity with the previous administration. Health shouldn’t be partisan.

In my opinion, Dr Adham, there is extra weight on a Health Minister beyond the basic constitutional, law-making and operational duties.

A Health Minister must aggressively advocate for greater emphasis on health, as health is a political choice and must be higher on the political agenda.

Therefore, you will be called upon to make unpopular, but necessary, decisions, such as extending the smoking ban, providing basic healthcare to non-citizens or making vaccinations mandatory.

The health professionals are uniting and we will support you in these decisions, but we ask that you stand firm alongside us.

Along with Dr Noor Azmi, your medical backgrounds and years in practice should make evidence-based policymaking a second nature.

We hope that health will be depoliticised under your leadership, with equal stature for scientists and technocrats, and an emphasis on evidence, ethics and the human right to health.

Congratulations again to all Cabinet ministers and deputy ministers. It is an incredible privilege and honour to serve, and we wish you all success.

We will fulfil our duty to support you, and that will also mean exercising our rights to hold the Cabinet accountable.

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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