ALMOST from the beginning of this Covid-19 pandemic we have been hearing one word repeatedly associated with the Malaysian public healthcare system. The word is shortage.
As Covid-19 started, there was a testing shortage as it were with not enough tests being done, especially outside the capital. This was because Malaysia had not set up enough testing capacity across the country. The OECD (Organisation for Economic Co-operation and Development) countries responded fast enough to testing needs because they have a network of public and private labs to serve the public healthcare system, and it was available even in rural areas.
Since the number of new cases began spiralling up, we have also been hearing about the shortage of beds, equipment and medical and nursing staff in our public hospitals. We have also been hearing how hospital staff faced workforce issues even before the pandemic began.
People – and politicians too, it seems – are only now starting to realise that Malaysia has underinvested in building hospitals, especially in less urban and rural areas. Along with that, we also have a shortage in terms of IT infrastructure for healthcare. It is sad that it took a pandemic before politicians felt the need to invest in data integration and appointment systems.
Not only have governments invested insufficiently in the public healthcare system but they have also not spent what was invested in the most needed areas. For example, enormous amounts of money have been invested in biomedical strategies in the past two decades. Yet there is a shortage of local capacity for vaccine production. Nor does Malaysia have the pharmaceutical manufacturing capacity that could be reallocated towards vaccine production.
Malaysia also has more than a million foreign workers earning low wages, undocumented immigrants and refugees. But there are no effective strategies for controlling the virus in this segment of the population and vaccinating them except for extreme measures such as mass detention of undocumented immigrants which may actually worsen the problem.
While think tanks and some politicians have been pushing hard for greater privatisation of the public healthcare system, the pandemic has proven them wrong. What Malaysia needs is a stronger public healthcare system, with private sector participation, to provide more cost-effective and efficient public healthcare.
Healthcare experts have long been advising governments to double healthcare expenditure from around 4% to 8% or more to reach OECD investment levels. They have also been urging politicians to equip the public healthcare system to shoulder a bigger burden of health needs by increasing public healthcare spending from less than 50% to around 70%. To finance these reforms, healthcare experts have been advising governments to use more than just taxes and include solutions such as levies, zakat and wakaf payments, etc.
We need to reform our public healthcare system now. Let innovation experts and agencies be drivers of change. Let us work towards equity and efficiency in our public healthcare system.
The government can start to reallocate and repurpose budgets, civil service manpower and resources towards the public healthcare system to bring the country out of the pandemic. And these reforms must be guided by evidence. Which means a greater role must be played by local health NGOs, the scientific community and global experts, and the Health Ministry – politicians must be willing to share their roles.
We need the Health Ministry to divest a good proportion of its workforce to staff expert scientific/innovation agencies which also should draw on expertise from the NGO and scientific sectors. What is clear is that it is not the intelligence of politicians and bureaucrats that the public healthcare system needs to rely on but rather innovation from all sides.
Tough times need tough decisions and the difficult decision we need to make is to have the Malaysian public healthcare system become an innovative one.
MOHIDEEN ABDUL KADER
President, Consumers Association of Penang (CAP)