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MALAYSIAN HEALTH CARE – A FINGER ON THE PULSE

28.8.2021

Salutations:

Our Malaysian health care system is a like sick man, really sick lying in bed.just out of ICU and with every possibility of going in again in the near future.

Sadly, this patient has been ill not just today but have been for a very long time. The doctors at his side with their fingers on his pulse have been there for decades advising, counseling and hoping to mantain him in good health but alas it does look all good advice have fallen on deaf ears.

Unfortunately, the powers to be have procrastinated,  looking for second, third and indeed endless opinions from WHO and WHOEVER  and  various well connected international bodies except from the very doctors at the patient’s bedside.

For more than four decades, health ministers have come and gone  together with their favoured  healthcare  consultancies  and think tanks.. Very few have stayed long enough to make a mark in their term of office. Our health care system was very much on auto-pilot mode on a trajectory set by the technocrats many 5-year Malaysia Plans ago.

There was much comtemplation and just as much discussions.  At the end of the day, absent political will meant no innovation and no affirmative implementation.. Budgets were cut and curtailed and money meant for direct patient care was  diverted to endless knee-jerk feel good programs which lasted only as long as the Minister’s tenure.

The patient was left to bleed and to moan Today, we  see the  patient, sick in bed and with nothing more than band-aids to keep him from falling apart. Such is state of Malaysian healthcare 2021.

The FPMPAM commisioned  the writing of this book in 2018 .It was completed in a mere six months. This was a remarkable feat by all our esteemed contributors powered by the drive of a  energetic team. For this we have to thank our team of our executive editor Ms Boo Su-Lyn and  our executive officer Ms Molly Kong.

My co-author, Dr Milton Lum and I would like to express our greatest appreciation to all our contributing authors for a job well done. They have put all that needs to be told in plain language that is simple enough for all, from the laymen to the almighty Parli men and Parli- women.Hopefully YBs and YABs  will find some time to read the book in between their hectic journey rushing from one house to another.for their strategic meetings to lobby for the well-being of our rakyat.

Unfortunately or fortunately, depending on how you look at it, the launch of this book was postponed twice,on both occasions,  due to the untimely change in government. Today, with yet another  change in government, with a new Minister of Health  at the helm, 

• amidst a backdrop of escalating Covid infections and deaths  and
• with a public healthcare system  under unprecedented stress and expectations,
• we are proud to present to you "Malaysian Health Care Maladies and Remedies. .

This is a frank discourse on what have befallen on a health care  system which was previously touted as one of the best in the world.

The contributing authors are all experts in their own way having had their boots on the ground for decades . Only they can tell you the story as seen by the deliverers of health care  and the experience of those who depended on our system since Merdeka.

This book calls for much needed reforms and examines among others, important topics such

• patient safety and quality of care,
• the over-regulation of  the practice of medicine,
• the strangulation of our general practice which was cost-effectively looking after 60% of our outpatient load ,
• the escalating commercialisation of  business of medicine,
• the phenomenal over production of doctors and
• the perpetual inequity and inequality health care delivery in our nation.

There is the important  chapter devoted  to a radical proposal for Malaysian health care by Tan Sri Datuk Dr. Abu Bakar Suleiman, whose advice and guidance is not something to be dismissed.

It is clear that we must learn the hard lessons from this  COVID-19 crisis i.e. that the old way of doing things must change. The BM word for this is UBAH. We hear this word being whispered from the jungles in Malaysia Borneo all the way to the padi fields in the Mudah Valley, Kedah.

It is time to end the previous top-down approach in enacting  legislations and policies related to health. Something must be seriously wrong if after more than a year, the simple act of going to work so that your can earn money to feed your family can be  a crime. Surely all this emphasis on the issue of criminality, fear of incarceration and stigma attached to the disease will not be helpful in mobilising the positive public opinion that we need to win this war.

It must be so, in order for us to be ranked today as the last out of a list of more than 50 nations in Bloomberg’s Covid Resilience Score.

The disruption caused by this pandemic has revealed not only the strengths and resilience of our healthcare system but also its many gaps and weaknesses which are consequences of continuing with the attitude of “top-down” and  the "government-knows-best". This book have many stories that foretold this coming.

 So, what’s next?

For a start, we need a reformed mindset at all levels of government. 

There is urgency to rebuilt from our assets at ground zero, i.e. our unshakeable public and private primary care infra structure .This is one of our greatest asset.

This structure has remain intact throughout this crisis but has been moving along seperately at its own pace and direction.
For a good part of the on-going COVID defense, there was little  attempt to synergise these two assets efficiently  which logically is our key fighting force in disaster response.

It is time to immediately implement more private-public partnership initiatives in primary care so as  to harvest the best from both components of our healthcare system.

On a broader perspective is the call for a Royal Commission on Health, eloquently aurgued by contributing author and one of today’s panellist, Datuk Dr. Yeoh Poh Hong, which is now even more urgent  given what we have seen and experienced over the past 18 months .The  silo approach to health care  reforms have resulted in the left hand not knowing what the right hand is doing.

We cannot continue to  pay  lip service only  to well meaning  input  from  patient groups, health care professionals, NGOs and other stakeholders who ultimately would be directly impacted by such measures.

What is needed are reforms based on what the rakyat needs and not what is dictated by the big boys in the business of medicine and political exigencies.

It is also time to de-commercialise the delivery of  healthcare , do away with the many and costly middle – men that have appeared in every nook and corner since the policy of privatisation 30 years ago. The remarkable turn around made by some of these companies during this time of widespread human suffering is a testimony that the pandemic may death for many but can be a gold mine for some.

There is indeed lots of whispering in the grape vine especially among the more poetically-inclined taxpayers, that privatisation and piratisation not only rhyme but sometimes eventually end up meaning the same as well.

There is no reason for the professionals in the frontline and the rakyat  to keep silent on problems affecting our personal health and lives out of a misplaced sense of gratitude. Hence the reason for this book.

Public health care is not free.It  is not paid by the people we elected. It is paid by taxpayers.

Being complacent threatens the continued wellbeing of the people. So, we have every right to demand the best quality care from the government.

In ending, I would like to thank GalenCentre, Azrul and the organising team for their management of this event.

I would like to acknowledge our co-editor Dr Milton Lum who will be expressing his views in the forum afterwards,

TanSri Munir Majid for your timely pre-print review of our book, our other two esteemed forum panellist Tan Sri Bakar, Datuk Dr. Yeoh Poh Hong all our contributing authors, members of the FPMPAM Council and all our sister societies for their unaminous support and the legal advice from the team led by Mssrs. Lee & Philip Koh.

I would specially acknowledge and express our appreciation to all our MPs, ADUNs,ex-Ministers and senior government officers present at this event.

Thank you also to all members of the media and all the participants in today’s event.

I specially acknowledge the presence and attention of YAB...... Congratulations to your appointment as Minister of Health Malaysia. We,  in the private sector look forward to working together with you.

Thank you.

Dr. Steven Chow
President FPMPAM.

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