Another Budget is approaching. I often wish the government could just fulfil all the requests and suggestions many of us have made and written about for all the past budgets.
Budget 2024’s allocation for healthcare was RM41.2bn – 10.5% of the total budget and the second highest after education. Although this looks large, it is not sufficient to support the growth we need in our ailing healthcare services.
For far too long, we have neglected our health services. Any small increment in the budget is swallowed up by the enormous needs and challenges our health services face.
One problem in underfunding our health services over the decades is that we have not adequately developed services for children and pregnant women while we now face the enormous burden of non-communicable diseases, psycho-social health issues, disabilities and elderly care.
And therein lies the rub, the quandary. We have limited resources, so where do we invest them? The needs and challenges are enormous.
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A critical request is that we consider two budgets for the Ministry of Health – the usual healthcare budget with annual increments, along with a large additional budget to fix our health service challenges.
We will need to provide this supplementary budget for several years. Some may say we lack funds for this. But we can stop funding some unnecessary areas and instead focus on health, education, welfare and economic areas.
If we do not do this, then we cannot expect our sickly health services to improve, let alone reach the inner-city poor, rural Sabah folk and the indigenous – all of whom now have limited healthcare access and services.
Decaying hospitals and equipment, some posing fire hazards, must not be overlooked either.
The supplementary budget is needed to meet urgent healthcare needs and develop appropriate services. The key, of course, is to invest in prevention and community services (I do not mean public health services but true services in the community).
We need to move ‘upstream’ to stop the enormous burden of disease that is developing downstream. Only then can we lighten the never-ending burden of physical diseases (the non-communicable diseases).
Some areas often get more funding because most of our clinicians are trained in disease rather than health. We no longer run a Ministry of Health but a ‘Ministry of Disease’. Hence, we focus on chronic illnesses and invest in dialysis and treating coronary disease, stroke, etc. These illnesses need attending to, but they are ever-growing and never-ending – unless we deal with prevention.
So the Budget needs to invest in and develop care in the community. This is the weakest link in our current healthcare services. We have not expanded the capacity of the community to better deal with their own health. Instead, we are addicted to a curative, specialist and drug-based illness system.
Community health services should be mobile (bus-based) rather than static (building-base) and they should be decentralised. They need to use adequate community health (nursing-based trained) and transdisciplinary workers. These workers should be trained in dealing with people with disabilities, older adults and those with adolescent-mental health issues. These community services also need to use civil society groups better.
The focus should be on empowering the community for self-care and training and supporting care partners.
Our urban, inner-city health services are poor; yet 75% of people in Malaysia live in urban settings.
Mobile health services will be able to reach out to the urban poor, people with disabilities, older adults, single mothers, pregnant women and young children.
I hope Budget 2025 will be a humane one focusing on the health, education, welfare and economic needs of the poor and middle class – the bottom 60% of households.
There are no health services without health personnel. But we have not supported our healthcare staff adequately by improving their pay, providing them more resources for their work, creating a meaningful work environment and reducing their workload.
The budget needs to tackle the staffing crisis, not just for doctors but also for nurses, pharmacists and other allied healthcare staff. We need to retain our healthcare professionals and provide clear pathways for their specialisation. We also need to deal with their widespread burnout because of a heavy workload. If we do not tackle these problems, we will continue to have a weakened health service.
Finally, as a paediatrician, I am appalled by the continued lack of investment in services for children. We do not really care for our children, no matter what we say.
The budget for paediatric services has shrunk relative to the total budget (1.5% of the total health budget in 2024 compared to 1.7% in 2023 and 2.2% in 2020).
Our intensive care service available for babies and children is one of the poorest in the region. This must stop. We cannot keep denying ill children the neonatal and paediatric intensive care beds they so desperately need. This is reflected in all our child mortality indicators that have been stagnant for over 20 years.
Many decades ago, I read an economic research article entitled “Jam Today vs Jam Tomorrow”. It argued that governments are more interested in “jam today”, which is curative health services, as these help to win elections. ‘Jam tomorrow’ – investing in prevention and the community – will take many years to bear fruit and hence is not politically expedient.
I hope Budget 2025 will reverse this trend for health. It does not matter if you do not win elections. What matters is investing in right and meaningful actions and sowing the seeds for a better tomorrow for our beloved nation.
Dato’ Dr Amar-Singh HSS is a consultant paediatrician and child-disability activist
AGENDA RAKYAT - Lima perkara utama
- Tegakkan maruah serta kualiti kehidupan rakyat
- Galakkan pembangunan saksama, lestari serta tangani krisis alam sekitar
- Raikan kerencaman dan keterangkuman
- Selamatkan demokrasi dan angkatkan keluhuran undang-undang
- Lawan rasuah dan kronisme
