The call to “future-proof Malaysian healthcare” was announced by Health Minister, Khairy Jamaluddin, through the tabling of a Health White Paper to the parliament. The brief would be developed to address the globalising and systemic challenges faced by the healthcare industry, and to secure a strong commitment among the public and private sectors towards delivering outcomes that reflect a healthier nation.
The Paper, while broad and ambitious, is still underway – having only recently elected the Advisory Council assigned to oversee the progression of the brief. There is a strong expectation that it would be tabled within this year.
In the meantime, this article will explore the challenges and factors contributing to the regression of achieving health in Malaysia, and the transformation required to effectively reform the healthcare system as a whole.
Reshifting the Focus of Health Services
In his piece to the FMT, Dr. Amar-Singh debated the boom in tertiary-level specialised services as a reflection of a model that prioritises the treatment of disease over public health and preventive medicine. “We no longer run a Ministry of Health (MOH) but a Ministry of Disease (MOD); an institutionalisation of medicine,” he writes. The initial success of achieving antenatal and child health in the 1970s an 1980s was neither sustained nor extended towards the urban setting.
The focus of care has, since, shifted towards one of disease and not of health.
Described as “illness-focused, expensive, fragmented, and institutional-based”, the model of treating disease first is widely inappropriate and not applicable to meet the health needs of the wider population. It has nurtured an addiction to curative services, where the dependency on drugs and procedures outweigh the concept of prevention.
It is, therefore, more pressing than ever that the White Paper invest in training of healthcare professionals to encourage a “wellness” or “illness” service, that looks at long-term prevention for not only the patient, but their families, as well. It should also look at encouraging more participation and service in the community to strengthen their interactions with health professionals on a regular basis.
“We no longer run a Ministry of Health (MOH) but a Ministry of Disease (MOD); an institutionalisation of medicine,”
To treat disease first is even more prominent in the private sector, where the Non-Communicable Disease (NCD) epidemic has driven tremendous profit for the health industry. This has contributed to the commercialisation of healthcare, which leads to a stronger distrust among communities. The conflict of interest arises when the government pursues collaborations with private sectors. As there is little to no major incentive to promote preventive health, big business from the private sector could be in subtle opposition to the preventive approach.
Addressing the Social Determinants of Health
The inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. When applied, the principle observes the failure of health delivery in Malaysia in relation to the social profile of a community. The country’s most poor and marginalised have the highest child mortality and morbidity rate, which, in contrast to published data by the government, could suggest otherwise.
This data, on one hand, is painted with a broad brush, and is unable to identify the social determinants (eg. urban or rural neighbourhoods, and levels of income) to properly suggest that the national mortality rates are “reasonable”. The numbers for indigenous children in Peninsular Malaysia and ethnic groups in Sabah and Sarawak, for example, are far from what the national data proclaims.
As resources become more disproportionate in allocation and spending, the communities based in non-urban regions are left empty. The access of health for the undocumented and detained are even poorer.
Hence, in the bid to develop progressive healthcare standards, the White Paper must be able to table solutions that are delivered to everyone, and not just for a portion. This starts with developing a database that accommodates disaggregated data, that is broken down by detailed sub-categories (i.e. indigenous, marginalised groups, ethnicity, level of income, gender, geographical regions).
In addition to this, Dr. Amar-Singh further suggests that the new system would also need compulsory death registrations and mandated medical certification of deaths by law.
The Need for Personalised Care
The absence of a family doctor concept where health services are comprehensive, continuous, and personal has frustrated the process of seeking care. This is observed especially when a patients admits themself into the hospital, and despite having gone through their records previously, they’re attended by another doctor who starts mangement plan all over again.
For Doctors on Ground (DnG), this has happened too many times in our referrals to government hospitals. Our patients, while treated in their homes by one doctor for the entire period of our service, is instead, passed on between different physicians when they’re admitted in the hospital.
In the case of Ramzan Bi, the hospital’s medical team had disregarded her complete profile documenting her illness and treatment history, and instead, sent her off for exploratory surgery.
The Virus Within
The overflow of poorly-trained medical graduates and low-quality training in house officers has resulted in an increase in incompetency and errors during clinical practice. As it comes with reform at the central and district levels, the fundamental problem of correcting institutional matters like these, similar to the issues of mass corruption and a lack of meritocracy in hiring a multiethnic civil body, is damaging to the wider pursuit of a better healthcare system.