Health

Barriers to public healthcare at affordable rates for non-citizen children

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Bina Ramanand

Association of Family Support and Welfare Selangor and KL (Family Frontiers)

3i Health

Review and reform healthcare policies concerning children with either parent Malaysian to:
1. Allow all children (up to the age of 18) with either parent Malaysian to access public healthcare at the same rate as Malaysians, upon provision of the Malaysian parent’s IC. This includes children born overseas to Malaysians who may not hold a Malaysian Birth Certificate.
2. Ensure non-citizen children participating in the national school system are included in school-related health programs, including dental check-ups and other initiatives led by the Ministry of Health (MoH).
3. Grant vaccinations and immunisation programmes free-of-charge to non-citizen children and maternal care for their mothers.
Apart from the above recommendations concerning non-citizen children born to a Malaysian parent with valid documents, healthcare policies concerning undocumented or stateless, and adopted children should be reviewed and amended to allow:
1. Access to public healthcare services for undocumented or stateless children at the same rate as Malaysians.
2. All adopted children of a Malaysian parent to access public healthcare services at the same rate as Malaysians, upon provision of the parent(s) IC.

Equity in health care funding

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Jeyakumar Devaraj

Parti Sosialis Malaysia / Peoples Health Forum

3i Health

Reject Health Financing Schemes that rely on contributions by the general public either through an EPF like mandatory contribution or a mandatory health insurance scheme.

The nation should focus more on how we can increase tax income from taxing corporations and the richest sections of society. This might have to be done in conjunction with other countries in international networks like ASEAN, Group of 77, UNCTAD and the UN.

Establish a public health services commission

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Chee Heng Leng

Citizens' Health Initiative/Peoples' Health Forum

3i Health

Set up a separate Public Health Services Commission (PHSC) that can (i) offer public health services personnel better remuneration, terms of employment and benefits, transparent criteria and processes for upskilling, promotions, and career prospects, and (ii) attend to the dissatisfaction driving loss of senior experienced staff. For example, for medical doctors and specialists, a current dissatisfaction is with the ad-hoc and non-transparent nature of the promotion system. Therefore, the PHSC may set up a transparent promotional system, with fixed periods for promotional exercises and clear criteria prioritisation for promotion. Another example is that currently, doctors cannot be promoted unless they undertake administrative posts. The PHSC may then set up a career structure to enable doctors to remain in general clinical service even as they are promoted. The PHSC can also incentivise doctors to remain in public service, by allowing official time-off to subspecialise, research and publish, teach, and attend conferences.

Give priority and invest more than 4% GDP on health budget

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Lim Chee Han

Agora Society Malaysia/ People's Health Forum

3i Health

Budget allocation should always look to strengthen the public health sector, address the short term needs as well as planning for long term.
Given the current pandemic exposed the shortcomings of the public health system and its capacity, the government should immediately elevate the budget allocation for MOH substantially (other than the COVID-19 fund), and aim to achieve 4% of GDP worth of public health expenditure within 5 years. That means the government should increase the MOH budget allocation by about RM10bil in addition per year for 5 years in a row

Lessons Learnt for Pandemic Preparedness in Malaysia

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Chan Chee Khoon

People's Health Forum

3i Health

• in coping with pandemics, MKN’s security and policing mindset should be replaced by a public health-led approach which seeks a balance between disease control, and economic and social wellbeing in often fluid circumstances. Coordinated responses on multiple fronts - health, economic, financial, essential goods & services, public order & security, social support – are key elements.
• Malaysia is reaping the consequences of decades of corrupt mismanagement of the ‘supply chain’ for foreign labor, viz. a persistently large pool of undocumented migrant workers who have strong incentives to avoid contact with government agencies. This is a deep-rooted problem which requires a separate submission to do it justice. Inaction on this front will repeat our costly experience in future pandemics.
• public/private burden sharing in pandemic response (a separate submission likewise needed to map out respective roles in various contingent scenarios)
• local manufacture of vaccines: Pharmaniaga’s RM 3 million investment for fill-and-finish of CoronaVac is a first step, but local capabilities in research and product development need to be strengthened. Offers by Cuba, Russia, and China for collaboration and JVs to position Malaysia as an Asean manufacturing and distribution platform for vaccines and essential medicines, should be pursued and expanded (bilaterally, and potentially within a BRICS context).

Migrant Health Care

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Sharuna Verghis

Health Equity Initiatives

3i Health

1. Migrants should be entitled to the same medical benefits that Malaysian citizens in the public health system.
2. Mandatory testing and deportation of migrant workers for infectious diseases should be replaced by universal approaches to testing and treatment.
3. Abolish the 2001 Bil (1)dlm.KKM/62/BPKK(AM)/Pel-22-Garispanduan melaporkan pendatang tanpa izin yang mendapatkan perkhidmatan kesihatan di hospital dan klinik kesihatan and institute firewalls delinking immigration enforcement actions from delivery of health care.
4. Abolish the five day medication policy.
5. Institute reform in detention health care services including standard setting, monitoring progress in disease prevalence and deaths, and establish a specific mechanism of accountability at a higher level where both Immigration and the Ministry of Health are reporting on indicators w.r.t. health care access, disease prevalence, deaths in detention centres. Prioritize alternatives to detention and stop the detention of children.
6. Collaborate with civil society organizations (CSOs) and community based organizations (CBOs) to expand access to health care for migrants by setting up translation services and incorporating cultural safety in health services at government hospitals. Involve CSOs and CBOs in screening, contact tracing, and health education activities for migrants.
7. Make accessible disaggregated data on migrant health in the country.

Moratorium on New Private Hospitals

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Jeyakumar Devaraj

Parti Sosialis Malaysia / Peoples Health Forum

3i Health

A temporary moratorium on the building of new private hospitals,. This should also include a ban on the expansion of beds in existing private hospitals.

This proposal has to be paired with another proposal that the government builds more public hospitals to address the over-crowding prevalent in the government hospitals.

Need more government hospitals in the urban area

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Lim Chee Han

Agora Society Malaysia/ People's Health Forum

3i Health

The government should commit into constructing substantially more hospitals or expanding the existing ones in the urban area which experience great healthcare demand. A good indicator would be the hospital bed occupancy rate, for those who have reached 80% and above. Given hospital construction will take time (3-5 years to complete), planning further ahead and allocation of matching fund from the developmental budget for MOH are instrumental. Therefore, significant increase of MOH budget is expected to build up the public healthcare capacity.

Perils of Stateless person access to Healthcare

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Maalini Ramalo

DHRRA Malaysia

3i Health

Healthcare for stateless persons should be half the rate of foreigner rate as offered to UNHCR Card holders. Besides the overall treatment charge, children immunisation programme, and maternal and child health follow-ups should be provided by the state free of charge as basic healthcare for the residents, without the discrimination of papers -- the government just needs to find ways to overcome the technical barriers in the administrative matters

Strengthen primary care by implementing Family Doctor system

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Lim Chee Han

Agora Society Malaysia/ People's Health Forum

3i Health

MOH should set up and implement family doctor policy and system to provide continuity of care, help do health screening and regular check up (ie. annually) and so to offer timely health advice to their patients, intervene before the case goes worse. Currently 70% GPs are in the private sector, and significant portion of them signed up the ProtectHealth PeKaB40 programme. For the family doctor programme to work, MOH has to integrate public and private sector and pay the enrolling GPs per capita they put under their care annually.
Therefore, the government should increase budget allocation for Public Health programme, where primary care is concerned. Health promotion and preventive care can work best if primary care is proactive and provide continuity.

Strengthen primary health care by connecting private and public sectors

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Chee Heng Leng

Citizens' Health Initiative/ People's Health Forum

3i Health

Improve primary health care in both private and public sectors, and strengthen the connection between them. Incorporate the general practitioners into the public health care service, and provide tax incentives for those who serve in rural areas. This can be done, for example, by a system in which the MOH contracts with GPs under a capitation payment system that covers a certain number of patients over a particular period of time. The capitation system offers to GPs ‘guaranteed patients’, and has an inbuilt mechanism to incentivise doctors to keep their patients healthy and does not incentivise them to over-medicate. Bonuses can be given to doctors to encourage regular medical screening for preventive health for their patients. Patients who now cannot afford to go to private GPs and who are overloading the government hospital out-patient clinics will be given medical care free at the point of service, in exchange for ‘tying’ themselves to a doctor or a group practice. There is scientific evidence that continuity of care provided by seeing the same doctor is beneficial for patients. This is a more holistic system that will include chronic disease management (follow up treatment, regular medication, blood tests and other tests, for example, eye test for diabetic retinopathy).

Strengthen public health services

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Chee Heng Leng

Citizens' Health Initiative/People's Health Forum

3i Health

Expand public health service capacity by recruiting more staff to ease work load and improve working conditions. While the long-term solution will require structural changes, there is much that can be done as an immediate response to the crisis situation. The first step towards this is to increase public health care staffing, i.e. nurses, doctors, specialists, allied health personnel. More staff are needed at primary, hospital, and specialist levels to be deployed in primary health clinics, district hospitals, and general hospitals. Since public health care personnel are covered by the JPA’s directive to trim civil servant numbers by 1 per cent, new appointments could only be carried out on a rotating basis. An appeal was made by the MOH to the JPA in 2019 for an exemption from the stipulation of the Human Resources Optimisation Policy. This should be implemented immediately so that additional posts can be added to overcome the shortage of health care workers, and to stop the deterioration of quality in public health service delivery. With more staff, workloads will decrease, and improvements can be put into place, such as continuing training and education for existing staff. This will start the virtuous cycle of improving working conditions for staff in public hospitals.