Editor’s note: This is a continuation of a three-part letter on the writer’s reasons for the current state of Malaysia’s healthcare.
Read Part 1 here and Part 3 here.
FAILURE to deal with social determinants of health (Inverse Care law)
It is important to recognise that a major failure in health delivery is the “social determinants of health”.
Families that are poor, disadvantaged, marginalised or have poor access to healthcare are the ones where the children have the highest mortality and morbidity. This is often called the “Inverse Care Law”.
Most of our services, resources and manpower are concentrated in selected urban locations and better reach the middle- and upper-income segments of our population.
Because we do not show disaggregated data – i.e. data broken down by detailed sub-categories like indigenous groups, inner-city children in slums, poor rural communities, marginalised groups and level of income – we suggest our national mortality rates are reasonable.
We can get a glimpse of the real rates using under-five mortality data on indigenous children as a proxy.
The age-specific mortality rate by ethnic group for Peninsular Malaysia indigenous children (Orang Asli) is 11 times that of major ethnic groups, while the mortality rate for indigenous ethnic groups in Sabah and Sarawak is 1.7 times that of the major ethnic groups (Malay, Chinese and Indian).
I often describe Malaysia as a developing nation with pockets of Sudan (severe unresolved poverty).
Resources and health services are disproportionately allocated to urban communities at the expense of rural and indigenous communities.
Healthcare for documented and undocumented migrants, the stateless, refugees and those in detention is often very poor.
Failure to provide personalised care
One major, persistent weakness in the Ministry of Health’s (MOH) healthcare delivery system is the near-absence of personalised care.
Every time a person with a chronic illness goes to the hospital, they see a different doctor – one who does not know their problem well, despite some case records.
This is extremely frustrating to our community and undermines the fundamental element of healthcare, which is a therapeutic relationship between the patient and the healthcare professional.
This is one major reason many choose to see a private specialist.
Very Important Persons (VIPs) and people with wealth, of course, often circumvent this in MOH.
The elephants in the room
Often in discussing reform, we do not address fundamental problems in our society – i.e. the “elephants in the room”.
One concern is the tsunami of poorly-trained medical undergraduates and the poor experience that house officers obtain due to their huge numbers.
This has resulted in a crisis at the health centre and district hospital level. Medical errors and incompetency have risen.
This needs to be addressed with concerted action.
Secondly, any reform needs to address the large impact of institutionalised corruption and corrupt practices on the healthcare system in terms of spending and development.
Any new system may also be open to becoming corrupt.
Thirdly, we have neglected the ethnic problem in our civil service. We are moving towards a near-mono-ethnic civil service, including in the MOH (both in staffing and leadership).
People who are not from the Malay ethnic group see little hope in the civil service in terms of growth, promotion, leadership, etc.
Meritocracy is lacking and this damages the use of the best person for the job and a hemorrhage of many health professionals into the private sector and overseas. – July 25, 2022
Datuk Dr Amar-Singh HSS is a consultant paediatrician.
The views expressed are solely of the author and do not necessarily reflect those of Focus Malaysia.
