THE HEALTH | NOVEMBER-DECEMBER , 2021

Budget 2022 provides RM32.4 billion to the Ministry of Health ( MoH ) for their operating and development expenditure . The allocation for the MoH is the second largest after the Education Ministry .

However , there are concerns that there has barely been an increase in the health allocation compared to the allocation for 2021 as the increase of 1.5 per cent is arguably the lowest increment to the health budget in more than a decade . Note that Budget 2021 provided a four per cent increase versus 2020 , while Budget 2022 only provides a 1.5 per cent increase over 2021 . There have been decades of underinvestment in the healthcare system and an over investment to compensate for this to enable the public healthcare system to cope with amplified responsibilities without jeopardising the quality of care should have been considered . It gives the wrong impression that despite the major crisis that Malaysians endured over the past 22 months , the health needs and service delivery issues remain the same .

As we know , the war with the Covid-19 pandemic is not over yet . An additional RM4 billion is provided specifically to continue the agenda on managing Covid-19 , which includes RM2 billion to fund the vaccination programme .

Another RM2 billion will be provided to enhance the capacity of public health service facilities including the purchase of medicine , consumables , personal protective equipment ( PPE ) and health kits . The government has not forgotten kids that have been orphaned because of the pandemic . RM25 million is being allocated as a start-up fund towards Yayasan Keluarga Malaysia which is established under the Prime Minister ’ s office with the objective of protecting the welfare and education of those orphaned due to Covid-19 .

The need to consider specialised treatments

Further , to continue the fight against Covid-19 , the Government intends to procure antiviral drugs that are effective against various viruses including Covid-19 . As battling Covid-19 will likely extend well into 2022 due to immunological uncertainties and virus variants , we need tools that go beyond vaccination .

Specifically , early-stage prophylactic treatments such as antiviral medications to prevent disease progression for non-severe cases should be considered . Malaysia also needs to consider specialised treatments such as monoclonal antibodies ( mAbs ) for those at higher risk of getting severely ill .

New treatments are being constantly developed and this allocation would not be only for antiviral medications or mAbs – it may be swapped for other emerging interventions the MoH deems promising , safe and effective .

The National Covid-19 Immunisation Programme ( NIP ) will be further enhanced to provide the third dose of the Covid-19 vaccine as a booster shot to all adults and continue the vaccination of children aged 12 to 17 years old . The government has signed agreements to procure 88 million doses , equivalent to 140 per cent of Malaysia ’ s population , sufficient to provide a third dose to all residents aged 12 years old and above .

The contracts of more than 10,000 medical , dental and pharmaceutical officers have been extended by the government for a maximum of four years after their two-year

compulsory service period to ensure continuity of service and prepare them for their specialist training . In addition , the government will provide sponsorship for 94 specialist programmes with an allocation of RM100 million for the benefit of 3,000 medical and dental contract officers .

While allocating RM100 million for doctors , dentists , and pharmacists to pursue specialist training is welcome , it should be accompanied by an increase in permanent posts . This lack of long-term solutions may cause dissatisfaction among health care professionals , with the possibility of a second ‘ strike ’ by healthcare professionals looming .

Overall allocation for mental health lower

The pandemic exacerbated the problems of poverty , domestic violence and depression which are the root causes of mental health . It has been reported that the Malaysian Mental Health Association observed “ more than a two-fold increase ” in stress-related help requests since the start of pandemic .

Other issues such as depression , suicide , and domestic violence have also seen an increase . Budget 2022 will allocate RM70 million so that mental health issues are continuously prioritised , significantly boosting counselling and psychosocial support services ; increase advocacy programmes , and empowering nongovernmental organisations as drivers of mental health programmes .

Though mental health was highlighted prominently during the budget speech , the fact is that the overall allocation for this important area of healthcare of RM319.58 million is lower than the 2020 allocation of RM344 million .

The increase in mental health allocation is not proportional to the rise in mental health issues caused by Covid-19 stressors . It remains lower than upper-middle-income and high-income countries who spend 1.6 per cent and 3.8 per cent of government health expenditure on mental health respectively .

This sets a dangerous precedent and a backwards trajectory that may prevent us from building a robust public health infrastructure as imagined in the 12th Malaysia Plan and required by a larger , older and sicker population .

Budget 2022 proposes many temporary stop-gap measures that must be part of longer-term strategies . Firstly , while social provisions and cash transfer allocations for

BY HARVINDAR SINGH

Though mental health was highlighted prominently during the budget speech , the fact is that the overall allocation for this important area of healthcare of RM319.58 million is lower than the 2020 allocation of RM344 million .” older adults in Budget 2021 were necessary , there must be a change in philosophy to encourage older adults to have more active participation in their own health care .

Without active participation , even exponential increases in the social care budget for the elderly will create the reality or perception that older people are constantly dependent on support . Each month , the initiative to provide 130,000 young women from B40 families with hygiene products such as sanitary pads is remarkable . Still , there needs to be a greater focus on durable strategies for long-term sustainable health development .

Cigarette taxes should have been increased

Budget 2022 however , includes a significant increase in the allocations for public health of more than RM200 million , benefiting areas such as disease control , health education and promotion , and family health development . This is welcome news to cover non-communicable diseases ( NCDs ) such as cancer , kidney disease , and cardiovascular diseases .

This will bring benefits in the long run by improving the quality of patients ’ lives and saving lives . Public health is the most important aspect of the healthcare system and needs to be strengthened holistically as we cannot afford to look at one crisis at a time .

In so far as hospital bedding facilities are concerned , under the Rolling Plan 2 and the 12th Malaysia Plan , the construction of two hospitals , the Infectious Diseases Institute in Bandar Enstek in Negri Sembilan and the Kapar Hospital in Selangor will each boast a capacity of 300 beds respectively .

The government ’ s decision to expand the scope of income tax exemption for clinical check-ups to cover consultation costs of registered psychiatrists , clinical psychologists and counselling services is welcome as it will encourage the affected individuals to step forward and seek help .

The announcement that the government will consider imposing excise duties on e-liquids and juices used for vape and e-cigarettes is welcome . However , the duties should extend to include those that are nicotine and non-nicotine . Not increasing the cigarette taxes was a lost opportunity for increased revenue and funds that could be used to support prevention and treatment of non-communicable diseases .

The lessons from the Covid-19 pandemic allows us to rethink the structure and components of our health care system and lay the groundwork for long-term health reform with emphasis on telemedicine , automation and digitising health care . This requires smart regulations that protect patients , help health professionals , and promote innovation .

As we enter the third year of Covid-19 , Malaysia must not miss the opportunity to build a robust and resilient healthcare infrastructure . More Malaysians are poorer after Covid-19 , which makes them more likely to use public healthcare facilities , making it crucial for us to over-invest in our public healthcare system . — The Health

Harvindar Singh is Managing Partner , Harvey & Associates and Tax Partner , SCS Global Consulting ( M ) Sdn Bhd