The reforms of the national health system recently proposed by Health Minister Khairy Jamaluddin are commendable. The shift in focus to primary health care, the promotion of wellbeing and the need for decentralization, optimal collaboration between authorities and the provision of quality care to all (including marginalized groups) provides an excellent opportunity to fill the many gaps in Sarawak’s current health care system to close system.
The Sarawak Civil Society Organizations – Sustainable Development Goals (CSO-SDG) Alliance Health Cluster welcomes the opportunity to contribute to the Health White Paper. Our top five recommendations are as follows:
Decentralization to facilitate the development of effective primary health care
In order to move forward, decentralization to the state level with the necessary resources and structures has top priority.
The state must then further decentralize to allow primary care clinics to serve as living centers of health and social care, serving the needs of different communities by working in partnership with them, community health promoters and other relevant agencies, including adequately funded NGOs . governmental organizations (NGOs).
A well-funded, well-planned structure will rejuvenate primary health care in Sarawak, promoting well-being and facilitating collaboration, resulting in more user-friendly, effective and efficient community health services, with the potential to reach people in their own homes.
The framework for decentralization should allow for both vertical and horizontal integration of health services to enable effective communication and planning with hospitals and the various primary health care providers.
This will enable the most appropriate service to be provided at the most appropriate time and facilitate a seamless transition of supply for consumers. Because transportation costs and staff training are critical to providing accessible, quality services in Sarawak, these crucial funds must be protected through earmarking.
Transparent data on how to deal with inequalities and resource allocation
Data on needs, access to health care, expenses and resource allocation must be collected and published in a timely and accurate manner.
The multiple dimensions of poverty measurement should capture all needs and groups, including people in remote areas who are not included in the National Household Income and Basic Services Survey and those awaiting citizenship status.
Measures should be taken to ensure alignment of health service delivery so that no one is left behind.
Governance should be representative and broadly based
Both the proposed Commission on Health Care Reform and the Advisory Board for the White Paper must have a balanced representation of Peninsular and East Malaysia and key stakeholders, including consumers and practitioners with lived experience.
They should commit to establishing and maintaining transparent systems to allow public oversight of whether the service is reaching the marginalized and providing quality universal healthcare.
At all levels of planning, decision-making and service delivery, pathways should be established for consultation with people with lived experience of physical and mental health problems.
Legislation should also be enacted to establish a health ombudsman so that there is an independent channel for handling patient complaints.
Use technology and enable access
The future of healthcare will involve the creative, effective use of technology both to share information and training, and to enable early intervention, treatment and specialist support in remote locations.
There is an urgent need for Sarawak to provide essential infrastructure throughout the state. Being able to get a reliable internet signal is not a fair measure of internet accessibility.
As school closures during the Covid-19 pandemic have revealed, many can send text messages but cannot download data, while others have no internet access at all.
By 2030, the aim should be to offer telemedicine services to all rural clinics and to disseminate the latest technologies (e.g. cervical cancer and breast cancer screening) that enable early detection of diseases even in remote areas.
National political decisions, e.g. B. the “accept only online payments” for services of the Ministry of Health, can make them difficult to access and use in already underserved areas.
Approach health holistically
1. Mental Health
Since 1990, mental illness has been recognized as a leading cause of disability in Malaysia. The pandemic has increased the incidence of mental health problems. More resources are needed to bridge the existing gap between physical and mental health services, with a focus on mental health promotion and upstream preventive interventions
2. Palliative care at the end of life and home care
Malaysia is an aging society. The development of home care and the extension of palliative care services to rural communities will help ease the pressure on hospital beds.
3. Caregiver care
Another gap is the lack of support for carers of older people, people with chronic physical and/or mental illnesses, terminal illnesses or disabilities – including children with special needs. Psychosocial and financial support are needed, as well as services to help share the stress of caring.
4. Early intervention for families with children with special needs
There needs to be an emphasis on early detection and diagnosis, which then leads to accessible and quality early intervention programs and inclusive education.
5. Youth Health
Adolescent health is often neglected. Adopting strategies for their healthy development and mental well-being will have lifelong positive effects. Adolescents need access to empathetic, non-judgmental health information and treatment, including mental and sexual reproductive health.
Wider accessibility and life skills training could reduce the development of serious mental health problems in adulthood, suicide and sexually transmitted diseases, including HIV.
6. Access to health care for stateless persons and foreign workers
This was omitted from the original proposal. A country cannot be healthy and productive unless everyone has affordable access. This is necessary for humanitarian and practical health reasons.
Vaccination was extended to everyone during the Covid-19 pandemic, recognizing that unless everyone is safe, no one would be safe. Sarawak has many people who have been denied citizenship despite having lived in the state all their lives.
Denying them health care and access to education is not in line with United Nations human rights conventions. For the same reasons, while foreign workers are now covered by life and health insurance, their living and working environments should be monitored.
7. Addressing social determinants of health
Social determinants of health are highlighted in the proposals, but no attention is paid to collaborative structures that allow all ministries to harmonize their efforts.
The health of a nation is determined by the following factors:
- 20 percent through access to quality health services.
- 30 percent promoted healthy behaviors through public acceptance.
- 10 percent through the built environment.
- 40 percent from socio-economic factors such as poverty eradication, income security, quality education, decent housing, and family and community support.
Investing in health means investing in all of these areas. While Sarawak ranks third in terms of gross domestic product after Selangor and the federal territories, it is the third poorest state as measured by the 2020 Household Income Estimate and Poverty Incidence Report, and has an acute shortage of health workers and many rundown clinics and hospitals Schools. That needs to change.
The Sarawak CSO-SDG Alliance Health Cluster is calling for bipartisan support from Sarawak politicians to ensure the health care reform white paper meets the needs of everyone living in the state.
This is a unique opportunity to fundamentally transform healthcare and create sustainable structures that advance the SDG agenda by delivering quality, universal healthcare (both geographically and financially), reducing inequalities and addressing the breadth of defining social determinants the health of a country.
The declaration was endorsed by the following affiliates:
- Kuching friends
- Kuching Parkinson Society
- Mental Health Association of Sarawak (MHAS)
- National Cancer Society of Malaysia Sarawak Branch (NCSMSB)
- Organization for Addiction Prevention and Rehabilitation (OAPTAR)
- Pink and Teal EmpowerHer (Persatuan Kesedaran Kanser Wanita)
- Sarawak AIDS Concern (SAC)
- Sarawak Women for Women Society (SWWS)
- Society for Cancer Advocacy and Awareness Kuching (SCAN)
- This is the personal opinion of the author or publication and does not necessarily represent the views of code blue.