Health reforms must survive political transitions - Health system specialist

Dr Khor Swee Kheng said the COVID-19 pandemic has highlighted some unfixed gaps and magnified inefficiencies in the country’s health system, accelerating the need for health reforms.

He pushed the idea of a health reform act and a Parliamentary Select Committee accountable to Parliament, that survives political transition, pandemics and changes in administration as well as the urgency for it, pointing out that health reforms in other countries have traditionally taken 10 to 20 years.

"And Malaysia, if we continue, shall we say, the political trajectory, we could be experiencing a period of instability; and we cannot let it impact reforms in the health system.

"Therefore, we need an institution that survives any political transition because health must be appropriately depoliticised," he said during a webinar titled "Build Back Better: Constructing Our Post-COVID-19 Future” organised by Research For Social Advancement Bhd (REFSA).

Touching on the social safety net (SSN), Dr Khor, who is also a physician, said specifically in Malaysia, the concept of social determinants of health (SDOH) is much more important than building hospitals, medicines, vaccines and surgeries.

"Assuming that I had an extra billion ringgit to spend, I would spend it on SDOH such as for education, proper employment rights and duties for the employers to take care of the people in the gig economy -- for example, improving gender equality, water and air quality," he said.

He said SDOH actually contribute to as much as 60-80 per cent of a person's health status.

Noting that some of the webinar participants were from the United Nations Development Programme (UNDP) and Employees Provident Fund (EPF), Dr Khor said the two organisations have an important role because the SSN for Malaysia is crucial during a pandemic.

“For example, we see the people going to pawn shops yesterday, meaning they are running out of money. So if essential healthcare workers -- nurses, cleaners in hospitals, for example -- are considered essential workers during a pandemic, I put it to you, they should also be considered essential workers during non-pandemic periods,” he said.

In this regard, he said the social contract between Malaysians will have to be re-written.

“It has to be re-written so that there are enough duties of the rich to the poor, employers to employees, the people who have versus those who do not have.

“The social contract in Malaysia has not been re-written for several years or even decades, and COVID-19 is forcing us to wake up to the need for the re-writing of our social contract, also to buttress the SSN that we have,” he stressed.

Meanwhile, Maria Castillo Fernandez, Head of Delegation of the European Union (EU) to Malaysia, said the COVID-19 crisis is leading countries around the globe to rebuild the human nation together, in greater collaboration.

However, this does not mean changes have to be taken in entirety, but it is more on accelerating the dynamics and trends, for example strengthening the health security and healthcare system, she said.

"We need to create and share resources like how can we produce vaccines, give better treatments and testings. All stakeholders including the government must participate in this endeavour and accelerate the effort in solidarity," Fernandez said.

She said although global collaboration is needed in scientific terms, countries may need, for example, to also strengthen the supply chain that was broken during the pandemic and have a closer centralised centre to protect the needs of their citizens.

"Nevertheless, open trade between countries is important to stabilise the economic framework for the economic recovery," she said.

Echoing that, UNDP Resident Representative for Malaysia, Singapore and Brunei, Niloy Banarjee, said COVID-19 has created the opportunity to rethink the development pathway to one which is more sustainable and inclusive.

Citing examples of China's extension of subsidies and tax exemptions for energy-efficient vehicles and the United Kingdom increasing taxes paid by owners of large utility vehicles and adding incentives for electric cars, he said Malaysia would need to invent its own module.

In transitioning into a greener economy and creating jobs, he said, Malaysia could invest in sustainable energy infrastructure including solar and biomass.

Businesses could also harness business model disruptions due to COVID-19 namely in telecommuting, local supply chains, e-commerce and digitalisation to reduce emission from transportation.

Niloy also suggested that if the government could do a programme or e-governance to bring a cohort of highly educated women into the workforce through those channels, it could contribute to building back a better country, while enabling them (the women) to take care of their children.

"Besides, there is also room into tax regimes as only about 15 per cent of the population is paying income tax.

"There should be an adjustment in corporate taxation and restructuring of the tax regime. But this requires political will and bold decisions need to come into play as transitioning would need money and investments," he added.