Don’t just fight disease, create health

 

Complaints about overcrowding and overwork at government hospitals have resurfaced.

One report described overcrowding at a particular hospital as being “like a scene from a post-apocalyptic movie: patients holding on to their own IV bags, in pain from their illness or wounds, some standing while others sit on the hard hospital floor”.

The report shared the comments of Azimah Abdullah Zawawi, in a Facebook post on Jan 17, over the treatment her son received at Hospital Pasir Mas in Kelantan following an accident. She claimed the doctor refused to ward him – despite his condition – because there were no free beds in the hospital.

The group championing the rights of contract doctors, @HKontrak (HartalDoktorKontrak) has also been clamouring for action, pointing to the fully occupied beds and packed emergency departments at hospitals and the shortage of doctors.

On Feb 2, The Star quoted some doctors as saying the emergency departments of some public hospitals were bursting at the seams and that the wait for beds could stretch to two days or more.

The Galen Centre for Health and Social Policy recently proposed that Putrajaya form a multi-sector task force to come up with long-term solutions to resolve the issue and, in the meantime, to recruit healthcare workers from abroad.

“Our healthcare professionals including doctors, specialists, nurses and medical assistants, are underpaid, overworked, overstretched, and working in facilities which are increasingly congested with patients.

“They are facing extremely difficult workplace conditions, some of which are at breaking point,” FMT reported Galen CEO Azrul Khalib as saying.

One reason for the overcrowding is that the number of beds in hospitals has only increased slightly over the years. As at the end of 2021, there were a total of 135 public hospitals with 39,263 beds and 11 special medical institutions with 5,586 beds. In 2009, there were 130 public hospitals with 33,083 beds and six special medical institutions with 4,974 beds.

It is no wonder that we face a bed shortage. What were the planners doing? Didn’t they know that the population would continue to rise and with it an increase in people needing medical treatment, especially given what everyone says is a largely unhealthy modern lifestyle? Perhaps the question should be: how were the allocations utilised and how much leakage was there?

I am not surprised that the problem of overcrowding remains unresolved. Neither am I surprised that the complaints of doctors and nurses being overworked persists.

How can you resolve such issues when you have a wrong focus?

Our healthcare system, as some have noted, is geared towards curing people; it is focused on treating illnesses. Malaysian healthcare is almost all about diagnosing, treating and managing diseases.

The name “ministry of health” is a misnomer. It is not about improving health.

Until and unless the focus shifts, complaints of overcrowding, overworked doctors, insufficient equipment, dispensing of wrong medicines, negligence of staff and such complaints will continue to increase or reappear much more frequently.

If health minister Dr Zaliha Mustafa wants to resolve the problems of workload and overcrowding, especially at emergency and trauma departments of hospitals, then she must shift focus and attach greater priority to creating health.

Government policy – not just the health ministry’s policy – should be geared towards creating a healthy society. She has to convince other ministries to include health creation as part of their policies.

She must impress on other ministers the importance of taking into consideration factors such as poverty, the environment and behaviour on health in planning and policy implementation.

For instance, the works, transport and local government development ministries must factor in the health impact of physical development projects on people and the workers involved in such projects. Their policies must also consider the impact on the wholesome health of the public and not just prioritise public convenience and costs.

For instance, she must convince other ministries about the need to have pedestrian and bicycle friendly environments; and for more open spaces and greens.

The government should focus on primary healthcare, which includes poverty alleviation and sound education apart from the provision of proper healthcare facilities and equitable distribution of such facilities so that everyone has access to them.

So, the government needs to implement more effective poverty eradication plans and programmes.

When people are healthy, they will be more productive personally and in their jobs. This means, not just a sense of self-fulfilment, but also a rise in national productivity. A healthy economy can be expected to result from a healthy population.

It will also mean less expenditure in fighting diseases. In 2020, the health ministry and World Health Organization noted that non-communicable diseases such as heart disease, diabetes and cancer cost Malaysia more than RM8.91 billion a year, or 0.65% of our gross domestic product. These are the diseases that can be reduced with better public health programmes and changes in lifestyle.

The government therefore needs to invest heavily in health creation. The money spent should not be seen as just expenditure but as an investment in a healthier future society.

It is the hope of many people, including those in the medical sector, that the government will increase the allocation for health in a new Budget 2023 which is to be tabled later this month in Parliament by the Anwar Ibrahim administration. A good part of this allocation should go towards creating health, not fighting diseases as at present.

The health ministry received an allocation of RM32.41 billion in Budget 2022, an increase of 1.5% from the RM31.94 billion allocated under Budget 2021. I’m sure we’ll see a bigger allocation this year, but let’s hope – despite the current economic situation – that it’s substantially higher. - FMT

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.