From Amar-Singh HSS, Yuenwah San, Selva Kumar Sivapunniam, Wong Poai Hong, Musa Nordin, Hartini Zainudin and Sangeet Kaur Deo
Do we love our children?
This may seem an odd question to ask, but not if it is directed at the government and its ministries and agencies. It is being asked in view of the impending budget announcement in October.
Politicians and ministers often tell us how much they love our children. We hear from them, “Children are our future. We must invest in our children”, and similar rhetoric.
But, as the old proverb says, “the proof is in the pudding”. Or, as the original version goes, “the proof of the pudding is in the eating”.
This means that we can gauge all assurances about children by their actions: how much do they allocate as investment in our children’s learning, well-being, health and safety? How much are lawmakers fighting for bigger allocations for such measures?
Let us sample some of the “pudding” to taste the flavour of politicians’ love for our children.
First on the tasting menu: child health, the seed of the nation’s future.
The table below shows the health budgets and paediatric budgets in the health ministry for the past five years, compared with 10 years ago.
In 2023, the total budget assigned to the ministry was RM36,139,861,200, but the paediatric budget at only RM610,506,300 equalled 1.7% of the total health budget. This was a 10-year low, dropping away from 2% in 2013.
The amount actually allocated to paediatric care in MoH hospitals is a tiny morsel. It has, relative to the total health budget, been decreasing over time.
Someone in MoH may say that other MoH budget allocations are also used to meet children’s health needs. To this, we recommend a visit to paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) all over the country that are struggling for space, equipment, and nursing resources, unlike adult ICUs.
Every single day, the PICUs and NICUs have to search for beds for ill children and babies. We spend large sums on adults with chronic illnesses, but very little on these children who are “our nation’s future”. We need to triple PICU and NICU beds and resources, reinforced by health promotion for our children.
Alarmingly, the critical indicators for child health in 21st century Malaysia have stagnated. Deaths among newborns, infants, and children made no discernible progress for the past two decades.
One Malaysian child in every five children aged under five is stunted (21.8% in 2019). The number of underweight Malaysian children aged under five has increased from 12.4% (in 2015) to 14.1% (in 2019). Wasting among our children increased from 8% to 9.7% during this same period.
Our children whom we love are increasingly malnourished. This, in the long term, is significantly associated with lower IQ, reduced productivity, higher paradoxical risk of obesity with non-communicable diseases, and premature deaths. Eventually, if they survive, such childhood risks place our children at increased risk of dementia.
Second on the tasting menu: child protection.
A minister announced (Mampu study 2019) that we have one social worker to 8,576 Malaysians, with 3,814 social welfare department (JKM) personnel focused on social work.
The reality is that, among over 3,800 JKM personnel, there are very few trained social workers, with only a small number involved in child protection. The average JKM officer has a frightening case load of 50 to 100 child protection cases a year.
Child abuse is an epidemic, with most child victims missed until too late. The bare minimum we need to meet child protection services is 30,000 to 40,000 trained social workers in JKM.
With the current focus and level of initiative, what are the chances of reversing the epidemic? We have eight public institutions of higher learning and five private institutions producing small numbers of trained social workers each year. There is no major initiative to strengthen the JKM workforce and its professionalism with trained social workers.
Third on the tasting menu is a time-hardened, less palatable chunk of the pudding to swallow: how we treat refugee, stateless, and migrant children.
Actions thus far mock the Convention on the Rights of the Child that Malaysia ratified. If we treat some children very poorly, we damage all our children’s future as it undermines our psychosocial, spiritual and moral well-being.
Long overdue initiatives to transfer undocumented migrant children from immigration department detention centres to safe shelters are moving at a snail’s pace. Meanwhile, their health, education, and well-being continue to be neglected. In addition, there have been recent raids with the detention of even more children.
There is much more on the tasting menu to share. Each year, approximately 900 to 1,000 children die on our roads and another 500 drown.
Children with disabilities are being left further behind their peers in education facilities and services, with woefully inadequate inclusion and reasonable accommodation.
Due to a poverty of understanding, knowledge, skills training, surveillance, and good governance, there are instances of abuse and bullying of children with disabilities in service centres and residential institutions.
Poverty has worsened among children, especially in Sabah and inner-city areas. The consequences for female children of child marriage and teenage pregnancies make for an uneasy national conscience.
Disaggregated data show that deaths for Orang Asli children under five is 11 times that of major ethnic groups. Vaping is a huge and growing epidemic among our children and current policies have worsened it.
There is more of this tasting menu. The problems are chronic and worsening.
No government can fix all these problems in a single term.
And yet, this demands of everyone – across the political spectrum, the whole of government, of society, and of the entire nation – a fresh start to improve the situation of Malaysia’s children.
We hope Budget 2024 will give our children the resources that they deserve from those who can make a difference. If we do not invest in our children now, there can be no meaningful tomorrow for this nation. - FMT
Dr Amar-Singh HSS is a consultant paediatrician and adviser to the National Early Childhood Intervention Council (NECIC) and National Family Support Group for Children and People with Special Needs, Malaysia.
Yuenwah San is the honorary senior adviser (Disability Inclusion), Social Development Division, United Nations Economic and Social Commission for Asia and the Pacific (ESCAP).
Dr Selva Kumar Sivapunniam is a consultant paediatrician and president of the Malaysian Paediatric Association.
Wong Poai Hong is the executive director of the Childline Foundation.
Dr Musa Nordin is a consultant paediatrician and a former president of the Perinatal Society of Malaysia.
Dr Hartini Zainudin is a child’s rights activist and co-founder of Yayasan Chow Kit and also the vice-president of Voice of the Children.
Sangeet Kaur Deo is a lawyer and member of the Harapan Law Reform Group.
The views expressed are those of the writers and do not necessarily reflect those of MMKtT.
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