As we begin the new year, several issues and concerns will impact the lives of Malaysians
Many in the healthcare industry are looking to 2021 with trepidation. The Covid-19 pandemic has wreaked havoc in society, severely distorting the plans and businesses.
The number of positive cases has surpassed 200,000 and the nation’s healthcare system is at breaking point. A state of emergency has been declared throughout the country with the Movement Control Order (MCO) re-imposed.
Malaysians are wondering how the pandemic and other pressing issues facing the country will be resolved? The Healthspoke to several industry heads on the key issues this year and what can be done to address them.
The President of the Malaysian Pharmaceutical Society (MPS) Amrahi Buang said the focus in 2021 would still be on the pandemic. He wanted more transparency on the government’s purchase of the vaccines and questioned how safe they were.
He said managing the pandemic would affect management of other diseases, notably Non-Communicable Diseases (NCDs). Noting the country was embarking on the 12th Malaysian Plan, he said the country would lose out if there was not much government policy change.
“The budget for the Ministry of Health is glaringly insufficient to meet the demands of healthcare, and more patients will go to public healthcare facilities because of economic turmoil.
“Expect lapses in medicines supplies since Malaysia imports about 90 per cent of its medicines,” he said, adding that private healthcare sector will be affected because of the impact of travel and border controls.
Dr Noor Ani, Director of the Institute of Public Health (IPH) from the National Institutes of Health (NIH), added: “It is expected that mental health problems will be among the major healthcare issues in 2021.
“The problems are possibly exacerbated by the financial hardship due to the current economic situation.”
She said that other social-related health issues such as violence, excessive consumption of alcohol and drug abuse might also be on the rise in 2021.
Referring to the 2019 National Health and Morbidity Survey (NHMS) findings, NIH also expects a rise in diabetes and obesity in Malaysia.
“It is expected that these health issues will still be our major health problems in 2021, as peoples are more sedentary and possibly consumed more unhealthy diet during MCO.
“Tobacco use might be on the rise, too, as studies found more people rely on tobacco and nicotine to reduce stress and anxiety during this challenging time.”
Resolving major health problems
Malaysian Medical Association (MMA) President Prof Datuk Dr M. Subramaniam shared the sentiment the pandemic was expected to continue throughout the year and possibly through to 2022.
“People will also still have to continue with the SOPs as the vaccine is not a cure for Covid-19.”
He added depression was a significant concern as many were affected by the pandemic’s impact on businesses, jobs, income and family. Cases of depression and anxiety were already seeing an increase.
“There is also a worry that people have become more sedentary during the pandemic. This can lead to an increase in cases of NCDs in the country.”
Malaysian Wellness Society President Dr Rajbans Singh said the pandemic had shown the most vulnerable group was those with low immune symptoms. Such people are those with chronic diseases like hypertension, diabetes, kidney disease and even obesity (the Metabolic Syndrome) and those with cancer and the elderly.
“Even though the Covid-19 situation will eventually get better especially with the vaccine, another virus can always return, and I believe we really have to focus on educating and helping people overcome these chronic diseases with lifestyle changes and wellness programmes.
“Metabolic diseases are the biggest healthcare burdens in Malaysia and the rest of the world.”
Association of Private Hospitals of Malaysia (APHM) President Dr Kuljit Singh anticipates an increase of load in the public hospitals as more patients will return to hospitals once the fear of Covid-19 transmission dissipates.
He added: “We are not sure how many people, especially those who lost their jobs because of retrenchment or because of restructuring of their job description, would be able to afford some of the health packages that they have, particularly EPF. They too may have to resort to public hospitals.”
With fewer patients and no medical tourists coming in, Dr Kuljit expressed concern on private hospitals trying to stay afloat.
Prioritising health issues
In the past couple of months, private hospitals have not seen so many patients. So, their business would have been entirely down.
The budget for the Ministry of Health is glaringly insufficient to meet the demands of healthcare, and more patients will go to public healthcare facilities because of economic turmoil.
– Amrahi Buang
“There was also a bit of concern because private hospitals did not have medical tourists coming in during this pandemic period. So, there was a little bit of revenue drop.
“Most people may think private hospitals have lots of income. But actually, the income is not as much as people would think because we have a lot of expenditure to maintain and upgrade our hospitals and its standards.”
Organisation Development Advisor Jas Bhar called for higher standards for the healthcare industry in 2021. He said patients were now more aware of demanding excellent service due to healthcare’s rising cost. This has given way to healthcare consumerism, value-based care and most of all, patient experience requiring higher standards of service quality.
“This can then be translated to the adoption of international quality management standards such as the ISO 9001:2015. This can be geared towards the medical healthcare industry with inbuilt soft skills requirements covering time management, stress management, teamwork principles, communication methodology, listening and adaptability,” he said.
The Malaysian Association of Advancement of Functional & Interdisciplinary Medicine (MAAFIM) President Dr Vijaendran Subramaniam lamented that just not Malaysia, but the whole world seemed to be preoccupied with Covid-19.
He stressed the need to prioritise other health issues that were there before, predating the pandemic.
Noting that many of the vital resources have been directed towards Covid-19 patients, he said: “There are still more people dying of tuberculosis, malaria and probably road accidents and other conditions. These problems are still here and need to be addressed.”— The Health
7 main issues and concerns
1. VACCINES AND THE PANDEMIC
There is controversy surrounding the vaccines the government is buying. The main concern is how safe they are and the transparency in procuring it.
In November, the government announced it had inked a deal with pharmaceutical company Pfizer to obtain Covid-19 vaccines for 20 per cent of the Malaysian population in 2021. However, the pricing was not disclosed.
The preliminary purchasing agreement of 12.8 million doses is to immunise 6.4 million Malaysians. Pfizer will deliver one million doses in the first quarter of next year, followed by 1.7 million doses in the second quarter, 5.8 million in the third quarter and 4.3 million doses in the fourth quarter.
Malaysian Pharmaceutical Society (MPS) President Amrahi Buang stressed the vaccine must be of quality, safe and effective/efficacious.
“Post marketing or pharmacovigilance activity is a paramount issue to monitor the Adverse Effects Following Immunisation (AEFI). This must be observed and reported to the National Pharmaceutical Regulatory Agency (NPRA).”
He said pharmacists could play significant roles in logistics, educate doctors and nurses about the vaccines, and collect and report the AEFI. They can also play a highly active role in vaccine advocacy to inform the public. Trained and certified pharmacists can become vaccinators for Covid-19 vaccines.
On the issue of transparency, he said if the government went for direct negotiation with the manufacturers, the purchase contents must be made known to the public. For local distributors, they must be capable, reliable, and efficient.
He said the reported ill-effects of the vaccine in some countries was expected. This was because the Covid-19 virus was novel in nature. However, more is known now compared to the beginning of the year.
2. DIGITAL HEALTH
With no signs of the pandemic abating, we are likely to see digital health play a vital role in the healthcare sector in 2021. We will see a level of technology not previously seen before the pandemic.
For one, there will be an expansion of telemedicine in 2021. With people taking more precautions to avoid being infected, there has been a behavioural shift where patients are more receptive to virtual consultation and telemedicine.
Nevertheless, there is a need for a change in mindset and perception telemedicine to take off. Patients worry whether the diagnosis and treatment will be just as effective as face-to-face treatment. Meanwhile, doctors have to cope with digitisation and seamless connectively with patients.
Chief Medical Innovation Officer of Ainqa Health Dr Dhesi Baha Raja said digital health was the spine of today’s healthcare, adding healthcare was about accessibility and affordability.
“Accessibility can only be achieved through technology. People want seamless connectivity with their physicians.
“Seamless connectivity will save many lives since unnecessary tests can be reduced, and patients treated based on the availability of their health records at any given point of time.”
He noted the Ministry of Health (MoH) was working closely with the Malaysian Medical Council (MMC) to develop guidelines to support the ecosystem of virtual consultations. Dr Dhesi also highlighted it was important for the government to relook at the existing infrastructure and roadmaps.
“The agility to move from one technology to another should be considered when building a roadmap for a country. The technology has to be industry-agnostic,” he said.
3. SHORTAGE OF DOCTORS
Despite having increasing numbers of local and foreign graduated medical professionals annually, Malaysia is facing a shortage of doctors, particularly in specialist fields.
Since the introduction of the contract system in Dec 2016, doctors have echoed their dissatisfaction. It would leave many jobless after completing their two-year compulsory service and halts their path towards specialisation.
The Covid-19 pandemic has also amplified the need for expansion in healthcare services, yet the Budget 2021 has failed to address the manpower shortage in public healthcare facilities.
While the Malaysian government’s decision in November 2020 to promote contract medical officers from Grade UD41 to Grade UD43 to earn the same emoluments as their permanent counterparts is very much welcomed, it does not address the long-term needs.
The Malaysian Medical Association (MMA) has continuously advocated and requested the government for an increase in permanent positions.
MMA President Prof Datuk Dr M Subramaniam said: “While we speak about the doctors to patient ratio, clearly this ratio has been insufficient in this pandemic. Simultaneously, the distribution of doctors remains questionable as we have seen severe shortages in certain stages.
“While the Ministry of Health (MoH) has been urged to provide doctors to these areas, we also see a need for the Public Services Department (JPA) to increase these positions.”
He also suggested narrowing the gap between government and private doctors by making the service more attractive.
“This would substantially reduce the ‘leakage’ of senior talents primarily due to frustration. The gap is at least 2-3 times now.”
“We have also requested from MoH to reduce the timescale for promotion to UD56. Previously, a doctor was promoted from UD54 to Grid Khas C. However, later UD56 was introduced, and now there is a further wait of 5-6 years to reach a JUSA post.”
The MMA has also urged the government to be transparent in selecting permanent positions and promotions at all levels.
Pointing out the pandemic has caused extreme fatigue among frontline doctors, Dr Subramaniam stated MoH provided psychological support for both frontliners and backliners through the Mental Health Psychological Support team state.
“Among the efforts started by the MMA include Helpdoc which was launched four years ago to help doctors to not only cope with stress but also address issues faced by doctors at work,” he shared.
“While we welcome all these initiatives, we believe that all frontliners should also qualify for hazard leave during this period. This is especially when they are not only working tirelessly but also sacrificing time and being away from their families.”
4. MENTAL HEALTH
Mental health cases are on the rise, especially during this pandemic with the implementation of movement restrictions and social distancing orders.
A study by the Institute for Public Health among Covid-19 hospitalised stable patients in 2020 revealed that depression was three times higher (7.5 per cent vs 2.3 per cent) while suicidal ideation was twice higher (4.0 per cent vs 2.1 per cent) among these Covid-19 patients as compared to the prevalence among the general population in Malaysia as reported by the National Health and Morbidity Survey (NHMS) 2019
The MOH’s Psychosocial Helpline received more than 35,000 phone calls from March to October 2020 on problems related to emotional stress, anxiety, and depression.
Statistics from The Befrienders Kuala Lumpur show more contacts received from those in distress and feeling suicidal in July, August and September compared to April, May and June.
Accessibility to a mental health diagnosis, treatment and support services is vital, even more so during this pandemic.
However, the allocation for psychiatry and mental health services was reduced by RM31.4 million from RM344.8 million for Budget 2020 to RM313.4 million for Budget 2021, which Dr Rajbans Singh, President of the Malaysian Wellness Society, feels will make things worse.
Along with mental health, the overall wellness of one’s health is also a concern going into 2021. To increase the country’s wellness level during the pandemic, Dr Rajbans said Wellness Education and the media could help.
He added: “The seven things the Blue Zones do is something we all can follow.”
Blue Zones are the world regions where people live healthier and longer than others. Five ‘Blue Zones’ have been posited, namely Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), Icaria (Greece) and Loma Linda in California.
5. PREVENTIVE HEALTHCARE
The 2019 National Health and Morbidity Survey (NHMS) findings showed little to no improvements in the prevalence and risk factors of non-communicable diseases (NCDs) amongst Malaysians.
Chronic diseases such as cardiovascular disease, diabetes and chronic respiratory disease are imminent for Malaysians in the long run if preventative and corrective measure are not put into place going into 2021.
The Covid-19 pandemic has severely disrupted all healthcare service and treatments, and brought about hesitancy among patients to visit healthcare facilities, fearing the virus transmission.
Dr Noor Ani Ahmad, Director of Institute of Public Health (IPH) from the National Institutes of Health (NIH) said: “Prevention is better than cure. It is better and easier to prevent the disease from occurring rather than to treat after they get sick.”
Preventive healthcare is essential. The repercussion of late detection can sometimes result in disease complications, disabilities and even death. Hence, prevention is very much imperative in all health conditions.
“The Malaysian population should be empowered to take care of its own health by adopting a healthy lifestyle, including regular health screening and early treatment to prevent complications.”
“We’re aiming not only to increase life expectancy but also to ensure good quality of life without disability towards healthy and active ageing.”
Referring to the NHMS findings, she said: “These figures demonstrate the lack of awareness among Malaysians in taking care of their own health.”
“A similar scenario is also seen with some Covid-19 patients when they presented to health facilities at a late stage resulting in longer hospitalisation and even death.”
The Ministry of Health (MoH), she said, advocated “all sectors are health sectors” which emphasised that health was everyone’s responsibility and not just the MoH.
Creating a supportive environment for a healthy lifestyle and disseminating health information, especially the importance of early detection and treatment, should be the ideal strategy.
“The Covid-19 pandemic taught us the most effective protection against it is for us to take care of our own health and avoid high-risk situations. These new norms should be our contemporary culture.
“While we’re protecting ourselves against Covid-19, we should also protect ourselves from other diseases by adopting routine health screening to detect non-communicable diseases such as diabetes and hypertension, and to screen against cancer.”
She also noted the awareness of the importance of health screening should be targeted at the younger generation by engaging them through social media platforms.
“We can also identify role models such as national athletes as change agents who can influence this group to adopt a healthy lifestyle and encourage regular health screening. The element of early health-seeking behaviour can also be added into popular TV series or telenovela.
“With comprehensive and holistic intervention strategies, it is hoped we can see better health-seeking behaviour among Malaysians in the next NHMS.”
6. ALTERNATIVE THERAPY
Alternative therapy, which includes traditional and complementary medicine (T&CM), has been used by many worldwide for many centuries to maintain the health and quality of life.
In 2007, the Ministry of Health (MoH) established a T&CM division to promote modern and herbal medicine.
The division classified alternative medicine into traditional Malay medicine, traditional Chinese medicine, traditional Indian medicine, homoeopathy, complementary medicine and Islamic medical practice.
In 2018, the MoH also launched the T&CM Blueprint 2018-2027 to guide a systematic and sustainable approach in developing the T&CM industry. Now, with renewed focused on preventive medicine, an alternative therapy is expected to grow significantly.
Malaysian Association of Advancement of Functional & Interdisciplinary Medicine (MAAFIM) President Dr Vijaendran Subramaniam said: “From the general observation of members of MAAFIM, I would say the trend change would be generally correct.”
He credits it to patients who are becoming more aware and informed. They are doing their homework and searching for solutions that would give them more concrete answers to health problems.
“And integrative and healing base systems have an essential role to play and integrate with existing health systems.
“More doctors are also turning to such modalities for themselves and equipping themselves with that knowledge to help their patients. So, I do think this trend, not just for 2021, is here to stay.”
When asked if conventional medicine was under threat from integrative medicine, Dr Vijaendran said it was essential to recognise they fulfilled different needs.
“For instance, if we are talking about childbirth, obstetric care, there is no alternative.
The existing medical systems that are already highly-developed have made childbirth safe, both for mothers and babies, and alternative and complementary treatment is not going to replace that.
“Similarly, in acute care and emergency care, and surgical fields, the preeminence of allopathic medicine is quite well-established.
“Where these alternative and complementary treatments will come in is in chronic diseases because we see a surge in non-communicable diseases.”
In conventional treatment, Dr Vijaendran explained often there was no cure for chronic diseases such as diabetes, hypertension and so on. Instead, they were only able to provide a control mechanism or control therapy.
“In complementary and alternative treatments, there are more effective approaches which can reverse some of these diseases. So naturally, these things can go hand-in-hand. And for some patients, such intervention can be beneficial in overcoming the illnesses.
“So, I don’t think we should see this as a threat to conventional medicine. It coexists, and it’s complementing conventional medicine.”
7. RISING COSTS
According to Aon’s 2021 Global Medical Trend Reports, Malaysia’s healthcare cost is among the highest in the Asia-Pacific (APAC) region.
Gross Medical Inflation for Malaysia in 2020 was 14 per cent, and the same rate is carried forward into 2021. Meanwhile, in 2018 and 2019, the inflation rates were 15.3 per cent and 16.1 per cent.
The report also stated the most essential elements of medical cost in the APAC region was hospitalisations at 95 per cent, followed by clinics and labs (84 per cent), prescription drugs (84 per cent), physician services (74 per cent), and maternity (47 per cent).
Association of Private Hospitals of Malaysia (APHM) President Dr Kuljit Singh said costs were rising as most products were purchased from abroad. He said there was hardly anything is manufactured in Malaysia, except for products like gloves and PPEs. But the rest of the stuff like medications and equipment are all from Europe and the US.
The costs abroad are also going higher, and with our exchange rate where US$1 is around RM4, it has not been good.
He said it was complicated to go lower on private hospital costs than what was being charged now. “Almost every private hospital is trying its level best to make it affordable.
“But anything lesser than that, private hospitals may not be sustainable anymore to the point of having to close down,” he said, adding it was not possible to cut corners as hospitals need to be maintained and be safe for patients.
Dr Kuljit said 2021 would be challenging not just for healthcare but other industries as well. They will encounter serious problems, and many may have to shut down.
“Healthcare is expensive, so it is an important thing people practice a healthy lifestyle and get treated early. The more complications there are, the more expensive the treatment would be.”— The Health