THE MABO RULING IN AUSTRALIA AND NATIVE CUSTOMARY RIGHTS OF SARAWAK

Dedicated to the First Sarawak Peoples, the brave indigenous peoples:

THE MABO RULING IN AUSTRALIA AND NATIVE CUSTOMARY RIGHTS OF SARAWAK

Francis H.H.Ngu, (non-indigenous Sarawakian and Malaysian).

“ A favourable Mabo decision by the High Court would free not only the Islander people and all Aboriginal people, but all the white people of Australia,” Eddie Mabo, initiator of the Mabo land case, prior to his death in 1992, five months before the historic Mabo decision.

Writer was in Australia doing a health services planning graduate programme in Sydney in 1982, when a Torres Straits islander and others gathered the courage and determination to take the Queensland State Government to court for denial of aboriginal land rights.

Eddie Mabo and others were defending the ownership right to their ancestral land at the northern tip of Queensland, handed down for generations according to Aboriginal legal traditions. In what was considered unwinnable, the High Court of Australia handed down an historic decision in 1992, over-turning the Terra Nullis principle, and recognizing Mabo and fellow islanders ownership rights to their own land.

At closer range , writer witnessed and continue to witness the equally courageous fight of the indigenous peoples of Sarawak for their land rights on Borneo island, and their economic rights associated with land. In spite of differences, there are compelling aspects of similarity which merit this simple narration.

The Aboriginals and the Torres Straits islanders are now acknowledged correctly as the First Australians. They represent perhaps the longest history of human civilization of some 40,000 years.

The Penans and other Dayak people of Sarawak are the First Sarawak people, and with the indigenous peoples of Sabah and of Malaya, the First Malaysians, though not generally so regarded by all of society as yet. To them, all Sarawak and Malaysian people ought to accord respect and honour, in that others later to come have been so congenially accommodated in this state and nation. Some indigenous people of Sarawak have a history of thousands of years of settlement and others a few hundred years.

There are outstanding common threads in the history and culture of Sarawak indigenous and Australian aboriginals, indeed many other indigenous peoples around the world. Apart from close kinship, what defines their existence and their culture is their sacred relationship to the land that they live on. Without ancestral land, lives and culture are in peril.

The Aboriginals live in perfect co-existence with their land from the tropical Torres Straits, to the vast desert scrubland of the continent, to the cold southern ranges. The Penans and others were, until their forcible displacement in recent history, an integral part of the Borneo ecosystem. As guardians of the Borneo tropical forests, they should perhaps also be accorded the honour of the First Environmentalists !
The close communal kinship of both groups in Australia and Borneo respectively, are enriched by unique cultures, a heritage of all mankind to be guarded, and nurtured not trampled upon by commercial interests.

The Aboriginal “dreamtime” is matched by rich Dayak imagery of folklore, both have walk-abouts, “berjalai” for adventure and opportunities in the case of migratory Sarawak Ibans.

Aboriginal paintings can be simultaneously contrasted and paralleled by Iban and Orang Ulu art on textile, both feature not only folklore but essential spirituality. Smart and effective hunting implements, the boomerang and the blow-pipe are well known respectively. One day in future, I hope, the Aboriginal didgeridoo may be merged with the Iban gongs and the Orang Ulu sapeh in a symphonic piece celebrating international indigenous friendship.

So the cultural list goes on, the rest well documented by learned anthropologists and sociologists. Suffice it to say that the rich cultural traditions and creativity can only inspire and benefit modern society. They are being constantly revived through elaborate ceremonies such as the Aboriginal coroboree and the Harvest Festivals of Borneo, the Gawai and Pesta Menuai.

Upon white settlement of Australia, the Aboriginals suffered for over 200 years from displacement, annihilation and cultural genocide through assimilation of the Stolen Generation. Land was taken over by immigrants mining and pastoral interests, as the principle of Terra Nullis states that Australia was no man’s land before white settlement and only the British Crown can lay claim on the whole continent. Aboriginals were to be confined to officially defined reserves. The historical facts of the ethnic persecution are well displayed at major Australian government museums, including the one at Perth, a commendable display of the conscience of a civilized nation among civilized nations.

The subjugation of Aboriginals haunted the 1982 Brisbane commonwealth games, as well as the bicentennial celebration of white settlement in Australia in 1988 respectively, so much so that PM Bob Hawke appeared on TV in tears to acknowledge, ”They have not been looked after (better).” PM Paul Keating, hailed the Mabo court ruling and went on to craft Aboriginal Reconciliation legislation and suggested a Social Justice package of socio-economic rights.

PM Kevin Rudd in 2008 went on to deliver an official apology on behalf of Government and Parliament for the maltreatment of Aboriginals including the Stolen Generation. Thousands of Australians, black and white, were moved to copious tears upon hearing the national apology. On that day too, Aboriginal elders also invited legislators into Parliament House, in a ceremony legitimizing the Australian Parliament even retrospectively after more than a century of Federation !

(Writer was in Australia and had the opportunity to watch live coverage of the event on ABC in 2008, at the same time thinking about the indigenous people of Sarawak.)

The NCR struggle of the indigenous peoples of Sarawak, in spite of the signal victories in court since the Nor Nyawai case, has a long road ahead, a Long Road of Freedom as Mandela said.

The Native Customary Rights of Sarawak natives, in place since the rule of the White Rajahs of Sarawak, have been traded away by the Dayak leaders of Sarawak in recent history. Large tracts of native customary right land were extinguished, and Dayaks displaced by logging and plantation interests all over the whole State, these documented by a hundred cases before Sarawak courts.

Weep, weep Sarawak for pushing the First Peoples of Sarawak to the margins of society !

The full restoration of NCR is now possible only with full and broad political change in Sarawak and Malaysia. The Land Code of Sarawak awaits to be re-written.

Thousands of white Australians rallied with the Aboriginals in their struggle; tens of thousands of non-indigenous Malaysians must also stand with Penans and other indigenous groups in their stuggle for land rights and social justice.

As the Mabo victory freed the non-indigenous Australians from the chains of lies and oppression, the ultimate victory of Penans and Dayaks will free all non-indigenous Sarawak people and all Malaysians from the shameful treatment of our fellow countrymen and women, the First Sarawakians and the First Malaysians.

The Dawn must come when the new Chief Minister of Sarawak will rise in the Dewan Undangan Negri of Sarawak in the year 2013 to tender the apology of the House to the First Sarawakians, and the Prime Minister of Malaysia will lead the Dewan Rakyat and Senate in the year 2013, in tendering the apology of the Malaysian nation to Dayaks and all indigenous people of Malaysia.

Then we can be proud as One People of Malaysia, all accorded social economic justice and freedom. Agi idup agi ngelaban ! (Iban- we strive for as long as we live !)

Thoughts on approaching Malaysia Day, 16th September 2010.

THE LOOMING MALAYSIAN HEALTHCARE DEBATE (PART 2)

Dr. Francis H.H. Ngu, M.B., B.S. (Mal.), M.H.P. (UNSW)
Sarawak.

THE CASE FOR INCREASE IN GOVERNMENT HEALTH CARE EXPENDITURE..

CUTTING BUDGET DEFICIT, CUTTING BUDGET FOR HEALTH CARE,
CO-PAYMENT TO FILL BUDGET GAP ARISING ???


It is evident that the timing of the proposal is awkward, following in the wake of botched government attempts to introduce the GST soonest and rapid withdrawal of multiple subsidies to shore up dwindling coffers, and a serious budget deficit. A major crises arising from the co-occurrence of national finance woes, health care woes and political woes has impacted on the Minister of Health to cap and even reduce government health service expenditure, while appearing to maintain or improve service.

Health care expenditure was targeted for reduction during the Great Austerity Drive of the mid-1980s, and is clearly targeted again in 2010. There has been a cutback of some 4.8% in the last budget, according to reliable sources.

It runs contrary to the 3rd proposal above (Part 1) to steadily increase government health care expenditure as percentage of GDP over 10 years to double to what it is at present. A total public-private health care expenditure of 7-8 % GDP is a shade higher than WHO recommendations for middling developing countries, but is at the lower end of developed countries. This is what it takes to qualify ourselves as a developed country in terms of health care after 2020.

At the current low levels of expenditure and serious public sector under-provision, Malaysia can hardly be said to be a nation continuing to make strides and progress when health care spending across the board were to be held back.

Such a proposal to increase health care expenditure would on the face of it sound lunatic, given the national indebtedness and poor fiscal shape! Read on.

The national indebtedness and fiscal deficit did not arise mainly from a chronically under-funded health care sector (under-funded, in terms of objective needs, citizen’s real life experiences and according to WHO recommendations), but to massive abuse and leakages of public funds, misallocations, mismanagement and wastage; and not let health care for citizens be the whipping target as the natural and acceptable sequaele.

Why not target the much larger defence expenditure at over 20 % of GDP for larger budgetary cuts ? A massive body of public discourse on corruption and cronyism, folly projects, overblown prices and costs and massive expenditure on defence hardware need not be re-canvassed here.

These are the roots of national indebtedness and fiscal woes which meager co-contribution in health care will do little to rectify.

NO SHORT-SIGHTED REFORMS, PUBLIC MUST NOT BE SHORT-CHANGED

HEALTH CARE COST INFLATORS:

In the event, health care needs requiring increased government expenditure arise from the following considerations:

1. Natural population growth of just under 2 %, much higher growth in Sabah from immigration;

2. Increasing population in the above 60 age groups, thus rising geriatric needs; in addition to a steadily changing population pyramid, slowly rising lifespans also impact on health care resources;

3. The impact of lifestyle diseases tending younger, and of neoplastic diseases (cancer) increasing in incidence as well;


4. High rates of road traffic accidents and industrial accidents/diseases; a major burden of disease is incidence and prevalence of mental illness in an industrial urban society facing different stress from different sources;

5. The growth of medical (doctors) personnel, as more Medical and Specialists posts will be filled; range and scope of service will expand faster with fast professional personnel growth; this is significant as professional personnel cost is a dominant component of recurrent health care expenditure;


6. Serious unmet hardware infrastructure needs in East Malaysia and elsewhere;

7. More outbreaks of traditional communicable diseases, and newer viral diseases;

8. The impact of subsidy withdrawal and GST introduction on domestic price inflation, both goods and services, to the health care budget;

9. Medical technology, which for Malaysia is largely imported, thus subject to international price pressures; the impact of imported inflation on medical and non-medical equipment and supplies.

10. Rapidly emerging new medical technologies, generally increasing health care costs.

A social need may be arising for fully or partly subsidized Nursing Homes in Malaysia in future, which the above proposal of 4.5-5 % of GDP does not cater for; this a most controversial matter best left to a later time for debate.
Similarly, rehabilitation facilities for the permanently handicapped is barely existent, however, this is largely within the founding mission of SOCSO.

Against these inflators of cost, the contribution from employers and employees, would be limited and rising slower than health care expenditure needs. This does not however, mean not thinking about co-contribution to a newly established national health finance fund. Considerations about co-payment will be dealt with in Part 3.

A BUDGETARY CUT REDUCES THE LOW PER CAPITA EXPENDITURE FOR HEALTH CARE EVEN MORE!

The cut-back on the chronically under-funded health care sector is as detrimental to the health and welfare of citizens, to their economic productivity, as it is morally and politically callous. If government cut-back, or reigning in of future budget outlays be the primary target of reform, then this reform is a no-go exercise in futility from the beginning, whether considered responsibly, rationally, professionally or politically.

Fortunately, it appears the Minister of Health is in support of greater government health care expenditure of up to 4 % of GDP, only that is shows up as a budget cut of 4% !

A steady government budgetary increase to 4.5-5 % of GDP, staggered out over a decade , is the responsible and sustainable way forward without critically affecting the budget deficit. With financial accountability and best practice, budgetary and fiscal prudence, colossal savings can be achieved elsewhere in the public sector; this even if government ignores the clamour from dissidents and oppositions, by just working on the Government’s own Auditor General’s Report published year after year.

This debate about long-term reform must be substantially re-geared !

A nation going forward must be able to deliver progressively better health care for all its citizens. A government budgetary commitment to health care is the essential measure of good and caring governance, under-writing its constitutional role and ensuring progress and social justice.

THE LOOMING MALAYSIAN HEALTH CARE DEBATE (PART 1.)

Dr. Francis H.H. Ngu, M.B., B.S. (Mal.), M.H.P. (UNSW)
Sarawak.

(This is written in the personal capacity of author, not necessarily reflective of the views of any organization or political party.
Writer has tried to balance, however imperfectly, public, political, health services planning and medical professional perspectives and interests, which are not always consonant with each other
.
Declaration of personal interests and possible bias : writer is the Head of the Health and Welfare Services Bureau, of Parti KeAdilan Rakyat in Sarawak.)

The recent announcement by the Minister of Health of a far-reaching reform for the nation, as the Health Care Financing System, is likely going to provoke a vigorous public policy debate, for which the following is an early warming up. This is a debate long overdue, a debate that should cut across all sections of Malaysian society.

THE CONTEXT :

The proposed healthcare reform takes place with the following being some of the major contexts relevant to the debate:

1. Historically, whether viewed from Malayan independence in 1957, or Malaysian Federation of 1963, the major structural Public Health Care Sector changes were the full federalisation of the Health Services of the States of Sabah and Sarawak within Malaysian Federal Health Ministry around 1970, proceeding into the 1980s, and, secondly, the general Privatisation Policy of the 1980s and 90s.

A major reform proposal by the Malaysian Medical Association for a National Health Commission since the 1970s, had been rejected repeatedly.

2. Malaysian government is constitutionally bound to shoulder the major part of providing health care for its citizens and funding thereof. Of further note, is the WHO Alma Mata Declaration which pledges Health Care for All by the Year 2000; Malaysia is a signatory nation.

3. The nation’s finances are under critical stress following the Asian Financial Crises of 1997 and the World Economic crises of 2008/9, other highly significant issues of National and State governance aside. The national debt is just above 50% of GDP, and the widening budget deficit of over 7%, of GDP which led to a Federal Government Minister warning that the nation may face Bankruptcy by 2019. Foreign Direct Investment has dropped to a historic low of below US $ 2 billion, with investment outflow more than twice the FDI inflow.

4. IN 2008, Malaysia spent about RM35 billion on healthcare, more than half of it in the private sector. The national healthcare expenditure represents slightly more than 4.7% of our GDP, with 2.2% coming from the public purse.

5. A dichotomy of Health Care, both in access and quality, has arisen and intensified, following Privatisation Policy, between those with access to high quality private care and those with full, partial or minimal access to public sector health care. This is reflective of the wider social dichotomy arising from income inequality that has increased steadily in Malaysian national life. The Gini co-efficient has risen over the years from around 0.40 to around 0.47.

6. The upper and middle middle classes are facing rising health care costs through expected higher private health insurance premiums and other own-pocket expenses, while the lower income groups and the poor face increasing rationing from congestion of and queuing for public sector service (this in spite of decanting to the private sector).

7. A serious dichotomy has arisen and intensified in the public sector health service
as well, with a much better developed tertiary and specialized services in the Klang Valley and a couple of other cities, and the laggard states of East Malaysia and elsewhere.

8. Malaysia remains a relatively low-wage, low-income economy wherein general world inflation and national inflationary factors impact on the expendable incomes of individuals and families. Public sector health care is thus an important part of what is a rather inadequate social safety net.

9. A Federal Coalition presiding over a highly centralized and long-lasting government, is fighting for electoral survival, in the face of mounting issues of governance, financial accountability and lagging economic growth.

10. An opportunity to learn from the cumulative experience of developed countries in health care over the decades, including a major over-haul in the British NHS currently; they provide an options looking glass for our own debate.

DESIRED PRINCIPLES OF RESPONSIBLE REFORMS:

In principle, any major healthcare reforms for the nation should be supported if they are based on all or most of the following, not necessarily ranked in order of importance:

1. Restating the core responsibility and major role of government in providing health care, or financing thereof; this holds for all responsible governments of developing and developed nations; a cardinal principle of governance should be the use of national wealth and income for material and social progress of citizens, including the appropriate provision of social welfare, of which health care is a major component.

2. The statement that a major goal of reforms is the universal, just and equitable access to health care, both across social (income) classes and diverse geographic regions ;

Health planning should be needs-based, to a large extent rational, and not overwhelmingly driven by political expediency.

3. A long term government pledge to steadily raise the government budgetary contribution from the current 2.2 % to around 4.5-5 % of GDP staggered over 10 years ; if the private sector expenditure were expected to rise to 2.5-3 % of GDP, it would increase national health care expenditure to around 7-8 % in 2021, from the current 4.7 %.

A budgetary commitment by government to healthcare is the essential measure of good and caring government, under-writing its constitutional role and ensuring progress in health care and social justice.

4. A firm government pledge to vastly improve both the scope and quality of service in the public sector as well as its geographical spread and rural reach; thus steadily reducing the dichotomy in quality of services provided by private and public sectors, and largely correcting the current imbalance of health care personnel vs. patients/population ratio;

5. Any new co-contribution by citizens should be take into account wages, real incomes, general inflation and poverty; the household threshold income defining poverty should be revised by cost of living realities, adjusted yearly or biannually
for inflation.

6. Establishment of a sound means-testing mechanism of eligibility of working age individuals and families for both free non-contributary health care and pharmaceutical benefits, as well as other social welfare benefits and subsidies;

7. A commitment to set up a comprehensive Pharmaceutical and Medical Supplies Benefits Scheme in around 2-3 years, so that medical practice which is evidenced based is better promoted;

8. Consolidating the unwieldy private health insurance sector, so that the number of insurance providers are reduced to 2 or 3 for efficiency, maintaining competitiveness and providing significantly better coverage for all age groups and all citizens, presence of morbidity irrespective;

9. Recognition that a sound public sector health care is the foundation of a progressive private health sector; health care tourism must compromise neither citizens’ health care needs, nor medical professionalism and ethics through over-zealous commercialization;

10. Appropriate integration of public and private care sectors, for fuller utilization of all resources of both sectors for better health outcomes of the public;

11. Consolidating the veritable achievements of Public Health (in relation to communicable diseases, maternal and child health, etc.), and emphasizing lifestyle health promotion through intensified inter-sectoral collaboration involving medical, educational, sports, media, legislative strategies, etc.

Primary and secondary prevention is where national health care cost containment would be truly achievable by government and the nation; it is at the same time beneficial to individuals and families;

12. Decentralising public sector health decision making to States and Health Care Regions, in particular the States of Sabah and Sarawak, which are sometimes not on the federal ministry radar screen sited at PutraJaya.

13. Increasing the pool of Health Services Planning and Management professionals in Malaysia, to provide a professional planning perspectives to future health care discourse which will feature more and more in Malaysia.

14. Urgent study on the optimal mix of health care personnel in view of a sudden enormous increase of trainee doctors, and the implications on training needs and standards as well as service hardware infrastructure.

15. Legislative, structural and educative response to develop a partnership of health care decision-making by government, professional providers and community (unions, employer bodies, health and welfare NGOs, health care clients). A participative structural framework must be the natural and just corollary to a co-contributary principle.

Indeed most of the above would need timely attention by any Malaysian government of the day, whether or not a co-contributary Health Care Financing System is put in place.

The above list is put forth as the core list of major policy considerations, though it is surely not exhaustive. There could be other large issues, especially about quality assurance for effectiveness and efficiency, practice safety, health information systems/IT, workforce issues/professional accreditation, traditional and complimentary health care, research and evaluation, etc.

These are subsets getting more and more technical, but will need exploration as well.


More instalments to come :
--
THE CASE FOR INCREASE IN GOVERNMENT HEALTH CARE EXPENDITURE..


INCOME THRESHOLD FOR CO-PAYMENT, QUANTUM, IMPACT.

INTEGRATION OF PUBLIC AND PRIVATE HEALTH CARE SECTORS

HEALTH CARE INSURANCE FUND (S)

THE PAUPER RESOURCE-RICH STATES OF SABAH AND SARAWAK

DEBATE ARISING ?