N Francis Sarawakiana

The looming malaysian healthcare debate part 3

2010-10-06T07:39:00.000-07:00

MALAYSIAN HEALTH CARE DEBATE (PART 3)

Dr. Francis H.H. Ngu, M.B., B.S. (Mal.), M.H.P. (U.N.S.W.)

Sarawak.

EXAMINING DIMENSIONS OF MEDICAL CO-CONTRIBUTION:
BETTER SOCIAL SAFETY NET NOW ?

Background

It is well known that government provided health care in Malaysia is virtually free for outpatient primary care and minimal for inpatient hospital care. Pharmaceuticals are also generally free. Those in abject poverty are exempted from even the minimal payments. Overall, Malaysians pay for less than 5% of the health care costs to government.

Public advocate groups have persistently opposed changes to the arrangement, and to the Privatisation Policy, especially the privatization of government hospitals.
However, to move health care to the next and sustainable phase of development, a health care financing mechanism is likely to be rolled out soon. Employers and employees are likely to have to contribute, together with Government, to a health care fund which will finance health care.

No public hearing has been conducted to gauge community views. Few details are known, except that the very low income, the very poor and the elderly may be exempted from payment. Strong social resistance to medical co-contribution may be anticipated.

Comparative foreign models

Co-contribution is a feature of the National Health Service of several developed countries including UK and Australia. The government of social-democratic parties of these countries, have some 60 years ago introduced a wide range of social welfare benefits, including highly subsidized public sector health care.

Patients pay a minimal amount for consultation, and medication prescribed. The poor, unemployed and lower income are means-tested by the national social security or welfare system, and are exempted from any payment.

In UK the NHS makes annual capitation grants set against performance targets to providers (GPs) for providing care. In Australia, the Federal government re-imburses the providers (doctors, pharmacies) on a case by case basis, according to schedules agreed upon. The general practitioner’s are “gate-keepers”, patients receive specialist and hospital care only upon referral by GPs.

A few differences between Malaysia and developed countries should be born in mind:

1. Wage earners of developed countries have incomes 5-15 times of Malaysian wage earners. Thus basic minimum wage in Australia starts at around RM 40 per hour, with heavy loading for weekends and public holidays.
2. Generous income support are given to the unemployed or low income families, of up to RM 5000 per month for a family of 5 or 6. The income at which poverty level is set is thus very high.
3. The thresh-hold for paying personal income tax is also very high, at around RM 50 K annual income, or much more.
4. The government of these developed countries allocate proportionately far more than Malaysia to health care; in Australia total national health care expenditure is over 10% of GDP, in UK somewhat less, in Malaysia least and under 5% of GDP.

There are many more salient points for consideration, but suffice it here to state the above.

Level of health care provision

Malaysia is praised internationally for a very extensive primary care network; the national health outcomes from public health programmes including maternal and child health are most outstanding.

Yet from the relative under spending as suggested by the above comparisons with foreign developed countries, there must exist many gaps and deficiencies. This is indeed the case. This writer, admittedly writing from a political perspective, has set out the broad outlines of the unmet health care needs of the State of Sarawak alone (1). The same holds for Sabah, and possibly pockets in Peninsular Malaysia.

INCOME THRESHOLD FOR CO-PAYMENT, QUANTUM of PAYMENT

The debate about co-payment will surely revolve around the income or wealth level at which co-contribution becomes applicable, and for the higher income employees, at what percentage of the base salary.

Threshold income

The threshold income at which wage earners have to co-contribute surely has to relate to the income level below which poverty is defined.

The Selangor State government sets it at RM 1500 pm per family of 5, this before the withdrawal of fuel subsidies in 2008. A consumer association puts the figure at around RM 2000 pm.
A federal minister suggested that the threshold income for personal income tax
should be RM3000 pm. (RM 3.15 = US$ 1 approx.)

This latter would suggest that taxing a wage earner with an income of RM 3000 pm would impose some hardship on the latter. Enforcing co-contribution, by the same logic would be unfair at that income level.

The official Malaysian poverty threshold as set at around RM 800 p.m. for a family of 5, is grossly off the point. Taking into account home loan payments, transportation costs, and a series of other commitments, co-contribution should be considered at a relatively high threshold income, say RM 5000 pm or much higher.

It is estimated that only about 30 % of Malaysian wage earners take home RM 3000 p.m. or more.

If the threshold for co-payment is set at RM3000 p.m., only a third of the workforce will pay, at RM 5000 p.m. as threshold, perhaps just 10 % of employees will make co-payments.

This limits the amount of funds for health care from employee contributions.

The Quantum of Co-contribution

In foreign countries like Australia, they started from as low as 1% of base salary, rising to 2-3 % after many years of policy adoption.

Co-payment of 1% of salary of a RM 3000 wage earner is RM 30 pm., RM360 pa. or 1% of a RM 5000 wage earner RM 50 pm, or RM 600.

Taking this percentage amount or even more from an employee would be intolerable. It also raises the point as to whether the maximum contribution will be capped, and then the amount at which the cap will be set.

(The figures quoted above are purely for the discussion, and do not imply that writer supports co-contribution at RM 3000 or RM 5000 monthly as threshold income.)

Limitation of wage earner’s contribution

Thus the amount for the National Health Care Finance Fund that can be raised from wage earners or low-income self-employed is thus much limited. This is due to the inability of the Malaysian public due to poverty and to a low-income wage structures to make a substantial co-contribution.

Even a low minimum wage regime, long canvassed by labour unions, is not in place.

Employer and corporate contributions

If employer contribution is rated according to employee pay, the employer contribution is similarly circumscribed; the quantum of corporate contribution (voluntary or mandated) is also expected to be limited and not rising much annually, due to a nett national investment outflow and lackluster GDP growth.

Would government and industry however agree to a small Health Care Levy on excess profits (or as market bonanza from time to time), especially in the resource sector ? The social and economic debate on the hefty resource and mining tax is currently still raging in Australia; though the initial proposed levy is regarded by many as outrageously high, the general principle of it seems to have considerable support.

Are we prepared to look at all avenues of social financing mechanisms adopted overseas, or do we selectively pick one, namely medical co-contribution, and maintain a blind spot for other potential mechanisms ?

Other social security organisations

Contribution from EPF to the national health fund is controversial as EPF as the old age pension fund for wage earners as originally designed, is already undermined by house purchase and other withdrawals; SOCSO has however a treatment and rehabilitation component in design which are synergistic with health care.

Both EPF and SOCSO contributions are also rated according to employees’ wages, generally low as earlier stated. While EPF is savings and growth in concept, SOCSO and any medical co-contribution are non-refundable population risk insurance in conception.

MECHANISMS ; FUND MANAGEMENT

It remains unclear as to the structural arrangements to control and manage what will eventually be a large fund, or if there are other sources of funding, other than from Government consolidated revenue and possibly employee and employer co-contribution.

Will the Fund collect directly, to the burden of employers, or delegate collection to an existing agency like SOCSO ? Are there safeguards for abuse of public funds, not unfamiliar to Malaysians ?

HAS THE THRESHOLD FOR A BETTER SOCIAL SAFETY NET NOT BEING
CROSSED ?

Means testing

Wage income threshold is technically an easier method of determining the liability for employee contribution, however incomes of self-employed may be harder to ascertain with accuracy.

Moreover for a given wage threshold, the family needs and commitments may differ considerably. Thus a family in Sarawak with a relatively high total income of RM 12,000 say, may have a couple of children studying without loan or scholarship, in KL; minus the expenditure on their childrens’ education what is their expendable income ? And not forgetting essential car and house mortgages to pay.

Thus in developed social democratic countries, large bureaucracies have to be set up for determining the income and fundamental expenditures of families, to determine their eligibility to a wide range of social welfare benefits, including free health care.

If the Government of the day thinks it is time to introduce GST, abolish subsidies and push medical co-payment, then has the time not arrived to also introduce a more comprehensive social welfare system ?

Such a welfare system would have to be based on Means Testing for social welfare benefits, including free health care without being subject to co-contribution; this in a “High Cost Few Subsidies” economy, where the majority of the people will be not just in the “Middle Income Trap,” but effectively be in the “Low Income Trap”

This writer wish to refer readers further to his initial assertion in 2008, and to propose here that in 2010 and thereafter, setting up a proper Social Welfare System has become all the more urgent, including for all the other reasons previously stated in 2008. (2)

Health care issues inexorably lead to the over-arching issues of the economy, the basic principles underlining public policies and the wider political scenario. However, it may best to leave to the better rationale of individuals, rather than to canvass a particular line of political and social thinking here.

Ref.:

1. Ngu, UNMET HEALTH CARE NEEDS, SARAWAK, 2010, PARTS 1& 2. (Pt.3 Due) Tindak Malaysia blog.
2. Ngu, Social Welfare Article in the wake of the fuel price shock of 2008, reproduced at Tindak Malaysia blog. Also on N Francis Sarawakiana blog, April 2009, “Reproduction: Social Welfare Article.”

2010-10-06T07:29:00.000-07:00

2010-09-08T06:15:00.000-07:00

THE LOOMING MALAYSIAN HEALTHCARE DEBATE (PART 4)

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

MALAYSIAN NATIONAL HEALTH SERVICE ?
PUBLIC HEALTH CARE VS PRIVATE HEALTH CARE, CAN THE TWAIN MEET ?

From 1957 to the mid-1980s, public sector provided health care was over-whelmingly dominant, except for primary care, where GPs in towns take care of it virtually independent of Government.

The Privatisation Policy put forth in the mid-eighties has seen the steady growth of private hospitals; the private sector health sector now incurs slightly more than 50% of the national health care bill, or some 2.5 % of G.D.P.

With the growth of the private sector, the third party in health care has emerged in the form of many health care insurance parties.

The general practitioners who have so far practiced independently will be roped in by government to provide care for patients of government clinics, though much uncertainties of implementation remain.

PRIVATE HEALTH CARE

In a free market economy, there is a definite place for private care and private hospitals, but its limitations in providing health care for a nation must be well acknowledged.

Quite apart from the problem of affordability by the majority of citizens, health care can never be a commodity that fits in perfectly with free market. From the outset, the supply and demand basis of market does not work; in health care, experience has shown that supply creates demand in defiance of free market principles. The choice of consumers in the perfect market place is guided by free information flow and highly informed consumers; in healthcare, knowledge and information is tilted highly in favour of providers (medical profession, institutions). Few commodities in the market place command an emotive overweight as much as health care. Health care as a commodity, which left to pure market mechanisms, may completely overwhelm the financial means of the average individual and family.

Thus, even in developed and affluent countries, social mechanisms to fund health care have been intensified, this belatedly in USA, (and even in USA !), under Obama Presidency.

The Privatisation Policy in Malaysia did not reduce national health care cost, but merely transfer cost from the public to the private sector. Indeed, the higher standards of private settings, together with the liberal use of expensive modern technology and higher professional fees, drive up total health care cost of the nation. Not only are the hospital bills beyond the ability of 80% of the population to pay, health care insurance premiums will also prove intolerable to the majority, even the upper middle class families, as costs escalate.

The major ills of Privatisation have been well presented by various groups, notably Citizens’ Health Initiative and YB Dr. Michael Jeyakumar of the Socialist Party, and are acknowledged by writer for readers’ essential reference.

PUBLIC HEALTH CARE

Constitutional responsibilities aside, the State (government) will always have to assume the major continuing responsibility of providing health care for citizens. If a nation progresses reasonably well, it will mean shifting administrative mechanisms from straight forward government institutions (MOH) to some form of National Health Service, providing access for the whole population, and continually improving standards of care. The NHS put in place in “High Income economies” of developed nations in the last few decades have included a low co-payment from those who can comfortably afford.

MALAYSIAN NATIONAL HEALTH SERVICE ?

What the Malaysian Government has deferred for some two decades is a stated policy to put in place an NHS, which in time will be as good as any others. It has been detracted from an NHS by the Privatisation Policy, and even at this late stage is reluctant to refer to a “Malaysian National Health Service.”, perhaps for obvious ideological reasons. Thus instead of debating about the shape of and respective roles of stake-holders in the NHS-like proposals, we find ourselves in the tight corner debating medical co-contribution towards a Health Care Finance Plan which will essentially be the cornerstone of an NHS.

The apparent Policy ambivalence must first be resolved, and make no mistake, for an NHS to be an improvement of the pre-existing arrangements, government has to initially make a massive injection of funds into the health care sector, and not expect a slowed down budgetary contribution. A firm stated commitment of government in medium to long term in providing funding support for a Malaysian National Health Service is the major prerequisite to inspire confidence of all.

On the corollary, if it is not about setting up a National Health Service, tailored for Malaysia, the debate about Medical Co-contribution would be premature. Why should the public support co-contribution when it is not about an all round improved national health care system that provides universal and equitable access ?

An NHS for Malaysia will among others, have to be built upon:

1. Providing health care resources more equitably over all parts of Malaysia ( hence this writer’s series about Unmet Health Care Needs of Sarawak), otherwise the injustice from paying the same co-contribution and receiving much less or not at all !

2. The National Health Finance Fund will pay for all primary care (outpatients, family medicine) at GP clinics, with small co-payment for those who can afford (defined as per my Part 3 previously), and for specialist services via a GP/family medicine gate-keeping mechanism.

3. Comprehensive co-operation with GPs for primary care, and optimal cooperation between private specialists and government hospitals in cities and large towns, and private GPs and district hospitals in smaller towns.

4. Choice for the public to use private or public hospitals, with the Health Finance Fund making re-imbursement of a fraction of the fees incurred at a private hospital under a schedule of reimbursements.

5. A pharmaceutical and medical supplies benefit scheme .

6. A decision on whether it would be built on a fee-for- service or a capitation principle; or could there a world-first, in giving both providers and consumers a choice of either, through an A List of fee-for service and a B Scheme for capitation grants, cognizant of how each may potentially affect health care delivery;

The Minister of Health has thus to persuade all the stakeholders that the interests of all will not only be protected, but will be vastly improved in the long-term:

1. Persuading cabinet and parliament that such a system requires a massive injection of public funds initially over 2-3 Malaysia Plans, but will in the long term deliver better patient care and community outcomes, and be the eventual best mechanism for national health care cost containment; that health care cost containment does not arise at a macroscopic level at this stage of under-provision vs needs over large parts of the nation;

2. Engaging Pakatan Rakyat legislators in discussion and debate to reach a broad bi-partisan consensus on a matter of reform of such national gravity; a bipartisan select committee on health and welfare should become a permanent feature of Malaysian legislature;

3. Persuading the public that this is the way forward for universal access to health care to a high level if deemed clinically necessary; that there will be continual improvement and upgrading; that private centre care remains an option if preferred; eventual public co-contribution is better marketed as an investment in public sector health care in the long haul, not a stop gap for current fiscal difficulties;

4. Persuading the all important medical profession that there will be greater professional flexibility and satisfaction, with steady growth of incomes assured and not compromised; similarly persuading with openness and due mutual respect, other allied profession; a package of professional incentives should be negotiated;

5. Persuading states, especially Sabah and Sarawak, that an NHS though in many ways are another form of central “command economy”, the space will be widely opened up for decentralized decision making to promote system responsiveness and service efficiency, to the ultimate extent of establishing Sabah and Sarawak Health Care Commissions respectively;

6. Persuading the cabinet that for a Malaysian workforce trapped in a “low income” economy, and for large sections of the population underserved, especially in Sabah and Sarawak, the compulsory co-payment of medical care cost by wage-earners should be deferred until real median incomes are 2-3 times current levels; (see Part 3 previously);

7. Persuading the cabinet that the National Health Care Fund will need to be topped up by respective Government civil service departments, as part of their respective human resource operational costs, to finance Government commitment to virtually free health care for civil servants and dependents, as well for the increasing number of pensioners;

8. Persuading all stake-holders that henceforth, health care planning will grow out of the civil service bureaucracy represented by the Ministry of Health to a more professional level, befitting a developed nation, by the establishment of a Malaysian Health Care Planning Commission; such a Commission will embrace the stake-holders of health care more comprehensively than the MOH civil service bureaucracy. (Writer acknowledge that the germinal thoughts on this matter originate from a certain lead member of Malaysian Medical Association)

The Minister of Health has much more to do to receive various input from all interested sources; public hearing should be conducted. The Minister should put its own proposals on the table, as a prerequisite to any meaningful dialogue with any group in a spirit of partnership in health care that Malaysians are looking forward to.

Once the Minister has broad consensus from other stake-holders, it is he who will drive health care policy decisions in the Cabinet; the Minister of Health must be so equipped with all logical (and illogical !) arguments pertaining to all aspects of health care policy that he will not be the one driven by the vicissitudes of the Cabinet, especially its current budget deficit fixation.

Information sharing must be the basis of establishing that trust between stake-holders; and dialogues not be seen as merely an avenue to push through unilateral decisions.

“Public- Private :Can the twain meet” has not been adequately covered here, but will be covered subsequently as “Medical professional isuues and interests.”

The establishment of a Malaysian National Health Service as good as any other, is a logical extension of its considerable achievements in health care, unmet needs notwithstanding. It would not only put Malaysia on the world map for comparative health care system studies, but also provide it with the needed international reputation of high public standards, if Health Care Tourism were to successfully become an important services sub-sector of the economy.

THE MABO RULING IN AUSTRALIA AND NATIVE CUSTOMARY RIGHTS OF SARAWAK

2010-08-23T01:36:00.000-07:00

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)

2010-08-16T08:35:00.000-07:00

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.)

2010-08-16T08:25:00.000-07:00

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 ?

The Column That Wasn

2010-03-02T23:34:00.000-08:00

The Column That Wasn

An overview of the "Allah controversy"

2010-01-08T01:32:00.000-08:00

Summary: Following a brief review of the current crises arising from a controversial Government ban on the use of the term ALLAH by non-Muslims, and ensuing court proceedings, this article quotes several responses from leaders in Sabah and Sarawak in addition. The spirit and letter of the Malaysia Agreement should not be forgotten in order to have full perspective in the debate. Possible repercussions in international relations and image are outlined, with particular reference to Indonesia. The article proposes major steps to restoring inter-religious harmony, beyond judicial decisions. In conclusion, writer appeals to a return to shared core values of all major religions.

There has not in my memory of recent history anywhere in the world where the word used to refer to God has given rise to such national controversy and attracted international attention. Against the backdrop of social change and political tension, Malaysia has gained an unenviable World First, a national passion promoted under the Mahathir regime.

Close on the heels of the 50th Anniversary of the Malayan Independence, a ban was gazetted by the Government for non-Muslims on Malaysia to use the term Allah in reference to God. The Government move was rather perplexing, saying that use of the Arabic word might offend the sensitivities of Muslims who make up 60% of Malaysia's 28 million population.

The ban was however overturned in court on December 31st, 2009, enraging certain sections of Muslims aligned to the ruling UMNO party. The High Court said it was the constitutional right for the Catholic newspaper, the Herald, to use the word "Allah". The Herald had faced the prospect of indefinite ban from publication for using the term Allah.

Protesters against the court ruling have apparently received implicit and explicit encouragement from statements of a few Federal Government Ministers and the decision of the Home Ministry to appeal against the High Court ruling. The Home Minister has in a rare departure from previous practice, granted permit for a mammoth demonstration by protestors; it has always been the contention by Malaysian Government that public demonstrations are “not our culture” and threaten public order. However, on the eve of the large demonstration,
the PM, the Home Minister and the Police (IGP) are reportedly making some conflicting and rather confusing statements.

The controversy is thus set to escalate. If of any help, the court has granted a government application for stay of execution of the High Court ruling pending the outcome of the Appeal by the Home Ministry, this consented to by the Catholic side.

For one, the former prime minister, Mahathir, said that the word Allah belongs to the Muslims, whereas the current PM is notably “uncommitted” on the matter. In sharp contrast, Mahathir’s activist daughter, Marina, says “It is not about God belonging to you, rather YOU belong to God.” She says that the constant battle for ownership of God is in quite wrong.

It is generally the contention of Government and some others that sections of the Muslim population in Malaysia would be easily confused over the usage of “Allah” by non-Muslims, insinuating that churches have used this as an excuse to convert Muslims out of their faith.

Mahathir further said that the term Allah may be used in such a way that could inflame the anger of Muslims, or in his own words, “they may use it on banners or write something that might not reflect Islam”, a statement condemned by Dr. Lim Teck Ghee et al. as wholly unworthy of the former PM.

TG Lim, in 2 separate articles at the Centre for Policy Initiatives website, reported in some detail the mass mobilization against the High Court ruling that has already spread to cyberspace in quite an alarming way in tandem with inciteful and intimidating articles in an UMNO controlled newspaper.

In a strident rebuke head on, an UMNO veteran, Tengku Razaleigh Hamzah says,” Umno is digging itself into an intolerant hardline position that has no parallel that I know of in the Muslim world.-- and the government it leads is taking up policy lines based on “sensitivities” rather than principle. The issue appears to be more about racial sentiment than religious, let alone constitutional principles.-- A nation is made up of citizens bound by a shared conception of justice and not of mobs extracting satisfaction for politicised emotional states.--Malaysia is a federation of sovereign entities, --it has come to be run habitually as a unitary state. We have to learn again how to be a federation.”(Concerns about federalism in the context of the “Allah debate” is also echoed by Sabah and Sarawak political leaders quoted later.)

“The Bible has been using Allah for hundreds of years, ever since they translated the Bible into Bahasa Malaysia/Indonesia. In fact, we have copies of a Bahasa-translated Bible published 200 years ago that used Allah”, says RPKamarudin. This being so, and surely for the 50 years of Malayan Independence, there has not been a significant exodus of Malaysian Muslims to embrace Christianity as this is legally not possible in Malaysia, in spite of constitutional provisions of religious freedom.

RPK says further, “The word ‘Allah’ existed before the word ‘Muslim’ or ‘Islam’.--- Muhammad the son of Abdullah –(or) ‘Muhammad the son of the Servant of Allah’ long before the Revelation when he ‘became’ a Muslim.” How do the Muslims (meaning Malays) explain this if they say that Allah belongs to the Muslims?” Thus RPK deduces that the term Allah would have been used by Pagan Arabs before the time of Prophet Mohammed, Praise be to His Name.

Those aligned to the Federal Opposition, Pakatan Rakyat, generally believe that the gazetted ban on non-Muslim use of “Allah” is a concoction of the UMNO-led Federal Government to project its Islamic image to Malay Muslims, and politically out-manoeuvre the Islamist PAS in the opposition Pakatan (Alliance). It is perceived that in face of the ban and the following controversy, the Malay Muslim base of PAS and possibly Parti KeAdilan Rakyat, would be eroded to the advantage of UMNO.

Pakatan Rakyat parties have come out in consistent support of the High Court ruling, based on fundamental Islamic teachings.

The Leader of the Federal Opposition, Datuk Seri Anwar Ibrahim, had also quoted an influential world Islamic cleric, Sheihk Dr.Yusof Al Qaradawi, as saying that there is no problem with Christians referring to God as Allah.
Tok Guru Nik Aziz, the PAS Menteri Besar of Kelantan had before the court ruling said that he did not oppose the Catholic Herald using the word ALLAH.

PAS issued a statement in prompt agreement with the High court: “it is consistent with the federal Constitution and Islamic principles”and that “based on Islamic principles, the use of the word Allah by the people of the Abrahamic faiths such as Christianity and Judaism, is acceptable” .--“PAS strongly objects to any aggressive and provocative approach that can lead to tension in society,” it is quoted.
In a measured response a day after the PAS statement, an official spokesman of Parti Keadilan Rakyat says "the wish of the non-Muslims to call their God Allah is a positive turn of events and should respectably be recognized. -- There is no necessity for any faction in society to take advantage of the current circumstances and turn the dispute into a narrow political propaganda.”
But far-reaching political ramifications are unavoidable. “-- the political and economic costs for Prime Minister Datuk Seri Najib Razak's administration will linger for much longer--- a significant setback to the central theme of his new administration — the “1 Malaysia” policy which is designed to bring the country's multiracial and multi-religious communities together, “ a Straits Times article quite accurately describes the political fall out.

It is clear that 1Malaysia mantra is also taking direct hits, in Sabah and Sarawak as much, or even more than in KL. Over 40% of the people of Sarawak are Christians, and a roughly similar proportion in Sabah, the majority being indigenous peoples.

1Malaysia will face a severe predicament as the Appeal Court is widely expected to reverse the High Court decision. In appeasing an arguably large Muslim constituency in Peninsular Malaysia, such a court reversal would adversely affect the Christians in Sabah and Sarawak. Both sides of the political divide will undoubtedly interpret the electoral significance of the issue on both sides of the South China Sea.

A senior Sabah Christian member of the Cabinet, Tan Sri Bernard Dompok, made an oblique comment favouring the continued use of the term “Allah”, suggesting that the use of “Allah” follows from the widespread use of the Malaysian national language. “The Sabah communities have always used Bahasa Melayu as it is the regional lingua franca and Christianity has been in Sabah since 1881,” the Plantations Industry and Commodities minister is quoted as saying.

In Sarawak, the sole KeAdilan State legislator, Dominique Ng (Padungan), has called on government to respect the ruling. Ng, a Buddhist himself, asks the government to explain why it may not now release all of the confiscated religious articles to the churches and individuals concerned. He refers to the reported confiscation in Kuching on September 15th 2009 ---of 15,000 imported copies of Bibles bearing the word ALLAH, and quoted other instances of confiscation of Christian articles. (Writer: In view of the stay of execution of the High Court ruling, the ban obviously remains in force.)

Ng said, “--that leading Muslim clerics and so many Malaysian Muslims are so religiously principled in their stand in sharing the use of the term ALLAH, is indeed a defining moment in Malaysian communal relations. -- the Barisan National would be well advised to embrace rather than resist through another court challenge and thus seeming to encourage other acts stoking social tension.”

“ This is indeed a litmus test of 1Malaysia. The Prime Minister should let Malaysians be ONE in the belief of God and Allah, a ONENESS which will be promoted using a shared term ALLAH, blessed be His Name ! ”

“ Sarawak Government should ---reassure all Sarawak Christians of their rights under the Malaysia Constitution and the Spirit of the Malaysia Agreement,” says Ng. Under the Malaysia Agreement in 1963, Sarawak and Sabah people have greater space for religious freedom in spite of Islam being constitutionally defined as national religion.
Sarawak KeAdilan chairman, Baru Bian, declared that there “is no place for religious extremists and religious bigots in this country, as we are a nation of varied religious beliefs and practices. --Cobbold Commission Report clearly recorded that ‘freedom to profess, practice and propagate any religion’ should be guaranteed-- that ‘Sarawak should be a secular state. This is the reason I believe that today Sarawak remains as such without any official state religion.”
Dr. John Anthony Brian of Sarawak, wrote on his blog, “For Sabah and Sarawak we are watching UMNO reaction carefully. We fully understood PAS and PKR stance on the issue now. UMNO should be able to manage their response in the most sensitive manner to the feeling of non- Muslim too.” “As natives of Sabah and Sarawak, as “pribumi” of Malaysia with Christianity as our religion we can also exercise our rights to organize protest over ABIM / PKPIM protest. But where will this road lead us to?” he retorted, referring to planned protest demonstrations in KL against the High Court ruling.
This writer had written in his blog in April 2009, a related article “Sugguh Besar Allahku” based on an Indonesian hymn bearing that title translated as “Glory be to God.”
I wrote further, “--an Iban (Dayak) showed me the the first lines of the Genesis in the Iban bible where clearly the word Allah was used from the very beginning that the Iban Bible was published (add: about a century ago). -- the implications of such a legal ban on the word Allah, for Christians in Malaysia using the local language Bible. Enormous distress, to say the least.” Thus the majority of the indigenous Christians, not knowledgeable in English or Chinese, would not have any Bible which they can use, this an intolerable infringement on their constitutional rights on freedom of worship.
I further pointed out that an Indonesian Christian would be banned from bringing the Indonesian language Bible into Malaysia for personal use or as gift to a Malaysian Christian friend, and for that matter any other Arab Christian carrying an Arabic Bible into Mallaysia.
The international relations repercussions from the ban should be anticipated. The battered image of Malaysia overseas will be dealt more blows in both the Western and the Islamic countries. Malaysia would be singularly out of step with the rest of the Muslim world, often described as Ummah, by banning non-Muslims from using the term Allah; this a highly arrogant move against learned and authoritative Muslim sources locally and overseas.
The Islamic Society of North America (ISNA) commends the landmark ruling by a Malaysian Court on December 31, 2009, that affirms the religious freedom of Malaysian Christians. –“We call on the Malaysian government to uphold the religious freedom of Christians and to let the court ruling stand. We also urge Muslim NGOs to respect Islamic teachings and long-held Islamic traditions, and to withdraw their opposition to the use of the word “Allah” by their Christian compatriots,” its statement reads.
Malaysian authorities have clearly ignored the scenario that the gazetted ban may have extended repercussions beyond its own Christian and Muslim citizenry.
News of the controversy is already widely reported by the media worldwide. “Prime Minister Najib Razak called the A-word controversy a “sensitive issue” -- What a disappointment for a man who ran for office promising to create “One Malaysia,” writes the Wall Street Journal.
Significant damage may also result from the controversy in relations with the Indonesian people; Indonesia is the largest Muslim nation, with growing clout on the regional stage given historical, cultural and geo-political realities. Imported Malay language Bibles are from Indonesia; banning implies that what is acceptable to Islam in Indonesia is not to the government of Malaysia. What this arrogance would do to the recently bruised relations with the major ASEAN partner remains to be seen. Other ASEAN neighbours would surely not welcome any unnecessary strain on inter-state relations by a quirk issue.
There has to be a way out of this serious impasse threatening harmony, beyond the decisions of civil courts.
The people in Sabah and Sarawak may arguably be exempted from the ban on the basis of the Malaysia Agreement, but this would be a 2Malaysia solution, surely welcome by Sabah and Sarawak Christians but perhaps unacceptable nationally.
Writer believes it is the duty of responsible government to work on a couple of fronts:
1. Political. The crises is widely believed to have political partisan origin. The partners, other than UMNO, in the 13 party BN (national front) coalition should have their voices heard on the issue, however feeble, especially the BN partners in Sabah and Sarawak. Federal BN rules by virtue of support of BN partners in Sabah and Sarawak, so the leverage by the latter may not be that weak! The folly of the ban should be admitted.
There should be an all- party (including Pakatan) round-table to desist from further using the issue to partisan political advantage, but this contingent on the following.
2. Community. Rather than holding mass demonstrations, community confidence-building forums should by held, organized by government and civil society.

3. Inter-Religious Dialogue. This is perhaps the most crucial in influencing positive or negative development in other areas. Top religious leaders of Muslim, Christian churches, perhaps other religions, should sit and agree to a joint position which will guide community, political parties, government and perhaps courts.
Lawyer Azril Mohd Amin, writing at Malaysia Insider, called for mediation as an instrument of conflict resolution, this synonymous with the above dialogue proposal.
” The Catholic Church --has expressed its willingness to engage in dialogue with the Muslim clergy and find an amicable solution to the Allah row currently threatening—“ reports MKini news-portal. This is a reassuring development which writer hope and believe the Islamic clergy will respond favourably to, in genuine and respected Islamic traditions .

Concluding this review, and lest it be forgotten, may I share with readers :

“The great faiths, and would one dare to say scientific non-theist faith, are Divine gifts to humanity, different in form to suit different cultures, at different times of history. They are however very similar in substance, in the shared core values of love and humanity, and they should be universally shared in the globalised confluence of digital age civilisation.

That apparent differences in faiths may not lead god-created communities, and indeed the entire world, to self-destruction in nuclear-age conflicts, but that the shared universal values be the driving force bonding humankind, divinity and divine-created Planet Earth.” (Being Easter reflections April 2009 on my blog.)

May God Allah be praised!

PROJECT NEW MALAYSIA

2009-12-21T15:49:00.000-08:00

“The Policies of Pakatan Rakyat.” THIS IS PROJECT NEW MALAYSIA !

Dr. Francis Ngu, member Parti Keadilan Rakyat, Sarawak. Dec.21^st, 2009

As the most serious nation-building document that has emerged for some time, the document now deserves responsible critique from the Malaysian community, partisan allegiance aside. This critique hopes to spur constructive public debate on the policies in the new found spirit of democratic participation ushered by the birth of Pakatan Rakyat.

This is an attempt to bring about far reaching reforms which the people are now anticipating. A fresh new national consensus is sought by Pakatan Rakyat which will be worthy of a progressive nation facing the challenges of the globalised scene of the 21^st Century.

It is wide-ranging in scope, covering major political, governance and social-economic areas, and is thus necessarily in an outline or summary form. Based on the “People’s Rights” values underpinning, it is now the role of civil and political society to fill in the details over time. Wide indeed are the spaces open up, in a new spirit of freedom, equitable rights and social compassion, to advance efficient and effective administration, infrastructure development, green economic progress, service delivery, etc. The agricultural sector however, deserves direct attention by itself.

Civil and political rights built upon an freely informed citizenry, will be guided by the Constitution and backed up by an independent judiciary and other effective criminal- justice institutions.

Beginning with a fresh Peoples’ Consensus, the Policy Paper not only calls for all to abandon ethnically and religiously divisive orientations, but to marshal all the strengths available from the fine values found in all religions and cultures to overcome the ills of society and nation. A humane market-based economy with more equitable wealth distribution will sustain a united people living in social harmony.

Under the part on Constitutional Democracy, the youth above 18 will be automatically given franchise. Malaysians will implicitly have to mature earlier, and the education, must among others, emphasize critical thinking and abandon rote-learning. The energies and creative imagination of Youth will be tapped earlier, as is the case in developed countries. The one- man one-vote principle will be enhanced, but part proportional representation is not as yet considered.

The spirit of Federalism (not just the letter of) is not only promised but guaranteed for Sabah and Sarawak by the Policy Paper. This, read together with the policy of administrative decentralization and Federal devolvement, holds hope for the 2 component States to explore a much higher level of State Autonomy as more and more strongly desired by Malaysians of the 2 States. Compelling political and historic considerations aside, greater devolvement of governance to the 2 states separated from the Peninsular by the South China Sea is technically and logistically more efficient.

Notwithstanding, wide devolvement of Federal functions and state funding realignment are by themselves giant steps forward for a united and progressive Federation. Guaranteed representation in Parliament by the smallest ethnic minorities of the nation in Parliament should be an added desired feature.

Attention is paid to regional disparity, and regional resource realignment is featured. Sabah and Sarawak can become the new engines of growth and progress for the nation, if the just guarantees of Federalism capture a new found sense of national commitment from Sabahans and Sarawakians at home and abroad.

Pakatan must remove a pervasive sense of despair and hopelessness of Sabah and Sarawak people facing decades of political and economic marginalization in the Federation. Pakatan “promises to make a fair and open assessment of the principal issues---”, but has not decided on whether the assessment is to be an administrative or academic research exercise, or of a more authoritative form, that of a Royal Commission on Sabah and Sarawak.

Thus Pakatan will be expected by Malaysians to make the first really serious national thrust in addressing regional imbalance and truly unite all Malaysians of Sabah, Sarawak and Peninsular Malaysia.

Based on the principle of People’s Economy, there is to be a beginning for Economy By the People, Of the People and For the People. This addresses a needs-based affirmative action policy, a social safety net for marginal groups, labour rights, minimal wage, housing for the poor, assistance to small private entrepreneurs.

Pakatan will thus put Malaysia on the road of social democracy, as practiced in advanced countries. The funds for social welfare will come from massive savings from prudent government spending and high financial integrity in government. Social welfare will itself boost domestic consumption and the retail and services economy.

Not mentioned, but needs-based affirmative action, and welfare benefits would require quite a large initial outlay in a sound means-testing mechanism to award eligibility, and periodic reviews of such eligibility. Introduced step-wise, cash welfare measures need not spark too much inflation, but be a small stimulus to an economy in 3 quarters of negative growth.

It is only possible to consider GST and withdrawal of fuel subsidies many years down the line, contingent upon broadly increased personal incomes and backed by a sound social welfare system.

On Infrastructure, broad-band internet must rank on par with other infrastructure, for both economic competiveness as well as environmental considerations. It is even said that before major highways are planned, the digital infrastructure must be assessed first. For one, work and other economic activities may be carried out from the home, reducing traffic on highways of large cities significant enough to slow highway development as well as reducing carbon footprint.

There will be belated but strong investment in public transport which is integrated and efficient; the public transport investment should cover smaller townships other than major cities to cover the day when fuel subsidies have to be wound down, and carbon auditing is enforced by an international regime.

On Environment, Pakatan should do more and set a step-wise timetable towards a future date by which to stop logging in all native-growth forest (primary jungle), and log only secondary and planted forests. This could be built into the international carbon trading schemes, and future international assistance in reforestation. The remaining living Habitat must be preserved for the welfare of the indigenous peoples, other environmental and ecological considerations not forgotten.

Environment education and consumer behaviour, human rights should feature strongly in the civics subject in schools, but no cramming for examinations please!

On Education, the challenges of the global village, may require the national education system, to be defined not as a conformist monolith, but to embrace diverse streams of education, including mission schools, mother tongue schools and even private schools.

A high level of autonomy for mission and mother tongue schools, even if government funded, should be assured to best bring out their time-tested dynamism, in healthy competition with fully national schools.

The growth of the services economy will derive essential strength from multi-culturalism;

opportunities should be widely available to learn several other foreign languages.

Critical to the nation, education must move away from rote learning for examination, to critical thinking, mental creativity, formation and articulation of ideas, communication of ideas, personal development, lifetime learning, appreciation of the arts and heightened social consciousness. Upon these are to be built, science, technology and material progress.

Malaysian people have a repertoire of artistic talents in their blood, but locked away under the stress of a materialistic and authoritarian society. How will their artistic and cultural talents be fully unleashed to add to both the spiritual and material wealth of society?

Greater attention needs be given to education in culture, and training in visual and performing arts from nursery to university. Music is acknowledged to promote neuro-linguistic development, benefit mental, even physical health. Social experiments among the poor enclaves in a Latin American country is said to have reduced crime among juveniles. Would music and arts be a relatively cheap instrument in addressing social problems in Malaysian youth?

Clearly, Pakatan is holding up public health sector as the mainstay of health policy, with implicit increase of both infrastructural provision and service funding. The Malaysian Health Services Commission will arrive, only a few decades later than advocated by the medical profession!

Conceivably with its inauguration, there will promptly emerge a National Health Plan with a national health financing mechanism to back it up long term. Health care is an extremely complex field; Pakatan should consider stepping up Health Services Management and Planning training to prepare management personnel conversant with issues facing modern health care delivery.

The excellent policy paper has not however mentioned Science and Technology Development so essential for Malaysia to free itself from the “middle income trap” or “the resource curse”, as so eminently addressed by an UMNO veteran Tengku Razaleigh Hamzah. There needs to be a further policy statement on Research and Development.

The Barisan federal government is now challenged with a serious and quite comprehensive policy paper from Pakatan Rakyat, to which now it would do well to give a meaningful response; such would be expected by people living under a two-party system.

No document is perfect, this included. For now, Pakatan joint policies put forward are certainly adequate to pull Malaysia out if its deep doldrums, even its terminal crisis. Fullest credit must be given to its brain-child, Datuk Zaid Ibrahim.

For the future, the document will surely be continually refined and improved with the participation of all Malaysians, partisanship notwithstanding. This must stand as a central and historic document, a living document whose narrative will steadily grow to meet the continually progressing aspirations of a nation whose citizens are seeking liberation from tyranny and authoritarianism.

This is Project New Malaysia, belonging as much to the people of Sabah and Sarawak as to people in Peninsular states. This is the tough project which all Malaysians have to work on for the next several generations. Until then, Malaysians will not be able to stand tall and equal. God-willing, and Insyallah, it shall succeed!

Upon Project New Malaysia, the health of the nation will be restored, its place in ASEAN and the international community enhanced. A New Malaysia in a New Dawn deserving of the commitment of every Malaysian!

My alma mater

2009-09-06T19:11:00.000-07:00

St. Joseph’s School Rally
Sons of St. Joseph a voice is resounding,
Promptly respond to your duty’s sweet call;
Answer you all for the trumpet is sounding,
Your mater’s proclaiming her watchwords to all.
Forward her children dear,
Ever with hearts sincere,
Render with joy to your mater her due;
All that is vile reject,
Heaven will e’er protect,
Sons of St. Joseph’s valiant and true.
Prayer and labour your motto still bearing,
Forward with courage in ways that are just;
True to your standard be doing and daring,
As faithful Josephians in Heaven will trust.
“Once a Josephian, Always a Josephian!”

MALAYSIANS, LOOK EAST THIS AUGUST 31ST. !

2009-09-02T07:37:00.000-07:00

Francis H. H. Ngu , Kuching, 31st August, 2009.

It has been some two decades since Malaysia under Mahathir adopted a Look East Policy, using Japan as the model for the development of Malaysia. On a historic day of political change in Japan, the Look East Policy is revisited for its broader ramifications to Malaysia.

The diligence of Japanese workers, work ethics and the team spirit are indeed worth emulating, but then these are the product of hundreds of years of culture. The backdrop of that culture includes hardships resulting from natural calamities, and sparse natural resources, against which Malaya and Borneo were and still are in sharp advantage as compared to Japan. The Japanese is also a culture where the prominent influence of Chinese civilization stares in your eyes. From tea-drinking and Buddhism, to chinaware and painting, and to lexicon and calligraphy, the creative Japanese have brought the Chinese influences into their unique own.

On to their own rich culture too, were grafted the science and technology of the Western industrial revolution through the process of the Meiji Renewal, and western concepts of democracy and Human Rights, particularly after WW II.

From the start, Malaysia looks a vastly different substrate from Japan. It has a culture on which Indian, Arabic, Chinese and later Western colonial cultures were preeminently grafted on to the indigenous cultures of the Malay archipelago. The foreign input into Malaysian culture may thus be said to be more sustained, direct and diverse than is the case of Japan. The strong infusion of the English language through colonial government and the growth of Chinese language education through sheer commitment of the sizable Chinese ethnic minority are also distinguishing features. The legacy of the British judicial system and the structured civil service, also puts Malaya and former British Borneo in comparative advantage. The Constitution and Westminister styled parliamentary were to be the basis of the healthy growth of a young nation.

Why then did Japan rise as Pheonix from the atomic holocaust of WWII to become the second largest economy in the World, and Malaysia rose to the Second World, but is now under threat to slip towards the Third World again ?

At first glance, Malaysia appeared open to positive foreign influences, from including its once aggressor, Japan; and Malaysia even promised to take a lead in the ICT age through the Multi-Media Supercorridor. But did it even ever Looked East to Japan ?

Japan was and is not shy of foreign influences, East or West, while Malaysia in great but unintelligent nationalist zest, jettisoned the English language from the education system, thus shut itself from an invaluable comparative advantage asset of learning and communication. The Chinese language education was softly suppressed, thus depriving Malaysia leverage of what is emerging as an increasingly important international language.

Japan kept corruption and crony-capitalism at bay through a robust criminal justice system; from the 1989 Judicial Crises, the Malaysian executive branch has controlled the Judicial branch, subverting the separation of Powers so essential to the healthy functioning of democracy. What is a great strength of Japan was not taken on board, but what functioning judicial infrastructure Malaysia had was slaughtered.

Japanese enjoy civil and political rights little different from any liberal western country; Malaysians are to be cowered by repressive legislation governing behaviour of academics and higher education students, the print media and rights of assembly and expression. Is it so difficult to understand that the free intellect and the free individual is the basis of a creative community and nation?

Malaysians are not allowed to learn the art of accountable local government from Japan or anywhere else. Grass-roots democracy or participatory democracy are remote concepts in Malaysian lexicon. Why deprive the Malaysians a vital instrument of social commitment and engagement? Are these latter not the accompaniments of the Japanese work culture about which Malaysians were exhorted to emulate ?

Look East or even look anywhere, has thus been mere rhetoric mired in the broader Malaysian ruling National Front agenda of the political and economic supremacy of a monoculture; as incitefully coined Ketuanan Melayu, this a mere pretence for the political survival of an unpopular ruling elite class.

The rejection of English may have had the effect of shutting out western ideas of civil and political rights, egalitarianism, feminist ideas and possibly religions deemed Western. Thus English language was temporarily brought back for Science and Mathematics education, but not for the liberal Arts subjects, if there is anything Liberal in Malaysian education. The refusal to promote the Chinese language education is to be understood from the ruling perspective and priority about monocultural hegemony over broader national competitiveness issues.

The Malaysian crony-capitalism, corruption, and political hegemony founded on race rhetorics meant that the worst aspects of the free market far supercede the its better strengths in its impacts on Malaysian economy. Distortion to labour, prices and incomes becomes further bugbear to progress and social stability. Investors leave Malaysian shores.

The political change of the largest world economy, USA, and now the second largest, Japan, puts Malaysia and the world on notice. On the heels of China, the new Democratic Party government of Japan will be using social welfare spending as one of the tools of stimulating its long ailing economy. Will both China and Japan be building a social security system to match those of western social democratic systems?

One can look East, South, North and West, the message is unmistakenly clear every where; CHANGE WE MUST ! Look to Japan for a smooth transition of power in a mature democratic Land of the Rising Sun. Looking East this season for Malaysians is as good as looking anywhere else, and look East really hard this time round.

Time Sarawak has Health Services Management School

2009-08-14T07:41:00.000-07:00

NEED FOR SETTING UP SCHOOL OF HEALTH SERVICES PLANNING AND MANAGEMENT IN SARAWAK.

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

AUG.2009.

“--- in an advanced nation as we aspire to be, there should not only be expensive top end medical technologies and services available for the elite few, but there should also be accessible and equitably distributed medical care –“

“A Keadilan government, genuine about human capital development, will positively engage with the medical and allied professional stakeholders, and health related NGO reps, in medical services development; we maintain that getting competent professional advice in public decision making will reduce the chance of large scale public policy and project failures.” YB Dominique Ng, ADUN Padungan, extract of speech in DUN.

SUMMARY:

In the general context of high complexity and rising national health care costs, Sabah and Sarawak will need a large injection of public sector funding for new facilities and upgrades to achieve a “catch-up growth”. The disparity of service provision between E. and Peninsular Malaysia, and the growing accessibility problem following Privatisation Policy, aggravated in face of a stalled economy, need to be addressed by government. The public interests in medical care in Sarawak has been largely canvassed by a single political party, but in the last 2 years receiving some limited bipartisan support.

Devolvement and decentralization as part of needed structural reform was stated, (but left to future discussion).

In anticipation of the needs outlined, the implementing capacity of government must be beefed up quickly by training a body of health services planning and management professionals of multi-professional backgrounds. It is suggested that such a school be set up, at relatively low cost, to benefit the State and nation. The new HSM profession will help better inform political leaders and the wider community in the much needed dialogue on health care and social welfare issues in the decades to come.

FULL TEXT

That no nation has it absolutely right attests to the complexity of providing health care services to nation states. USA spends double digits of its GDP on Health, but has been struggling with reforms even as you read this, as Obama tries to provide universal coverage for a large section of the lower socio-economic groups left out under market mechanisms. UK has its well established NHS, very tightly rationed, partly through GPs as controlling “gatekeepers.” Australia provides high quality universal coverage to its citizens at high costs, but not without funding constraints and deficiencies in practitioner

supply to rural and remote areas. The “socialist market economics” which power the rest of the Chinese economy, has left the greater part of the population not covered to receive affordable medical care.

Medical care is human resource and technology intensive, subject to great flux in a social-political environment undergoing ever more rapid change. The multi-disciplinary high-knowledge personnel teams have to be optimally engaged to deliver patient-care individual and community outcomes.

Health services delivery, based on whichever international models, has proven to constitute an increasingly larger part of the GDP. In Malaysia the public and private combined outlay of just under 4% of GDP is relatively low compared to some western nations. However domestic political and health care policy re-orientation in Malaysia may see the share by Health in the public sector jump by 50-100% in the medium term. The increased supply of Medical graduates at around 3000 a year nationally, will further create its own demands and in its wake, rising national health care costs, a sequel predictable by health care economics.

The health care needs and deficits of Sabah and Sarawak are quite staggering, as we have outlined in “Time to review medical care services in Sarawak”, which we went to press in April, 2008 and which we canvassed again in August 2008 (1):

“-----reiterating the following proposals:

Sibu, Miri and later Bintulu should be upgraded to Regional Referral Hospital status, providing a wider range specialist and sub-specialist services in 5-10 years, such as psychiatry ,cancer, cardiology, nephrology, urology, burns among others.
A few other divisional hospitals need to be upgraded to general hospitals with 5-6 basic specialist services, as expressed initially by Parti Keadilan Rakyat and later the BN MPs of Sarikei, Limbang and Kapit. The Sri Aman, Lubok Antu and Saribas population has also long been underserved.
State Government, Federal and Education Ministries must urgently and jointly address health services manpower issues, in view of the enormous upgrading of health services due to the people of Sarawak.
Attention should be paid to health services planning and management training to policy level, necessitated by a newly arising scenario of bipartisan recognition of the need to address severe medical care services deficiency.
There needs to be a systematic devolvement of decision making authority and responsibilities from central government to state government if the medical care needs of Sarawak were to be met in the decades ahead.”

“Parti Keadilan leaders in Kuching had during the 2006 State general elections campaign, called for the building of 3 standard polyclinics and 3 general hospitals around the growing Kuching metropolis within the next 10 years or so. They are to serve residents of Petra Jaya-Santubong, Pending-Samarahan-Asajaya and Batu Kawa-Padawan-Mambong respectively. Planning should start soonest—“ (1)

It is evidently clear that the medical care agenda is so massive that even if the present MOH planning and management machinery were to move entirely from KL to Kuching, it can barely cope with the needs of Sarawak, not to mention Sabah as well. Even the proposed second hospital for Kuching, whether new or converted from SIMC, will prove an enormous stress to the manpower capacity of the Ministry for the subsequent 3-5 years. (2)

Catch-up growth in the public health sector is mandated by both the disparity of development between Peninsular and E. Malaysia, and also by a large hiatus due to sharply reduced public sector health care infrastructural development as a result of the wider government Privatisation policy of the Mahathir era.

Large scale privatization of medical care replacing public sector financing is hazardous politically even with a highly robust and broad middle class economy; the ills are becoming increasingly apparent for a nation facing economic stagnation since the Asian Crises of 1997, increased income and social inequality and a drop in real disposable incomes as a result of world-wide inflation. Private and individual financing for medical care is feasible for some 20% of Malaysians nationwide, but even less for Sabah and Sarawak. Holding back public sector funding will prove more and more politically untenable for government. Sooner rather than later, this has to be a bipartisan recognition of the political realities of Health Care.

To meet the health service planning and management demands of the needed catch-up growth, the 2 East Malaysian states, with also the highest population growth among the states, must urgently develop their full health services planning and management competencies, this reasonably achievable within 5 years.

The jury may still be out on whether health care is economically productive, but to leave the planning and management of health care without the contribution from the disciplines of public policy, health economics, accountancy, general and business management, health and social statistics, engineering, architecture and design among others, would be irresponsible and even catastrophic. The current Sarawak International Medical Centre fiasco is a case in point.

The health services planning and management field (H.P./ H.S.M.) attempts to forge a multi-disciplinary approach to the optimal delivery of modern health care, including public health and epidemiology, social science, economics and accountancy, general management, demography, law and ethics, media and communications, research science among others, and aided by IT. Major fields of learning and related professions provide a facilitatory and enabling structural and management framework for the medical, nursing and allied professionals to apply best practice evidence-based medicine to patient care. Some of our finest professionals should be called to contribute to health care, which is challenging us with advancing new technology, rapidly rising costs and difficult bioethical issues.

The health service management professional may be trained through a diploma course or as a primary degree undergraduate course, or be drawn from other established professions like medicine, nursing, public administration, economics and management through a (post)graduate programme. Accreditation as a HSM professional would follow training specified by a profesional accreditation agency. Italics (2).

Malaysian central planning and educational authorities are lagging in awareness of the field of health services management (HSM). Limited exposure to planning and management is provided in the Master of Public Health programmes at local universities, rightly reflecting the over-riding importance of tropical communicable diseases before morbidity from lifestyle changes and the explosion of medical technology set in.

A couple of medical officers are sent overseas to do Dip. Hospital Administration or graduate H.P./HSM programmes annually. Their subsequent input into the health system is however curtailed by structural arrangements.

On return, they are appointed either as Hospital Directors or as officers in the Planning Department of the Ministry of Health in Kuala Lumpur. The Planning Department is however a misnomer, for it does not deal with the whole range of national health policy, structural issues, health service financing or holistic planning, but rather it engages in newly approved physical facilities and their design; even this, it is deficient in the post-commissioning evaluative phase processes which are invaluable in influencing subsequent physical projects.

Sarawak would make a national contribution if it were to start a School of Health Services Management, at Diploma, undergraduate and graduate levels in conjunction with reputable overseas partners, as are found at a couple of Australian universities.

The cost of setting up is rather minimal, as only small lecture rooms and tutorial rooms are needed, and much academic material may be sourced online. The greater operational costs relate to academic staffing and resource library. However a small to modest annual outlay of around RM$10 million is needed initially. The sum pales in comparison to the RM$350 million spent on the Sarawak International Medical Centre project, a giant fiasco which would have been wholly avoidable had the protagonists been exposed to proper professional HP/HSM advice.

The financial investment is small, but the returns to health care management and health sector efficiency and effectiveness would be enormous. HP and HSM training must proceed, notwithstanding the health care model adopted. It may be crucial to the long-term success of inevitable health care structural reform for Sarawak and Malaysia in future; it would greatly help the further development of both the public and the private health care sectors, including future health tourism ambitions as part of the services economy. Professionalism will be greatly enhanced at all levels from policy makers at national and state levels to middle rung managers of hospitals, large polyclinics, and local divisional and district health management. Italics (2)

There will be developed a common language to help bridge the communications gap between the medical and nursing professions with legislators, NGOs, political leaders, managers and administrators from other professions. Other professional fields engaged extensively with Health Care would also be duly benefited, these as the wider social spin-offs which are only partly tangible.

Certain basic principles will also be imparted to political leaders as reference points on which to base their political platforms in relation to health care policies. Among others, these relate to resource allocation issues, health services financing, evaluation of new technology, HRM in Health, quality assurance, etc.

A new core of HSM professionals will be borne to replace the only 3 Sarawak-borne doctors who benefited from such training, and all of whom have reached retirement age. There is need for a much larger group drawn from various professions, in addition to medical, who will articulate policy, needs, values, reforms, process and outcome issues,

and take a lead role in steering the health care delivery of Sarawak for the new century.

The emergence of a professional group will guide discussion of a range of health and social welfare issues and thus also help promote meaningful community participation and input into future health care and social welfare policies.

1 Ngu, F.H.H., ” Rational Medical Care Planning”, press-release Kuching, 7th Aug. 2008.

2. This author, in a discussion paper, unpublished, “A structural framework for DECENTRALISING MANAGEMENT OF HEALTH CARE SERVICES for SARAWAK.’

Reproduction: Social Welfare Article

2009-04-13T23:16:00.000-07:00

A plea was made at the peak of the Oil Crises in 2008 for a new Social Welfare Policy for Malaysia primarily to mitigate the hardship of Malaysians in the lower socio-economic groups from the oil price shock, though other macroeconomic considerations feature prominently as well.

While a few of the assumptions of the writer have clearly changed due to circumstances brought on by the subsequent global economic crises and the collapse of commodity prices, the central plank of social welfare as good public policy holds. If anything, the economic downturn makes such policy rethink all the more pressing. Nations in the Asian region, Singapore, China and Taiwan(China)have all beefed up welfare aid to the economically depressed. Australia on top of its institutionalised super-generous social security , was the first to give out handouts as a driving component of its stimulus package. A second handout is being given out around Easter, benefiting those with incomes of AU$100k per annum and below.

A fresh boost to social welfare in Malaysia, however weak comparative to neighbours, should be on the agenda.

Indeed a measure of the quality of public policy of any nation is the quality of its safety net provisions for the vulnerably disadvantaged. Social security would present a humanising side to mitigate the avariciousness of the unfettered free market.

In today's Malaysian Insider blog comment to an article "Malaysia to push economic reform", Professor Chan Chee Khoon of the Science University of Malaysia has timely called on government to address the wages and incomes issue, and institute minimum wage to spur aggregate demand.

This writer believes that social security is an essential policy tool to boost domestic demand, reduce petty crime, building of truly caring society and other desirable social objectives.

In the "Islamic Welfare State" of PAS, and Khalid Ibrahim's "Merakyatkan Ekonomi", one hopes the first seeds are now been sown which will in time bloom into a decent
Social Security system for Malaysia.

Francis Ngu

TEXT OF REPRODUCED ARTICLE
DR. FRANCIS NGU CALLS FOR MAJOR SOCIAL WELFARE POLICY INITIATIVE.

SUMMARY:

The abandonment of subsidy for fuel and even other subsidies will lead to severe and multi-sectoral repercussions yet to be fully realized, including stagflation, increased unemployment, social unrest, manifold increase in poverty and poverty related crime. At this crucial juncture, a long term social welfare policy programme should be put up, even belatedly, to mitigate quite disastrous spin-offs from the controversial policy of abandoning fuel and other subsidies. The implemention of a social welfare policy is proposed here as a major prong of a social justice reform programme, and to mitigate the effects of local and international economic slow down.

FULL TEXT:

In the midst of social anger and large and small protest actions of various groups, it is incumbent upon social welfare NGOs, political workers, scholars, professionals, leaders in the business and civil service, and legislators to begin an urgent debate and discussion on the medium and long-term socio-economic impact of a possible doubling of petrol price in the near term to around RM4 per litre.

Considering that fuel price would have risen 3-4 fold over a medium length period of 5-10 years, if the pump price approaches RM 4, and all the other essential goods see price rises to compound, the purchasing power of the Malaysian consumer will fast evaporate.

This is well understood and painfully felt by the public at large. The anticipated dive in consumer and investment confidence, and the drop in GDP is reflected in the opening bells of the KLSE on the morning of June 5th.

The concurrent effort in wages reform in the private sector, even though feeble, and the need to scale down foreign labour, add to the difficulties of various business sectors. Job creation will slow down, unemployment will worsen.

All taken together, a stark scenario of rapid inflation and slowed growth, in Malaysia and overseas, sets the ground for the worsening of poverty and increase in the poverty rate towards levels of 1970s, if not earlier. In its wake, social unrest and poverty related crimes. Without political will for reform, poverty eradication will be thrown into the ever distant future.

There is no doubt that Malaysia is facing a severe crisis, which, to the lower socio-economic groups, is far more severe than the 1997, Asian Financial Crisis.

Yet, ironically, the crisis to the average consumer, may not have to be so severe, or there need not even have to be a crisis at all ! This is because we are also in an unprecedented commodities boom! The export price of petrol has increased 10 fold from under US $20 to US $ 140 ! CPO is the mother of all golden crops now at some RM 3500 per tonne.

It only points to the fact that the nation’s wealth distributive mechanisms have failed miserably. The GINI index has risen steadily to 0.47.

For some 2 decades, government has resisted any notion of meaningful wage reform, including a minimum wage as a start. A systematic social welfare net has been denied to the lower socio-economic groups, even during the 1997 Asian Financial Crises. Such an institutionalised social safety net is not mentioned even as we face paying the full price of fuel on world markets.

The promoters of the denial mentality paint a glowing picture of pristine economic health against a fictitiously low unemployment and poverty rate.

The most prosperous nations of the world have poverty rates of 10-12 % against Malaysia’s poverty rates of 2-3 %. Unemployment rates of 4-5 % only occur in intolerably booming western economies. The claim that Malaysia has one of the lowest prices for fuel and essential goods should at least be balanced by the fact that wages in those other high cost countries are 5-15 times Malaysian wages. Again, in those high cost countries, annual income of RM 150K and below is considered low income in public policy debates; an annual income of RM 50K may already entitle a family to receive welfare assistance. The monthly social welfare payment to a poor family overseas may be 4-5 times the starting wage of a professional in us “lucky” Malaysia!

When we face the reality of prices in a globalised world, when subsidies are being dismantled, it is hoped that the denial and feel-good mentality will fade away. Otherwise, there can be no meaningful debate on public policy.

It is hoped that meaningful public policy debate will lead to meaningful public policy within the short term. We are now moving painfully away from a distorted market economy with multiple subsidies, but we are faced with a market economy where eventual removal of price controls is leading to inflation at a pace threatening the livelihood of many. Nearly all the first world free-market economies have solid social welfare systems put in place 50-100 years ago, both as a principal of social justice and also as an essential policy to safeguard social stability.

A Malaysian Social Welfare System must be set up soonest, and should be running before any further price rises in fuel and further removal of other subsidies. The compensation to vehicle owners is a queer cabinate invention, which does not address the rising cost of living for all consumers, especially the poorest who obviously may not even own a motor vehicle. A long-term social welfare programme must proceed alongside a more vigorous wage reform drive in the private sector and regulation of foreign labour. Personal tax cuts and refunds by significant elevation of the lower thresholds should also be considered.

Welfare as a social policy principle.
When the livelihood of a large segment of society is threatened to a level affecting social stability, the arguement for and against individual charity vs institutionalized charity becomes academic and should be put aside. The basic dignity of living is too serious a matter to be left to charitable whims of individuals, but must be effectively addressed by institutionalized welfare. Individual and community charity initiatives continue to grow ever stronger in countries with matured social welfare protection.

In these countries too, there is no proof of generalized economic malaise as a result. Fine tuned welfare programmes are nowadays tied together with skills re-training and with employment search for the healthy unemployed.

Social welfare recognizes the right of citizen to have a basic dignity of living and belonging to society, something so important to social peace and cohesiveness. It is further an instrument for providing a level playing field for all, and for individuals and families to realize their full potential. Human creativity and initiative may be suppressed and trapped by grinding poverty.

Last but not least, social welfare is an integral part of the programme of major political parties promoting people’s welfare using different terms such as social justice, democratic socialism, welfare state and others. It is now more apparent than ever before that a dose of welfarism is needed to survive the disaster caused in part by the globalised and ailing free market.

Social welfare is affordable. Although Malaysia is a mid-range developing country, the present commodities prices boom alone enables Malaysia to put in place a robust social welfare programme soonest. The present petrol price rise is saving the nation of a massive “subsidy”, which is really increased profit to Petronas. When the pump price is floated at international market prices, the profit increase to Petronas is RM 50 billion, more if world crude rises further. All other subsidies, if finally withdrawn, is estimated to save government another RM 50-80 billion. All leakages of subsidies, and to undeserving sectors, would have been plugged.

Certainly, much of the RM 50 billion or RM 100 billion earned by Petronas or saved by government, should be set aside for economic investment, especially public transport infrastructure. It is immediately obvious that even 10% of either sum is sufficient to launch the programme, 25 % of either will establish a good programme and 50% will send all the street protestors praising the government. Thus welfare aid is institutionalized at a level consistent with the economic strength of the nation.

Social welfare payments may be implemented within months.
Emergency Implementation.
Should it be necessary to reduce public panic, emergency implementation may be necessary, with all the pitfalls fully realized.
With the progress in electronic banking, there should not be difficulty to effect payment to all IC card holders with a bank account. Payment to minors should be through parents.
Payments to the poorest of the poor without bank accounts, may have to be separately dealt with, as well with some Sarawakians with no IC cards. Without means testing, this may mean a significant leakage to the small wealthy segment of society; however it should be a tolerable price to pay for staving off social unrest.

Long term Implementation.
Fine tuned long term programs will have to be based on Legislative Framework, Means Testing, Welfare Fraud Detection and Judicial Sanctions. If we can embark on space age ambitions and mega-projects, can we not establish an efficient and effective implementation network nation wide for social welfare within 1-2 years?

Social welfare to mitigate economic slow-down.
Malaysia is said to have negotiated its way out of the 1997 crisis by pump-priming the economy by spending on infrastructure, among other measures. The economic slow down this time round is dictated by rising cost of production and severely damaged consumer and investor confidence and anticipated dipping of export demand for manufactured goods. Tourism and related services may also be affected. A social welfare system spending of RM 20-30 billion alongside infrastructure spending will help maintain domestic retail and services demand and restore part of the business confidence.

Thus a social welfare system is justifiable in terms of public policy, affordable , technically feasible and even economically sound.

OBAMA; PAX GRANDE UNIVERSALIS?

2009-04-13T20:19:00.001-07:00

OBAMA STRIKES: PAX GRANDE UNIVERSALIS ?

In the midst of global Recession and on-going campaign against terrorism, President Obama has in recent days reinforced himself as a statesman ready to rewrite USA foreign policy, and paint a new international relations landscape for the new century.

Recapitulating, his "Change we can" campaign slogan not only fired up Americans, but inspired all those around the globe yearning for a better social and world order. His inaugural " -- history is not on their (dictators') side--" gave the needed confidence to those engaged in democratic and human rights movement; his outstretched hand softened public opinion in staunchly anti-American countries, including Iran. He has delivered on some major policy provinces, of which there are two which are perhaps the most far-reaching to date.

ABOLITION OF NUCLEAR WEAPONS

The president is on record to have called for the abolition of the entire nuclear arsenal in the world, the first US President to have committed to so. He also announced an immediate return to the 1972 Nuclear Test Ban Treaty which his predecessor had so recklessly abandoned and one which had underpinned international nuclear non-proliferation efforts.

One would have thought his declaration would have delivered a seismic shock to nations shielded by the US nuclear umbrella, like Japan, S. Korea and Australia.
On the contrary, in a article in the Melbourne Age on March 8th, several Australian luminaries led by former Prime Minister Malcom promptly call on Australia to seize the Obama moment and play a proactive role in the abolition of Nuclear Weapons.They point to the catastrophic geo-political, social, health and economic fallout from even a "minor" nuclear conflagration. The same broadsheet has on Easter Monday given a generous endorsement of the President’s foreign policy overtures as well.

It is now incumbent upon leaders of nations possessing nuclear weapons to engage positively with President Obama on nuclear non-proliferation, test ban and abolition of the entire arsenal. Nearer home, Wisma Putra and the ASEAN Secretariat, should add their voices in line with the ZOPFAN principle. Credit also should be given to Dr. McCoy and others in Malaysia who have campaigned for years on the issue, though drowned out by national political problems.

END OF ISLAMOPHOBIA ?

Following an enchanted tour of Europe, Obama not only declared to the Turkish Parliament " --we will not fight war with Islam--", but must have stunned many by stating that Islam has enriched the culture of USA. He will undoubtedly be slammed by many on the far right; but here is a statesman, Christian at that, who marvels at the magnificence of a Turkish mosque and gives meaning to the “out-stretched hand” of his inaugural speech. . In one stroke, he has not only tried confidence building, but has really started a civilizational dialogue, as essential to world peace as it is presidential.

Islam-bashing following 911, much of the non-Islamic world will now have to reorientate itself to a new language of trans-cultural reconciliation; an that of course would include the print and electronic media.

Home in Malaysia, may we credit a towering Malaysian leader who authored "The Asian Rennaisance", and made an impassioned plea for civilisational dialogue over a decade ago. He would have been pleased with the Obama initiatives, like some of us, but even more pleased that, even as Obama spoke those re-assuring words to Muslim sisters and brothers, many non-Muslim Malaysians (voters) showed they are able to cross the cultural and religious divide and seem poised to embark on the noble road of ethnic reconciliation.

At first glance unrelated, these two major areas of US policy have in reality considerable inter-relation.With the end of Cold War, a “clash of civilisations” is believed to be the likeliest trigger for a nuclear conflict, such as in the Middle East or in South Asia. Thus the policy re-tuning in the above fields is indeed of visionary wisdom.

GESTURES TO LATIN AMERICA

Again, at the Pan-American Summit, the President lost no time in taking intiative to
reduce hostility to the US from her "traditional sphere of influence" which is Latin America. Declaring "I am not interested in arguements of the past--", he set out to envisioned a new future of cooperation and progress based on mutual respect. His conciliatory message to Cuba will in due course spring us with many surprises and hope for greater stability and social justice in a whole hemisphere. Though US-Cuban
antagonism has long ceased to be a threat to world peace, like it was in 1961, improvement in their bilateral relations would nontheless be consistent to a more peaceful and harmonious world order.

Has a new world millenium just begun, a more enlightened millenium, some 10 years late ? Will the years ahead see peace and goodwill break out in the world? Is it penultimate naivity to dream of a peacefuland harmonious order in world history ever?

It is as much for civil society, as leaders of nations large and small, to press for millenial change in the space that Obama has created.
It may have been the most meaningful pre-Easter message one hears; and shall we conclude with : In God Allah we trust.

Francis Ngu.
(updated 19th April)

SUNGGUH BESAR ALLAHKU

2009-04-11T23:10:00.000-07:00

An attendance at an Indonesian language Christian Easter service today has provided the substance for this post; it throws some reflection for me a Malaysian, in the face of the gazetted ban in Malaysia for Christians to use the word Allah.

The main explicit reason for the ban was that shared usage of the word ALLAH would cause confusion to the majority Muslim population of Malaysia, but this has been firmly refuted by a most respected Malaysian Muslim cleric, Tok Guru Nik Aziz.

During a recent short husting during the Batang Ai by-election campaign in
Sarawak, an Iban (Dayak) showed me the the first lines of the Genesis in the Iban bible where clearly the word Allah was used from the very beginning that the Iban Bible was published. Anyone can figure out the implications of such a legal ban on the word Allah, for Christians in Malaysia using the local language Bible. Enormous distress, to say the least.

Since then I have come down to Melbourne meet my children here.

There is this suburban Uniting Church of Australia (amalgamation of Methodist and Presbyterian churches), which hosts an Indonesian language service for Indonesian Methodists resident in Melbourne. Many of those at the service are of ethnic Chinese origin, but there is also a sprinkling of the Indonesian ethnic diaspora and just a couple of fairer skin Australians among the small congregation. Thus I was able to speak with a Sumatran Batak, who number only 2 million back in Indonesia and of whom 5% are Christians.

Although not a Methodist myself, I nevertheless feel brotherliness with a congregation celebrating in Bahasa Indonesia of which my national language in Malaysia is so similar. There was for me a certain "at home in Malaysia" feeling.

Throughout the service, the mainly ethnic Chinese congregation used the words "Tuhan" and "Allah" in reference to GOD repeatedly. The above caption " Great is the Lord God" was flashed on the projection screen as the hymn to the same title was solemnly sung. Thus in Indonesia, with the largest Muslim population among nations in the world, there is acceptance for Christians to refer to God as Allah.

With the gazetted ban on Christians in Malaysia using the the word Allah, would it follow that an Indonesian Christian would be banned from bringing the Indonesian
language Bible into Malaysia?

Had Malaysian authorities foreseen that the gazetted ban may have extended repercussions beyond its own Christian citizenry ?

Blog master

Easter and a Revisit

2009-04-11T17:30:00.000-07:00

On this Easter sunday, the eternal massage is that by the death and ressurection of one, Jesus Christ, God and Man, (add a Palestinian of Judaic traditions), humankind has the prospect of salvation from the eternal damnation from Sin. Following Him and His teachings, people will rise from death and attain the Paradise. Hallelujah! ( I hear Handel's Messiah).

I remember attending religious classes in my days at a Sarawak Catholic LaSallian School, whose Irish brothers I remember with highest respect. They evengelised without coersive orientation, but by combining spiritual humility and enlightened multicultural tolerance and appreciation.

In that enlightened Catholic Christian context, the classes I refer to were introduced to simple texts "One God Many Paths".

In the belief that I have subsequently evolved, the book title is quintessentially Christian, and "Catholic" at that. Mark however, the notion of "One God Many Paths" may be contested by not people of other faiths but by many new found Christians. It is comforting though for one to hear on BBC on Easter, from the lead Anglican cleric in Bagdad, who believes that good followers of Judaism and Islam may be saved just like good Christians.

Back to Easter. The passage from death to life, from darkness to light or from evil to goodness resonates through different faiths of course: the Hijrah of Islam (Alhamdullilah!), the Passover of Judaism, the Buddhist enlightenment under the Bodhi Tree celebrated at Wesak, the Deepavali of the Hindus, even the scientific humanism of the atheist. Thus a conscious and spiritual search for the Truth and Goodness, whether the faith is polytheist, monotheist or nontheist, much of it also embodied in a relatively new faith of Bahai.

The great faiths, and would one dare to say scientific nontheist faith, are Divine gifts to humanity, different in form to suit different cultures, at different times of history. They are however very similar in substance, in the shared core values of love and humanity, and they should be universally shared in the globalised confluence of digital age civilisation.

That apparent differences in faiths may not lead god-created communities, and indeed the entire world, to self-destruction in nuclear-age conflicts, but that the shared universal values be the driving force bonding humankind, divinity and divine-created Planet Earth.

Hallelujah!

Francis Ngu

Harnessing the talent in Pakatan

2009-04-10T23:04:00.000-07:00

A statement of concern for the "Dearth of talent in PKR--" by Muaz Omar has appeared 0n the Malaysian Insider blog today. PKR may count itself lucky to be singled out among Pakatan parties, or for that matter all other parties for criticism; it challenges PKR national leadership to conduct its own assessment of the truth or otherwise of the writer's assertion.

While one can fairly easily dispute Omar's contention, one may more critically question Keadilan if it has adequately and optimally harnessed available talent in the party. I think there are qualified people in numerous professional fields, business people and experienced NGOs among its membership nationwide, many of them, thuough second to Khalid Ibrahim's profile, have not emerged to the front at this stage of the struggle. Nor should all of them be in the frontline in future; it is however of critical importance for them to begin playing co-ordinated supportive roles to Pakatan/Keadilan legislators, even in the backrooms.

Even in the late- on- board East Malaysia, among its indigenous leadership there are a couple of PhDs., MBAs, lawyers and medical doctors, and numerous other graduates. A few newly retired civil servants of profile may also be in the pipeline. These would be readily overwhelmed by highly qualified professionals among the membership in Peninsular Malaysia, though some more would be undoubtedly welcome.

It has to be appreciated that many young professionals with high "market worth" would hardly think it a wise choice career-wise to join a movement which in its heydays was lambasted by some for its determined presence on the streets. To most of the middle and upper middle class,an association with the "Reformasi " mould was just not "in". Even if they did come in, professionals may not generally be the ones most effective in mobilising the masses in the all important electoral battles past, present and to come.

Going forward it may be time for the party to start co-ordinating its intellectual base and harnessing their full potential for the better governance of future federal and state governments.

And here it is for management consultants, such as Muaz, to contribute. Correct me, if with my meagre experience in human resource management, if I were to recommend the following basic measures to the party for a start:

1. Start a HR electronic databank for the party, separate registers for Diploma, degree, masters and PhD; electronic sorting by public-sector or business and industry experience or both should be possible, among other characteristics ;

2. An HRM national team of the party to identify key people for designated public policy areas;

3. Assigning public policy teams to State Excos, related shadow cabinet, and other state and federal YBs;

4. Public policy ad-hoc briefings, seminars, work camps for shadow cabinet and Pakatan legislators (could BN legislators be invited too?);

5. Public forums on public policy for confidence building by Pakatan parties

A voluntary contribution from Muaz and others would be undoubtedly welcome by the party.

Francis Ngu,
MBBS (Mal.), MHP(UNSW)

2009-04-10T22:02:00.000-07:00

LATE ON BOARD

A near IT-illiterate, I chance upon a blog invitation to set up my own blog, so here I am trying to navigate the blogger's jungle. I have said a few things on other's blogs; so now I try say more on my own tool.

Welcome on board the late sail out of exotic Borneo !

Francis Ngu

N Francis Sarawakiana

The looming malaysian healthcare debate part 3

THE MABO RULING IN AUSTRALIA AND NATIVE CUSTOMARY RIGHTS OF SARAWAK

THE LOOMING MALAYSIAN HEALTHCARE DEBATE (PART 2)

THE LOOMING MALAYSIAN HEALTH CARE DEBATE (PART 1.)

The Column That Wasn

An overview of the "Allah controversy"

PROJECT NEW MALAYSIA

“The Policies of Pakatan Rakyat.” THIS IS PROJECT NEW MALAYSIA !

Dr. Francis Ngu, member Parti Keadilan Rakyat, Sarawak. Dec.21st, 2009

This is an attempt to bring about far reaching reforms which the people are now anticipating. A fresh new national consensus is sought by Pakatan Rakyat which will be worthy of a progressive nation facing the challenges of the globalised scene of the 21st Century.

My alma mater

MALAYSIANS, LOOK EAST THIS AUGUST 31ST. !

Time Sarawak has Health Services Management School

Reproduction: Social Welfare Article

OBAMA; PAX GRANDE UNIVERSALIS?

SUNGGUH BESAR ALLAHKU

Easter and a Revisit

Harnessing the talent in Pakatan

Dr. Francis Ngu, member Parti Keadilan Rakyat, Sarawak. Dec.21^st, 2009

This is an attempt to bring about far reaching reforms which the people are now anticipating. A fresh new national consensus is sought by Pakatan Rakyat which will be worthy of a progressive nation facing the challenges of the globalised scene of the 21^st Century.