We Need A Well-Organised And Humane Health Care Governance!

Emeritus Professor Tan Sri Dato' Dzulkifli Abdul Razak 
Opinion - Bacalah Malaysia 
July 1, 2023 

It was reported that the Malaysian Medical Association recently hit at a ‘disorganised and messy’ doctor placement system when hundreds of complaints from junior doctors were transferred to hospitals lacking facilities for their specialisation. 

Many doctors applying for their placements faced system errors and crashes, causing them to reapply multiple times according to a survey of 154 junior doctors about their experience with the system, called, eHO. 

The Ministry of Health (MOH) was urged to compile and release a complete list of all health facilities and the number of doctors needed for each, with priority given to doctors who have passed their examinations to continue their specialisations. This sounds like a reasonable request that should have been considered without being asked. 

Be that as it may, without any prejudices, there may be some ‘hidden’ issues acting as ‘barriers’ to what many would regard as a common-sense approach, pure and simple.

For example, most recalled another seemingly ‘disorganised and messy’ encounter involving the same ministry involving the declassification of nicotine for e-cigarettes and vapes in the liquid and gel forms! 

The mess started on April 1, and it is now coming to the fourth month without any sense of urgency to resolve it. Despite numerous professional advice and promises, it remains very much ‘disorganised and messy,’ and getting even worse! 

Yet, as late as last week the Health Minister reportedly is still harping that the issue needs to be taken seriously due to the smoking habit, especially the increasing use of e-cigarettes and vaping, contributing to the increase in the burden of diseases in the country.  

This was precisely the forgone conclusion that she categorically brushed aside when advised not to declassify nicotine during the eventful Poisons Board meeting in March.

It was vetoed, and now “crying over spilled milk” by begging “all parties to support efforts to ensure the Control of Smoking Product for Public Health Bill 2023 can be tabled in Parliament at its next sitting.”

What happened to the promise that was on record for the May sitting? 

Even then, in the last Dewan Rakyat meeting on June 12, the government failed to secure passage of the Control of Smoking Products for Public Health Bill 2023 – in regulating e-cigarettes and   vape –sending the Bill instead to the Health parliamentary special select committee (PSSC) after first reading in the Lower House. 

Allegedly, prior to the June 12 tabling for the first reading, no MPs had seen the draft Bill due to the Official Secrets Act, with the Health PSSC and other legislators giving feedback only after receiving MOH briefings based on the “principles” of the Bill. What a mess!

All these are a waste of time, efforts, resources and more so lives that are precious, should the first term Minister be humble enough to listen to those who are more experienced in dealing with such a complex life-and-death decision!

Her recounting: “Smokers or their family members and friends should take this opportunity to show their love by getting help from smoking cessation programmes,” is virtually hollow because the horses have bolted, and she as a Minister must be made responsible and to apologise. 

By quoting the 2019 National Health and Morbidity Survey report and admitting that “Malaysia is witnessing an increase in non-communicable disease cases” which “can actually be prevented through the culture of a healthy lifestyle including not smoking,” only serves to strengthen the views of being ‘disorganised and messy’ in handling the evident-based situation. 

What is more, the survey also showed that an estimated 27,200 deaths every year in this country are due to smoking. It claimed that “the prevalence of smokers in the adult group is 21.3 percent of the population with an estimated 4.8 million people.” 

To top it off, the upward trend in the use of e-cigarettes and vaping with a prevalence of 4.9 per cent or equivalent to 1.13 million users among adults came as a shock.

Especially findings from a youth health survey involving young people, aged 13 to 17, showing an increase in e-cigarettes users from 211,084 people in 2017 to 301,109 people in 2022. 

This excludes the use of conventional cigarettes involving this group of teenagers, which is a total of 186,817 people in 2022. While the Minister is spot-on that “the data shared is a real scenario that demands concern and joint action from all parties,” to date, she hardly shown effective leadership on this. Why? 

Perhaps this can be gleaned from her remark that the declassification of liquid or gel nicotine from the Poisons Act 1952 last March 31 as being “in line with the government’s collective decision” to impose excise duties on e-cigarette or vape liquids containing nicotine.

If so, it opens up the Pandora’s Box implying that the ‘disorganised and messy’ mantra may go beyond just a particular Minister and the Ministry. 

It demands a more compelling response from the government that the fundamental rights of the rakyat in ensuring health well-being is not squandered in exchange for monetary reasons as claimed.

It, therefore, must come to a closure soon as reminded by the World Health Organization recently. Lest, this may be potential an electoral issue. So, let truth be told!

• The writer is the rector of the International Islamic University Malaysia