Latest news with #underfunding
Malay Mail
a day ago
- Health
- Malay Mail
Health Ministry struggles to cope with chronic underfunding — Chan Chee Khoon
JULY 18 — Speaking at a public forum in Kuala Lumpur in 2023, a senior officer from Ministry of Health's (MOH) planning division denigrated the UK National Health Service as a poor example to emulate given its current sad state. Unfortunately, he seemed unaware of how the NHS had been ravaged in the preceding decades by both Tory as well as Labour governments, and what lessons MOH could draw from that decline (given the shared legacy of our Bevan–Beveridge institutional architectures). Just as we shouldn't unduly blame NHS for the service failures emanating from its subjection to an 'internal market' regime, we shouldn't blame MOH for its desperate resort to RakanKKM to monetise its (contested) inpatient spare capacity for supplementary revenues. Without supplemental taxes and substantial increases in federal allocations, MOH is desperately trying to cope with chronic underfunding by spawning a 'private' non-profit subsidiary. This was envisaged to generate some margins beyond cost recovery, from user charges for medium-cost services provided on a priority basis, by physicians of choice. The supplementary earnings were intended as cross-subsidies for MOH's regular patients, as well as incentives for MOH staff retention. Citizens' Health Initiative would like to offer a context and narrative that weaves together various strands in the continuing public discourse following the recent hikes in health insurance premiums. We do not present this necessarily as the unfolding of a premeditated strategy. It is more a descriptive chronology of contingent circumstances that nonetheless interacted in a manner that is gradually re-balancing the system towards healthcare provided on the basis of ability to pay, rather than on the basis of need. Why Malaysia needs to double its public sector healthcare spending Our post-Merdeka improvements in life expectancies at birth were internationally acclaimed, all the more remarkable given our very modest government healthcare expenditures (rarely exceeding 2 per cent GDP). The Rural Health Service's initiatives in village midwifery (bidan kampung), vaccine-preventable childhood ailments, tandas curah ('Jitra bowl'), the Applied Food and Nutrition Programme (AFNP), potable water supply, and control of communicable diseases were very well-chosen low-cost interventions which markedly reduced mortality among young children and mothers. Commendable increases in life expectancy at birth however mask a much less satisfactory trend in life expectancy in late adulthood, in comparison with Singapore, Taiwan, Hong Kong and other developed countries in the Asia-Pacific region: This poor adult life expectancy largely reflects Malaysia's burgeoning epidemics of Non-Communicable Diseases (NCDs), along with the highest prevalence in Southeast Asia of risk factors like obesity and being overweight. Meanwhile, the prevalence of diabetes mellitus had almost tripled from 6.3 per cent in 1986 to 11.6 per cent in 2006 to 17.5 per cent in 2015 (Yap et al, 2019; Safurah Jaafar et al, 2013). Malaysia's well-distributed primary healthcare system might have performed well for acute, episodic, self-limiting diseases in our early decades, but we are currently in new territory amidst escalating epidemics of NCDs. This epidemiological-cum-demographic transition requires multi-sectoral promotive as well as comprehensive primary health care, and the commensurate financial, staffing, and material resources to deliver it. We should not be captive to historical health budgeting practices whose modest annual increments are no longer adequate for the scale of effort that is now required—the prevention, detection, and oftentimes lifelong treatment of NCDs, with referral linkages and continuity of care at multiple levels, provided in a timely manner at adequately staffed and equipped facilities. Chronic underfunding of Health Ministry has obliged many Malaysians to prepare for contingencies – Picture by Raymond Manuel MOH's chronic underfunding At a public forum in September 2019, Tan Sri (Dr) Abu Bakar Suleiman (DG Health, 1991–2001) attributed the chronic underfunding to a developmental strategy premised on large inflows of FDI attracted through competitive lowering of corporate and income tax rates, which hobbled the fiscal capacity of states. This however was not the sole reason for MOH's chronic underfunding. There was concurrently active encouragement of for-profit healthcare, with tax incentives and subsidies, to cater to 'market-capable' segments of society. Tun Dr Mahathir Mohamad (PM 1981–2003) unwisely chose not to expand the public sector to meet increasing healthcare needs, preferring instead to allow space for the rapid growth of for-profit healthcare. Seductive logic of targeting Faced with this chronic underfunding, a succession of health ministers argued that Malaysians who could afford it should patronise the private sector (suitably encouraged thus with income tax rebates) so that the government could conserve its modest resources for the 'truly deserving poor'. This intuitively appealing rhetoric of targeting will more likely hasten the arrival of a two-tier healthcare system of deluxe priority care for the rich, and a rump, underfunded public sector for the rest. RakanKKM to the rescue of market failures? Chronic underfunding of MOH has obliged many Malaysians to prepare for contingencies they will likely face when seeking urgently needed inpatient care at congested public hospitals. For those without deep pockets, such contingency plans invariably look to commercial hospitals and the requisite insurance coverage for urgent critical care if and when its need arises. When large segments of the 'market-capable' middle class get entangled however in a tug-of-war between profit-driven health providers and profit-driven health insurers, the government is compelled to intervene, in this case with a 'premium economy' option RakanKKM in publicly owned hospitals. It is far from clear that MOH has enough spare capacity to scale up proof-of-concept trials to cater to policy holders abandoning unaffordable premiums. This could exacerbate existing backlogs of regular MOH patients even as neighbouring Singapore is aggressively recruiting Malaysian doctors and nurses for their own envisaged non-profit MOH hospitals. Unkept promises and a proposed Tabung Kesihatan Negara Meanwhile the Madani government continues to ignore electoral promises and calls for increased allocations and expanded capacity for publicly provided healthcare. This would require a dedicated ring-fenced Tabung Kesihatan Negara which could be funded by a supplementary progressive health tax, corporate taxes, property and capital gains taxes, Tobin-type taxes, 'sin' taxes, (zakat?), with credible stakeholder representation, accountability, and transparency. This however seems to be off the radar screen currently, hobbled in part by public scepticism over the stewardship of public financial resources. Will the Madani government live up to its name, or will we need to elect a government which keeps electoral promises, and which we can trust with the management of public monies? * This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
ABC News
2 days ago
- Health
- ABC News
'Health is a big issue': What's on Tasmanians' minds as they head to the poll this Saturday
Ben I'm a nurse and I currently work in the hospital and I have first-hand experience of how dire the situation is. We've got chronic underfunding, chronic under-resourcing, chronic underpayment of staff. We're not being paid enough so we're unable to attract staff. So we can't staff wards appropriately, we can't staff units. That includes nurses, doctors, allied health, pharmacists, like admin as well. Across the board we've been perpetually underfunded for the last ten years. Leon Compton One issue you'll be thinking about this state election on Saturday? Anne Well I think I've already given you a hint, I'm definitely going to be thinking a lot about health. Leon Compton And about health policy and about the future of investment in healthcare systems? Anne Oh definitely, because we have not enough staff, hospital staff. The Royal is definitely very, very understaffed and under-resourced and because I spend a lot of time at the Royal Hospital, because I'm a transplant patient, I really think a lot about health. I mean there was an article in the paper a while ago that said that people were being put in a cupboard at the Royal and I thought, yes I've been in that cupboard. So they're actually using resources that are not appropriate for what they're designed for. Leon Compton You've literally been put into cupboard space in order to receive treatment, Anne? Anne It was a very fancy cupboard, it was an under the stairs cupboard, but it definitely had a sense of light and every time you saw it you had to wave at it. Leon Compton Wow. Kelly Yeah, health is a big issue. We are an older population, we are sicker, we've got a bigger health load. I worked in health for nearly 40 years, I'm retired. And this government, this has consistently scunned out the health system. It's always about cutting, never about improving. Tegan I don't really like Liberals or Labor at the moment, I'm going for the Greens. Leon Compton Right, is that a new thing for you Tegan or have you been there before? Tegan No, it's been a while coming. The Liberal Party and the Labor Party just don't have what I need for what's going on with my family going forward. They don't have any policies regarding transgender health. And if they do, they're weak, so the Greens it is. Romeo Well I suppose those who are really interested in the welfare of the people are the ones I go for.
The Herald
08-07-2025
- Business
- The Herald
Stats SA must be protected to preserve democracy, says deputy minister
Deputy minister in the presidency Nonceba Mhlauli has sounded the alarm over the chronic underfunding and vacancies plaguing Stats SA, warning that the institution's ability to uphold democracy and drive development is at stake. Speaking during the Stats SA budget vote debate in parliament, Mhlauli said investing in the agency was not optional. 'A well-funded, capacitated Stats SA is not a luxury. It is an essential endowment to our democracy and our developmental state. Reliable data is the bedrock of reducing inequality, targeting services, and measuring progress,' she said. Her remarks come amid growing concerns over the agency's operational constraints. Last month, Stats SA presented a dire picture to parliament's portfolio committee on planning, monitoring and evaluation, citing financial challenges, ICT system deficiencies and a high number of unfilled posts. Statistician-general Risenga Maluleke cautioned that if these issues persist the quality of the agency's work would deteriorate. 'If the situation doesn't change, it will have serious consequences and [the] quality will start imploding,' Maluleke said. 'In the end, Stats SA might have to close.' Mhlauli echoed these concerns, stating: 'Inadequate funding and persistent vacancies at Stats SA risk weakening one of the very tools meant to strengthen our country.' She also sought to clarify the institution's role in light of recent public debates about the accuracy of unemployment figures. 'Stats SA does not create unemployment. It measures it. Stats SA does not make policy. It informs it. It is for us — the policymakers, the lawmakers, the executive — to use these insights wisely,' she said. The deputy minister highlighted the strengthening of Stats SA's mandate through the Statistics Amendment Act signed into law in December last year. 'The new act enables improved co-ordination across government and enshrines the professional independence required for statistical credibility,' she said. Mhlauli noted that national statistics agencies face evolving global challenges such as public mistrust in institutions, misinformation, declining survey response rates, digital exclusion and the growing cost of data collection. 'In this environment, we must adapt by embracing digital tools, investing in data literacy among our people, strengthening partnerships with community leaders and reaffirming the independence and credibility of our statistical systems,' she said. Minister in the presidency Khumbudzo Ntshavheni added that over the next five years, Stats SA will embark on a process of reinvention to modernise its products and processes. Among its upcoming initiatives, the agency plans to research the use of artificial intelligence (AI) in producing official statistics, introduce web-based data collection in economic statistics programmes, apply data science to big and alternative data sources and explore the use of cloud technology. 'These reforms are necessary to ensure that Stats SA remains relevant, agile and accurate in a rapidly changing information environment,' said Mhlauli. TimesLIVE
RNZ News
24-06-2025
- Health
- RNZ News
GPs welcome funding boost
health policy 24 minutes ago General Practice networks say any money for the severely underfunded sector is welcome, but it doesn't fix the decades of underinvestment. Royal College of GP's president Samantha Murton spoke to Charlotte Cook.
BBC News
11-06-2025
- Politics
- BBC News
Justice system starved of money, police leaders say
Public safety is at risk because the justice system is starved of resources, two police and crime commissioners (PCCs) have Donna Jones and Thames Valley counterpart Matthew Barber said the government's Spending Review on Wednesday should address "chronic underfunding" of the Ministry of Conservative PCCs said cuts had led to "clogged" courts, collapsed legal cases and overstretched services to manage offenders in the Ministry of Justice (MoJ) said the government had already invested in prison-building and probation services, as well as increasing sitting days at crown courts. The PCCs, who oversee police forces in their areas, said the "buckling" justice system had "left victims in limbo".In an online statement, they wrote: "Officers are working tirelessly to arrest dangerous individuals."Too many of these cases are falling apart because courts are clogged, evidence is lost, or legal processes fail due to under-resourcing."Releasing thousands of prisoners early and proposing lighter sentences in the community may relieve pressure, but only if community supervision, rehabilitation services and offender management teams are properly funded. "Where rehabilitation is right, it must be resourced and monitored. At the moment, neither is happening to the standard the public expects." The commissioners said 16,231 prisoners were released early in 2024 under the government's plan to ease overcrowding in number of court cases awaiting trial nearly doubled in five years to 73,105 cases in September 2024, they MoJ said: "This government inherited a justice system in crisis, but we are gripping the situation and have taken immediate action."We've confirmed plans to invest £4.7bn more in prison building to make sure the public are never again put at risk by running out of prison places."This is backed by a boost of up to £700m a year by 2028-29 for probation services, and a record allocation of crown court sitting days to tackle the backlog and deliver swifter justice for victims."In a separate statement, Dorset PCC David Sidwick urged the government to change the police National Funding Formula, which he said left his county "continually at the bottom of the list".The Conservative said: "Currently, Dorset receives the second lowest amount of police grant funding of any force in England and Wales."The Home Office has been approached for comment on the funding system. You can follow BBC Hampshire & Isle of Wight on Facebook, X (Twitter), or Instagram.
