KUALA LUMPUR, Nov 7 ― While many have lauded the Health Ministry’s (MoH) overall increased share in Budget 2021 to fight Covid-19, several industry observers today expressed concern at what they say are significant cuts across the board that reduce funds for the public healthcare workers and medical supplies for lifestyle diseases like diabetes and cardiovascular ailments.

Medical research group Galen Centre pointed out that there is a 20.5 per cent reduction that will leave only RM11.3 billion in the medical budget for public hospitals and clinics next year, a decline compared to the RM14.2 billion it got in Budget 2020.

In a report published on its Code Blue website, the research group gave a breakdown of sweeping spending cuts on what it said were nearly all major diseases and health care services, including a massive 74 per cent decrease for pharmacy and supplies.

According to Galen Centre, the budget for hospital support services under MoH’s special programme has been slashed by 94.91 per cent, from RM1.93 billion in Budget 2020 to RM98.36 million in Budget 2021.

Bandar Kuching MP Dr Kelvin Yii also expressed alarm at the government’s reduction in spending on non-communicable diseases (NCDs) and the MoH’s operating expenditure.

"The National Health and Morbidity Survey (NHMS) 2019 which was published earlier this year highlighted the insidious nature of NCDs and risk factors such as diabetes, kidney disease, cardiovascular disease and obesity which are causing a catastrophic impact and burgeoning cost on the Malaysian healthcare system and society as a whole.

Bandar Kuching MP Dr Kelvin Yii also expressed alarm at the government’s reduction in spending on non-communicable diseases (NCDs) and the MoH’s operating expenditure. — Picture by Ahmad Zamzahuri

"For example, under MoH’s Budget 2021, nephrology received a 78 per cent  budget cut with an RM56.5 million allocation for next year, while the allocation for cancer treatment was drastically reduced by 58.49 per cent  from RM 328.7 million in 2020 to RM 136.4 million.

"We also see a significant reduction of 66.7 per cent for Cardiothoracic, 14.28 per cent or RM 248 million for General Medicine, 10.46 per cent  for Respiratory and 10.03 per cent  or about RM 50 million for Anaesthesiology and Intensive Care,” he said in a statement today.

Dr Yii also decried a decrease in spending on psychiatry and mental health, saying the government has allocated only RM30 million or 9.11 per cent of the Health Ministry budget for this area despite recent news reports suggesting more Malaysians are facing issues like depression, anxiety and have attempted suicides.

"On top of that, due to the interventions related to Covid-19 such as the movement control order, the incidences of various NCDs have and are expected to worsen and increase as many patients have missed their appointments and even treatment.

"All these backlogs are expected to be addressed especially next year and it is a disservice to cut all those allocations that will jeopardise the quality of care given to those patients,” the DAP lawmaker said.

Dr Yii was not alone in voicing this. His party mate, Teluk Intan MP Datuk Ngeh Koo Ham said the same thing, highlighting a screencap from the budget 2021 document about the allocation reduction.

"PN (Perikatan Nasional) government proposed the biggest allocation in Malaysia history for its propaganda agency ― Jasa but dramatically reduced several important health allocations. It is clear that PN cares more about politics than people’s health,” Ngeh tweeted today, referring to the controversial Special Affairs Department that has been criticised as a government propaganda unit.

The unit was disbanded in May 2018 when Pakatan Harapan took power but was revived earlier this year under PN and is now parked under the Communications and Multimedia Ministry.

Under Budget 2021, Jasa has been given two allocations ― one for "strategic communications” and another for new policies ― amounting to RM85.5 million.

Akademi Sains Malaysia fellow, Prof Datuk Awang Bulgiba Awang Mahmud, raised concerns over a dip in the Health Ministry’s operating expenditure (opex).

He noted the opex in Budget 2020 was RM27.9 billion but has been trimmed to RM27.2 billion for next year.

"There is some allocation of RM50 million for the teaching hospitals (which are under the Ministry of Higher Education rather than MoH) to cope with Covid-19 patients as they are also part of the pandemic fight but the amount is not large and will need to be spread out among a number of hospitals,” he said in a statement.

Awang Bulgiba noted an additional RM3 billion has been budgeted for Covid-19 vaccines, though unavailable just yet.

"It is not clear how many doses are expected for the allocated amount but that would depend on the unit price of the selected vaccine or vaccines,” he added.

However, he welcomed the injection of RM100 million for infectious disease research. He suggested some of the fund could be used on epidemiological modelling of the coronavirus.

"The country also needs to carry out behavioural science research to ameliorate pandemic fatigue and into the long-term health, economic and socio-cultural consequences of the Covid-19 pandemic as it would give us some much-needed data and help Malaysia improve its pandemic preparedness plan,” Awang Bulgiba said.

For the Malaysia Medical Association (MMA), Budget 2021 was lacking as the government did not show its commitment to resolve permanent and contract positions for junior healthcare workers ― a long-standing issue.

Its president Datuk Dr Subramaniam Muniandy said the announcement of further contract positions for nursing and other healthcare support staff did not bode well for the welfare of the staff and the job opportunities under the government's Short Term Employment Programme lacked clarity as to who exactly would benefit or if there would be new positions for existing contract staff.

"We would have expected that seeing the need for enhanced public healthcare to deal with the pandemic, there would be allocations for increased healthcare positions.

"Disappointingly, we don’t see any major allocations for the much-needed boost in our healthcare workforce.

"We hope that once the finer details are released that the government will address these urgent issues,” he said in a statement yesterday.

Finance Minister Datuk Seri Tengku Zafrul Abdul Aziz announced a 4 per cent increase of the MoH allocation from last year to RM31.9 billion in Budget 2021 yesterday.

MoH will received an additional RM1 billion next year to be channelled to the ministry in its efforts to stem the third wave of Covid-19, which includes RM475 million to purchase reagent supplies, screening kits and consumables as well as RM318 million to provide personal protective equipment and hand sanitisers to frontliners.

In addition, the government has agreed to provide a one-off payment of RM500 in appreciation of the contribution by the frontliners, which is expected to benefit 100,000 medical staff.

In the detailed budget provided by the Finance Ministry report however, an item labelled "Bekalan Perubatan Fasiliti Kesihatan” (Health Facility Medicine Supply) was given an allocation of RM2.9 billion, which caters to medicine possible for Covid-19 and other issues.

Budget 2021 is the largest Budget in Malaysia’s history, with a total of RM322.5 billion compared to RM297 billion for Budget 2020.