#Budget2021 must invest in #SihatBersama2030
There is a large Gap in Malaysia’s Investment in Health
Pooled Health Expenditure = USD 420 per capita
Malaysia’s Health Expenditure = USD 244 per capita
Malaysia’s Investment Gap = USD 176 per capita
#Budget2021 must invest in #SihatBersama2030
Government investment in health has declined from
⁃a high of 2.14% of GDP in 2003 to
⁃1.89% of GDP under BN
⁃2.0% of GDP (PH) in 2020
Malaysia’s Investment in Health is insufficient
The target is 4.0% of GDP
#SihatBersama2030
Govt investments alone NOT sustainable
-Low pooled financing (62%)
-Dependent on federal budget
-Decline in govt expenditure as %GDP
-Stagnant Private Health Insurance
-High Medical Price Inflation (13.6%)
-High out-of-pocket spending-RM 2,827/household/yr
#Budget2021 must invest in #SihatBersama2030
Malaysia’s Hospital Beds/1000 pop < Upper Middle Income Average
Critical Care Beds/1000 pop <S’pore
Doctors/1000 pop <S’pore/S.Korea
Nurses/1000 pop is 50% of OECD
Is it any wonder that M’sia’s Health Performance is SUB-PAR!
Male life expectancy at 60yr=good proxy for NCD management
We r behind Taiwan, HK, S’pore, NZ
They have a faster rate of improvement from a higher starting point
There is a widening performance gap bet M’sia and them
#Budget2021
Malaysia’s lacklustre Health Performance is disconcerting!
Even where we have traditionally been strong eg Maternal & Child Health (MCH), we have not made further progress in the 21st century
Mortality rates which declined 30yr post-Merdeka has flattened since 2000
There is an epidemic of Non-Communicable Diseases (NCD)
1.7M live with Diabetes+High BP+High Cholesterol
3.4M live with 2 of these
High sugar/BP/cholesterol r major risks factors for CardioVascular Diseases
Stroke+Heart Attacks (CVD) are the leading Causes of Deaths in Malaysia
1 in 5 adults in M’sia have Diabetes=3.9 Million
The trend of Diabetes is increasing fr 2011-2019:
- From 7.2% to 9.4%
- 8.9% did not know that they have Diabetes in 2019
- Most young adults from 18-49yr did not know that they have Diabetes #Budget2021 must invest in HEALTH
IMHO this is a culmination of old school public health tools
Think out of the box and re-strategize
Few ideas to consider: 1. Use Rapid RTK-Ag not Slow PCR testing-no backlogs 2. Universal testing not targeted testing-esp #Sabah 3. Ramp up RTK-Ag in #Sabah- 100K not enough
4. Cap the cost of RTK-Ag testing at private labs/hospitals so #NowEveryoneCanTest 5. Frequent HCW testing to protect them & patients in healthcare settings 6. More resources/HCW deployed to #Sabah. Pre-COVID #Sabah was underfunded/understaffed/underpaid/overworked
7. Make sure HCW/Volunteers feed/rest/sleep well so as to mitigate burnt-out & low morale. Pay elaun stat! 8. Set up more low risk Isolation Centres to nurse pre/asymptomatic/mild COVID cases-esp #Sabah 9. Create more COVID beds in MOH. Decant non-COVID cases to private hospitals
Nuances here more political than scientific.
IMHO the data shared (and unshared) points to a few scientific issues 1. It proves the sci that the election is a super-spreader event 2. Some returnees/politicians (no data shared) cud be super-spreader persons thestar.com.my/news/nation/20…
3. The massive surge of cases in Sabah reinforces this super-spreading phenomenon of the elections 4. The 30.8% Sabah cluster in Klang Valley could have been prevented if MOH: a)quarantined the returnees/politicians from #Sabah (b)re-tested the returnees
5. @DrAmarMOH showed down-trending of unlinked cases fr 63% to 7% (12 Oct). Shows that Klang Valley outbreak was clustered. This is “relatively good” news since clusters are easier to detect-track-contain. It debunks need for CMCO if rapid testing-tracing-isolation was robust!
1/ Successes of Public Health (PH) is largely invisible
They go unreported-out of sight out of mind!
PH funding < Sec/Tertiary/Curative/Tehab
eg Success of Vaccines-Took us 15 years to get PCV in our Nat Imm Program in 2020
But 1 case of polio/diphtheria-Msia goes hysterical!
2/ To detect #COVID19 before it spreads, PH needs FREQUENT/ACCESSIBLE/RAPID TESTING
We cannot detect pre/asymptomatic cases before they spread if we do not test FREQUENTLY
RTK-Ag picks out the infectious cases.
A powerful test for #COVID19 contagiousness youtube.com/embed/4vvgefwK…
3/ RTK-Ag perform best in areas of active transmission
And when collected from a case with highest viral loads (most infectious)
2 days before (pre/asymptomatic) and up to 5-7 days after symptom onset
Rapid testing=Rapid isolation=Faster control of spread=Containment
On-point @ProfAdeeba
Didn’t they preach 3Cs?
Distance>2m+Talk<15 min+Mask are NOT high COVID risk!
CMCO is an OVERKILL
-Kills livelihoods
-Kills economy
-Harms mental health
-Spawns national HYSTERIA
Why punish MakCikKiah who wants to put food on table? astroawani.com/berita-malaysi…
COVID-19 + MCOs disproportionately burdens low rank/paid workers aka #MakcikKiah selling goreng pisang at PPR flats
Causes big holes in their pockets and brains-anxiety/depression/suicides
M’sia MUST use all tools available NOT JUST MCOs! WHO dah kata-kan? malaymail.com/news/what-you-…
Unlike @DrAmarMOH others blurt nos without analysis of trends
Downtrending of unlinked cases=decreasing community spread
Data speaks against CMCO
RTK-Ag as part of pop-level strategy to “sweep” & isolate infected individuals is the way fwd to contain/eliminate #COVID19Malaysia
14 yrs siege limited entry of materials required to develop water and sanitation infrastructure.
Thus 97% of water is not-drinkable.
We built H2O treatment plants to provide safe & clean water world over inc Palestine, Org Asli villages, Cox Bazaar, Palu... #SafeWater
HRH The Sultan of Perak inaugurated 10 H2O treatment plants and a dam built by IMARET for several Orang Asli villages
Safe water technology inspired & in partnership with Malaysian Armed Forces #SafeWater
Soil in Cox Bazar, Bangladesh, housing 1 million refugees is cyanide rich.
Our H20 treatment plants had to eliminate this poison.
Several built to provide #SafeWater to the refugees
Solar activated.
Low maintenance
In partnership with @AlkhidmatOrg