THE night after Budget 2021 was read out in Parliament, messages were going around in social media and WhatsApp that many expressed shock and anger that the government even contemplated on heavily slashing the budgets of many medical programmes.

People thought that these were the “compromises” made for shifting resources towards fighting Covid-19 (since these endeavours were read out loudly and clearly in the budget speech), as well as to development expenditure.

For the latter, it is not surprising that the general public feel this way, since they see that the total Health Ministry budget increased by RM1.3 billion – additional RM2.1 billion goes to development expenditure, but RM718 million was removed from the operating budget.

Patient groups, including those who suffer from kidney, heart or cancer health problems, was terrified to be told that the concerning programmes have their budgets cut by more than 50%.

In fact, some of them went to see the extract of the estimated expenditure themselves, and were convinced that those allocations for “services and supplies”, that bought them medicine, are all mysteriously zero-ed.

I did find anomalies, but I also managed to locate two new budget allocation items, one under the section “Specific Programmes”, which entitled “Medical Supply for Health Facilities” (worth RM2.89 billion) and another one under the new section “Financial Commitment”, which entitled “Private Concession for Medical & Laboratory supplies” (worth RM1.4 billion). When I summed them up and compared them with the total Budget 2020 total amount, it suggests that the Ministry of Finance has probably given RM300 million more for the purpose of purchasing medical products and laboratory supplies.

Last night, Finance Minister Tengku Zafrul Tengku Abdul Aziz issued a clarification confirming my suspicion, that the budget item reclassification is the main culprit for the great confusion, anxiety and outrage expressed by the general public.

I would not blame the average Joe and Jane for the misunderstanding. The government should remember well the mantra “If it ain’t broke, don’t fix it”. Yes, central procurement by the government has been a practice for a long time, and private concession given to procure the APPL list of drugs is also not new. These should not be the reason for a reclassification.

The “affected” programmes should be restored and given an allocation for the sake of budget clarity, transparency and accountability, so that the public could track and understand the resources in each programme.

A centralised and pooled figure, though it may serve the health ministry well for the flexibility of allocating funds according to immediate needs, could have the unintended consequence of causing anxiety and stress to doctors and management officers in various medical departments, as well as among patients who worry if the common pool has been emptied or if their request is in competition with other medical programmes. The more is unknown, the more insecure one becomes.

However, given that the health ministry is currently enjoying high public confidence and approval – on many occasions we heard that the Director-General Dr Noor Hisham Abdullah has been championing for strengthening public health – my hopes were high that the ministry could secure a much improved and significantly higher budget than normal projection.

Sending the wrong signal

I was disappointed to find the percentage of growth (at 4.4%) and absolute amount (RM1.3 billion) is the smallest since 2017. I was disturbed to see that the total operating budget allocation for “services and supplies” was reduced by nearly RM1.3 billion, even if the medical supplies are not affected.

For the disease control division under the Public Health department, not only has the allocation for “services and supplies” reduced, the number of positions in that division does not grow (but effectively deducted by one).

This might send the wrong signal to the public that the ministry does not invest more into disease control considering the pandemic Covid-19, the dengue problem and the rise in non-communicable diseases. Rabies and polio are threatening to return to haunt us, too.

Not all is gloomy, however. I am particularly pleased that this time the MOH heeded many calls by investing more into maintaining and expanding infrastructure. It may well be because this has been long overdue.

Attention has always been given to the physical capacities of the facilities attending to so many patients. There has been some concern about the state of maintenance of the buildings, especially after the frustration vented by a doctor in Sabah last May highlighting the dilapidated state of health facilities in Sabah.

Make no mistake, the development expenditure for 2021 is at a historic high at RM4.7 billion. Whether this decision was made due to the economic impact these construction projects have weathered or due to the benefits these projects would bring to the community, is something the finance minister can clarify, but such investments are never too late.

Budget allocation for upgrading and expanding hospital facilities is, by far, the largest – 60.7% of the DevEx or RM2.86 billion. It is good to see the government is planning ahead and thinking about the future to meet the expected surge in public healthcare demand.

Allocating more resources for vehicles and equipment purchase is also a wise decision, given that the district health offices might need more mobility for Covid-19 screening and monitoring related activities at the community level. 

Is it enough?

The government has pledged another RM20 billion to the Covid-19 Fund, bringing the total to RM65 billion for tackling the pandemic. Currently, the third wave is still at peak infection.

Perhaps people are concerned if the allocation is sufficient.

Firstly, we were told that the government reserved more than RM3 billion for vaccine procurement, planning to immunize at least 70% of the population. After calculation, for a vaccine course of two doses per person, the government would have a working budget of RM131 per person, which is higher than the average estimate made by COVAX Facility for a person. Alternatively, the government could even simply purchase more and go beyond the 70% coverage.

An RM1 billion budget allocation was announced for various Covid-19 fighting purposes, such as the purchase of Personal Protective Equipment (PPE) (RM318 million) and Covid-19 test kits (RM475 million).

For the PPE, if the amount is divided by 100, 000 medical front liners in this country, then one would have an average personal annual budget worth of RM3,180 or about RM10 per work day. Depending on what medical specialization or expertise the person is in, this could well be sufficient.

For the Covid-19 test kits, let’s say the same number of people undergo screening next year, about 2.26 million as of November 7, if the cost can be kept at RM100 per person or lower, the current budget allocation should allow Malaysia to weather through twice the current screening amount.

Perhaps with the large reserve of RM65 billion in the Covid-19 fund, we should worry less about the financial implication of the government’s effort, but more about getting enough helping hands (expertise or volunteers) to address the current situation.

All in all, not enough was tendered during the Budget 2021 presentation to make it sweet enough to call it an Election Budget. – November 8, 2020.

*Dr Lim Chee Han is a healthy policy researcher.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.