Royal Commission Of Inquiry Into Health Services

(Speech by Parliamentary Opposition Leader, DAP Secretary-General and MP for Petaling, Lim Kit Siang, in the Dewan Rakyat on Tuesday, 17th June 1980 when introducing motion calling for establishing of Royal Commission of Inquiry into Health Services)

DAP calls for Royal Commission of Inquiry into Health Services

I move:

“That this House TAKES NOTE of the recent report of a Committee of the Malayan Medical Association Council under the Chairmanship of Dr.M.K.Rajakumar on ‘the Future of the Health Services in Malaysia’ and RESOLVES that a Royal Commission of Inquiry be established to study, and make recommendation for the realization of, the health needs of Malaysians for the next two decades.”

In April this year, the Malaysian Medical Association released a report which it commissioned a committee, under the chairmanship of Dr.M.K.Rajakumar, former MMA President, and comprising as members Dr.Abu Bakar bin Dato Suleiman, Dr. Lee Choong Hing, Dr. Molly Cheah and Dr. Yeoh Poh Hong, on “The Future of the Health Services in Malaysia.”

As stated in this report, for the past ten years, the successive Presidents of the Malaysian Medical Association had asked for a Royal Commission on Health. In 1979, a delegation of the MMA met the Minister of Health, Tan Sri Chong Hon Nyan, when he first took office, and raised the matter of a Commission on Health. The Minister was agreeable to the idea and proposed that terms of reference be worked out with the Director-General of Health. Since then, the MMA had been unable to obtain further action by the Ministry on the matter.

In view of the urgency of the matter, the MMA Council decided to make its own study. At the end of the Report, the Committee returned to the call for a Royal Commission of Inquiry.

I here quote the conclusion portion of the Report:

“Malaysia is most fortunate in having a rapidly expanding economy, a permanent surplus and our current account at extremely bright prospects for the future. We also have rising standards of literacy and a better informed and sophisticated problem.

“If we plan ahead carefully, it is possible for us to achieve extremely high standard of health care and avoid many of the bad consequences to health from industrialization and urbanization.

“This twin targets of access to health care irrespective of geography and social class may not be fully achievable in this century but a wholehearted and determined effort will make a great difference in the life of the great majority of the people.

“We cannot succeed if we carry on stumbling from problem to problem, reacting in ad hoc fashion to new problem and fixed in the current pattern of health care by mechanical incremental response to demand.

“It is time to take a fresh look at the problems of health in our country. A Royal Commission on Health is needed to undertake a review and to point new directions. A Royal Commission will provide an opportunity for the community to make known its view. It will also provide an opportunity for those in the Ministry, the EPU, in the Treasury and in the profession to introduce new social objectives in health planning and to find ways of achieving it. A Royal Commission is long overdue and is greatly needed. We urge the appointment of a Royal Commission of Health without further delay.”

I do not understand why the Minister of Health, having agreed to the MMA proposal for the establishment of a Royal Commission on Health in 1979, had sat on the matter, and up till now, there are no signs of such a Commission being established.

The Report of the MMA study reinforces the call for the establishment of a Royal Commission on Health. The MMA committee made 52 specific recommendations relating to health problems of the community, reforms to the health service, primary health care, hospital services, maintaining health by preventing diseases, etc., and these deserve to be future of health needs of Malaysians for the next two decades.

Chapter 9 on the Brain Drain of Doctors, not only from the Government Service, but from the country, by way of emigration, has reached crisis proportion – and threatens to gravely affect the health services of the country.

For instances, there has been a reduction of 849 doctors between 1972 and 1979 in the country, which must be accounted principally by migration abroad.

The MMA study also conducted a survey of the doctors in the country and found that out of all the doctors surveyed, 16.3% or 161 doctors had expressed their intention to emigrate, while 34.6% or 340 doctors were not sure. The MMA study found that there is not much variability in the reasons given by doctors in government and private practice for intending to emigrate, and that the two most frequently mentioned reasons are uncertain future and their children’s education.

The MMA also found that mong the government doctors, at least 56% were contemplating resigning from the government serfice. Of those intending to resign half had not made by definite plans to do so, but 24% were about to resign within a year and the rest on the completion of their compulsory service. Their reasons for resigning appear to be no different from those who had already resigned, suggesting that the situation had not improved very much. The main reasons for dissatisfaction of government doctors are: 1. No proper financial incentives; 2. unsatisfactory promotional prospects; 3. unsatisfactory working hours.

These problems have been accumulated over the years, and as medical education is a very expensive form of investment, the country and government must wake up for their indifference to this loss of precious qualified manpower to retain doctors in government service, and to remove the causes of emigration overseas.

In fact, the government should seriously consider sending a mission to Australia and other countries to invite Malaysian doctors to return to Malaysia to serve the country, by allaying their fears about the uncertain future and the educational future of their children.

I do not propose to go into detail the views and recommendations of the Rajakumar Report, except to point out some of the highlights.

The Government should take note of the Report’s comments on the Hospital services, in particular with reference to the Report’s reference to the building of the Kuala Lumpur General Hospital, as an example of hospitals growing in size in an unplanned manner. The KL General Hospital was planned to have 900 beds but ended with 2,300 beds in 1979, and this expected to grow to 3,000 beds in the next few years – which has been described as a ‘monumental blunder’. The Report recommends decentralization of the hospitals so that they could be more responsive to the needs of the individual patients and be of greater service to the different parts of the city, for instance.

The Report expressed surprise that after 23 years of independence, there is still no accumulation of expertise to effectively plan, design and supervise the building of hospitals and other related facilities either in the Ministries of Health, Public Works and Utilities or in the local consultancy firms in Malaysia.

There is also a need for a study as to how private doctors could tapped to help to contribute to the public health services, where they could work not only in close co-operation with the hospitals, but in the hospitals. This will be of mutual benefit both to the private practitioners and the hospitals, for the private practitioners could gain greater experience and professionalism, while the hospitals would gain from the service and contribution of the private practitioners.

An important proposal is the suggestion for the institution of a a national health insurance scheme, aimed in particular at the upliftment of health standards and care in the rural areas. We in Malaysia have a situation where half of the people subsist below the poverty line, and if we are to provide more than nominal health care and services to the masses, then such a national health insurance scheme is necessary.

A Royal Commission of Inquiry into Health will look, not only into the areas covered by the Rajakumar report, but also other areas, like the question of medical education, whether we are producing enough doctors to meet or national needs, the matter of the Third Medical Faculty which is to be sited in Kota Bahru, whether this is the most desirable choice of place, etc.

As a professional body, like the MMA, has specially concerned with health and medicine, has made a call for Royal Commission of Inquiry, I hope that my motion will get the support of the House.