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Suturing the gap - the urban-rural health dilemma

There are lots of things to be thankful for this Ramadan. Apart from there’s never a dearth or shortage of Ramadan bazaars for Malaysians to choose from, we too are grateful for another chance to be in such a blessed month to purify the body and mind, to reflect and recalibrate our moral compass and to devote ourselves to become better Muslims through good deeds.

A famous Islamic scholar, Dr Bilal Philips, once said, “Ramadan is not a temporary increase of religious practice, it is a glimpse of what you are capable of doing every day.”

Despite the Malaysian culture to overspend, we are always reminded that Ramadan teaches us to put ourselves in the shoes of others, particularly those who are destitute and unfortunate. Malaysians’ willingness to spend over food should not be easily mistaken for wealth and prosperity but merely a facade to the struggle in coping with inflation since the infamous Goods and Services Tax (GST) was introduced back in April 2015.

It is truly unsettling to witness how much, for the past decades, we have accomplished as a nation but yet still lack in so many vital areas especially when it comes to eliminating income inequality that exists between those who live in rural areas and those of urban-dwellers.

There is a huge disparity between the urban and rural income and it has been growing ever since. Based on the records obtained from the Economic Planning Unit, in 1970, the rural-urban income gap was recorded to be RM228. It continued to increase into the 80s, 90s and now in the 2000s. In 2014 the income gap has expanded to a whopping RM3,002.

Therefore, what are the solutions that have been proposed by the BN-led government to rectify such issues and if the past policies and economic incentives have any impact at all in bridging the ever-growing gaps?

The urban-rural divide does not end there. We, too, have serious healthcare disparities between different regions in our country. Due to lack of specialists and medical equipment, most of the time patients who are seeking treatments or follow up treatment are forced to be referred to another public hospital that could cater their respective medical needs. Often they would have to travel across state borders at their own expense which is a financial burden and time-consuming.

Our nation’s healthcare systems are lacking of lots of things ranging from insufficient of the latest medical equipment to providing adequate number of doctors/specialists per population. Such inadequacy is made worse when we look at the inequity in access to healthcare in rural and urban areas.

For an example, in 2010 it is reported that Malaysia only has 55 tertiary care centres that specialise in treatment of cancer of which 28 are public hospitals and 27 are privately owned. And of all the 55 hospitals, most are found in the west coast of peninsular Malaysia.

In 2015, the average doctor to patient ratio is 1:633, far from the ideal ratio of 1:400 that the government would like to achieve by the year 2020.

Putting scepticism aside, even if the government managed to conjure enough doctors to fill in the gap, immediate steps need to be taken to ensure that those who live in rural areas would be able to access the same healthcare services enjoyed by their urban counterpart.

Apparent gap in healthcare accessibility

According to the State Health Plan 2011-2015, the doctor to patient ratios in Sabah and Sarawak are 1:1357 and 1:957 respectively while in peninsular Malaysia, states like Kelantan and Kedah fare better at 1:917 and 1:837 respectively. It is a matter of great concern that even amongst the poor states in Malaysia there is an apparent gap in terms of healthcare accessibility.

Although we truly welcome the government’s initiative to bridge the healthcare rural-urban gap in its 11th Malaysia Plan with the introduction of 1Malaysia clinics, but it is also important to highlight the serious lack of judgment and irresponsible decision made by the respective ministry to put the health and fate of our citizens at the hands of nurses at the price of one ringgit Malaysia.

Although we were assured that the 1Malaysia clinics would only treat common illnesses like fever, cough and cold as well as follow-up treatment for diabetes and hypertension, but there is still a matter of whether it is ethical or even legal for someone other than the doctors or pharmacists to prescribe drugs or to assess the patient’s health condition.

As a country that prides itself to becoming a developed nation by the year 2020, it is safe to say that we have a long road ahead to perfect our healthcare systems in providing a gold standard and quality healthcare to the rakyat.

It goes without saying that it is the federal government’s responsibility to ensure that all citizens from all walks of life are able to enjoy the benefits of excellent healthcare policies and able to access to high quality public healthcare services irrespective of where they live.

Building more specialist hospitals and finding ways to recruit more doctors and specialists to be placed in rural areas would be the right step to take. If the KPJ Healthcare Sdn Bhd’s latest plan to build eight specialist hospitals for the cost of RM1.3 billion is any indication, we could assume that one specialist hospital would only cost around RM400 million.

New hospitals especially in rural areas would also mean more training grounds for medical graduates to do their housemanship as we have hundreds of new medical graduates that would have to wait for three to six months for a placement in public hospitals every year.

But in order to achieve all of these, the Malaysian government must increase its spending on health. According to the World Health Organisation (WHO), the government expenditure on healthcare is still fairly low compared to developed countries like the Germany and USA. Between 2004 to 2013, our expenditure on health only ranges from 1.7 to 2.4 percent of total Gross Domestic Product GDP where else our counterparts spend about 6.5 to 9 percent of total GDP.

Through prudent and responsible use of public resources, the government would be able to build more hospitals and invest more on appropriate and latest medical equipment of which in return would benefit the rakyat.

The welfare and well-being of the rakyat should be the top priorities of any democratic government and thus in the spirit of Ramadan, we are optimistic that the government would take the right step to ensure that is the case through responsible, accountable and transparent governance.

DR AFIF BAHARDIN is Penang state exco member for Agriculture and Agro-Based Industries, Health and Rural Development and PKR Youth vice-chief.

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