Supplements, Rebates, and Savings: Reforming Policies for Wellness in Budget 2025

WORDS DATUK DR RAJEN MANIKA

FEATURED EXPERT
DATUK DR RAJEN MANIKA
President and Council
Malaysian Dietary Supplement Association (MADSA)

As we await the upcoming Budget 2025, set to be tabled in Parliament this October, we are presented with a critical opportunity to reassess the current tax policies, particularly on dietary and health supplement products.

THE QUESTION THAT MUST BE ADDRESSED IS: SHOULD HEALTH AND WELLNESS BE TAXED?

The simple answer is no, and yet, dietary supplements in Malaysia are currently subjected to a 5% sales and service tax (SST), with certain finished products also facing a 5% import duty.

This taxation is an unnecessary financial burden on Malaysians striving to maintain or improve their health.

Revising these tax policies is not just an economic adjustment; it is a vital step towards enabling all Malaysians to adopt healthier lifestyles, a change that has been long overdue, especially since the last review request was in 2021.

BALANCING PROTECTION AND QUALITY IMPROVEMENT

To fully understand the urgency of this issue, it’s important to consider how these taxes are not only affecting consumers, but also hindering the growth and quality of the local supplement industry.

The imposition of import duties on selected ingredients and finished dietary supplements is counterproductive. Instead of protecting local industries, these duties end up increasing production costs and consequently, retail prices.

In reality, the local supplement industry is heavily dependent on imported ingredients, and as of yet, there is no viable alternative.

For instance, let’s take a look at fish oil. Malaysia’s tropical waters simply do not yield the cold-water fish required to produce high-quality fish oil. The import duty on this essential ingredient does nothing to protect local industries, because there is no local equivalent that can meet the demand or quality.

By removing these import duties, production costs would decrease, and these savings could be passed on to consumers, making health supplements more affordable and accessible to the general public.

This is not just a matter of economic efficiency; it’s about prioritizing the health of our nation.

SST EXEMPTION FOR DIETARY SUPPLEMENTS?

The current application of SST on dietary supplements is another area in dire need of reform.

Currently, several dietary supplements containing ingredients such as vitamins, fish oil, spirulina, essence of chicken, Haruan fish, and more are imposed a 5% SST. On the other hand, all pharmaceutical products, including ascorbic acid (vitamin C), elemental iron, and medications containing multivitamins and minerals are tax exempted.

Exempting dietary supplements from SST aligns with the principle of allowing individuals the freedom to make informed choices about their healthcare. By removing SST from these products, the government can make them more affordable, encouraging more Malaysians to invest in their health.

Furthermore, as more Malaysians turn to dietary supplements, we can expect a decrease in non-communicable diseases (NCDs), which will ultimately lead to reduced healthcare costs for the government. It will be a clear win-win situation, where the public gains access to better health resources and the government reduces its long-term financial burden.

INTRODUCE LIFESTYLE TAX RELIEF AND TARGETED SUBSIDY STRATEGIES

In addition to removing taxes and import duties, the government should consider including dietary supplements in the existing lifestyle tax relief.

Tax reliefs have proven effective in encouraging healthier behaviors, and extending this benefit to include supplements would provide financial relief to those actively investing in their health.

However, broad-based subsidies can create a dependency that is counterproductive in the long term. Instead, the government should implement targeted subsidies for vulnerable groups, ensuring that financial assistance reaches those who need it most without fostering a culture of reliance. An end-of-subsidy monitoring plan could also be established to evaluate the effectiveness of these measures, ensuring they are both sustainable and successful in their intended goals.

Achieving long-term success in dietary supplementation requires a multi-faceted approach. It is imperative that local government agencies collaborate with supplement producers and relevant NGOs to educate the public about the benefits of dietary supplements. Through comprehensive education campaigns and awareness programs, we can empower consumers to make informed decisions about their health, dispelling myths and misinformation along the way.

For instance, the current ‘Tolak Ubat Tidak Sah’ campaign by the Ministry of Health could be similarly applied to dietary supplements as a friendly, accessible means to educate and spread awareness.

By adopting these measures, the government can support consumer health choices, enhance the quality of local products, and create a more competitive and vibrant supplement market.

Now is the time for action. By revising tax policies, offering targeted subsidies, and educating the public, we can ensure that dietary supplementation becomes an integral part of Malaysia’s approach to health and wellness. The health of our nation depends on it.

ASEAN Unveils Groundbreaking Platform to Combat Airborne Infections and Boost Pandemic Preparedness

WORDS LIM TECK CHOON

On 8 August 2024, the 16th ASEAN Health Ministers Meeting (AHMM) witnessed the launch of a pioneering initiative set to transform the region’s approach to airborne infections and pandemic readiness. This milestone took place in Vientiane, Laos.

KEY HIGHLIGHTS
  • The Airborne Infection Defense Platform (AIDP) was officially launched.
  • The platform focuses on strengthening tuberculosis response and overall pandemic preparedness.
  • It is supported by United States Agency for International Development (USAID) and implemented by Stop TB Partnership and Stop TB Partnership Indonesia with the endorsement of ASEAN member states.
THE AIDP: A RESPONSE TO URGENT HEALTH CHALLENGES

The AIDP emerges as a critical solution to address the growing threat of airborne respiratory infections across ASEAN.

With more than 2.4 million people affected by tuberculosis in the region, and five ASEAN countries on the WHO’s high burden tuberculosis list, the need for a coordinated response has never been more pressing.

  • In Malaysia, there were 26,781 cases in 2023, a 5.47% increase from 2022.
  • In the ASEAN region, there was an estimated increase of nearly 500,000 additional deaths from 2020 to 2022 due to COVID-19 disruptions.

The AIDP aims to:

  • Enhance cooperation among ASEAN member states,
  • Agree on policies and methodologies.
  • Exchange learnings and resources.
  • Create surge capacity for tuberculosis cases.
  • Improve overall pandemic preparedness.

The objectives would be carried out via a two-phase approach:

  • Landscape assessment. Evaluate the current capacities of 10 ASEAN countries.
  • Strengthening initiatives. Support community-based and primary health care activities

The AIDP will utilize cutting-edge technologies such as:

  • Portable digital X-rays.
  • Rapid molecular diagnostic platforms.
  • Real-time digital surveillance tools.
A VISION FOR A RESILIENT HEALTH SYSTEM

His Excellency Dr Bounfeng Phoummalaysith, Minister of Health of the Lao People’s Democratic Republic, emphasized the importance of learning from the COVID-19 pandemic.

“We must create a stronger and more resilient system. The TB program has several management principles that can be easily adopted for any airborne disease. We need to invest in platform technologies and create infrastructure that can be deployed for future airborne pandemics,” he said.

Professor Tjandra Yoga Aditama MD, the Stop TB Partnership Indonesia Senior Advisor and AIDP Project Lead, stressed the importance of regional cooperation: “The condition of tuberculosis in ASEAN is quite concerning. This demonstrates the importance of working with ASEAN to strengthen the TB response system to not only create surge capacity for TB cases but also enhance pandemic preparedness.”

Additionally, Dr Suvanand Sahu, the Deputy Executive Director of the Stop TB Partnership, highlighted the project’s potential impact. “The first phase will improve understanding by carrying out a landscape assessment across 10 ASEAN countries. Our second phase will support initiatives to strengthen the preparedness capacity of TB responses across ASEAN,” he said.

His Excellency Dr Teodoro Herbosa, the incoming Stop TB Partnership Board Chairman, added that investing in tackling one airborne infection, such as tuberculosis, is an investment into tackling all airborne infections.

The launch of the AIDP marks a significant step forward in ASEAN’s commitment to public health and pandemic preparedness. As the region continues to grapple with the challenges posed by airborne infections, this innovative platform offers hope for a more resilient and responsive health system.

Weighing the Facts of Malaysia’s Battle Against Obesogenic Environments

WORDS UMI ATIKAH MOHD HASHIM & ASSOCIATE PROFESSOR DR ZAHARA ABDUL MANAF

FEATURED EXPERTS

UMI ATIKAH BT MOHD HASHIM
BSc Nutrition and Community Health UPM
Student of Master Clinical Nutrition
Universiti Kebangsaan Malaysia
ASSOCIATE PROFESSOR DR ZAHARA ABDUL MANAF
Senior Lecturer
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

The Malaysian lifestyle has been undergoing changes over time. With improved socio-economic conditions, Malaysians tend to consume more food today than they did previously. Excessive intake of high-calorie foods combined with little daily physical activity has led to increased numbers of overweight and obese people in the population.

Malaysia has the second highest in the number of overweight and obese people in the Southeast Asian region. Furthermore, the rate of increase in overweight and obese individuals in Malaysia was found to be the highest in the region. Since the percentage of overweight and obese people increased consistently from 2010 to 2014, there is a high possibility that this trend will continue in the coming years.

The root of this issue lies not just in personal choices but in what experts term an “obesogenic environment.”

WHAT IS AN OBESOGENIC ENVIRONMENT?

An obesogenic environment is characterized by conditions that promote obesity among populations.

In Malaysia, this includes a combination of the following factors.

  • Readily available high-calorie foods, exacerbated by the proliferation of fast-food outlets and online food delivery service.
  • Notable scarcity of outlets offering fresh and nutritious foods in urban areas that makes healthy eating more challenging and often more expensive, steering individuals towards less healthy but more accessible and affordable options.
  • Sedentary lifestyle. Increased screen time, whether for work, education, or leisure, reduces the time spent on physical activities. The convenience of smartphones and other devices has made it easier for individuals to order food online, play video games, or consume digital content for hours, thereby limiting physical movement.
  • Urban planning that discourages physical activity. Urban infrastructure often lacks safe, accessible spaces for physical exercise, further contributing to sedentary behavior. Parks and recreational facilities are often too few or inadequately maintained, especially in lower-income areas.
  • Social and economic pressures. People in lower socioeconomic brackets may prioritize cheaper food options, which are often processed and high in calories, due to budget constraints. Furthermore, individuals working multiple jobs or long hours may have less time and energy to prepare healthy meals or engage in physical exercise.
  • Cultural factors. Food plays a significant role in Malaysian culture, with social events often centered around eating. The emphasis on food abundance can sometimes overshadow the importance of food quality.
IMPLICATIONS FOR THE PEOPLE AND THE NATION

The implications of this obesogenic landscape are profound, impacting not only the physical health of individuals but also the nation’s healthcare system.

  • Public health crisis. Rising obesity rates increase the prevalence of non-communicable diseases (NCDs) such as diabetes, heart disease, and certain cancers, straining the healthcare system.
  • Economic burden. The rise in obesity-related diseases, such as diabetes, hypertension, and heart disease, places an increased burden on healthcare resources.
  • Social and emotional toll. Obesity can lead to psychological issues, including low self-esteem and depression, affecting individuals’ quality of life and productivity. Furthermore, obese people often encounter stigma and discrimination.
TACKLING THE CHALLENGE OF OBESOGENIC ENVIRONMENT WITH A MULTIFACETED APPROACH

Addressing the challenge of obesogenic environments requires a broad, collaborative approach that involves public policy changes, community engagement, and individual action.

  • Enhance urban planning and infrastructure. Prioritize the development of pedestrian-friendly infrastructure, safe cycling paths, and more green spaces within urban areas.
  • Improve economic accessibility to healthy foods. Implement policies aimed at reducing the cost of fresh produce and healthy goods while potentially taxing high-calorie, nutrient-poor foods.
  • Promote cultural shift towards healthy living. Launch public health campaigns that educate about healthy eating and celebrate it as part of the national culture.
  • Leverage technology for health promotion. Harness technology to encourage physical activity and healthy eating through apps and virtual services.
  • Strengthen public health policies. Implement comprehensive policies that tackle the availability and marketing of unhealthy food options, especially those aimed at children.
  • Launch education and public awareness campaigns. Encourage employers to create wellness programmes that promote physical activity and healthy eating. Invest in educational programmes that start from early childhood and extend into adulthood to build lifelong habits of healthy eating and regular physical activity.
  • Improve access to healthcare and nutritional guidance. Ensure individuals have access to regular health check-ups and consultations with nutritionists and dietitians to help prevent and manage obesity.

The battle against obesogenic environments in Malaysia is complex, involving an intricate web of societal, economic, and individual factors. However, by understanding these challenges and adopting a collective approach to address them, Malaysia can pave the way toward a healthier future. It requires commitment from all sectors of society—from government and industry to schools and families—to create an environment where healthy choices are easy, affordable, and valued.

Why Did the Ministry of Health Ban Pei Pa Koa-Flavoured Ice Cream? A Pharmacist Explains

WORDS LIM TECK CHOON

FEATURED EXPERT
LIM EN NI
Chief Pharmacist and Director of Engagement
Alpro Pharmacy

On 30 July 2024, the Ministry of Health announced a ban on the selling of Pei Pa Koa-flavoured ice cream in an ice cream chain store.

The official reason cited for this ban was that mixing Pei Pa Koa—a cough syrup that is marketed as an over-the-counter traditional medicine—with food products is an act prohibited under Section 13B(2) of the Food Act 1983.

WHAT IS THE PROBLEM WITH USING THE COUGH MIXTURE AS AN ICE CREAM FLAVOURING?

According to Lim En Ni, unregulated consumption of this cough mixture can be harmful especially to pregnant women and young children.

This is because Pei Pa Koa contains licorice (甘草) that can bring about the following health issues.

Fluid Retention and Hypertension

Licorice contains glycyrrhizin, a substance that resembles the structure of the hormone aldosterone and, when it is in the body, mimics the function of aldosterone.

As a result, high levels of glycyrrhizin can lead to fluid retention, hypertension, and an imbalance of electrolytes in the body.

Blood Pressure Issues

Glycyrrhizin can cause an increase in blood pressure by reducing potassium levels and increasing sodium levels in the body.

In pregnant women, high blood pressure can lead to complications such as preeclampsia.

Preterm Labour Risk

Lim En Ni points out that some studies suggest that consuming large amounts of licorice during pregnancy may increase the risk of preterm labour by increasing production of prostaglandin, a hormone-like compound that is involved in triggering labour.

Baby Developmental Issues

There is evidence suggesting that excessive licorice consumption during pregnancy might affect the cognitive development of the child. It has been associated with lower intelligence and behavioral problems in children.

THE TAKE-AWAY MESSAGE

While over-the-counter medications are readily accessible, they should not be taken lightly—and definitely should not be used as flavouring for foods and beverages!

  • Always exercise caution and read labels carefully before use.
  • For optimal safety, consult a pharmacist or doctor prior to taking any new medication, even those available without prescription.

The above two simple precautions can help prevent adverse reactions and ensure the most appropriate treatment for your condition.

Two Experts Explain Why Coaching in Palliative Care Is Necessary for the Wellbeing of Our Population

WORDS DR JESRINA ANN XAVIER & DR LIEW KEAN YEW

FEATURED EXPERTS

DR JESRINA ANN XAVIER
Senior Lecturer
School of Management & Marketing
Faculty of Business & Law
Taylor’s University
DR LIEW KEAN YEW
Palliative Care Specialist
Hospital Ampang
INTRODUCING PALLIATIVE CARE
  • Palliative care is specialized medical care for people living with serious illnesses.
  • It aims to improve the quality of life for patients and their families associated with life-threatening illnesses.
  • Palliative care services were first offered in Malaysia in 1995, and they are gradually being included in the standard healthcare system.
RISING NEED OF PALLIATIVE CARE
  • The need for palliative care is on an upward trend all over the world due to the ageing population and the rising burden of chronic diseases.
  • In Malaysia, the proportion of palliative care needs to deaths hovered at 71% in the observed years. By 2030, it is observed that the growth for palliative care specifically will increase to 240%.
  • Sarawak, Perak, Johor, Selangor, and Kedah will become the top five Malaysian states with the highest needs in 2030.
COACHING IN PALLIATIVE CARE
  • Coaching in palliative care refers to the practice of providing support, guidance, and education to individuals facing terminal or life-threatening illnesses, as well as their families and caregivers.
  • It aims to improve quality of life by early detection and treatment of pain and symptoms.
  • It also enables patients and their families to take an active role in choosing how they will be treated, reclaiming a sense of control over their lives.
THE BENEFITS OF COACHING IN PALLIATIVE CARE
Improved Communication and Expression Skills
  • Anthony Grant, a revered psychologist, informs that coaching can be considered an emerging cross-disciplinary occupation, with the main goals being to improve performance, enhance well-being, and support organizational and individual change.
  • Palliative care coaching adopts a comprehensive strategy, acknowledging that every person’s experience with illness is distinct and multifaceted.
  • Coaching helps individuals develop their communication skills and express their needs, preferences, and concerns more effectively.
  • It can lead to increased satisfaction in care outcomes.
Assists in Enhancing Patient Wellbeing 

Through a coping mechanism, palliative care coaching assists patients and their families through goal setting, problem-solving, and symptom management.

Empowers Patients and Their Loved Ones to Make Informed Decisions
  • Making decisions about treatment options, advance care planning, and end-of-life care is rather challenging when undergoing treatments.
  • By providing information, the clarification of options, and assistance in weighing the advantages and disadvantages of various possibilities, coaching makes it easier for patients to advocate for their rights and choices.
Providing Patient-Centered Care
  • Coaches can deliver patient-centered care that respects people’s cultural backgrounds, attitudes, and beliefs.
  • Palliative care coaching helps patients, families, and healthcare professionals coordinate and collaborate, which promotes continuity of treatment to achieve shared objectives.

Malaysia’s First Women Ophthalmology Forum Commemorates International Women’s Day

WORDS LIM TECK CHOON

On 7 March 2024 Roche Malaysia Sdn Bhd launched the inaugural Empowering Visions: Malaysia Women Ophthalmology Forum in conjunction with International Women’s Day.

Moderated by talk show host Freda Liu, the forum featured the following prominent panelists:

  • Datuk Dr Nor Fariza Ngah, Deputy Director of Health, Research & Technical Support
  • Dr Tara Mary George, a consultant ophthalmologist
  • Dr Shamala Retnasabapathy, a consultant ophthalmologist

The panelists covered a multitude of relevant topics such as breaking barriers and overcoming stereotypes, patient care, the importance of interpersonal skills, the significance of continuous education as well as the professional development of women in the medical profession.

WOMEN BRING VALUE THAT CAN ELEVATE THE MEDICAL PROFESSION

According to Datuk Dr Nor Fariza, women bring a distinct perspective that enriches the profession and elevates patient care.

“In a domain where empathy, communication, and meticulousness reign supreme, women’s inherent strengths make them indispensable contributors,” she said during the forum.

She added: “Moreover, diverse representation ensures healthcare systems are attuned to the varied needs of patients, including those specific to women. By championing and empowering women in ophthalmology and healthcare at large, we not only advance gender equality but also enhance the caliber and efficacy of healthcare provision for all.”

A COMPASSIONATE APPROACH TO OPHTHALMOLOGY

Dr Tara Mary George said: “It is the compassionate approach commonly associated with us women which can significantly enhance patient care. Through empathetic communication and understanding, we can alleviate fears, clarify treatment plans, address patient concerns with as much sensitivity and understanding as possible, and cultivate a supportive environment where patients feel valued and heard.”

FAMILY SUPPORT VITAL FOR WORK-LIFE BALANCE

This key point was brought up by Dr Shamala Retnasabapathy, who said, “The supportive role of family is pivotal in achieving work-life balance, contributing to the empowerment of women in their professional endeavors.”

For her fellow women in the field of ophthalmology, she advised no to neglect continuous education and professional development, as these are essential when it comes to staying abreast of the latest advancements.

“This is another way of showcasing our commitment to providing the highest standard of care to their patients while contributing to the advancement of the field as a whole—and how we pave the way for greater inclusivity, diversity, and progress within the profession,” she added.

AN INITIATIVE TO CHAMPION DIVERSITY & INCLUSION

Choong Mei Chen, who is the Ophthalmology Country Disease Area Lead for Roche Malaysia, Vietnam, Philippines and Indonesia, told us that initiatives such as the Empowering Visions: Malaysia Women Ophthalmology Forum send a resounding message of support and empowerment.

“Together, let us boldly challenge the status quo, dismantle barriers, and pave the way for a future where every individual, regardless of gender, enjoys equal opportunities to excel!” she said.

UKM & AMM Organized Liver Cancer Awareness Day in Conjunction with World Cancer Day

WORDS LIM TECK CHOON

February 4 was World Cancer Day. In conjunction with World Cancer Day 2024, the Gastroenterology and Hepatology Unit, Department of Medicine and the Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) collaborated the Academy of Medicine Malaysia (AMM) organized a Liver Cancer Awareness Day event at Komune Living & Wellness, Bandar Tun Razak, Cheras, Kuala Lumpur.

THE MINISTER OF HEALTH CALLS FOR REMOVAL OF GREATER AWARENESS OF CANCER AMONG MALAYSIANS

The event was officiated by YB Datuk Seri Dr Dzulkefly Ahmad, our Minister of Health, and witnessed by the residents of Bandar Tun Razak.

In his speech, Datuk Seri Dr Dzulkefly congratulated the UKM Faculty of Medicine for organizing a community program that has the community closer to the university.

“Approximately 48,639 new cancer cases and 29,530 cancer deaths were reported in 2020 in Malaysia. And more worryingly, experts have predicted that the incidence of cancer in Malaysia will increase 2 times by 2040,” he shared.

He further stated: “There is no doubt that cancer is on the rise. I strongly believe that, as a community, we should learn what cancer is and most importantly to remove the taboo behind the word ‘cancer’.”

LIVER CANCER IS ONE OF THE TOP 5 MOST COMMON CANCERS IN MALAYSIA

“Currently, liver cancer is one of the 5 most common cancers in Malaysia; others are breast cancer, colorectal cancer, lung cancer and nasopharyngeal cancer,” Datuk Seri Dr Dzulkefly revealed. “Primary liver cancer, which starts from within the liver itself, unfortunately, has one of the worst prognoses because it is often diagnosed at a late stage when symptoms appear.”

Our Minister of Health also added that obesity is often associated with an increased risk of fatty liver disease known as metabolic dysfunction associated fatty liver disease (MAFLD), which is becoming the main cause of liver cancer.

However, liver cancer can be prevented either through hepatitis B immunization or early treatment of liver disease detected in patients with known hepatitis or cirrhosis.

LIVER CANCER DAY OFFERED EDUCATIONAL EVENTS & HEALTH SCREENING FOR ALL ATTENDANTS

The objective of the Liver Cancer Awareness Day event was to increase community awareness of liver cancer in addition to knowing more about liver cancer, its symptoms, risk factors, detection, and prevention.

A public forum on liver cancer was held during the event. This forum became a platform for liver cancer patients to share their experiences. Additionally, a group of panelists from the Ministry of Health Malaysia, University Hospitals, agencies and medical associations discussed the issue of public access to affordable cancer medicine in an effort to bridge the gap between the rich and the needy when it comes to cancer care.

In addition to public forums, the Liver Cancer Awareness Day event also provided attendants with screening services such as mammograms by Majlis Kanser Nasional (MAKNA), metabolic disease screening, hepatitis B and C screening, and fatty liver screening as well as consultation by experts, health fairs, quizzes, and lucky draws.

Meanwhile, the Malaysian Relief Agency (MRA) donated food packs to 90 residents of Bandar Tun Razak, Cheras. The participation of residents in this area was made via a community network between the UKM Faculty of Medicine and the residents of Bandar Tun Razak, Kuala Lumpur.

AUSPICIOUS GUESTS ADDED IMPACT TO THE EVENT

In addition to the gracious presence of the esteemed Minister of Health, the Liver Cancer Awareness Day event was attended by: Professor Dato’ Dr. Hanafiah Harunarashid (Pro Vice Canselor Kuala Lumpur Campus UKM), Professor Dr. Abdul Halim Abdul Gafor (Dean of the Faculty of Medicine UKM), Professor Datin Dr Marina Mat Baki (Deputy Dean of Industry Community and Partnerships Affairs), Professor Dato’ Dr Razman Jarmin (Director of Hospital Canselor Tuanku Muhriz UKM), Professor Dato’ Dr Ismail Sagap (Director of Hospital Pakar Kanak-Kanak UKM), Professor Dr Rosmawati Mohamed from the Academy of Medicine Malaysia, as well as various hospital directors and heads of department.

This program was made possible by the efforts of the Dean of the UKM Faculty of Medicine, Professor Dr Abdul Halim Abdul Gafor, and members of the faculty’s top management.

 

Malaysian Medics International (MMI) Responds to Zero HO Protocol

WORDS MALAYSIAN MEDICS INTERNATIONAL (MMI)

We are deeply concerned regarding the article released on 15th January by CodeBlue highlighting the implementation of a “Zero HO Protocol” within the medicine department of the University Malaya Medical Centre (UMMC). This protocol aims to address the critical shortage of house officers (HO) in different medical units as the services provided by house officers are now prioritised based on departmental workload.

Some of the key points of the protocol are as follows:

  1.  ICU prioritization with stable patients being admitted to medicine department wards and at-risk patients being placed in the Intensive Care Unit (ICU).
  2. Encouraging medical officers to perform procedures like IV cannula insertion and blood tests themselves to emphasize clinical judgement and discourage unnecessary test requests.
  3. Proposal for task sharing among medical officers, lecturers and consultants.
  4. Emphasis on mindfulness during patient admission as patient management is the responsibility of the admitting doctor.

House officers and medical officers are the grassroots of the healthcare system to achieve peak efficiency. Thus, we humbly call upon the Ministry of Health and Ministry of Higher Education to consider the following:

Decrease in manpower resulting in more harm than good

The diminishing numbers of house officers in the healthcare system are manifesting as a significant concern with multifaceted repercussions.

The increased workload on the existing staff is leading to burnout, adversely affecting their overall well-being.

Service reductions or cuts to cope with the strain could potentially compromise access to crucial medical services for patients, raising serious concerns about healthcare delivery and patient safety.

Hence, urgent attention is needed to address extreme shortages and maldistribution.

A targeted approach could involve expediting the intake of medical graduates into the housemanship system for a quicker transition from graduation to practical training. This would also overcome the “brain dead” issue which has been a concerning trend in the healthcare system.

On the other hand, Singapore offers a shorter time between graduation and work compared to waiting around six months in Malaysia. Hence, with a shorter gap, more medical graduates are able to work sooner to reduce the shortage of house officers.

Task delegation, focusing on critical departments, is crucial for effective management without compromising quality. Public hospitals should identify critical departments that are particularly affected by the shortage and maldistribution of HOs, as it would allow task prioritisation based on urgency and importance. Task delegation should focus on ensuring that essential responsibilities are managed effectively without shortage drawbacks. This emphasizes the need for immediate attention and comprehensive strategies from healthcare authorities to rectify this concerning trend and fortify the resilience of the healthcare system.

Collaboration between MOH and MOHE

Efficient collaboration between the Ministry of Health (MOH) and the Ministry of Higher Education (MOHE) is essential to bridge gaps and ensure better healthcare outcomes.

Clear communication with specific objectives and anticipated outcomes is necessary to foster a more cohesive and effective healthcare system.

Implementing interdisciplinary training programs for medical students, tailored to their academic schedules can provide essential skills learning for them.

Therefore, the workload among our healthcare workers can be reduced by providing opportunities for medical students to sharpen their skills under supervision.

Moreover, assessing the skills and competencies of available healthcare professionals ensures that responsibilities are delegated to individuals with appropriate expertise.

This diversified approach ensures a more efficient distribution of tasks, compensating for the diminished workforce and minimizing the impact on patient care. Early intervention at the foundation level can mitigate the issue of doctor shortage.

In conclusion

We urge the Ministry of Health and the Ministry of Higher Education to promptly consider and address the aforementioned issues. While this protocol might be perceived as a temporary drastic measure taken to cope with the decrease in house officers or medical officers, it could impact the present and future of Malaysia’s healthcare sector.

Thank you.

MALAYSIAN MEDICS INTERNATIONAL
TERM 2023/2024

About Malaysian Medics International (MMI)

MMI is an international medical student-led organization that aims to connect, educate, and cultivate. Since our inception in 2013, we have grown into a global network of more than 200 leaders from seven countries around the world. Presently, we are an active advocate for inclusivity and diversity, reform in medical education, and the welfare of our junior doctors and medical students.
Website: malaysianmedics.org
Email: admin@malaysianmedics.org

References:

  1. Zainuddin, A., & Su-Lyn, B. (2024, January 17). UMMC’s medicine department mulls ‘Zero HO protocol’, with indefinite critical Houseman shortage. CodeBlue. https://codeblue.galencentre.org/2024/01/15/ummcs-medicine-department-mulls-zero-ho-protocol-with-indefinite-critical-houseman-shortage/
  2. Zainuddin, A. (2024, January 19). MOH and MOHE must resolve their ‘Bad blood’: Musa Nordin. CodeBlue. https://codeblue.galencentre.org/2024/01/18/moh-and-mohe-must-resolve-their-bad-blood-musa-nordin/
  3. Zainuddin, A. (2024a, January 18). UMMC doctors tout parallel houseman system, full independence from MOH. CodeBlue. https://codeblue.galencentre.org/2024/01/16/ummc-doctors-tout-parallel-houseman-system-full-independence-from-moh/

An Expert Discusses What Happened to the Generational Endgame Bill of Malaysia

WORDS MUHAMMAD ZAID ZAINUDDIN

FEATURED EXPERT
MUHAMMAD ZAID ZAINUDDIN
Lecturer (Anatomy)
Centre of Preclinical Science Studies
Faculty of Dentistry
Universiti Teknologi MARA (UiTM)
IN RECENT NEWS

In November 2023, the Dewan Rakyat passed the Control of Smoking Products and Public Health Bill.

The Bill aims to regulate the sale and purchase of tobacco products, smoking materials, tobacco substitute products, and smoking devices, which includes smoking products such as electronic cigarettes or vape.

Though the passing of the bill is a positive step for the country’s public healthcare system and future generations, it has left members of the parliament and public health experts outraged.

WHY THE OUTRAGE?

The passed Control of Smoking Products and Public Health Bill is a watered-down version of the ambitious proposal initiated by our former Minister of Health, Khairy Jamaluddin.

The previous bill, dubbed the “Generational Endgame Bill”, proposed to prohibit persons born on or after 1 January 2007 from purchasing and smoking tobacco products, substitute tobacco products and smoking substances which includes e-cigarettes and vapes.

The bill passed in November 2023 removed this bold clause that would give rise to a smoke-free Malaysian generation in the future.

WHAT WOULD HAPPEN IF THE GENERATIONAL ENDGAME BILL WAS PASSED IN ITS ORIGINAL PROPOSED FORM?

In terms of impact on healthcare, the proposed Generational Endgame policy would ban smoking and vaping for those born in 2007 and onwards for the rest of their lives.

Ideally, this will create a smoke-free generation in the coming decades and save north of RM6 billion ringgit per year in terms of healthcare expenditure in the years to come.

This is stipulated by 2020 data, whereby the country had spent RM6.2 billion to treat three major diseases caused by smoking; lung cancer, heart disease, and chronic obstructive pulmonary disease. This cost was estimated to increase to RM8.8 billion by 2030 and will increase further if smoking had not been curbed.

THEN, WHY WAS THE GENERATIONAL ENDGAME CLAUSE DROPPED?

The Generational Endgame clause was dropped after considering the views from the Attorney-General’s Chambers, who claimed potential constitutional arguments.

The clause is unconstitutional.

In brief, the passing of the bill would create unequal treatment under the law between persons born before 1 January 2007, and individuals born after.

This is contradictory to Article 8 (1) of the Federal Constitution, which states that every person shall be equal under the law and have equal protection of the law.

The proposed bill would be unconstitutional as it would create two sets of laws for two different groups of citizens based on age.

Socio-economic impact on Malaysians.

An assessment of Malaysia’s Generational Endgame Policy by Oxford Economics, published in September 2023, states that the policy would be unlikely to deliver a reduction in healthcare costs. This is because future smokers would switch to illicit products.

This is on the basis that Malaysia has one of the largest illicit tobacco problems globally, with an estimated 57% of all cigarette sales in 2022 occurring through illicit channels.

An argument against the bill claims that a total ban of tobacco products would just expand the illicit tobacco market.

Impact on the economy.

The report also estimates that the legal tobacco industry in Malaysia currently supports a RM983 million contribution to the country’s GDP, RM3.3 billion in tax receipts, and 7,940 jobs.

A total ban of tobacco products would decrease these economic benefits on top of having to sustain an expensive expenditure on policy implementation, public communication, and enforcement programmes in addition to efforts needed to control the expanding of illicit markets.

IS THIS THE END OF THE GENERATIONAL ENDGAME POLICY?

Absolutely not!

The passing of the current bill is a small step forward toward achieving the Generational Endgame policy.

Though not banning the selling of tobacco products in its entirety, the Control of Smoking Products and Public Health Bill protects the younger generation from modern smoking devices, a rampant disease amongst our teenage youths.

The bill prohibits the sale and purchase of tobacco products, smoking materials, or substitute tobacco products as well as the provision of any services for smoking to under 18-year-olds, ultimately curbing the increase of smoking and vaping habit amongst children and teenagers.

IN CONCLUSION

Though our healthcare workers and policy makers are working hard to curb the rise of smoking and vaping, it is of the highest importance to maintain public awareness of the dangers of smoking and vaping. Such public awareness should be promoted and reiterated from generation to generation.

References:

  1. Bernama. (2023, December 7). Experts: Anti-smoking bill first step towards a smoke-free generation. NST Online. https://www.nst.com.my/news/government-public-policy/2023/12/987431/experts-anti-smoking-bill-first-step-towards-smoke-free
  2. Choy, N.Y. (2023, November 23). Health minister pledges to table Generational Endgame bill on tobacco before the end of Parliament sitting. The Edge Malaysia. https://theedgemalaysia.com/node/690959
  3. Harun, H. N. (2023, November 28). GEG dropped due to constitutional arguments – Dr Zaliha. NST Online. https://www.nst.com.my/news/government-public-policy/2023/11/984010/geg-dropped-due-constitutional-arguments-dr-zaliha
  4. Cabello, K. (2023, October 6). An assessment of Malaysia’s ‘Generational Endgame Policy’. Oxford Economics. https://www.oxfordeconomics.com/resource/gegmalaysia/

Are You Aware of Your Child’s Handwashing Habits? Here’s Why You Should Be

WORDS LIM TECK CHOON

FEATURED EXPERT
PROFESSOR EMERITA DR ELIZABETH SCOTT
Chair of the Global Hygiene Council
FIRST, THE BIG CONCERN
  • Infectious diseases are the leading cause of death all over the world.
  • Every year, there are about 525,000 children under 5 that perish from diarrhoea-related diseases.
  • A single emerging infectious disease can cost the global economy anything from USD30–50 billion.
  • There is also the rise of drug-resistant infections to worry about.
WHAT DO OUR CHILDREN HAVE TO DO WITH THIS?

Professor Dr Elizabeth Scott reveals that about 1.8 million children under the age of 5 die each year from diarrhea-related diseases and pneumonia.

However, it does not have to be this way. Professor Dr Scott shares that:

  • Simple handwashing could protect 1 in 3 children from diarrhoea.
  • Likewise, handwashing can shield 1 in 5 children from pneumonia.

“Access to handwashing essentials such as soap and water, and hand washing education in schools not only fosters good hygiene habits but can help to improve attendance,” she goes on to explain.

She adds: “Furthermore, early hygiene habits potentially enhance child development in some settings.”

Are you washing your hands correctly? Click for a larger, clearer image.
OUR KIDS AREN’T WASHING THEIR HANDS ENOUGH OR CORRECTLY, THOUGH!

Results of the Global Hygiene Council’s survey on nearly 5,000 parents, primary school teachers
and children aged between 5 and 10 found that:

  • 40% of primary school children are not always using soap when washing their
    hands at school.
  • 27% of primary school children did not learn how to wash their hands at school.
  • Only 37% of parents and teachers know that hands can still contain germs when they are visibly clean.
  • 47% of primary school children believe that if their hands are visibly clean, they will not get sick.
  • 65% of primary school children say they have seen people in their school not wash their hands after going to the toilet.
  • 50% of parents and teachers believe that children’s handwashing habits have little effect on whether they get ill.
OH DEAR, IS THERE ANYTHING THAT CAN BE DONE ABOUT THIS?

The Global Hygiene Council offers the following recommendations, which they call the ‘four pillars of change’:

Pillar 1: Build on lessons learned from the COVID-19 pandemic.

Link lessons learned from the implementation of hygiene practices in previous pandemics (such as handwashing, mask wearing, and surface disinfection) to provide policy guidance for future public health campaigns and infection, prevention and control policies.

Pillar 2: Mainstream AMR-sensitive infection prevention and control tools.

Direct more focus on infection prevention and investment in new antimicrobials, vaccinations, and antimicrobial stewardship. National action plans on antimicrobial resistance should be adapted to include hygiene and Water, Sanitation, and Hygiene (WASH) recommendations for home and community settings.

Pillar 3: Quantify the economic benefits of hygiene.

Consider hygiene education and access to appropriate hygiene facilities as a critical and cost-effective solution for facilitating hygiene behaviour change and protecting against the spread of infectious diseases in schools, at workplaces, and throughout communities.

Pillar 4: Establish strong hygiene habits.

Make public communications campaigns easy to understand and built on evidence-based approaches. Highlight the personal impact that changing hygiene behaviour has on the health of families and communities with respect to reducing the risk of infection.

PROTECTING FUTURE GENERATIONS AGAINST PANDEMICS

To protect against future pandemics, including the threat of antimicrobial resistance, there is a need for greater public awareness of the role of targeted hygiene practices in preventing infections within home and community settings.

Future public health campaigns and infection prevention and control policies should include clear and practical information on evidence-based practices, as well as ensuring adequate access to clean water and hygiene resources to help prevent the spread of infections, including those that are drug resistant.

References:

  1. World Health Organization. (2021, March 10). Diarrhoea. https://www.who.int/health-topics/diarrhoea
  2. McArthur D. B. (2019). Emerging infectious diseases. The nursing clinics of North America, 54(2), 297–311. https://doi.org/10.1016/j.cnur.2019.02.006
  3. Liu, L., Johnson, H. L., Cousens, S., Perin, J., Scott, S., Lawn, J. E., Rudan, I., Campbell, H., Cibulskis, R., Li, M., Mathers, C., Black, R. E., & Child Health Epidemiology Reference Group of WHO and UNICEF (2012). Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet (London, England), 379(9832), 2151–2161. https://doi.org/10.1016/S0140-6736(12)60560-1
  4. Ejemot, R. I., Ehiri, J. E., Meremikwu, M. M., & Critchley, J. A. (2008). Hand washing for preventing diarrhoea. The Cochrane database of systematic reviews, (1), CD004265. https://doi.org/10.1002/14651858.CD004265.pub2
  5. Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L. (2008). Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. American journal of public health, 98(8), 1372–1381. https://doi.org/10.2105/AJPH.2007.124610