Decentralisation, said Dr Khor Swee Kheng, would enable greater accountability, better governance and increase the effectiveness, equity, and efficiency of stronger health outcomes.
He said the Malaysian health system has many weaknesses, which include unequal resource distribution, problems with hiring, unequal health outcomes and lack of responsiveness.
“If you look at Sabah, the state has fewer doctors, nurses, hospital beds, CT scans compared to other states. Inequity is definitely present in centralised models.
“In terms of health outcomes, it is also rather unequal around Malaysia. Poorer states usually have poorer health outcomes,” he said in an online forum organised by Wisdom Foundation.
Khor said many decisions are also made only by the health ministry and public service department (JPA) which can create a built-in conflict of interest.
He said this built-in conflict of interest also has to be decentralised to build greater transparency in governance and accountability.
“We may also need to consider a hybrid decentralisation model where public healthcare services can operate semi-autonomously and receive coordination, oversight, governance and money from both federal and sub-national governments,” he said.
Khor said decentralisation was a long-overdue process in Malaysia but it must be carefully planned and must take time.
Bandar Kuching MP Kelvin Yii, who also attended the forum, said by decentralising healthcare, local state governments can take into account the vastness of geographic and demographic issues, social diversity and the ever-growing health needs of the local population.
Yii also said each state should be playing its role in public health control, especially during the Covid-19 pandemic.
Citing the healthcare situation in Sarawak, he said many doctors in the state are not empowered to be policymakers and this should change if the state ever wants to achieve full healthcare autonomy.
Recently, calls for decentralisation have emerged in the handling of the Covid-19 pandemic with Bukit Mertajam MP Steven Sim saying that Covid-19 prevention and management strategies should be decentralised and that state and local governments must be empowered with resources and devolution of power.
In May, DAP secretary-general Lim Guan Eng also said the implementation of standard operating procedures (SOP) should be decentralised as this would help to contain the third wave of Covid-19 infections.
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