ParliamentOne of the common complaints I hear about the government, including the Ministry of Health (MOH), is their refusal to consult stakeholders in policymaking or when drafting legislation.

Any meetings called – sometimes invites are sent only a couple of days before the meeting – are often meant to just “inform” stakeholders that the government plans to do this or that, without any intention to get stakeholders’ views to draft regulations and laws that consider the interests of as many parties as possible in a democracy. In doing so, the government treats Malaysia like a nanny state, believing that the minority in power knows best for the majority of the people.

This isn’t a flaw unique to Pakatan Harapan; the previous Barisan Nasional government was just as opaque and dismissive of Malaysian citizens, if not more so.

Laws, regulations and policies are often implemented without prior feedback from affected people or institutions, some of which end up getting rolled back when public backlash occurs. When proposed laws or policies are announced in advance, the process for providing the government opinions on how these might affect us, either as a normal citizen or as an organisation, is vague and unstructured.

If you’re an individual, you are likely just forced to use social media to express your views, or to call your MP if they have an active office. If you’re an organisation or a business, you must rely on “contacts” with the relevant government ministry. If you’re lucky, you may get a meeting with the minister. But if the minister’s staff act like arrogant gatekeepers, how can you get your feedback across?

One of the ways that we can decentralise power in Malaysia and refocus politics on policymaking – as opposed to joining cults of personality – is to empower backbencher Members of Parliament to check the government, or the Executive. The power to affect the lives of 30 million Malaysians should not be concentrated in the hands of just 28 people in Cabinet.

By doing so, the Cabinet’s allure dims and there is less opportunity for corruption because certain quarters cannot just seek to influence one person – the Minister – since Parliament has equal power to push back on undesirable laws or policies mooted by the Executive.

Currently, Malaysia has an online site called the “Unified Public Consultation” – under the Malaysia Productivity Corporation (MPC), which is an agency under the Ministry of International Trade and Industry – where anyone can give feedback on various proposed government regulations. Most Malaysians are probably unaware of the website’s existence, since MPs don’t talk about it. The design of the site is very poor; it’s difficult to look for policies related to specific ministries.

MOH posted on that website last July 26 to gather feedback on proposed drug price controls, but since MOH didn’t publicise it on its social media pages, it’s unknown how many members of the public actually took part in the so-called “consultation”. The website only shows chatroom-style comments by five anonymous people. If other stakeholders like pharmaceutical companies, or physician or pharmacist groups had submitted feedback by emailing the MOH official listed on the page, the public does not know their views as the website doesn’t upload any documents of written responses.

 

Form Single Parliament Committee On MOH

Parliament Speaker Mohamad Ariff Md Yusof announced plans last April to form another 11 special select committees – besides the current six – including one examining health, education, community and social development as a whole.

Since the 11 Parliament select committees have yet to be set up, I propose that a committee be formed specifically on health alone, as MOH is one of the biggest ministries in terms of budget allocations. MOH received RM30.6 billion in Budget 2020, comprising about 10 per cent of the overall RM297 billion federal government budget for next year. If you add the Education Ministry’s RM64.1 billion budget, the allocations of both ministries reach almost a third of the entire federal budget. That is way too much money for a single Parliament committee to monitor.

It’s also crucial for a singular Parliament select committee to examine the spending, policies, and administration of MOH and its associated bodies, like ProtectHealth Corporation which runs the Peka B40 health screening and aid programme, since MOH sparks a conflict of interest by playing multiple roles as health care provider, funder, and regulator.

Malaysia’s Parliament select committee can monitor not only MOH’s work, but also health policies or programmes under the purview of other ministries, like the mySalam health protection scheme which is under the Finance Ministry’s jurisdiction, or drug decriminalisation that involves the Home and Youth and Sports Ministries.

In the UK, these roles are played by independent bodies, with the Care Quality Commission and the National Institute for Health and Care Excellence checking the NHS by regulating health and social care, and recommending medicines and treatments for use in the NHS respectively.

The UK’s Health and Social Care select committee in Parliament, which monitors the Department of Health and Social Care and its associated bodies, held 31 inquiries in the 2017-2019 Parliament, including 244 witnesses in 64 oral evidence sessions.

https://twitter.com/CommonsHealth/status/1191777689604165632

The Parliament committee examined the quality of sexual health services, changed the government’s approach towards medical cannabis, and heard from pharmaceutical companies and public bodies after negotiations broke down about purchasing Orkambi, a cystic fibrosis drug. The innovative drug is now available on the NHS. Malaysia’s MOH, on the other hand, allegedly doesn’t bother negotiating with drug makers, according to cancer advocates, which means that the newest treatments are not available in government hospitals.

The UK’s Parliament select committees provide the general public guidance on how to give evidence to inquiries, be it written (less than 3,000 words), or oral (in Q&A format). The public can observe the select committees’ evidence sessions. Committees publish online most of the written evidence they receive, while oral evidence sessions are recorded on Parliament’s broadcast channel, with written transcripts uploaded online.

You can even subscribe to email alerts for whichever Parliament select committee so that you can attend evidence sessions on issues you’re interested in. Our own Parliament website is very bare bones, without even the terms of reference listed for the six Parliament select committees, much less details on how the public can participate in them.

https://www.youtube.com/watch?v=o_2RDuDs44c&feature=youtu.be

The way the UK Parliament operates, with detailed steps and procedures on how ordinary citizens can participate, is very transparent and empowering. Malaysia should follow suit.

 

How A Parliament Committee Can Examine Drug Price Controls

Malaysia’s Parliament select committee monitoring MOH, for example, could comprise MPs who work on health issues like Klang MP Charles Santiago, Bagan Serai MP Dr Noor Azmi Ghazali, Bandar Kuching MP Dr Kelvin Yii, Permatang Pauh MP Nurul Izzah Anwar, or Rembau MP Khairy Jamaluddin.

To determine whether Malaysia should introduce price ceilings for innovative medicines, the Parliament committee can invite foreign and local pharmaceutical manufacturers, as well as associations representing doctors, pharmacists, and hospitals to publicly testify on why they’re against such regulations.

Let MPs grill pharmaceutical executives in public so that they can justify the sky-high prices of some originator drugs and explain why lifesaving medicines should be subject to the free market.  

The committee can also accept evidence from patient groups, non-government organisations, think tanks, and academics who support or oppose drug price controls. Even related ministries like the Ministry of International Trade and Industry, which may be concerned about the impact on foreign investments into Malaysia, can submit their views, as well as MOH itself, of course.

MOH has yet to explain exactly how much money patients can save from medicine price regulations, even though the Pharmaceutical Association of Malaysia (PhAMA), which represents multinational pharmaceutical companies in Malaysia, claims that the 400 innovative molecules targeted for price controls only account for 3 per cent of Malaysia’s total health care cost.  

All oral and written evidence by the Parliament select committee monitoring MOH should be made available online, since some of us may not be able to physically attend the hearings. The government can then decide, based on all the evidence it has received, on whether to go ahead with a potentially disastrous policy for Malaysia’s health care system.     

It’s not enough for MOH to hold town hall sessions with general practitioners (GPs), pharmacists, and pharmaceutical industry players, though I’m sure stakeholders welcome these. Such sessions (which are not available for the public to attend, though some are broadcast on Facebook) may be helpful to identify general areas of concern, but it’s also important to have a public process to receive and document stakeholders’ views on specific policies or legislation. Openness and transparency are key.

 

All Views Matter, Even Contrarian Ones

One of the interesting inquiries by the UK Parliament committee monitoring the government health department was the one assessing the case for introducing a minimum unit price on alcohol in England. The Parliament select committee held an oral evidence session in January 2018, taking evidence not just from public health specialists who supported implementing the policy, but also from liquor trade associations who called for postponement of the policy throughout UK pending the impact of its implementation in Scotland.

A whole slew of health groups, think tanks, individual academics, police, as well as industry stakeholders representing convenience stores and wine, spirit, beer and pub businesses, submitted written evidence.

England and Northern Ireland currently don’t plan to introduce minimum pricing for alcohol, even though a study recently found that the minimum pricing imposed in Scotland since May 2018 based on the strength of alcoholic drinks (50p per unit) has cut drinking by half a pint weekly.

Malaysia’s MOH may not like pharmaceutical, tobacco, vaping or alcohol companies very much, but this doesn’t mean that the government should ignore their concerns. Any proposed ban on vaping products or other planned legal amendments should be made a Draft Bill first, like in the UK, to enable public consultation and pre-legislative scrutiny, before tabling it formally in the Dewan Rakyat. The Parliament select committee monitoring MOH can launch an inquiry on the proposed vaping ban to receive feedback on draft clauses of the Bill. The government shouldn’t spring the Bill on MPs’ desks last minute without going through proper consultation with both the general public and key stakeholders.  

Businesses, which employ Malaysian citizens, are a huge part of society and should not be summarily dismissed so that the State can claim dominion over our private lives. Small and medium businesses, especially, are the lifeblood of a vibrant and thriving society. Regulations, no matter how well intended, always tend to hurt small businesses over huge corporations.

Public health is not a zero-sum game.