Towards equity and equality in our healthcare

Equality and equity are two concepts which are often opposed to each other, though most people often mention them in the same breath.

Equality is about giving everyone the same level of something. This means that if you want to give three people a packet of nasi lemak, everyone gets one packet each.

Equity, on the other hand, is about making sure that everyone is given the adequate amount of something that they need, which may not necessarily be equal for each person. Take the nasi lemak example.

If among the three people getting the nasi lemak, one person is malnourished; then that person should get two packets of nasi lemak while the other two people get half a packet each (assuming of course, that there were only three packets of nasi lemak to be distributed).

Many people do not realise that providing equality is not the same as providing equity, in terms of the policies and resources allocated to achieving the task concerned. More importantly, providing services to everyone equally and equitably requires completely different approaches and implementation strategies.

A Sarawakian enjoys the same access to healthcare as a Malaysian living in the shadow of KLCC.

In terms of putting in the systemic building blocks to providing equal and equitable healthcare, we have done well over the years. But is that enough?

Can we say that Malaysia is delivering the best healthcare in terms of equity and equality. The answer, unfortunately, is not a resounding yes.

Sustainable execution of many of the strategies to ensure equal and equitable delivery of healthcare continues to run into snags, manifesting time and again during a crisis.

Disparities among nutrition and growth levels among our children in the urban poor population is a reflection of these inefficiencies, as well as the recent disease outbreaks and other health-related issues seen in various Orang Asli communities.

Or in the case of disparities that exist between cancer patients who are unable to get new life-saving medications, because they are unable to pay for them?

These situations, and others like them, point to a bleak picture that our delivery is not up to the standards of equity and equality in healthcare that we ourselves have worked hard to develop and deliver in the past. But whose fault it this?

Sad to say, it is the fault of the majority of us Malaysians. We are often more interested in ensuring that the government is pressured towards carrying out policies that are beneficial towards the middle-income Malaysian, leaving those who are underprivileged in many senses out to dry.

Take the PeKa B40 initiative. For those unclear of this initiative, it is a targeted scheme to get underprivileged Malaysians to be screened for chronic diseases as well as to enable them to gain access to additional medical aid including financial aid to buy medical devices, complete cancer treatment and a transport allowance to attend medical treatment. This is a scheme targeted to improve equitable access.

PeKa B40 has come under quite a bit of fire, with some even accusing it of being a waste of government resources which could be used for the Ministry of Health’s operating expenditure.

There was even a comment that the government could reopen some of the former “Klinik 1-Malaysias” to reuse the money that they were “wasting” on the PeKa B40 programme. This is really a misconception and is an example of how equitable strategies are dismissed as being a frivolous waste of time.

PeKa B40 is one clear strategy the government has formulated on improving equitable access to healthcare and it should be lauded and supported as we push through its implementation. Its success hinges on that, and more importantly, may prove to be a barometer for future such projects on further improving equitable delivery of healthcare here in Malaysia.

It’s not all grey clouds, however. To dispel the gloom somewhat on the issue of equity and equality in health, please allow me to put the spotlight on the foundation stone of our healthcare services, our healthcare personnel.

As a young house officer in Hospital Kuala Lumpur, I was taught about this by Dr S. Jeyaindran, whose passing leaves a great vacuum in the hearts of the Malaysian medical fraternity.

Jeya would go into even the seemingly irrelevant detail (for us house officers at that time) of asking the patient when their family would come to take them home if they were from out of town and would order their discharges to be processed following that timeline.

When we would ask him on why he bothered doing that, he would always patiently remind us that “for poor patients, discharging them early without them being able to go home would mean they would have all these extra expenses they would have to incur.”

That’s the kind of health professionals we were taught to be, to go above and beyond in providing services to any and all Malaysians.

Malaysia’s healthcare professionals continue to be one of the country’s shining examples on delivering equal and equitable services.

From ambulance drivers helping to buy food for patient’s family members; nurses going to the most remote villages to provide postnatal care; to GPs going to provide free services to a dying patient at home… our health services have shown themselves to be time and again, a service that provides equal and equitable service for all Malaysians irrespective of race, colour or creed.

In these divisive and troubling times, as we look to institutions that preserve what it is to be together as Malaysians, look no further than at our health service personnel, be they in the private or public sector.

We have been, and continue to be, Malaysians working to provide an integral service equally and equitably to all Malaysians.

Salam Merdeka and Selamat Hari Malaysia!

The views expressed are those of the author and do not necessarily reflect those of FMT.