New government, new health leadership: resetting the war against Covid-19

With the resignation of the Muhyiddin government, the new prime minister and his or her new government must put war against Covid-19 on the top of their list.

The survival of this new government hinges on its success (or failure) to bring down the number of cases, ICU admissions and deaths. Getting public health leadership right is a crucial test for the new prime minister.  

First, a senior minister of health

Never has the choice of a health minister candidate been so consequential on the lives (and deaths) of ordinary Malaysians. Before 2020, the health minister had not been considered a top ministerial appointment.

In the United Kingdom, “great offices of state” are chancellor of the exchequer, foreign secretary, and home secretary. In Malaysia, the most important portfolios are finance, home, and defence. Education is also a politically heavyweight post.

Under the UMNO-Barisan Nasional government, the health portfolio was treated as a junior role, given to its component parties, usually MCA or MIC. The UMNO bigwigs were never keen on this technical and burdensome appointment.

It was unsurprising then when Muhyiddin government’s Covid-19 management effort was handicapped by a subpar minister in the name of Dr Adham Baba whose first fumble was to promote drinking warm water as a prevention against the virus. He never really recovered from his blunder.

To fight this pandemic and prepare our healthcare system for future crises, as well as to pre-empt an increasingly ageing society, the health portfolio should be seen as one of the “great offices”.

The new health minister should be a highly competent political leader with stature among his cabinet colleagues to enable confident and effective communication of difficult health policy changes to the cabinet, and more importantly, to the public.

The Muhyiddin government introduced a “cluster” approach in organising policy sectors of security, economy, education and social, and infrastructure development. If it is maintained, the health minister should be anointed senior minister for the social cluster.     

The health minister should also be the person to handle vaccine coordination. Under the Perikatan Nasional government, Khairy Jamaluddin was tasked to handle vaccine matters after Adham Baba failed to grasp the issue which is currently the most important concern of all Malaysians. Khairy did a great job but he was hampered by the fact that he wasn’t running the health bureaucracy.

As a nation, we need to reform the healthcare system beyond Covid-19. The pandemic exposes all the existing weaknesses which would require leadership, political will and visions to rebuild. The new health minister must also be able to articulate health policy choices for the nation in the years to come, including health financing, data collection and analysis in healthcare, prevention and management of future pandemics, etc. 

Second, appoint a new health director-general

During the first months of Malaysia’s Covid-19 battle last year, Tan Sri Dr Noor Hisham Abdullah was seen as the national hero. However, people began to question the director-general’s credibility when he failed to handle the returnees of the Sabah state election campaign in September 2020.

Of course, we thank Dr Noor Hisham for his initial contributions but he made some bad calls which resulted in huge consequences.

The delay in both the approval of vaccines by the National Pharmaceutical Regulatory Agency (NPRA) and test kits by the Medical Device Authority (MDA) can be attributed to the DG of health to some extent, since he oversees these two entities.

In fact, these entities should not be placed under the purview of the DG of health as the public health system is the largest purchaser of drugs and medical devices. There could be possible conflict of interests. These bodies should be run transparently by an appointed board and responsible to the minister and through whom to the Parliament.

Dr Noor Hisham’s erstwhile insistence on using PCR tests (gold standard, but too time-consuming) and refused for months to deploy RTK-antigen tests in a big way slowed the process of testing significantly. Even now, Malaysia tests too few. We need to test at least 300,000 people or 1 % of our population a day.

The sole reliance on lockdown to combat Covid-19 – Noor Hisham’s standard recipe – contributed to huge economic dislocations.

The refusal to share granular data with state governments including the worst-hit Selangor, running a health ministry-centric approach and not a whole-of-government approach, and the tendency to exclude private hospitals and private GPs in the fight against Covid-19 are some other mistakes which I hope the new DG of health can remedy quickly.

Third, a strong health civil service

The health ministry consists of two parts, the medical and health service led by the DG of health and filled with medical professionals, and the generic civil service led by the secretary-general of the ministry and filled by rotating and career administration and diplomatic officers (PTD).

It is similar to the structure of the defence ministry, which also has two parts, the armed forces led by the chief of armed forces, and the generic civil service led by the ministry’s secretary-general.

A PTD officer can be posted from one ministry to another, from agriculture to health to defence, and from federal to states. A good officer would know all the rules and have extensive peer contacts across the entire government structure.

By adopting this system, Malaysia emulated India rather than United Kingdom. Some officers gain expertise and develop their specific skillsets and specialised areas through tertiary studies but most PTD officers see themselves as administrators, not as experts of the tasks entrusted to them.

The Westminster system necessitates that ministers are generalists. But at the ministry, the secretary-general (ketua setiausaha or KSU) is also a generalist. The entire civil service side of the health or defence ministries are also generalist in nature.

But the world has grown very sophisticated, and expertise is needed at all levels of a ministry.

For instance, the finance or procurement head of division in the health or defence ministries needs to know not just finances but really need to have sufficient knowledge and understanding of either medical devices or weaponry. 

The convention of rotating officers from one ministry to another has its merits but some mid-level officers with expertise should be groomed and retained for a much longer time within a ministry or a cluster of policy area.

There is a need to find a way to develop expertise and specialisation in the generic civil service, and perhaps the health ministry is where new arrangements could be implemented first, given the importance of public health now and in the years to come.   

In conclusion, the appointments of a respectable and effective health minister and a new DG of health who will bring fresh thinking, as well as the quick build-up of expertise in the generic civil service of the health ministry, will decide whether the new government is capable of resetting the Covid-19 situation and the health sector in general.

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