RSOG Policy Discourse Series
PEKA B40 – Unleashing its Potential
Dr. Rozita Halina Tun Hussein
When: 2 May 2019
Where: Razak School of Government
Guest Speaker: Dr. Rozita Halina Tun Hussein
The framework of the Session
There is an abundance of sayings in various languages that continuously remind people on the importance of good health such as “the first wealth is health” and “badan sihat, otak cerdas.” In short, a good health is universally accepted as one of the foundations to build a life, a community, and an economy. Considerable investments are made into health-related agendas from building infrastructures to enhancing professional skills in this field, application of technology, and research and development. Such commitment has not gone unnoticed – Malaysia is regularly cited as a developing country (previously) that achieved effective universal health coverage (UHC) early (about 1980s). Since UHC is a shifting goal, the pursuit continues with the recently launched Skim Peduli Kesihatan Untuk Kumpulan B40 (PeKa B40). The scheme that targets the underprivileged helps in terms of health screening, medical equipment, incentives to complete cancer treatments, and transportation incentives, all paid by the Government. This session aims to explore PeKaB40 from a wider perspective. For instance, what were the considerations in planning and implementing this scheme? What could pose as a potential constraint in its implementation? These are some of the areas of discussion during the session.
Key Takeaways from the Session
If you were asked, “have you had the opportunity to undergo health screening?”, what would your answer be? Your response is likely to be dependent on which segment of the population you belong to. Your response may also lead to follow-up questions and uncover some characteristics based on your demographic make-up. Considering the myriad possibilities of responses, policymakers are left with the tough task of ensuring that policy and programmes implemented addresses the issues at hand for the masses, especially when its outcome affects how a nation can grow and prosper. On 2 May 2019 at Razak School of Government, YBrs. Dr. Rozita Halina Tun Hussein, Senior Deputy Director in the Planning Division of the Ministry of Health shared the potential of a pilot project called Skim Peduli Kesihatan Untuk Kumpulan B40 (PeKa B40) and how it can unleash other possibilities.
One of the growing concerns of Ministry of Health is the rise of Non-Communicable Diseases’ (NCD), which are non-infectious diseases with risk factors usually due to a person’s background, lifestyle and environmental causes. According to National Health Morbidity Survey (NHMS) 2015, there are at least 3.5 million adult Malaysians living with diabetes, 6.1 million with hypertension, and 9.6 million with hypercholesterolemia. The survey also reported that 47.6% of the B40 population aged 50 years and above have at least one undiagnosed NCD, among the trio of hypertension, diabetes or high cholesterol. Adding to the worry is the growth of undetected mental health illnesses such as depression and anxiety, and the rise of cancer, especially ones detected at a later stage or left untreated. In 2020, Malaysia will be an aging population, whereby at least 7% of the population is aged 65 years and above. Therefore, PeKa B40 comes at an importune time as it targets Bantuan Sara Hidup (BSH) recipients aged 50 years and above who fall in the bottom 40% of income level in Malaysia.
While timing and timeliness makes a difference, the formulation of this programme was not an overnight thought. With over 30 years of on-going analysis and evaluation of the healthcare system in Malaysia, the ministry is not without aspiration of the nation’s healthcare trajectory. The Guest Speaker shared the importance of data and analytics to support the types of interventions that one must undertake. This information also assists when further constraints exists such as financial and/or human resource constraints and urgency of the deliverables. It is no surprise that innovation often sprout when one is bounded by many limitations. The programme overcame many stumbling blocks by going back to the objective of why the programme must be implemented, which include to increase access to quality healthcare services especially for NCDs, enhance public-private partnerships especially at the primary care level and reduce the burden of illness for the poor. Based on the objectives, the ministry had to identify how can it be realised despite existing constraints.
One of the key success factors in rolling this pilot programme despite the constraints was the ability to negotiate the right pricing in procuring the screening services. The intention is to ensure that the government as a strategic purchaser pays a cost-effective price which is still efficient but does not compromise on quality nor encourage a monopoly of its service procurement. Another important factor is meaningful engagement with stakeholders and end user. For instance, transportation costs were highlighted as one major reason why patients, especially those who are underprivileged, often default treatment. Another factor was establishing a free web-based and mobile-enabled information management system instead of requiring users to purchase special systems or programmes. However, in remote locations with limited internet connectivity, other modalities were also developed to ease the process of data entry of important information.
Recognising also that changing human behaviour and mindset change is an uphill task, PeKa B40 offers 4 benefits to entice participation. Once the individual completes the health screening i.e. benefit 1, they are then eligible for the other 3 benefits such as the health aid, incentive to complete cancer treatment and transportation incentive. In ensuring that the benefits are communicated to the target group, the Ministry employs several outreach activities such as engagements with assemblymen and mainstream & social media, distribution of collaterals such as posters, flyers, buntings and working with large corporate partners in the retail business.
While PeKa B40 is not yet a month old, there are several potentials identified by the Ministry. First, the integration of public-private sector in the delivery of healthcare services may be further enhanced by looking beyond screening and redistributing the workload between the two sectors. Secondly, the role of ProtectHealth Corporation as a strategic purchaser, can be further expanded to cover a broader range of health services and to introduce new provider payment mechanisms. Thirdly, utilising big data in medical analytics and risk profiling will better guide health system planning and development to further improve patient care management, quality of care and to unleash more targeted interventions. Fourth, PeKa B40 can expand the use of incentives to influence patient’s health seeking behaviour favouring appropriate preventive, promotive and early curative services. And finally, PeKa B40 can serve as the catalyst to further health systems reform to upgrade Malaysia’s health system.
The tagline of PeKa B40 is “Lebih PeKa, Lebih Cakna.” Peka is essentially how responsive one is, and Cakna refers to being caring. With good health universally accepted as one of the foundations to build a decent life, a sustainable community, and a prosperous economy, the potential of PeKa B40 is looking very promising.
Key issues raised
- In instituting change or implementing nation-wide policy, context setting is important to juxtapose aspirations of government and reality check of the ground.
- The introduction of ProtectHealth Corporation into the health system equation in Malaysia has enabled a purchaser-provider split for both public and private healthcare sectors, which was absent in the past. Creating ProtectHealth Corporation also enables the cross-fertilisation of knowledge and skills between the two sectors of the same industry.
- The impoverished and underprivileged are often the ones bereft of access to information. Therefore, it is a current challenge for PeKa B40 to reach all beneficiaries especially those in most need.
About the Speaker
Dr. Rozita Halina Tun Hussein serves as a Senior Deputy Director in the Planning Division, Ministry of Health Malaysia since 2015. She holds a Master of Public Health (Health Policy and Management) from Harvard University. She is involved in the planning of health systems reforms for Malaysia, and currently the design, implementation, and development of Skim Peduli Kesihatan untuk Kumpulan B40 (PeKa B40). She helped incorporate ProtectHealth Corporation Sdn. Bhd., the not-for-profit organisation under the Ministry of Health that functions as the arms-length payer in PeKa B40. Dr. Rozita started from a public health research background since 1995 and has been actively involved in various research activities, especially related to health financing and economics, including the National Health and Morbidity Surveys (NHMS) since 1996 and the Malaysia Health Systems Research (MHSR) from 2014 to 2018 where she was the project manager. She also set up the Malaysia National Health Accounts system (MNHA) in 1999 to 2003. Her expertise related to health financing has been recognised in multiple international arenas, and she is often invited as speaker to share her knowledge and experience.