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Seikat bak sirih, serumpun bak serai. This commonly-cited, Malay-essay-staple peribahasa means more than just paper unity. Rather, it represents a sense of togetherness in a community that goes beyond. Interestingly, this was what our Minister of Finance, Datuk Seri Tengku Zafrul had in mind in tabling Budget 2021 during Parliament a little over a week ago.

Covid-19 has landed its blows – businesses are experiencing immense economic damage, the tourism industry is suffering major losses – clearly escalating to a crisis on humanitarian and socioeconomic levels. The government is taking the right step in prioritizing a portion of Budget 2021 to combat the virus – but allocation of money to a new division in the medical field comes with the downsizing of funding for public healthcare. What does this mean for treatment of non-related Covid diseases? What is the government’s plan for the virus in the year ahead, and how does this reflect financially? How does a global pandemic translate into our country’s expenditure?

Crunching the numbers

At RM322.5 billion (an approximate 20.6% of Malaysia’s GDP), Budget 2021 will stamp its place in history as Malaysia’s biggest allocation yet. A stark contrast to 2020’s aim of lowering spending to reduce the fiscal deficit, 2021 sees a 10% increase from last year’s budget allocation of RM297 billion. 

Budget 2021 is now divided into three categories for funding allocation:

1. Development expenditure, meant for developing infrastructure like hospital and schools (21% ➜ ~ RM 68 billion)
2. Operations expenditure, meant for running a government like rent and salary payment (73% ➜ ~ RM 235 billion)
3. Covid-19 Fund, a new addition specifically for dealing with the pandemic (5% ➜ ~ RM16 billion)

For comparison, Budget 2020’s funding allocation was only split into 81% (RM 241.02 billion) for operation expenditures and 19% (RM 56 billion) for development expenditure. This shows an approximate RM6 billion decrease to operations expenditure, which corresponds to the shift in focus towards a rakyat’s-wellbeing centered budget.

Budget 2021 for Covid-19

An additional RM1 billion has been assigned to tackle a potential third wave of Covid-19 in 2021 – primarily meant for purchase of testing kits, procurement of PPE for front-liners, funding the National Disaster Management Agency, apparatus for university teaching hospitals, and equipment to facilitate standard operating procedures at health service areas. 

While these pre-emptive measures commend our government’s intuition, it may look discouraging when compared to the efforts of our Asian neighbours – Japan has a 234.2 trillion yen budget (RM9.23 trillion), and Korea an emergency disaster relief payment of up to 1 million won per household (RM3.7 thousand). In fact, our RM16 billion Covid-19 fund for 2021 is actually less than half of the allocation spent this year (a supersized RM38 billion); for a budget meant to cushion the effects of Covid-19, one might wonder if we are designating enough.

On the flip side, praises should be sung for proposals like increasing the Covid-19 expenditure ceiling by RM20 billion to RM65 billion to improve the KITA PRIHATIN package. The government has also affirmed their commitment to sourcing a viable vaccine for Covid-19 through Malaysia’s involvement in the Covid-19 Vaccine Global Access (COVAX) programme. 

Is the opportunity cost worth it?

Shockingly, the allocation of Budget 2021 to the Ministry of Health (MoH) has only increased by a mere 4% to RM31.9 billion despite the raging pandemic. To bear the outgoing costs of Covid-19, MoH has had to slash its budget for public healthcare by 20%, declining from RM14.2 billion in 2020 to RM 11.3 billion in 2021.

As the government narrows its focus (and finances) onto ending the pandemic battle, it is concerning to see that this could be happening at the expense of patients with illnesses unrelated to Covid-19. Resolving a virus and providing satisfactory care for long-term diseases should not be mutually exclusive. Afflictions in the field of nephrology and cardiothoracic (top 2 fields experiencing the largest cuts) are normally chronic – in which case the primary goal is to ease the patient’s symptoms instead of healing the overall condition. Fixating only on the Covid-19 crisis will indirectly cause the suffering of many others as they are denied affordable, accessible treatment.

Take nephrology, for example. MoH treatments range from clinic services, to dialysis care, to catheter insertion. A worrying decrease of 77.61% in this department could lead to the loss of care opportunities to the estimated 51,000 dialysis patients in 2020. Of these, how many of the vulnerable who rely on government subsidies – the old, the young, those earning lower incomes – should be overlooked for this pandemic? Is this all that’s left of seikat bak sirih, serumpun bak serai?

Nonetheless, Datuk Seri Tengku Zafrul has announced a RM25 million allocation on home dialysis treatment. Perhaps we can be optimistic that funding for treatment is not obsolete, but merely redistributed amongst other sections in Budget 2021.

Concluding words

While the healthcare budget allocation might be far from perfect, one has to acknowledge that the MoF has proposed Budget 2021 with the goal of a comprehensive financial plan in mind. After all, Malaysia has withstood a corrupt financial scandal, an unexpected political turnover, and massive economic loss this year – all amidst an ongoing pandemic. The unprecedented circumstances of today only serve to show how important it is that the rakyat stand as one. 

Discussions for Budget 2021 are set to conclude mid-December, and until then, we can only bide our time as we root for the best for our nation.