Deklarasi Titiwangsa 2019: Ke arah liputan kesihatan sejagat (Malay/English)

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A long queue waiting at the crowded Penang General Hospital

[ENGLISH VERSION BELOW] Kami, para pemimpin dan pewakilan setiap badan professional setiap persatuan saintifik, setiap badan pertubuhan kemasyarakatan, setiap agensi dan jabatan kerajaan, setiap entiti swasta yang berpandu keuntungan dan rakyat Malaysia dan para rakyat umum dari serata mukabumi ini, yang mengambil bahagian dalam Healthcare Financing and Delivery Reform towards Universal Health Coverage Forum for Malaysia di Kuala Lumpur pada 15 Jun 2019,

MENGAMBILKIRA tema-tema pengarkaan dan asas yang dinyatakan di dalam Perlembagaan Pertubuhan Kesihatan Sedunia tahun 1946 dan dikemaskini 2014,

DIILHAMKAN dari aspirasi murni 17 Matlamat Pembangunan Mampan bagi Agenda 2030 (Sustainable Development Goals of Agenda 2030) untuk pembangunan mampan Pertubuhan Bangsa-bangsa Bersatu (sustainable development of the United Nations) yang ditekadkan pada 2015,

PENGUKUHAN kesemua prinsip dan komitmen yang telah dinyatakan di dalam Deklarasi Astana pada 2018 adalah begitu istimewa dan berwawasan,

MEMBAYANGKAN suatu sistem perkhidmatan kesihatan di Malaysia yang menjaga seluruh masyarakat dengan mengutamakan, mempromosi dan melindungi kesihatan dan kesejahteraan manusia; berperikemanusiaan, menyeluruh, berkualiti tinggi, mudah dapat, mampu milik dan mampan; disediakan dengan penuh rasa simpati, hormat dan bermaruah oleh para pengamal perubatan cukup terlatih dan amat bersemangat; dan menampung persekitaran yang mendorong di mana semua manusia dan komuniti akan diberikan hak dan akan dilibatkan dalam usaha mempertingkatkan kesihatan dan kesejahteraan mereka, dan

DEMI liputan kesihatan sejagat (universal health coverage), diisytiharkan:

1. Bahawasanya kami menegaskan komitmen kami yang berterusan pada hak-hak asasi kemanusiaan bagi setiap insan di Malaysia kepada setinggi-tinggi tahap piawaian kesihatan dan kesejahteraan, tanpa sebarang halangan mahupun apa-apa jenis pembezaan yang dinyatakan dalam nilai-nilai dan prinsip-prinsip yang tersemat dalam kedaulatan Perlembagaan Persekutuan Malaysia dan Deklarasi Hak-hak Asasi Manusia Sejagat 1948, terutamanya keadilan dan perpaduan perkhidmatan kesihatan.

2. Bahawasanya kami yakin kesihatan sebenarnya menjangkaui semata-mata kesejahteraan fizikal, mental dan sosial seorang individu; ia turut menjurus kepada modal kesihatan (health capital) yang penting kepada pembangunan masyarakat dan negara di Malaysia, sejajar dengan prinsip-prinsip sejagat bagi keadilan, perpaduan dan kemakmuran. Kami berpegang bahawa liputan kesihatan sejagat mencapai bukan sahaja kebaikan bio-psiko-sosial kepada setiap individu, malahan juga suatu kebaikan awam yang lebih menyeluruh yang membawa kepada keharmonian dan ketahanan sosial, dan

3. Bahawasanya sungguhpun berlaku kemajuan natijah-natijah kesihatan yang luar biasa di Malaysia semenjak Kemerdekaan pada 1957, beberapa keperluan kesihatan masih belum mendapat perhatian yang sewajarnya terutamanya yang melibatkan kalangan miskin (bandar dan luar bandar) dan orang-orang yang berada dalam situasi mudah terjejas. Atas sebab­ sebab etika, kemanusiaan, politik, sosial dan ekonomi, kami berpegang bahawa ketaksamaan akses dan perbezaan natijah-natijah akan tetap wujud dan kedapatan pertambahan bilangan dari kalangan kita yang tidak dapat lari dari menjadi jatuh miskin kerana menanggung bayaran untuk kesihatan, hidup tidak menentu di bawah ancaman kemusnahan kewangan akibat daripada permasalahan kesihatan.

Dengan mengambil kira Deklarasi tersebut. kami bertekad untuk:

1. Memenuhi liputan kesihatan sejagat

dengan pengukuhan sistem kesihatan primer melalui infrastruktur dan insentif yang bersesuaian;

dengan kaedah telus melakukan promosi kepada awam, peningkatan, pencegahan, rehabilitasi dan penjagaan paliatif dan bukan hanya penjagaan perawatan semata-mata;

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dengan menghapuskan segala bentuk halangan kepada akses, sama ada halangan fizikal, mental, budaya, institusi mahupun emosi;

dengan memanjangkan perlindungan fizikal, infrastruktur dan kewangan kepada seluruh populasi bagi mendapatkan perkhidmatan kesihatan yang berkualiti tinggi dan kos-berkesan pada masa yang bertepatan;

sehinggakan sebarang perubahan untuk mencapai liputan kesihatan sejagat mestilah benar-benar berlandaskan sains yang praktikal dan mampan, yang mana sebenarnya memerlukan konsultansi yang mendalam, telus dan bermakna bersama dengan para pengamal perubatan di pelbagai peringkat dan juga di semua sektor;

juga melalui kaedah yang teliti, merekayasa bayaran akses perkhidmatan kesihatan agar dapat pada masa yang sama menghalang kesempitan kewangan, menjamin kadar kebergantungan kesihatan yang bertepatan serta menjamin kesihatan fiskal nasional untuk jangka masa panjang

yang menjurus kepada populasi yang sihat dan lasak tanpa menyebabkan sesiapa pun yang keciciran di mana-mana bahagian perkhidmatan kesihatan yang lestari,

2. Memberi kuasa kepada individu dan komuniti

dengan memberi sokongan yang berterusan kepada individu, keluarga, komuniti dan masyarakat keseluruhannya supaya mengambil bahagian dalam membuat keputusan dan pengurusan keperluan penjagaan kesihatan masing-masing;

dengan secara aktif dan pasif mempromosi pengetahuan kesihatan terutamanya kepada populasi yang kurang perhatian, yang diperlukan untuk mempertingkatkan kesihatan mereka ataupun kesihatan orang yang mereka jaga;

dengan mengilhamkan sebuah perasaan pemilikan kesihatan dan kesejahteraan diri secara peribadi dan komuniti, dipandu oleh para pengamal perubatan profesional yang penyayang dan berpengetahuan;

dan juga dengan menggalakkan perasaan kebergantungan kepada diri­ sendiri ataupun berdikari untuk kesihatan namun mempunyai perpaduan yang setara dengan komuniti kita, kerana kesihatan mempuyai terlalu banyak perhubung-kaitan untuk diasingkan kepada seorang individu, dan

3. Keadilan perkhidmatan kesihatan dan sosial

dengan berterusan menjamin dan menampung sumber-sumber yang mencukupi melalui pelaburan yang lebih besar dalam perkhidmatan kesihatan dari kalangan perwakilan negeri dan bukan negeri;

dengan tanpa berasa belas mengurangkan ketirisan dalam bentuk ketidakefisienan, korupsi, pembaziran, penipuan dan penyalahgunaan;

dengan menyatukan para penggubal kesihatan dan penggubal kewangan dalam persekitaran dengan kecenderungan yang sama iaitu “kesihatan suatu pelaburan” (health as investment) dan pengagihan sumber-sumber yang berpatutan;

dengan sewajarnya menggubal kaedah pembuatan keputusan yang bersandarkan kos berkesan dan bukti di pelbagai peringkat pentadbiran kerajaan;

dengan tidak hanya menumpu kepada cabaran-cabaran masa kini seperti penyakit-penyakit tidak berjangkit tetapi juga menitik berat cabaran masa mendatang seperti penjagaan penuaan, perubahan iklim dan pergolakan teknologi.

Berpegang kepada kesemua komitmen tersebut, kami menegaskan sekali lagi tanggungjawab yang abadi oleh pelbagai peringkat kerajaan dalam melindungi dan mengetengahkan kepentingan setiap orang untuk menikmati tahap piawaian kesihatan setinggi yang boleh.

Kami memahami bahawa liputan kesihatan sejagat tidak hanya memerlukan percaturan penentu-penentu kesihatan bio­ psiko-sosial tetapi juga penentu-penentu ekonomi dan persekitaran.

Maka, kami memaklumi keperluan keputusan politik yang berani menggunakan kaedah masyarakat menyeluruh supaya polisi-polisi liputan kesihatan sejagat terukir di dalam semua pewakilan negeri dan bukan negeri dalam erti kata persekitaran pelbagai sektor dan trans disiplin yang sebenarnya.

Kami menyeru kesemua pemegangtaruh supaya dapat bergabung bersama-sama dalam mencapai kesemua komitmen yang telah termaktub di dalam deklarasi ini, berlandaskan semangat kebersekutuan, kepemurahan dan keazaman.

READ MORE:  Goverment must integrate healthcare within the ecosystem

Bersama, kita akan beroleh dan kita akan mencapai kesihatan dan kesejahteraan untuk semua, tanpa mencicirkan sesiapa.

English version

Titiwangsa Declaration 2019: Towards universal health coverage

We. leaders and representatives of professional societies, scientific associations, civil society organisations. governmental agencies and departments, private for-profit entities, non-governmental non-profit organisations and citizens of Malaysia and common citizens of our planetary commons.

CONSIDERING the overarching and foundational themes expressed in the Constitution of the World Health Organization in 1946 and updated in 2014,

INSPIRED BY the 17 aspirational and lofty sustainable development goals of Agenda 2030 for Sustainable Development of the United Nations resolved in 2015,

REAFFIRMING the principles and commitments expressed in the ambitious and visionary Astana Declaration of 2018,

ENVISIONING a whole-of-society healthcare system in Malaysia that prioritises, promotes and protects the health and wellbeing of all human beings; is humane, comprehensive, high quality, easy to access, affordable and sustainable; is provided with compassion, respect and dignity by healthcare professionals who are well trained and well motivated; and sustains an enabling environment where all human beings and communities are actively empowered and engaged in enhancing their health and wellbeing, and

IN PURSUIT of universal health coverage, hereby declare:

1. That we strongly affirm our eternal commitment to the fundamental human right of every human being in Malaysia to the highest attainable standard of health and wellbeing, without any impediment or distinction of any kind. described in the values and principles enshrined in the sovereign Constitution of the Federation of Malaysia and the Universal Declaration of Human Rights of 1948, in particular healthcare, justice and solidarity.

2. That we are convinced that health is beyond just complete physical, mental and social wellbeing for an individual: it also leads to health capital that is crucial for society and nation-building in Malaysia, alongside the universal principles of justice, solidarity and prosperity. We hold that universal health coverage achieves not only bio-psycho-social good for individuals but a more holistic public good that extends to social harmony and resilience, and

3. That despite the remarkable progress in Malaysia’s health outcomes since Independence in 1957, there remains unaddressed health needs particularly among the poor (urban and rural) and people in vulnerable situations. For ethical, humanistic, political, social and economic reasons, we hold that it is unacceptable that inequity in access and disparity in outcomes persists and increasing numbers among us are not free from impoverishing payments for health, living precariously under the threat of financial ruin due to ill-health.

With these declarations in mind, we commit to:

1. Achieving universal health coverage

by reinforcing our primary healthcare system through appropriate infrastructure and incentives;

by visibly promoting public, promotive, preventive, rehabilitative and palliative care, not just curative care;

by removing barriers to access, be they physical, mental, cultural, institutional or emotional barriers;

READ MORE:  Goverment must integrate healthcare within the ecosystem

by extending physical, infrastructural and financial coverage to the entire population for the right high-quality and cost-effective health services at the right time; that any changes to achieve universal health coverage must be soundly based on practical and sustainable science, which therefore requires deep, sincere and meaningful consultation with healthcare providers at all levels and in all sectors; and

by thoughtfully re-designing healthcare access charges to simultaneously prevent financial hardship, ensure appropriate self-reliance on health and long-term national fiscal health, leading to a healthy and resilient population with no one left behind on any part of our continuum of care.

2. Empowering individuals and communities

by continuing to support individuals, families, communities and the broader society to participate in decision-making and governance for their healthcare needs;

by actively and passively promoting the health literacy especially in under-served populations that is needed to enhance their health or the health of those for whom they care;

by inspiring a sense of personal and community ownership for their health and wellbeing, guided by warm-hearted and knowledgeable healthcare professionals; and

by encouraging a sense of self-reliance for health and yet equal solidarity with our community, as health is too inter-linked to be atomised to an individual, and

3. Healthcare and social justice

by continuing to secure and sustain adequate resources through greater investment in healthcare from state and non-state actors;

by ruthlessly reducing leakages in the form of inefficiencies, corruption. wastage, fraud and abuse;

by bringing health and finance decision-makers together around the shared goal of “health as investment” and appropriate resource allocation;

by appropriately enacting cost -effective and evidence-based decision-making at all levels of government;

by focusing not only on the challenges in the present like non-communicable diseases but also casting an eye to future challenges like aged care, climate change and technological disruption.

Holding these commitments in mind, we reaffirm the timeless responsibility of all levels of our fovernment in protecting and advancing the right of everyone to enjoy the highest attainable standards of health.

We deeply understand that universal health coverage requires addressing not only bio-psycho-social determinants of health but also economic and environmental ones.

Thus, we acknowledge the need for bold political choices using a whole-of-society approach in order that universal health coverage policies become embedded in all state and non-state actors in a truly multi-sectoral and trans-disciplinary setting.

We call on all stakeholders to join us in achieving the commitments expressed in this declaration in a spirit of partnership, generosity and ambition.

Together, we can and we will achieve health and wellbeing for all, leaving no one behind.

  1. Academy of Family Physicians of Malaysia (APFM)
  2. Academy of Medicine of Malaysia (AAM)
  3. Agricultural Institute of Malaysia (AIM)
  4. Aliran
  5. Alzheimer’s Disease Foundation Malaysia (ADFM)
  6. Asian Medical Students’ Association Malaysia (AMSA)
  7. Centre for Orang Asli Concerns (COAC)
  8. Family Medicine Specialist Association of Malaysia (FMSA)
  9. Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM)
  10. Federation of Reproductive Health Associations Malaysia (FRHAM)
  11. Galen Centre for Health and Social Policy
  12. Hospis Malaysia
  13. International Medical University (IMU) Malaysia
  14. Islamic Medical Association of Malaysia (Imam)
  15. Bar Council Malaysia
  16. Malaysian AIDS Council (MAC)
  17. Malaysian Dental Association (MDA)
  18. Malaysian Healthy Ageing Society (MHAS)
  19. Malaysian Medical Device Association (MMDA)
  20. Malaysian Pharmaceutical Society (MPS)
  21. Malaysian Society of Occupational Health Doctors (MSOHD)
  22. Malaysian Society for Quality in Health (MSQH)
  23. Malaysian Society of Anaesthesiologists (MSA)
  24. Malaysian Society of Nephrology (MSN)
  25. Malaysian Society of Oncology
  26. Malaysian Society of Ophthalmology (MSO)
  27. Malaysian Society of Transplantation (MST)
  28. Malaysian Students’ Surgical Society (MSSS)
  29. Malaysian Thoracic Society
  30. Medical Practitioners Coalition Association of Malaysia (MPCAM)
  31. Mental Illness Awareness and Support Association (Miasa)
  32. Mercy Malaysia
  33. National Cancer Society Malaysia (NCSM)
  34. National Council of Women’s Organisations Malaysia (NCWO)
  35. National Stroke Association of Malaysia (Nasam)
  36. Perdana University Graduate School of Medicine (Pugsom)
  37. Perinatal Society of Malaysia
  38. Pertubuhan Doktor-Doktor Islam Malaysia (Perdim)
  39. Pertubuhan Pembangunan Kebajikan Dan Persekitaran Positif Malaysia (Seed)
  40. Positive Malaysian Treatment and Access Advocacy Group (MTAAG+)
  41. Institute of Engineers Malaysia (IEM)
  42. UCSI University
  43. University of Cyberjaya

This declaration was initiated by the national health policy committee of the Malaysian Medical Association. It was presented to Health Minister Dzulkefly Ahmad on 18 January 2020.

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