By Amar Singh HSS, Yuenwah San et al
Do we love our children? This may seem an odd question to ask, but not if it is directed at the government, its ministries and agencies. It is being asked in view of the impending Budget announcement in October 2023.
Politicians and ministers often tell us how much they love our children. We hear from them: “Children are our future… we must invest in our children” and similar rhetoric.
But the proof of the pudding is in the eating. This means we can gauge all assurances about children by actions: how much do ministers allocate as investment in our children’s learning, wellbeing, health and safety? To what extent are Malaysia’s elected representatives fighting for bigger allocations for this to be ensured?
Let us sample some of the ‘pudding’ to taste the flavour of politicians’ love for our children.
First on the tasting menu: child health, the seed of the nation’s future.
The table below shows the total health budgets and paediatric budgets in the Ministry of Health (MoH) for the past five years, compared with 10 years ago.
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In 2023 the total budget assigned to the ministry was RM36m, but the paediatric budget was only RM611m or 1.7% of the total health budget. This was a 10-year low, dropping away from 2% in 2013.
The amount allocated to paediatric care in MoH hospitals is a tiny morsel. It has, relative to the total health budget, fallen over time.
Someone in the ministry may say that other MoH budget allocations are also used to meet children’s health needs.
To this, we recommend a visit to our paediatric intensive care units and neonatal intensive care units all over the country that are struggling with space, equipment and nursing resources, unlike adult ICUs. Every single day, the paediatric and neonatal intensive care units have to search for beds for ill children and babies.
We spend large sums on adults with chronic illnesses but very little on these children who are “our nation’s future.”
We need to triple the beds and resources at these paediatric and neonatal intensive care units, and reinforce this with health promotion for our children.
Alarmingly, the critical indicators for child health in 21st Century Malaysia have stagnated. Deaths among newborns, infants and children made no discernible progress for the past two decades.
Graphic: Khazanah Research Institute’s “Social Inequalities and Health in Malaysia” report published on 1 December 2020
One in every five Malaysian children under the age of five is stunted (21.8% in 2019). The number of underweight Malaysian children under age five has increased from 12.4% in 2015 to 14.1% in 2019. And wasting among our children [children who are too thin for their height] increased from 8% to 9.7% during this same period.
Our children, whom we love, are increasingly malnourished. And this, in the long term, is significantly associated with lower IQ, reduced productivity, higher paradoxical risk of obesity with non-communicable diseases, and premature deaths. Eventually, if they survive, such childhood risks place our children at increased risk of dementia.
Second on the tasting menu: child protection.
A minister announced (in a Mampu study in 2019) that we have one social worker to 8,576 Malaysians, with 3,814 Social Welfare Department personnel focused on social work. The reality is that, among these personnel, there are very few trained social workers, with only a small number involved in child protection. The average welfare officer has a frightening case load of 50 to 100 child protection cases a year.
Child abuse is an epidemic, with most child victims missed until too late. The bare minimum we need to meet child protection services is 30,000 to 40,000 trained social workers in the Social Welfare Department.
With the current focus and level of initiative, what are the chances of reversing the epidemic? We have eight public institutions of higher learning and five private institutions producing small numbers of trained social workers each year. There is no major initiative to strengthen the department’s workforce and its professionalism with trained social workers.
Third on the tasting menu is a time-hardened, less palatable chunk of the pudding to swallow: how we treat refugee, stateless and migrant children.
Actions thus far mock the Convention on the Rights of the Child that Malaysia ratified. If we treat some children very poorly, we damage all our children’s future as it undermines our psychosocial, spiritual and moral wellbeing.
Long-overdue initiatives to transfer undocumented migrant children from Immigration Department detention centres to safe shelters is moving at a snail’s pace. Meanwhile, their health, education and wellbeing continue to be neglected. In addition, there have been recent raids with the detention of even more children.
There is much more on the tasting menu to share. Each year, about 900 to 1,000 children die on our roads and another 500 drown.
Children with disabilities are being left further behind their peers in education facilities and services, with woefully inadequate inclusion and reasonable accommodation. Due to a poverty of understanding, knowledge, skills training, surveillance and good governance, there are instances of abuse and bullying of children with disabilities in service centres and residential institutions.
Poverty has worsened among children, especially in Sabah and inner-city areas. The consequences for girl-children of child marriage and teenage pregnancies make for an uneasy national conscience.
Disaggregated data show that deaths among Orang Asli children under the age of five are 11 times that of major ethnic groups. Vaping is a huge and growing epidemic among our children and current policies have worsened it.
There is more of this tasting menu. The problems are chronic and worsening.
No government can fix all these problems in a single term.
And yet, this demands of everyone – across the political spectrum, the whole of government, of society and of the entire nation – a fresh start to improve the situation of Malaysia’s children.
We hope Budget 2024 will give our children the resources they deserve, from those who can make a difference. If we do not invest in our children now, there can be no meaningful tomorrow for this nation.
- Dato’ Dr Amar-Singh HSS, consultant paediatrician, child disability activist, adviser to the National Early Childhood Intervention Council (NECIC)
- Yuenwah San, The OKU Rights Matter Project
- Dr Selva Kumar Sivapunniam, consultant paediatrician, president of the Malaysian Paediatric Association
- Datin PH Wong, Childline Foundation
- Dato’ Dr Musa Mohd Nordin, consultant paediatrician, past president of the Perinatal Society of Malaysia
- Dato Dr Hartini Zainudin, Yayasan Chow Kit, Voice of the Children
- Sangeet Kaur Deo, member of the Harapan Law Reform Group