Quality in Health - the Consumers’ Perspective

Presented by Anwar Fazal  at the 1998 National Conference on Quality in Health, organised by the Malaysian Society for Quality in Health, on  5-7 March 1998 at  Kuala Lumpur, Malaysia.

Brothers and Sisters, let me start by saluting and paying tribute to the thousands of healthcare personnel in this country who have contributed to building a standard for healthcare that has been by and large remarkably responsive to community needs. For their caring, commitment and competence under very often difficult circumstances, consumers every where say thank you very much. We shall remember your goodness in our hearts.

Today, the life and work of healthcare personnel is done under even more difficult times. The last decade of rapid, furious and even maddening growth has unleashed a whole new set of challenges, new dilemmas, new mathematics (or should I say new accounting) about who lives and who dies and at what pain and price.

Our country is at one of those critical thresholds and problematic crossroads, made starkly unforgettable by the killer haze and painfully expensive by the financial crisis.

A growth paradigm documented by a free-wheeling, marketeering and eco-destruction driven by greed and cash register morality is giving communitarian values, ethics and equity a rough time.

This conference could not have come at a better time to put us on track on the ethical, equitable and effective dimensions of healthcare - what we can call the  “triple-e bottom line”.

The World Health Organization (WHO) recognises there are two very basic health fundamentals.

The first fundamental is that health is a state of complete physical, mental and social well being, not merely the absence of disease or infirmity.

The second fundamental is that the enjoyment of the highest attainable standard of health is one of the basic rights of every human being.

The first challenge for all of us who are concerned with quality in its broadest sense is to address these two fundamentals.

The second challenge is address two very cruel realities:

The first cruel reality is that the last century has seen an explosion of man-made ill health through the destruction of our environment, polluting our air and water and creating the kind of stressful lifestyles that are anti-health.

The second cruel reality is that the last century also saw the larger scale of undermining health practices that were part of the natural cycle of life. I shall share three striking examples.  The first is the way breastfeeding - the natural, ecological, medically sound basic food security - was systematically subverted and it required an international WHO code to get us back on track.  UN statistics suggest over 1.5 million lives could be saved each year, if we just protected, promoted and support breastfeeding. The second example involves the injudicious and gross misuse of pesticides globally that has been associated with ill health, deaths, destruction of eco systems, more resistant strains of disease caring organisms. Organic and other benign systems of food growing were displaced and frowned upon. The third example is the saga of the tobacco industry which is also of great tragedy and scandal and the terrible power of vested interests.

Today, we realise our folly and are rediscovering these natural systems just as we are rediscovering breastfeeding. And every where, good people are fighting the power of the tobacco lobby.

Today, globally, there is new revolution of consumers, by consumers, for consumers. Consumers worldwide are asserting their rights and being challenged about personal and societal responsibilities. Globalisation and market driven systems are creating new equity distortions and generating frustration and anger. The growth of the health industry - the industry based on ill health -  has been spectacular and worrisome when profits are placed before health.

Consumers International, the organisation that represents consumers worldwide advocates eight consumer rights.  They are as follows:

1.         The right to basic needs - the right to basic goods and services which guarantee survival. It includes adequate food, shelter, health care, education and sanitation.

2.         The right to safety - the right to be protected against products, production processes and services which are hazardous to health or life. It includes concern for consumers long term interests as well as their immediate requirements.

3.         The right to be informed - the right to be given the facts needed to make an informed choice or decision. Consumers must be provided with adequate information enabling them to act wisely and responsibility. They must also be protected from misleading or inaccurate publicity material, whether included in advertising, labelling, packaging or by other means.

4.         The right to choose - the right to have access to a variety of products and services at competitive prices and, in the case of monopolies to have an assurance of satisfactory quality and service at a fair price.

5.         The right to be heard - the right to advocate consumers’ interests with a view to their receiving full and systematic consideration in the formulation and execution of economic and other policies. It includes the right of representation in governmental and other policy-making bodies as well as in the development of products and services before they are produced or set up.

6.         The right to redress - the right to a fair settlement of just claims. It includes the right to receive compensation for misrepresentation for shoddy goods or unsatisfactory services and the availability of acceptable forms of legal aid or redress for small claims where necessary.

7.         The right to consumer education - the right to acquire the knowledge and skills to be an informed consumer throughout life. The right to consumer education incorporates the right to the knowledge and skills needed for taking action to influence factors which affect consumer decisions.

8.         The right to a healthy environment - the right to a physical environment that will enhance the quality of life. It includes protection against environmental dangers over which the individual has no control. It acknowledges the need to protect and improve the environment for present and future generations.

The implications for healthcare systems of these rights are many and in the brief time we have, I like to suggest five roads you may explore:

Firstly, there should be proactive properly constituted processes in place for consultation with consumers at the hospital level and also at national level.

Secondly, health facilities themselves must be and feel healthy - be people friendly and eco friendly. There is no greater force than kindness, caring, comfort and a staff attitude and environmental ambience that nurtures that.  The “feeling good” syndrome is powerful and positive medicine.

Thirdly, every healthcare facility, especially private hospitals, must be required to meet the WHO/UNICEF guidelines for being baby friendly i.e. have unequivocal measures to protect, promote and support breastfeeding. Any facility that cannot get this in place has no legitimacy or credibility as a health institution. I hope the accreditation authority can take this on and insist on it as a standard in this country for all healthcare facilities.

Fourthly, public health and lifestyle issues must be addressed far more vigourously. Indirect tobacco advertising and sponsorship must be banned. No health authority will have credibility if it does not insist on it. Let us produce each year a popular “state of our health” report of our country and get people involved in it.

Fifthly, engage in Malaysia’s most significant public health debate - The Citizens Health Manifesto which is going to be officially launched tomorrow.  I have arranged for all of you to have a copy in advance.  It raises many burning health issues and has very broad public support. A constructive dialogue on the basis of this manifesto can contribute a great deal to quality health care in the country. There’s much talk of a financial crisis, a stock exchange crisis but there is a real health crisis too in our midst. We have to address it vigourously if we want to avoid irrational and unjust systems to take root.

Malaysia has had a remarkable record in health and a caring and community-centred public supported healthcare system. We can lose that easily if we are not careful.

We have the world’s tallest buildings and Malaysians have climbed the highest mountain. Let us develop a healthcare system that is a model of caring and competence, that is rational and equitable and among the best in the world. That would be something to be really proud of.

The Citizens Health Manifesto suggests a way forward - study it, debate it and I am sure we will make real progress in quality healthcare that means real things to real people.

Let me end by sharing with you a little poem, by an author unknown which captured my eye:

“We squander health

in search of wealth

We scheme and foil and save

then squander wealth

in search of health


We live and boast

of what we own

and all we get is a grave

then we die

and all we get is a stone”

Good health and thank you.

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