COMMENT | 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.
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, as the old proverb says “the proof is in the pudding.” Or, as the original version goes “the proof of the pudding is in the eating.”
This means that we can gauge all assurances about children by actions: How much do ministers allocate as an investment in our children’s learning, well-being, health and safety? How much are lawmakers fighting for bigger allocations for these 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 Health Ministry for the past five years, as compared with 10 years ago.
In 2023, the total budget assigned to the ministry was RM36,139,861,200, but the paediatric budget at only RM610,506,300 equalled 1.7 percent of the total health budget. This was a 10-year low, dropping away from 2 percent in 2013.
The amount actually allocated to paediatric care in government hospitals is a tiny morsel. It has, relative to the total health budget, been decreasing over time.
Someone in the Health Ministry may say that other ministry budget allocations are also used to meet children’s health needs. To this, we recommend a visit to our Paediatric Intensive Care Units (Picus) and Neonatal Intensive Care Units (Nicus) all over the country that are struggling with space, equipment and nursing resources, unlike adult ICUs.
Every single day, the Picus and Nicus 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 Picu and Nicu beds and resources, reinforced by 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.
One Malaysian child in every five children aged under five is stunted (21.8 percent in 2019). The number of underweight Malaysian children aged under five has increased from 12.4 percent (in 2015) to 14.1 percent (in 2019).
Wasting among our children increased from 8 percent to 9.7 percent 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.
Social workers
Second on the tasting menu: Child protection.
A minister announced (Malaysian Administrative Modernisation and Management Planning Unit study 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 over 3,800 department personnel, there are very few trained social workers, with only a small number involved in child protection. The average social welfare officer has a frightening caseload 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 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 Social Welfare Department workforce and its professionalism with trained social workers.
Undocumented children
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 futures as it undermines our psychosocial, spiritual and moral well-being.
Long overdue initiatives to transfer undocumented migrant children from Immigration Department detention centres to safe shelters are moving at a snail’s pace.
Meanwhile, their health, education and well-being 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, approximately 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 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 girls of child marriage and teenage pregnancies make for an uneasy national conscience.
Disaggregated data show that under-five deaths for Orang Asli children 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 that 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.
Signatories
Dr Amar-Singh HSS, consultant paediatrician, child-disability activist, National Early Childhood Intervention Council adviser.
Yuenwah San, The OKU Rights Matter Project.
Dr Selva Kumar Sivapunniam, consultant paediatrician, Malaysian Paediatric Association president.
PH Wong, Childline Foundation.
Dr Musa Mohd Nordin, consultant paediatrician, former Perinatal Society of Malaysia president.
Dr Hartini Zainudin, Yayasan Chow Kit, Voice of the Children.
Sangeet Kaur Deo, Harapan Law Reform Group.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
