Aussie Consultant in Health Plan Spooks Civil Society

PENANG, Apr 21 (IPS) - Civil society groups here are eager to meet the newly- appointed Australian consultant who has been tasked with drawing up a blueprint for a new national health-financing scheme.
The local press revealed earlier this month that a little-known Australian consulting firm, Karol Consulting, headed by Karl Karol, had been appointed to come up with a blue-print for a national health insurance scheme. No further information was divulged..
The government says it cannot cope with rising health care costs and wants to find a new way to finance the country's health care system. It spends just two percent of GDP on health care -- well short of the World Health Organisation's recommendation of 5-6 percent
It now plans to introduce a national health insurance scheme under which Malaysians, apart from exempted groups, would have to pay health insurance premiums to a proposed National Health Fund.
Civil society groups like the Coalition Against Health Care Privatisation (CAHP) are worried that foreign consultants and donor agencies would advocate a neo-liberal approach, treating health care as a commodity, with patients treated as ‘consumers' and having to pay more for what they now receive at a nominal cost in the public sector.
Last year, IPS had highlighted the Australian link to Malaysia's health financing plans. The former Health Insurance Commission (HIC) Consultancy of Australia had undertaken a project in 2002 aimed at providing consultancy advice on the proposed establishment of a National Health Financing Authority in Malaysia. Its project on Malaysia involved the preparation of a submission, covering the key issues that had prompted the reform of the national health financing system.
From Oct. 1, 2005, HIC became known as Medicare Australia, an agency of the Australian government that delivers health-related programmes. Karol is listed as the director of Medicare Australia Consultancy Services on Medicare Australia's website. But when IPS telephoned the organisation, they said that he had left the organisation late last year.
Karol teamed up earlier this year with another agency, the Sydney-based Aus Health International (AHI), to work on the Malaysia project. AHI represents the New South Wales health system and was set up in 1996 as a ‘‘government-owned business''. It is involved in international development assistance and commercial activities and has worked in countries like Tonga, Fiji, the Philippines and Mongolia in the ‘structural reform' of their health systems.
On its website, AHI announced it ‘‘has won a health financing project in Malaysia in partnership with Karol Consulting''.
IPS telephoned both Karol and AHI's general manger for project management, Sharon Gudu. Both seemed reluctant to reveal much and did not respond to a list of emailed questions.
AHI revealed on its website in its section for Malaysia that "the Secretary General of the Ministry of Health, accompanied by senior officials, (made) a study tour with a focus on the structure and organisation of hospitals, privatisation of hospitals, hospital management, and integration of health services.''
Karol, for his part, did mention that he was working with AHI on the Malaysia project while Gudu, based in Australia, said the two groups were still in discussion.
Karol emailed IPS later saying, ‘‘I mentioned your enquiry to the client (the Malaysian authorities) and have been asked to request you to address all questions to the MOH (ministry of health). ''
The project funder for the health financing study in Malaysia is the United Nations Development Programme. Among its projects in Malaysia is democratic governance ‘‘designed to promote accountability, transparency and anti-corruption, thereby improving the quality of service delivery.'' Attempts to reach its resident representative in Malaysia, Dr Richard Leete, proved unsuccessful.
When asked over the phone later whether he was upholding transparency, Karol said, ‘‘I am being transparent, but I think you are aware of (the line of) communications here with the health ministry.''
A potential conflict of interest could arise if AHI is involved in the health financing study. AHI already has an interest in the Malaysian private sector through an Oncology Centre in Malaysia. The Centre is a joint venture between AHI and Gleneagles Hospital, a leading private hospital operator in Malaysia and Singapore, with AHI holding majority shares. The Centre provides consultation services by consultant oncologists and haematologist and facilities for chemotherapy and radiotherapy.
Asked whether AHI's interest in the Malaysian private sector would compromise its ability to provide independent advice, Sharon Gudu told IPS, ‘‘No, that would not be a conflict of interest. I am sorry I have not got any more comments to make.''
Malaysian Health Ministry Director General Ismail Merican told IPS he did not know of AHI's role in the consulting. ‘‘I have not been briefed on that.'' He said that Karol Consulting had been appointed and it would carry out its work in the next 9 to 12 months.
Health ministry parliamentary secretary Lee Kah Choon too was unaware of AHI's role in the consulting project. As far as he was concerned, Karol Consulting was appointed as the consultant for the project. He revealed that it would be working together with Malaysian consultants. When asked who they were, Lee said they were a group called ‘‘First Principal''.
Lee was also quick to dispel concerns that public interest groups might not get to meet Karol and the other consultants to air their concerns. ‘‘I was made to understand that part of their survey is that they will have to meet other groups,'' he told IPS. ‘‘How can you do your consulting if you don't meet anybody?''
The CAHP, made up of some 80 civil society groups, meanwhile is concerned that they will be presented with a fait accompli, if civil society's views are not taken into account.
‘‘There is a strong and growing argument that the involvement of commercial interests and the market skews the distribution of these social services and leads to rising inequity,'' notes CAHP secretary Jeyakumar Devaraj, a respiratory physician. This, he says, is a fundamental challenge to the paradigm that regards the market mechanism as the most efficient way of providing essential social services through a public-private mix.
Devaraj explains: "These larger issues have to be debated and sorted out first before concrete planning can be undertaken to revamp health care financing. Such a major decision is going to have an impact on the future of Malaysian health care.''
The coalition wants these concerns brought to the people - the academics, the health profession, and civil society. According to Devaraj, ‘‘the issues are not so complex that you can't discuss it with the public and they can be easily debated. We should not decide in haste and under pressure of commercial interests.''