Sunteți pe pagina 1din 7
‘UN Special Rapporteur on the right of everyone tothe enjoyment ofthe highest attainable ‘standard of physical and mental health ‘Mr. Dainius Paras Country Visi to Malaysia, 19 November to2 December 2014 Preliminary observations and recommendations Kuala Lumpur, 2 December 2014 ‘Members ofthe press, Ladies and gentlemen, Allow me to begin by waamly thanking the Government of Malaysia for inviting me to visit the ‘counlry to assess, ina sprit of dialogue and cooperation, the realisation of the right to health in Malaysia. Tam very grateful for ther efforts in facilitating my vst, which stated on 19 November, During my visit, have met with Government officials, members of Parliament, the National Human ‘Rights Commistion (SUHAKAM), as well as with representatives of interational organization, and ‘wide range of civil society actors. I have visited health facilites in Kuala Lumpur, Melaka, Negeri ‘Sembilan, and the State of Sabab. Ihave aso visited a prison and two immigration detention centres. {ake this opportunity to thank the UN Country Team for their suppor to my visit and all tose whe have given me the benefit of their ime and experience. After two weeks inthe counzy, Ihave gathered a wealth of information and testimonies, which will help me asses the realisation ofthe right to healt in Malaysia. Today, I will confine myself to presenting some of my preliminary observations and recommendations, which wil be elaborated in ‘more detail ina report that will be considered by the UN Human Rights Council n June 2015, ‘Context and achievements First, I would like to commend the Government of Malaysia fo its achievements in improving the Inalth stats inthe country through a sustained commitment to pablic health policy. Malaysia has placed the health of ts popolstion atthe hear ofits development policy sine it pained independence in 1957, ‘The country hs made considerable improvements in inceasing the life expectancy of large sectors of the populstion. It as halved maternal, infant and child mortality rates over the past decades, reaching levels that are similar to those of high-income developed countries. 1 also wish to commend achievements related to some of the essential underlying determinants of health in the country, including improvements in acces to education, water and sanitation, and the effective contol of outbreaks of recent epidemics. ‘The health sector in Malaysia has developed over the past few decedes with a strong focus on primary cae, achieving universal coverage for most ofits population and fhisly good standards of availability, accessibility, aceptability and quality. In cis regard Malaysian model of primary Iealtheare may serve as an example to other countries. Malaysia has also made serious atempts (0 address the challenges ofthe ongoing demographical and epidemiological transition ftom a country With a foeus on communicable diseases to a country where non-communicable disses are ‘ecoming the main sue of concern. Malaysia is a member of the UN Human Rights Council and in 2015 will hold seat at the UN Security Council, and the Chairmanship of ASEAN, This will place the country in a unigue regional ‘and global position, and can offer the possibilty fo move forward towards the goal of achieving ‘sustainable and incisive growth wih equity and respect for all human rights. Challenges and groups in vulnerable situations ‘Malaysia has achieved rapid economic growth and development over the pat few decades, which has allowed for some ofthe postive achievements regarding the realisation ofthe right t health. However it his only ratified three ofthe care international haman rights treaties, Ths, together ‘ith the reservations introduced to the treaties ratified, and the slow pace in reporting t0 the respective monitoring bodies i seriously affecting the accountability of the Goverment and can undermine the efforts undertaken s fr. Many of the challenges that Ihave preliminarily identified during my vist ae related to selective approach to human righ. Tis approach is mostly based on restrictive interpretations of cultural and religious norms and practices, and to a departure ftom universal human rights principles and ‘standards, This is having an impact on many groups ofthe population that are being excluded inlaw and practice from the efforts to promote and protect the right to healt. In addition, during my visit Thave ascertained the challenges and risks that civil society faces in ‘Malaysia witen working on right to health issues. They operate in avery restrictive envionment and ‘important sectors of evil society work under the fear of being prosecuted under the Sedition Act (1948). This seriously constrains their legitimate work and hinders the effective promotion and protection of the right to health inthe country. Sustainabiiy ofthe health care system ‘Malaysia is facing complex challenges for the sustainability of the healtheare system including the ‘uality of the services provided; increased expecations of heslthcare consumer the growth of private sector and out-of pocket payments; and the drain of medial doctors and muses fom public to private sector. ‘The Government recognizes the need of transformation ofthe healthcare system and is considering ferent options for change. I will be providing specific recommendations on this important issue in ‘my repost. At this particular moment, I would underline some of the main principles that have to be taken into account for an effective tnsfomnation of public healthcare systems applied to the Malaysian context. First, the stongths of the healthcare system in Malaysia, which include a solid and accesible primary care system and community-based initiative, should continue to be supported. Also, the further development of inftasucture of hospitals in a rational and cost-effective way should be coatinued. Second, the current share of healthcare financing within the GDP, which stands at 4.3%, iow and shouldbe inreated to allow for more resources tobe injected for the further development of the sector. Third, financial baries that restrict aocess to heath care, especialy for groups in vulnerable situations, shouldbe removed, * ali a rated the Convention oa he Eimnnto fl forms of Disininaton against Wome (1995) tb Convention ofthe Rights fe Call (1985 ans vo Opal Proicels (2012) and te Convention onthe igs of Pano wt Dies 2010) ‘The sustainability of the health care system is at stake. A model of health financing should be ‘consolidated as to ensure thatthe ability to pay does not affect an individual’s decision whether to seek access to necessary heath goods and services. As we know, in many countries, the primary financial baer to acoessing health ear is out-of-pocket payments, which are made by the user for health goods and services at the point of service delivery. This can cause catastrophic health consequences and push into poverty and social exclusion those most vulnerable. This is why the share of out of pocket payments within health expenditures in Malaysia should be reduced or, st Teast, no allowed to grow. Right to health of women and girls During my vii, I leamed about positive initiatives to empower women in public life, such as the ‘goal to increase thee participation inthe workforce of the country, as well a inthe public sector. In addition, there are commendsble programmes to facilitate aocess of women to ealih care, such as the Mammography subsidy programme, introduced in 2007 However, women and gils in Malaysia face significant barriers to access sexual and reproductive. / health and rights, including services, mostly due to certain interpretation of cultural, religious and pplitesl noms, values and traditions. Comprebensive sexuality education is not integrated in school ‘currcala and girls do not have access to basic information to make informed decisions on their reproductive heal, This has led to a high prevalence of unintended pregnancies amongst girls below the age of eighteen, aswell asa high risk ofthe spreading of sexually transmitted disease, including HIV/AIDS. ‘Therapeatic abortion is available in Malaysia? but, during my visit, I found out thet women and // doctors lack infomation about the avalabiity of tee services and face legal and social peste aginst thee se. Domestic violence isan issue of public health concern and I commend the establishment of One Stop Crisis Centres (OSC) to provide integrated services for vitims in public hospitals in Malaysia, However during my visit, received credible reports indicating that some of the OSCC are either aot _scessible in practice or not flly operational 1am asp particularly eoncemed shout th stvtion of women end gis whic face compounded foms of discsmination dos to ther social, elf and religous backarounds. These inlude ‘women and gis who ze exposed to harmful radiional practices, such as id mariage and female ‘ental muslaton. Iwill elaborate on thes sms in my Sepors tothe Human Rights Coun. The situation of migrants, refages and asylum-seeters Malaysia is a multi-ethnic, multi-cultural, and mult-rligious society that due to its economic <éynamism has become a min destination of workers’ migratory movements in the region. Tt is cstimated that there are curently over 6 million migrant workers in Malaysia, of which only about 2.9 millon are reportedly documented. Documented migrants are forcibly tested before initiating their joumey inthe countries of origin, and are denied work permits if found to be HIV/AIDS positive or pregnant. This practice poses a serious ‘problem with respect tothe right not to be disriminated on the basis of health stats, the sight t0- privacy, and the fun ‘Principle of informed consent There are also reports indistng that 1A 312 Malaya Pea Code migrant workers suffer from high levels of exploitation atthe workplace, including physical, sexual ‘and emotional abuse, as wells high occupational zisks Documented migrants, as foreign nationals, face specific bariers when accessing the healtheare system, They have to pay higher foes to accets healtiare and, sice June 2014, cannot access ‘medication with prescription for chronic illnesses for more than five days. Additionally, undocumented migrants face the extraordinary challenge to be considered illegal inthe ‘county and face criminal penalties for being undocumented, ranging fom fines to imprisonment and ‘caning: During my visi, I eared about the establishment of immigration coustes inside public hospitals to facilitate the referrals of undocumented migrants and asylum seeker to the police when ‘hey come seeking medical attention I consider that this practice goes against public health interests ~L* and the code of ethics of doctors. ‘The establishment of these counters will deter undocumented ‘migrants from seeking health care for fear of being reported, which among other things could cause the spread of communicable diseases. (7s comeston, Im same a esinoios eee stout a sent wave of amet of ‘undocumented women migrants and asylum seckers who, only a few days after giving bits, were taken from hospitals direlly to detention centres. In those ceatres, some of these women and their ‘new-born babies reportedly di not receive the necessary medical attention or the appropriate care Som the authorities, [urge the authorities to stop this practice, and to refiain ftom using the health system fr law and order purposes. ‘The vulnerable situation of asylum-seekers and refugees inthe country is exacerbated by the fact hat ‘Malaysian law does not provide for them protection since the county is nota signatory to the UN 1951 Convention on the Status of Refugees. AS e result asyium-seekers are subject to the ‘Immigration Act as undocumented migrans, and hence are Hable to being imprisoned, whipped or seatback. “Moreover, the detention conditions in immigntion detention centres bave been reported asa source of concern ffom the right fo health perspective. I have visited Legueng Detention Centre and the ‘Kuala Lumpur Intemational Aiport immigration depot Daring my visits to these centes, among other issues, I ound out that women who have just given birth are held ina separate area where they have mattesses for them and their ew-born babies sad are provided with the necessary hygienic products. However, det does not seem sufficient for breastfeeding mothers. ‘This seems to bean issue for other detainees es well, sit ws reported tht ‘often they only gt two meals per day. In addition, the conditions of detention in some wards of the centres fill short of complying with interatonal standards. I am also concerned that most of the

S-ar putea să vă placă și