Prepared by Nur Sakinah Alzian
17 September 2023
One of the core values that forms the Madani concept is prosperity or ‘kesejahteraan’, in its original Malay acronym. However, prosperity is not just measured through economic development but also the well-being of Malaysians. As enshrined in the WHO Constitution, citizens have the right to the highest attainable standard of health, including having access to timely, acceptable and affordable health care. In the last few weeks, the Ministry of Local Government Development and Ministry of Health proclaimed that they are considering installing medicine vending machines in people’s housing projects (PPR)(1). While not much details were given to the public as the programme is still being studied, it is clear that this idea aims to improve the accessibility of essential medicines to residents at PPRs.
The Rationale of Medicine Vending Machines
The People’s Housing Project (PPR) is designed to provide affordable housing for individuals with a monthly income of RM3000 or less, primarily catering to households falling within the B40 income bracket, with some even struggling below the poverty line(2).
Research conducted by the Khazanah Research Institute has shed light on crucial aspects of PPR living. Among the PPRs studied, it was revealed that one out of every ten households includes a member with a disability, and households led by women tend to have larger numbers of occupants compared to those led by men(3). This finding resonates with the study from the Permatang Pauh Multidimensional Poverty Index Report 2021 which investigated how Covid-19 affected poverty by utilizing the Multidimensional Poverty Index (MPI). It revealed that households led by women scored significantly higher in terms of deprivation in every dimension of poverty compared to households led by men.
These findings underscore the vulnerability of PPR residents within our society, especially households headed by women. These vulnerable groups may encounter various obstacles, such as social, geographical, and economic barriers, when seeking healthcare. Accessing the nearest clinic or pharmacy for essential medications during nighttime hours may prove challenging, especially for those reliant on public transportation.
As a solution, the installation of medicine vending machines within PPRs can offer residents a convenient and safe means of obtaining over-the-counter (OTC) medicines and essential first aid products. This initiative aims to address the healthcare accessibility issues faced by PPR occupants, ensuring they can access necessary medical supplies effectively, regardless of the time or transportation constraints.
Addressing Different Layers of Accessibility
However, prior to rolling out this initiative, it is imperative that the two ministries overseeing its implementation give earnest attention to various facets of accessibility, extending beyond mere geographical considerations. The realm of healthcare service access encompasses multifaceted dimensions, including geographical, organizational, social, and economic facets, all of which warrant comprehensive examination before the successful execution of this program can be ensured(4).
Evidently, this newly planned initiative is set to improve geographical access to healthcare. The WHO suggests that in measuring geographical access, travel time is a better indicator than distance since it takes into account road conditions and means of transport. In the context of PPRs, placing medicine vending machines will allow individuals to obtain medicine in an instant.
Making Medicines in Vending Machines Affordable
Nonetheless, it's crucial for the program to take into account the financial accessibility of medicines, especially considering that a majority of households in PPRs fall within the B40 income category. If the medications dispensed through the vending machines are sourced from the private sector, there is a risk that these products may not be affordable.
A study on access and affordability of medicines in Malaysia has highlighted the significant price variation of medicines in the private sector, primarily due to the absence of regulatory controls on pricing(5). Consequently, competition in the open market does not necessarily lead to lower prices when medicines are procured at a relatively high price.
In such a scenario, if the medicines stocked in the vending machines at People's Housing Projects (PPRs) are priced in accordance with prevailing market rates, it's highly likely that residents would choose to go to healthcare services at government-run clinics or hospitals instead. This preference comes from the fact that government healthcare facilities offer most medicines to patients for free. Consequently, this could hinder the objective of ensuring equitable access to medicines for all.
Critically Considering Vending Machine Types
The vending machines should also be socially inclusive to PPR residents. Increasingly, vending machines have evolved into smart-vending machines, often featuring digital interfaces and compatibility with e-wallet payment systems. One notable local instance of this transformation is Pharmaniaga's Royale Pharma 24/7 smart medicine vending machines(6). While smart vending machines offer an array of advantages such as heightened convenience and operational efficiency, this digital shift may also pose certain challenges.
One of them is the maintenance cost. Smart vending machines require periodic maintenance to ensure their seamless functionality. These maintenance costs can potentially strain operational budgets, making it essential to strike a balance between the benefits of advanced technology and the associated upkeep expenses. Furthermore, operational challenges may arise, particularly in locations with unreliable power or network connectivity. Such challenges can result in downtime and disrupt the accessibility of essential goods through these vending machines.
However, perhaps one of the most poignant concerns revolves around the digital divide. While many residents, especially the younger generation, may comfortably navigate the digital interfaces and employ e-wallets for transactions, certain segments of the population, such as the older generation, may face obstacles due to limited digital literacy. For these individuals, the process of using e-wallets or engaging with digital interfaces may be unfamiliar and intimidating.
Therefore, to ensure equitable access and usability for all PPR residents, it's imperative that smart vending machines are designed with inclusivity in mind.
Conclusion
Overall, the prospect of introducing medicine vending machines in PPRs holds promise as a means to enhance healthcare accessibility for residents. Nonetheless, several critical considerations must be addressed for the successful implementation of this program such as affordability of medicines sold in the vending machines and the type of vending machines installed. A comprehensive assessment must encompass organizational, social, and economic facets of healthcare service access to ensure equitable coverage for all residents. By doing so, this initiative can contribute significantly to enhancing healthcare access and well-being within these communities, aligning with the core values of prosperity and health for all Malaysians.
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Gerard Gimino, “Medicine Vending Machines Being Considered for PPRs, Says Nga,” The Star, August 22, 2023, https://www.thestar.com.my/news/nation/2023/08/22/medicine-vending-machines-being-considered-for-pprs-says-nga.
Khazanah Research Institute, “ Decent Shelter for the Urban Poor: A Study of Program Perumahan Rakyat (PPR)” (Kuala Lumpur: Khazanah Research Institute, 2023).
Khazanah Research Institute. Decent Shelter for the Urban Poor. 2023.
Naing Oo Tha et al., “Geographic Accessibility of Healthcare Services and Health Seeking Behaviors of Rural Communities in Kudat and Pitas Areas of Sabah,” Borneo Epidemiology Journal 1, no. 1 (2020)
Shui Ling Wong et al., “Access and Affordability of Medicines in Malaysia: Need for a National Pricing Policy,” Applied Health Economics and Health Policy, 2019.
Adrian David, “Round-The-Clock Medicine Vending Machine,” NST Online (New Straits Times, March 14, 2022),.