Tembeling 2.0

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  • When population health is no longer a priority

    https://jamanetwork.com/journals/jama/fullarticle/2846529

    The recent Perspective article in JAMA raises a deeply unsettling argument. The problem facing population health is no longer simply neglect. It is the growing possibility that policy decisions themselves are beginning to work against health.

    The authors describe how, over the past decade, the United States has already experienced stagnation and even decline in key health indicators such as life expectancy. This was not unexpected. For years, public health experts had pointed to the structural determinants that shape health outcomes, including access to healthcare, socioeconomic inequality, education, environmental exposures, and the strength of public health institutions.

    The solutions were not unknown. Expand access to care. Strengthen social protection. Regulate harmful industries. Invest in science and public health systems. Address inequality. These are long-established principles supported by evidence.

    What is new, and concerning, is the shift away from these solutions. The article argues that recent policy directions have not merely failed to improve population health but may actively undermine it. Reductions in support for scientific research weaken the evidence base that informs policy. Erosion of public health protections reduces the ability to prevent harm before it occurs. Policies that increase social and economic vulnerability widen health inequities.

    In this framing, worsening population health is no longer an unintended consequence. It becomes predictable. When policies disregard the foundations of health, outcomes follow accordingly.

    This perspective invites reflection beyond the United States.

    In Malaysia, several structural signals warrant attention.

    First, the burden of disease is already high. Malaysia has one of the highest prevalences of obesity in Asia, accompanied by a growing burden of non-communicable diseases. This reflects sustained exposure to behavioural and environmental risks, particularly dietary patterns that are deeply embedded in daily life.

    Second, the healthcare system is under strain. Workforce challenges, including shortages, migration, and burnout, are increasingly evident. A constrained workforce limits the system’s ability to balance curative services with preventive and public health functions, shifting focus towards short-term demand rather than long-term health outcomes.

    Third, there are gaps in policy and enforcement related to known health risks. Tobacco control, including the regulation of e-cigarettes, remains an area of concern. Reluctance to implement and enforce stronger measures risks sustaining nicotine dependence and enabling new patterns such as dual use, particularly among younger populations.

    These are not isolated issues. They represent interconnected elements within the broader population health landscape.

    The concern is not that Malaysia is currently adopting policies that directly undermine health. Rather, it is the possibility that, without decisive and sustained action, existing conditions, cultural norms, and policy hesitations may collectively produce similar effects.

    The lesson from the JAMA article is clear. Population health is shaped by policy choices. When health is not consistently prioritised across sectors, deterioration becomes a foreseeable outcome rather than an unexpected one.

    Malaysia remains at a point where the trajectory can still be shaped. Recognising these signals early allows for a more deliberate response, ensuring that population health remains central in policy and practice, rather than becoming an afterthought.

  • Science, Health, and the Philosophy of Knowledge in the Thought of Syed Muhammad Naquib al-Attas

    Introduction

    Tan Sri Prof. Diraja Dr Syed Muhammad Naquib al-Attas is widely known for his contributions to Islamic philosophy, education, and the study of civilisation. While he did not write specifically on medicine or health sciences, his philosophical framework on knowledge, education, and the Islamic worldview offers important insights for understanding science and health in the contemporary Muslim context. His writings emphasise that knowledge must be understood within a coherent worldview rooted in tawhid, where intellectual inquiry, including scientific investigation, is guided by ethical responsibility and metaphysical clarity (Al-Attas, 1978; Al-Attas, 1995).

    Science within the Islamic worldview

    Al-Attas argued that modern knowledge, including science, is shaped by the worldview of the civilisation that produces it. He observed that modern Western science emerged within a secular intellectual tradition that tends to separate knowledge from divine guidance. For him, this separation creates a conceptual imbalance because knowledge is no longer connected to its ultimate source, which in the Islamic understanding is Allah.

    In contrast, the Islamic worldview situates all knowledge within the unity of God, or tawhid. Scientific inquiry is therefore not rejected but placed within a broader metaphysical framework. Nature is understood as a creation of Allah, and studying it becomes a legitimate and meaningful intellectual activity. However, scientific knowledge must remain connected to ethical and spiritual considerations so that it contributes to human well-being and justice rather than purely technological advancement (Al-Attas, 1978).

    The hierarchy and classification of knowledge

    A key element in al-Attas’s philosophy is the classification of knowledge. He distinguished between revealed knowledge (naqli), which originates from revelation, and acquired knowledge (aqli), which arises from human reasoning, observation, and experience. Science and medicine fall within the category of acquired knowledge.

    Al-Attas did not diminish the importance of acquired knowledge. On the contrary, he recognised its necessity for the development of civilisation and the welfare of human society. However, he insisted that acquired knowledge must remain guided by revealed knowledge so that intellectual activity does not lose its ethical and metaphysical direction. This hierarchy ensures that scientific inquiry remains aligned with truth and justice rather than becoming detached from moral accountability (Al-Attas, 1995).

    Ethics and responsibility in scientific knowledge

    One of the central concerns in al-Attas’s philosophy is the ethical orientation of knowledge. He emphasised that knowledge must lead to justice and proper conduct. Knowledge that is not guided by ethical discipline may lead to confusion and misuse.

    This concern is particularly relevant in scientific and medical practice. Scientific progress brings great power, but without ethical grounding it may lead to exploitation or harm. Al-Attas argued that knowledge must always be accompanied by proper discipline, or adab, which ensures that knowledge is used responsibly and in accordance with moral principles.

    In the context of medicine and health sciences, this perspective highlights the importance of aligning scientific expertise with compassion, integrity, and accountability. Scientific competence alone is insufficient if it is not guided by ethical responsibility towards patients and society.

    The concept of ta’dib in education

    Al-Attas introduced the concept of ta’dib as the proper aim of education. He argued that education should cultivate individuals who possess intellectual clarity, moral discipline, and awareness of their responsibilities within the order of creation (Al-Attas, 1980). For him, the purpose of education is not merely to produce skilled workers or professionals but to nurture balanced human beings who understand the proper place of knowledge.

    Applied to science and health professions, the concept of ta’dib implies that medical and scientific training should go beyond technical competence. Education should develop professionals who combine knowledge with ethical awareness, humility, and a sense of service to humanity. In this sense, the training of doctors and scientists becomes part of a broader moral and intellectual formation.

    Science and civilisation

    Al-Attas viewed knowledge as a central element in the formation of civilisation. Scientific knowledge, when properly understood, contributes to the advancement of human society. However, civilisation cannot be sustained by technological progress alone. It must be guided by a coherent worldview that integrates intellectual, ethical, and spiritual dimensions.

    In this framework, science and medicine play an important role in improving human welfare, but they must remain aligned with higher ethical principles. Scientific progress that is detached from moral guidance risks undermining the very civilisation it seeks to advance.

    Implications for modern science and health

    Although al-Attas did not specifically address contemporary medical or public health issues, his philosophy provides a framework for thinking about science and health in a holistic manner. His emphasis on the unity of knowledge, the ethical orientation of intellectual activity, and the moral formation of educated individuals offers a perspective that remains relevant for modern scientific disciplines.

    For fields such as medicine and public health, this perspective encourages a balance between scientific competence and ethical responsibility. The pursuit of knowledge should aim not only at technical advancement but also at the protection of human dignity and the welfare of society.

    Conclusion

    The intellectual legacy of Syed Muhammad Naquib al-Attas lies in his effort to restore clarity to the meaning and purpose of knowledge. While his writings do not focus directly on science or medicine, his philosophical framework provides a foundation for understanding scientific inquiry within a moral and spiritual worldview. By emphasising the integration of knowledge, ethics, and civilisation, his work continues to offer valuable insights for contemporary discussions on education, science, and the role of knowledge in human life.

    References

    Al-Attas, S. M. N. (1978). Islam and Secularism. Kuala Lumpur: Muslim Youth Movement of Malaysia.

    Al-Attas, S. M. N. (1980). The Concept of Education in Islam: A Framework for an Islamic Philosophy of Education. Kuala Lumpur: ABIM.

    Al-Attas, S. M. N. (1995). Prolegomena to the Metaphysics of Islam: An Exposition of the Fundamental Elements of the Worldview of Islam. Kuala Lumpur: ISTAC.

  • Rebuilding Confidence in Malaysia’s Medical Workforce

    A recent report by Sinar Harian highlighted that only about 10 per cent of available positions for medical graduates in the Ministry of Health Malaysia were filled. The report raised concerns about the low uptake of public sector positions despite ongoing healthcare needs. This development has triggered renewed discussion about employment pathways, workforce distribution and long-term planning in the health sector.

    Several years before the pandemic, there was a strong narrative suggesting that Malaysia had an oversupply of doctors and that the profession was no longer critical. Such perceptions inevitably influenced planning decisions. When workforce planning becomes reactive, the system risks moving from one imbalance to another.

    Malaysia’s total approved quota for undergraduate medical training is around 4,800 places annually. Approximately 1,600 places are allocated to public universities, with the remainder allocated to private institutions. Public universities consistently utilise their quota, while private institutions do not.

    More telling is the decline in provisional registration with the Malaysian Medical Council, which fell from 6,147 in 2017 to 3,142 in 2024, almost a 50 per cent reduction within seven years. This signals a significant contraction in the number of new graduates entering the system.

    One likely explanation is reduced enrolment in private medical programmes. Parents may be concerned about the future of the medical profession in Malaysia, particularly uncertainties surrounding contract appointments, permanent posts and long-term career progression. Medical education is costly. If employment prospects appear unstable, confidence declines. For similar reasons, fewer parents may be sending their children overseas to study medicine, given the high financial commitment and uncertain pathway upon return.

    There is also a noticeable migration of locally trained graduates to neighbouring countries where career structures may be perceived as more predictable.

    Health workforce planning cannot afford to be cyclical or reactive. It must be grounded in long-term projections that consider demographic change, epidemiological transition and the country’s specialist needs. Most importantly, the future of healthcare workers must be secured through stable employment structures, transparent career pathways and sufficient training opportunities. When confidence in the system is restored, enrolment will stabilise, talent will remain, and the nation will avoid repeating cycles of perceived oversupply followed by genuine shortage.

  • A principled perspective on the roles of Public Health Medicine Specialists and PTD officers in the Ministry of Health

    The discussion on whether Public Health Medicine Specialists (PPKA) can replace or assume roles currently held by PTD officers must be framed correctly. It is not fundamentally a question of replacement, but rather a question of role alignment, competency utilisation, and leadership development within a complex health system. Any modern health system functions best when professional expertise and administrative competence complement each other, not when one is viewed as substituting entirely for the other.

    The foundational principle of professional and administrative competence

    A key principle in organisational leadership, particularly in highly specialised sectors such as healthcare, is that it is generally easier to train a technical expert in administrative and management functions than to train a general administrator to acquire deep professional and technical expertise. This is because professional training in medicine and public health requires many years of structured education, supervised practice, and competency development. Public Health Medicine Specialists undergo rigorous training through Master’s and often Doctor of Public Health programmes, covering epidemiology, health systems, health policy, programme planning, management, and evaluation. Their training inherently integrates management principles within the context of health systems, rather than management in isolation.

    In contrast, PTD officers enter the civil service with diverse academic backgrounds, often without specific training in healthcare, epidemiology, or health systems. However, they bring valuable strengths in governance, administrative procedures, finance, policy implementation, and organisational coordination. These competencies are essential for the functioning of large institutions such as the Ministry of Health. Their role is therefore complementary, not inferior nor superior, but different in nature.

    The unique training and competency of Public Health Medicine Specialists

    Public Health Medicine Specialists are uniquely trained to understand the health system as a whole. Their competencies include disease surveillance, epidemiological analysis, programme planning, prevention and control strategies, health policy development, and health system evaluation. Importantly, their training also includes management and leadership within healthcare settings. They are trained not only to analyse disease patterns but also to design and implement interventions at population level, coordinate services across sectors, and evaluate outcomes.

    This gives them a critical advantage when making decisions that directly affect health service delivery, disease prevention, and population health outcomes. Their decisions are informed by both scientific evidence and operational realities. For example, an epidemiologist overseeing disease surveillance does not merely analyse data but plans preventive strategies, allocates resources based on risk, and coordinates responses across multiple levels of the health system.

    Their management training is therefore context-specific. It is grounded in healthcare realities, which makes them particularly suited for leadership roles that require integration of clinical, preventive, and system perspectives.

    The appropriate positioning of Public Health Medicine Specialists within the health system

    Public Health Medicine Specialists should primarily be recognised and positioned as specialists, equivalent in professional standing to clinicians in hospitals. Just as clinicians lead clinical services based on their expertise, Public Health Medicine Specialists should lead technical areas such as disease surveillance, prevention programmes, health policy planning, and population health strategy.

    Many specialists, whether clinical or public health, naturally progress into administrative and leadership roles as part of their career development. Their technical background strengthens their administrative effectiveness because their decisions are grounded in real-world professional experience. This is consistent with the model seen globally, where healthcare organisations are often led by individuals with professional training in medicine or public health, supported by administrative professionals.

    However, this does not mean that all specialists must become administrators. Many should remain focused on technical leadership, which is essential for maintaining the integrity and effectiveness of health programmes.

    The continued relevance and complementary role of PTD officers

    PTD officers play an important role in supporting the health system. Their expertise in public administration, finance, human resource management, and policy implementation (if they really have the expertise) provides essential organisational support. They facilitate the operational and administrative processes that allow technical specialists to focus on professional and programme leadership.

    Rather than viewing the roles as interchangeable, it is more accurate to view them as complementary. PTD officers can support specialists by managing administrative systems, while specialists provide technical direction and professional leadership. This collaborative model ensures both administrative efficiency and technical excellence.

    Leadership roles must be determined by competency, not professional category alone

    Leadership is not automatically determined by whether an individual is a Public Health Medicine Specialist or a PTD officer. Leadership requires specific competencies including strategic thinking, decision-making, communication, integrity, and the ability to guide organisations effectively. These competencies must be developed over time through training and experience.

    Not all specialists are suited for leadership roles, and not all administrators are suited for technical leadership roles. Both groups require leadership development if they are to assume senior management positions. The key principle is that leadership roles must be assigned based on demonstrated competency, relevant experience, and suitability, rather than professional designation alone.

    Where leadership involves technical decision-making related to health systems, disease control, or service planning, individuals with professional health expertise have a natural advantage because they understand the implications of decisions at both clinical and population levels.

    The relationship between directors, deputies, and administrative leadership

    In many healthcare systems, directors provide strategic and professional leadership, while deputies support operational coordination, administrative implementation, and organisational management. When deputies have professional health expertise, this can strengthen decision-making by ensuring that operational and administrative decisions align closely with technical realities.

    However, administrative expertise remains essential. Administrative officers provide continuity, governance, and procedural oversight, ensuring that organisational systems function efficiently.

    The most effective model is therefore one where technical leadership and administrative expertise work in partnership.

    Leadership at the Ministry level and the distinction between administrative and technical leadership

    At the highest levels, such as the Secretary-General and Deputy Secretary-General positions, leadership involves national-level policy implementation, resource allocation, organisational coordination, and governance. These roles require strong administrative and leadership competencies, as well as an understanding of the health system.

    Whether such roles are held by individuals with health professional training or administrative training depends on their competency, experience, and leadership capability. Individuals with public health expertise bring strong understanding of health systems and population health, while those with administrative training bring strengths in governance, policy coordination, and organisational management.

    Both backgrounds can contribute effectively if the individual possesses the required leadership and management competencies.

    Conclusion

    The issue is not whether Public Health Medicine Specialists should replace PTD officers, but how both groups should be optimally positioned to strengthen the health system. Public Health Medicine Specialists should be recognised as professional specialists with leadership roles in technical and health system domains, equivalent in standing to clinical specialists. PTD officers should continue to provide essential administrative and governance support.

    Leadership roles should be determined based on competency, experience, and suitability, not solely professional designation. Both specialists and administrators have important roles, and the most effective health system is one where professional expertise and administrative competence work together in a coordinated and complementary manner.

    This approach ensures that decisions affecting health services and population health are both technically sound and administratively effective, ultimately strengthening the overall performance of the Ministry of Health.

  • Causality, the Philosophy, Evaluation, and the Tawhidic View

    Understanding causality is essential in everyday life because it shapes how people make decisions, assign responsibility, and anticipate outcomes. From simple actions such as taking medicine to relieve pain, to complex choices like implementing public health policies, people rely on assumptions about cause and effect. When these assumptions are unclear or mistaken, decisions may be ineffective or harmful. Reflecting on causality is therefore not merely philosophical, it directly affects daily routines, professional judgement, and ethical responsibility.

    The classical philosophical discussion of causality begins with Aristotle in the 4th century BCE. Aristotle proposed that a complete explanation of anything requires four causes. The material cause explains what something is made of, the formal cause explains what makes it the kind of thing it is, the efficient cause explains what brings it about or produces change, and the final cause explains its purpose. These causes work together rather than separately. Aristotle assumed that causes have real power in nature. Under similar conditions, similar causes will tend to produce similar effects. Nature, in this view, is orderly, purposeful, and intelligible, and human reason can understand how it operates.

    This understanding was critically examined within Islamic thought, most notably by Al-Ghazali in the 11th century CE, particularly in Tahafut al-Falasifah written around 1095. Al-Ghazali challenged the idea that natural objects possess intrinsic causal power. His critique focused on efficient causation and the notion of natural necessity. He argued that observing events occurring regularly together does not prove that one causes the other by itself. Fire does not burn by its own power, and medicine does not heal by itself. Rather, Allah creates both the apparent cause and the effect at each moment. The regularity observed in nature reflects divine custom, not independent natural necessity. Al-Ghazali did not deny purpose, but he rejected the idea that purpose is built into nature itself. Final causation, in his view, belongs to divine wisdom rather than autonomous natural processes.

    Modern discussions of causality emerged strongly in the 18th century CE through the work of David Hume, especially his writings published around 1748. Hume argued that humans never observe necessary connections between events. What we observe are repeated patterns, from which we form expectations through habit. Causality therefore becomes an inference rather than a certainty. This view influenced modern science, where causation is treated as probabilistic and open to revision. Rather than claiming absolute certainty, science evaluates causal claims based on evidence, consistency, and explanatory value.

    In applied sciences, particularly epidemiology, causality is evaluated using structured reasoning rather than philosophical proof. Austin Bradford Hill articulated this approach in 1965 by proposing considerations to assess whether an observed association is likely to be causal. These considerations accept uncertainty as unavoidable and focus on judgement rather than necessity. Causality in modern science is therefore practical, evidence-based, and aimed at guiding decisions rather than establishing metaphysical truths.

    From a tawhidic perspective, Muslims engage with all these levels of causality while maintaining a clear theological position. Islam affirms that Allah is the ultimate cause of all events. Natural causes, regularities, and scientific laws are real at the level of human experience and reasoning, but they operate only by divine permission. This allows Muslims to accept empirical causality for evaluation and action, while rejecting the idea that nature possesses independent or self-sustaining power. Causality therefore operates at two levels, an observable level that supports scientific inquiry and decision-making, and an ultimate level grounded in tawhid, where all power, purpose, and outcome return to Allah.

    In this way, causality is not rejected but properly ordered. Philosophy explains its structure, science evaluates it through evidence, and the tawhidic worldview places it within a coherent and meaningful understanding of reality and daily life.

  • A Simple Guide to MHIT and Medical Insurance in Malaysia

    Introduction

    Many people purchase medical insurance without fully understanding why premiums keep rising or why different insurance products can feel different when someone needs treatment. This article explains, in plain language, what MHIT is, how it compares with conventional medical insurance, and why MHIT may help reduce medical cost inflation if implemented under the right conditions. It also clarifies a common misunderstanding about “basic coverage”, especially childbirth, which is often assumed to be included but usually is not.

    What is MHIT

    MHIT stands for Medical and Health Insurance or Takaful. In Malaysia, MHIT commonly refers to the Base MHIT plan introduced under a national reform effort involving Bank Negara Malaysia and relevant ministries.

    MHIT is a standardised medical insurance plan offered by private insurers under a common framework. A key feature is that participation is voluntary, meaning people choose whether or not to enrol, and there is no legal requirement for the population to join.

    MHIT focuses on essential care, mainly inpatient private hospital care such as ward admission, surgery, investigations, and inpatient treatment. It is intended as a foundation layer, providing safe and sufficient cover for common hospital needs rather than unlimited choice or premium extras.

    An important development highlighted by the Malaysian Medical Association is the involvement of general practitioners in outpatient management of selected high-volume conditions such as dengue fever, pneumonia, bronchitis, and influenza. This approach is intended to strengthen primary care and reduce avoidable hospitalisation by managing suitable cases earlier and more efficiently in the community, rather than defaulting to hospital admission, as reported by

    CodeBlue (January 2026)
    .

    What is conventional medical insurance

    Conventional medical insurance refers to private medical cards offered by insurance companies, including plans such as AIA My Medical Plan and similar products from other insurers.

    These plans are not standardised. They vary widely in annual limits, lifetime limits, cost-sharing rules, hospital panels, and optional add-ons. Many conventional plans offer higher limits and broader coverage, including more outpatient and long-term care benefits, but they are generally more complex and can be more expensive over time.

    A key point for the public is that “basic coverage” in conventional medical insurance is often narrower than assumed. Normal childbirth is usually excluded. Caesarean section is commonly excluded unless it is medically necessary. Maternity benefits usually require a separate rider, a waiting period, and additional premium. This means conventional insurance is not automatically broader for basic care unless the policy has been upgraded with add-ons.

    Important terms explained

    1. Annual limit

    The annual limit is the maximum amount the insurer will pay in one policy year.

    Example: If the annual limit is RM100,000 and the hospital bill is RM120,000, the patient pays RM20,000.

    2. Deductible

    A deductible is the amount the patient must pay before the insurance starts paying.

    Example: A RM500 deductible means the patient pays the first RM500 of the bill.

    3. Co-payment or co-insurance

    This refers to cost sharing between the patient and the insurer.

    Example: A 10 percent co-insurance means the patient pays 10 percent of the bill while the insurer pays the remaining 90 percent.

    4. Clinical care guidelines

    Clinical care guidelines are evidence-based recommendations that guide doctors on appropriate investigations, treatments, and length of hospital stay. They aim to support safe, consistent care based on research and patient outcomes.

    Conclusion

    MHIT provides standard, evidence-based care with a design aimed at affordability, predictability, and cost discipline. For basic and common inpatient care, MHIT can be broadly comparable in practical effect to conventional medical insurance, including plans such as AIA My Medical Plan, because the core clinical management is similar and financial protection can be strong within the plan limits.

    Conventional medical insurance remains more suitable for complex, long-term, or very high-cost conditions where extended outpatient care, advanced therapies, and very high limits are required. MHIT’s role in strengthening primary care and managing common infections earlier and more efficiently supports both cost control and better system functioning, while the public healthcare system continues to remain the central safety net.

  • Understanding Change and Leading It Effectively

    What is Change

    Change is the process through which individuals or organisations move from a current state to a desired future state. It is not merely the introduction of a new policy, structure, or system, but a transition that affects how people think, feel, and behave. While organisations often view change as a technical or strategic exercise, change is fundamentally human in nature.

    People rarely resist change because it is irrational or unnecessary. They resist change because it threatens familiarity, identity, competence, and control. Change disrupts routines, challenges assumptions, and creates uncertainty. As a result, people often confront change emotionally before they attempt to understand it rationally. This explains why well-designed reforms frequently fail when the human dimension is ignored.

    Effective change, therefore, is not about forcing compliance. It is about helping people make sense of why change is needed, how it affects them, and how they can successfully adapt to it.

    ADKAR as a Framework for Change

    One of the most practical models for understanding and managing change at the individual level is the ADKAR framework, developed by Prosci. ADKAR recognises that organisational change succeeds only when individuals successfully transition through five sequential elements.

    Awareness refers to understanding why change is necessary. Without awareness, people question the purpose of change and remain disengaged. Leaders must communicate the rationale for change clearly, honestly, and repeatedly.

    Desire reflects the individual’s willingness to support the change. Awareness alone is insufficient. People may understand the need for change but still resist it due to fear, perceived loss, or lack of trust. Desire is influenced by leadership credibility, perceived fairness, and alignment with personal and professional values.

    Knowledge refers to knowing how to change. This includes skills, information, and guidance. Even motivated individuals cannot change if they do not know what to do differently. Training, mentoring, and clear instructions are essential at this stage.

    Ability is the capacity to implement change in practice. Knowledge does not automatically translate into performance. Ability requires time, resources, supportive systems, and opportunities to practice without fear of punishment.

    Reinforcement ensures that change is sustained. Without reinforcement, people revert to old habits, especially under pressure. Reinforcement comes from feedback, recognition, accountability mechanisms, and alignment of policies and incentives with the new way of working.

    The strength of ADKAR lies in its simplicity and diagnostic value. Resistance to change often indicates that one or more ADKAR elements have not been adequately addressed.

    What Leaders Need to Apply Change Effectively

    Leading change requires more than authority or technical expertise. It requires moral clarity, emotional intelligence, and consistency between words and actions.

    First, leaders must provide meaning. People follow change when they understand its purpose and see its relevance to a larger mission. Leaders must articulate why change matters, not only to the organisation but also to the people within it.

    Second, leaders must build trust. Trust determines whether people listen, believe, and engage. This requires transparency, honesty about challenges, and willingness to listen to concerns without labelling them as resistance.

    Third, leaders must role model the change. Behaviour speaks louder than strategy documents. When leaders practise the behaviours they expect from others, change becomes credible.

    Fourth, leaders must involve people. Participation creates ownership. When individuals are engaged early in shaping change, they are more likely to support and sustain it.

    Fifth, leaders must align systems with intentions. Change fails when evaluation, workload, incentives, and structures remain unchanged. Systems must support, not undermine, the desired behaviours.

    Finally, leaders must exercise patience and persistence. Change is a process, not an event. It unfolds over time and requires continuous reinforcement, reflection, and adjustment.

    Closing Reflection

    Change is not something that happens to people. It is something people must live through. Frameworks like ADKAR remind leaders that successful change is not achieved by issuing directives, but by guiding individuals through understanding, acceptance, capability, and commitment. When leaders respect the human experience of change, transformation becomes not only possible, but sustainable.

  • Leading as a Doctor With the Head, Heart, and Soul

    By Jamalludin Ab Rahman

    Leadership in medicine does not begin with a title, an appointment, or a position of authority. It begins the moment a person chooses to serve others through the profession of medicine. From that point onwards, every doctor carries leadership responsibilities, whether visible or not, formal or informal, recognised or unnoticed. Leadership is not something added to a medical career, it is woven into it and practised daily across a lifetime.

    Competence is the head of leadership. A doctor who leads must first be able to do, not merely instruct. Competence allows a leader to think clearly, decide wisely, and act safely. Leadership without competence erodes trust and places others at risk. In the life of a doctor, competence is practised continuously. As a medical student, it is shown through preparation for ward rounds, knowing one’s patient thoroughly, taking responsibility for learning, and helping peers understand without being asked. As a house officer or junior doctor, competence is demonstrated by performing the procedures one expects others to do, personally checking investigations, recognising limitations early, and seeking senior input before harm occurs. As a specialist or senior doctor, competence means remaining clinically relevant, staying updated with evidence, guiding complex cases by example, and making sound decisions during uncertainty. Competence is not optional, it is part of the amanah entrusted to every doctor.

    Compassion is the heart of leadership. Leadership is not about being served, it is about serving. Compassion allows a leader to understand the people they serve before making decisions that affect them. In the daily life of a doctor, compassion begins with patients. It is expressed by listening before deciding, explaining diagnoses and plans even when time is limited, and recognising fear, pain, and uncertainty alongside clinical findings. Compassion extends to colleagues and healthcare workers. It is shown by understanding workload and fatigue, correcting mistakes privately rather than humiliating publicly, supporting nurses and allied health professionals, and fostering a safe working environment. In leadership roles, compassion means understanding the impact of policies on people before implementing change, doing the best sincerely without seeking recognition, and remembering that recognition, if it comes, is only a bonus. Without compassion, leadership becomes mechanical and disconnected from those it is meant to serve.

    Conscience is the soul of leadership. It is the inner compass that keeps a doctor accountable to Allah above all else. Leadership guided by conscience requires moral courage and clarity. In a doctor’s life, conscience is tested in moments of pressure and power. It is practised when patient safety is prioritised despite inconvenience, when one speaks up against unsafe practices, and when ethical principles are upheld even at personal cost. As authority increases, conscience is reflected in resisting misuse of power, acting with integrity when no one is watching, and remaining sincere when recognition or reward is absent. Towards the later stages of leadership roles, conscience is shown by preparing successors, mentoring juniors, and being ready to let go of position willingly. Leadership is temporary, accountability is not.

    Leadership as a doctor is not measured by how long one holds power or how many titles one accumulates. It is measured by how faithfully the trust was carried across a lifetime of service. When competence guides the head, compassion shapes the heart, and conscience anchors the soul, leadership becomes not only effective, but meaningful and sincere. This is leadership that honours the profession, serves humanity, and seeks only the acceptance of Allah.

  • PrEP Must Be Implemented with Mandatory Behavioural Intervention

    From a public health perspective, harm reduction is not confined to lowering biological risk alone. It must also address the behaviours that generate that risk. While HIV pre-exposure prophylaxis, or PrEP, is effective in reducing the probability of HIV transmission, it does not modify sexual risk behaviour and cannot replace personal responsibility or behavioural change.

    From the standpoint of the Health Belief Model, behaviour is strongly influenced by an individual’s perceived susceptibility and perceived severity of harm. When PrEP is introduced without structured behavioural intervention, it may substantially reduce the perceived risk of HIV transmission. This lowered perception of harm weakens the motivation to change behaviour, resulting in the continuation, or even escalation, of high-risk sexual practices. In this context, PrEP risks undermining the behavioural drivers essential for sustainable prevention.

    When PrEP is promoted without mandatory and structured behavioural interventions, it ceases to function as genuine harm reduction and instead becomes a mechanism that enables the continuation of unhealthy and high-risk sexual behaviours under the false assurance of biomedical protection. This represents a shift from prevention to harm containment, which is inconsistent with established public health principles.

    Beyond biomedical and behavioural considerations, public health interventions must also recognise the moral, ethical, and spiritual dimensions of human behaviour. For Muslim communities in particular, health promotion should not be detached from faith. Islam emphasises accountability before God, moral conduct, self-restraint, and the pursuit of what is good and beneficial for oneself and society. Prevention strategies should therefore encourage individuals not only to avoid harm, but also to return to values grounded in belief in God and commitment to doing good.

    Crucially, HIV prevention and control cannot be addressed by the Ministry of Health alone. It requires a deliberate, coordinated, and sustained multi-agency approach. Ministries responsible for education, youth and sports, higher education, religious affairs, social welfare, women and family development, as well as law enforcement, community leaders, religious institutions, non-governmental organisations, and families must all share responsibility. Behaviour, values, and social norms are shaped far beyond the healthcare system, and ignoring this reality weakens any national response.

    The provision of PrEP must therefore be embedded within a comprehensive and structured prevention framework that is multi-sectoral by design. This includes rigorous behavioural risk assessment prior to initiation, continuous sexual health counselling, reinforcement of safer practices, adherence monitoring, and periodic reassessment of ongoing need, supported by education, moral guidance, and community engagement across multiple agencies. Without these elements, the use of PrEP risks normalising sustained high-risk behaviour and may contribute to rising rates of other sexually transmitted infections.

    A relevant comparison is nicotine replacement therapy. Nicotine patches are never offered in isolation. They are part of structured cessation programmes with counselling, monitoring, and a clear objective of stopping smoking. PrEP, in contrast, is too often framed as a long-term biomedical solution without a defined behavioural trajectory or exit strategy. This difference is significant and must be addressed in policy and implementation.

    If the Ministry of Health advocates PrEP as part of the national HIV prevention strategy, it carries a responsibility to ensure that its delivery is ethically sound, behaviourally anchored, and evidence informed. Biomedical tools must support behavioural change, moral responsibility, and ethical reflection, not substitute for them, and this must be reinforced through coordinated action across agencies.

    PrEP can play a role in HIV prevention, but only as an adjunct within a structured, monitored, behaviour-focused, values-conscious, and genuinely multi-agency strategy. Sustainable HIV control will not be achieved through medication alone. Behavioural modification, ethical responsibility, moral guidance, and shared societal accountability remain central and must be treated as non-negotiable components of any effective national HIV prevention programme.

  • Responsible Leadership in the Age of Popular Vote

    Introduction

    Modern democracies increasingly face a paradox. Leaders are elected through popular vote, yet popularity does not reliably translate into improved communities, functional cities, or stronger nations. Charismatic figures may win elections, dominate public discourse, and command loyal followings, but their tenure often leaves institutions weakened and public trust diminished. This tension forces a difficult question. Is the failure one of leadership, or of society itself?

    This paper argues that leadership outcomes in democratic systems reflect not only the quality of leaders but also the moral, cognitive, and institutional maturity of society. Improving leadership therefore requires more than producing better individuals. It requires reshaping the conditions under which leadership is chosen, sustained, and constrained.

    Popularity is not leadership

    Leadership theory has long distinguished influence from responsibility. Popular leaders are often highly influential, but influence alone does not ensure meaningful outcomes. Transformational leadership theory explains how leaders inspire and mobilise followers through vision and emotional connection. Yet inspiration without ethical grounding, systems awareness, and delivery capability risks becoming performance rather than progress.

    The repeated failure of popular leaders to improve cities and nations suggests that charisma, while electorally powerful, is insufficient for governing complex societies. Leadership in complex systems demands moral restraint, competence, and institutional stewardship, qualities that are rarely captured by popularity alone.

    Values as the foundation of responsible leadership

    Before discussing voter behaviour or institutional constraints, it is necessary to address a more fundamental issue, values. Leadership does not emerge in a moral vacuum. Leaders act based on what they believe is right, acceptable, or negotiable. Likewise, societies choose leaders based on what they admire, tolerate, or excuse.

    Values therefore sit at the core of leadership quality. A leader with technical brilliance but weak values may deliver short-term gains while corroding trust, justice, and institutional integrity. Conversely, leaders grounded in strong values are more likely to exercise restraint, accept accountability, and prioritise long-term societal wellbeing over personal or political survival.

    From this perspective, nation-building is inseparable from values formation. Development is not merely economic or infrastructural. It is moral and civilisational.

    Values shape both leaders and voters

    People who believe in and act upon values tend to recognise those same values in leadership. Where honesty, justice, responsibility, and humility are socially respected, leaders who lack these traits struggle to sustain legitimacy. Where values are weak or selectively applied, leaders without integrity can still thrive, provided they remain entertaining, divisive, or symbolically reassuring.

    This explains why leadership reform cannot rely solely on replacing individuals. Societies that wish to be led by leaders with values must themselves value integrity, truthfulness, competence, and service. In this sense, leadership choice becomes a mirror of collective moral priorities.

    This is not a moral judgement on citizens. It is a sociological reality. People respond to norms that are consistently rewarded in their environment.

    A tawhidic perspective on values and leadership

    In Islam, values are not socially negotiated preferences. They are rooted in tawhid, the affirmation of the oneness of Allah, which unifies belief, ethics, and action. A tawhidic mind does not separate power from accountability, success from responsibility, or leadership from moral consequence.

    From this worldview, leadership is an amanah, a trust, not a personal entitlement. Authority is exercised with the consciousness that all actions are accountable beyond worldly institutions. Justice is not optional, truth is not strategic, and service to people is inseparable from obedience to Allah.

    When values flow from tawhid, leadership is restrained by moral consciousness even when institutional oversight is weak. Equally important, a society shaped by tawhidic values is less easily deceived by rhetoric, because it evaluates leaders not only by what they promise, but by how they act, decide, and govern.

    Thus, values in Islam are not abstract virtues. They are operational principles that shape governance, accountability, and public trust.

    Leadership outcomes depend on decision conditions, not voter character

    It is tempting to conclude that societies simply choose poorly. This framing is misleading. Behavioural science shows that individuals operate under bounded rationality. Faced with complex policy choices, people rely on emotional cues, identity alignment, familiarity, and trusted narratives. These are not moral shortcomings but cognitive adaptations to uncertainty and information overload.

    However, values influence which cues people trust. Where values are strong, emotional manipulation loses effectiveness. Where values are weak or fragmented, deception becomes easier. The quality of leadership choice is therefore shaped by both cognitive constraints and moral orientation.

    Institutions determine whether values are protected or eroded

    Strong institutions reinforce values by making ethical behaviour normal and misconduct costly. Weak institutions allow values to be overridden by expediency and personality. Over time, this erodes public expectations, creating a cycle where both leaders and citizens lower their standards.

    Institutions alone cannot create values, but they can protect them. Likewise, values alone cannot guarantee good leadership, but they provide the moral compass without which institutions become hollow.

    Civic maturity is cultivated, not innate

    The ability to evaluate leadership is learned. Civic maturity develops when societies normalise ethical reasoning, discuss trade-offs honestly, and expose manipulation without cynicism. Education, public discourse, and moral leadership all contribute to this maturation.

    In societies where values are continuously reinforced, leadership quality improves not through coercion, but through expectation.

    Conclusion

    It is accurate to say that people matter in a democratic system. It is incomplete to say that people simply need to change.

    Leadership quality emerges from the interaction between values, institutions, and public choice. In the absence of values, popularity becomes dangerous. In the absence of institutions, values become fragile. In the absence of informed citizens, both are easily undermined.

    From an Islamic perspective, strengthening leadership therefore begins with strengthening values grounded in tawhid. A society that believes and acts upon values will choose leaders with values, not perfectly, but consistently enough to change its trajectory.

    Ultimately, societies do not merely elect leaders. They cultivate them.