A/HRC/44/40/Add.1 ensuring basic living standards.53 Despite these shortcomings, many officials denied there was anything amiss in the social support system. 36. The more recent focus on the bottom 40 per cent of the population (B40) means a large number of households receive cash transfers but the payments are too small to make a real difference. Such transfers could do more if targeted at poorer households or those with more children, or if overall funding were increased. 54 Many of those who most need social protection or cash transfers appear unaware of the programmes or unable to access them 55 and the Special Rapporteur met many struggling low-income families receiving no support whatsoever. Health care 37. Malaysia is justifiably proud of its health-care services, which are reasonably accessible for most of the population. Despite a relatively low level of public expenditure on health, households receive protection from the financial risks of high health-care costs where care is accessible.56 According to the World Bank, only 1.4 per cent of households experience catastrophic health expenditure. 57 38. The two-tiered public-private health-care system has the effect of segregating health-care provision by socioeconomic status, leading to lower-income households predominantly seeking care at public facilities, while higher-income households account for the majority (two thirds) of visits to private facilities. 58 In its response to the Special Rapporteur, the Government incomprehensibly characterized this as evidence of a “progressive health system”. By one estimate, 70 per cent of specialists are now in the more costly private system, typically located in wealthier areas, where just 30 per cent of complicated cases are treated. This lopsided allocation creates shortages of critical staff in an overburdened public health-care system and has contributed to “rising incidences of overcrowding, long waiting times, delayed consultation and late admission for emergency cases”.59 39. Access to health services, medicines and vaccines in rural areas presents a real challenge. One third of rural households in Sabah and 43.6 per cent in Sarawak are more than 9 km from a public health centre 60 and villagers need to travel much further to a hospital for any serious medical issue. Stakeholders emphasized that health care is in effect not free for those who cannot afford to get to a health centre or a hospital. 40. Malaysia has come very close to providing universal health care and should strongly consider legislating a national right to health care to cement its commitment to ensuring that every household is able to access the highest standards of physical and mental health. Education 41. Education is crucial to lifting people out of poverty. As of 2017, the median monthly income for a household without formal education was RM 1,100 (US$ 270), compared to RM 3,400 (US$ 836) for those with a tertiary education.61 Malaysia has made impressive progress in increasing school enrolment rates, including universal primary education. 62 However, attrition from the school system is a major challenge, especially for low-income 53 54 55 56 57 58 59 60 61 62 Stewart Nixon, Hidekatsu Asada and Vincent Koen, “Fostering inclusive growth in Malaysia”, pp. 10 and 16. World Bank, Malaysia Economic Monitor, December 2018: Realizing Human Potential, p. 65. UNICEF Malaysia, “Children without: a study of urban child poverty and deprivation in low-cost flats in Kuala Lumpur”, p. 24. Stewart Nixon, Hidekatsu Asada and Vincent Koen, “Fostering inclusive growth in Malaysia,” p. 28. World Bank, Malaysia Economic Monitor, December 2018: Realizing Human Potential, pp. 62–63. Ibid, p. 61. Stewart Nixon, Hidekatsu Asada and Vincent Koen, “Fostering inclusive growth in Malaysia,” p. 28. Department of Statistics, Household Income and Basic Amenities Survey Report 2016, p. 98. Ibid., “Salaries and wages survey report 2017”, available from https://bit.ly/2KnJEwn. World Bank, Malaysia Economic Monitor, December 2018: Realizing Human Potential, pp. 54 and 57. 9