In government hospitals, palliative care services form part of the country’s health service provision, with funding provided from the institution’s overall budget. In addition, the government has allocated some funds to NGOs in recognition of their expertise and commitment to end of life care. Devaraj:

‘The Ministry of Health has been helping hospice groups from the year 2000 with medications - most patients are on medication started at government hospitals - and with plans for inpatient services here [in Penang]. In terms of grants, government has given the Malaysian Hospice Council some money, and we’re one of various hospice groups that have asked. Since 2001 they’ve given us about 22 per cent of what we asked for: just over 12 million ringgits (US $3.6 million) and they’ve given us about three million (US $905,000). At the last meeting I had with the ministry, I was trying to get them to give NGOs 50 per cent of the operational costs of running hospice services – not successful so far.’ ²³

Occasionally, grants are also available from state governments. In Ipoh, the Perak Palliative Care Society receives an annual award from Perak’s Social Welfare Department to support medical staff and caregivers in Rumah Sri Kenangan Ulu Kinta. Support is given in the form of visits, training and ‘hands-on’ teaching. Yet NGOs mostly raise their own funds, which usually come from fundraising activities, corporate pledges and personal donations.

Due to its NGO status, Mount Miriam Hospital Cancer Centre, Penang, does not rely on government funding. Established as a not-for-profit organisation by the Christian Franciscan Missionaries of Divine Motherhood (1976), the hospital subsidises its treatment for the poor through its charitable donations. For example, in 2002, donations to the Linear Accelerator Fund amounted to RM 701,000 of which RM 645,000 were given to the poor as fee reduction. Social worker Lim Guat Lim explains how she helps patients to access funds for their treatment:

‘Here at Mount Miriam we are a non-profit hospital but the medical charges for the patient can be quite costly, because many are patients who are not insured so they need financial help. So our hospital provides some assistance for the patient in their struggle and that is where I come in. When patients are struggling to find financial help they can approach me and I will explain to them what is required in our hospital. Our hospital has a committee which goes through these applications for the palliative part of care. For this part our hospital subsidises the ward costs for the patient admitted here and also for the job itself. Our palliative patients have automatic financial assistance. For the ward, they have a subsidised 15 weeks with no charge for the doctors and consultant; and for the general drugs to be used - they also have a certain percentage off. It is already subsidised but if they need further treatment, any extra costs, we will see what we can do.’ ²⁴

Also in Penang, the Pure Lotus Hospice of Compassion²⁵ provides inpatient care to cancer patients of all religions free of charge. Venerable Lyan Shih, a former nurse tutor, manages the operations of the hospice, where funding is raised through charitable donations, including:

• Direct appeals and special activities carried out by the hospice.
• Donations from other charitable organisations both in cash and in kind.
• Sale of collected recyclable products (especially paper). Sale of donated items at flea markets and the Pure Lotus shop.
• Donations of direct consumables and other items.

Lyan Shih comments on one source of donations:

‘In China you know, at the funeral, they give gifts of money: gift money. Some of the families of the patients - and others who have no link through family - donate. So we receive donations for any amount from one dollar to 1,000 dollars. We do not receive any funds from the government at all; we have not asked. In the very beginning we did ask for some land or an old building but nothing was forthcoming, so we decided to proceed on our own. Most of the other centres have been receiving some kind of support from the government, but not us.

‘I believe this is good. As we give this free service, patients and their families come and can see for themselves. They appreciate the effort we are putting into the service. They then return home and talk about us, therefore they spread the news for us. So the donations come in. In this way we have been able to buy up this building, just two years after starting the project.’ ²⁶

Despite the successes, raising funds is an arduous task for NGOs, especially those which provide both the service and medications free of charge. Kasih Hospice Care Society²⁷ was established in 1997 and registered as a society in March 2005. Lo Ee Chin is one of three volunteer doctors and recalls the challenge of raising funds:

‘When we first started it was all funded by ourselves; but when we met Lama Zopa’s²⁸ followers they donated some money. Then we came to a point that, because we registered as our own society, we had to do our own fundraising. So we started with zero and through our fundraising we had to make sure that we raised enough money to buy medicine. The other commitment we have made is that we will supply free medicine until the end – a commitment we make on compassionate not accounting grounds. So we formed a fundraising committee and hoped to have enough funds to run. Then some kind hearted people gave us a bit of money and we have enough – a few thousand (ringgits) - to buy medicines as we go along.

‘So basically we’re funded by the community and the patients we serve. A lot of the patients are very kind, in fact they donate generously to us. At one point our accounts were nearly in the red and one of our patient’s relatives gave us 20,000 ringgits and we revived again. So now we just have enough to get by; but we still have to work very hard and do some fundraising.’²⁹

Hospis Malaysia (KL) became operational in 1992 and, as the largest palliative care service provider in Malaysia, has a long history of fundraising. Between 1999 and 2004 the organisation reported around 100% increase in expenditure which needed an accompanying rise in income (Table 5).

Rosehayati Ahmed Noordin, general manager of Hospis Malaysia, outlines the benefits of being a company rather than a society:

‘Hospis Malaysia is registered as a company, a foundation no doubt, but a company limited by guarantee. So we have to submit annual reports, audited accounts and have an AGM – and all strictly guided by the council and by the chairman. So it’s easier for us in terms of fundraising - rather than the societies – because societies are only allowed one fund raising event a year. We would not be able to manage with one event because we need 1.4 million ringgits a year.’³⁰

Table 5 Hospis Malaysia: financial expenditure statements, 1999-2004

In Kota Kinabalu, Ranjit Oommen has developed a model of government-funded inpatient care in tandem with an associated home care service, supported by voluntary contributions. Among the fundraising events is a sponsored charity dinner and concert, with entertainment by internationally known musicians (The Drifters, Three Degrees, Boney M), attended by leading members of government and the business community who provide generous financial support. Speaking in 2005, Ranjit Oommen explains:

‘The next concert is going to be on 18 March this year [2005] and we’re getting the famous Drifters. In the second or the third fundraising concert, we wanted to raise half a million because we wanted to put up a building. At that time a diamond watch was donated so we were able to raise 460,000 ringgits. So our plan is to make it a yearly affair, a prestige event where, socially, you should be there because it’s a good concert. It’s a top class performance so the tables are quite highly priced. We also talk a little bit about palliative care.’³¹