While the Covid-19 pandemic has cast a long shadow on our country, it has also highlighted Malaysia’s contract doctor system, revealing the harsh reality behind the public health care system.
Since 2004, a mushrooming of medical colleges in Malaysia has caused an influx of medical graduates, making mandatory placements in public hospitals a difficult process due to limited available positions for housemen.
According to The Straits Times, currently only 3.47 per cent, or 789 of 23,077 contract doctors have found permanent positions in the public sector.
The lack of transparency on the selection of permanent medical officers has brought further negative implications, as junior doctors are left wondering if they have a chance to secure a livelihood upon the completion of their two-year mandatory service.
In light of recent events, the situation does not only put the future of young doctors in jeopardy, but also patients who are receiving treatment in public hospitals.
These events demonstrate that speedy reformation is vital to ensure the security and sustainability of Malaysia’s public health care system.
There are different factors to take into account, but the Wisdom Foundation strongly believes that decentralisation is one of the key steps necessary for long-term reformation, among the many steps required for creating a better public health care system.
For example, the health minister announced on August 4, 2020, that there is a ratio of one doctor for every 454 Malaysians. However, it was then pointed out that the official ratio of doctors to the population is 1: 662 in Sarawak and 1: 856 in Sabah.
Highly centralised decision-making has created a gap between the understanding of needs at the federal level and the grassroots level, causing inefficient administration and the erroneous assessment of conditions on the ground.
By distributing decision-making throughout the different levels of governance, the needs of local situations can be better met.
Hence, we implore the federal government to adopt a hybrid decentralisation system in the reformation of the public health care system. This will improve its effectiveness, equity, and efficiency, and will improve the future of our young doctors, as well as our nation.
Wilfred Madius Tangau is executive chairman of the Wisdom Foundation.
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