Experts Want Health Service Commission For Public Health Care Profession

Dr Azman Abu Bakar and Dr Adeeba Kamarulzaman say that health care professionals under MOH, MOHE, and Mindef should be managed by a health service commission separate from JPA.

KUALA LUMPUR, August 17 – Experts have called for a health service commission to manage health care professionals separately from other civil servants under the Public Service Department (JPA).

Former Health deputy director-general (medical) Dr Azman Abu Bakar pointed out that the legal profession in the public sector has its own separate judicial and legal service commission that manages the human resources of government legal officers.

“If legal staff can have their own commission, why the heck are we going under the big umbrella?” Dr Azman told a panel on human resources for health yesterday at the Health Policy Summit 2022 organised by the Ministry of Health (MOH). 

“Do they understand what we’re here for? Do they go on the ground? Do they face what we’re facing as clinicians? Three, four people sitting in one room, where’s the confidentiality when they manage patients?

“This is a big issue. A health services commission is the way forward to manage our own fraternity.”

Universiti Malaya infectious disease physician Prof Dr Adeeba Kamarulzaman agreed with Dr Azman’s proposal for a health service commission, adding that health care professionals from university teaching hospitals under the Ministry of Higher Education (MOHE) and from the Ministry of Defence (Mindef) should also be placed under the health service commission along with Ministry of Health (MOH) staff.

“I agree with the formation of a health services commission. That’s what I meant by ‘break the system’,” Dr Adeeba said.

“In order to achieve all those things outlined, we need to break the system, but at the same time we need to build new systems. When I say we need to break the system, I mean the ‘kekangan’ (restrictions) we’re in from the rigidity from JPA and others that are put on us.”

She pointed out that although medical education in Malaysia needs to be improved with more people trained in big data, health informatics, and genomics, JPA only allows a certain number of new staff to be hired for a particular facility, like Universiti Malaya’s faculty of health.

“In the same way that the Ministry of Health is leading the charge to transform the health system, MOHE must step up and transform medical education. Medical education doesn’t just mean for doctors, but nurses, allied health, community health workers, and counsellors in areas that we don’t often think of – in prisons, AADK (National Anti-Drugs Agency), and all those systems.”

Dr Adeeba stressed that health is an entire ecosystem, noting that failure to address infectious disease in prisons, for example, will lead to severe cases of tuberculosis in hospitals.

Public Health Care System Bears 70%-80% Of Health Care Burden

A presentation by moderator Dr Hirman Ismail, deputy director of the development of the medical profession branch at MOH’s medical development division, showed that 70 per cent to 80 per cent of the health care burden in Malaysia is borne by public health care facilities, particularly in MOH, both in primary care and secondary or tertiary care settings.

The public health sector manages more than 80 per cent of hospital outpatient attendances, antenatal care, delivery, and Covid-19 hospitalisation, as well as more than 60 per cent of hospital admissions and utilisation of outpatient health care.

Another presentation slide by Dr Hirman also noted that a senior medical officer appointed as director of a district non-specialist hospital in East Malaysia was asked to perform multiple procedures, including assisted delivery, appendicectomy, and postmortem, among others, due to the lack of trained physicians.

Medical officers posted to rural areas are relatively junior, while their senior counterparts tend not to stay long in the service with high turnover. 

While hospital cluster initiatives send visiting specialists or senior medical officers to district hospitals, Dr Hirman’s presentation noted that this was not the same as permanently posting senior officers or specialists in these facilities.

“The nearest specialist hospital was 1.5 to two hours away and in some places, it could be further than that. Such a loss of opportunity affects clinical outcome. Sustainable human resource capacity is needed for the rural and underserved areas,” he noted.

Dr Azman warned the government that failure to create a progressive workforce, both in quantity and quality, would affect the sustainability of the health workforce and the effectiveness of the health care system.

“If we don’t reform soon, the health consequences are going to be even more devastating,” he said.

“You’re going to overburden clinical services, which will result in further compromise of health service delivery quality. This might lead to burn out. This will lead to more medico-legal litigation, and public dissatisfaction is going to increase further and further.”

The former Health deputy DG pointed out that nurses in the public sector, for example, are less than 50 per cent of the numbers required – and this is just in hospitals.

“What we have now is just peanuts,” Dr Azman said. “People now talk about food security, but we’ve forgotten about health security.”

Build Cadre Of Community Health Care Workers

Dr Adeeba urged the government to fund, train, and accredit community health care workers to manage primary, preventive, and aged care, rather than just focusing on training medical specialists that takes six to eight years.

She noted that Botswana was the third country in the world to achieve – and even surpass – the global 95-95-95 HIV goals of 95 per cent of people living with HIV knowing their status, with 95 per cent of those on treatment, and virally suppressed so that they are no longer infectious.

A population-based survey led by Botswana’s health ministry found the country had a 95-98-98 score. According to the UNAIDS, the global average score in 2020 was 84-87-90.

Dr Adeeba pointed out that the southern African country is able to essentially end HIV/AIDS as a public health threat despite 30 per cent of people in the southern African country living with HIV.

“How did they achieve that? Not by having lots of Prof Adeeba or [infectious disease expert] Christopher Lee; they had lots and lots of community health care workers going out to test, initiate treatment, and ensure people are on treatment,” Dr Adeeba said. 

“While we wait to train super specialists, the crisis right now that we have – the NCDs (non-communicable diseases) that require people to be more health literate, to understand the importance of nutrition, the importance of exercise – you don’t need a super specialist for that.”

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