Closing The Primary Care Gap: A Leadership Imperative – Sustainably Sihat

In my own Klinik Kesihatan in a busy suburban area in Selangor, we receive upwards of 1,000 patients a day, offering many services, but our ability to do our jobs properly is often hampered by operational and systemic failures.

A strong and robust primary health care system is essential to achieving universal health coverage. 

Our work in the Klinik Kesihatan (KK) is just as important as health care provided in the hospital setting. 

Primary care plays an instrumental role in the prevention and treatment of infectious and non-communicable diseases, curbs outbreaks before they spread, and meets 80 per cent of the population’s health care needs at every stage of life, from womb to tomb. 

In fact, primary care provides first-line health care, ranging from promotion and prevention to treatment, rehabilitation, and palliative care. Investments in primary care has been shown to improve equity and access in addition to health care outcomes. Hence, there must be a concerted effort to shift health care expenditure to primary care.  

As such, we still have a lot of room for improvement.

In caretaker Health Minister Khairy Jamaluddin’s recent Instagram stories, he spoke to a KK medical officer in Langkawi whose clinic facility was standing on disintegrating floorboards and asked her, “What do you need?” 

She boldly replied, “For long term… honestly, a new clinic”. He went on to show the stacks of manual antenatal records, and quipped, “We need digital records. This is 2022!”

Unfortunately, such dilapidated, worn, and resource-strapped conditions are the norm, rather than the exception. 

In my own KK in Selangor, which is a type 1 KK in a busy suburban area, we receive upwards of 1,000 patients a day. We offer many services: non-communicable diseases follow-up, antenatal care, wound dressing, Covid assessment, school health programmes, medical check-ups, dental, home visits, domiciliary care, and other related services such as social support assistance, patient education, and outreach programmes.

But our ability to do our jobs properly is often hampered by operational and systemic failures. Things like forms being in short supply, running out of prescription and MC books, unstable internet access, and non-functioning equipment have become the default mode we function with, and using our own time and finances to compensate for the lack of resources is necessary to stay afloat. 

There is a desperate need for collaborative partnership (between hospitals & KK, KKs and patients, as well as KKs and private GPs) to bridge the gap. 

This service gap exists. 

Often, other facilities are not aware of – and are not able to provide knowledge of – what the other has to offer for the patient. Hospitals frequently offload patients without proper plans for continuation of care, with the expectation that KKs can do things like stat blood investigations or manage poorly controlled illnesses that are refractory to treatment. GPs also always refer patients, expecting KKs to be a utopian facility that can provide everything for free. 

Well, news flash, you cannot do a stress test in KK. Nor do we have paediatricians, influenza tests, or pneumococcal vaccines. Even the X-ray machine is frequently out of order in my clinic!

Most importantly, we need leaders who can communicate this urgent need for capacity building. Leaders who understand the scope of our duties beyond numbers and Key Performance Indexes (KPIs), but in achieving actual health outcomes. 

Leaders who are brave enough to pause and take a step back and draw hard boundaries when asked to do what we simply don’t have the resources for, and demand for those resources first to ensure we can reasonably respond to growing challenges.

This is not to say we should stay complacent. It is simply that realistically, we can only adapt so much, and only bend far enough before we break ourselves. For this, people with the ability to affect change must possess pragmatism and integrity. Good governance requires leaders having self-awareness of the shortcomings of themselves and their institutions.

Unfortunately, these leadership skills may not necessarily come together with clinical skills – and this is important to note, because investment in leadership training is necessary to prepare our junior health care practitioners for their eventual roles as “people with the ability to affect change”. 

Otherwise, those they lead will have to bear the brunt of unrelentless exploitation. A workforce that is not resilient will be prone to compassion fatigue, and we see this in the current climate where every clinic insists on looking out for their own interests. 

And this will lead to a vicious cycle and subsequently develops toxic workplace cultures. 

We have all seen friends and colleagues succumb to workplace pressures. We can do better. From us in KK and further beyond, let us all start within our spheres of influence, and hopefully make an impactful change on the way things are done upstream.

“Sustainably Sihat” is a pseudonym for a medical officer working in a Klinik Kesihatan in Selangor. CodeBlue is granting her anonymity because civil servants are prohibited from writing to the press without prior authorisation.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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