KUALA LUMPUR, Jan 9 – It is exceedingly rare for a career politician to assume power to finally be able to do something about the issues that she’s passionate about.
Dr Zaliha Mustafa from PKR achieved just that.
In July 2021, just over a year before the freshman MP of Sekijang was appointed health minister in December 2022, Dr Zaliha supported the #CodeBlackMY campaign for the job security and welfare of contract doctors in the public service. The campaign demanded a clear postgraduate pathway to specialisation, detailed and transparent criteria for permanent posts, and equal and fair treatment or benefits for contract and permanent staff.
“The contract doctor and contract health worker system must be revamped for the security of the national health ecosystem by providing options for specialisation to contract doctors,” Dr Zaliha wrote on her personal Facebook page on July 4, 2021, posting a TikTok video of herself with the caption: “Jom bersolidariti bersama 23,000 doktor2 kontrak yang mempunyai hak atas masa depan mereka“.
(Translation: “Let’s join in solidarity with the 23,000 contract doctors who have a right to their future”).
“Besides that, the campaign by the Malaysian Medical Association (MMA) also demands that the government create and publicise transparent and detailed selection criteria for the appointment of contract doctors into permanent service, including fair and equal treatment for all contract and permanent staff,” Dr Zaliha added in her July 2021 post.
In a July 6, 2021 YouTube video explaining the #CodeBlackMY movement, Dr Zaliha noted that contract doctors face a “very bleak” future as they are unable to pursue specialisation following the end of their two-year compulsory service.
She proposed four solutions: redefine essential services, extend contracts beyond two years if doctors fulfil certain key performance indicators (KPIs), open up housemanship training to private hospitals, and increase positions in medical specialties and subspecialties in the public service.
“It’s the government that has to make these policies,” Dr Zaliha said in her YouTube video.
“When there are no placements, we have got to understand that doctors are essential. Medical services are essential. The government must revise these essential services — which services are essential or not essential.”
Last Friday, as health minister, Dr Zaliha announced a 19 per cent increase, or 677 additional posts, in open permanent positions for medical officers from 3,586 for 2022 to 4,263 for 2023, which was welcomed by MMA as a “big step in the right direction”. In total, Dr Zaliha announced 4,914 vacant permanent positions for medical, dental, and pharmacy officers for 2023.
Contract doctors’ movement Hartal Doktor Kontrak, however, reportedly questioned “where all the permanent posts came from”, noting that former Health Minister Khairy Jamaluddin was only able to announce 4,000 plus open permanent positions in February last year for doctors, dentists, and pharmacists after numerous consultations. Khairy had also promised 1,500 permanent posts annually moving forward from 2023 to 2025.
The health minister’s 2023 New Year address to Ministry of Health (MOH) staff also did not include any of the solutions to the contract doctor system that she had previously proposed when she was not yet in public office, nor making the selection criteria for permanent posts clear and transparent.
In a rare move, the MMA has asked Human Resources Minister V. Sivakumar to intervene and regulate – together with the Public Service Department (JPA) – the working hours of “exploited” and overworked house officers.
Medical Brain Drain: ‘The Government Must Be Alert to This and Do Something’
On October 25, 2021, Dr Zaliha told Khairy and the Ismail Sabri Yaakob government to take “immediate” action on the brain drain of Malaysian doctors and health care workers to Singapore.
In her October 2021 remarks, Dr Zaliha was commenting on a Berita Harian report about the potential emigration of hundreds of Malaysian doctors and nurses to Singapore, due to extremely lucrative salaries up to 10 times higher offered by hospitals in the neighbouring country.
“Dr Z feels that this isn’t something to be silenced or to close an eye to,” Dr Zaliha said in a TikTok video that was also posted to her personal Facebook page on October 25, 2021, referring to herself in the third person.
“The government and minister must be alert to this and do something. We don’t want to end up losing human resources that are crucially needed to ensure that our country is in the best state of health and fulfils criteria that have been set by the World Health Organization (WHO).”
Dr Zaliha “liked” a comment on her video on Facebook that said: “Kena tukar kerajaan barulah kakitangan KKM terbela dr” (there must be a change of government; only then will MOH staff be defended, doctor).
The very same issue popped up again last month, after Prof Dr Adeeba Kamarulzaman, the previous Dean of Medicine of Universiti Malaya, highlighted the annual exodus of at least 30 top medical graduates from her university to Singapore, in her response to the severe overcrowding of emergency departments in public hospitals reported by CodeBlue.
This time, now in the driver’s seat as health minister in a new government, Dr Zaliha told The Vibes: “The ‘brain drain’ issue is a long-standing one – virtually every skilled employment sector in Malaysia is affected by this phenomenon and the health care sector is no exception.”
She also said the formation of a health service commission – which would be proposed in the Health White Paper whose drafting was started by her predecessor, Khairy – would address brain drain problems. The Health White Paper has yet to be published or tabled.
Health director-general Dr Noor Hisham Abdullah, who was appointed to his position about a decade ago in 2013, similarly told The Star that brain drain is everywhere.
‘Fight For The Budget. Never Let The Health Care System Collapse’
In another TikTok video posted on July 25, 2021, during the height of the brutal Delta wave, Dr Zaliha highlighted the plight of health care workers struggling to deal with a surge of Covid-19 cases, particularly in the Klang Valley.
She was commenting on reports of 3,000 contract doctors quitting the service that she sought to corroborate with her friends working in public hospitals, noting that the previous day, nearly 16,000 new coronavirus infections were reported in Malaysia.
“Patients coming in have to wait in the emergency ward for five days before admission into the actual ward. They have to take turns. There are really a lot of patients. People who need oxygen support are forced to share a tank. They modify, actually, the apparatus so that it can be shared,” Dr Zaliha said.
“Patients who are in whatever condition – it is our duty, especially the doctors and the health workers – we must make sure that they are safe or saved. We cannot allow patients to deteriorate with each passing day.”
She also stressed that doctors must be retained in the public service. “Something has to be done urgently.”
“I plead with you – those in upper management positions – go down to the ground, look at the actual situation. Don’t just sit in your office and allow the situation to go unaddressed.”
Last December 12, CodeBlue reported similarly long waits in the emergency department (ED) of Raja Permaisuri Bainun Hospital (HRPB) in Ipoh, Perak. This time, in 2022, mostly non-Covid patients presenting with advanced chronic conditions were stranded in the emergency room for up to six to seven days, including critically ill people on ventilator support, due to insufficient beds in wards and staff. At least two patients died after they were stranded in the ED of HRPB for more than four days.
As health minister, however, Dr Zaliha did not announce making any visit to HRPB after CodeBlue’s report was published, although she did visit the emergency department of Tengku Ampuan Rahimah Klang Hospital in Selangor last December 28.
The minister’s December 26 statement, issued two weeks after CodeBlue’s report on HRPB’s overcrowded ED, omitted any mention of the Ipoh tertiary hospital, remarking instead on the congestion of emergency rooms in MOH hospitals in general.
Last Friday, during her New Year address to staff, Dr Zaliha told public health clinics (Klinik Kesihatan) to extend operating hours – beyond the usual 8am-5pm – to relieve overcrowding in hospital EDs, noting that 70 per cent of emergency room visits are non-critical cases.
Her announcement drew scorn on Twitter, as government doctors pointed out that staff in public health clinics are overworked too. MMA said in a statement last Saturday that extended hours at Klinik Kesihatan can only be done with sufficient manpower, pointing out that family medicine specialists at public health clinics are burdened with much administrative work apart from clinical work.
Back in her July 2021 video, when she was not yet in public office, Dr Zaliha called for extra funding, if needed, to retain doctors in the government service.
“If [it] really needs budget for that, fight for the budget. Fight for the budget. That’s our job – as someone with the position and who is given the responsibility to take care of our health care system,” she said.
“We cannot let our health care system collapse. Never. We cannot do that, okay? Please do something.”
Last Friday, as health minister, Dr Zaliha simply expressed hopes and prayers that MOH would receive a bigger budget for 2023 than 2022, telling ministry staff that Anwar had assured her that the 2023 health allocation would “at least be maintained”.
The unity government is set to table Budget 2023 in Parliament on February 24. In the 2023 budget tabled by then-Prime Minister Ismail Sabri, but which was not passed before the dissolution of Parliament, an RM36.1 billion allocation for MOH was proposed, marking a huge 11.5 per cent increase from the RM32.4 billion allocation for 2022.
Advocates have called for health financing reform, including earmarking tax revenue or introducing a payroll-funded social health insurance scheme.