With the conclusion of the ministerial retreat involving Prime Minister Anwar Ibrahim and his 27 Cabinet colleagues, the Galen Centre for Health and Social Policy proposes four issues for consideration by the unity government to be adopted as key performance indicators (KPIs) for the health portfolio in the first 100 days of its administration.
Whether the government recognises it or not, the Malaysian health care system and the health of people in this country are currently in crisis.
Rising numbers and complexity of people living with non-communicable diseases, abnormally long waiting times in hospitals, persistent workforce shortages and exodus, patients struggling to access the care they need, and burnt out health care workers, are all symptomatic of a service that is struggling and is on the brink of breaking.
This is not an exaggeration, but an everyday reality faced by many health workers and patients.
The Galen Centre calls on the unity government to adopt the following issues as key performance indicators to measure its progress in health for the first 100 days:
1) Staunch the outpouring of talent, expertise, and manpower from the public health care system
The government must prepare and present a comprehensive plan to address the massive haemorrhage of talent happening today. Politicians cannot behave as if there will still be doctors and nurses in the health system whatever they do or say.
Almost weekly across the country, dozens of young, experienced, and senior medical professionals, including doctors, nurses and specialists, are submitting their resignations from contract and permanent positions.
Reasons for leaving include frustration at the lack of transparency on the issue of contract and permanent positions, bullying and sexual harassment in the workplace, accusations of violations of workers’ rights and exploitation (such as working beyond permitted hours), being underpaid, burnout and poor work conditions.
Covid-19 has inflicted massive damage on our health care system, especially the health care workers who we depend on. The government must recognise the brain drain and present a plan to address it.
2) Tackle the congestion in hospital emergency departments
The Auditor General Report 2018 described these departments as being understaffed, overcrowded, underfunded and not having enough equipment to provide proper levels of care.
As a result, patients are facing unreasonably long hours waiting for treatment and care in the ED, and sometimes even longer periods which have stretched to days waiting for transfer to beds in wards.
This is not just an inconvenience for patients and staff; ED crowding is a significant source of patient harm. People are being treated and even dying in corridors. The situation is also an indicator of a dysfunctional health care system.
This was almost five years ago, before Covid-19 hit. The government must develop and present a plan of action which addresses this crisis and takes into consideration the impact caused by the pandemic.
3) Address the concern regarding safety of our public health care facilities
Around a third of Malaysia’s public hospitals are more than a hundred years old, with several dozen having no fire certificate till today. In comparison, a private hospital would never be allowed to operate without one.
The threat of fire is not theoretical. The intensive care unit of Hospital Sultanah Aminah (HSA) burned in 2016, claiming the lives of six patients, and injuring several others including staff.
Shockingly, there had already been several fires prior to that, including another in 2020. A fire broke out in a public clinic in Kuching in 2021.
The government needs to implement an audit of all fire and related safety measures on all its health care facilities, imposing the same standards that it insists on for private health care facilities.
It must also publicly release the report from the independent committee convened to investigate the 2016 HSA fire which, despite being declassified and three health ministers later, remains unavailable for public scrutiny. Enough excuses. This report needs to be released.
4) Table the Tobacco Control Bill for voting and passage
Vaping and vape products, which are covered under this proposed legislation, need to be regulated immediately.
The consequences of currently having no regulation are clear: the age of those who vape are getting alarming younger (school children are now vaping), nicotine concentration in Malaysia is exceptionally high (5 per cent) and not available in most countries which regulate vape, the cost of vaping is lower than cigarettes making it an attractive habit to take up, and nicotine addiction is slowly increasing rather than decreasing.
This Bill was worked on and reached a compromise by a parliamentary special select committee, which was bipartisan and worked hard to accommodate the views of all parties.
It is a great showpiece of different parties with varying positions and views working hard and sincerely to shape a better and healthier future for Malaysians.
Together, the first letters of each above paragraph spell out the word “STAT”, which, in medicine, refers to an immediate or urgent need.
Malaysia’s health care system needs immediate attention to improving existing infrastructure, retaining manpower, increasing coverage and quality of service delivery, and addressing the multiple crises that it is currently experiencing.
The unity government is an opportunity to implement tough, necessary and delayed reforms, and progress on issues which were previously stymied by lack of vision or political will.
It needs to work in collaboration and consultation with patient groups, affected communities, the private sector, and civil society organisations.
Azrul Mohd Khalib is the chief executive officer of the Galen Centre for Health and Social Policy.