Poll: 95% Of Health Workers Say Malaysia’s Public Health Care System Is In Crisis Now

According to a CodeBlue survey among over 1,600 government doctors, pharmacists, dentists, medical assistants, nurses, and allied health care workers nationwide, more than half are willing to go on strike, while seven in 10 are thinking of quitting.

KUALA LUMPUR, Jan 30 – Government health care professionals in Malaysia nationwide, not just doctors, are reporting high levels of anger and dissatisfaction at the situation in the public health care system.

Even though Prime Minister Anwar Ibrahim’s administration appears to treat health as status quo, a whopping 95 per cent of 1,652 respondents in an online CodeBlue poll – held exclusively among government health care workers across every state and federal territory in the country this month – believe that Malaysia’s public health care system is currently in “crisis”.

CodeBlue’s survey, titled “Dissatisfaction Among Health Care Professionals and Workers in Malaysia’s Health Service”, sought to identify if government health care workers were frustrated at work and what kind of workplace issues they faced. Respondents were predominantly Ministry of Health (MOH) staffers.

Disturbingly, 73 per cent of respondents (1,205 people) said they’re thinking about quitting the government health service.

Over half (52 per cent) said they would take part in a strike if one was organised for public health care workers (867 people), while a third (34 per cent) expressed uncertainty about their participation (557 people). Put together, more than 1,400 government health care professionals are either willing to or uncertain about walking out from work.

Only 14 per cent opposed taking industrial action.

The fact that more respondents are willing to quit rather than to go on strike shows potential challenges by the government to retain public health care professionals. Industrial action means that workers may remain in the service if their demands are acceded to, compared to those who leave quietly without stating what can be done to make them stay.

On a scale of zero (“not angry”) to four (“furious”), more than half (53 per cent) of respondents said they are “furious” – the highest level of anger – at the existing situation in the public health care system. More than a quarter (27 per cent) are “very angry”, while 13 per cent are “angry”. Only two per cent said they are not angry.

A whopping 83 per cent (1,365 people) feel the government isn’t serious about addressing issues in the public health care system. Dr Zaliha Mustafa, a freshman MP from PKR, is the current health minister in the unity government, succeeding Khairy Jamaluddin.

Dr Noor Hisham Abdullah has been the Health director-general for a decade since Prime Minister Najib Razak’s administration in 2013, serving across multiple health ministers, namely Dr S. Subramaniam, Dzulkefly Ahmad, Dr Adham Baba, Khairy, and now Dr Zaliha.

About eight in 10 respondents in CodeBlue’s survey said they are overworked and underpaid. Nearly three-fourths (74 per cent) said they’re burned out, and six in 10 expressed insecurity about their career progression.

After making headlines last year, a quarter (25 per cent) of respondents said they face workplace bullying, while two per cent (35 people) said they face sexual harassment at work.

What is interesting about CodeBlue’s survey findings is the near equal representation of contract and permanent staff, the participation of senior doctors up to the subspecialist level, as well as the (albeit small) representation of pharmacists, dentists, medical assistants, nurses, and allied health care workers.

This indicates that workplace frustrations in the public health service, particularly in the MOH, are shared across seniority and profession, not just limited to junior and contract doctors who held a one-day strike in mid 2021.

Malaysia’s longstanding failure to invest in public health care infrastructure and workforce – even after Covid-19 highlighted the damaging outcomes of a chronically underfunded health care system – has stretched health care workers to the limit.

The pandemic appears to have exacerbated burnout, workforce shortages, and staff turnover, with more people likely sicker now after disrupted care from the past three years, though MOH has not released data on patient load and health human resource trends.

Themes Of Complaints: Heavy Work Burden, Understaffing, Unfair Pay, Equipment Shortages

Some 17 per cent of respondents (288 people) wrote verbatim responses on issues that they’re facing at work. Their complaints broadly relate to immense work burdens, understaffing, unfair pay, and insufficient amenities and equipment in public health care facilities.

A contract medical officer (MO) working at a public hospital in Melaka highlighted the discrepancy in pay and perks between existing permanent MOs and those who were recently appointed into permanent positions. For the latter, their pay grade does not reflect their previous years of service when they were under contract.

“It starts from zero. Meaning, if you’ve been a contract MO, say, from 2018 and then you got your permanent post in 2022, you still get the same base pay, and [it] only increases four years after permanent employment. That’s eight years of service. Why? Do contract officers don’t do the same job? They don’t hold the same responsibilities? Why the discrimination between years of service? Work is work,” the MO wrote.

“I, personally, am actively seeking out employment out of the country. I do not want to keep working and be stuck in a system that doesn’t appreciate the work I do, that does not care for the welfare of officers. And of course, there’s the horrible pay for on-calls, I’m sure you’ve read about it.

“So, if anyone has the opportunity to leave, they will. And when the ministry realises they’ve turned a blind eye for way too long, it’ll be too late.”

Others complained about the burden from multiple programmes and additional services for patients amid severe understaffing, such as value-added services (VAS) in pharmacy and school dental programmes.

“Work in klinik kesihatan (KK) not only have to deal with a lot of patient daily and on-call, but at the same time, have to run so many program, audit, KPI, suddenly new idea/ program from superior up there. Basically KK have to see outpatient, NCD/ chronic disease patient, MCH (maternal and child health), klinik berhenti merokok, klinik methadone, mental health clinic, TB clinic, do audit for DM (NDR), audit hypertension, audit asthma, audit antibiotic and many other audit klinik, KPI for all those primer and NCD program, NHSI, Peka B40, implement new MyVAS appointment system, implement virtual clinic, and many more which all the burden goes to KK,” wrote a permanent medical officer at a government health clinic in Pahang.

Job mismatch was also apparent in some of the complaints.

A permanent MO working at a government health clinic (klinik kesihatan) in Selangor, who said she does not have any job satisfaction, complained about her inability to pursue a career in public health, despite completing a talent grooming programme, passing her MedEx (Medical Specialist Pre-entrance Examination), and having years of experience in public health.

“But I’m still placed in klinik kesihatan without district portfolio and I’m UD52, while others who did not wish to further their study are given district portfolio. Why is that so? Why is there no rotation? Some staff and MOs work more than 10 years, but still in the same position and location. Why is there no reshuffling so that others will be able to have the same opportunity to discover the other side of public health?” she wrote.

Survey Respondents: Mostly Doctors, MOH Hospitals, Klang Valley, Young Adults

CodeBlue’s poll of 1,652 government health care workers nationwide covered government doctors (across seniority), pharmacists, dentists, nurses, assistant medical officers, and allied health care workers in every state in Malaysia.

About 64 per cent of CodeBlue’s survey respondents are medical officers, while 11 per cent are house officers. Medical specialists and pharmacy officers each made up 8 per cent of respondents, while medical subspecialists accounted for 3 per cent of respondents.

The survey also received responses from assistant medical officers or medical assistants (2 per cent), dental officers (2 per cent), nurses (1 per cent), and other public health care workers, including physiotherapists, optometrists, dental surgery assistants, pharmacist assistants, medical lab technologists, a science officer, a hospital administrator, and drivers.

Doctors across seniority, from housemen to subspecialists, comprised the majority of respondents at 87 per cent. About 52 per cent of total respondents are on contract, while 48 per cent are permanent staff.

More than three quarters (77 per cent) of respondents work in MOH hospitals, while 16 per cent work in government health clinics. Five per cent work at university hospitals, while the remaining work in public dental and community clinics, state health departments, district health offices, the National Institutes of Health, and the National Population and Family Development Board (LPPKN). At least 93 per cent of overall respondents are MOH staff.

One in four (25 per cent) respondents are working in Selangor, followed by 15 per cent in Kuala Lumpur, and 9 per cent each in Sabah, Penang, and Sarawak.

Respondents also included those working in Perak (6 per cent); Johor (5 per cent); Negeri Sembilan (5 per cent); as well as 3 per cent each in Pahang, Kedah, Melaka, and Terengganu; 2 per cent each in Kelantan and Putrajaya; Perlis (0.4 per cent, or seven people); and Labuan (0.1 per cent, or two people).

More than four in 10 respondents overall are working in the Klang Valley.

About 53 per cent of respondents are female and 40 per cent are male. Another 7 per cent opted not to disclose their gender. CodeBlue’s survey did not ask for respondents’ ethnicity as we felt it wasn’t relevant for analysis.

More than half (55 per cent) of respondents are aged 30-39, followed by those aged 20-29 (37 per cent), 40-49 (6 per cent), 50-59 (2 per cent), and 60 years and older (0.1 per cent). Young adults in their 20s and 30s comprised 92 per cent of respondents.

Selected verbatim responses from CodeBlue’s survey about the issues that respondents are facing at work will be published on our Twitter account @codebluenews from today. We will also be publishing stories from our interviews with some of the respondents.

Survey Methodology, Weaknesses, Suggestions For Improvement

The survey was conducted online on SurveyMonkey in English and Bahasa Malaysia for two weeks from January 11 to 24, 2023, guaranteeing anonymity as respondents did not have to sign in with an email address to take the poll.

CodeBlue did not publish the link to the survey to prevent the general public from taking the poll, but distributed the link via text to the editorial team’s personal contacts in the public health care sector, and asked them to forward it to their colleagues.

CodeBlue also provided the survey link upon request to those who emailed CodeBlue after verification that they work in the government health service, such as checking the Malaysian Medical Council (MMC) registry of medical practitioners.

Overall, the survey collected 1,668 responses, but 16 (under 1 per cent) were removed due to duplicate entries and responses from individuals who did not match our target audience criteria – i.e. those working in the private sector or who have already resigned from public service. We also excluded a few responses that omitted their job position or type of facility that they’re working in.

A total of 1,652 responses were used for analysis.

CodeBlue’s sample size is bigger than a poll by YouGov, a British data analytics firm, among NHS workers with 1,000 people and Merdeka Center’s government approval ratings poll in October 2022 with a sample of 1,209 respondents.

One of the major weaknesses with our survey is potential self-selection bias due to reliance on social networks among respondents, who probably share similar opinions. The title of the survey, “Dissatisfaction Among Health Care Professionals and Workers in Malaysia’s Government Health Service”, is also more likely to draw dissatisfied respondents.

However, we believe that our survey is a good representation of overall sentiments in the public health care workforce, due to the large sample size in a difficult-to-get group, as well as the participation of non-medical personnel and respondents from every state in the country.

For future polls of a similar nature, MOH can provide its staff database to a polling company, so that randomised sampling techniques can be undertaken to ensure equal representation of different professions and more representative findings.

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