Malaysian Public Health Care Service Approaching Breaking Point — Galen Centre

With more demand for care as patients pour into hospitals and clinics, health care professionals are being forced to choose between care for themselves and care for their patients, which is incredibly unfair.

The Galen Centre for Health and Social Policy calls for the formation of a multi-sectoral taskforce, recruitment of overseas health staff, and a strengthened allocation for health under Budget 2023 to address the chronic and widespread problem of an overstretched and overworked public health care workforce.

CodeBlue’s findings from its survey among Malaysian health care workers reconfirmed what we have known previously. That our health care professionals including nurses, doctors, specialists, medical assistants are underpaid, overworked, overstretched, working in facilities which are increasingly congested with patients, and facing extremely difficult workplace conditions.

This was described in the Auditor-General’s 2018 report released in July 2019.

The people who work on the frontlines of health care are our greatest asset and are key to delivering high-quality care. They have shown remarkable resilience and commitment. Yet, their concerns appear to not be taken seriously.

Many of the recently proposed solutions to the congestion in emergency and trauma departments are seen as stop-gap measures. Most have already been tried, tested and at times failed because they depend on having sufficient staff.

There is excessive workload, burnout amidst widespread anxiety, trauma, and mental fatigue which are causing many staff to decide to leave, causing shortages, and increasing pressure on staff, thus creating a vicious cycle. The emergency and trauma departments have been described as war zones even before the Covid-19 crisis.

The pandemic has exacerbated these long-term issues, weakened parts of our health care system, and caused permanent damage. In some hospitals today, people are waiting between 24 hours and several days for a bed.

Health care workers are still doing 30-hour shifts. Many, especially junior doctors, housemen or medical officers, return home physically and mentally wrecked and exhausted. Some have been involved in accidents and car crashes. Tragically, some have even lost their lives as a result.

With more demand for care as patients pour into hospitals and clinics, health care professionals are being forced to choose between care for themselves and care for their patients, which is incredibly unfair. They have their own families, their own health issues, and their own worries.

Like any normal workplace environment, heavier working hours, toxic work environments, bullying and the contract worker situation, will drive people into resigning. Many are experiencing burnout and there are significant numbers intending to leave or have already left. Some are leaving to work in other countries, or worse leaving medicine altogether.

This is a leaky bucket where water poured into the bucket is going out via holes in the bottom. The holes are growing bigger.

The government needs to convene a multi-sectoral taskforce comprising other ministries and agencies (such as the Public Service Department, Ministries of Human Resource and Higher Education) to put together a national health workforce strategy, to listen to staff, look at these issues and to put together long term plans to address both recruitment and staff retention.

It is important to improve the retention of staff already working in the service. It is critical to listen and take the views of the women and men who are our health care workers seriously.

The government must make the formation of this taskforce a priority for its first 100 days.

This is not business as usual or “an old story”.

However, these measures alone may not suffice and it will also take time to come into effect. The government will need to consider recruitment of health care staff from overseas to fill the immediate needs, especially in areas of specialised care.

The revised version of Budget 2023 will be tabled and voted on in the next couple of weeks. Any reduction in this year’s health allocation will be reflected in the prevalence of non-communicable diseases, ability to provide quality care, number of health care professionals leaving the service and worse, morbidity and mortality data for years to come.

We need to maintain and strengthen our investment in health, not reduce it.

We need the government to demonstrate not only compassionate leadership on this issue, but also boldness and vision.

Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.

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