KUALA LUMPUR, Feb 16 – Two groups representing government doctors across Malaysia have listed their demands to the government to avert a potential strike amid an ongoing crisis in the public health service.
Although these groups said they are not actively planning a strike, some are reportedly ready to take part in what could be a massive walkout, if one was organised.
One doctor who spoke to CodeBlue, on condition of anonymity, claimed that any upcoming strike involving health care workers will be “huge” as it will attract not only contract doctors, but specialists, subspecialists, and medical officers in permanent positions, as well as allied health care professionals.
“I think doctors are fed up with listening to ‘kita akan buat sesuatu’ (we will do something). With more and more people voicing out now, we have finally realised that it is a dead end,” the doctor said.
The doctor claimed that he heard by word of mouth that a group of doctors are planning a strike, which is expected to take place earlier than initially planned in June or July. CodeBlue was unable to verify his claims.
The escalating threat of industrial action from the public health service comes after years of low wages, unclear career pathways, increasing staff shortages, and broken facilities that have left the public health care system in a state of crisis. The country is also facing a “tsunami” of non-communicable diseases and an increasingly ageing population, which will see demand for public health services rise even more.
Many health care workers who participated in CodeBlue’s two-week survey for the public health service last month felt that the Ministry of Health (MOH) was not serious in resolving issues with staff shortages, unfair wages, poor facilities, and toxic work conditions that have persisted for more than a decade.
In CodeBlue’s poll of 1,652 government health care workers across professions (both permanent and contract staff) and from every state and federal territory (predominantly MOH staff), 95 per cent of respondents believe that Malaysia’s public health care system is currently in crisis; 98 per cent are angry at the current situation. Over half said they would take part in a strike if one was organised for public health care workers.
While no group representing workers in the public health service has officially announced a strike so far, Ipoh Timor MP Howard Lee Chuan How, the Malaysian Medical Association (MMA), and Health Minister Dr Zaliha Mustafa herself have made references to purported “unannounced” industrial action.
Dr Zaliha’s TikTok video yesterday, in which she said that a strike wouldn’t solve problems, received mostly angry responses on Twitter, with many expressing support for industrial action from the public health service.
Reformasi Kesihatan Malaysia: Strike Means Nothing More to Lose
A representative from Reformasi Kesihatan Malaysia (Twitter @reformMYhealth), a group of government doctors, said while going on strike is not ideal, public health care workers will likely have no other choice if the situation gets worse.
“When one goes on a strike, there is nothing further to lose because there is nothing left on the plate. If anyone decides to do so, then they should be maxed out already,” Reformasi Kesihatan Malaysia told CodeBlue.
“Imagine having to work for years and your boss doesn’t review your salary. Imagine having to work for years with a lack of promotion and transparency. Imagine having to leave your family at home to serve the people but in the end, your boss doesn’t even bother or listen to you.
“That’s what’s happening today. It’s easy to say that the government cares, ‘give us time’ etc., but a lot [of those] in administrative positions have been there long enough to see and understand these problems.”
He said the government should at least commit to spending more on health care in the new Budget 2023 that is scheduled to be tabled in Parliament next week.
“It’s either we still want to use the word ‘kekangan kewangan’ (financial constraints) year in and year out and say that the budget is limited, or we want to improve the health care [system] and quality of life for all Malaysians,” the representative said.
Reformasi Kesihatan Malaysia listed a dozen demands for the federal government to fulfil:
1. Transparent criteria for permanent posts
No criteria since 2016? This is a shame, especially with so many JUSAs in the ministry.
2. Increase on-call allowances
Since 2011, we have now matched the rates at retail outlets. Should we go sleepless for RM9.20/ hour?
3. Previously promised JUSA positions
Announcements are announcements, but where are the results? Why is Putrajaya lying to us?
4. Increase human resources
Show us our actual numbers and doctor-to-patient ratio. Are we moving forward or regressing?
5. Improve facilities and infrastructure
Some hospitals don’t even have enough prescription books and some have to fork out their own money and vehicle to provide services.
6. Review salaries for all health care personnel
Medical inflation rate is about 8 to 10 per cent yearly. Are we increasing our salaries yearly? When was the last? MOH can answer.
7. Stop discriminating against and threatening health care staff
We are not allowed to speak. If we did, we would be threatened and this information may be denied, but many of us have got calls, messages, and personal WhatsApp messages on this.
8. Treat those in training equally like JPA, not two-tier treatment
Are MOH staff provided equal benefits during training? MOH is aware of this discrepancy and also the revision of these allowances, but has not taken action to date.
9. Subspecialist allowance
Doing subspecialty should be an added advantage, but is it in MOH? Some have to withdraw their own EPF (Employees’ Provident Fund) money while supporting their family. Once they get back, what incentive is given? Has there been favouritism in some fields compared to others in promotions? There’s a certain field where many were promoted, but those promoted have mostly left MOH.
10. Review the health care financing model
Possibility of social health care insurance – RM1 for emergency treatment and RM5 for specialist treatment. Why are politicians so scared of increasing the rate? Won’t it also help with overcrowding? These rates have been there since 1982. Do you remember the price of nasi lemak then and now? Is it the same? So, where is the political will of all politicians? Not only the current government. No one dared to make that move till today.
11. Establish a Health Care Commission that reports to the prime minister
This has been proposed by multiple parties. Sadly, some up there refuse to form such a commission. This commission should be free from the current administration and should take into account NGOs and associations. Brave yourselves to listen to the ground, not have poor insight and listen to yourselves.
12. Liberalise routes to specialisation. Allow private facilities to train them
This would surely require planning, but is a step forward we have to look into.
Hartal Doktor Kontrak Will Announce Any Strike In Advance
Hartal Doktor Kontrak (HDK), which organised a one-day strike in 2021, issued a fresh call two weeks ago for government doctors to join their movement although it did not specify if they are planning to organise another strike.
Speaking to CodeBlue, two HDK spokespeople said any strike planned by the group would be announced in advance, as was done in July 2021, to avoid “unnecessary issues” to the public health service.
HDK spokesman Dr Mustapha Kamal said the group’s demands remain unchanged: permanent posts for all contract doctors and clear criteria for permanent positions.
In a statement issued early this morning, HDK denied any involvement in the “unannounced” strike mentioned by the health minister, saying: “We believe that a well-organised strike is the last resort. Patients’ health and safety remain our priority.”
Besides unclear career progression with the contract employment scheme for government doctors, the group also highlighted discrimination against contract doctors in terms of wages and benefits like hazard leave and housing loan schemes.
Health Minister Dr Zaliha Mustafa previously announced 4,914 vacancies in permanent positions for medical officers, dental, and pharmacy officers in the public sector for 2023 – a 17 per cent increase from the 4,186 positions created for 2022.
Still, the higher number of permanent positions created comprise only about 12 per cent of the estimated number of health care workers on contract.
Before she was appointed health minister, Dr Zaliha, a freshman Sekijang MP, 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.
As of May 31, 2021, a total of 35,216 health care professionals were on contract, comprising 23,077 medical officers, 5,000 dentists, and 7,139 pharmacists. An additional 12,153 undergraduates are enrolled in a training programme under MOH’s contract recruitment scheme. Junior doctors formed the bulk of the country’s Covid-19 health workforce.
When asked if MPs should support a strike by health care workers, HDK’s Dr Mustapha told CodeBlue it was completely up to each parliamentarian.
“If they say they care so much about the people and the country, they must know that most health care workers [are at the] frontlines, leaving behind personal issues, loved ones, and mental health while trying to keep everyone safe in the hospital or health care facility. But instead, we are treated like s**t after Covid [ended].”
Hartal Ahli Farmasi Kontrak Not Planning Any Strike ‘At the Moment’
CodeBlue also spoke to contract pharmacists from the 2016-2017 batch behind Hartal Ahli Farmasi Kontrak (Twitter @HFarmasiKontrak).
The group is demanding permanent posts for contract pharmacists, specifically for 321 contract pharmacists in the 2016 to 2017 batch, who have been serving in the public health care system for over five to six years, including during the Covid-19 pandemic.
The contract pharmacists are also seeking an equal number of permanent positions for pharmacists as for doctors to ensure that pharmacies can run smoothly. The group said the government should revise the number of pharmacists for every hospital and klinik kesihatan (government health clinic).
“Nowadays, pharmacists have a lot of activities such as managing the pharmacy value-added services (VAS) system, Sistem Pendispensan Ubat Bersepadu (SPUB), ubat melalui pos (UMP), methadone clinic, medication therapy adherence clinic (MTAC), smoking clinics, Paxlovid dispensing, and store management. Some klinik kesihatan have already started extended hours, but we don’t have sufficient staff,” Hartal Ahli Farmasi Kontrak told CodeBlue.
The group questioned why, out of the 4,914 permanent posts made available this year, only 316 positions are for pharmacy officers compared to 4,263 positions for medical officers.
Other issues raised by Hartal Ahli Farmasi Kontrak include “unfair” workplace transfers and a call for the establishment of a committee to identify and troubleshoot problems in pharmacies in government hospitals and klinik kesihatan so that the health system runs well.
“We are not planning for any strike at the moment. But we would like to talk. Shall we? When?” Hartal Ahli Farmasi Kontrak tweeted last night in response to Dr Zaliha’s video.
