KUALA LUMPUR, Feb 23 – At a town hall with government doctors yesterday, Dr Zaliha Mustafa gave little solid commitment to solutions for multiple chronic problems plaguing a public health service in crisis – amid the spectre of health worker strikes.
At the closed-door meeting at the Ministry of Health’s (MOH) headquarters in Putrajaya with both junior and senior medical doctors from the public sector, the health minister admitted that she was unaware of some of the issues raised.
Dr Zaliha also failed to propose substantive measures with timelines for many of the problems brought up by town hall participants; neither did she commit to adopting most of the specific solutions proposed by the doctors themselves.
One solution that she committed to was for MOH’s mental health department to work together with the Malaysian Medical Association (MMA) on the doctors group’s HelpDoc complaints helpline that she said could be implemented immediately as “low-hanging fruit”.
“The rest, macam I nampak, there are things that memang, actually, not within my knowledge lah. Perhaps because I’m still new, and I have to know more things, I’m going to this [sic], um, how they do things lah in the KKM (Kementerian Kesihatan Malaysia),” Dr Zaliha said, based on an audio recording of the town hall obtained by CodeBlue.
“But, nevertheless, with all these things, I think I should go and sit with several departments yang ada untuk deep dive on the matter and find the best solution on that.”
Presentation slides presented by the MMA at the town hall, as sighted by CodeBlue, did not just touch on contract doctor issues, but other human resource problems like doctors’ low on-call allowance rates (RM9 per hour on weekends) and salaries, as well as the alleged exploitation of health care workers (including wage theft, bullying, and long working hours or overwork).
MMA also raised issues faced by specialist doctors (no subspecialist allowance and insufficient subspecialist training allowance), as well as non-clinical doctors with postgraduate Masters and PhD (such as in health administration or clinical research) who are not recognised as specialists.
MMA’s slides further highlighted the lack of publicly available granular data on human resources and the actual need in the public health service.
Facilities and infrastructure were the second problem highlighted by MMA’s presentation, such as bed shortages that are causing congestion in emergency departments, outpatient departments, and wards; the lack of consultation rooms that sees more than one doctor-patient consultation in a single room; as well as dilapidated or damaged equipment or facilities.
MMA’s slides also highlighted that MOH has yet to publish the independent committee’s report on the 2016 fire tragedy at Sultanah Aminah Johor Bahru Hospital that killed six patients, the worst hospital fire in history.
Zaliha ‘Looking Into’ Selection Criteria for Permanent Positions
The town hall with some 300 participants, held under the Chatham House Rule, excluded top civil servants in the MOH, such as Health director-general Dr Noor Hisham Abdullah and MOH secretary-general Harjeet Singh Hardev Singh.
The meeting, co-organised between MOH and MMA, was held with Dr Zaliha and Deputy Health Minister Lukanisman Awang Sauni, moderated by Dr Helmy Haja Mydin (special advisor to the health minister), and was also attended by government backbenchers from the DAP – Bandar Kuching MP Dr Kelvin Yii and Ipoh Timor MP Howard Lee Chuan How.
Town hall participants proposed some solutions that do not require funding, such as publishing the selection criteria for permanent positions for house and medical officers, as well as the selection criteria for JUSA positions for specialist doctors.
One participant pointed out that family medicine specialist (FMS) trainees reportedly have not received a single JUSA post since 2015.
On the selection criteria for permanent positions, which government doctors have long been pushing for to make transparent, Dr Zaliha simply said she has discussed this with MOH’s human resource division.
“We’re looking into the criteria. Perhaps we can add one also from our side – doctors – to be part of the interviewer. Insya Allah, that one I’m pushing; criteria will come out.”
4,914 Vacancies In Permanent Positions For 2023 Came From Resignations
Dr Zaliha also revealed to the town hall, shockingly, that the 4,914 vacancies in permanent positions for medical, dental, and pharmacy officers this year, which she announced last month, had actually opened up because of resignations – instead of 4,914 actual new positions being created.
She noted that the previous administration had decided to create 1,500 new positions for the health service annually.
“But actually, when we look into that, we found out actually there were already permanent posts being left by our doctors and others – those are the ones that we find back. That’s how we got the numbers of 4,900 the other day. That one, we can fill back. The process is going on; so that’s why we opened up applications,” the health minister said.
“We find few thousands more, so that is good news actually. Again, it has to go through the due process. To me, maybe the bottleneck is at the interview level, so kita akan facilitate and try to accelerate the process, tapi without compromising the quality of our doctors.”
Dr Zaliha also said she has instructed MOH to produce a mapping of needed redistribution of manpower and the actual need in the service for health care workers across different professions “in the long term”, even though multiple complaints from doctors and pharmacists, among others, about severe understaffing and rising resignations in the public health service are a problem today.
Zaliha Has Sent ‘Signal’ To Review Contract Doctor System
On the contract doctor system, which was introduced in 2016 under the then-Barisan Nasional (BN) administration, Dr Zaliha said this was not an “easy thing” to resolve, as she pointed to government “policy”.
Dr Zaliha, a first-term MP from PKR, is part of the new unity government led by Pakatan Harapan, including BN and other parties.
“If you really want to change it, it’s a revamp lah of the whole system; it has to be done at the policy level. Memang tak mudah. Bukan tak boleh, tapi adalah, government has to agree and come up with the policy.
“Tapi apa pun, I have sent a signal to them that it has to be reviewed, and something has got to be done with the system and with the policy. Tapi maksudnya, kita dah bagi signal tu, hopefully, on the other side tu ada make something lah. I’ll do follow-up on that issue.”
MOH’s 2023 Budget Likely 2.2% Of GDP
Dr Zaliha said MOH’s allocation in the federal 2023 budget, which will be tabled in the Dewan Rakyat tomorrow, will likely only increase to 2.2 per cent of the country’s gross domestic product (GDP) from the current 2 per cent.
“Our budget is very very low; we get only 2 per cent. At the most, this time, we’ll get 2.2 per cent out of the GDP.”
MOH received RM32.41 billion in Budget 2022.
Dr Zaliha said that on facilities and infrastructure, MOH will concentrate on upgrading existing facilities in the next two years. New hospitals, which were promised by the previous government and included in the 12th Malaysia Plan, would continue to be opened.
She stressed that funding for health services was an “investment”, telling her audience of doctors that productivity increases in a healthy population.
The health minister added that she would push for the transformation of the country’s health system from “sick care” to “health care” in her five-year term.
Dr Zaliha also expressed hopes of tabling the Health White Paper, a document that is meant to propose health care reform over 15 years, in the next parliamentary meeting.
“We don’t want commissioner macam biasa ni; it does nothing. What we want is a health reform commission, insya Allah, so hopefully we can come up with that.”
It’s unclear what “commissioner macam biasa ni” that Dr Zaliha was referring to.
Zaliha: We Can’t Give Any Solutions Today
At the start of the town hall, before participants gave their presentations or interventions, Dr Zaliha’s opening remarks equated the multiple problems in the health service to a disease that must be diagnosed first – even though many of the issues are chronic.
“So I need some time to understand all this, then hopefully, we can come up with the best outcome. And you know that the best solutions sometimes, it doesn’t cure with one. For example, if you have cough, and the cough goes on for more than five days for example, do you need more? Perhaps antibiotics, or perhaps you need investigations. You have to understand more about the disease,” she said.
The health minister stressed that she was “working towards solving the problems”.
“I understand also that the list of problems yang kita ada ni is not one thing lah. I understand that. It is about (audio unclear). It is about our pay. It is about, what else? So many things, you name it, everything under the sun.
“Bila kita cakap, because of this lah, you know, we don’t have enough health workers with us. Because of this, there’s brain drain problems. Because of this, our health services is going to collapse. I think, as a minister, what I hope is actually we work hand in hand; engagement is very important. Kita buat town hall ni is to understand each and everyone.”
Dr Zaliha stressed that “one thing doesn’t fix all”, adding: “Because of that, I think, again I hope lah, in this session…I don’t think we can actually solve all or give any solutions by today. Today, the motive or objective of having you all here is for me to hear.”
The town hall prohibited participants from taking recordings due to the Chatham House Rule; CodeBlue did not attend the meeting as it was not open for media coverage. However, CodeBlue is publishing this story on the minister’s remarks out of public interest as Dr Zaliha is a public official and elected legislator.
Participant: Town Hall Win for Government, Not for Doctors
In comments to CodeBlue, a participant thanked Dr Zaliha for organising the town hall with doctors from the public service, but pointed out that the session did not yield any clear answers or decisions.
“We know that this listening session was a win for the government, but not for the doctors,” the participant said, when asked for his response to the town hall.
“Many were frustrated that the issues were not resolved. While we understand that time is required, it is apparent that MOF (Ministry of Finance) and JPA (Public Service Department) play key roles and that KKM is not able to penetrate their decisions.
“At this stage, I can only hope that the Budget 2023 will shine some light on doctors, but in reality, I know I’m being ambitious as many of us realise that we are more slaves than staff of the government, simply because there is no political will.”
A press statement released by Dr Zaliha’s office yesterday after the town hall simply summarised the issues raised at the event as contract doctor issues, improvement of public health care facilities, shortage of doctors in emergency departments, improvement of career pathways for medical officers, and other “technical” issues.
The statement omitted problems of unfair wages, bullying, and worker exploitation that were the very first issues brought up at the town hall.
“With all these suggestions and feedback obtained, she will work to resolve the related issues, whether from the policy or technical side, that involves the MOH,” read the statement by the minister’s office.
Hartal Doktor Kontrak (HDK), in a brief statement to CodeBlue, described the town hall as generally a good meeting and that Dr Zaliha “guaranteed that she would try to investigate and try to solve” the issues raised. “A good start,” said HDK, an informal group of contract doctors.