KUALA LUMPUR, March 2 — A primary care medical officer (MO) serving at a public health clinic in Selangor attributes staff shortages to the large number of programmes run by the Ministry of Health (MOH).
The MO from a klinik kesihatan held that while MOH top officials believe the programmes are beneficial to the people, the ministry has lost sight of the ground-level staff who run their programmes.
According to the government doctor, MOH introduces many new programmes, and while such programmes come with good intentions, it further stretches limited existing staff.
In addition to the problems that come with a multitude of programmes, the MO also addressed transitioning contract doctors to permanent staff, the disillusionment of budding doctors, and strike action.
The MO was among the 1,652 respondents of CodeBlue’s poll among government health care workers that revealed 95 per cent believe Malaysia’s public health care system is currently in crisis, 98 per cent are angry at the situation, 73 per cent are thinking of quitting their job, and 52 per cent are willing to go on strike if one is organised.
On workplace issues, 83 per cent perceive that the government isn’t serious about addressing issues in the public health care system, 80 per cent say they’re underpaid, 78 per cent complain of overwork, 74 per cent suffer from burnout, and 61 per cent feel insecure about their career progression.
One in four allege workplace bullying, while 2 per cent claim workplace sexual harassment.
Below is the medical officer’s story in their own words. As civil servants are prohibited from speaking publicly, CodeBlue is providing them anonymity. The transcript of CodeBlue’s interview with the medical officer has been edited lightly for clarity.
Too Many Programmes, But Too Few Staff
Personally, I think we need more staff because we are running multiple programmes. When we are running lots of programmes, but the number of staff remains the same, there will be some inadequacy there.
In primary care, for example, there are many programmes: maternal and child care; fever centres for those who are having symptoms; screening programmes; non-communicable diseases (NCDs); audits in progress; and education and promotion programmes.
Basically, staff are in between two things (programmes).
As time goes by, the MOH tries to improve the system – which is a good thing – [and] that is why we have so many programmes.
But sometimes, it takes more time to talk to and consult patients. Since it’s not a touch-and-go thing, everyone wants what is best for the patients.
The doctor needs to see X number of patients per day, but sometimes it has to take into account that one doctor will go for a course, one will attend a meeting, or maybe one will start with some patients who need a longer time for examination or referral, and other things.
Things like that happen. If we don’t have an adequate number of medical staff, it’ll be stressful to run the clinic every day.
With the short number of MOs, it will be difficult to run all the programmes well and to create a better working environment for all.
Add Value On Existing Programmes, Not Add New Programmes
Just keep programmes as minimal as possible, as we have to take into account the number of staff that manages a facility.Medical officer, klinik kesihatan, Selangor
The most important thing is the enforcement and monitoring of those programmes and their impact.
We should try not to add more programmes, but instead, maybe there is a need to adequately monitor and put an added value on the existing programmes to improve them.
So many programmes running together will be, sometimes, difficult to monitor, difficult to enforce, and difficult to cater to.
The intention is good, and the data collection is important but it has to take into account the burden and workload on staff.
Sometimes we forget that it’s the same staff that run these programmes. It’s basically one person doing many tasks at one time.
Quality Of Health Workers Is Important, But So Is Quantity
I do hope, if it’s possible, to increase the number of doctors. We have to attract more doctors, especially contract doctors so that we can have adequate strength. We have to keep them and not let them quit.
Contract status is difficult because there is maybe no increment in their salary. If there is no incentive, there is no attraction, and there are many private clinics that can offer more than the government.
If we keep on losing MOs, then it will be difficult because government clinics and hospitals cater to those who are not able to afford to go to the private sector.
Something must be done to maintain and increase the number of medical staff other than doctors – like paramedics and other staff – so that we can work together in a more positive environment.Medical officer, klinik kesihatan, Selangor
I think everyone, after the Covid-19 pandemic, needs more time to relax and unwind, especially those who were working very hard during the pandemic.
If you create a better environment, it will be better because post-pandemic, everyone is still tired from doing all kinds of jobs during the pandemic, with the screening, treatment, and everything. If you have an adequate number of staff working, it reduces the burden and stress. It’s good for the mental health of the staff and reduces the risk of burnout.
I think it is similar in other industries. Only lately, suddenly, the spotlight came on the health care system. I think this is similar if you go to other industries in the private sector where profits are the priority and things will be like this – understaffed but they want to produce more profits.
For me, the MOH wants to give the best for the community, but it is tiring for the staff on the ground, especially after the pandemic.Medical officer, klinik kesihatan, Selangor
I think it would be better if maybe the SPA (Public Services Commission of Malaysia) can revise the number of staff, as it’s important to have an adequate number in the public health system.
They can revise the contract, at least. If they cannot give permanent posts, maybe they can do something that benefits them, and they can continue to pursue their studies.
I think this is very beneficial to the doctors who are contract doctors. They will still be attracted to continue working in the government sector.
We want to maintain the number because people say quality is important, but quantity is also important. Especially nowadays, we never know what kind of pandemic, or what kind of situation will come next.
Even if we don’t have an emergency, we still need a strong number of health care staff so that we can do health promotion and prevention education. It doesn’t mean we only need the number when there’s an emergency or a pandemic.Medical officer, klinik kesihatan, Selangor
Before the pandemic, we still battled with diabetes and hypertension with inadequate knowledge in certain groups of the population. So, this is continuous work. We have to have a strong number of staff, and we need to have strength when we want to raise awareness and when we want to give the best treatment to the community.
I think everybody in MOH has very good intentions to bring the best and spread good things to the community and to deliver the best health care service in the community. But they have to take into account the number of staff and strength in certain facilities, certain districts, and certain states so that it will be okay.
Strikes Not The Answer To Frustration
I’m not a person who is going to support any strike because for me, even if it is difficult, we really have to channel our frustrations to the correct place without disturbing the public health service. If you can talk nicely, comment and explain nicely, and channel it correctly, then things would be better.
I’m not into any strike because we have NGOs (non-governmental organisations). We have MMA (Malaysian Medical Association), so maybe we can talk to them and then use the correct channel to talk to NGOs, and hopefully, the issue will be highlighted at the ministry level.
Those wanting to go on strike want to be listened to, so it would be better if somebody from the ministry’s top management could allocate some time to listen to them.Medical officer, klinik kesihatan, Selangor
At the same time, they will have to take into account the workload of the current situation and listen to the demands of these MOs who want to go on strike. You will have to invite quite a lot of groups so that you will have more points of view and more ideas on how to make everyone have this win-win situation, and we have the issue solved.
Maybe you can invite MMA and any other NGOs. Maybe you can invite the head of the MOs who want to go on strike and also SPA so they can listen.
It’s not only the Health Ministry that needs to listen to their demands, but other people so that they can properly highlight and identify issues.
Because sometimes, we keep being emotional, but we miss the main issue. As long as you cannot pinpoint the main issue, then you won’t be able to solve any issues.
The junior doctors are frustrated, I think, because of their dreams when they were medical students before becoming doctors – they have the idea that if you become a doctor then you may be paid well, and you may have certain things you want in life. You have your own status and everything. But suddenly, whatever dreams they had, they cannot achieve because suddenly, the permanent post changed to contract and everything became insecure for them.
Some other people just want to continue studying and have a stable life. So when they didn’t get it, they started becoming very insecure. And maybe that drives them to be more emotional and start to join groups and go on strike.
When you are in a very stressful condition, you are in limbo, you become emotional, and you feel like you want to quit. Sometimes, when things are a bit better, you will find ways to face them.
When people have permanent posts, they have a more secure future. So they feel like they can compensate for whatever they are feeling and having right now with dreams of the future.
But some people are so stressed that they burn out, but the government doesn’t pay much. They don’t have increments in salary, but they are still doing extra workload. When you have to do lots of jobs, you do lots of duty, a lot of work, but you don’t have any security, especially in future, then things would be more uncontrollable.
Recalculate Workload And Available Bodies In Service
I think MOH should recalculate how much workload and how many available (permanent) bodies there are in the service.
Is it adequate with all the programmes that they are running and that they are planning to run in the future? Then they start to consider everything because we don’t want medical doctors only, we want specialist consultants in the health care system, in the government service.
So if the contract doctors leave – most probably don’t continue or pursue their studies to become specialists – then the number of specialists will be decreasing over time.
Over time, you will get some specialists or consultants who will retire because they have other things to do to enjoy life.
They want to enjoy themselves too after continuously being on-call and being busy during their productive life. So after they retire in old age, you have to keep on replacing them, and actually, you have to keep on producing specialists and consultants to make sure that the health care system will be better.
I’m just hoping we will increase the number of staff, recalculate the numbers, and at the same time, we make sure all these medical doctors or contract workers have the opportunity to be offered permanent positions in our ministry.
That’s my hope. We cannot lose anybody. We need to keep the strength, we need to keep increasing the number so that we can focus on our work: promotion, education, prevention, treatment, and everything!Medical officer, klinik kesihatan, Selangor
It benefits the people. I believe nowadays, with the economic crisis, lots of people don’t have any option, but to go to their government hospital or public health care clinic.
Actually, I love to be in government service; that’s what everyone wants. They want to become doctors because they want to contribute to the community. But because of certain issues in solving things, we change our minds.