KUALA LUMPUR, March 6 – Bandar Kuching MP Dr Kelvin Yii urges Health Minister Dr Zaliha Mustafa to announce a master plan by Sunday, her 100th day in office, for the immensely strained public health care system.
The government backbencher said health care workers want to see a way forward or direction out of “tangible challenges” in the public health service, though Dr Yii refrained from framing the current situation as a “crisis”.
“I think a clear policy on how to address some of the issues has to be announced,” Dr Yii told CodeBlue in an exclusive interview last Tuesday, when asked what is the one solution that should be implemented within the minister’s first 100 days by March 12.
Ministers in Prime Minister Anwar Ibrahim’s Cabinet were sworn in last December 3.
“I think health care workers want to see a way forward, a direction. So I will be hoping that the Minister of Health and Ministry of Health (MOH) will basically share their macro policy on what is moving forward, and what is supposed to be done in the next couple of months, next couple of months, and so on and so forth — mid, short, like milestones,” Dr Yii said.
“From there, we can then be part of the process itself and also keep the government accountable when it comes to deliverables.”
When asked if the government should publish the selection criteria for permanent and JUSA positions in the health service, as asked for by doctors at Dr Zaliha’s February 22 town hall with them, within the first 100 days, or one or three months, Dr Yii said this depended not just on MOH, but also the Public Service Department (JPA).
“While I do not question the professionalism of SPA (Public Service Commission), I believe maybe up to 99.5 per cent of cases are professionally handled. But any one case can cause doubts, can cause mistrust against the system, so that’s where we need to address it,” said the DAP lawmaker.
“But I think we can find ways on how to improve transparency of the system, add trust in the system.”
Dr Yii pointed out that in his recent debate in Parliament, he had suggested for a representative from the Malaysian Medical Association (MMA), the Malaysian Pharmacists Society (MPS), or whichever related organisation or union, to be present during the selection process for permanent positions in the health service.
“Whether they have voting rights and powers, that can be discussed, but more importantly, it has to be, there has to be some level of oversight. I can say, of course, there’s resistance to that idea.
“But together, we can find ways to make it more transparent, for health care workers themselves to trust the system.”
‘Words Of Affirmation Do Not Feed Their Family’
CodeBlue’s survey last January among more than 1,600 government health care workers nationwide, predominantly MOH staff, revealed that 95 per cent believe the public health care system is currently in crisis.
A whopping 98 per cent expressed anger at the current situation, while seven in 10 respondents said they were currently thinking of quitting their jobs in the public health service.
“I think our public health service is facing some tangible challenges, especially after the Covid pandemic that was a stress test that revealed a lot of gaps in the public health care system itself,” Dr Yii said, when asked if he believes the public health service is currently in crisis.
“Now, post Covid, we’re facing another increase of patients, especially non-communicable diseases (NCDs), which has put a strain on the public health system.
“There are many tangible challenges. If we do not do anything comprehensive or holistic, we may be heading down towards that path.”
CodeBlue, citing statistics that showed 1,354 contract medical officers quit their jobs in 2022, exceeding the 1,279 resignations in the previous two years combined, asked Dr Yii if the situation in the public health care system was “a lot more dire now or at breaking point”.
“I think it’s multifactorial. The reason why I say that post-pandemic is a contributing factor – it’s fully understandable. Many of the health care workers – I’m not just talking about doctors, but the whole ecosystem – has been overworked. They feel burnt out. They feel frustrated, especially during the pandemic,” Dr Yii said.
“In times of pandemic, their focus was mainly on saving the people. But now post-pandemic, there’s still issues that have to be dealt with. But we must understand the mental health status of the health care workers. I’m not saying this in a condescending way. This is understandable. This is why a lot of frustrations are being vented; a lot of frustrations are being shared.”
The government backbencher said all related ministries and agencies, not just MOH, have a “huge” challenge in handling health care workers’ frustrations and addressing “systemic” issues in the public health service, including providing a better working environment, remuneration, and “proper” appreciation.
“As I said, while we appreciated them during the pandemic, words of affirmation do not feed their family, to a certain extent.”
Three Steps That MOH Should Take For Health Workers
Dr Yii listed three steps that MOH should take for the benefit of health care workers in the public service, amid increasing complaints of a toxic work environment.
The first, he said, was to address workers’ welfare in a review of the financing of health care workers.
The DAP lawmaker said MOH must also provide a “conducive” working environment, though he admitted it was “impossible” to create “extra comfortable” conditions due to patient load and the condition of the public health care system.
Third, MOH should provide a “certain level” of job security and career progression, particularly for junior and younger doctors.
“I think once we address that — it’s challenging, it’s not easy, this is systemic, it’s a legacy issue — but once we address that, hopefully, we can reduce the amount of brain drain to the private sector or even other countries, which we cannot deny is happening.”
Data On Staff Shortages And Actual Need
Dr Yii said he expected MOH to prepare a proposal to JPA on the number of health care workers, including doctor and allied health staff, that are needed in each public health care facility.
“They have to allocate specific [positions] and protect a specific number of positions, purely for health care workers. So any vacancy cannot be transferred to other government agencies. As I said, while there are sentiments that say the government service is bloated, but it’s not the same case as in the health care workers, where we know it’s lacking,” he explained.
“So I believe the Ministry of Health will prepare and has prepared a paper, when it talks to JPA on the exact needs, and even on top of increasing what is necessary to help the capacity of our health care system.”
When asked if he believed that these figures should be published, Dr Yii said he personally believed in transparency.
The government backbencher also pointed out that although on a macro level, at 1:428, Malaysia may have close to the World Health Organization’s doctor to population ratio of 1:400, the numbers include doctors in the research fields and those in the private sector. In terms of distribution, the Sarawakian legislator noted that there are insufficient medical practitioners outside the Klang Valley.
“I believe MOH has a better grasp of the specific needs, but hen it comes to vacancy and placement, it’s under JPA. I don’t think MOH is pushing the buck to JPA, but they need to find a way to work together on being specific on the needs,” said Dr Yii.
“Being transparent with the needs — I personally am supportive of transparency — but more importantly, come up with a formula. So MOH should be more involved in making decisions when it comes to placement of health care workers.”