KUALA LUMPUR, August 18 — Health Minister Dr Zaliha Mustafa claimed today that the Pakatan Harapan-Barisan Nasional government solved the “legacy” contract doctor issue for the short to medium term.
Dr Zaliha, in an interview with RTM this morning, referenced Prime Minister Anwar Ibrahim’s announcement last month of absorbing 12,800 contract doctors over three years.
This year, effective last July 31, more than 4,100 contract medical officers – out of the current 20,333 contract doctors (including 12,800 house officers) – were appointed to permanent positions.
The contract system for doctors, dentists, and pharmacists in the public health service began seven years ago in late 2016, initially meant as a short-term solution to a glut back then of medical graduates amid insufficient permanent positions.
“I see that the Madani government – for at least the short and medium term – we solved the contract issue that people say has been a long inherited legacy issue,” Dr Zaliha said.
The health minister added that the 4,000 over permanent positions provided for medical officers this year cost the government a “not insignificant” amount of RM1.7 billion.
Health director-general Dr Muhammad Radzi Abu Hassan’s statement last August 4 noted that the large-scale appointment of more than 4,000 medical officers for permanent positions was actually kick-started last year – under then-Health Minister Khairy Jamaluddin – before the offers for permanent appointments were made this year.
Khairy said in February 2022 that the Cabinet, under then-Prime Minister Ismail Sabri Yaakob’s administration, had agreed to create 4,186 additional permanent positions in the Ministry of Health (MOH) for 2022, comprising 3,586 medical officers, 300 dental officers, and 300 pharmacy officers.
He also said the Cabinet had agreed to create at least 1,500 new permanent positions for medical, dental, and pharmacy officers in the MOH every year from 2023 to 2025.
Dr Zaliha did not provide a breakdown on how many of the more than 4,000 permanent appointments for medical officers made this year were the creation of new positions, or the filling of existing vacancies due to resignations.
The permanent appointment of some 4,100 medical officers this year leaves behind an excess of some 7,500 medical officers still under contract, as well as 12,800 contract housemen.
Even if Anwar goes through with his promise of providing some 4,000 permanent positions for doctors for 2024 and 2025 – based on the MOH’s budget that, like other ministries, is created on an annual basis – that still leaves tens of thousands of doctors under contract, comprising existing ones and new cohorts from 5,000 to 6,000 medical graduates every year.
While a purported “glut” of medical graduates was a problem that triggered the contract system in 2016, however, based on MOH’s own data and anecdotes of a shortage of house officers due to a brain drain of medical graduates, it appears that the problem now, especially with a post-pandemic spike of contract doctor resignations, is a shortage of doctors across all levels, from trainees to subspecialists.
Dr Zaliha did not provide data mapping the actual needs of the service and distribution of health care professionals – versus the number of positions made available for the MOH by the Public Service Department (JPA) – to justify her claim that 4,000 permanent positions for doctors every year, a seemingly arbitrary number, was a “solution”.
Doctors routinely complain about staffing shortages, based on anecdotal evidence from their own facility – be it a public hospital or health clinic – regardless of whether the staff are permanent or contract.
The health minister also did not acknowledge the severe disruptions to health services from doctor shortages, particularly in the Klang Valley, Melaka, and Negeri Sembilan, that was triggered by the MOH’s first mass relocation of over 4,000 medical officers.
Neither did she say if there would be any changes to future permanent appointment and relocation exercises next year and in 2025 – presumably also involving 4,000 over doctors, as per Anwar’s pledge of 12,800 permanent positions over three years – to learn from this year’s disruptive exercise.
Crucially, Dr Zaliha did not state if the selection criteria for permanent positions would be made transparent, an issue that doctors’ groups have been harping on for years since the contract system was introduced in 2016.
The health minister, in a separate interview with The Vibes on the Health White Paper (HWP), said she would finalise the terms of reference and composition of a Health Care Reform Commission that would be given independent authority to oversee the reforms stated in the HWP.
She did not state if a separate National Health Services Commission – as pledged in Pakatan Harapan’s manifesto for the 15th general election – would be set up.
This commission to regulate health care professionals separately from other civil servants was not mentioned either in the HWP that contained general and motherhood statements on health reforms.
Dr Zaliha only said that the High-Level Committee by chaired by Deputy Prime Minister Ahmad Zahid Hamidi has been established to “definitively address the issue of contract doctors, by comprehensively reviewing the entire ecosystem, including education and practical training, licensing and registration, public sector recruitment, deployment and retention”.
Madani Economy In Line With Health White Paper
Dr Zaliha said the principle of the Madani Economy could be linked to the HWP, as there are a few principles that are in line with that of the HWP, including inclusivity, economic sustainability, social well-being, and economic growth.
“When we make the Health White Paper as a framework for our health system, what do we want to achieve? We want to achieve, in the end, the best health services for our people,” Dr Zaliha told RTM.
“The best health services for our people encompasses a few issues. Amongst it is we look at the accessibility of health services for the people. Equality of accessibility is one. Secondly, we also look at it from the angle of affordability, the people’s ability to get the best health services, and thirdly, we also want our health system to be sustainable or future-proof.
“So, we have to make sure that in the health system, that’s what we want to achieve, and of course, one thing I always say is that when the people are healthy, then productivity also increases, and finally, it causes us to have economic growth.”
In order to support her stance, Dr Zaliha drew attention to a World Health Organization (WHO) study on health expenditure that shows a direct impact of health care expenditure on the economy.
“This is very interesting for me. In English, every penny that you spend will increase up to 1.4 per cent of positive effect to the health of the people or country, meaning we need to remember that if we spend on the health of the country, it means that indirectly, we make the people healthy and ultimately catalyse the economy.”
The health minister went on to outline the four pillars of the HWP in her interview with RTM.
Dr Zaliha also touched on the Madani Medical Scheme, touting it as a successful hospital decongestion method.
She said that about 70 per cent of people who frequent the emergency department are from the B40 community, and those who come after office hours.
“We want to lower the congestion where these sorts of cases, which are simple illnesses such as fever, flu, cough, small wounds and so on, we want to send them to peripheral clinics, outside clinics. So, we introduced the Madani Medical Scheme.
“And finally today, we see that the Medical Madani Scheme is very helpful and has gotten a very good response from the people, and we will extend it to the whole country. God willing, we will shift from focusing on congestion reduction, and secondly, [we will] provide services that are fast and immediate to the people in simple cases.”
The Madani Medical Scheme – where the low-income can get fully subsidised treatment at private general practitioner (GP) clinics – has been recently extended to 11 new districts.
The four new districts where the scheme has been implemented are Kota Setar and Kuala Muda in Kedah, as well as Kuala Terengganu and Kuala Nerus in Terengganu.
The Madani Medical Scheme will be implemented in the other seven districts – Kota Bharu and Pasir Mas in Kelantan; Kuantan, Pahang; Melaka Tengah, Melaka; Seberang Perai Tengah, Penang; Seremban, Negeri Sembilan; and Perlis – from the fourth week of this month.
