Inspire A Just Culture In MOH – Dr Musa Mohd Nordin

Dr Musa Nordin offers some insights on the issue of maldistribution of the health care work force, including data-driven manpower distribution, minimising discrimination in the selection process, and a fair and competitive salary scheme for doctors.

Ill-thought-out Ministry of Health (MOH) policies, namely the contract system that started in 2016, form the root cause of the present perceived shortages of junior medical doctors. 

It is not a “new problem for the unity government”, as suggested by some. 

More recently, a write-up by a frustrated medical officer suggested that the health care system is on the verge of complete and utter collapse, but not suggesting much in terms of remedies to the doom-and-gloom scenario.

In a previous interview, I suggested a few ideas to deal with the acute shortage of house officers at university hospitals by holistically addressing the bigger issue of circumventing the silo operations of the MOH and Ministry of Higher Education (MOHE), harmonising the distribution of house officers and medical officers, addressing salary implications for junior doctors, rectifying the maldistribution of the health care workforce, and reviewing the parallel pathway and Master of Medicine programmes.

I would like to offer some insights on the issue of maldistribution of the health care work force, and try to be a part of the solution and not a part of the problem.

The ideal ratio for doctor-to-population is 1:400, as recommended by the World Health Organization (WHO). Malaysia’s ratio in 2021 stood at 1:420. This seems to suggest that we are not desperately short in terms of numbers. 

Put it another way, there are 2.4 doctors for every 1,000 persons in Malaysia. This compares favourably with other ASEAN countries.  Singapore, Brunei, Thailand, and Indonesia have 2.7, 1.6, 0.9, and 0.6 doctors per 1,000 population respectively.

Even within Malaysia, there is a gross mismatch of the number of doctors servicing the population, with over-representation of doctors in the Klang Valley, versus rural Malaysia and East Malaysia.

Simply put, too many doctors are sitting in Putrajaya, Jabatan Kesihatan Negeri (JKN), major hospitals, major medical and surgical departments, and similar facilities.

The technocrats in Putrajaya and JKN have obviously failed to distribute doctors equitably and failed to serve the health care interests of the wider Malaysian community.

The chronic omission and commission of their basic duties has triggered the anger of junior doctors who feel betrayed with unfair salary schemes, benefits, and unjust career pathways. This has spurred a brain drain from the MOH towards better pastures elsewhere.

Many of the woes in the MOH can be mitigated, if not solved, by the technocrats in the MOH, by showing a basic sense of civility and decency, with a sense of urgency and best practices, at virtually zero cost, undertaking among others:

Rectify The Maldistribution Of The Medical Work Force In The MOH (And With The Task Force In The MOHE). 

I was led to understand that the paediatric fraternity has virtually solved their manpower distribution with an ingenious data-driven, doctor-to-workload norm, which can be further improved, refined, and digitalised for the other disciplines. 

With Artificial Intelligence (AI) and algorithms, the movement and rotation of doctors can be fairly and promptly decided.

Data driven by a prolific Health Information System (HIS) could empower the MOH to better forecast medical manpower needs and better allocate medical personnel.

The MOH must take the lead from global multinational corporations when it comes to manpower distribution, just like we learnt the safety culture from the airline industry.

Stop Or Minimise Discrimination In The Selection Process By Directors-General, Deputy Directors-General, State Directors, Head Of Services, Consultants And Administrators

We can do this by having clear selection criteria for promotions, transfers, entry to post-graduate programmes, attaining scholarships, etc. 

Pilih kasih is real and malignant trend in the MOH and everywhere else in the civil and political service. Health Minister Dzulkefly Ahmad, a Muslim democrat by word and deeds, has embraced, and must now inspire the practice of a just culture in the MOH.

Fair And Competitive Salary Scheme And Promotion Schedule For Junior Doctors 

The selection criteria for permanent and Jawatan Utama Sektor Awam (JUSA) posts must be made known publicly. 

Other non-financial incentives such as posting of choice upon completion of service to an underserved location should be strongly considered.

Public-private partnerships, such as attractive travel fares or priority seats, should be explored to facilitate and incentivise the relocations of doctors to underserved areas in rural or East Malaysia. 

The monumental task of the health minister is to ensure the MOH, MOHE, Ministry of Finance and Public Service Department act promptly and justly when handling the crisis management of depleting medical human resources and its adverse effects on the healthcare services. 

The dissatisfaction index and attrition rates of the health care human capital are worrisome, and must be addressed urgently with compassion, care and finesse.

Dr Musa Mohd Nordin is a consultant paediatrician and neonatologist at KPJ Damansara Specialist Hospital.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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