As we reflect on 2024, congratulations are in order for CodeBlue on its exceptional contributions and stellar achievements.
As a vital platform for Malaysian health care workers to voice their concerns anonymously, given their prohibition from engaging with the press, it has become a cornerstone of free expression within the health care sector.
Throughout the year, CodeBlue provided a glimpse into the struggles faced by health care workers, with letters pouring in from health care facilities across the country, including Seri Manjung, Ampang, Sibu, Temerloh, and plenty others.
Despite the proliferation of these complaints, the Ministry of Health (MOH) often issues clarifications, such as reassurances from the Perak State Health Department addressing a complaint from a Seri Manjung doctor.
While these responses aim to maintain a sense of normalcy, they fail to address the deeper issues within the system.
The struggles of health care workers are not new, but they have intensified in recent years. Between 2019 and 2023, an incredible 6,417 medical officers left public service, which translates to an average of 3.5 resignations per day.
This figure excludes the 1,086 contract medical officers who secured permanent positions and 1,046 specialists who exited the system. These alarming trends reflect a workforce overwhelmed by systemic shortcomings, including understaffing, low wages, and stagnant allowances.
Former Health director-general Dr Noor Hisham Abdullah described the MOH in 2019 as underfunded, understaffed, overworked, and overstretched, with overcrowded facilities creating a highly stressful work environment.
It is important to note that this reality has worsened with the impact of the Covid-19 pandemic. Low wages and stagnating allowances further discourage retention, with on-call allowances unchanged since 2012 and the promised Budget 2025 increase relegated to a vague “pilot project“.
Such circumstances erode morale and push many health care workers to pursue better opportunities overseas or in the flourishing private sector, which has been reporting record earnings, where monetary compensation is more attractive and working conditions more manageable.
Health Minister Dzulkefly Ahmad has acknowledged these issues, citing staff shortages and unequal burden distribution as critical challenges. While he has pledged to address these during his second term, the limited civil service positions (jawatan) remain unresolved.
Compounding this issue is the rigid salary structure of civil service employment, which struggles to compete with the private health care sector and lucrative overseas opportunities.
These constraints, coupled with bureaucratic inefficiencies, undermine efforts to retain talent within the public health care system.
Unequal distribution of health care workers exacerbates the situation. Health care workers often face abrupt placement notices, with less than two weeks to report for duty, with a significant number in remote or less desirable locations. This lack of flexibility deters many from accepting their assignments.
While Deputy Minister Lukanisman Awang Sauni has proposed a rotation system, it does not solve the issue of frequent uprooting of health care workers, often those with young families, which can be disruptive.
The Malaysian Medical Association (MMA) has called for a digitised mapping system to transparently allocate resources and improve efficiency in approvals and budgeting.
The MMA has also proposed establishing standardised norms for health care workforce distribution across all major clinical specialties to support data-driven manpower planning.
These norms will provide a clear basis for justifying workforce requirements. It is essential that the respective Heads of Service are held accountable for implementing and adhering to these standards.
Sadly, such proposals have received little traction from the MOH.
All ministers aim to leave a legacy that ensures they are remembered fondly by future generations. Remaining in this quagmire of stagnation will not bring meaningful progress.
A potential game-changer lies in establishing a Health Services Commission. Such a body could provide the autonomy needed to manage health care human resources effectively, ensuring equitable distribution, competitive compensation, and streamlined decision-making.
This approach would free health care workers from the constraints of civil service bureaucracy and address their unique challenges.
Systemic reform is undoubtedly a monumental task, but the benefits of a healthier public health care system, improved job satisfaction, and better retention of talent is one we must contemplate seriously.
As we move into 2025, it is time for visionary leadership to prioritise the well-being of our health care workers and the sustainability of our health care system. With bold steps, such as the establishment of a Health Services Commission, we can lay the foundation for lasting improvements.
May the new year bring renewed commitment and tangible improvements to the health care sector.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
