KUALA LUMPUR, August 28 — In a major blow to doctors and other health care workers, the Health parliament special select committee (PSSC) has recommended an indefinite postponement in establishing a Health Service Commission (SPK).
In a 455-page report titled “Proposal to Form a Health Service Commission” that was tabled in the Dewan Rakyat yesterday, the Health PSSC found that even if an SPK were to be formed, the authority to approve the filling of positions in the Ministry of Health (MOH) would still lie with the Public Service Department (JPA).
“The establishment of SPK may not necessarily resolve all the problems in the health sector, as it would involve very high financial implications and could potentially face resistance from existing service officers to move to the new scheme,” said the Health PSSC.
“The Committee notes that several areas of SPK’s jurisdiction are limited and do not cover all aspects of staffing management, as any staffing decisions still fall under the jurisdiction of central agencies such as JPA and MOF (Ministry of Finance).”
The Health PSSC’s recommendation appeared to be primarily based on MOH deputy secretary-general (management) Zahrul Hakim Abdullah’s opinion in a March 17 hearing (Zahrul is currently the ministry’s deputy secretary-general [finance]).
Zahrul told the parliament committee then that a suggestion to form an SPK was first raised 16 years ago to Cabinet – under Prime Minister Najib Razak – on May 27, 2009, during which Cabinet had decided to defer the proposal to form the commission.
“Like what I just presented, this was first brought up and may have been debated even back in 2009, and the Cabinet at that time already saw the implications that would arise from the existence of this commission,” said Zahrul, according to the Hansard published in the PSSC’s report.
“Because if we say we want to raise the level of professionalism of medical officers, for example, by establishing an independent commission outside the control of certain parties, in reality, it will not fully solve the problem. One reason I see is that it would involve very high financial implications for a new commission.
“Secondly, there may be resistance from within the service itself, because if we want to migrate the service scheme involving the large number of medical officers and others, some of them may not agree to move into the new scheme.
“So, these elements may have been considered by the Cabinet at that time, in addition to the fact that staffing issues can actually be resolved by granting special exemptions for the health sector, which is a premier sector.”
Zahrul also said establishing an SPK might require amendments to the Federal Constitution and the Service Commissions Act 1957 (Act 393), besides changes to Public Officers Regulations and other related regulations.
The main function of an SPK, according to Zahrul, would be to peruse, plan, and implement the appointment of officers in the MOH, specifically from closed schemes. Secondary functions include confirmations in service, giving pension status, transfers, promotions, and disciplinary control for members of the health service.
“The jurisdiction of this Health Service Commission will cover all health sector services, except shared-use services, for example the administrative and diplomatic officer (PTD) scheme.”
The MOH deputy secretary-general explained that establishing an SPK would incur huge financial and staffing implications, since a separate service commission would require commission members, a chairman, and staff.
“To implement health reform by forming a Health Service Commission isn’t an easy matter because it involves policy and it does not mean granting the commission the fullest possible autonomy to carry out matters involving staffing. This is because the commission’s role would still be limited only to matters involving services,” said Zahrul.
During the March 17 hearing, MOH medical development division director Dr Mohd Azman Yacob told the Health PSSC that the only way the ministry could stop doctors and nurses from leaving for the private sector was to reject applications for early retirement.
“So if they want to leave, they’ll have to resign. Some are willing to resign. When they resign, this means they won’t get pension,” he said.
Health PSSC chairman Suhaizan Kaiat, who is also Pulai MP, quipped: “Plant a little love for the country in the heart.”
“Yeah, we have to plant, but we’ve already planted a lot,” replied Dr Azman while laughing, as per the Hansard.
Zahrul said, “Your Honourable, to instil a sense of love for the country and service to the nation among our medical officers, we must prioritise serving the nation by ensuring that other elements may not be given priority. This is what we are currently discussing at the MOH level.”
Zahrul added that he believed that the MOH’s powers were currently sufficient to carry out its functions, even as he pointed out that health did not just involve the MOH but also central agencies and other stakeholders.
“For example, our own graduates and officers – if we can get buy-in from all relevant parties, I believe that we can restore trust to become the best health sector in the world. What the government does currently is based on current capabilities.”
When Health PSSC member and Kuala Langat MP Dr Ahmad Yunus Hairi asked if this ultimately depended on the country’s financial strength, Zahrul replied that MOH was trying to get support from central agencies on why the health sector cannot be compromised, such as infrastructure.
“If we delay the construction of roads or highways, the impact may not be as severe as if we reduce allocations for health care. We are currently gathering data and compiling information based on existing facts to present it again to the Cabinet,” said the MOH deputy secretary-general.
The Health PSSC’s recommendations included raising medical officers’ on-call allowance (ETAP) with reviews every five years, besides increasing their salaries and other benefits.
The parliament committee also suggested limiting doctors’ on-call duties to once a week and to mandate rest hours as part of official regulations.
Further, the Health PSSC recommended that MOH turn Malaysia into an international training hub for specialist doctors by taking in foreign students with potential. “This measure will not only be able to generate income for the country through student fees, but also help support the sustainable financing of the development of the public health care sector.”
The PSSC concluded by saying that although it recommended deferring the establishment of a Health Service Commission, all of its recommendations should be made the basis for consideration in drafting an SPK framework in future.
“This is important so that SPK won’t just be an administrative change, but bring true reform that addresses the root causes of problems.”
Should Prime Minister Anwar Ibrahim’s administration adopt the Health PSSC’s recommendation to put off setting up an SPK, or just not do it altogether until the next general election due in February 2028, this means that a Health Service Commission would have been “delayed” for nearly two decades since 2009.
