The Health parliament special select committee (PSSC), chaired by Pulai MP Suhaizan Kaiat, interviewed dozens of government officials and representatives of health professional groups to produce a 455-page report on a proposal to establish a Health Service Commission (SPK).
The PSSC’s report was tabled in the Dewan Rakyat on August 27, but it wasn’t debated in the main chamber of the House because, according to Suhaizan, his committee was only permitted to table one report for debate. (The PSSC chose its vape report over the health care workforce report for debate).
Suhaizan told me that the Health PSSC didn’t issue a press statement about its SPK report either – which recommended deferring the establishment of a Health Service Commission – because “we initially thought that the commission could solve problems. Turns out no. So back to the status quo to MOH (Ministry of Health).”
“We’re holding this meeting not to pressure MOH, but we have to do our jobs,” Suhaizan previously told Health deputy director-general (medical) Dr Nor Azimi Yunus at a Health PSSC hearing last February 27.
Six months later, backbencher MPs seem to think that they’ve already done their job, without even bothering to highlight their own recommendations and problems identified to stakeholders and the general public, despite the time invested by interviewees who had pinned their hopes on politicians to solve their problems.
Having said that, the Health PSSC’s inquiry was illuminating, shedding light on never-before-seen data by the Public Service Department (JPA) and how high-ranking bureaucrats thought about the issue of health worker shortages that they had never revealed publicly before in such a frank manner.
Perhaps the single most important piece of information disclosed in the parliamentary committee’s investigation was the cost of raising doctors’ on-call allowance – which the government has refused to give – that would amount to only RM80 million a year, just 0.2 per cent of MOH’s RM45 billion 2025 budget.
The Hansard in the Health PSSC’s report showed bureaucrats from MOH, JPA, and the Public Service Commission (SPA) playing the blame game over shortages of medical officers, specialists, nurses, and medical assistants.
MOH criticised JPA for not providing sufficient staffing positions, especially for old hospitals.
In response, JPA implied that MOH already enjoyed a certain degree of privilege by consistently getting new positions every year, even as other ministries or agencies were forced to “trade off” 200 to 300 positions (i.e. eliminate those positions to create other more critical positions) before getting approval for new positions.
JPA also pointed out that MOH couldn’t even fill all the positions approved, citing the rising rate of vacancies in the ministry from 5 per cent in 2016 to 17 per cent in 2024.
SPA simply pointed the finger at both JPA (can’t approve all positions requested) and MOH (responsible for filling vacancies), as the commission defended itself by saying that it expedites processing appointments for MOH above other ministries.
A government hospital director, commenting on CodeBlue’s report about the MOH-JPA-SPA blame game, remarked to me: “They keep blaming each other; why not just sit down and try to solve it?”
Politicians hold a lot of power, hence the frequent “menurut perintah” touted by civil servants to absolve themselves of any responsibility. The government of the day is formed through the participation of individual Members of Parliament. Without MPs, there is no Executive or Cabinet.
But elected representatives rely heavily on the expertise of bureaucrats, especially administrative and diplomatic officers (PTDs) as the so-called “bulwark of the civil service”, to guide the government in making public policy.
This was exemplified by the Health PSSC’s recommendation to defer the formation of a Health Service Commission. Despite MOH complaining about not getting enough positions from JPA, the ministry opined in the same breath that an independent commission would be useless.
MOH’s Human Resource Division (BSM), which is mostly staffed by PTDs, said “we” had proposed limiting the on-call allowance raise to the now-axed Waktu Bekerja Berlainan (WBB) pilot project to reduce financial implications from RM80 million to RM20 million.
Going by BSM division secretary Noor Azman Abdul Rahman’s testimony to the Health PSSC, it appears that the suggestion to limit the on-call allowance increase to a select group of doctors was self-restriction on the part of MOH – rather than the Ministry of Finance (MOF) directly rejecting a request from MOH to provide the raise to everyone under Budget 2025.
If MOH themselves won’t fight for their own doctors, then who will?
With regard to the issue of an overworked, underpaid, and understaffed health service, bureaucrats appear to be trapped in their own little boxes. They simply repeat, over and over again, “We do X, Y, Z”, even though the system clearly isn’t working, as doctors and nurses continue to resign in droves and waiting times lengthen in public health care facilities.
Just like how a government is formed by individual MPs, the State is formed by individual civil servants, many of whom are averse to change out of a misplaced desire to protect a system that does not love them back.
Are some resistant to an independent Health Service Commission because this would make them directly responsible for outcomes?
Or is the real problem an unspoken but pervasive attitude among PTDs who see health care professionals and, by extension, MOH, as already receiving privileges in the civil service, like exemptions from universal interim contract appointments and higher salary scales than everyone else?
Doctors were often told by their superiors, “If you don’t like it, quit.” More than 6,400 medical officers, plus another 1,000 plus specialists, left the government health service from 2019 to 2023.
Perhaps PTDs across MOH, JPA, SPA, and the civil service at large resent a demand from doctors to be treated as valuable human resources, (wrongly) perceiving such demands as calls for special treatment, even though doctors toil at 33-hour shifts for lower pay than fast-food workers.
Did this resentment among PTDs – who themselves constitute the nobility of the civil service – grow as health care worker issues gained traction in the mainstream media and Parliament over the past several months?
“Don’t bring up this issue. There are already too many issues about MOH,” a BSM representative allegedly told Health Minister Dzulkefly Ahmad in front of Malaysian Medical Association (MMA) Schomos chairman Dr Timothy Cheng at a meeting, according to Dr Cheng’s testimony to the Health PSSC on February 6.
With that, powerful PTDs return to their inner sanctum, free of accountability to the people.
Series of CodeBlue articles on the Health PSSC’s report:
- MOH Short Of 14,000 Medical Assistants, Says Association
- Patient Arrivals In MOH Rose 18% From 2020 To 2023
- MOH, JPA, SPA Play Blame Game Over Health Worker Shortages
- PTD Scheme Open To OKU This Year In Historic First
- JPA Estimates RM4 Billion Cost Of 51,000 New Health Worker Positions Approved Since 2019
- On-Call Allowance Raise For All Doctors Costs RM80 Million Annually: MOH Official
- Defer Forming Health Service Commission, Says Parliament Committee
Boo Su-Lyn is the co-founder and editor-in-chief of CodeBlue.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
