Malaysia’s public health care system faces two undeniable realities. We need more health care workers, and we need more health care capacity.
These are not competing priorities. We need both.
I make this observation not as an outside observer, but as someone who spent 20 years serving in the Ministry of Health (MOH). During that time, I served at Sultanah Aminah Johor Bahru Hospital, Kuala Lumpur Hospital, Queen Elizabeth Hospital Kota Kinabalu, and Tambunan Hospital.
As a medical officer and later a consultant, I also conducted specialist outreach visits to numerous district hospitals. These experiences gave me a firsthand appreciation of the challenges faced by both tertiary referral centres and smaller rural hospitals.
There is no question that Malaysia faces significant workforce challenges. Doctors, nurses, pharmacists, allied health personnel and support staff are the backbone of any health care system. Without them, buildings alone cannot deliver care.
At the same time, workforce shortages should not become a reason to delay much-needed expansion of public health care infrastructure.
Hospital planning is a long-term undertaking. From planning and approval to construction and commissioning, a major hospital can take many years to complete. Workforce numbers, however, are far more dynamic. They are influenced by recruitment, retention, migration, remuneration, training capacity, working conditions and government policy.
Indeed, it was not that long ago that we were having the exact opposite discussion. There was widespread concern that Malaysia was producing more doctors than the system could absorb. Many will remember the large numbers of housemen and medical officers entering the workforce and the difficulties in finding adequate training and placement opportunities. District hospitals that had never previously trained housemen were asked to do so because the numbers entering the system had increased so rapidly.
In response, the government increasingly relied on contract appointments rather than permanent positions with the accompanying benefits, job security, and career progression.
Today, only a few years later, Malaysia faces significant shortages of doctors, specialists, nurses and other health care workers.
The irony should not be lost on us.
The same health care system that once struggled with concerns about an oversupply of doctors is now grappling with shortages across multiple categories of health care workers. This is not a criticism of anyone. It is simply a reminder that predicting workforce requirements five, ten or fifteen years into the future is far from an exact science.
That is why long-term infrastructure planning should not be paralysed by current workforce shortages. The need for hospital beds, clinics and health care services in a growing population is much easier to predict than the precise number of doctors and nurses who will be available years from now.
The need for additional public hospital capacity is particularly evident in highly populated urban centres such as Kuala Lumpur and Petaling Jaya.
While the health care needs of rural communities rightly receive considerable attention, the needs of patients living in urban areas should not be overlooked. It may seem counterintuitive, but access to timely health care in densely populated urban centres can be every bit as difficult as in many rural settings, especially for patients who do not have private health insurance or the financial means to seek treatment in private hospitals.
I have worked in both settings. The challenges are different, but they are no less real.
Public hospitals in major urban centres are often operating at or beyond capacity. Clinics are overcrowded. Wards are full. Emergency departments are under constant pressure. Waiting times for appointments, investigations and procedures can be prolonged. Anyone who has worked in these hospitals knows this is not theory. It is the daily reality.
For many patients, the existence of numerous private hospitals nearby offers little practical benefit if the cost of care remains beyond their reach. They may live within a few kilometres of several private hospitals and yet have no realistic option other than joining the long queues at public facilities.
This is especially relevant in Petaling Jaya and the Klang Valley, one of the busiest health care corridors in the country. Demand for affordable, accessible and timely health care continues to grow. Additional public hospital capacity is not a luxury; it’s a necessity.
At the same time, workforce shortages must be addressed aggressively. The challenge facing the MOH is not merely one of recruitment. It is also one of retention.
Many talented doctors, nurses and allied health professionals leave the public sector because of workload pressures, administrative burdens, career uncertainty and remuneration concerns. Addressing these issues should be a national priority.
Importantly, expanding hospital capacity and strengthening the workforce do not have to occur one after the other. They can and should happen simultaneously.
A new hospital does not need to open at full capacity on Day One. Around the world, including Malaysia, hospitals frequently commence operations in phases. Emergency services, outpatient clinics and selected inpatient services may begin first, with additional wards and specialties introduced as staffing levels grow. This allows patients to benefit from new infrastructure while workforce development continues.
Malaysia’s growing population will require more doctors, more nurses, more specialists, more clinics and more hospitals in the years ahead.
The answer is not to choose between infrastructure and manpower. The answer is to invest in both.
Patients deserve a health care system that is adequately staffed and adequately resourced. Achieving one without the other will never be enough.
The author is an infectious disease physician.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
