If the Ministry of Health (MOH) were a human being, a person, then we would act immediately to give her cardiopulmonary resuscitation (CPR). We would be doing chest compressions with assisted breathing (bag-and-mask) and using a defibrillator (a life-saving device that delivers an electric shock).
Once we have some signs of life we would intubate, set up inotropes (blood pressure maintaining drugs) and transfer her quickly to the Intensive Care Unit (ICU).
There, a team of experienced and specialist health care professionals, comprising doctors, nurses, pharmacists, and other allied health professionals, would provide round-the-clock intensive care.
Hopefully, this would then allow her to be fully restored and live a productive life.
Sadly, this does not seem to be the stance of our government towards MOH. Many of us have spoken about the critical state of our national health services – the prolonged and severe crisis experienced by both staff and patients.
The response of the government has been subdued, suggesting that they are not listening to the severe problems faced daily on the ground.
The government have suggested some initiatives in recent years. For example, a workforce structural reform package, special inter-ministerial task force on doctor/specialist shortages, Rakan KKM initiative, revival of the Waktu Bekerja Berlainan shift system for doctors, doctor mobilisation to Sabah and Sarawak. They have also suggested (again) a national health financing model.
But most of these are stop-gap measures, some with small impact, and are not transformative. Of concern is the leaning of the government towards private sector models: a fee-for-service model.
We must recognise that much of private health services, especially those in private hospitals, are no longer in the hands of doctors or specialists. They are currently run by business corporations whose motive is profit for their shareholders.
Hence, while we can learn some ideas from the private sector, we, however, cannot take private sector models and use them to design or transform our national health service.
We do not run our national health service with any profit or financial motive. MOH, our national health service, is for the service of the people, the general public. We need a meaningful, caring, accessible, effective and altruistic national health service.
Rather than rehash all that has been said by many of us over the past few years, allow me to summarise the key problems identified and solutions suggested for our national health service.
Listed below are some of the key problems plaguing MOH:
- Acute and worsening health workforce crisis – many describe it as workforce collapse.
- Chronic underfunding of the health sector (and proposed budget cuts).
- Institutional and governance weaknesses within MOH (long-standing issue of bureaucracy and not promoting the brightest and the best).
- Rising non-communicable disease (NCD) burden amid grossly underfunded and under-resourced prevention programmes.
- Overcrowding, with degraded patient safety, in outpatient, inpatient and emergency departments.
- Geographic inequity in access to care, especially in Sabah, Sarawak, and rural and indigenous communities.
- Corruption, procurement opacity, and weak accountability (which is pervasive in government ministries).
Listed below are some of the initiatives we need, to resuscitate MOH:
- Establish an independent Health Service Commission (Suruhanjaya Perkhidmatan Kesihatan) with full independence over health workforce manpower and funding.
- Protect and increase health financing – move toward the benchmark of public health expenditure reaching 5 per cent of GDP.
- Abolish the contract system for doctors, pharmacists, dentists and other allied health professionals, and create transparent, permanent career pathways.
- Retain and motivate the existing workforce through pay improvements, career progression, post-graduate training opportunities, and working conditions, before turning to foreign recruitment.
- A complete revamp of MOH management with improved transparency, governance, and anti-corruption safeguards, and addressing the lack of meritocracy and diversity in the MOH workforce and management.
- Accelerate and properly govern implementation of the Health White Paper with clear milestones, dedicated budget, transparent governance structures, and an empowered, accountable monitoring body.
- Strengthen preventive care in all areas, including addressing NCD drivers.
- Improve equity of access for Sabah, rural and indigenous communities.
- Ensure a whole-of-government approach to health workforce planning.
To drive the resuscitation and transformation of MOH, we need to remove it from politics. The change must not be led by politicians, but by an empowered task force of health care professionals.
They should comprise individuals who have served previously in MOH and dedicated their lives to public service. We should not have people who have a vested interest in the private sector, as that would be a conflict of interest.
For far too long we have allowed our public health services to decay. There are no easy fixes, no easy solutions. But I do believe that we can resuscitate and transform our dying national health service.
To do this, we must accept and believe that health is a human right, not a commodity that citizens must pay to receive.
The author is a specialist doctor.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
