The reported no-shows of medical officers posted to Sabah and Sarawak should concern the Ministry of Health (MOH), but perhaps not for the reason many assume.
The immediate reaction may be to ask: why are doctors refusing to report for duty? The more uncomfortable question is: why are doctors increasingly prepared to walk away from government service rather than accept the way the system treats them?
That question deserves an honest answer.
Malaysia has built a health care system that has achieved broad universal coverage and is recognised internationally for its significant health gains.
It would be a tragedy if such an important public institution becomes internally unhealthy because its management culture has failed to evolve.
The workforce is the health system. If the workforce is disengaged, fearful, exhausted, or resigning, the system itself is sick.
‘Service Needs’ Cannot Become A Magic Phrase
There is a legitimate need for government to deploy doctors where patients need them. Public servants cannot simply choose every aspect of their employment.
But “kepentingan perkhidmatan” or “service needs” should not become a magic phrase that ends every discussion.
The Public Service Department’s (JPA) own public-service framework recognises that transfer decisions should consider factors such as health and family circumstances, that transfers should not be used as punishment, and that officers should be given reasonable time to prepare.
The question therefore is not whether government has authority to transfer, but how that authority is exercised.
When “service needs” genuinely means the needs of patients and the health system, it is legitimate.
But when it becomes a convenient justification for management’s own preferences, convenience, or manpower failures, it becomes something else. Authority without accountability can easily become arbitrary power.
The ‘Napoleon’ Problem
Every large bureaucracy faces a danger: leaders who become so accustomed to exercising authority that they eventually mistake authority for leadership.
The symptoms are familiar: “Because I said so.” “You have no choice.” “This is service need.” “If you don’t agree, resign.”
Such statements may produce obedience, but do not produce loyalty. Telling an officer who disagrees with a transfer to simply resign is particularly troubling.
If resignation becomes the solution offered to employees who raise legitimate concerns, management is not solving a workforce problem, but exporting the cost of its own management decisions to the individual.
Where is the accountability for leadership? There is an obvious asymmetry in the public service.
Junior officers can be disciplined for failing to meet expectations. But what happens when senior leaders repeatedly lose staff, generate complaints, damage morale, or create an environment where people would rather resign than remain? Where is the equivalent accountability?
If mental health is genuinely a priority, it cannot simply be measured through counselling programmes and awareness campaigns. It should also be a leadership KPI.
How many people resign under a particular leadership structure? How many request transfers? How many report bullying or intimidation? How many take prolonged medical leave? How many would recommend working under that leader?
These should be organisational indicators, not inconvenient statistics.
JPA And The Ministry Of Finance Must Be Part Of The Solution
This is not solely an MOH problem. JPA and the Ministry of Finance (MOF) must also be part of the solution.
If the government genuinely needs doctors to serve in Sabah, Sarawak, and other difficult locations, then the employment proposition must reflect that reality.
Appropriate incentives, accommodation, relocation support, predictable posting duration, career progression, and family considerations are not luxuries, but workforce policy.
JPA already has mechanisms for regional and location-related incentives. If those incentives are no longer sufficient to attract and retain doctors, then JPA and MOF must be prepared to review them.
You cannot discipline your way out of a workforce-retention problem.
Hold Leaders Accountable For Resignations Too
Perhaps it is time to introduce something fundamentally different into public-service management: upward accountability.
Every officer should have access to a genuinely anonymous and independently administered mechanism to evaluate their immediate superior.
Leadership should be assessed on professionalism, fairness, communication, psychological safety, use of authority, bullying, staff retention, and how disagreement is handled. And the results should matter.
A leader who consistently loses good people should be required to explain why. Not every resignation is a management failure.
But repeated resignations, repeated transfer requests, and persistent complaints from the same organisational unit should trigger an independent leadership review.
If an officer can be held accountable for poor performance, why should a leader who repeatedly produces poor workforce outcomes be exempt from meaningful accountability?
The MOH Must Be Willing To Fix Itself
The answer to the Sabah and Sarawak problem cannot simply be more warnings, more circulars and more disciplinary action.
Some individual cases may warrant discipline, but mass non-reporting is also a system warning.
When large numbers of doctors decide that leaving is preferable to staying, management should look beyond individual disobedience and examine the environment that produced that decision.
Malaysia has built a health care system worth protecting. It would be wasteful, and deeply ironic, to have one of the country’s most important public institutions undermined by an outdated command-and-control culture.
We cannot tell doctors to show empathy towards patients while showing little empathy towards doctors.
We cannot promote mental health awareness while tolerating unhealthy leadership. We cannot demand sacrifice from frontline officers while insulating senior decision makers from the consequences of their decisions.
And we cannot continue confusing authority with leadership. The time has come to modernise public-service management.
Authority must come with accountability, leadership must have consequences, and mental health must have measurable KPIs.
JPA and MOF must support sustainable workforce policy. And perhaps most importantly, before demanding that the workforce change, the institution must be prepared to change itself.
Because a healthy health care system cannot be built on an unhealthy workplace. The higher the authority, the greater the accountability.
The author is a public servant in the Ministry of Health. CodeBlue is giving the author anonymity because civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
