Strengthen public health services

By:

Chee Heng Leng

Affiliations:

Citizens' Health Initiative/People's Health Forum

Policy Code:

3i Health

Problem Statement:

The majority of Malaysians depend on public health services which are now overloaded and underfunded. There is overcrowding of hospitals and shortage of specialists, resulting in delays in diagnoses and treatment, negative impact on training of junior doctors, and a general drop in quality of services and morale of staff. The lack of senior doctors in health clinics and district hospitals contributes to patients by-passing these facilities and crowding the general hospitals. Before the COVID-19 pandemic, Malaysians were already facing a critical epidemic of non-communicable diseases (NCDs). Poor detection and control of NCDs at the primary care level leads to more expensive treatment needed at the secondary and tertiary levels. To handle this, the public health services need to be reorganized to prioritize NCD screening and continuity of care. On top of this, COVID-19 patients are mainly treated in public health services. Going forward, the public health services will have to expect increased patient loads due to (i) COVID-19 cases due to variants and breakthrough infections, (ii) “long COVID” patients facing chronic problems over the long term, and (iii) reversion of patients economically affected by the pandemic from private to public facilities.

Value(s) and Belief(s):

Good quality health care delivered without delays and without charge at the point of service is important to preserve the health status of the Malaysian population. This can only be achieved by a health and medical workforce that is happy, dedicated, and with a high morale.

Proposal of Solution:

Expand public health service capacity by recruiting more staff to ease work load and improve working conditions. While the long-term solution will require structural changes, there is much that can be done as an immediate response to the crisis situation. The first step towards this is to increase public health care staffing, i.e. nurses, doctors, specialists, allied health personnel. More staff are needed at primary, hospital, and specialist levels to be deployed in primary health clinics, district hospitals, and general hospitals. Since public health care personnel are covered by the JPA’s directive to trim civil servant numbers by 1 per cent, new appointments could only be carried out on a rotating basis. An appeal was made by the MOH to the JPA in 2019 for an exemption from the stipulation of the Human Resources Optimisation Policy. This should be implemented immediately so that additional posts can be added to overcome the shortage of health care workers, and to stop the deterioration of quality in public health service delivery. With more staff, workloads will decrease, and improvements can be put into place, such as continuing training and education for existing staff. This will start the virtuous cycle of improving working conditions for staff in public hospitals.

Additional Information:

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Translation

Isu dan Polisi Semasa:

Kebanyakan rakyat Malaysia bergantung kepada perkhidmatan kesihatan awam yang sekarang ini sesak dan kekurangan dana. Kesesakan di hospital awam ditambah dengan kekurangan doktor pakar menyebabkan kelewatan dalam proses diagnosis dan rawatan. Ini turut memberi impak negatif kepada latihan doktor-doktor baharu justeru menyebabkan penurunan kualiti perkhidmatan serta semangat kakitangan perubatan. Kesesakan di hospital pusat berpunca daripada kekurangan doktor berpengalaman di klinik kesihatan dan hospital daerah menyebabkan pesakit mengelak dari fasiliti ini dan terus menghadiri hospital pusat. Sebelum pandemik COVID-19, rakyat Malaysia telah mengalami epidemik penyakit tidak berjangkit (NCD) yang kritikal. Pengesanan dan kawalan NCD yang lemah di peringkat primer menyebabkan rawatan yang lebih mahal diperlukan pada peringkat sekunder dan kepakaran. Untuk menangani isu ini, perkhidmatan kesihatan awam harus disusun semula untuk mengutamakan saringan NCD dan rawatan yang berterusan. Selain itu, pesakit COVID-19 juga kebanyakannya dirawat di fasiliti awam. Perkhidmatan kesihatan awam dijangkakan menerima pertambahan pesakit berikutan (i) kes-kes COVID-19 yang disebabkan varian dan jangkitan walaupun telah menerima vaksin, (ii) kesan jangka panjang COVID-19 yang perlu dihadapi bekas pesakit COVID-19, dan (iii) pemindahan pesakit yang menerima kesan ekonomi negatif daripada pandemik dari fasiliti kesihatan swasta ke fasiliti awam.

Nilai-nilai dan Kepercayaan:

Perkhidmatan kesihatan berkualiti yang diberikan tanpa kelewatan dan tanpa bayaran pada masa ia diberikan adalah penting untuk menjaga kesihatan penduduk Malaysia. Ini hanya dapat dicapai dengan staf kesihatan dan perubatan yang bahagia, berdedikasi, dan mempunyai semangat yang tinggi.

Penyelesaian:

Memperluaskan kapasiti perkhidmatan kesihatan awam dengan merekrut lebih ramai staf untuk meringankan beban kerja dan memperbaiki keadaan kerja. Walaupun penyelesaian jangka panjang memerlukan perubahan struktur, banyak perkara yang boleh dilakukan sebagai tindak balas segera dalam situasi krisis. Langkah pertama adalah mempertingkatkan bilangan staf kesihatan awam seperti jururawat, doktor, pakar dan kakitangan kesihatan bersekutu. Lebih ramai kakitangan pada peringkat primer, hospital, dan kepakaran diperlukan untuk berkhidmat di klinik kesihatan primer, hospital daerah dan hospital besar. Memandangkan kakitangan kesihatan turut dirangkumi oleh arahan JPA untuk mengurangkan jumlah penjawat awam sebanyak satu peratus, maka pengambilan kakitangan baharu mestilah dilakukan secara bergilir. Pada tahun 2019, KKM telah membuat rayuan kepada JPA untuk dikecualikan daripada Dasar Kawalan Saiz Perkhidmatan Awam (Dasar Pengoptimuman Sumber Manusia). Ini perlu dilakukan dengan segera agar perjawatan tambahan dapat ditambah untuk mengatasi kekurangan kakitangan kesihatan dan mengatasi kemerosotan kualiti perkhidmatan kesihatan awam. Bebanan kerja akan berkurangan dengan pertambahan kakitangan dan penambahbaikan dapat dilakukan seperti latihan dan pendidikan berterusan bagi kakitangan sedia ada. Ini akan mewujudkan keadaan yang baik dan berterusan untuk memperbaiki persekitaran kerja bagi kakitangan di hospital awam.

Informasi Tambahan: