Strengthen public health services
Chee Heng Leng
Citizens' Health Initiative/People's Health Forum
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.
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