DECEMBER , 2023 | THE HEALTH

AS MALAYSIA strives for a resilient and motivated healthcare workforce , ensuring the well-being of both healthcare professionals and the people they serve is paramount .

However , the country ’ s healthcare system grappled with an alarming 1,131-per cent surge in the resignation of contract doctors in 2022 , a stark escalation from the 110 cases reported just five years ago in 2017 .

This disconcerting trend exhibits a consistent rise each year , as depicted by the increasing numbers : 168 resignations in 2018 , 475 in 2019 , 511 in 2020 , and a staggering 1,354 in 2022 , as revealed by data from the Ministry of Health ( MoH ).

Factors contributing to this trend include frustration with the system , limited career prospects , bullying , a toxic work environment and burnout . The situation is underscored by a recent Malaysian Medical Association ( MMA ) survey , shedding light on the challenging work environment medical professionals face .

The survey exposes that 30 to 40 per cent of doctors in the country have encountered some form of bullying during their careers . Furthermore , it discloses the prevalence of overtime work with 60 per cent of junior doctors and 20 per cent of those with over two years of experience working beyond regular hours daily .

Against this backdrop , Malaysia grapples with critical issues affecting the well-being of its healthcare workforce , prompting a closer examination of the underlying factors contributing to this trend .

Health Director-General Muhammad Radzi Abu Hassan said : “ Healthcare workforce transformation is imperative , considering shortages , maldistribution , and evolving healthcare needs .”

HEALTHCARE WORKFORCE TRANSFORMATION AND INITIATIVES

“ The Ministry of Health ( MoH ) employs mapping technology to visualise workforce distribution , identifying areas for publicprivate partnerships . The research includes a predictive model for future needs , forming the foundation for continuous monitoring and policy-making ,” said Radzi .

To bolster the workforce , MoH has implemented various initiatives to address the challenges , among others , in improving the number of medical officers , pharmacists and nurses to provide the best health services to the people such as : i . Creating 1,500 new posts for Medical Officers , Dental Officers and Pharmacy Officers yearly for 2023 to 2025 in line with the Government ’ s decision on Jan 19 , 2022 ; ii . Implementing the permanent appointment of medical officers at the MoH . From 2019 to September 2023 , 8,596 contract medical officers have been offered permanent appointments . Most of these permanent appointments are contributed through permanent appointment matters :

• SPA is implementing permanent posts and planning to offer them a second time in 2023 , involving 1,226 contract medical officers who are considered reserved candidates . This appointment will take effect on Dec 18 , 2023 ; iii . Recruitment of Nursing Diploma trainees ( MoH Sponsored ) has increased from 1,000 to 2,000 each year , and Nursing Diploma recruitment to upgrade Community Nurses to Nurses increased from 800 to 1,000 people per year ; iv . The MoH is working with the Ministry of Higher Education to cancel the moratorium on the opening of new private nursing colleges to increase the production of local nurses ; v . To appeal to the Central Agency to create additional positions in phases involving various service schemes for the existing facilities of the MoH for 2023 to 2025 , and ; vi . The regular recruitment of Nursing Diploma graduates from IPTA and IPTS will be done in phases in 2024 .

ADDRESSING BURNOUT AND WORKPLACE HARASSMENT

MMA President Dr Azizan Abdul Aziz emphasised the urgent need for solutions to combat doctor burnout and workplace harassment . “ MMA has been calling for improvements to the work culture in public healthcare facilities , and we have provided solutions to tackle the issue of bullying .

“ One of the suggestions proposed was to hold all Heads of Departments accountable for any bullying in their department . Bullying can impact the level of care and patient safety , so it is fair to ask department heads to take accountability for any potential threat to patient safety , including bullying among healthcare workers .

Meanwhile , Parti Sosialis Malaysia Chairman and health activist Dr Micheal Jeyakumar highlighted concerns about employment conditions of the lowestpaid workers in the public health sector , specifically those under third-party contractors : cleaning services , security , laundry , etc .

“ The terms of employment are often quite bad , wages are perpetually at the minimum wage level , often overtime is wrongly calculated , there are attempts to further “ casualise ” labour , etc . The MoH should take ownership of these issues and ensure that the contract workers working on its premises are not bullied and exploited .”

The mental health of healthcare workers is always one of the important components that MoH takes care of , assured Radzi .

“ The MoH strengthens mental health teams and implements the KOSPEN WOW programme . This aligns with the “ Global Strategy on Human Resources for Health : Workforce 2030 ” by the World Health Organisation , focusing on improving motivation , satisfaction , retention , and performance .”

The MoH has submitted a proposal to increase the On-Call Duty Allowance rate to the Public Service Department ( JPA ) in 2022 for added support . However , the Government is of the view that the current rate received by officers is still appropriate because Medical Officers also receive other allowances , such as :

• Critical Service Incentive ( Bayaran Insentif Perkhidmatan Kritikal );

• Specialist Incentive Payment ( Bayaran Insentif Pakar );

• After Office Hours Allowance ( Elaun Bertugas Pegawai Perubatan Selepas Waktu Pejabat ) in Health Clinics and Hospital Emergency Departments ( Locum Allowance ) and

• Elective Surgery Allowance ( Elaun Pembedahan Elektif )

FUTURE OUTLOOK AND POLICY PROPOSALS

Proposals for policy improvements in medical graduate production and job market expansion are on the horizon , said Radzi .

In a larger perspective , the MoH is currently looking at the whole ecosystem of medical practitioners in the country , which includes the production of medical graduates and the job market for medical practitioners . It will propose some improvements in terms of policy for medical graduates ’ production and expansion of job opportunities for medical practitioners .

“ This will require amendments to the Medical Act 1971 and other related regulations to create a more viable , sustainable and dynamic job market , particularly for medical practitioners . We hope these efforts strengthen the overall pull factor and reduce the push factor for the migration of health professionals .

Dr Azizan stressed : “ There can only be brighter and better prospects when there is a strong commitment to healthcare reforms . The leadership needs to take control , plan and drive the necessary reforms .

“ What we hope to see next year and in the future are mainly steps taken to improve the welfare of our public healthcare workforce .

“ Reward them for their hard work with a much-deserved increase in remuneration , increase doctor ’ s on-call allowance as the MMA has proposed , improve the work culture , ensure healthcare workers have a work-life balance and ensure better planning of healthcare human resources .” – The Health