MARCH-APRIL , 2023 | THE HEALTH

According to the Report , the financial performance for PICK was 46.5 per cent to 100 per cent and was in line with the implementation of activities .

• State-level PICK implementation MOSTI has distributed RM393.42 million to all State governments to implement PICK at the State level , which covers vaccination centres ( PPV ) operating costs . The allocation and expenditure of PICK for the Federal Territories in Malaysia are managed by MOSTI .

As of Oct 31 , 2021 , a total of RM247.99 million had been spent to implement PICK at the State level , while another RM15.15 million was spent at the Federal Territories level .

Minutes of the Covid-19 Immunisation Task Force ( CITF ) meeting stated that the PPV operations must be completed before Oct 15 , 2021 , and the remaining unused allocation returned .

The Report found that the State governments had yet to return RM145.37 million of the remaining KWAN fund allocations until April 2022 .

Selangor and Sabah had not yet finalised their respective fund expenditures , which resulted in the remaining funds not being used for PICK implementation . MOSTI and MoH met to finalise the return of the remaining allocation to the KWAN fund with the Selangor and Sabah State Government Secretaries on Oct 20 , 2022 . The Sabah Government confirmed the final balance to be returned to KWAN amounted to RM17.40 million , while for the Selangor Government it amounted to RM47.38 million .

• Vaccine procurement Until April 2022 , the MoH had spent RM4.462 billion of the RM5.577 billion allocation to procure 75.88 million doses of vaccines consisting of Comirnaty ( Pfizer ), AstraZeneca , CoronaVac ( Sinovac ) and Convidecia ( CanSino ) vaccines .

As of April 2022 , 71.26 million doses had been used , with a balance of 11.59 million doses . Of this remaining amount , 1.10 million vaccine doses had expired between one and 212 days . They not only caused a loss but had to be disposed of .

The audit review , therefore , recommended that the MoH increase the level of awareness among adults to take booster doses to minimise the amount of expired vaccine doses .

HOSPITAL STAFFING AND STORAGE ISSUES

Besides financial issues , the audit also found that the MoH had critical staffing and storage issues during the pandemic .

• Imbalance of nurse staffing According to the audit Report , filling nurse positions is not equivalent to staffing requirements . It does not follow the recommended level of care ratio , especially when considering the scope of services provided in the Emergency and Trauma Department ( ETD ).

The audit was conducted at Hospital Sungai Buloh , Hospital Raja Perempuan Zainab II ( Kota Bharu ), Hospital Tunku Jaafar ( Seremban ) and Hospital Tampin .

The audit Report found that the staffing

Image 1

Anesthesiology Department Store , Ampang Hospital - No shelf / cupboard to store syringe pump and infusion pump equipment ( 08.05.2022 )

Image 2

ICU , Duchess of Kent Hospital - Storage of ventilators in seminar rooms ( 22.07.2022 )

Image 3

Level 5 , Hospital Bersalin Kuala Lumpur - Oxygen concentrator in buildings that are no longer used and different from patient care buildings ( 14.07.2022 )

Image 4

Corridor of the Respiratory & Hemodynamic Unit , Kuala Lumpur Hospital - Ventilators placed in open spaces ( 14.07.2022 )

( Source : National Audit Department )

at the hospitals had been filled with only between seven and 62 nurses , and the percentage of shortage of ETD nurses was between 61.2 per cent and 95.3 per cent .

The Report also found that the number of existing nurses stationed in the Intensive Care Unit ( ICU ) ward during the pandemic was insufficient and created difficulties , especially when nurses were on quarantine leave .

In response to the shortage , the hospital management was said to have mobilised nurses from other general wards to the ICU ward only for the pandemic . The nurses involved were to return to their original placements after the end of the period .

However , despite the mobilisation , the ratio of nurses and patients in the ICU ward still could not be met . This is because the number of nurses who could be mobilised to the ICU ward was limited due to the need for trained nurses .

The Report stressed the MoH was at risk of creating a recurring burnout situation due to the lack of health workers

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“ All the previous governments failed to ratify weaknesses highlighted in the A-G Report . Year in and year out , repeated mistakes had been detected , such as a lack of monitoring , supervision , allowing leakages , mismanagement , corruption and handing over matters to companies that do not play by the rules .”

Every year , the A-G Report highlights cases of procured goods , services , and works being paid for well above market prices , underutilised , and substandard .

“ It is pointless for the government to develop good policies if the ministers , public servants , contractors , and businessmen do not possess the integrity in implementing the formulated policies .

“ Make them responsible and accountable for any weaknesses or leakage . Many contracts are alleged to have been dealt by political lobbyists that are vendor or contractor-driven where figures are marked up to pay bribes or kickbacks ,” said Satar , who is also ex-President of Transparency International Malaysia .

He said the marked-up costs are either passed on to the public through higher taxes or the work completed would be sub-quality , adding that open tender contracts will avoid cronyism and contracts awarded to the best contractors .

ENHANCE PROCUREMENT PROCESS

He also observed that officials who commit such offences are allegedly protected under the esprit de corps policy , i . e . ‘ spirit of oneness ’ or “ old boys ’ network ” that is overwhelming in certain lines of services . “ Those reprimanded are often merely transferred to another department without any stern disciplinary action taken . Some with records of poor behaviour or performance even get promoted . “ He said the priority must be to prevent abuse and enhance the procurement process with strong institutions , adequate controls and safeguard . Every ringgit a corrupt politician or public servant puts in their pockets is stolen from the poor .

On healthcare , he noted that equipment still being used at hospitals is over two decades old or beyond repair .

“ The Report stated that there was an excess of 3.08 million pairs of shoe covers and 0.84 million pieces of personal protective equipment ; weakness in the health management and leadership aspect both in the ministerial level and hospitals . “ I hope there is no fraud issue i . e . order for the sake of commission . Always ensure there is a “ need ” before placing an order .”

He said there was a need to relook at the role of heads of department in hospitals . There is a need for training in leadership and management , plus set up integrity units to prevent leakage and fraud .

“ We must start now . Intellectual honesty is important , and leaders must walk the talk . Some claimed to be God-fearing but enriched themselves through corruption

“ When will we learn our lesson from the A-G Report ?”