Kuala Lumpur, 17 March 2023 — “In early January, the Galen Centre for Health and Social Policy identified four issues for the Unity Government to be used as indicators to gauge performance in the health portfolio for the first 100 days of its administration. The government has begun work on 3 of these issues. We give three out of four stars, or a B grade for the first 100 days,” said Azrul Mohd Khalib, Chief Executive of the Galen Centre.

“Whether the Government wants to recognise it or not, the Malaysian healthcare system and the health of people in this country are currently in crisis. Urgent action is needed and these four issues require government attention and commitment.”

“Firstly, actions to address the exodus of healthcare workers from the Malaysian public healthcare system. Almost weekly dozens of young, experienced and senior medical professionals including doctors, nurses and other healthcare professionals from all levels are resigning from contract and permanent positions,” Azrul pointed out.

“Their reasons for leaving include frustration at the lack of transparency on the issue of contract and permanent positions, poor workplace conditions which include experiencing bullying and sexual harassment, accusations of violations of workers rights and exploitation (such as wage theft, working beyond permitted hours), being underpaid, and burnt out. COVID-19 has inflicted massive damage on our healthcare system, especially the healthcare workers who we depend on. We asked for the government to prepare and present a plan to address the massive haemorrhage of talent.”

“We are pleased that the government, as recently announced in Parliament by the Deputy Prime Minister, has taken up the recommendation to form a multi-ministerial taskforce chaired by the Chief Secretary to the Government to look into this issue as part of essential public sector reforms. It needs to look at long term plans to address both recruitment and staff retention. Town halls with healthcare workers beginning with doctors have also already been convened or are being planned, to listen, to consult, and find solutions. These consultations need to also include nurses, allied health workers, and assistant medical assistants,” emphasised Azrul.

“Secondly, the issue of congestion in hospital emergency departments (ED). This is not just an inconvenience for patients and staff, ED crowding is a significant source of patient harm. Patients are facing unreasonably long hours waiting for treatment and care in the ED, and sometimes even longer periods which have stretched to several days waiting for transfer to beds in wards. This is not an exaggeration but real world incidents. People are being treated and sometimes even dying in corridors and makeshift wards. In some extreme situations, their deaths may go unnoticed until hours later. The situation is an indicator of a dysfunctional healthcare system.”

“The government has put forward a number of proposals which include extending operating hours for select hospitals and clinics, increasing adoption of the “lean healthcare” management system, modernising and upgrading digital health systems, and recruiting more people into the workforce. However, we find that extending operating hours will likely not solve problems but exacerbate them due to the limits of a strained and overworked workforce.” Azrul pointed out.

“Only the proposed Madani Medical Scheme or Skim Perubatan Madani, if implemented properly and effectively, has the potential of making a real impact and difference in significantly reducing the congestion seen in emergency departments. Allowing those eligible for the scheme to seek fully subsidised treatment and care at private general practitioner panel clinics rather than depend on the ED is a potential game changer. It can reduce the numbers of those seeking treatment at EDs. This should be rolled out as soon as possible.”

“Thirdly, tabling the Control of Tobacco Products and Smoking Bill for voting and passage. Vape in this country remains unregulated, unrestricted, and out of control. Children can now be seen vaping outside schools. More and more people are taking up this habit and becoming addicted to nicotine. For the first time, the numbers of new vapers are now overtaking new smokers. The government has indicated that it wants to regulate and tax vape as well as support the intention to adopt the generational ban on smoking and cigarettes. The latest amended provisions of the proposed Bill as recommended by a Parliamentary Special Select Committee provide a better chance for adoption and passage of this legislation.”

“Lastly, it is worrying that the government has not begun a review or audit of the safety of our public healthcare facilities. A third of Malaysia’s public hospitals are more than a hundred years old. Several dozen have no fire certificates. In comparison, a private hospital would never be allowed to operate without one. A fire in Hospital Sultanah Aminah (HSA) in Johor in 2016 claimed the lives of six patients, and injured several staff. In 2021, a fire broke out in a Kuching public clinic. Yesterday, a fire occured in the Pharmacy Department of the Tuanku Ja’afar Hospital (HTJS) where fire alarms did not go off and staff were unprepared. Recent floods in Johor have also damaged government clinics and facilities, causing loss of vital equipment and essential medicines.”

“The government needs to implement an immediate audit of all fire and related safety measures on all its healthcare facilities. It must also publicly release the independent committee report convened to investigate the 2016 HSA fire which despite being declassified and three health ministers later remains unavailable for public scrutiny. We call on the Government to release and make the report available to the public,” Azrul emphasised.

“Malaysia’s healthcare system needs immediate attention to improving existing infrastructure, retaining manpower, increasing coverage and quality of service delivery, and addressing the multiple crises that it is currently experiencing.”

“We call on the Unity Government to take the opportunity to implement necessary and delayed reforms, and to continue to work in collaboration and consultation with patient groups, affected communities, the private sector, and civil society organisations.”