Dr Koh Kar Chai
President, Malaysian Medical Association
WHILE THE Covid-19 pandemic has revealed gaps in Malaysian healthcare service delivery and infrastructure, it is also noteworthy that some of these issues pre-existed even before the pandemic broke.
The gaps need to be addressed to bolster the nation’s healthcare delivery system and preparedness for a future public health crisis.
Malaysian Medical Association (MMA) President Dr Koh Kar Chai believes the way forward now will be to integrate public and private health facilities to allow for seamless management and provision of health services.
Getting the right talent
“We already have overworked health workers in different areas of healthcare in both the hospitals and the primary care centres,” said Dr Koh.
“Although dedicated, these workers were stretched thin on the ground, having to multitask on the frontline when hit with the unprecedented pandemic. We were just not prepared, which is akin to an unvaccinated person.”
The solution, he shared, was to look into the mismatch of health personnel and allot more personnel in areas that require more workforce.
“And personnel in redundant or underutilised areas can be transferred to where they are needed.”
Another issue with regards to the workforce is the challenge to retain talent in the public sector.
“The gap is always there as the government cannot match the remuneration available in the private sector.
“The government had allowed public sector doctors to have some form of private sector engagement so that they may boost their income.
“This comes in the form of limited locum practice or practice in the private wings of public or academic health institutions.”
He also stressed the benefit of successful integration of public and private health facilities would be sharing the financial remuneration.
Infrastructure and facilities
According to Dr Koh, another gap that needs addressing is the outworn and defunct public health infrastructures and facilities.
“We have public health facilities built to cater to the population at that time and have been functioning for many years.
“The number of patients has increased through the years, and these facilities have been bursting at the seams.
“On top of that, these buildings are archaic already, badly in need of either extensive refurbishment or replacement,” he said, adding that it is also the same with the equipment in these health centres, which may be obsolete.
“An extensive audit is needed on the existing health facilities throughout the country, be it in the urban centres or the remote rural regions.
“All health facilities must be able to function efficiently and with the safety of the patients in mind. Hence complex infrastructure needs to be identified and dealt with.
“Protocols must be developed to weed out non-functional or outdated equipment and a proper maintenance schedule put in in place to ensure the working condition of such equipment including timely updating of software.”
Shortage of doctors and specialists
When asked about concerns about the persistent shortage of doctors, Dr Koh said: “Shortage of doctors will always exist if the growth of doctors is not in tandem with population growth.”
He also noted that losing doctors to foreign countries is more of a problem than shifting brains from the public to the private sectors as they are still within our healthcare system.
“With the present dichotomous system, more doctors should be retained in the public sector to manage the unequal distribution of patients between these two sectors.”
He expressed the need for young doctors to be guaranteed good career prospects to remain in this country.
“Whether it is about offering them permanent positions or longer contracts, the young doctors need to feel that their service to the nation is being appreciated.”
Regarding the shortage of specialists, he said: “We need to groom the young doctors to be the specialists.
“The government needs to create more opportunities for them to specialise by first allowing them a more extended contract, if not permanent posts, so that they will be able to have the training needed for them to specialise.
“Create more postgraduate programmes to allow an increase in the intake of postgraduate students.
“Having individual financial grants to assist these young doctors who wish to take up such programs will go a long way too.”
Noting the issue mentioned above on workforce, especially during the pandemic, doctors and healthcare personnel tend to experience burnouts, fatigue and mental health problems while working in a high volume and a high stress working environment.
Dr Koh shared that from the onset of the pandemic, the Ministry of Health (MoH) via the State Health Departments and Mental Health PsychoSocial Support (MHPSS) Team from the Department of Psychiatry and Mental Health in all hospitals, have been offering Psychological First Aid to the frontliners.
“This is still going on. Also, frontliners suffering from various forms of stress-related disorders and mental health conditions are given the necessary psychological support and treatment.”
He stressed: “The main contributing factor to the problem is the shortage in human resources. Though there is a downtrend in cases, the issue needs to be addressed in the long term.” KHIRTINI K KUMARAN — The Health