Malaysia's public healthcare system is under great strain. This we know. Now we have official confirmation of this.
At a groundbreaking ceremony, Health Minister Datuk Seri Dr Dzulkefly Ahmad, with the rarest of frankness seen in politicians, described the strain thus: underfunded, understaffed and overworked.
Call it the disease of a government machinery that runs on taxes. There needs to be innovation on both sides of the equation: new ways to increase taxes and creative ways to run ministries.
New ways of increasing taxes is a Leader for another day. This one is about creative delivery of public healthcare services.
This Dzulkefly has promised as part of the Healthcare Financing Reform to be announced soon. His statement "if you don't allow me the resources, allow me to be resourceful" points to the shape of the reform.
If making do with what we have is the model, then the focus must be on the distribution of public healthcare staff — the understaffed and overworked parts of the strain.
Start with the staff-to-population ratio. According to Health Facts 2023, there were 79,443 doctors in 2022, meaning one doctor for every 412 Malaysians. Nurse-to-population ratio was better at 1:279, though community nurses and other medical staff were a stretched lot, with a ratio of one-to-a-thousand odd.
Be that as it may, the ratios can be said to be second only to Singapore. But the city state is a developed country while we are a middle-income one. Not exactly an apple and orange story, but you get the drift.
It is clear from the data above that much of the "understaffed" and "overworked" part of the problem can be solved by tackling the maldistribution of manpower.
The urban-rural gap is worrying, especially in Sabah, Sarawak, Kelantan and Kedah. This needs to be sutured, to use a surgical term. For the here and now, only redistribution will help.
Incentives — needn't be monetary, which the Health Ministry can ill afford — will help. For the long term, institutions that produce doctors, dentists, radiographers, opthalmologists, nurses, medical technologists and some such professionals must devote a good number of seats for locals.
This will, to a large extent, solve the reluctance of medical staff to relocate far from their homes. We may be a 21st-century society, but being close to the family is a valued thing. This must be given its rightful weightage. Plus, it will go a long way to end burnout, a major issue.
Another is the absence of computerisation in certain hospitals, even in Kuala Lumpur. A rheumatologist doesn't know what the cardiologist has prescribed because they each laboriously write their diagnosis and prescriptions on sheets of paper to be inserted into files that harken back to the 1960s.
Millennial doctors in a baby boomer's world? Over time, that would be wasted hours that could be spent with patients. For the patients, missed expeditious treatment — one reason for the long queues in public hospitals. And for the doctors, burnout. Ditto dentists, radiographers, opthalmologists and the like.
The burnout doesn't just stop there. It trickles down to the nurses and the rest who man hospitals, clinics et al, in every nook and corner of the country. A computer on every doctor's table will help stir reform.