An open letter to the Health Minister

by Dr TC

Dear Dr Dzulkefly Ahmad,

Congratulations on being appointed the new health minister of Malaysia. You have probably received countless suggestions and requests on issues that need to be worked on. Here are some of mine:

1. Complete independence of the Malaysian Medical Council

The director-general of health is also the president of the MMC. Not only is this a conflict of interest, it is also unwise to give these two heavy portfolios to one person as it will affect efficiency and productivity. This is clearly shown by the delay in the issuing of Annual Practicing Certificates (APC). Some of us only received our APCs five months into 2018. A statement of explanation by the president was merely lip service and was not even apologetic.

2. Infrastructure

A casual conversation with the director-general of health Dr Noor Hisham sometime last year revealed that “more than 50 hospitals are not functioning properly”. I am certain that this is not an exaggeration. The ministry needs to review the contractual agreement with hospital maintenance companies and terminate them. From broken operating theatre lights and elevators to the disruption of electricity and water supply, we are facing a serious infrastructural issue that is a constant hurdle to providing optimal patient care.

Stop wasting money on programmes that merely look good on paper. A lot of these new “strategies/plans/programmes” are useless if your hospital does not have constant electricity/water supply, or floods every time it rains.

3. Human resource

There is a maldistribution of doctors – take house officers, for example. In the current system, some work shifts and some work more than 24 hours in a stretch. There is no standardisation between hospitals (or even departments), and this results in a mismatch of training. The same goes for medical officers. There needs to be a transparent and planned system for the distribution of manpower across the country.

The current yearly review (sasaran kerja tahunan/penilaian prestasi) is a flawed system of evaluation for those working in the ministry. The marks obtained in the review have a direct effect on career advancement but are only decided on by two people. This has resulted in the suppression of certain individuals who are unfairly graded because of work-related issues. It also prevents whistleblowing and encourages the unhealthy culture of buttering up to superiors.

4. Audit and accreditation

It is an open secret that accreditation exercises in Malaysian hospitals are a joke. Hospital walls are painted, repairs miraculously completed, and facilities upgraded just before a major audit. Even the attire of doctors in the hospital becomes extra formal during this time.

Forget the traditional audit and accreditation system. Conduct surprise visits and appoint members of the workforce across the board, from the hospital attendant to the senior consultant, to evaluate and assess the facility they are working in. Listen and pay attention to opinions and input from the workforce at large, and don’t dismiss them with nice sounding words.

5. Hierarchy

Do away with the mentality that the head of a unit/department/hospital is the most senior person around. Remove administrators who have not been performing, or who have been there merely because “no one else with that grade” is willing to do the job. We need to look at capability and maturity, not age and seniority. The recent election is proof that the people have entrusted even those in their 20s with governing them. When will the health ministry learn?

I hope the new ministry leadership will look into these issues and take prompt action as they are all related to patient care. After all, this ministry exists for the welfare and well-being of our patients. Let us never forget that.

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