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Malaysia’s ailing public healthcare system

The Southeast Asian nation is not only unable to produce enough doctors and nurses but is also losing them to foreign shores
A Malaysian doctor holds a placard during a strike outside the Sungai Buloh Hospital in Selangor state on July 26, 2021, protesting against poor conditions.

A Malaysian doctor holds a placard during a strike outside the Sungai Buloh Hospital in Selangor state on July 26, 2021, protesting against poor working conditions. (Photo: AFP)

Published: May 30, 2024 11:29 AM GMT
Updated: May 30, 2024 11:39 AM GMT

The student council of a university meant only for Muslim-Malays and indigenous people in Malaysia has come out against a proposal to allow post-graduate medical students from other ethnic groups into a cardiothoracic surgery program.

Universiti Teknologi Mara held a “wear black” campaign on May 14-16, saying they would oppose any move to challenge the particular position and the constitutional rights of Muslim-Malays and indigenous people from Sabah and Sarawak, who are referred to as "Bhumiputera" or sons of the soil.

The proposal came from a senior consultant surgeon at the university’s Faculty of Medicine, Dr Raja Amin Raja Mokhtar. He suggested the university temporarily open admissions to the non-Bumiputera to help meet an acute shortage of cardiothoracic surgeons.

Only 14 full-time heart surgeons work in the seven government cardiothoracic centers nationwide. Each center reported between 300 and 1,000 heart patients on its waiting list, with waiting periods extending between six months and a year.

Some patients die waiting for their heart surgery, according to the Malaysian Medical Association, the national association for medical doctors.

More than 70 percent of Malaysians depend on the public healthcare system, and the ones most affected are the lower-income group who have no other option.

Malaysia has universal healthcare in place, with the government heavily subsidizing the treatment costs.

The temporary measure would not have harmed the special position of Bumiputera. Political and professional groups condemned the university students. The public called them heartless for refusing to prioritize the country's needs. 

The university administration shifted decision-making to the government, which said there had been no official discussion on the issue so far.

The controversy momentarily took away attention from a core issue: the recognition of a parallel pathway program leading to a Fellowship of the Royal College of Surgeons in Edinburgh.

The health ministry initiated the Cardiothoracic Surgery Parallel Pathway Programme in 2016. Since then, 33 surgeons have entered the program, with 22 receiving government-bonded scholarships.

The program allows doctors to pursue specialist training early in their careers while working at government facilities where they can get ample clinical experience.

This is a necessary step as a local university master's program alone is not enough to meet the shortage of surgeons, according to the Malaysian Association for Thoracic and Cardiovascular Surgery.

The Malaysian Medical Council (MMC), the national medical regulator, initially recognized the program but removed it from the specialist register list in 2021.

The council now faces a string of lawsuits from those who qualified under this program for rejecting their specialist registration applications.

The parallel pathway program ran into trouble as it involved some overlapping of power between the MMC and the Malaysian Qualifications Agency (MQA).

On May 29, the government said it was looking into amending laws to resolve the issue but did not give any details. It may seem like a scramble to get things sorted out after the horse has bolted but the matter cannot be left unresolved.

It is not just cardiothoracic surgeons but a shortage of specialist doctors across Malaysia. A recent survey showed that only 5 percent of public hospitals and clinics have adequate manpower.

Malaysia needs about 30 percent of its doctors, or 24,000, to be specialists by 2030. Presently, there are only 8,953, and achieving the target in less than six years would be a big leap.

In addition, there is an acute shortage of nurses, as admitted by the health minister.

Malaysia is not only unable to produce enough doctors and nurses, but it is also losing them to foreign shores. The lure of better pay, incentives, and work culture makes many move from the public to the private healthcare sector or overseas.

The Malaysian government has been trying to get specialists from the Malaysian diaspora to return and meet the manpower shortage, but its success rate has not been made public.

The private sector, the backbone of the robust healthcare tourism industry, also needs manpower. Malaysia is one of the top destinations for health tourists and recorded one million arrivals in 2023. The numbers are expected to grow with the government supporting the private sector, which can also reduce the burden on the public healthcare system.

The Health White Paper, tabled in the Malaysian parliament in June 2023, mentioned the need to revamp the financing of government hospitals and include private hospitals as key stakeholders.

This has fueled fears about the government’s diminishing role, which may adversely impact the existing public healthcare system. It may leave vulnerable people, such as low-wage earners, retirees, and those in the villages, with little or substandard medical care.

*The views expressed in this article are those of the author and do not necessarily reflect the official editorial position of UCA News.

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