High alert, bring in the nurses!


Despite a one-year window from November 2023 for expediting foreign nurse recruitment, the process has stalled due to requirements from various ministries. The problem is made worse by local nurses taking up job offers overseas for higher pay while many also left the profession following the stress of the pandemic years. — Photo: The Star

THE long lines for admission or a medical procedure at hospitals are a grim indicator of how overwhelmed Malaysia’s healthcare system is.

The shortage of nurses has only exacerbated the situation, with doctors harried by the surge in patients after the Covid-19 pandemic.

Private hospitals have to hold back on expansion as there are not enough nurses. New hospitals cannot be built because of uncertainty over staffing.

The Private Healthcare Facilities and Services Act 1998 prohibits private hospitals from setting up more beds if there are not enough nurses. There are specifications on the ratio of nurses and personal aides to patients as prescribed by the Health Ministry.

The World Health Organisation has a nurse-to-population target of 1:300. According to a letter by a former matron published by CodeBlue last September, there were 113,787 registered nurses in 2021 or a nurse-to-population ratio of 1:454.

Last October, Deputy Entrepreneur and Cooperative Development Minister K. Saraswathy told Parliament there were 114,922 nurses in the country as of Aug 31, with 78,118 in government healthcare and 36,804 in private healthcare.

This means that the nurse-to-population ratio has deteriorated as the population has grown to 34 million, according to the latest data from the Statistics Department.

According to the Malaysia Social Statistics Review 2023 edition, private hospitals increased to 257 from 254 between 2010 and 2022, while private clinics increased to 13,352 from 7,954. In the same period, government hospitals increased from 131 to 160, while clinics increased from 2,782 to 3,122.

Recruiting foreign nurses would be a welcome temporary measure for private healthcare. Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh says the nursing shortage will be felt in the coming years and this will affect the entire healthcare system. The quality of care will be affected as private hospitals will be forced to turn away people, while government hospitals won’t be any better off.

Private hospitals are turning to technology to cope, and while this is an ongoing process, it is a cost that must be balanced against other costs, such as salaries and equipment.

“It is also expensive to implement and private hospitals need to answer to their shareholders,” Dr Kuljit notes. But patient care is different from filing documents or sending blood and urine samples from one corner of the hospital to another. For this, nurses are needed and the shortage is critical.

Due to the Covid-19 pandemic and lack of interest in nursing as a career, even nursing schools, both government and private, are seeing declining numbers.

Dr Kuljit, like other healthcare professionals, says one solution is to expedite the recruitment of foreign nurses. “Here is an opportunity to quickly fill up the ranks of nursing staff in private hospitals with suitably qualified personnel while supporting the growth of a vital industry that brings in revenue,” he says.

According to the Health Ministry’s expenditure report for 1997-2019, the total expenditure on health came to RM64.3bil, or 4.3% of GDP, in 2019, from which the government spent 52% and the private sector spent 48%.

In 2019, out-of-pocket (OOP) spending on health amounted to 35% or RM22.49bil of total expenditure on health. This OOP spending is equivalent to three-quarters of private sector health expenditure, with private hospitals taking nearly half of this spending in 2019. OOP spending on health constituted 1.5% of GDP in 2019.

Decisive leadership is needed to ensure that the healthcare system remains sustainable and is able to weather any storm.

Dr Kuljit stresses that the recruitment of foreign nurses and adoption of technology can help to surmount the nurse shortage. Both have their obstacles, with technology adoption needing funding at a time when healthcare cost has escalated.

Despite a one-year window from November 2023 for expediting foreign nurse recruitment, the process has stalled due to requirements from various ministries.

The problem is made worse by local nurses taking up job offers overseas for higher pay while many also left the profession following the stress of the pandemic years.

Government and private sector nursing schools cannot churn out enough nurses to make up for the attrition rate. Dr Kuljit stresses that private hospitals are ready to work with the government to expedite the recruitment, and suggests that one ministry or agency be responsible for the process.

This article first appeared in Star Biz7 weekly edition.

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