BURSTING at the seams and held together by a mere “bandage strip”, it has been a tumultuous and challenging decade for the public healthcare sector that was teetering on the brink of collapse.
And the heart of the problem is the contract system that was introduced in 2016.
The system that saw new healthcare workers hired under contract was announced in Budget 2017. The rationale for the contract system was to address the glut in medical graduates.
It was meant to be a temporary stopgap solution to clear the backlog of medical graduates waiting too long for placements in the government service. It began with over 2,000 medical, dental and pharmacy graduates serving the government on a contractual basis and the numbers have grown to some 30,000 now.
Then health minister Tan Sri S. Subramaniam said that the contract system would provide flexibility in recruitment in the future, as the number of contracts could be increased based on need.
“So with this move, waiting period for doctors to get the placements will also be reduced,” he said back then.
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Also, the contract system was meant to serve as an evaluation tool to gauge the performances of under-performing healthcare workers.
On top of that, in 2011 there was a five-year freeze on new medical courses in the country to address the glut of future doctors graduating from 32 local institutions, and more than 360 medical programmes in 36 countries.
In 2016, the freeze was extended. At the time, the rationale seemed to make sense.
In fact, this writer recalls that in 2016, a whistleblower provided documented evidence of the poor quality of some medical students, including those with subpar science results who had nonetheless been accepted into medical schools, raising concerns about whether entry was a matter of money over merit for such a highly specialised field.
What no one foresaw then, however, was that less than five years later, the healthcare system would face its most severe test in a century – the Covid-19 pandemic.
Covid-19 exposed the cracks in the contract system, reminding the nation that the temporary solution was never meant to be long term.
Hospitals did not have enough manpower. Healthcare workers were worked to the bone due to the rising number of patients and fatalities, that many of the biggest and reputable government hospitals in the country looked like ‘war zones’, unable to cope with the patient load.
The manpower shortage and the cries of exhausted healthcare workers became a constant fixture in news reports during the pandemic.
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Such SOS calls for help came from hospitals, ironically the very place where lives are saved.
Contract doctors who wanted to serve the government could not continue to do so as they were not offered permanent positions. Some quit as the contract system did not offer job security.
In fact, contract healthcare workers also reached their boiling point when they launched two separate movements to protest the unfair contract system in July 2021. The Code Black social media campaign which culminated in the ‘Black Monday’ on July 12 and the Hartal Doktor Kontrak strike on July 26 the same year.
Some of my own schoolmates who were first batch contract healthcare workers had left the country.
A commentator once told this writer that there will come a time where there will be jobless doctors and the situation would be dire as patients would not get timely care.
And that has rang true, with many of the contract doctors who had exhausted the seven-year maximum extension being rendered jobless and having to find other fields of work.
And now, “brain drain” has become a term we hear all too often with the migration of doctors overseas being spoken about over and over again.
The public is paying the price. The waiting times at hospitals have become longer. That means a six-hour wait at the Emergency Department or one doctor seeing up to 100 patients a day at some Klinik Kesihatan.
It has taken a toll on the quality of patient care. In fact, there have been claims of cases of death and accidents due to exhaustion and micro-sleep among healthcare workers.
Many doctors have questioned whether the system for placement and permanent positions was actually done on meritocracy or first-come, first-served basis.
Dr Sean Thum, who is a long-time advocate for junior doctor rights and a doctor who had been in the contract system himself, said he would only believe it when the Health Ministry can provide in black and white that it is working to end the contract system.
“It is less about a new achievement and more about righting a long-standing wrong,” he said.
Like Dr Thum, many doctors are sceptical about the announcement by Health Minister Datuk Seri Dr Dzulkefly Ahmad that the government is working to abolish the contract system.
They have waited too long and heard too many unfulfilled promises and about-turns in policies.
This matter has been unresolved and has spanned over five governments. It remains to be seen whether Dzulkefly will be able to resolve this and find a cure to the biggest problem plaguing the healthcare system.
It is in the best interest of the nation to abolish the contract system.
We can never have enough healthcare workers. We cannot afford a ‘sick’ public healthcare system.
