Strengthen healthcare workforce to combat future pandemics

MOH has seen a 50% decline in the number of housemen or PPS deployment since 2019, a change attributed to a decrease in the number of medical graduates entering the workforce 

by GLORIA HARRY BEATTY & AZALEA AZUAR 

ADDRESSING manpower issues in the public healthcare sector has proven to be crucial in light of recent pandemic outbreaks. 

According to Malaysian Medical Association (MMA) former president Dr Azizan Abdul Aziz, urgent attention should be given to the planning and development of Malaysia’s healthcare human resources. 

Ultimately, she pointed out that it will be the healthcare workers who will be on the front lines, battling through diseases as evidenced by the hard-hitting COVID-19 pandemic that upended not just the nation but the whole world. 

“The effects of the shortages we are experiencing now across the board will be more pronounced during a pandemic. “It can be said that personnel shortages were a major contributor to the public healthcare system being stretched to its limits during the pandemic, resulting in burnout among many healthcare workers.

“Millions can be spent on improving infrastructure but without a strong workforce, the system can be easily overwhelmed and patient care compromised, especially when managing a pandemic,” she told The Malaysian Reserve (TMR). 

A special report published by TMR in July this year indicated that the shrinking number of doctors in Malaysia’s public healthcare sector poses a serious threat to the nation’s future. 

Data sighted by TMR showed that the number of housemen at the Health Ministry (MOH) or the deployment of graduate medical officers (PPS) shrunk by 50% since 2019, following a drop in medical graduates. 

As a result, the data implies that the decrease has led to an uneven distribution of housemen across different government hospitals. 

There were 6,134 housemen in 2019; 4,934 (2020), 4,173 (2021), 3,245 (2022) and 3,271 (2023). 

It is further exacerbated by protests made by doctors, which started in 2021 at the peak of the pandemic, when many doctors, burdened by the influx of patients and increased workload due to the deployment of contract doctors nationwide, felt overwhelmed. 

The combination of stress and uncertainty regarding job security, particularly concerning permanent postings, was the catalyst for the initial protest. 

MOH has received a lot of backlashes on the lack of manpower issue and said it has plans to rectify the situation, albeit the problem still persists to this day. 

Commenting on COVID-19, Dr Azizan believed that the government, particularly the MOH, has taken necessary steps to improve the country’s pandemic preparedness. 

This includes the sharing of knowledge among healthcare personnel, improving protocols, public health messaging and developing a comprehensive framework to manage pandemics. 

“We have also stepped up vigilance concerning infectious diseases. Surveillance efforts are currently being carried out for monkeypox while healthcare personnel in the public sector have also been briefed on detecting and managing cases,” she added. 

As of Sept 17, Malaysia has recorded only 10 cases of monkeypox since July 26, 2023, all of which are Clade II infections. 

At a recent press briefing at Kuala Lumpur International Airport, Health Minister Datuk Seri Dr Dzulkefly Ahmad announced that the country has implemented measures to combat the spread of monkeypox, including the installation of thermal scanners at international entry points such as airports. 

He noted that all 34 suspected cases of monkeypox, including 33 Malaysians and one Thai national, have been confirmed as negative, with a total of 3.2 million people screened since Aug 16. 

On Aug 14, the World Health Organisation (WHO) declared the disease a Public Health Emergency of International Concern after an outbreak in several parts of Africa. 

“Looking back at COVID-19 as an example, I think we, as a whole nation, did considerably well to bring the situation under control and prevent as much as possible loss of lives,” said Dr Azizan. 

She noted that Malaysia was among the early recipients of the vaccines with more than one type available. 

In addition, the nation achieved a high vaccination rate and a good level of public compliance to the standard operating procedure (SOP), which she believed helped economic activity to resume much quicker. 

Furthermore, she shared that the MOH had frequently engaged with MMA and other key stakeholders for input throughout the pandemic. 

“The private healthcare sector played a key role in the testing for COVID-19 in the initial stages and vaccination during the rollout of the programme. 

“The government should also do more in engaging and empowering the 11,000 general practitioners who are the first point of contact in pandemic preparedness,” she added. 

A Proactive Response Against Pandemics

In June last year, the long-awaited Health White Paper was tabled in Parliament, proposing a comprehensive health reform aimed at creating a system that is equitable, sustainable and resilient. 

This reform focuses on utilising digital health technologies to enhance data collection and analysis, which will improve preparedness for health emergencies and responses. 

The reform also prioritises preventive health measures, aiming to keep Malaysians healthy rather than merely treating the ill. 

Covid-19 has highlighted the need for enhanced public health and emergency preparedness, underscoring the importance of regular assessments, training and cross-agency coordination. 

To address these needs, an inter-agency task force will be established to integrate health policies and facilitate communication among government agencies. 

This task force will leverage cross-agency committees to monitor the achievement of the United Nations Sustainable Development Goals, particularly in addressing social determinants of health and health equity. 

The readiness of a special task force for future pandemics is a key concern. 

Public health physician and epidemiologist Datuk Dr Zainal Ariffin Omar believes that the government already has mechanisms in place. 

These include an inter-agency committee and SOPs to respond to outbreaks, epidemics, or pandemics as necessary. 

“So far, MOH has taken immediate and appropriate measures including surveillance at the entry points, early testing and travel advisory,” he told TMR. 

The Health White Paper also outlines plans to establish a National Disease Control Centre (NDCC) to enhance preparedness for health crises. It is currently in the planning and conceptual stage. 

An oversight body will be set up to oversee the implementation of the Health White Paper’s reforms, ensuring proper reporting, hecks and balances, and proposing solutions from diverse expertise. 

The former MOH disease control deputy director also said NDCC can integrate data from various sources to create a comprehensive early warning system for potential pandemics through the use of the MySejahtera app and other information databases. 

“The primary functions of NDCC in preventing and controlling the spread of infectious diseases include capacity building/ training in epidemic management, continuous surveillance, establishing networks with local and global authorities/agencies in the prevention and control of diseases, and the development of outbreak management tools,” he added. 

Financial Planning for Future Crises

UniKL Business School economic analyst Associate Prof Dr Aimi Zulhazmi Abdul Rashid said Malaysia’s annual debt service load is expected to be around RM4.6 billion, representing about 16% of total government revenue. 

He expects the figures to increase as debt levels continue annually. 

“Thus, the predicament that the government is presently in certainly requires better financial management should another disastrous issue as significant as the Covid-19 pandemic or bigger sweep the world. 

“Strategic planning could be assigned to a Special committee led by the chief secretary to the government involving major ministries and key government agencies like finance and human resources,” he told TMR. 

The pandemic has led to a higher government debt, reaching RM1.5 trillion in 2024, indicating a debt-to-GDP ratio of almost 65%. 

This is higher than the country’s economy, compared to Indonesia and Thailand’s lower ratios of 39% and 56% respectively. 

During the pandemic, the previous government’s response included special budget allocations to address challenges exacerbated by the pandemic. 

Digital Divide, Challenges in Healthcare

According to a study by the International Islamic University Malaysia (IIUM), the digital divide between urban and rural areas remains a significant issue, exacerbated during the pandemic. 

However, it revealed that there was increased computer ownership, information communication technology skills performance and socioeconomic status. 

Therefore, bridging access to hardware and digital creative solutions is crucial for youths. 

Meanwhile, Taylor’s University School of Media and Communication Head of School Prema Ponnudurai highlights that the urban-rural digital divide is approximately 76:24 which is significantly high. 

In order to address the difficulty for rural residents in obtaining information, traditional media contributes to public health communication by disseminating information to rural communities. 

“Therefore, disseminating health messages through physical newspapers, TV and radio broadcasts are vital means of communication. 

“These channels should be optimised by providing short updates and simplified information on current health conditions, spread of new waves of diseases, symptoms and tips in order to prevent the spread quickly,” she told TMR. 

Efforts should be made to educate rural communities on health and wellness, particularly during health crises. 

Collaboration with students and organisations is essential for effective community engagement. 

During the early stages of the pandemic, South-East Asia was susceptible to COVID-19 fears and misinformation through social media. 

This led to a “social contagion” that tested public confidence, resulting in panic buying of food and items, following rumours of deaths and lockdowns. 

Prema stressed the importance of trustworthy information sources in life-threatening situations. 

“For example, the array of myths and misinformation shared during Covid-19 which spread and was untrue. Therefore, it is important that the communication comes from the ‘right’ person,” she added. 

Malaysia has been leveraging Big Data and digital-forward responses to monitor clusters during the pandemic. 

Such examples are the MySejahtera, SELangkah, COVIDTrace and Jejak Johor which are used to trace contacts. 

Moreover, e-COVID19 is a web-based system used by the National Public Health Laboratory and Crisis Preparedness and Response Centre (CPRC) to ensure accurate, real-time Covid-19 case reporting. 

It allows CPRC hospitals to plan resources and monitor real-time cases using the Malaysian Health Data Warehouse and Geographic Information System. 

Based on a Malaysian Journal of Medicine and Health Sciences report by Universiti Putra Malaysia, Malaysia lacks clear legislation for geofencing and surveillance systems, such as facial recognition or financial transactions. 

The personal health data collection is subject to the Personal Data Protection Act 2010, but only applies to private sectors. 

Malaysia uses Act 342 of the Prevention and Control of Infectious Diseases Act 1988 for MySejahtera. 

Siemens Healthineers, Singapore & Malaysia MD Siow Ai Li explained that artificial intelligence (AI) and Big Data can significantly enhance early pandemic detection and health threat identification. 

“In times of crisis, such as during a pandemic, the ability to quickly access and interpret data can be the difference between a well-managed response and a situation spiralling out of control,” she said. 

However, utilising these technological advancements comes with a price — data privacy, security and ethical considerations are three common issues. 

Siow explained that national healthcare information accessibility raises privacy concerns, necessitating anonymisation, use of original data, patient consent and serious measures from data providers. 

Healthcare databases storing sensitive information are vulnerable to cyber attacks which potentially expose personal health data, leading to identity theft and public trust loss. 

The use of AI in pandemic preparedness may raise ethical concerns such as racial bias, fairness and transparency. 

“To prevent this from happening, the data collected for AI models should be diverse and representative of the population. 

“Additionally, the AI-based decision-making processes should be made transparent so that the public understands how decisions are made,” she said. 

Siow added that healthcare institutions must balance AI-driven insights with individual rights, ensuring transparency and adherence to ethical guidelines. 

Integrating AI and Big Data into pandemic preparedness requires several key infrastructure components. 

“To make the infrastructure resilient to external factors, it is essential to implement redundancy and failover systems, such that a single point of failure should not disrupt the entire system. 

“Collaboration between the public and private sectors is key, with public-private partnerships fostering more robust and scalable solutions,” she said. 

Malaysians Share Their Covid-19 Experiences

Medical officer Dr Muhammad Yassin was a frontliner during the height of the pandemic, assigned to the Covid-19 ward at Hospital Tuanku Jaafar in Seremban, Negri Sembilan, managing Stage 3 and 4 Covid-19 patients. 

“It was indeed tiring, as we had to work long hours — from 8am to 8pm — and wear personal protective equipment (PPE) at all times. 

“There was a constant fear that we could bring the virus home to our loved ones,” he told TMR. 

Dr Muhammad worked in the ward for four months before being transferred to Jelebu Prison, where he managed the COVID-19 outbreak for two months. 

“It was an eye-opening experience, as it was my first time working with and seeing inmates who had mostly been convicted for drug-related offenses. 

“Despite that, all of us who had to look after their health gave our utmost care without any prejudice,” he shared.

Meanwhile, former Hulu Langat Health Office medical officer Shahidatul Munirah Zaidun recalled how her team had to act quickly to contain the virus before it spread in certain areas. 

Due to a shortage of staff in the communicable diseases department, personnel from other departments also had to assist. 

“I had to go to prisons and affected communities wearing PPE for long hours. During the Extended Movement Control Order (EMCO), we had to quarantine before leaving our camp in Kajang. 

“That area had a lot of foreigners, so we had to also work with immigration, as some people were attempting to escape the area,” she told TMR. 

Former MOH Liaison Officer Dr Amin Fauzi stationed at the Higher Education Leadership Academy quarantine centre remembered receiving a large number of Persons Under Surveillance (PUS) from other countries. 

His team had to allocate 120 quarantine rooms for the PUS. 

“We screened each person in each room for around two weeks before they could be released. We also monitored them via WhatsApp in case they experienced sudden symptoms,” Dr Amin shared. 

He added that they had to respond to many cases of breathing difficulties in the middle of the night, requiring the team to arrive promptly in PPE. 

Due to manpower shortage, there was only one staff on the graveyard shift, making it an even more challenging task. 

TMR also reached out to a few everyday Malaysians to share their experiences during the pandemic. 

Marketing and administration executive Nordiana Zulkiflee said in the beginning, things were tough due to all the changes, restrictions and being stuck at home. 

“I had to adjust to working remotely and felt isolated at times, but I also learned a lot — such as using new digital tools and managing my time better. I stayed connected with friends and family online and picked up some new hobbies like cooking and gardening. 

“Although it was challenging, the experience taught me to be adaptable and appreciate the little things,” she said. 

Having gone through the pandemic, Nordiana felt better prepared for another potential lockdown. 

However, when it comes to additional rounds of vaccines, she doubted that she would take them. 

Nordiana believed in making health decisions that felt right for her and she would focus on other ways to stay healthy, like maintaining a strong immune system and following safety guidelines. 

Meanwhile, civil engineer Amani Osman shared that during the lockdown, most of her family members contracted the virus after sharing a birthday cake without any form of social distancing. 

Those who were infected alerted MySejahtera and did their best to recover quickly as the family was due to travel the following week. 

Despite the uncertainties, she was grateful that her company did not undergo any retrenchment activities. She adapted to working from home and preferred it to working in the office. 

In the event of another pandemic, she believes she will be better prepared. 

Amani said she has a substantial stockpile of face masks at home and still wears them in public on sick days. 

Additionally, she continues taking daily supplements, such as Vitamin C, and ensures that her family follows the same routine, as it helps build their immunity against diseases. 

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• This article first appeared in The Malaysian Reserve weekly print edition

The post Strengthen healthcare workforce to combat future pandemics appeared first on The Malaysian Reserve.