Health is a critical profession
WE welcome the announcement that the government has postponed the removal of the critical service incentive (bayaran insentif perkhidmatan kritikal, or BIPK) for new appointees to 33 civil service categories beginning Jan 1, 2020. We were especially concerned that the BIPK will not be provided to new dentists, doctors, medical assistants, nurses and pharmacists starting their service after that date.
As responsible partners of the government, we urge the government to completely reinstate the BIPK. In addition, we urge the government to appropriately improve the terms of service of all health professionals to retain talent inside the civil service.
As responsible Malaysians, we support the government’s duty to be fiscally responsible and to demonstrate good financial governance. We acknowledge that the BIPK was introduced in 1992 to attract talent in critical roles in the civil service, that it is not a permanent allocation, and is subject to periodic reviews.
However, it is disappointing that the 2019 review determined that 33 service categories no longer fulfil the criteria for BIPK, including the five largest categories of staff in the Health Ministry. The current oversupply of health professionals is partially because the Health Ministry needs more posts to deliver effective healthcare to Malaysians. There are also 10 other criteria to decide on the BIPK, and health professionals fit at least seven of them: cost of living, hardship, specialisation, additional competencies, uniqueness of service, importance of retention, and encouragement.
We stress that health professionals are critical. Our 130,000 dentists, doctors, medical assistants, nurses and pharmacists save lives in cities, towns, villages and remote junglessites from Arau to Tuaran. They work long hours in an “underfunded, understaffed, overworked and overstretched” service, sacrificing nights, weekends and holidays at physical and emotional cost to themselves and their families. Many are motivated by duty and patriotism, remaining in the civil service despite better pay and environment in the private sector or other countries. Malaysia must appreciate their service and sacrifice by adequately compensating health professionals in financial and nonfinancial terms.
The decision to remove the BIPK could reduce the effectiveness of the health service, already suffering from fewer positions and an emphasis on contract over permanent posts. In the short term, the morale and stature of health professions could be negatively affected. In the long term, we could reduce our ability to attract talented Malaysians to the health service and see more departures to the private sector or to other countries. All this could reduce the effectiveness of the health service, which will in turn affect the health and wellbeing of all Malaysians.
We urge the government to reinstate the critical service allowance for all five categories of health professionals. Firstly, health is a critical profession, and it is unjust that health professionals are not fairly compensated for the same work and in the same service grade. The BIPK can be 15% to 25% of takehome pay, a significant amount when the cost of living is rising.
If Malaysians want good healthcare, then we must first help our health professionals adequately care for their own families. Their service and sacrifice cannot be taken for granted, as they are also human beings and citizens with rights, emotions and personal needs.
Secondly, the morale and dignity of the profession must be preserved. Labelling health as noncritical is a signal that health is not important, which can reduce the public’s trust in our health service. It can also affect the stature and morale of the profession, even signal to young Malaysians that the health sector has no viability. Financial compensation in the civil service already lags behind the private sector so the moral support of the government is crucial.
Thirdly, we must attract and retain talent in our public healthcare service. The private healthcare sector in Malaysia and internationally already pays much more than our public sector, even including the BIPK. Therefore, appropriately increasing the salaries of our health professionals is the correct direction. The Malaysian public healthcare service cannot lose the human capital that we have invested in over the years, especially to other countries.
Finally, we want to enhance the effectiveness of Malaysia’s public healthcare service. A public service cannot deliver effective care if its professionals are not compensated fairly, have low morale, are distracted by financial commitments, or constantly leave the service.
As responsible citizens, professionals and partners, we will continue our service with passion. While we are aware of broader macroeconomic issues of fiscal sustainability and stagnant wages, we highlight these other considerations in our desire to continue delivering effective healthcare to all Malaysians.
Healthcare is a critical service to Malaysia, and better health will lead to social and economic progress. We urge the government to reinstate the critical service allowance for all five categories of health professionals, for better terms of service for all civil servants and to deliver effective healthcare to all Malaysians.
Coordinated by DR KHOR SWEE KHENG (Blavatnik School of Government, University of Oxford) Signed by AMRAHI BUANG, president, Malaysian Pharmaceutical Society DR GANABASKARAN NADASON, president, Malaysian Medical Association DR LEONG KEI JOE, president, Malaysian Dental Association MUSTAFA ABD MAJID, president, Malaysian Association of Medical Assistants SHARIPAH ASIAH SYED JUNID ALJUNID, president, Malaysian Nurses Association