JANUARY 19 — In an effort to strengthen the well-being of society at a global level, the third Sustainable Development Goals (SDG) which is Health and Well-Being was introduced to achieve universal health coverage. This goal emphasises the need to provide access to quality and equitable health services to all levels of society, regardless of gender or age. In line with that commitment, the Malaysian Ministry of Health (KKM) Strategic Plan 2021-2025 also prioritises the strengthening of a fair, sustainable, and quality health service delivery system. This approach is considered a key step to improve the health of the community and address current health challenges.
Human capital is the main pillar in a country’s development, especially in supporting a sustainable health system. The combination of skills, knowledge, and dedication of the health workforce plays a role as social determinants of health. A sustainable health system requires strategic investment, including improving the quality of health workforce training through education and professional development, fair distribution of resources to ensure equitable health services, as well as social support to health personnel to increase job satisfaction and motivation. However, Malaysia is now facing a bigger challenge, namely the phenomenon of brain drains as stated in the Dewan Rakyat Session in July 2024, especially among personnel in the health sector. This phenomenon involves the migration of skilled personnel such as doctors, nurses, and other health personnel to foreign countries that offer better career opportunities.

Social inequalities also occur in the health sector, affecting both service recipients and health workers themselves. Factors such as gender, locality, economic status, and education level contribute to significant disparities in wages, promotion opportunities, workload, and access to professional training. A report by the World Health Organisation (WHO) in 2023 shows that women in the global health sector only receive 75 per cent of men’s salaries for the same job, in addition to facing constraints in management positions. Meanwhile, Malaysia faces the issue of health personnel in rural areas that show a low level of job satisfaction due to heavy workload and lack of logistical support as reported by the Ministry of Health in 2022.
This resulted in the phenomenon of brain drain which worsened the situation. Data from the Malaysian Ministry of Health (KKM) shows a drastic decrease in the number of critical medical workforce. The number of medical officers (MO) who failed to report for permanent appointments increased from 78 in 2022 to 1,118 in 2023. Resignations of contract doctors increased to 1,354 in 2022, compared to only 110 in 2017. In addition, the number of internal officers appointed (HO) decreased from 6,136 in 2019 to 3,271 in 2023. KKM also projected a shortage of at least 8,000 nurses in 2024, which is expected to increase to 60 per cent by 2030. The Malaysian Medical Association (MMA) 2023 report shows that around 15 per cent of young doctors choose to work abroad, contributing to the shortage of staff in hospitals and local government clinics.
This phenomenon has a direct impact on the health system’s ability to provide high quality services to the people, especially in critical situations such as pandemics and disasters, in addition to burdening the number of available staff, increasing the risk of professional fatigue (burnout), and ultimately affecting health care quality. Therefore, efforts to address or mitigate this problem need to be prioritised in order to preserve the number of local health personnel.
One of the main mitigation measures is that the Ministry of Health is advised to submit proposals to increase the salaries of health workers through the coordination of existing Employment Warrants (WP), as well as strengthening the Public Service Remuneration System (SSPA). The government also needs to provide more opportunities for education and professional training such as scholarship programmes, conditional study leave, and opportunities to further their education or obtain specialist training in the country to improve the skills and knowledge of staff. This measure will not only provide motivation but also help improve the quality of the country’s health services. In addition, there is a need to improve the working atmosphere by providing modern medical facilities, adequate equipment, and a conducive working environment because a more efficient hospital management system, including the use of automation technology, can reduce staff workload, thus reducing stress and the risk of burnout.
Improving the working environment and infrastructure of the health sector is important to ensure that the staffs feel valued and are able to perform their duties well. With an aging population and an increasing burden of chronic diseases, local health system requires strategic investments to meet those needs. At the same time, social inequalities among health personnel reflect structural weaknesses in the health system that require urgent attention. Collective efforts from the government, private sector, and stakeholders in addressing all these emerging problems down to the roots are urgently needed so that the brain drain phenomenon can be controlled and the country can retain its health workforce and ensure that the country has equitable, sustainable, and quality health services.
* By Nurul Izyan Husna Ibrahim & Dr Velan Kunjuraman [Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia]
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.