The ineptitude in the handling of the
employment of young doctors in the medical service is mind-boggling. The
healthcare system is collapsing in the face of the pandemic. Healthcare workers
are being strained to the limit of their capacity. The daily count of
infections and deaths does not put a number on the efforts of these valiant
workers. Now, eighteen months into the pandemic, there is still no visible
signs of when the pandemic will be brought under control. Instead, a danger looms
of the system itself failing. Against this background, instead of treating the
additional numbers of qualified doctors as a boon to the health system and the
nation as a whole, decision-makers are embroiled in an unnecessary controversy
about the tenure of these young doctors and their future careers. If matters
are not quickly resolved the situation would alienate a whole generation of
doctors and stifle their enthusiasm and motivations.
This country needs more doctors regardless
of the doctor to population figure standing at 1:454 (2020). With a dispersed
population and many living in rural areas, the WHO ideal of 1:400 does not say
anything about whether public healthcare reaches those in remote and fringe
areas. The ideal figures also say nothing about how these ‘ideal’ figures will cater
for extraordinary situations like those created by a pandemic like that being
experienced now. Total Covid-19 cases from March last year exceed 900 thousand.
New positive cases reported daily exceed 10 thousand patients. The system is
under great strain, not least because of the shortage of doctors. A sufficient
number of skilled and motivated health workers is critical to the performance
of any health system, particularly now in the COVID‑19 pandemic. Faced with similar situations, other countries,
including OECD countries, have cut the bureaucratic red tape to press doctors
who are outside formal systems into service to fight the pandemic.
Unfortunately, very often in this country, official
decisions on important social matters as those now concerning the employment of
doctors in the public service are often influenced by issues of race, religion,
and political expedience. In the present case, an additional, widely held reason
preventing a rational decision is that the doctors graduated from private
universities. This is not based on the quality of their education but simply
that they are the products of ‘money-making’ enterprises. For that reason alone,
it is being proposed by some that the numbers qualifying from private institutions
must be reduced in the future to prevent similar future predicaments. This is
an untenable argument which, the sooner it is put to rest the better.
Private universities, including those with
medical schools are the product of an evolution that was shaped by the
unfulfilled demand for higher education. A large section of our population, at a critical moment in their lives, would not have had the opportunities for
further education after school but for the offerings of private colleges. From
around the 1980s, long before the law allowed the creation of private
universities, private colleges in this country changed the very nature of
higher education as traditionally defined to make it more accessible to
learners. The innovations private colleges introduced (too many to repeat in
this article), separated the substance of higher education from the physical
trappings of the university and allowed a university-level education to be
delivered outside the lecture rooms and even outside the country of its
location. What followed was a historical transformation that democratized
higher education and brought it within the reach of our school-leaving youth
even as their growing numbers found them no place in local public institutions.
The private sector of higher education in
this country must be respected for its contribution to higher education. Many
of the owners of these private institutions are there not just to make money.
They set up colleges and universities out of a commitment to providing
education and with philanthropic motives. The development of the private sector
of higher education, which now hosts more than half the tertiary education
population in this country, no doubt, also played an important role in stilling
potential social disquiet that would have arisen because of the unmet demand for
higher education. Reviewing the sector in 2008, the EPU report entitled, Strengthening Private Education Services in
Malaysia, 2009, described the private education landscape then as;
‘. . . a thriving
sector widely recognized in international academic circles as one of the most
innovative and progressive in the region. Education experts and investors
consulted during the course of this project have highlighted Malaysia as one of
the most “open” regimes and more “attractive” markets in Asia. Among its
achievements are;
Split-degrees and
international transfer programs, particularly the proliferation of ‘twinning’
programs with premier international institutions are often heralded as some
of the innovations introduced by the private education entrepreneurs; Malaysia
is the 10th largest exporter of education, catering to 80,000 foreign students
or 2% of the global market share.
Most of the achievements reported by EPU
were realized before the passing of the Private Higher Educational Institutions
Act in 1996 (Act 555). The far-reaching policy changes implemented by the Act set
the pace for the next big leap in the development of the private sector. The Act
legitimized private education and assigned it an equal role with that of public
institutions. It allowed, for the first time in the country’s history, for private
universities to be established. The significance of that move was the government’s
relinquishment of its long-held monopoly over universities. Because of this bold
step and other reasons, Act 555 radically altered the landscape of higher
education. The provisions on private universities also allowed foreign universities
to set up branch campuses in this country. As a result of these changes the private
sector of higher education today is so diverse that it represents all the main
systems of the English-speaking world. The same factors that attracted foreign
universities also attracted foreign students in large numbers into local
universities and colleges. The stimulus for these radical developments was the
presence in 1996 of a mature, locally developed, private higher education
system that was recognized internationally. It was a system that was well
prepared to build on the opportunities created by Act 555.
The private sector of higher education is
subject to tight control by different regulatory authorities established by Act
555 and other legislation. An important part of the regulatory system is the
accreditation of the courses which is by statute vested in an independent
agency – the Malaysian Accreditation Agency (MQA). Under the MQA Act, medical
and other professional qualifications can only be accredited with the approval
of the related professional body. In fact, the relevant provisions of the MQA
Act 2007 gives the MMA and the medical profession a greater say on accreditation
than the Agency itself.
Many of the doctors at the heart of the
present controversy would be graduates of the private medical schools
established under the regime of Act 555. The predicament they face is not of
their making but that of a failure by the Health Ministry to anticipate the
increased output of doctors from the private sector. The doctors from private
medical schools are entitled to the same treatment as their counterparts from public medical schools. Their absorption into the medical health service on traditionally
established terms should not be delayed any further.
One final point. The first medical school
in this country, the King Edward VII College of Medicine was established in
1905 only because of the persistence and funding provided by philanthropic businessmen
of that era. Malaysia’s first university, Universiti Malaya now claims its
ancestry to that institution.
