RURAL HEALTHCARE IN MALAYSIA

Doctors, nurses,
pharmacists, dentists and other allied healthcare workers are employed and deployed by
the Minister of Health to various healthcare centres: from rural clinics to district hospitals
to tertiary specialist hospitals throughout the country.
The distribution of these resources to various parts of the nation is arguably based on
the size, need and population of the various districts and states. However, the reality is that
in the rural and more mountainous or remote (less accessible river-bound or jungle/forest)
regions, the deployment of facilities as well as manpower is uneven and there remains
great disparity and inequitable distribution of health care personnel, especially doctors.
Nevertheless, Malaysia boasts of having a healthcare facility within every 5 km
radius, which, renders especially for the rural folk, relatively easy access to these clinics
whenever the need arises. However, not all are manned with adequately trained staff—
most are under the charge of a jururawat desa (or rural health nurse), with sporadic visits
by a medical assistant or a doctor, ranging from weekly to monthly schedules.3
Deployment of medical personnel to such rural sites remains very unpopular with the
better-trained and educated staff, that views the remoteness of such postings, unrewarding.
There should be greater monetary and even promotional/seniority incentives such as
hardship allowances or tax breaks, (such have been offered to teachers) promised
preferential selection for training and development protocols and career development, to
attract more doctors and personnel to such areas.9
The MMA (Malaysian Medical Association), through its Section Concerning House
Officers, Medical Officers and Specialists (SCHOMOS) has been arguing for more
structured deployment planning, such that even with these incentives, there should be
detailed contractual undertakings that these personnel would be re-deployed to bigger
centres of their choice, (for clearer career development programmes or pathway) once they
have completed their ‘hardship’ service in the interior.10
Failure to appreciate these doctors in particular, have led to many younger doctors
complaining that the government is not concerned about their welfare and their future.
Thus after such remote postings which they view with some discomfort, many are ready to
throw in the towel and leave once their service contracts in compulsory service is over. By
showing more concern and offering more incentives, we may be able to hold on to more of
our public service staff, rather than losing them immediately after these postings.