AS we enter 2025, our public healthcare system is facing significant challenges. Healthcare workers (HCW) in government services are still awaiting credible solutions to their plights, but it seems their wait may be far from over.
This is not to say that the health minister has made no effort to improve the situation. However, these efforts appear to have been misguided.
The latest proposal on working schedules has faced bipartisan criticism, with HCW and the groups representing them vehemently opposing its implementation, even though it is still in the pilot study phase.
The proposal in question, the Waktu Bekerja Berlainan (WBB) system, seeks to reduce doctors’ consecutive on-call work hours from 24-33 hours to 18 hours.
On the surface, reducing consecutive work hours seems like a positive step forward as it allows doctors more time for much-needed rest. While 18 hours remains excessively long, it is nonetheless an improvement.
However, it is the way the WBB system is structured that has sparked anger among those affected.
Under the WBB system, only weekend and public holiday work qualifies as on-call duty. This means that on weekdays, medical officers are not eligible for on-call duty allowances as the 18-hour WBB shifts are integrated into the standard 45-hour work week. These shifts are scheduled to run from 3pm to 9am the following day.
Additionally, those on certain shifts are only eligible for passive on-call allowance instead of active on-call allowance, resulting in reduced income for medical officers.
For example, on weekends or public holidays followed by weekends or public holidays, group A (shift from 7am to 10pm) and group B (shift from 6pm to 9am) would qualify for active on-call allowance at the new rates - RM275 per shift for medical officers and RM315 per shift for specialists.
However, if the weekend or public holiday is followed by a weekday, only group A would be eligible for the active on-call allowance. Another group (shift from 8pm to 12 midnight) would receive only a four-hour passive on-call allowance, after which they must continue working from 12 midnight to 9am without any additional allowance as these nine hours after passive on-call are considered part of the standard 45-hour work week requirement.
The WBB system’s treatment of night shifts as equivalent to day shifts is a major issue. It is well-ascertained that night shifts have adverse effects on physical and mental health, which can, in turn, impair the performance of medical officers. This could result in a diminishing quality of care for patients.
Making medical officers to work night shifts without adequate compensation could also result in higher turnover rates, further worsening the already critical manpower shortage in our public healthcare system.
Thus, while the WBB system may appear effective on paper in reducing consecutive working hours, it is likely to be counterproductive in terms of staff retention.
The adverse effect of the WBB system will be more pronounced in departments with fewer medical officers, as dividing the workforce into shifts will leave each shift with even fewer personnel to handle the same workload.
While working hours are one of many serious issues for HCW, the root causes of the inhumanely long shifts lie in the shortage of manpower and inefficient resource management.
Simply shortening working hours does little to address these underlying problems and could potentially worsen the situation by increasing waiting times in public hospitals as manpower continues to diminish.
What is particularly concerning about the WBB system is not just its ineffectiveness but also the manner in which it was introduced to the public, HCW and even Health Minister Datuk Seri Dr Dzulkefly Ahmad.
The pilot study for the WBB system was first leaked and subsequently reported by the media on Jan 15. Notably, Dzulkefly had neither been briefed on nor approved the WBB system. This is despite claims that the pilot project is scheduled to commence on Feb 1 in seven departments across various hospitals nationwide.
Even though Dzulkefly has stated that the implementation of the WBB system is optional, why was this not brought up in any recent parliamentary sessions? Furthermore, why is this information being made available to the public now? Was the matter discussed in cabinet meetings or has it bypassed the usual channels of deliberation?
Recent developments regarding the WBB system have seen Dzulkefly clarifying that the letter circulating online was merely an internal memo intended to prepare for the pilot study, which was allegedly leaked by an unknown party.
Furthermore, Dzulkefly emphasised that only he and the Public Service Department have the authority to approve the expansion of the WBB system following the pilot study. He also noted that the letter in question was not signed by the director-general.
He further stated that the Medical Advisory and Action Committee holds the authority to decide whether or not to proceed with the pilot study at specific times and within specific departments, a decision that is entirely independent of him.
When Prime Minister Datuk Seri Anwar Ibrahim announced Budget 2025, the government promised to increase the on-call allowance by RM55 to RM65 (equating to a maximum hourly increase of just RM2.74). Dzulkefly later clarified that this would be part of a pilot project. Was this clarification in reference to the WBB system?
If the WBB system is linked to the on-call allowance increase promised in Budget 2025, why does the system actively exclude weekdays from being classified as on-call duty, coupled with directives that further restrict eligibility for on-call allowances?
Moreover, if the pilot study for the WBB system fails, will the promised increase in on-call allowances still be implemented as per Budget 2025 or will they remain at the current levels?
The decision to allocate resources to the WBB system without properly consulting the public and key stakeholders raises serious concerns. Our public healthcare system cannot afford to expend valuable time and other resources on initiatives that appear to rely on a speculative “hope it works” approach, rather than being guided by meticulous planning and evidence-based decision-making - research-driven outcomes over outcome-driven research.
That is precisely how the WBB system appears to many: a quiet attempt to push ahead with the pilot study, with the decision to proceed with the actual system seemingly already made. It gives the impression that the pilot study is being treated as a mere formality, as if its success is a foregone conclusion, without adequately anticipating potential setbacks - an example of outcome-based research driving decisions, rather than decisions being guided by research-driven outcomes.
It would be far prudent for the Health Ministry to put the pilot study on hold, prioritise transparency, take accountability and actively engage with our HCW to genuinely and holistically address their concerns.
Failure to do so risks exacerbating an already critical situation, potentially leading to the further loss of HCW and placing an even greater strain on the public healthcare system.
Chia Chu Hang is a research assistant at Emir Research, an independent think-tank focused on strategic policy recommendations based on rigorous research.
