Concepts and Frameworks
Health workforce or health human resources (HHR), are defined as the professionals whose task is focused on protecting and improving the health of the entire community. The term ‘workforce’ aptly reflects the increased number and expanded roles of people in different health professions. These generally include presence of diverse clinical and non-clinical professionals who are able to implement appropriate public and individual health interventions (WHO, 2018). In other words, the health workforce has been recognised as an essential component for proper performance and functioning of labour-intensive healthcare systems. The healthcare workers are not only working professionals. They are considered integral parts of the functioning of healthcare teams, where each member professional contributes a plethora of clinical skills and perform several functions (Lopes, Almeida & Almada-Lobo, 2015). However, some countries have been identified to suffer from a shortage of health workers, owing to their reluctance in developing effective strategic plans and HHR policies that are imperative for guiding and building the human infrastructure required for appropriate functioning of the health systems (Aluttis, Bishaw & Frank, 2014). The report will elaborate on the national health workforce planning of Malaysia (WHO Western Pacific Region) and compare it with that of Australia.
Health improvement programmes and human capital are identified of central importance for the economic growth and sustainable development of any country. Drastic changes have been found in the healthcare system of Malaysia from the traditional remedies, with the aim of meeting the health preferences and needs of the population. Major reorganization have been observed in the healthcare services of the country, since its independence in 1957. One of the first reorganization of public primary healthcare services began since Alma Ata Declaration (1978) (Shazali et al., 2013). The Ministry of Health (MOH) is the primary provider of healthcare services to all citizens of Malaysia. It is comprised of a young population, with a relatively good health status. Furthermore, it has also been identified as one of the few countries that is working towards achieving the target of the Millennium Development Goals (Merriam, 2015). An increase is also observed in the proportion of the elderly population, with an elevation in the number of individuals suffering from chronic diseases. The country has a widespread healthcare system, with a life expectancy at birth of 74 years. Furthermore, the rates of infant mortality have also reduced to 7 per 1000 live births in 2013, from 75 per 1000, in the year 1957.
Overview, Trends, and Issues in the Australian Health Workforce
Owing to the fact that the healthcare system in Malaysia is categorised into private and public sectors, the Malaysian government took initiatives in the formulation of a plan 1Care for 1Malaysia, with the intent of making healthcare reforms based on the need and ability of the population (Leng & Hong, 2014). Furthermore, the society also places due importance on expanding and developing the healthcare system. One major issue that guided the selection of this country is the poor retention of skilled healthcare professionals, which has resulted in a shortage of health workers in the Malaysian public health sector. This shortage can be attributed to limited promotion opportunities, low salaries and lack of scope for continuing education. On the other hand, reports suggest that there are an estimated 1 million people in Australia, employed in delivery of health services. Thus, Malaysia was selected from the WHO Western Pacific list of countries, for comparison with Australia.
The health workers are the corner stone of the health care systems that can provide health care services to the population for improving the health outcomes. Poor retention of the skilled worker is one of the significant issue affecting the health care system of Malaysia. Current trends indicates that there is an overall shortage of the health workers in the Malaysian public health sector. In order to mitigate this, the Malaysian HRH policies and strategies has been laid out in the five years development plan. According to the Ninth Malaysian plan, the economy will be centred on human capital. As per this plan Malaysia would be considered as a regional health tourism centre. According to this policy the human resource and development will be given the highest priority to lessen the shortage of the medical staffs, for which the training of the health care workers would be increased. This policy emphasizes of the professional development initiatives that would be increased to meet the higher levels of care. The policy aims to provide attractive opportunities to the health care staffs for preventing the brain drain and the retention of the medical health professionals in the public health sectors. All the health regulation has to be reviewed including the same practice of alternative medicine. The Tenth Malaysian plan, 2011 and 2015, focuses on improved specialist training, expansion and the improvement of the post basic training for the nurses and the allied health care professionals. It is to be noted that the tenth Malaysian planning is based on addressing the personal by the provision through better remuneration, promotional opportunities and steps for providing greater job satisfaction. In Malaysia the recent development that has affected the workforce planning in Malaysia are the wage scales, complaints of the overwork, inadequate remuneration, and delays in promotion. In compliance with the national policy of the expansion of the higher education, the policies covering the expansion of the higher education have been liberalized.
Workforce Planning and Human Resource Management
In 2008, COAG collaborated in the National Partnership agreement on hospital and the health workforce reform. The health workforce Australia was established as a national agency for the progressing the health workforce reform in Australia. The health workforce plan was to present the future outcomes of the health workforce. This was previously known as the national training plan which was changed by and renamed as the health work force 2025, doctors, nurses and the midwives. The key planning of this policy is an authority’s national planning approach. The methodical robustness of the Australian health care cannot be matched with the Malaysian health care system. The health workforce plan of Australia was conducted in to two phases, developing the projections for the size and the variety of the health work force required to meet the future use. This policy mainly supported the clinical training needs of an increasing number of undergraduate health students. The intern training and the prevocational training had been a major contribution towards the workforce planning in Australia.
Medical workforce- The health workforce in Australia is diverse and large, and covers a range of occupations that include highly qualified professionals, support staff, and health volunteers. Nurses and midwives form the largest group of registered health workforce with an estimated number of 353,000 registered and 301,000 nurses and midwives, who were employed in the year 2014 (Aihw.gov.au, 2018). The health workforce in Australia comprises of nurses, medical practitioners, midwives, oral health workers and Aboriginal and Torres Strait Island health workers. The number of clinicians increased from 297 in 2008 to 331 in 2011. An increase was observed in the number of specialists and trainee doctor from 2008 to 2011. However, the rates of general practitioners were similar in both the years (112per 100,000 population) (Health Workforce Australia, 2018).
On the other hand, higher increases were observed in the numbers of the medical practitioners that included all doctors, trainees and specialist doctors), in Malaysia from 25,102 in 2008 to 36,607 in 2011 (WHO, 2014).
Figure 1
Nursing professionals- The total registered nursing workforce in Australia significantly increased from 325,583 nurses in 2008 to 328,817 in 2011. Of the 328,817 nurses, 81.8% were registered nurse and 18.2% were enrolled nurse. Furthermore, approximately 58.6% of the registered and enrolled nurses were found to work in the public sector in Australia (Health Workforce Australia, 2018). In the context of Malaysia, the total number of nurses underwent a huge increase from 54,208 nurses in 2008 to 74,788 in the year 2011 (WHO, 2014).
Workforce Planning Processes
Figure 2
Dental workforce- Differences were also observed in the numbers of dental practitioners, among the health human resource profile of the two countries. While there were 12,734 dentists in the dental workforce in Australia in 2011, the workforce was comprised of only 4,253 dental practitioners in Malaysia, in 2011 (Health Workforce Australia, 2018) (WHO, 2014).
Figure 3
Midwives- The total number of midwives in the year 2011 was approximately 14,710 in Australia in the year 2011 (Health Workforce Australia, 2018). However, community nurses and midwives comprised of 120.10 per 10,000 population in Malaysia in the same year (WHO, 2014).
Physiotherapists- They are a part of the allied health workforce and their number was found to be around 15,929 people in Australia, in the year 2011 (Health Workforce Australia, 2018). On the other hand, the workforce data of Malaysia indicates that there were approximately 818 physiotherapists working in the year 2011 (WHO, 2014).
Figure 4
Pharmacists- A significant increase has been observed in the number of pharmacists in Australia from 12,308 in the year 1996, to 15,337 and 19,934 in 2006 and 2011, respectively (Health Workforce Australia, 2018). On the other hand, an analysis of the Malaysian health workforce indicates a steady increase in the rates from 2,828 in 2002 to 6,397 and 8,632 in 2008 and 2011, respectively (WHO, 2014).
Figure 5
Optometrist- Significant increase was also observed in the number of optometrist over the years in Australia (Health Workforce Australia, 2018). The number of optometrist was near an estimated 3,628 in 2011. However, in Malaysia, there were 899 optometrists in the same year (WHO, 2014).
Figure 6
Thus, a comparison between the countries suggests that the increase in number of medical practitioners in Malaysia could not meet the rapid population growth. However, significant increase has been observed in the numbers of midwives, nurses and allied health professionals. The increase in pharmacists can be attributed to introduction of provisional services in Malaysia in recent years (WHO, 2014). Further analysis of the workforce distribution also provides evidence for the high proportion of female workforce in Malaysian health sector.
Figure 7
A three years rural service as well as urban service has been integrated by the Australian government, in line with the NIHW Declaration of the health for all. Malaysia has the most noteworthy weight of malady of any mainland (per populace) however has the least number and proportion of wellbeing specialists per populace. The Malaysian medical council medical issues reflects essential medical issues, irresistible illnesses, nourishing infections and maladies emerging from natural issues, in any case, utilize a similar profile of wellbeing labourers and wellbeing administrations as the created industrialized nations that need to bargain for the most part with issues of degenerative ailments. The lion’s share of Malaysia’s wellbeing specialists serve a minor populace found in urban zones where the vast majority of the wellbeing offices are likewise settled. The greater part living in rustic zones are frequently ignored (Hawthorne, 2012). Some of the significant critical isues that has been identified in the Malaysian health care is that there is an overall shortage of workforce in the Malaysian health care and shifting of the health care professionals to the private health care sectors. WHO has recommended that 23 health care workers per 10,000 population is ideal to achieve the Millennium developmental goal (Hawthorne, 2012). This misdistribution of the workforce is creating disparities in health care delivery to the vulnerable groups of the society such as the migrants, the urban poor and the ethnic minorities in remote and rural settings. Numerous factors have contributed to the poor retention of the health care professionals in the public health care sectors. At the level of the health care worker the factor involve lower salaries, less opportunities for the promotion and the continuation of the education and professional development. Financial incentives in Malaysia is very less in comparison to that of Australia (Thomas, Beh & Nordin, 2011). The financial incentives of Australia has increased over time that has improved the performance of the health care professionals.
Specific Human Resource Issues in the Health Workforce
The poor budgetary interest in wellbeing, limits space for development of compensation expenses that affects the workforce development. The demographic and the pattern of disease transition, increasing health care costs, increasing demands of the health care pose challenges towards better health outcomes (Cometto et al., 2013). Despite of the socioeconomic development plans in Malaysia, issues still exists in relation to equity and accessibility to healthcare by the rural population and the indigenous group.
Six recommendations has been proposed by WHO for transforming the health workforce planning.
Job creation
It is necessary for the stimulation of the investments in creating decent health sector jobs, particularly for the youths and the women. As per the study the female workforce in the profession of the health care professions have been found to be more in Malaysia than that of Australia.
Gender and women’s rights
WHO recommends active participation of the women in the health sector jobs by institutionalizing their leadership and addressing the gender bias. As per the report of the World Bank, about 44 percent of the women are a part of the formal labor force and for nearly the three decades the rate of the women participation has stagnated between the 44 and 47 percent.
Education, training and skills
The health workforce policy in Australia primarily focuses on the education, training and skills. Australia has been prioritizing the investment in education. The Malaysia did not seem to follow this recommendation as little focus is given to the education and the training skills.
Health service delivery and organization
The health care system of Australia mainly focused on the clinical facilities. The primary care system is well developed. The primary care sector is affected due to lack of poor workforce in Malaysia.
Technology
Health education technology enhance health education and primary care delivery. Gaps are still left in the use of technologies of Australian health care. The condition technology in Malaysian health care is worse than that of Australia. Malaysian health care needs to adapt itself to digital technologies.
Crisis and humanitarian settings
Each country should have its enough health work force to deal with the emergency situations. The increasing staff turnover of Malaysian health care can be an attributing factor in the appalling health care condition. The number of vacant posts in Malaysian health care is an indicator of the issues related to workforce (Abdul Rahim & Mwanri, 2012). Australia have special workforces involving the paramedics, occupational therapist and other primary care worker.
Comparison of Health Workforce Planning in Malaysia and Australia
Financing and fiscal space
The financing and the fiscal space in Australia is broader than that of Malaysia. Funding of the Australian health care is a vexing issue. The current health service spending of Australia is 9 % of the Australian GDP.
Partnership and cooperation
Intersectoral collaboration is required at the regional and the international level. 13 countries have collaborated with Australia for launching a global digital health partnership. Health care collaborations has been made with Ireland for expanding the Malaysian health care.
International migration
Immigration in Australia can be alarming and has affected the workforce of the country more than Malaysia.
Data information and accountability
Malaysia does not take a robust research and analysis of the health workforce in comparison to Australia.
Conclusion
Significant evidences have been found regarding the existence of the worldwide shortage of the health care professionals. The problem is severe in the low middle income countries like Malaysia. The shortage has been further impacted by the global shortage by the active recruitment of the trained workers from the overseas. On the other hand the health force of Australia is large and diverse, covering many occupations, ranging from the highly qualified professionals. The nurses and the midwives consists of the largest group of the health workforce. The female health practitioners involved are much more in comparison to the Malaysian workforce. The complex health care problems and the shifting of the health workforce from public sector to private sector is a major concern. An effective national approach to the health policy in Malaysia and health legislation is required for the long term retention of the professionals
References
Abdul Rahim, R., & Mwanri, L. (2012). Health workforce crisis: recruitment and retention of skilled health workers in the public health sector in Malaysia. Asia Pacific Journal of Public Administration, 34(2), 157-170.
Aihw.gov.au. (2018). 2.3 Who is in the health workforce? [online] Available at: https://www.aihw.gov.au/getmedia/cce76972-bbfd-415c-9e9d-c68fac8243bd/ah16-2-3-who-is-in-the-health-workforce.pdf.aspx [Accessed 11 Jun. 2018].
Aluttis, C., Bishaw, T., & Frank, M. W. (2014). The workforce for health in a globalized context–global shortages and international migration. Global health action, 7(1), 23611.
Cometto, G., Tulenko, K., Muula, A. S., & Krech, R. (2013). Health workforce brain drain: from denouncing the challenge to solving the problem. PLoS medicine, 10(9), e1001514.
Hawthorne, L. (2012). Health workforce migration to Australia. Melbourne: Health Workforce Australia.
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Leng, C. H., & Hong, P. H. (2014). ‘1Care’and the Politics of Healthcare in Malaysia. Routledge Handbook of Contemporary Malaysia, 312.
Lopes, M. A., Almeida, Á. S., & Almada-Lobo, B. (2015). Handling healthcare workforce planning with care: where do we stand?. Human resources for health, 13(1), 38.
Merriam, S. B. (2015). Qualitative Research: Designing, Implementing, and Publishing a Study. In Handbook of Research on Scholarly Publishing and Research Methods (pp. 125-140). IGI Global.
Shazali, N. A., Habidin, N. F., Ali, N., Khaidir, N. A., & Jamaludin, N. H. (2013). Lean healthcare practice and healthcare performance in Malaysian healthcare industry. International Journal of Scientific and Research Publications, 3(1), 1-5.
Thomas, S., Beh, L., & Nordin, R. B. (2011). Health care delivery in Malaysia: changes, challenges and champions. Journal of Public Health in Africa, 2(2), e23. https://doi.org/10.4081/jphia.2011.e23
WHO, western Pacific region (2013).Human resources for health country profiles Malaysia, Retrieved from: file:///C:HRH_Country_Profile_2013.pdf
WHO. (2014). Human resources for health country profiles: Malaysia. Available at: https://www.wpro.who.int/country_support/countries/mys/en/ [Accessed 11 Jun. 2018].
WHO. (2018). Health workforce. Available at: https://www.who.int/healthsystems/topics/workforce/en/ [Accessed 11 Jun. 2018].
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