PETALING JAYA: Former health director-general Dr Ismail Merican disagrees with what he described as a “last-minute decision” to ask private hospitals to help alleviate the worsening Covid-19 situation, saying the government should have been open to collaboration with them from the onset.
Ismail, who held the position from 2005 to 2011, said the government should have integrated the entire health sector – both public and private, including the stakeholders – in the management of the pandemic.
“What we see is, initially, a more ministry of health-centric approach in handling the pandemic, and ignoring the fact that there are public health experts in handling crises such as this in the universities and the private sector,” he told FMT.
“What I would have done differently is to engage the private sector right from the beginning, not now when you’re desperate and you’re essentially forcing them.
“The private hospitals have been looked down with disdain by many as institutions which only look at profits and not much else. While that may be true, there are a large number of doctors in the private sector who are keen to help but are saddled with constraints”.
Ismail, who was among those who had managed the country’s first coronavirus SARS outbreak in 2002, acknowledged, however, that although the private sector was more than willing to help, they were limited in their capacities to comply with the requirements of the government.
“At the end of the day, the private hospitals will only be able to do as much as they can,” he said, adding that there would be a strain on their resources, including human capital, needed to manage the patients.
With government facilities stretched to the limit, health director-general Dr Noor Hisham Abdullah has asked the private sector to provide 1,000 hospital beds, including 70 critical care beds, nationwide to treat Covid-19 patients.
He also said 97 private hospitals had been identified to take in Category 3, 4, and 5 patients.
Ismail, now a specialist at Prince Court, said intensive care unit (ICU) beds in the private sector were limited.
“We must bear in mind that there are not enough ICU beds throughout the country. There should be at least 10% of ICU and high-dependency unit (HDU) beds compared to the total number of hospital beds, depending on the location of the hospital. Now, we have less than 1%.
“If private hospitals wish to expand ICU beds for Covid-19 cases, they may need to sacrifice certain wards, including renovating some sections of the hospitals.”
The hospitals need to get permission from the Private Medical Practitioner Control Department (CKAPS) at the health ministry to do that, he said, and the delay may pose challenges to both the hospitals and patients alike.
Ismail said expanding ICU wards would also mean hiring more trained nurses and buying expensive equipment.
“Who bears the costs? The patients? The hospitals? Is the government willing to help with financial outlay?”
Prime Minister Muhyiddin Yassin recently announced an allocation of RM100 million for the private sector to assist in managing the pandemic but, Ismail said, as of now, there had been no clear guidelines or details on how the financial support would be channelled to the private sector.
As a result, he said, the private healthcare sector may end up compromising their standards in an effort to meet government directives.
On human capital problems, Ismail stressed that specialists in private hospitals were “single operators” unlike those in public hospitals, which had a hierarchy of specialists, medical officers and housemen, staff nurses and student nurses.
“If you are a Covid-19 patient, you have to be seen three to four times a day. Can you do that in the private sector, with the same person going to see a patient three to four times a day?”
He also there was a risk of contaminating other patients with the limited number of doctors also needing to handle non-Covid patients.
“The private sector can help manage Covid-19 patients if the government is willing to discuss with them regarding challenges they will face and help them overcome those challenges.
“The government must also discuss with the insurance companies to be more accommodating in assisting the private sector manage patients who would otherwise be managed at public hospitals.”
Decongesting public hospital Covid-19 wards
Ismail recommended that the government discharge Category 1 and 2 Covid-19 patients to decongest wards at public hospitals as a strategy in handling the pandemic, leaving only the severe cases (Category 3, 4 and 5) treated in-house.
This would free up to 80% of the beds, leaving enough room for both Covid and non-Covid patients needing critical care.
However, he said, asymptomatic and mild patients would need to be advised by a technical team for them to stay isolated from other family members for 10 to 14 days, and also to watch out for any worsening in symptoms.
He said they must also immediately alert the technical team if they developed these symptoms.
“For this to be successful, the public must be responsible and disciplined. There have been reports of complacency and laxity by those who are home-quarantined. This will not do at all.”
He said the private sector could then be roped in to manage non-Covid cases at subsidised costs to the patients.
5 steps to beat the Covid-19 threat
Ismail recommended five steps to “turn the tide” in the fight against the pandemic:
• A strong, stable and credible leadership with good governance and genuine appreciation of the problems the people face, especially as a result of the economic and psychological repercussions of lockdowns, which should not be the only strategy used.
He said the health ministry, from the minister down to the director-general and his technical team, must be given the authority to present the “hard facts” and advise on measures that need to be taken.
• A robust and well-resourced medical and public health system with input and advice from the best available experts, not just from MOH.
• The government must empower, educate and engage communities, so they are committed, responsible and knowledgeable and not get carried away with disseminating misinformation, half-truths and fear, especially about the vaccines.
• Vaccine procurement must be accountable and transparent, with MOH taking the lead, instead of the science, technology and innovation ministry.
• One “trusted” government source to provide consistent and accurate communication to instil public confidence and compliance. - FMT
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