A good doctor treats the disease; a great doctor treats the patient who has the disease.
– William Osler, Canadian physician
I have written on health autonomy and shortage of doctors in my past columns. Nevertheless, I am compelled to write on the issue again! From Kuching to Kapit, from Lawas to Lundu, the story is the same; patients face long queues, exhausted doctors stretch beyond their limits, and rural folk still struggle to get timely medical treatment.
This is not a problem that can be wished away overnight; we are no bomoh, who with herbs, geomancy, and mantras, could summon doctors for every district hospital and specialists for every medical discipline. No, solving Sarawak’s healthcare woes demands structural reform. And that is why health autonomy for Sarawak is not just desirable, but essential.
Deputy Premier Datuk Amar Dr Sim Kui Hian made this point yet again on Aug 2, 2025, at the Sarawak Neurosurgery Conference in Kuching. He reminded us that Sarawak, with its growing income, is capable of managing its own healthcare system. With health autonomy under the Malaysia Agreement 1963 (MA63), Sarawak would be empowered to deliver more efficient medical services and manage resources more effectively.
The figures he cited are telling. Sarawak’s state budget allocation has ballooned from RM5.8 billion in 2018 to RM15.8 billion last year. By the end of this year, it is expected to hit RM20 billion. This is not a state struggling for funds; this is a state with the financial muscle and, as the man himself stressed, Sarawak has the talent to manage its own healthcare system.
Sarawak is facing a critical shortage of doctors with over 2,000, by conservative estimates. National standards dictate we should have at least 6,000 doctors. Yet we only have around 4,000, many of whom are posted from Malaya and often do not stay long.
Universiti Malaysia Sarawak (UNIMAS) produces about 150 medical graduates annually. Even if every one of them stayed, it would take more than a decade to close the current gap, and that assumes no attrition.
Meanwhile, specialists and junior doctors are working dangerously long hours, which inevitably affects performance and morale. It is not fair to patients, and it is not fair to our healthcare workers. We cannot continue patching holes with overworked personnel.
Federal health funding, tied strictly to population size, grossly disadvantages Sarawak. This formula ignores our vast geography which is almost as large as the entire peninsula, and the logistical challenges of serving a widely dispersed rural population. A clinic in Kapit or Belaga cannot be run on the same model as one in Penang or Petaling Jaya. Sarawak needs a healthcare system designed for Sarawak.
To grasp how deep the problem runs, let us look at comparative statistics. In 2015, Sarawak’s doctor-to-population ratio stood at approximately 1:1,104, nearly double the World Health Organisation’s recommended ratio of 1:600. In many rural districts today, the ratio stretches to 1:1,200-2,000.
Sarawak today has just 4,000 doctors for a population of nearly 3 million, while national standards say we need 6,000. That’s a shortfall of 2,000 doctors, more than half the target. Malaysia overall averages about one doctor for every 680 people. But this national figure hides sharp disparities: most Malayan states enjoy far better coverage than Sarawak.
And compare that to Singapore, which has a doctor-to-population ratio of 1:399 which is more than twice as many doctors per capita as Sarawak.
The brain drain compounds the crisis. Monash University Malaysia graduates about 150 doctors annually, but half head to Australia. Newcastle University in Johor Bahru tells a similar story, with 90 per cent of graduates leaving for the UK.
Why do they leave? Salaries are a major factor. It is hard to convince a specialist to stay when public hospitals pay as little as RM3,130 a month. Even offering RM30,000 in allowances would not match overseas earnings, but it would at least make staying more viable.
Attrition is not confined to graduates. At the national level, 1,354 contract medical officers quit the public health service in 2022 alone, exceeding the total resignations in the two previous pandemic years combined. Over five years, more than 6,000 medical officers have resigned from government service, citing low pay, contract insecurity, and punishing workloads.
To resolve all these problems, health autonomy is the answer. Yes, I repeat, health autonomy!
For example, with health autonomy, we could recruit and retain doctors more effectively. Federal pay scales are uncompetitive. With autonomy, Sarawak could provide bonuses and allowances, just as it already does for state civil servants.
Let us set our medical education policies where we should have the authority to expand medical seats in UNIMAS and partner with private universities to produce more doctors locally. The current quota system deprives many bright Sarawakian students of medical education opportunities.
Another advantage is decentralised decision-making. Rural Sarawak requires unique solutions, from mobile clinics and telemedicine hubs to incentive packages for rural service. These cannot be crafted in Putrajaya boardrooms.
With autonomy, we can tackle the brain drain head-on. Sarawak could design attractive return packages and cut through red tape that currently discourages Sarawakian doctors overseas from coming home, including easing permit issues for foreign spouses.
We could also leverage existing talent. I was made to understand some Sarawak-Malaysia My Second Home (S-MM2H) residents are qualified medical specialists. Why not engage them? If the authorities are serious, I am willing to assist in identifying them.
The Ministry of Health’s Health White Paper (HWP), passed in June 2023, was supposed to pave the way for such decentralisation. Deputy Minister Michael Tiang hailed it as a milestone, saying it would direct Sarawak “towards the path of health autonomy”. Yet two years on, Sarawakians are still waiting for concrete progress.
One of the saddest realities is that Sarawakians who wish to return to serve often encounter so much bureaucracy that they eventually give up. Several specialists, I was made to understand, tried to come back, only to be bogged down in messy red tape, especially in securing work permits for their foreign spouses. Disappointed, they returned to their adopted countries.
This is tragic. Sarawak desperately needs their expertise. If autonomy were granted, the state could fast-track such applications and even offer spousal work rights to ensure retention.
We are not asking for a free handout. We are asking for the right to manage what we can clearly handle. Dr Sim’s push for the Sarawak Private Health Institute Master Plan, in partnership with UNIMAS, shows the state’s seriousness. Such initiatives, however, must be backed with autonomy, not hamstrung by federal red tape.
Our leaders, from Premier Datuk Patinggi Tan Sri Abang Johari Tun Openg to Dr Sim, have been working religiously and regimentally on this matter. We cannot fault them for effort. But we must also acknowledge: patience has its limits. Sarawak has been patient for far too long.
Putrajaya must stop treating Sarawak’s health autonomy as a negotiable side issue. It is a matter of life and death. Every day of delay means patients waiting longer, doctors burning out faster, and rural communities falling further behind.
Yes, Sarawak is part of Malaysia. But Malaysia was formed under the MA63 framework, which recognises Sarawak’s distinct needs and rights. Health autonomy falls squarely within that spirit.
We do not expect magic. But we do expect action. Putrajaya must immediately devolve healthcare decision-making powers to Sarawak under MA63 and allow Sarawak to determine its own medical workforce needs like creating more specialist posts and setting rural service incentives.
I strongly advocate the removal of bureaucratic obstacles for returning Sarawakian doctors and their spouses, and the need to leverage S-MM2H doctors and foreign-trained specialists already living in the state.
The late veteran journalist James Ritchie once told me, “Sarawak has always had to fight twice as hard to get what’s fair.” Those words ring true today.
Our demand for health autonomy is not about pride or politics. It is about the basic right of Sarawakians to quality healthcare. It is about ensuring that no mother in Belaga has to take a boat for hours just to see a doctor, that no specialist in Kuching collapses from exhaustion, and that no bright Sarawakian student is denied a medical career because of quotas.
Sarawak has the money, the will, and the talent. What we lack is the autonomy to act. The time for patience has passed. The time for action is now.
The views expressed here are those of the columnist and do not necessarily represent the views of Sarawak Tribune. The writer can be reached at rajlira@gmail.com
