A sense of urgency required in resolving dilapidated health and education infrastructure for East Malaysia                    

2023 marks Sabah’s and Sarawak’s 60th year anniversary of independence. The unity government does not have much time to delay/postpone resolving the MA63 agenda.

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While it marks a good starting point for newly-minted Health Minister Dr Zaliha Mustafa to provide free sanitary pads at the ministry level, the period poverty issue is just the tip of the iceberg.

Period poverty refers to a lack of or inadequate access to menstrual products, sanitation facilities and information on menstruation – often leading to adverse health, psychological and social consequences. As highlighted by EMIR Research, the Covid-19 pandemic has exposed the underlying risks of inadequate access to sanitary pads among low-income and poorer girls and women.

With shrinking income and job losses, the affected working-age women were left with very few options but to go for unhygienic methods by using tattered clothes, coconut husks, old/discarded newspapers and even banana leaves during their menstruation period.

Period poverty is just one chronic issue.

The other issue would be the insufficient number of medical specialists and healthcare amenities in sub-urban and rural areas.

Malaysians who reside outside major cities and conurbations have to travel afar to access the necessary medical treatment. 

Such a phenomenon is especially acute in Sabah and Sarawak (including the Federal Territory of Labuan), which account for 60 per cent (i.e., 198,100 square kilometres) of the total area of Malaysia. In 2021, Sabah’s, Sarawak’s and Labuan’s official ratio of doctors to the population were 1:776, 1:662 and 1:837, respectively, lower than the national average of 1:420.

Moreover, Sabah’s and Sarawak’s teacher-to-student ratios in the rural secondary schools were 1:11.75 and 1:12.61 in 2020, respectively, lower than the national average of 1:9.36. The issue of the dilapidated schools in both Sabah and Sarawak also becomes a hindrance for students to experience a conducive learning environment.

As of April 2020, out of 1,296 schools in Sabah, 589 of them were dilapidated (as the latest obtainable figure). For Sarawak, latest derived figure is as of September 2022 which show that 476 dilapidated schools were yet to be repaired or upgraded.

Due to a limited number of Comprehensive Special Model Schools 9 (K9) – which offers schooling from Year One to Form Three – in the remote areas of Sabah and Sarawak, fewer children have been graduating.

As a result, only 12.7% and 13.4% of the rural workforce in Sabah and Sarawak received tertiary education qualifications in 2020.

East Malaysians with lower educational attainment could only opt for lower-skilled jobs, which deprived them of opportunities to earn a higher income. 

As 2023 will mark Sabah’s and Sarawak’s 60th year anniversary of independence and, by inclusion and extension, of the Malaysia Agreement/MA (1963), the unity government does not have much time to delay/postpone.

Both newly-appointed education and health ministers have to start carrying out the necessary groundwork, understand the underlying/legacy issues and develop solutions to ensure a brighter future for the next generations.

Pakatan Harapan (PH) has claimed that among all 21 issues under MA63, 17 were resolved during the tenure of its administration between May 2018 till February 2020. However, one month before the 14th Parliament dissolved on October 10, 2022, former Minister in the Prime Minister’s Department (Sabah and Sarawak Affairs) Datuk Seri Dr Maximus Ongkili has refuted that in insisting that 15 MA63 issues remain outstanding.

The purported outstanding issues include jurisdiction over health issues, the remaining (i.e., based on and derived from pre-existing Shared List of the Federal Constitution) jurisdiction on the environment, labour issues and the release of land ownership rights to the federal government.

Although the current unity government aspires to resolve all MA63 issues within a month (due by this month), it remains to be seen whether the federal ministers will be able to effectively translate the political commitments into policies and laws.

Also, the federal government has to be proactive in organising frequent engagements with the state governments of Sabah and Sarawak.

This includes ensuring complete decentralisation of power from the federal to the state in the matters of health and education. However, it is currently challenging for the federal government to fully delegate to as Sabah no longer has its own health and education ministries.

When the Warisan-led PH Plus governed Sabah between 2018 to 2020, then Chief Minister Datuk Seri Shafie Apdal set up both the (state-level) Ministry of Health and People’s Well-Being and the Ministry of Education and Innovation.

Sarawak also followed in Sabah’s footsteps post-2021 state election. The cabinet rebranding saw the establishment of the Ministry of Education, Innovation & Talent Development as well as the Ministry for Public Health, Housing & Local Government under Sarawak Premier Tan Sri Abang Johari Openg.

Given that Datuk Seri Hajiji Noor remains as the Chief Minister of Sabah (the state assembly is due to expire by December 9, 2025), he may consider having the current state Local Government and Housing Minister Datuk Seri Panglima Haji Masidi Munjun holding an additional, i.e., health, portfolio.

Whereas Datuk Haji Yakubah Khan, the current state Science, Technology and Innovation Minister, could be put in charge of education as well to ensure effective transition of power devolution from the federal to the Borneo territories.

When both Sabah and Sarawak have their respective state ministries to manage health and education affairs, the Anwar administration will find the MA63 agenda a less daunting task to achieve within his first 100 days serving as Prime Minister (by March 3, 2023).

In promoting the overall national health and education infrastructure, EMIR Research has supplementary policy recommendations for the current unity government to look into:

  1. The Ministry of Health (MOH) should think of ways to increase the number of medical officers (MOs) for permanent positions without compromising on the three-tier assessment system that is already in place.

The three-tier assessment comprises the Permanent Appointment Technical Committee at the medical programme level, the Permanent Appointment Selection Committee chaired by the Deputy Secretary-General (Management) and finally, the committee to certify the permanent appointment by making the final recommendations to the ministry’s top management.

If some MOs are yet to have their contract renewed after the two-year compulsory service, the MOH could work with potential employers in the private sector, i.e., including the government-linked hospitals (both federal and state), to absorb them.

Also, MOH should look into the working conditions of the contract MOs such as giving them unrecorded leave and maternity leave for female MOs, and financial assistance/sponsorship for post-specialists’ training.

2. It is highly commendable that Education Minister Fadhlina Sidek intends to bring back the National Education Advisory Council.

Although she did not specify the council’s purview, it would be ideal that the membership comprising of experts, academics and representatives from teacher and parent associations formulate an integrated plan for post-pandemic education.

Moving forward, the Ministry of Education (MOE) should go ahead and implement the plan to revamp the national education system with a stronger emphasis and focus on science, technology, reading, engineering, arts and mathematics (STREAM) but encompassing the primary, secondary and university levels.

In abolishing the arts and sciences streams – so that whatever subjects the students choose will still revolve and orient around some science and engineering or technology-based subjects – they will also be at the same time exposed to a holistic and well-rounded perspective (i.e., via the introduction of liberal arts disciplines such as communications, philosophy, literature, classic, etc. in addition to the conventional subjects of history and geography, inter alia).

Essentially, the vision is to, ultimately, revamp the education philosophy to produce graduates who are both generalists (minoring) and specialists (majoring) in their respective STREAM of choice – which will also boost their employability in the “new” economy.

This will also facilitate the promotion of skills flexibility needed for upskilling, reskilling and cross-skilling to adapt to the rapidly evolving economic and industrial landscape.

Nonetheless, the STREAM initiative has to be supported by the necessary digital devices and connectivity. Students without digital and Internet accessibility could not upgrade themselves with the relevant knowledge set and practical skills, diminishing their chances of securing higher-paying jobs after graduation.

Aside from STREAM education, MOE also could introduce sexual and reproductive health education, moral education and civic education to provide a more holistic framework for Malaysians from a young age (see, “Women’s issues are also issues that require the national (or the other gender’s) attention”, EMIR Research, April 6, 2022).

3. Initiate discussions with MOE and MOH to allocate more teachers and doctors to be based in the rural areas of Sabah and Sarawak.

Both ministries could provide training and job guarantee incentives to motivate more Sabahans and Sarawakians to contribute to their home territories through teaching and medical professions.

Encouraging more Sabahans and Sarawakians to become teachers and doctors would eventually narrow the gap between the number of teachers/doctors required and the number of students/residents in a particular rural district of Sabah and Sarawak.

4. Provide full autonomy for both Sabah and Sarawak state governments to carry immediate upgrading of dilapidated health and education infrastructure or initiate developments for new hospitals/clinics/schools.

Towards this end, as part of a new era of partnership between the Peninsular and East Malaysia, the unity government should “standby” to provide additional funding if the Sabah and Sarawak state government require more financial assistance for developing their health, education and other socio-economic infrastructure.

5. Monitor the construction progress regularly to ensure that built infrastructure comply with requirements (i.e., construction industry standard by the Construction Industry Development Board/CIDB, road safety audit by the Public Works Department/JKR, etc.).

Also need to ensure that projects are completed within the specific time frame under the project phases (i.e., three months, six months or one year, for instance).

Prime Minister Datuk Seri Anwar Ibrahim’s commitment to combat wastages, leakages and graft in the public sector (including projects related to health and education infrastructure) whereby an open tender environment/culture should be the default system has re-ignited fresh and renewed hope for our beloved nation.

Let us pray that the Prime Minister will lead Malaysia towards promising economic growth prospects and stable governance in the next five years and more to come!

Amanda Yeo is Research Analyst at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

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