The Auditor-General’s Report on federal agencies’ financial statements for 2023 revealed that Universiti Sains Islam Malaysia (USIM) and two other universities recorded the highest consecutive losses for three straight years.
USIM recorded a loss of RM14.21 million in 2021, RM2.62 million in 2022, and a whopping RM44.02 million in 2023.
The other two universities were Universiti Malaysia Sabah (UMS) and Universiti Putra Malaysia (UPM). The report stated that the losses incurred by the three universities were due to operational grants and self-generated income (student fees) being insufficient to cover expenses.
Higher Education Minister Zambry Abd Kadir disagreed with the term “incurring losses”, saying it was misleading because public universities are not profit-driven institutions. His deputy, Mustapha Sakmud, also rejected the term “deficit” used in the report, stating that the financial struggles stem from insufficient government grants and limited self-generated income rather than actual losses.
He further explained that public universities rely on government funding for 80 per cent of their budget, with the remaining 20 per cent coming from their revenue-generating activities.
However, this is a serious dilemma for USIM which I think merits serious discussion.
The RM44 million deficit, loss, or financial struggle for USIM in its third year of losses involved a big amount of money and was accrued in 2023 when we were already out of the Covid-19 situation.
In 2021 and 2022, the fact that some students failed to complete their studies and had to learn from home during movement control orders led to reduced student fees. What was the reason for the 2023 deficit?
Lecturers were constantly being reminded of their duty to generate income for the university and to successfully get as many research and consultancy grants as possible.
But even if USIM lecturers secured every major national grant like the Fundamental Research Grants Scheme (FRGS) or Translational Research Grant Scheme (TRGS), of which 2.5 per cent would be revenue-generating income, we would never be able to cover the RM44 million losses.
Several cost-cutting measures were introduced from time to time e.g halting temporarily the financial assistance for academic conferences, journal publication incentives and even cutting off allocations for staff competing in intervarsity sports like Kejohanan Sukan Staf Antara Universiti Malaysia (SUKUM), which was held in Sabah recently and which the staff had to self-sponsored their flight tickets going there.
These cost-cutting measures only managed to demoralise staff more.
The pertinent question arises if operational grants and student’ fees were quoted as being insufficient to cover expenses, other universities would be in the same predicament, wouldn’t they?
The two universities mentioned together with USIM already have their revenue-generating instruments, which are either in their early years of operating or soon to be opened.
Hospital Universiti Putra Malaysia or Hospital Sultan Abdul Aziz Shah (HSAAS) started its operation in 2019. UMS’ university hospital was inaugurated by the prime minister on March 2, 2018 and is scheduled to be operational in 2026.
Health Tourism
One of the revenue-generating income streams for USIM, which had long been planned, was our teaching hospital, Hospital Pengajar USIM. This was initially planned to be built next to the medical faculty in Nilai, but it was changed to Kota Tinggi, Johor, some 300km away from the faculty.
I remember a few years back; while traveling to Penang, I was seated next to a man of an Indian national. He was scheduled for a cardiac angioplasty procedure in one of the hospitals in Penang. Curious, I asked why he would travel to Penang for such a procedure, as such facilities would be readily available in India.
He told me that he didn’t come by himself but with his family who would take care of him after his medical procedure. He had arranged it in such a way that this trip would be a form of vacation, in a new environment, experiencing new food and new culture.
He believed that such an arrangement would be a win-win situation for both parties (the patient and the caretaker) and the last thing he wanted was for his family to feel stressed and burdened. This is what we call health tourism.
Health tourism encompasses both medical tourism (travel for treatment) and wellness tourism (travel for preventative care and relaxation), while medical tourism specifically focuses on traveling for medical treatments and procedures, the latter perfectly fits the case I described above.
Located in Nilai, USIM’s medical faculty is 20km away from KLIA, 50km to Kuala Lumpur and Putrajaya, and 100km to Malacca. These are popular tourist destinations, facts that we have established through years of accommodating our colleagues from abroad as they came over for medical and health conferences.
The intercity connection is further facilitated by the nearby Nilai commuter station located 7km away from the main campus. The niche area of USIM in integrating the knowledge of Aqli (reasoning) and Naqli (divine) is hoped to attract more prospective patients and international students from the Middle Eastern regions. This has always been the plan.
USIM’s teaching hospital, if it was to be built in Nilai as originally planned, should continue to serve the local community. Early this year, Menteri Besar Aminuddin Harun reported on the congestion of public hospitals in Negeri Sembilan, adding more reasons why a teaching university hospital will be of great help.
Hospital Tuanku Jaafar in Seremban is currently the only public hospital that serves as a tertiary referral centre in Negeri Sembilan. USIM’s university hospital shall have experts with subspecialties that can be of benefit.
The private wing of USIM’s teaching hospital in Nilai will promise a better return on investment and a tool for the 20 per cent revenue-generating activities needed to cover the university’s expenses, as compared to if it is built in Kota Tinggi.
Location and good infrastructure are also very pertinent for university teaching hospitals to get enough case-mix for medical teaching purposes, which will be my next point. The last thing that we need is a university teaching hospital saddled with debt because of its non-strategic location and one that would continue to depend on the ministry for its funding.
Requirement For Teaching Hospitals
University teaching hospitals prioritise education above everything else, besides providing bright prospects and potentials for research opportunities, medical specialist training, up-to-date medical facilities, and community services. It must keep abreast of the latest practices and cutting-edge technology as it trains future doctors in the countries.
Teaching hospitals need to be in areas where there is enough case mix of patients for students to learn from different disciplines. There must be a minimum number of cases measured in a specific timeframe to reflect its efficiency.
For example, as outlined in the Malaysian Medical Council (MMC) Guidelines, the surgical department must have not less than 10 emergency cases and 15 elective cases per week, while the obstetric and gynaecological department must ensure not less than 50 normal deliveries and 10 caesarean section deliveries per week to ensure the students have enough exposure.
This can only be achieved in high-density areas such as in Nilai. As mentioned above, UPM’s teaching hospital HSAAS is located in Serdang and is just next to the Ministry of Health’s (MOH) Sultan Idris Shah Serdang Hospital. UMS’ teaching hospital is in Kota Kinabalu, near MOH’s Queen Elizabeth Hospital.
A substantial number of USIM clinical specialists resigned over the years, as there were more directives rather than proper consultation meetings where two-way feedback was adequately addressed to reach such an important decision.
The uncertainties in USIM’s planned teaching hospital – where many had cast doubt in its form and success – left clinicians with no choice but to leave USIM, as they need to charter their career pathway and maintain their clinical skills.
With an RM44 million deficit and a teaching hospital with uncertain financial sustainability and feasibility of accreditation for training, USIM needs new leadership.
This new leadership must chart the direction and future of our existence as a higher institution learning proficient in strategic planning and be capable of maintaining its operations without depending so much on external financial support. Listen more to voices on the ground.
Professor Dr Rafidah Hanim Mokhtar is from the Faculty of Medicine and Health Sciences at Universiti Sains Islam Malaysia (USIM).
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
