There have been many calls and proposals put up to set up a Health Service Commission to overcome the many issues regarding the public health human resources and its delivery of services. This was brought up to the Health Parliament Special Select Committee and many others have provided their input and support.
From my experience in the Ministry of Health, one would realise that the Ministry of Health (MOH) is engrossed in solving immediate issues rather than looking at long-term issues. This is because the MOH is an integrated agency where policies and operations are within a single agency.
It operates the largest number of health care facilities, with 66 per cent of total hospital beds, and 3,114 clinics in the country, besides employing one of the largest number of employees (about 300,000) in the public service.
MOH has the second largest federal budget (RM47 billion) after the Ministry of Education. The number of inpatients, day-care patient, and outpatient attendances was over 68.2 million in 2023.
As a result of this, in most senior-level meetings attended by the top echelon of MOH, operational issues like patient complaints and staff transfers are discussed together with policy issues like health transformation.
In these meetings, a lot of time and effort is spent on operational, urgent and fire-fighting issues; structural issues of the ministry are sadly left behind or in committees.
Right now, Malaysia’s public health care system is facing growing structural pressures that threaten its long-term sustainability. Persistent workforce issues, like rising attrition among doctors and specialists, maldistribution of personnel, and limited flexibility in remuneration and deployment have constrained the MOH’s ability to respond effectively to increasing service demand.
These challenges have been exacerbated by prolonged reliance on contract employment and constrained employer authority over key human resource levers. Along with this, the government, through MOH, has also approved many new private hospitals to overcome the shortage of new government hospitals.
As these new hospitals are built and completed within a couple of years, there is great demand for specialists and para medical staff in these new private hospitals. Under Act 586, for a new hospital to begin a service, it requires a fully staffed team of qualified specialists, nurses etc. to be physically present and registered before operations begin.
There is also a great demand for these personnel from Singapore. Unfortunately, the source of these human resourcess come from MOH Malaysia.
While proposals to establish a Health Service Commission (SPK) reflect legitimate concerns over the adequacy of existing Public Service Commission (SPA) and Public Services Department (JPA) arrangements, the Health Parliament Special Select Committee did not agree to this proposal.
It was concerned over high financial costs and noted that human resources management would still require the approval of JPA and the Ministry of Finance (MOF). It also requires major changes to existing laws, including amendments to the Federal Constitution. The Parliament committee instead recommended improving career prospects and increasing existing allowances.
Proposal: National Health Authority (NHA)
Experience from Hong Kong, Singapore, and the United Kingdom shows that health care systems succeed when policy stewardship is separated from service delivery and employment functions.
Therefore, to separate stewardship and service delivery, I propose the establishment of a National Health Authority (NHA) as a statutory operator of public health care services.
The model is explicitly designed to be constitutionally feasible, fiscally disciplined, and operationally effective, without requiring amendments to the Federal Constitution or the abolition of existing public service institutions.
This proposal is not new; it was previously rejected by the MOH due to a perceived “loss of power and oversight over human resources and budgetary consideration” if operations were devolved into a separate entity.
But now is the right time to reconsider this separation and establishment of a new entity to operate clinics, laboratories, hospitals, and other health facilities in MOH, as the ministry’s structural problems can’t be ignored any longer.
The current governance and employment structure presents several systemic weaknesses. MOH has limited flexibility to deploy targeted incentives for scarce skills or high-burden facilities.
Career mobility across facilities and states is administratively cumbersome. Specialist and nurse retention is increasingly difficult in the face of public–private competition and overseas migration.
Many government-sponsored doctors do not return and specialist compulsory tenure after qualification is relatively short. These challenges have limited MOH’s capacity to manage the public health care workforce dynamically and contributed to workforce dissatisfaction and inefficiency.
Incremental administrative reforms have proven insufficient and slow, indicating the need for structural realignment rather than procedural adjustment.
Proposal: Act Of Parliament
It is proposed that an NHA be established through an Act of Parliament as a federal statutory body, accountable to the Minister of Health and operating within funding parameters approved by the MOF.
The NHA will function as the national service delivery operator for public health care facilities, including hospitals and major clinical services. It will be responsible for workforce management, operational planning, and service delivery execution, while remaining subject to public sector governance, audit, and accountability frameworks.
Crucially, the NHA’s establishment won’t require a constitutional amendment, nor does it diminish the functions of SPA or JPA. Further, it’s consistent with existing precedents for statutory authorities operating in the public interest.
MOH retains full authority over national public health, health policy, regulation, standards, and national strategic direction. NHA assumes responsibility for service delivery operations and acts as the principal employer for public health care services.
MOF and JPA will continue to control fiscal and human resources ceilings and budget approval through defined funding envelopes. This oversight by MOF and JPA can evolve when a new health care financing framework is implemented.
The Role Of A New NHA
This separation preserves constitutional safeguards while enabling operational agility at the service delivery level. To ensure feasibility and minimise disruption, the NHA will operate a dual-track employment framework.
Existing MOH personnel remain civil servants, seconded to the NHA with full preservation of accrued rights, pensions, and service continuity.
New clinical entrants and selected categories, particularly specialists and scarce skills, may be recruited directly under public NHA contracts. No compulsory migration is envisaged. Transition will be gradual and voluntary, ensuring workforce stability while enabling reform.
National salary structures and civil service pay principles remain intact. Within this framework, the NHA will be empowered — subject to MOF and JPA oversight — to implement structured scarcity, hardship, and rural incentives; contractual retention mechanisms for specialists and critical disciplines; regulated dual-practice arrangements, including enhanced Full Paying Patient (FPP) or Rakan KKM schemes; and streamlined internal mobility across facilities without loss of seniority.
These measures are intended to improve retention and service coverage while maintaining equity and fiscal discipline. The NHA will shift workforce planning from a predominantly headcount-based approach to activity- and acuity-based staffing models, ensuring closer alignment between service demand and workforce allocation.
Facility-level staffing plans will be integrated into national manpower forecasting, allowing more accurate deployment of resources and reducing reliance on ad-hoc or emergency measures. This approach enhances transparency, predictability, and responsiveness across the system.
Implementation In Phases
Implementation is proposed to proceed in phases to manage risk and ensure continuity of care. It can take three to five years to get the approval, enactment of NHA legislation, pilot phases, recruitment of new entrants under NHA contracts, roll out new reforms and incentives, and consolidation of a new entity.
The proposal does not require immediate expansion of overall headcount. Transitional costs relate primarily to administration and targeted incentives, which are expected to be offset over time by reduced attrition, improved efficiency, and better utilisation of existing human capital investments.
Key risks—including staff resistance, misperceptions of privatisation, and fiscal over-extension—are mitigated through voluntary transition, statutory public governance, and MOF-approved funding controls.
Malaysia’s health care workforce challenges are structural and cannot be resolved through isolated administrative reforms.
Establishing a National Health Authority as a statutory service operator provides a constitutionally sound, fiscally responsible, and operationally effective pathway to strengthen public health care delivery.
By separating policy stewardship from employment and service execution — while preserving civil service protections — the proposed model enables reform without destabilisation and positions Malaysia’s public health care system for long-term sustainability.
Chua Hong Teck, PhD, is an independent public policy and health analyst.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
