KUALA LUMPUR, May 6 — The Galen Centre for Health and Social Policy has recommended the formation of a Health Service Commission (SPK) with the power to create permanent positions and set salary scales.
Galen Centre chief executive Azrul Mohd Khalib suggested that emoluments and funding for positions in the health service could be earmarked in a five-year fiscal framework under the SPK, as agreed by the Ministry of Health (MOH), Ministry of Finance (MOF), and Parliament.
“Within that approved budget envelope, the SPK should have authority to fill posts, prioritise critical shortages, and plan long-term staffing,” Azrul told CodeBlue.
Ring-fenced five-year funding subject to approval, he said, would simultaneously address issues of short-term requests for positions and mitigate the use of an autonomous SPK as a “blank cheque”.
Azrul stressed that the SPK must be designed with “clear fiscal safeguards”, with funding coming through MOF and approved in the national budget process.
“Malaysia’s health workforce crisis is no longer a routine HR problem. It directly affects patient safety, waiting times, burnout, access to medicines, specialist services, and the ability of public hospitals and clinics to function,” he said.
“Health care staffing cannot be managed like a generic civil service headcount exercise under the Public Service Department (JPA). It is totally unsuited for managing health care workers.
“An SPK could help by giving the health sector a dedicated body that understands the needs of hospitals, clinics, public health services, laboratories, pharmacies, and emergency care.
“It could speed up recruitment, reduce dependence on short-term contracts, improve career pathways, and plan staffing based on service needs rather than ad-hoc, yearly approvals or which government is in power.”
Ring-fencing funding for health care workers on a five-year basis under an SPK, instead of being subject to annual budget allocations, may help protect positions and allowances that are vulnerable to spending cuts, such as the Regional Incentive Payment (BIW) allowance for transfers to East Malaysia.
The existing Education Service Commission (SPP) and Judicial and Legal Service Commission (SPKP) – which regulate staff in the respective services separately from the general civil service under the Public Service Commission (SPA) – do not have the authority to create new positions or set salary schemes for these positions.
Salaries to civil servants are paid out from the federal consolidated fund managed by the MOF. One of the concerns about an autonomous SPK with powers to create or fill positions, or decide salaries, is that this may create a situation where salaries to be paid exceed the amount that can be allocated by the government.
Under Article 144 of the Federal Constitution, the duties of service commissions are limited to appointing an individual into the civil service, confirming that person under a pensionable scheme, and promoting civil servants or exercising disciplinary functions.
The creation and filling of new positions are still under JPA’s purview, subject to budget allocations by the MOF.
Hence, the Galen Centre’s proposal will likely require amendments to the Federal Constitution to give an SPK new powers that aren’t provided to the SPP, SPKP, or SPA.
The think tank previously argued that doctors should be treated “special”, due to the importance of the public health care system.
Unlike teachers, police, or fire and rescue officers, doctors and nurses in Malaysia’s public service are particularly subject to intense poaching by either the private sector or other countries.
Doctors’ groups revived proposals for an independent SPK after Health director-general Dr Mahathar Abd Wahab’s rare public acknowledgment about the fragmentation of the health workforce pipeline, particularly doctors, between the Ministry of Higher Education (MOHE), JPA, and MOH.
Health Minister Dzulkefly Ahmad told reporters recently that the MOH has set up an Interministerial Special Task Force – comprising the MOH, MOHE, JPA, and MOF – to address doctor shortages.
MPs Mixed About Creating Health Service Commission With New Powers
Eight Members of Parliament polled by CodeBlue on both sides of the divide expressed different views, when asked if they would support the establishment of an SPK authorised to create new positions and set salary schemes for health care workers.
Dr Kelvin Yii (PH-Bandar Kuching) said such an autonomous SPK was critical to depoliticising and professionalising Malaysia’s health care workforce in the public sector.
“While the process may have its technical challenges, this is an important long-term step to truly establish a commission that can make informed decisions on grounds that are implementable.
“Such a commission would enable agile, merit-based human resource management, break bureaucratic delays, and improve recruitment and retention of medical personnel,” Dr Yii told CodeBlue.
The Sarawakian legislator stressed that the SPK must be staffed by individuals trained in health system management or health economics, not solely by administrative and diplomatic (PTD) officers.
“This ensures that decisions are grounded in the operational and financial realities of health care delivery. Including allied health professionals alongside medical doctors further broadens the necessary perspective, fostering a more efficient, responsive, and equitable health system.”
Suhaizan Kaiat (PH-Pulai), however, disagreed with establishing a Health Service Commission, opining that complexity in creating health manpower lay with the MOH.
“In short, the solution is to increase salaries, provide incentives, create a conducive work environment, and reduce workloads in general hospitals. Those are the duties of the MOF and MOH; there’s no need for a Health Service Commission,” said Suhaizan, who is also chairman of the Health parliamentary special select committee (PSSC).
Dr Ahmad Yunus Hairi (PN-Kuala Langat), who is a member of the Health PSSC, expressed support for an SPK empowered to create new positions and determine financial remuneration.
“Positions/human resources and emoluments/salaries are big issues in the health service because of our dual health care system,” Dr Yunus told CodeBlue.
“The attrition of doctors and specialists is rising every year, while the interest of the young generation in this field continues to decline. Needs for the health service are increasing in an ageing nation. We need an SPK to fix the currently fragmented system.”
Isnaraissah Munirah Majilis (Warisan-Kota Belud) said she was in favour of establishing an SPK with autonomy over positions and salaries, but stressed the need for transparent financial governance.
“We must ensure that this doesn’t create an excessive silo that ends up jeopardising coordination between ministries,” she told CodeBlue.
“My main focus is to ensure that this SPK will have a specific mandate to close the gap in facilities and specialist manpower in areas such as Kota Belud and the interior regions of Sabah/Sarawak. Salary autonomy can be used as an incentive to attract specialists to serve in rural areas.
“I am prepared to support this reform measure in Parliament, provided that its primary objective is to safeguard the welfare of health care workers and ensure people’s access to quality, comprehensive care regardless of geographic location.”
Wilfred Madius Tangau (Upko-Tuaran) similarly backed the establishment of an SPK, highlighting overcrowding in public hospitals, the migration of health care professionals to the private sector or abroad, and disparities in access to care.
“That said, it is equally important to acknowledge that the establishment of a Commission is not without its challenges. There is the risk of overlapping mandates with existing institutions, which could result in inefficiencies unless roles are clearly defined and well-coordinated,” the Sabahan MP told CodeBlue.
“For the Commission to succeed, it must be anchored in a clear legislative framework, supported by strong governance principles, and developed through meaningful engagement with key stakeholders—including health care professionals, regulators, and the wider public.”
Three other MPs – Tan Kar Hing (PH-Gopeng), Dr Halimah Ali (PN-Kapar), and Young Syefura Othman (PH-Bentong) – reserved judgment on the proposed SPK.
Young Syefura said the Health PSSC was still reviewing the proposal for an SPK, clarifying that the committee’s recommendation last August to “defer” its formation didn’t mean that the PSSC opposed it.
“There are several matters that need to be reviewed and reassessed, such as whether, if the SPK is established, it should be granted full authority to address health care workers’ welfare issues, or whether that mandate should instead be entrusted to existing authorities within the MOH,” the Health PSSC member told CodeBlue.
Tan said he was still studying the feasibility and long-term impact of the proposed SPK, particularly because it involved amending the Federal Constitution.
“However, I agree that we must urgently strengthen the health service scheme. Any reform we consider must move beyond administrative changes and deliver improvements in career progression, workplace welfare, and the overall resilience of our health care system.”
Dr Halimah called for a royal commission of inquiry (RCI) to be held first to diagnose structural problems in the health care system before looking at whether an SPK should be established.
“To be honest, we need to know the root cause of the chronic workforce problem in MOH. Only a royal commission can get facts and figures. With accurate analysis, then only we can offer the right solutions,” she told CodeBlue.
“MOH doesn’t just have a numbers’ issue, but bullying, doctor suicides etc.”
