The reluctance of doctors to accept permanent positions in Sabah and Sarawak should concern all of us.
Many of the reasons have already been discussed: distance from family, difficult working conditions, inadequate infrastructure, limited career opportunities and the challenges of serving in remote areas.
But simply repeating the problems will not solve them.
With the federal budget this October, followed by the Sabah and Sarawak state budgets, this is the right time for both the federal and state governments to act.
We need to go back to basics and ask a simple question: What would make a young doctor genuinely want to come to Sabah or Sarawak, build a career here and perhaps eventually make Borneo home?
The approach should no longer be: “You have been posted to Sabah or Sarawak. Report for duty.” Instead, the message should be: “Come to Sabah and Sarawak, and build your career.”
That requires a completely different approach.
Start With Recruitment
Sending someone unwillingly to a place where he or she has no desire to work is unlikely to produce long-term retention.
Priority should therefore be given to:
- Sabah- and Sarawak-born doctors, as well as doctors with family ties to either state.
- Medical officers who voluntarily choose to serve in Borneo.
- Doctors who completed their housemanship or significant medical training in Sabah or Sarawak and have already developed professional and personal connections here.
The objective should not merely be to fill vacancies. It should be to recruit doctors who have a reasonable prospect of staying.
Make Borneo Service Attractive
The federal government should introduce a comprehensive Borneo Medical Service Package in the upcoming national budget.
This should include an enhanced Borneo allowance, with higher payments for increasingly remote postings. A doctor serving deep in the interior should receive substantially greater incentives than one working in a major urban centre.
The allowance should also increase progressively with each year of continued service. But money alone will not retain doctors.
Doctors who commit at least three years to Sabah or Sarawak should receive a clearly defined career pathway, including improved access to postgraduate and specialist training.
If we tell young doctors to spend some of the most important years of their professional lives in Borneo, we must show them that those years will advance their careers, not delay them.
Those who complete an agreed minimum period of service should also have a clear pathway to request transfer should they subsequently wish to return closer to their families.
Other practical incentives should include:
- Twice-yearly funded return flights to visit their families.
- Safe, furnished accommodation with reliable electricity, water, internet access and parking.
- Full reimbursement of relocation expenses.
- Assistance with children’s education, spouse employment or transfers, and support where elderly parents require care.
- Government-funded professional courses and conferences.
- Regular rotations through tertiary hospitals so doctors working in smaller or rural facilities continue to develop specialist skills and clinical exposure.
State Governments Must Also Play Their Part
Health care may largely be a federal responsibility, but Sabah and Sarawak can contribute significantly to retention.
The state governments should consider providing an additional state allowance for doctors serving in their states, particularly those working in difficult or underserved areas. A year-end state service incentive or bonus could also be considered for doctors who remain in designated areas.
More importantly, the states must address the living conditions surrounding our health care facilities.
We cannot invite a doctor to serve in rural Borneo and then expect him or her to tolerate unreliable water, electricity, poor internet connectivity, inadequate roads, unsafe accommodation, or poor security.
These are not luxuries. They are basic requirements for attracting and retaining a modern health care workforce.
Give Young Doctors A Reason To Stay
If these commitments are provided, our young doctors must also be prepared to respond.
Give Sabah or Sarawak three years of your life. Consider it not merely a posting, but an adventure, a period of professional growth and an opportunity to experience a part of Malaysia that many people never truly get to know.
Many of us came to Sabah and Sarawak decades ago under very different circumstances. Some of us never went back. We built our careers, raised our families and made Borneo our home.
The new generation is different, and understandably so. They think carefully about career progression, family responsibilities, education, quality of life and long-term professional development.
Government policy must recognise that reality. Stop treating Borneo postings as vacancies to be filled
This is ultimately about changing the philosophy of health care manpower planning. Recruitment is not retention. Getting a doctor onto an aeroplane to Sabah or Sarawak does not solve the problem.
The real measure of success is whether that doctor is still here three, five or 10 years later, professionally fulfilled, properly supported and willing to encourage another young doctor to come.
That requires cooperation between the federal government and the governments of Sabah and Sarawak.
The federal government must provide the funding, career pathways, allowances, training opportunities and manpower policies. The state governments must help provide the infrastructure, accommodation, connectivity, security and living environment that make staying possible.
And both sides must recognise one fundamental reality: Health care in Borneo will cost more. Geography, distance, rural populations and infrastructure challenges make that unavoidable.
Therefore, the federal government has little choice but to increase health care funding for Sabah and Sarawak, while the state governments must ensure that the basic conditions necessary to attract and retain health care professionals are progressively improved.
The problem has been discussed long enough. It is time to stop explaining why doctors do not want to stay in Sabah and Sarawak, and start giving them compelling reasons to stay.
The author is the immediate past president and founding president of the Association of Private Practitioners Sabah (APPS).
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
