The prime minister’s announcement that the government will phase out the contract system for medical officers and offer permanent posts to more than 9,000 contract doctors in 2027 has injected some hope into the healthcare workforce.
Budget 2027 also raised the post-basic incentive for nurses and paramedics from RM100 to RM200 a month, and the Air Health Service incentive from RM30 to RM100.
These moves recognise that a health service cannot run on buildings and equipment alone. It depends on people who are trained, supported and willing to stay.
These are significant commitments. However, success will ultimately depend on whether the government can recruit these healthcare workers, relocate them and provide the support they need to remain where their services are most needed.
Recent figures show why the situation remains troubling.
In the latest round of medical officer postings, only 673 of the 1,055 medical officers offered placements in Sabah and Sarawak had reported for duty.
Those who did not report cited relocation costs, personal and family circumstances, health concerns and limited opportunities for specialist training.
In all fairness, the health ministry has made significant strides over the past few weeks in addressing these concerns and taking immediate steps to retain healthcare workers, particularly young medical officers.
For doctors moving to East Malaysia, the government had already agreed in February to allow eligible contract doctors offered permanent appointments in 2025 to claim transfer and relocation costs, with claims of up to 100% for inter-regional moves.
Earlier this month, the ministry also confirmed approval for claims by specified cohorts.
This represents significant progress, but it is important to clarify that this is not a newly introduced allowance.
On social media, officers continue to express frustration over the lack of clarity and transparency in the application and payment processes.
Clear rules on eligible expenses, advances, documentation and payment timelines are needed. Most importantly, these rules must be communicated to relocating officers in a timely manner so they can access the support before relocation costs become a barrier.
Additionally, on Oct 8, the health minister said that eligible medical officers returning to their home regions could receive a disturbance allowance equivalent to one month’s basic salary.
Later that week, the minister also announced that the ministry was studying a proposal to allocate a dedicated 30% share of Federal Training Award places to medical officers serving in Sabah and Sarawak. Both measures could make postings more attractive, but the proposed training quota remains under study and has yet to be implemented.
For those who are unclear about the issue, it may be helpful to explain the allowances available to officers.
Bayaran Imbuhan Wilayah (BIW) supports eligible officers serving outside their home regions. Bayaran Imbuhan Sara Hidup (BISH) is a cost-of-living allowance linked to locality, while Bayaran Insentif Mengikut Lokasi dan Tahap Kesusahan (BIMLTK) applies to designated facilities in remote or difficult areas, with rates determined by hardship level.
Under the current rules, BIMLTK is tiered, while BIW has fixed rates for newly eligible officers and protections for existing recipients.
One concern raised relates to BIW. Previously, the allowance was calculated as a percentage of salary. Following the change to a fixed-rate structure, some officers have seen their actual payments fall significantly.
BISH is determined by locality and officers’ grades, which may not accurately reflect actual living costs. Meanwhile, BIMLTK eligibility is tied to designated facilities rather than rural status alone.
The overarching concern is the lack of clarity over why an individual qualifies for, or is excluded from, a particular allowance. With different rules and arrangements being implemented, officers have little transparent information on how their entitlements are determined.
Therefore, the government should publish the relevant claim rules, required documents, processing deadlines and payment dates within the next fortnight, and allow advances to be paid before relocation.
Within the next three to six months, the government should establish a centralised digital service linked to ePlacement, allowing officers to check their entitlements, apply directly, upload documents once and track the progress of their cases.
It should also review the fixed BIW rate and assess remote sites across Sabah, Sarawak and qualifying parts of Perak, Kelantan, Terengganu, Pahang and Johor against consistent criteria.
In the longer term, the government should work with state governments to prioritise the repair and maintenance of health service residential quarters in rural and remote areas, while developing clear rural career pathways for doctors, nurses and other healthcare workers.
A coordinated, phased approach to these measures should help address the barriers preventing younger officers from taking up their postings. The issue should not be reduced to a question of willingness to serve, nor should it be attributed to a lack of interest or patriotism.
Over the past fortnight, the government has made several welcome commitments to the healthcare workforce, further reinforced by the 2027 Budget.
The next test is delivery: clear entitlements, timely relocation support, fair regional allowances and credible career pathways.
A posting letter can fill a vacancy only when the terms make the move possible — and give people a reason to stay.
The views expressed are those of the writer and do not necessarily reflect those of FMT.