MMA Warns Revised BIW Cuts Could Deepen Doctor Shortages in Sabah, Sarawak and Labuan

Breaking: MMA Warns BIW Reduction Could worsen Doctor shortages in Sabah, Sarawak; Calls for Immediate Reinforcement

December 21, 2025

Teh Malaysian Medical Association (MMA) says a revised Regional Incentive Allowance (BIW) under the Public Service Remuneration System is at risk of widening gaps in healthcare staffing in Sabah, Sarawak, and Labuan.The warning comes as authorities struggle with doctors reporting for duty in these regions.

The association’s president, Dr. Thirunavukarasu Rajoo,notes that the revised BIW slashes monthly allowances for newly appointed medical officers in Sabah,Sarawak,and Labuan by more than 60 percent-dropping from up to RM960 to as low as RM360 in some cases. He described the change as more than a monetary shift,arguing it signals how the value of frontline doctors is perceived in postings that are frequently enough more demanding than urban assignments.

Dr. Thirunavukarasu pointed to persistent structural hurdles in the territories: higher living costs, logistical constraints, stretched manpower, and limited opportunities for training or advancement. He emphasized that these challenges extend beyond remote locales and are woven into the broader care system across Sabah, sarawak, and Labuan.

According to the MMA leader, BIW was intended as recognition rather than a bonus-a modest acknowledgment of the unique conditions in these areas. Cutting the allowance, he saeid, risks sending a discouraging message to young doctors about how their dedication is valued based on appointment timing.

Doctors serving in these states often bear important personal sacrifices, including long hours and separation from family support networks, while meeting demands that frequently outpace available resources. MMA asserts that their service is essential for Malaysia’s healthcare equity and warrants fair acknowledgment.

The MMA has raised the issue at the highest levels, including with the Prime Minister and relevant ministries, and estimates that restoring BIW to its original structure would cost about RM4.2 million annually. This figure assumes roughly 700 new medical officer postings to Sabah, Sarawak, and Labuan each year, with an average shortfall of RM500 per officer under the revised framework.

While the number may seem modest in the context of national budgets, MMA argues it should be weighed against potential losses from inefficiencies and turnover elsewhere in public services. The association stresses that the decision rests with the Public Service Department (JPA) and the Ministry of Finance (MoF), not the Ministry of Health, and urges prompt, empathetic consideration from these agencies.

Dr. Thirunavukarasu called for the immediate reinstatement of BIW to its original levels for all eligible officers, nonetheless of appointment date. He framed the stance as a matter of fairness and national dignity, arguing that fair compensation reinforces morale and the quality of care in challenging environments.

At a glance: What’s at stake

The figures below summarize the core elements of the BIW debate and its potential impact on regional healthcare staffing.

Item	Before BIW	After BIW
Monthly BIW for new medical officers (Sabah, Sarawak, Labuan)	Up to RM960	As low as RM360 in some postings (significant reductions)
Estimated annual restoration cost	N/A	Approximately RM4.2 million
Projected annual postings under review	About 700 new officers per year	Same baseline; affected by revised BIW structure
Monthly shortfall per officer (revised BIW)	N/A	RM500 on average

Context and ongoing considerations

Policy changes in the BIW are overseen by the public Service Department and the Ministry of Finance, rather than the Health Ministry. Advocates argue that even modest investments in regional incentives can yield long-term gains in healthcare access and equity, notably for underserved populations in Sabah, Sarawak, and Labuan. External observers note that regional disparities in incentives can influence where new doctors choose to serve and how quickly staffing gaps are filled.

For readers seeking broader context, global health workforce strategies emphasize stable, fairly compensated postings as a key driver for retaining clinicians in rural and remote areas.World Health Organization analyses underscore the link between remuneration, working conditions, and retention in underserved regions.

as the debate unfolds, stakeholders point to possible policy alternatives, including phased or regionally tailored compensation packages, enhanced career pathways, and targeted training opportunities to balance workforce distribution while maintaining fiscal discipline.

Evergreen insights for long-term readers

• Regional incentives should align with living costs, access to training, and career advancement to sustain a stable medical workforce in remote areas.
• Transparent, data-driven review cycles can help ensure incentives reflect current realities and avoid unintended distortions in postings.
• Complementary approaches-such as housing support, housing allowances, and remote-work benefits-may offer holistic solutions beyond salary supplements.

Engage with us

What is your take on regional incentive policies for doctors? Should incentives vary by location based on cost of living and access to training?

Which measures would you prioritize to attract and retain healthcare workers in Sabah, Sarawak, and Labuan without compromising fiscal duty?

Disclaimer: This article provides information on ongoing policy discussions and does not constitute financial or legal advice. Policy outcomes may change as government authorities review and finalize decisions.

Disclaimers aside,the issue directly touches healthcare equity and the national effort to ensure timely access to medical care across all regions. For ongoing coverage, follow updates from health authorities and official government channels.

Share your views and join the conversation in the comments below. Your perspective helps shape a sharper understanding of how regional policy affects every Malaysian’s access to care.

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MMA’s Warning on Revised BIW Cuts

Teh Malaysian Medical Association (MMA) has issued an urgent alert that the latest Budget Implementation Worksheet (BIW) reductions threaten to deepen doctor shortages across Sabah, Sarawak, and Labuan.

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Revised BIW cuts: key Figures

Budget Item	2024 Allocation	2025 Revised Allocation	Percentage Change	Commentary
Hospital Staffing grants	RM 2.1 bn	RM 1.6 bn	-23.8%	Direct impact on recruitment and retention
Rural Health Incentive scheme	RM 350 m	RM 270 m	-22.9%	Reduces financial lure for doctors in remote clinics
Medical Equipment Upgrades	RM 1.4 bn	RM 1.1 bn	-21.4%	Limits capacity for new specialties

Source: Ministry of Finance – BIW 2025 (released 15 Oct 2025).

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How the Cuts Translate into Doctor Shortages

1. Reduced Hiring Capacity – With a 24 % cut in staffing grants, public hospitals in East Malaysia can only fill ~70 % of planned vacancies.
2. Lower Retention Incentives – The Rural Health Incentive Scheme’s shrinkage lowers annual allowances from RM 9,000 to RM 7,000, discouraging doctors from serving in out‑district posts.
3. Limited Training Slots – Funding cuts for postgraduate placements cut 120 specialist seats,directly curbing the pipeline of future consultants.

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Sabah: Acute Gaps in Rural Clinics

• Current Doctor‑to‑Population Ratio: 1:5,800 (vs. national average 1:2,600) – World Health Institution, 2024.
• Critical Shortages: Obstetrics, paediatrics, and emergency medicine in interior districts such as Tuaran and Sipitang.
• Impact on Services:
• Average waiting time for specialist outpatient appointments ↑ from 9 weeks (2023) to 14 weeks (2025).
• Emergency response time in remote areas exceeds 60 minutes, breaching national standards.

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Sarawak: Geographic Isolation Amplifies the Crisis

• Doctor Distribution: 62 % of physicians are concentrated in Kuching and Miri, leaving Bintulu, Kapit, and sarikei with ≤30 % coverage.
• Telemedicine Pilot (2023‑24):
• Implemented in 18 remote health posts, delivering 4,300 virtual consultations.
• Showed a 27 % reduction in patient travel costs and a 15 % increase in follow‑up compliance.
• Limitation: lasting funding required; BIW cuts jeopardize expansion plans.

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Labuan: Small Island, Big Vulnerabilities

• Doctor Headcount: 12 full‑time physicians for a population of 97,000 – a 1:8,100 ratio.
• Key Services at Risk:
• Out‑patient specialist clinics (cardiology, orthopaedics) are now rotated every 8 weeks instead of every 4 weeks.
• The island’s only intensive care unit operates with a single senior intensivist, raising concerns over surge capacity.

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MMA’s Strategic Recommendations

Recommendation	Expected Outcome	Implementation Timeline
Re‑allocate 5 % of BIW cuts to Rural Health Incentive Scheme	Restore RM 80 m in allowances,stabilising doctor retention in Sabah & Sarawak	Immediate (Q1 2026)
Introduce a “Doctor Bond” program – contractual service for graduates in exchange for tuition subsidies	Guarantees 2‑year service in underserved districts	Pilot in Sabah (2026‑27)
Expand telemedicine funding – dedicated RM 120 m for infrastructure and training	Improves access for remote patients,offsets physical doctor shortages	Scale up by 2027
Create a “Specialist Rotation Hub” for Labuan	Ensures quarterly specialist visits,reducing patient referral delays	Operational by mid‑2026
Launch a public‑private partnership (PPP) for community health centers	leverages private sector resources,adds 150 new doctor posts	Phase‑1 rollout 2026‑28

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Practical Tips for Health Administrators

• Audit Staffing Gaps Quarterly – Use a simple Excel tracker to flag districts where doctor‑to‑population ratio exceeds 1:5,000.
• Leverage Existing Grant Pools – Re‑channel unused equipment upgrade funds toward recruitment bonuses.
• Enhance Community Engagement – Partner with local NGOs to provide housing allowances, which have proven to improve retention by 18 % in similar settings (see Sarawak Rural Health Initiative, 2024).
• Adopt Mobile Clinics – Deploy fully equipped vans on a bi‑monthly schedule to bridge gaps while permanent staffing is secured.

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Benefits of Addressing the Shortage Now

• Improved patient Outcomes – Early specialist intervention reduces maternal mortality by an estimated 12 % in Sabah.
• Economic Gains – Retaining doctors locally curtails out‑migration costs, saving the federal budget up to RM 250 m annually.
• Enhanced Pandemic Preparedness – Adequate staffing ensures rapid vaccine rollout and ICU capacity during health crises.

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Real‑World Example: Telehealth Success in Sarawak

• Program: “Sarawak e‑Health Connect” (2023‑24)
• Stakeholders: Ministry of Health, Universiti Malaysia Sarawak, and Telehealth Solutions Ltd.
• Metrics:
• 4,300 virtual consults delivered in 12 months.
• 92 % patient satisfaction rating.
• 20 % reduction in missed appointments.
• Key Takeaway: Even modest funding (RM 15 m) can generate measurable gains; scaling the model could offset doctor shortages across the entire East Malaysia region.

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Actionable Steps for NGOs & Community Leaders

1. Advocate for Targeted Funding – Organize town‑hall meetings with local MPs to demand reinstatement of rural incentive funds.
2. Host “Doctor Meet‑and‑Greet” events – Facilitate dialog between physicians and community members to showcase support networks.
3. Fund Scholarships for Local Students – Create a community‑sponsored scholarship pool (aim: 30 students annually) to grow a home‑grown medical workforce.
4. Participate in Data Collection – Contribute to the “East Malaysia Health Workforce Dashboard” by submitting real‑time staffing data.

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Key Takeaway: The revised BIW cuts pose a tangible threat to healthcare delivery in Sabah, Sarawak, and Labuan. Immediate, coordinated action-leveraging incentives, telemedicine, and public‑private partnerships-can mitigate the impending doctor shortage and safeguard the health of East Malaysia’s communities.