In Sarawak, where dense rainforests and scattered rural settlements shape the land, access to consistent and quality healthcare has long been a logistical challenge. For many communities in the interior, reaching the nearest clinic or hospital can mean hours (or even days) of travel by road, boat, or foot. These realities have amplified the urgency for innovative, scalable healthcare solutions.
Telemedicine and digital health tools are emerging as a vital part of that solution. By enabling remote consultations, digital diagnostics, and virtual health monitoring, these technologies are helping Sarawak overcome the traditional boundaries of distance and infrastructure. Over time, digital health access is becoming a lifeline for those living far from urban centres.
Backed by Sarawak’s broader digital economy agenda and post-pandemic development strategies, telehealth initiatives are gaining ground. As Sarawak continues its digital transformation, this article explores how telemedicine is evolving across the state: the successes seen so far, the gaps that remain, and what it will take to build an inclusive, resilient healthcare future.
Understanding the Context: Healthcare Access and Digital Health in Sarawak
Delivering quality healthcare in Sarawak is an immense logistical undertaking. With a landmass nearly equivalent to Peninsular Malaysia but a far lower population density (only 23 people per square kilometre compared to the national average of 99) Sarawak’s geography alone presents structural obstacles.
Poor road connectivity, limited public transport, and inconsistent digital infrastructure further complicate the delivery of equitable health services, especially in rural and interior regions where 45.3% of Sarawakians live; almost double the national average of 24.4%.
The Health Access Gap: Infrastructure, Workforce, and Costs
A comprehensive review by the Health Thematic Group of the Sarawak CSO-SDG Alliance paints a stark picture of facility conditions across the state. Of Sarawak’s 272 government health clinics, over 75% are classified as being in poor condition. Many lack essentials such as treated water (30%), tar-sealed road access (26%), and reliable electricity (12%). Internet connectivity – crucial for digital health systems – is also unavailable at more than half of these clinics.
Staffing is another critical issue: in many cases, rural clinics operate without doctors, staffed only by a handful of medical assistants. One such clinic, serving over 2,000 residents across seven villages and two schools, is managed by just two assistants.
Access is not merely a matter of infrastructure but also affordability. The financial burden of seeking treatment can be immense for rural residents, with indirect costs such as transportation and accommodation often exceeding actual medical fees. In low-income households or in cases of chronic illness, these out-of-pocket expenses can be a significant barrier to care. Civil society groups point to international research, such as findings from India, showing that indirect costs account for up to 96% of cancer-related healthcare expenses – a pattern echoed in rural Sarawak.
Compounding these challenges is a persistent shortage of medical professionals. The state faces a shortfall of over 2,000 doctors. Although Universiti Malaysia Sarawak (UNIMAS) graduates around 150 doctors annually, not all are Sarawakians – and many local professionals remain based in Peninsular Malaysia.
“At this rate, it will take us a decade just to produce 1,500 doctors,” noted Deputy Premier Dr Sim Kui Hian, underlining the urgency of long-term workforce planning.
To address these systemic gaps, civil society groups and policymakers alike are advocating for decentralised healthcare governance. Delegating authority to regional and district levels could empower local authorities to tailor services to the unique health needs of their communities.
Proposals include modernising the Village Health Promoter (VHP) scheme into a more professional Community Health Worker (CHW) model, revitalising mobile medical teams, and training district-level hospitals to enhance care access in underserved areas.
Recognising these structural hurdles, the Sarawak government has taken a proactive stance by self-funding the Public Health Master Plan 2050, which outlines a RM17 billion investment roadmap to overhaul healthcare infrastructure and delivery. The plan positions Sarawak as a potential model for decentralised, people-centric health systems tailored to diverse terrains and communities.
Digital Health as a Strategic Response
Parallel to these systemic reforms is a growing emphasis on digital health innovation – positioned as both a response to Sarawak’s geographic realities and a pillar of its long-term digital transformation strategy. Central to this push is the Sarawak Digital Economy Blueprint 2030, which identifies digital health as a priority sector to modernise service delivery, reduce inefficiencies, and extend care to remote populations.
Among the key initiatives is the Digital Health Platform, a comprehensive system aimed at integrating health data and services across Sarawak. With a RM10 million allocation approved in 2024, this platform is expected to serve as the digital backbone for patient records, hospital coordination, and public health management. Complementing this is the Ministry of Health’s forthcoming Digital Health Records policy, which promises seamless, secure data sharing across healthcare facilities.
To support clinical decision-making and knowledge transfer, Sarawak is also adopting hub-and-spoke models and tele-mentoring systems. These setups connect specialist hospitals in urban centres with rural clinics, enabling remote diagnostics, consultations, and even supervision of local medical procedures. Cloud-based systems now allow for real-time data exchange, laying the groundwork for continuity of care even across difficult terrain.
Reliable connectivity is, of course, a prerequisite. Sarawak has invested RM3.5 billion since 2020 to extend high-speed internet to rural and interior areas. This effort is supported at the federal level by the JENDELA initiative, which works in tandem with state programs like SALURAN to deliver digital infrastructure capable of supporting health services.
Digital transformation extends beyond infrastructure. Sarawak clinics are beginning to adopt the Cloud-based Clinical Management System (CCMS) under a nationwide initiative, expected to reduce patient wait times drastically (from an average of three hours to just 30 minutes) while also safeguarding medical records against disasters such as floods.
Public-private partnerships are also emerging as key drivers. For example, the Diagnosis-Related Group (Casemix) system implemented by the Malaysia Productivity Corporation in collaboration with private healthcare providers uses digital analytics to enhance cost transparency, resource planning, and service quality in hospitals.
Further, collaborations with institutions like UNIMAS and Sarawak General Hospital have birthed digital dashboards and patient care platforms aimed at improving real-time monitoring and care delivery.
Local Implementations: Grounding Sarawak’s Digital Health Future
Sarawak has begun to embed many of these lessons into its own digital health transformation, leveraging both public innovation and strategic partnerships.
A landmark example is Sihat Xpress, a collaborative initiative by MEASAT and Mudah Healthtech. Announced in May 2024, this project aims to deploy up to 2,000 telehealth kiosks across rural Malaysia, including remote areas of Sarawak. By enabling self-checks and doctor consultations via MEASAT’s satellite broadband, these kiosks are tackling one of Sarawak’s most persistent barriers – access to timely care for rural populations.
Meanwhile, teleconsultation services in government clinics are expanding rapidly. As of 2025, over 500 public clinics nationwide, including many in Sarawak, offer virtual follow-ups, particularly for chronic illness management, family planning, and maternal health. These services are integrated into the MySejahtera app, replacing earlier ad hoc solutions and offering patients a unified digital health interface.
To structurally support these innovations, the Ministry of Health (MoH) has established a Digital Health Division and is rolling out an ICT Masterplan across Sarawak. This includes implementing Electronic Medical Records (EMRs) and Electronic Lifetime Health Records (ELHRs) and planning a Health Information Exchange (HIE) – crucial for secure, real-time data sharing across health facilities.
Sarawak’s own initiatives are equally notable. The Sarawak Wound Care Digital Platform, launched in early May 2025, targets diabetic wound care in underserved populations. This initiative provides education, specialist referrals, and remote care tools for healthcare workers and patients alike. It represents a new model of proactive, digital-first intervention in the fight against non-communicable diseases.
The use of Artificial Intelligence (AI) in Sarawak’s telemedicine is also gaining traction. As of early 2025, the MoH has begun pilot programs integrating AI for diagnostics and teleconsultation quality control, enhancing access and accuracy in remote care.
All these digital health efforts are underpinned by Sarawak’s broader digital economy strategy. Infrastructure programs like JENDELA and Sarawak’s RM3.5 billion connectivity investment (since 2020) ensure that telemedicine services are not just piloted, but scalable and sustainable. Without robust internet access, these tools cannot reach their full potential, hence the crucial role of connectivity in achieving healthcare equity.
Impact and Challenges: Building an Equitable Digital Health Landscape in Sarawak
Sarawak’s early telemedicine and digital health initiatives have already yielded significant, measurable benefits – especially in accessibility, chronic disease management, and system efficiency. At the same time, the state’s efforts remain a work in progress, with notable challenges that must be addressed to secure long-term sustainability and inclusivity.
Tangible Benefits of Digital Health in Sarawak
One of the most transformative outcomes of digital health in Sarawak is improved accessibility. In a state where geographic barriers have historically limited healthcare access, telemedicine now allows patients in remote communities to receive care without enduring long travel times or logistical burdens. This is especially impactful for Indigenous populations and interior settlements where health services are often irregular.
In addition to convenience, cost-effectiveness has emerged as a critical advantage. Teleconsultations are generally more affordable than physical visits, reducing financial strain on patients while helping public health facilities better allocate limited resources. By minimising unnecessary in-person appointments, these services also reduce congestion in government clinics.
Efficiency gains have been equally striking. Clinics adopting digital patient management platforms have reported a reduction in waiting times from several hours to mere minutes. Telehealth platforms also expedite referrals, enable faster follow-ups, and reduce administrative burdens for healthcare staff.
Importantly, telehealth empowers patient engagement and self-care, a cornerstone of modern public health. Digital tools such as remote monitoring, medication reminders, and educational portals enable patients to participate actively in managing their own health, particularly in managing chronic illnesses like diabetes and hypertension.
These digital capabilities support continuity of care for chronic disease patients, allowing consistent monitoring and early intervention. Programs such as diabetic retinopathy screening and the recently launched wound care platform are already improving outcomes by facilitating earlier detection and response.
The resilience of Sarawak’s healthcare system was also tested and proven during the COVID-19 pandemic, when telemedicine provided a critical continuity channel. Digital consultations enabled care delivery while minimising infection risk, and the success of this shift has accelerated telehealth’s permanent integration into public healthcare.
All of this has been underpinned by investments in digital infrastructure, including broadband connectivity through federal programs like JENDELA and Sarawak’s own Digital Economy Strategy. These infrastructure upgrades have enabled services such as Sihat Xpress kiosks and rural teleconsultation hubs to operate in even the most digitally underserved regions.
Persistent Challenges in Expanding Digital Health
Despite these advances, Sarawak’s digital health ecosystem faces several entrenched challenges. Chief among them are infrastructure limitations. Many rural health clinics continue to struggle with inconsistent internet access, which hampers teleconsultations and the use of cloud-based patient data systems.
Equally pressing is the issue of digital literacy and acceptance, particularly among older residents who may lack experience or trust in digital platforms. Building user confidence through community outreach and training will be essential to ensuring equitable uptake.
From a governance standpoint, regulatory gaps remain a risk. While the Online Healthcare Services Regulatory Lab (OHS RegLab) provides interim guidance, Sarawak still lacks a dedicated legal framework governing digital health. Without formal laws, issues around data privacy, consent, liability, and platform misuse persist, especially as AI becomes more deeply integrated into diagnostics.
Another concern is inadequate data collection and integration, particularly from rural or Indigenous communities. These data gaps make it difficult to track health outcomes accurately, evaluate program effectiveness, or address health disparities with evidence-based policies. Advocacy from civil society groups continues to push for more inclusive and ethical data practices.
Workforce limitations further constrain the system. There are not enough healthcare workers trained to deliver digital health services at scale. Many clinics are still adapting to EMRs and telehealth platforms, and frontline staff require ongoing digital skills training to provide high-quality care.
The issue of equity and the digital divide looms large. Not all Sarawakians have equal access to smartphones, computers, or stable internet. Unless digital health services are designed to accommodate these disparities (e.g., multilingual interfaces, offline options, community mediators), there’s a risk of reinforcing existing healthcare inequalities.
Telemedicine’s sustainability is another open question. Services must be regularly evaluated and refined based on patient outcomes and feedback. Without continuous improvement mechanisms, telehealth may plateau or become under-utilised, particularly in more complex care scenarios.
Financial constraints also present risks. Core health outreach programs like the Flying Doctor Service remain essential in areas beyond digital reach, yet face chronic underfunding. Telemedicine should complement, not replace these vital services.
Finally, the integration of AI presents ethical and legal concerns. While AI can enhance diagnostic speed and accuracy, it also opens doors to risks like misidentification through deepfakes or filtered video consultations. Safeguards are urgently needed to ensure ethical AI use in healthcare, especially in remote interactions where patient verification is challenging.
Future Directions: Refining Telemedicine and Digital Health for All Sarawakians
To fully unlock the promise of telemedicine and digital health, Sarawak must address the structural, human, and systemic gaps that currently limit the reach and effectiveness of these services. A coordinated, multi-sectoral approach is essential to ensure that digital health continues to evolve not as a parallel system, but as a core pillar of public healthcare delivery.
1. Expanding Infrastructure and Connectivity
At the heart of any digital health solution lies the availability of fast, stable internet. While significant progress has been made under the JENDELA initiative and Sarawak’s own digital economy strategy, many rural clinics and longhouses still lack reliable connectivity, impeding teleconsultations and data-sharing capabilities.
Expanding access through projects like Metro-E, which aims to provide fibre-based infrastructure and cloud computing capacity to underserved areas, is essential to support continuous, high-quality care via telemedicine platforms.
2. Strengthening the Healthcare Workforce
A robust telehealth system also depends on the readiness of healthcare professionals to manage new digital workflows. This includes targeted training programs for clinical staff on teleconsultation protocols, remote diagnostics, and patient data management. Furthermore, Sarawak must address the maldistribution of medical specialists, who are heavily concentrated in urban hospitals.
Through tele-mentoring and hub-and-spoke referral models, specialist knowledge can be extended to peripheral clinics – enhancing service quality without necessitating full-time deployment to rural posts.
3. Empowering Patients through Digital Literacy
Patients are not just recipients of digital care – they are active participants. However, low digital literacy remains a major barrier, particularly among elderly populations and those unfamiliar with online platforms. Targeted patient education, community-led outreach, and culturally appropriate support services are needed to help users adapt to digital consultations and health monitoring apps.
In parallel, ensuring patients can provide accurate health data from home, such as blood pressure or glucose levels, will improve the effectiveness of remote clinical decision-making.
4. Establishing Strong Policy and Regulatory Foundations
A key enabler of sustainable telemedicine is a clear, enforceable legal and regulatory framework. While interim guidance exists through the Online Healthcare Services Regulatory Lab, Sarawak would benefit from comprehensive legislation such as a Digital Health Act to address critical concerns like data privacy, liability, professional standards, and cross-jurisdictional care.
In tandem, healthcare institutions will require support in the form of change-management programs to transition safely and efficiently into virtual service delivery aligned with national healthcare transformation goals.
5. Data-Driven Planning and Equity-Oriented Design
Evidence-based planning begins with better data. Disaggregated health information from remote and Indigenous communities is essential to identifying service gaps, health inequities, and specific intervention needs.
Policymakers must also consider social determinants of health, such as income, transportation costs, and educational access, to ensure digital health services do not unintentionally widen disparities. Stronger collaboration with local NGOs and researchers can improve data quality and inform more inclusive service design.
6. Ensuring Cost Effectiveness and Quality of Care
While affordability is a core strength of telemedicine, cost-effectiveness must not come at the expense of care quality. Telehealth services must adhere to clinical standards and integrate auxiliary capabilities such as real-time vital sign monitoring, two-way interactive sessions, and remote diagnostics to improve outcomes and build trust among patients.
Regular performance evaluations and patient feedback mechanisms should be institutionalised to ensure continuous improvement.
Conclusion: Towards a Healthier, Digitally Inclusive Sarawak
Sarawak has made a strong start in embedding telemedicine into its healthcare strategy, with clear gains in accessibility, system efficiency, and resilience. However, to move from pilot projects to a truly inclusive digital health ecosystem, sustained investment, cross-sector collaboration, and responsive policy frameworks will be critical.
By expanding infrastructure, investing in workforce readiness, supporting patient engagement, enacting strong governance, and embracing data-informed planning, Sarawak can chart a path toward a healthcare future that is accessible, affordable, and equitable regardless of geography or socioeconomic status. In doing so, the state can serve as a model for how digital transformation can be harnessed not just to modernise healthcare, but to humanise it.
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MALAYSIA’S TELEMEDICINE BLUEPRINT: LEADING HEALTHCARE INTO THE INFORMATION AGE (1997)
