Digitalising Healthcare in Sabah: Why Online Appointments Must Match Development

DIGITAL appointments are often framed as progress, a system where patients book online, arrive on time, queues are reduced, and efficiency improves. In theory, this model fits neatly into a modern health system that values speed, order, and predictability. In practice, the idea becomes far more complicated once it meets the geography and lived realities of Sabah.

In the final weeks of December 2025, rumours spreading online suggested that government clinics would soon refuse walk-in patients altogether, triggering unease among many Sabahans who rely on physical attendance rather than digital systems. Although the Ministry of Health Malaysia (MOH) swiftly clarified that walk-in services would remain available, particularly for emergencies, senior citizens, and those without access to technology, the episode exposed a deeper and long-standing anxiety about access to care in places, where going fully digital remains out of reach. The clarification itself quietly acknowledged an uncomfortable truth. Digital healthcare cannot move faster than the ground it stands on.

For many Sabahans, the challenge begins long before opening the MySejahtera application. Internet access remains uneven and unreliable, particularly in rural areas. Sabah has long struggled with broadband access. According to the Malaysian Communications and Multimedia Commission (MCMC), fixed broadband penetration in the state stood at just 2.7 subscriptions per 100 people in 2019, placing Sabah at the bottom nationally. While mobile broadband coverage has expanded on paper, many rural and interior communities continue to experience unstable connectivity that makes everyday digital services difficult to depend on.

Mobile broadband penetration reflects the same imbalance, with Sabah recording the lowest rate in Malaysia at 78.8%, compared to a national figure exceeding 100%. These figures are not abstract measurements of progress. They describe daily constraints, where families share devices, ration mobile data, or live with patchy signals that vanish whenever it rains.

During the pandemic, these gaps became visible to the rest of the country through widely shared stories of Sabahan students in Pitas, most notably Veveonah Mosibin, who climbed trees and trekked uphill to secure a stable internet signal for online examinations, reflecting a reality faced by many rural students across the state. Those moments were often treated as extraordinary, even inspirational. For many rural communities, they were neither. They were routine. Studies suggest that around 35% of Malaysia’s rural population still lacks consistent internet access due to poor coverage or high costs, and Sabah’s interior districts are disproportionately represented within that group. An appointment system that assumes universal connectivity risks excluding those who already face the greatest barriers to care.

Connectivity alone does not define access. Sabah’s physical landscape imposes its own limits. Large parts of the state remain separated by long distances, rugged terrain, and road networks that are frequently damaged or impassable during monsoon seasons. Poorly maintained rural roads can isolate entire villages, cutting them off from clinics, schools, and markets. In some interior areas, residents must still travel on foot, through forest trails or even by boats to reach basic healthcare services. In places such as Terian, Long Pasia, and island communities like Pulau Jambongan and Pulau Bum Bum, patients often rely on river transport or long jungle paths to reach the nearest clinic, journeys that can take several hours and are easily disrupted by heavy rain or rising water levels. Under these conditions, fixed appointment times become an added burden rather than a convenience, especially when flooding or damaged roads make timely arrival impossible.

Even where access is possible, capacity remains a pressing concern. Sabah’s doctor-to-population ratio stands at roughly 1:800 people, far worse than the World Health Organization (WHO) recommendation of 1:200 and double the ratio seen in Peninsular Malaysia. The shortage extends beyond personnel to facilities themselves. With a population of 3.4 million, Sabah currently operates with only 95 government health clinics, a figure cited during the 2026 Sabah state budget debate to highlight disparities in healthcare access; in comparison, Sarawak has 194 government clinics to serve a broadly similar population.
In towns such as Sandakan, where the Duchess of Kent Hospital remains the main referral centre for the east coast and clinics in the district struggle under heavy patient demand, lawmakers and health advocates have repeatedly raised concerns about overcrowding, long waits, and insufficient facilities to serve the population.

For rural patients, this imbalance often translates into repeated long-distance travel for follow-up visits, specialist care, or chronic disease management. Elderly individuals, pregnant mothers, and patients with long-term conditions carry this burden most heavily. When appointments are scarce and travel is difficult, missing a single slot can mean delaying care for weeks. In this context, insisting on appointment-only systems without flexibility risks widening rather than narrowing health inequities.

Digital literacy further complicates the picture. Many older Sabahans are unfamiliar with smartphone applications or uncomfortable navigating online systems. Some do not own smartphones at all. Others depend on younger family members who may live or work far from home. For these groups, digital-only entry points to healthcare are not merely inconvenient. They are exclusionary.

There is also a patient safety dimension that deserves attention. Digital systems do more than organize queues. They shape how and when people decide to seek care. When appointment pathways delay early clinical assessment or shift triage decisions onto patients and families, the risk of late presentation and preventable complications increases. This risk falls most heavily on older adults and individuals living with chronic conditions, for whom delays can carry serious consequences. Digitalization must therefore be paired with clear guidance on warning signs, assisted navigation for those who struggle with technology, and clinician-led triage to ensure urgent cases are identified early rather than filtered out by rigid booking systems.

This is why walk-in services continue to matter. They function as a safety net, ensuring that access to care is not determined by signal strength, device ownership, or technological confidence. Maintaining walk-ins is not resistance to progress. It is recognition that healthcare systems must serve people as they are, not as policy documents assume them to be.

At the same time, Sabah is not standing still. Significant investments are underway to expand both digital and physical infrastructure. Under the National Digital Network (JENDELA) plan, 4G coverage in Sabah’s populated areas has grown to nearly 97%, with ongoing efforts to extend high-speed fibre links and build out 5G access across more communities, while rural development plans continue to target improvements in roads, electricity, and water supply.

In healthcare, innovative models are beginning to emerge. Telehealth services at NADI internet centres allow villagers to consult doctors and undergo basic screenings closer to home. Pilot projects using drones for medicine delivery and satellite-powered telehealth kiosks in areas without connectivity suggest that technology can be adapted to local contexts rather than imposed upon them.

What is often missing from this discussion is the role of fiscal capacity. Sabah’s 40% net revenue entitlement under the Malaysia Agreement 1963 (MA63) presents a real opportunity to address the structural gaps that make digital-only healthcare unrealistic. If directed wisely, these funds could strengthen primary care clinics, improve rural road access, support mobile and outreach services, and expand community-based digital access, ensuring that healthcare digitalisation rests on solid foundations rather than assumptions.

From a public health perspective, the issue is not resistance to technology but readiness. Dr. Ahmad Asyraf bin Abdul Rahim, a Public Health Medicine Specialist and District Health Officer, Papar District Health Office, stated that “In rural and semi-rural districts, barriers to care are layered. Connectivity, transport, manpower shortages, and health literacy all intersect. While the Ministry of Health Malaysia continues to make significant efforts to equip clinics with adequate ICT infrastructure to support digitalisation, gaps in these foundational determinants remain. When digital systems are rolled out without fully strengthening these basics, those most at risk of being left behind include rural households, older adults, and patients with chronic conditions. In that sense, flexibility is not inefficiency. It is equity.”

These initiatives offer an important lesson. Digital health works best when it complements development rather than substitutes for it. In Sabah, progress requires hybrid systems that combine online appointments with on-site registration, community outreach, and triage processes that allow healthcare staff to prioritise patients based on clinical need and local access constraints, rather than rigid appointment rules alone. It requires recognising that efficiency cannot come at the cost of equity, and that innovation must be grounded in the realities of geography, infrastructure, and human capacity.

Sabah’s slower pace in adopting fully online health appointments is often framed as lagging behind. A more honest reading is that development has been uneven, and healthcare digitalisation cannot outrun that history. Technology should lower barriers, not raise new ones. Until connectivity, infrastructure, and healthcare capacity are truly more evenly distributed, the most responsible path forward is one that balances ambition with compassion, and progress with inclusion.

Footnote : Melvin Ebin Bondi is a PhD candidate in Public Health at Universiti Malaysia Sabah. He writes a weekly public health column for The Borneo Post.