SPECIAL REPORT The maintenance of the facilities in public hospitals in Malaysia, otherwise known as hospital support services (HSS), had been outsourced to private companies since 1996, when 15-year concessions were awarded to several companies.

These concessions were worth a total of RM7.5 billion, economist Chan Chee Khoon told Malaysiakini , adding that one of the companies had its contract renewed in 2015 for another 10 years.

These concessions were "negotiated tenders", he explained, adding that they are not awarded through an open, competitive bidding process.

"How does the Health Ministry ensure that it gets value for money?" he asked.

He revealed that many of the officers from the ministry who were previously handling the in-house HSS had also left to join the new concessionaires, something which may raise some eyebrows, if not totally out of the ordinary.

But more urgently he noted that this left a hole in the ministry's expertise pool which had to be plugged in with another outsourcing project costing more taxpayers' money.

Since the ministry now lacks personnel who could properly benchmark and monitor the performance of the concessionaires, it also had to outsource the monitoring to another contractor, Sistem Hospital Awasan Taraf Sdn Bhd (Sihat), he said.

"With all these transactional costs, where are the savings and efficiency gains?" he asked.

Chan noted that in the Health Ministry's annual report for 2012, it is stated that the HSS fees had increased from RM500 million in 1997 to RM1.1 billion in 2011 to accommodate for the increase in HSS assets.

The HSS contracted out to the companies consisted of five services – the facilities engineering maintenance services (FEMS), biomedical engineering maintenance services (BEMS), clinical waste management services (CWMS), cleansing services (CLS) and linen and laundry services (LLS), according to the Health Ministry.

Though the Budget 2016 recently underwent a revision to adapt to the reduced government income following the falling global oil prices, Chan said that he has not seen any explicit mention of cuts to HSS, nor were there significant increases.

"On the other hand, patient loads at public hospitals will increase as the economy slows down, as our weakening ringgit translates into escalating medical charges at private hospitals," said Chan ( pix ).

News reports last month have already highlighted the issues that public hospitals are facing with their maintenance, with air-conditioning units breaking down in public hospitals in Kuantan, Selayang, Malacca and Segamat.

Yesterday, Malaysiakini also highlighted a personal account of the substandard conditions of the facilities at public hospital in Johor.

Sihat, which was tasked with monitoring the performance of the concessionaires, sealed its agreement with the Health Ministry in 2006, according to the ministry's annual report in 2006, though, according to the firm's website, it had been a consultant to the ministry for HSS-related matters since 1997.

Within the same year, the report noted that a total of 45 complaints had been recorded and follow-up action had supposedly been taken.

"A database, known as ADU, was constructed to retain complaints from hospitals regarding non-compliance of HSS clause towards the concession company," the report read.

It is not known if the issues faced by the hospitals with reported problems are also recorded in the system and if the issues had been addressed.

Malaysiakini has reached out to the health director-general on an update on the database and other issues related to HSS concessions but has yet to receive a reply.

Related story:

Part 1: Hospital horror - after air-con glitches, now lifts malfunction