1

ACCELERATING SECTORAL GOVERNANCE REFORM

(ASRR):

Private Higher Education

Accreditation of Nursing Programme

Final Draft Report

8 Jul y 2017

MALAYSIA PRODUCTIVITY CORPORATION

Transformation. Innovation. Partnership

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Contents

FOREWORD ......................................................................................................................................................... 4

ABBREVIATIONS ............................................................................................................................................... 6

GLOSSARY ........................................................................................................................................................... 6

Section 1: About the Review ............................................................................................................10

1.0 Introduction to the Review ................................................................. 10

1.1 Conduct of the Study .....................................................................................................15

1.2 Scope of the ASRR Study ................................................................. 17

1.3 ASSR (Higher Education): Accreditation of Nursing Programme ...... 18

1.4 Structure of the Report ...................................................................... 18

Section 2: Regulations and Regulatory Burdens ...................................................................20

2.1 Purpose of Regulation ....................................................................... 20

2.2 Regulatory Burdens .......................................................................... 21

2.3 Unnecessary Regulatory Burdens ..................................................... 22

2.4 Government Initiative in Good Regulatory Practice ........................... 27

2.5 Costs of Regulatory Compliance ....................................................... 29

Section 3: Economic Analysis and Education Value Chain .............................................32

3.0 Snapshot of Education Sector (with statistical data) .......................... 32

3.1 Malaysian Education Levels .............................................................. 35

3.1.1 Higher Education and Professional Qualification............................................36

3.1.2 Enrollment into Higher Education ...................................................... 37

Section 4: Acts and Regulations (Accreditation of a Nursing Programme) ..............40

4.0 Introduction to the Regulators ........................................................... 40

4.1. Governing Authority for Higher Education, MOHE ............................. 41

4.2 Malaysian Qualifications Agency (MQA) .............................................................41

4.2.1 Accreditation of Higher Education Programmes ................................ 43

4.2.2 Malaysian Qualifications Framework (MQF) .....................................................44

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4.3 Malaysia Nursing Board (MNB) ......................................................... 45

4.5 Accreditation Process of a Nursing Programme ................................ 48

4.6.1 Standards for Accreditation of Nursing Courses in Malaysia ............. 53

Section 5: Analysis of Findings and Recommendations ....................................................54

5.0 Background Information ................................................................... 54

5.1 Analysis of Findings .......................................................................... 55

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FOREWORD

Through regulation the government can leverage its policy interests on

businesses. Regulation can contribute to a range of social, environmental and

economic goals. However, in practice, many regulations are not implemented

efficiently or cost-effectively, and some regulations do not even adequately

achieve the ends for which they are designed. Poor regulatory regimes

invariably result in unnecessary regulatory burdens which will stifle business

growth.

Malaysia Productivity Corporation (MPC) had since 2013, started the work on a

comprehensive review of business regulations affecting the conduct of

businesses in Malaysia based on the mandate stipulated under the 10th

Malaysia Plan.

In essence, MPC is mandated to review those regulations affecting the conduct

of business in Malaysia with the view to modernise business regulations. This is

crucial in order for the country to move towards its aspiration of becoming a

high-income nation. Towards this, MPC has embarked on review of existing

business regulations – for a start, focusing on the 12 National Key Economic

Areas (NKEAs) which have been identified as having high growth potential.

At the same time, MPC, through the MSDC (Malaysia Services Development

Council) Meeting chaired by YB MITI Minister was tasked to spearhead the

Working Group on Institutional and Legislative Framework (2013-2014). The

primary focus was on reviews of regulations affecting the services sector. The

work to improve the regulatory environment for services sector has been

expanded and on-going and in 2015, based on EPU Development of Action

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Plan Services Sector Blueprint 2014, WGILF was then renamed as WGGR

(Working Group on Governance Reform). Under the Action Plan Services

Sector Blueprint report, WGGR continues to deliberate on Accelerating Sectoral

Governance Reform (ASRR) and expanding the implementation of the National

Policy for Development and Implementation of Regulations (NPDIR).

WGGR membership was also expanded to ministries and agencies involved or

affected by the regulations that are being deliberated at the WGGR meetings.

In this study, the research team led by Puan Jamaliah Binti Daud has been

tasked to examine the regulatory regimes of the education sector with the aim

of recommending options to remove unnecessary regulatory burdens. For this

particular study, the focus is on the higher education sector (pilot study on

accreditation process of a Nursing programme). The sector was selected as it

is deemed as high value added, high knowledge-based and one of the growing

sectors identified under the Services Sector Blueprint.

The study emulated the approach used by the Australian Government

Productivity Commission (AGPC). The team selected a sample of private higher

education institutions and private hospitals with own nursing schools (in Klang

Valley) and carried out interviews with the senior management personnel to

identify the issues of concern relating to the various regulations imposed on

accreditation of a nursing programme. From these issues and using principles

of good regulatory practices, the team then formulated feasible options for

further deliberation. These issues and options will be subjected to public

consultation with relevant stakeholders in order to develop concrete

recommendations to reduce unnecessary regulatory burdens on private

hospitals.

In the course of the study, MPC benefited greatly from discussions with some

PHEIs, Professional Bodies (Malaysia Nursing Board), Ministry of Higher

Education, Malaysian Qualifications Agency, relevant business association

(APHM), government officials and other related business organisations.

The study was conducted in MPC Head Office by the PCD Smart Regulation

Directorate led by Mr. Zahid Ismail.

MPC is grateful to all those who assisted it.

Dato’ Mohd Razali Hussain

Director General Malaysia Productivity Corporation (MPC)

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ABBREVIATIONS

APHM Association of Private Hospitals Malaysia

EPU Economic Planning Unit

FA Full Accreditation

MITI Ministry of International Trade and Industry

MOC Malaysia Optical Council

MOE Ministry of Education

MOHE Ministry of Higher Education

MNB Malaysia Nursing Board

MQA Malaysian Qualifications Agency

MSDC Malaysia Services Development Council

PA Provisional Accreditation

PHEI Private Higher Education Institution

PEMUDAH Pasukan Petugas Khas Pemudahcara Perniagaan

(Special Taskforce to Facilitate Business)

PHFS Private Healthcare Facilities and Services

PTPTN Perbadanan Tabung Pendidikan Tinggi Nasional

(National Higher Education Fund Board)

WGGR Working Group on Governance Reform

GLOSSARY

Accreditation Recognition granted by the Malaysian Qualification

Agency after examining and assessing :—

(a) a higher education programme or qualification;

or

(b) a higher education provider under Chapter 4 or

7 of Part VIII of the MQA 2007 which is in

accordance with the Framework;

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GLOSSARY

Ministry of Higher

Education (MOHE)

Government ministry responsible for Malaysian

educational matters (higher education).

Ministry of Education Government ministry responsible for Malaysian

educational matters (from kindergarten to secondary

school).

Malaysian

Qualifications Agency

Agency established under section 4 of the MQA Act

2007 :

(a) to implement and update the Malaysian

Qualifications Framework;

(b) to accredit programmes, qualifications and

higher education providers;

(c) to conduct institutional audit and review of

programmes, qualifications and higher

education providers;

(d) to establish and maintain a register to register

programmes, qualifications and higher

education providers;

(e) to conduct courses, training programmes and

to provide consultancy and advisory services

relating to quality assurance;

(f) to establish and maintain liaison and

cooperation with quality assurance and

accreditation bodies in higher education within

and outside Malaysia;

(g) to act as a qualifications reference centre on

accredited programmes, qualifications and

higher education providers;

(h) to advise the Minister on any matters relating

to quality assurance in higher education; and

(i) to do all things reasonably necessary for the

performance of its functions under MQA Act

2007.

Professional Bodies Any Body established under any written law for the

purposes of regulating a profession and its

qualifications or any other body recognised by the

Government;

Malaysia Nursing

Board

A restructured body within the Ministry of Health

Malaysia currently under the directions of the

Director General of Health and was established in

1954.

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GLOSSARY

PHEIs An aspect of higher education, which is driven

primarily by private entrepreneurial initiatives rather

than by the state.

Regulation Any laws or other government ‘rules’ which

influence the way people behave. It is not limited to

primary or delegated legislation; it also includes

‘quasi-regulation’ (such as codes of conduct,

advisory instruments or notes etc) where there is a

reasonable expectation by government on

compliance.

International students Those who travel to a country different from their

own for the purpose of tertiary study.

Board of Architects

Malaysia

A statutory authority responsible for the

enforcement of the Architects Act 1967.

Board of Engineers

Malaysia

A statutory body constituted under the Registration

of Engineers Act 1967 with perpetual succession

and a common seal, which may sue and be sued. It

was formed on 23rd August 1972.

Bar Council The Central council of the Malaysian Bar

established under section 47 of Legal Profession

Act 1976.

Regulatory Impact

Statement (RIS)

The RIS is a document prepared by the department,

agency, statutory authority or board responsible for

a regulatory proposal following consultation with

affected parties, formalising and evidencing some of

the steps that must be taken in good policy

formulation. It requires an assessment of the costs

and benefits of each option, followed by a

recommendation supporting the most effective and

efficient option. It must be incorporated into the

assessment process used by all areas of

government responsible for reviewing and reforming

regulations.

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Key Points

MPC which has been mandated to facilitate the implementation of the

National Policy on the Development and Implementation of Regulations has

taken the initiative to carry out this regulatory review with the aim of reducing

unnecessary regulatory burdens on the education sector.

The objective of MPC is to:

Validate and report the concerns raised in the Services Sector

Blueprint Report on the tedious process of accreditation of a tertiary

programme (focusing on a nursing programme, as a pilot case study),

which is found to be one of most concerns with PHEIs.

Provide recommended options for further reviews and discussions

with interested parties.

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Section 1: About the Review

Content: (1.0) Introduction to the Review, (1.1) Conduct of the study, (1.2) Scope of the ASRR

Study, (1.3) ASRR (Higher Education): Accreditation of Nursing Programme, (1.4) Structure of

the Report

1.0 Introduction to the Review

The growth of the Malaysian economy started to plateau after the Eighth

Malaysia Plan. This was of great concern to the county’s leadership as we have

crossed the half-way mark towards the national Vision 2020 to becoming a

high-income and developed nation. The country seems to be struck in the so-

called middle-income trap (Figure 1.1). The world’s Middle Income Countries

(MICs), are those having a per capita gross national income of US$1,026 to

$12,475 (2011).

Figure 1.1: The Middle-income Trap1

1 The Economist 2016: Focus - The middle-income trap;

http://www.economist.com/blogs/graphicdetail/2012/03/focus-3

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Source: World Bank (The Economist)

This realisation prompted the Government to enhance its collaboration with the

private sector. The focus of this collaboration is to address the misalignment of

regulatory practices that stifle the ease of doing business. In 2007, the

Government took a significant step in rationalising Malaysia’s regulatory regime

by launching PEMUDAH, a special task force to facilitate business. This is a

cross jurisdictional collaborative taskforce between Government ministries and

the private sector.

During the first three years of its inception, PEMUDAH worked on issues

relating to the ease of doing business as raised by the private sector. Many of

the issues which were successfully resolved relate to problems of complying

with local regulations. From these initial successes the Government realised an

institutional programme on good regulatory practice would be needed for the

country. This resulted in a new development programme being formally

incorporated into the 10th Malaysia Plan.

In the 10th Malaysia Plan it was mandated on MPC to carry out regulatory

reviews with the goal of making it easier to do business in Malaysia. The review

is in line with the aspiration envisaged in the New Economic Model (NEM) to

transform Malaysia into a developed economy. The NEM strongly indicates the

need for good regulatory management to improve regulatory quality. The 10th

Malaysia Plan in Chapter 3 on Modernising Business states:-

“The regulatory environment has a substantial effect on the behaviour and

performance of companies. Private sector participation in the economy

and innovation require a regulatory environment provides the necessary

protections and guidelines, while promoting competition”. Too often,

Malaysian firms face a tangle of regulations that have accumulated over

the years and now constrain growth. At the same time, regulations that

would promote competition and innovation are absent or insufficiently

powerful”. “To achieve this goal, the Government will begin with a

comprehensive review of business regulations, starting with regulations

that impact the NKEAs”.

Specifically, the MPC was:

To review existing regulations with a view to removing unnecessary

rules and compliance costs. Priority is given to regulations affecting

NKEAs.

To ensure that regulators conduct regulatory impact assessment for

new regulations.

To make recommendations to the Cabinet on policy and regulatory

changes that will remove unnecessary regulatory burdens and

enhance productivity.

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The reviews of existing regulation involve public consultation with stakeholders

and interested parties. The process will be implemented with the intention to

improve the quality of existing regulations. Other processes within MPC will

focus on ensuring the good quality of new regulation particularly by applying

regulatory impact analysis.

In the Regulatory Review Framework shown in Figure 1.2, the review process

takes into account both government and business perspectives as well as

reports, data and reasoning of organisations such as the World Bank, the

OECD and the Australian Government Productivity Commission (AGPC).

Figure 1.2: Regulatory Review Framework

Source: Malaysia Productivity Corporation (2013)

With the mandate, MPC has since implemented the National Policy on the

Development and Implementation of Regulations (NPDIR) which was launched

by the Chief Secretary to the Government of Malaysia in July 2013. This

document was established to support the modernisation of the regulatory

regime in the country. The focus of the document states:

“Global competition, social, economic and technological changes require

the government to consider the inter-related impacts of regulatory

regimes, to ensure that their regulatory structures and processes continue

to be relevant and robust, transparent, accountable and forward-looking.”

Essentially, the document is targeted to promote the NEM policy objective of

improving economic efficiency through enabling fair competition. The objective

of NPDIR is to ensure that Malaysia’s regulatory regime effectively supports the

country’s aspirations to be a high-income and progressive nation whose

economy is competitive, subscribes to sustainable development and inclusive

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growth. The policy is to ensure a regulatory process that is effective, efficient

and accountable as well as to achieve greater coherence among policy

objectives of government.

It took more than three years for the NPDIR to be formulated and established

and four years for it to be “officially implemented”. The NPDIR is not merely

changing the rules of implementing regulatory regime, but involving paradigm

change from a “control” regime to a “facilitating” regime. It will take a long time,

perhaps a decade or two, for such a paradigm change to take root. This is

unfortunate as time is not in the country’s favour with less the five years

towards Vision 2020. Unless this is appreciated, Vision 2020 is going to be a

pipe dream.

This realisation is observed in the emphasis made in the 11th Malaysia Plan

which calls for accelerating regulatory reforms, as stated in clause 1.24:

“Regulation reforms will be accelerated to ensure new and existing

regulations as well as their administration and enforcement are aligned

with good regulatory practices. This will be done by expanding the

adoption of the National Policy on Development and Implementation of

Regulations (NPDIR), and conducting regular regulatory review for

ministries and agencies. In addition, a “cost-in, cost-out” evaluation will be

applied on all new business regulations to reduce regulatory burden.

Under this evaluation, the direct cost of each new regulation on the private

sector will be determined and the introduction of the new regulation will

need to be accompanied by the abolishment of outdated or unnecessary

business regulations to ensure that the total regulatory cost to business

does not increase.”2

Since the introduction of the NPDIR, MPC has carried out various regulatory

reviews on Reducing Unnecessary Regulatory Burdens (RURB) on business. It

has been a slow incremental change in the implementation of the NPDIR which

begs the question whether the significance on accelerating regulatory reforms

is appreciated by all involved parties in the Government.

In the meantime, MPC continues with the RURB initiative at sectoral level to

promote change in regulatory mind-set. The study on accelerating sectoral

regulatory reforms for the private higher education on the accreditation of

nursing programme is another attempt at this.

The study is aimed at reviewing the impact of the existing regulatory regime to

the ease of doing business in the private higher education industry and to

2 Malaysia 2015, The Eleventh Malaysia Plan, 2016-2020, Economic Planning Unit;

http://rmk11.epu.gov.my/index.php/en/

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recommend feasible options to reduce the unnecessary regulatory burdens on

the business.

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1.1 Conduct of the Study

The study will involve the collection, review and analysis of data and

information from secondary data from literature reviews and followed with

interviews of related key stakeholders in the private higher education industry.

Secondary data are from many sources and are classified as follows:

i. The existing regulations in force on the industry

ii. Relevant local business information on the sector

iii. Research papers published by international agencies such as the

World Bank, the UNESCO, ICEF, ASEAN, among others

iv. Country papers such as the AGPC and the OECD

v. Local research papers and reports commissioned by the government

such as the Economic Planning Unit (EPU), Ministry of International

Trade and Industry (MITI), the Ministry of Higher Education (MOHE)

and Malaysian Qualifications Agency (MQA)

vi. The Malaysian Government Plans such as the 5-year plans, the

Higher Education Master Plan, the NKEAs

vii. Statistical data from both international and local sources such as the

World Bank, WTO, MITI, MOHE, MQA, DOS, MNB (Malaysia Nursing

Board), WENR (World Education News and Reviews)

viii. Other information derived from federal, state and local government

agencies, quasi-government bodies, trade associations, businesses

and news, reports and statistics

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Generally, the study is conducted in a systematic approach as illustrated in

Figure 1.3.

In order to identify the issues to be addressed, primary data was collected

through interviews with business players, associations, and relevant regulators.

The draft report is then released for comments and feedback from stakeholders

and other interested parties. These include the businesses, non-governmental

organisations (NGOs), the consumers, regulators and other Government

agencies.

The study is being carried out in two stages. Firstly is the exploratory stage to

prepare the draft report which will identify the feasible options for reducing

identified unnecessary regulatory burdens. To facilitate the interviews and data

collection, an issues paper with a list of questions was prepared and circulated

to the respondents.

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The second stage is public consultation with stakeholders and interested

parties. After receiving comments and feedback on the draft report, the MPC

will produce a final report containing the assessment, comments and final

recommendations.

1.2 Scope of the ASRR Study

In undertaking the annual reviews, the MPC would:

1. identify specific areas of the Government regulation that:

a. are unnecessarily burdensome, complex or redundant; or

b. duplicate regulations or the role of regulatory bodies, including in

other jurisdictions;

2. develop a short list of priority areas for removing or reducing regulatory

burdens which impact mainly on the sector under review and have the

potential to deliver the greatest productivity gains to the economy;

3. for this short list, identify regulatory and non-regulatory options, or

provide recommendations where appropriate to alleviate the regulatory

burden in those priority areas, including for small business; and

4. for this short list, identify reforms that will enhance regulatory

consistency across jurisdictions, or reduce duplication and overlap in

regulation or in the role of regulatory bodies in relation to the sector

under review.

In proposing a focused agenda and providing options and recommendations to

reduce regulatory burdens, the MPC is to:

seek public consultations at the beginning January 2017 to consult with

business, government agencies and other interested parties;

have regard to any other current or recent reviews commissioned by the

Governments affecting the regulatory burden faced by businesses in the

sector, including the Government’s response to the report of the

Taskforce on Reducing Regulatory Burdens on Business;

report on the considerations that inform the MPC's review of priorities

and reform options and recommendations; and

have regard to the underlying policy intent of government regulation

when proposing options and recommendations to reduce regulatory

burdens on business

The report will be published and the Government’s response announced as

soon as possible.

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1.3 ASSR (Higher Education): Accreditation of Nursing Programme

The study on ASRR Higher Education was initiated and elaborated from the

action plan items listed in the Services Sector Blueprint, as shown by the table

below:

Table 1.1 : Services Sector Blueprint by EPU

Source: Services Sector Blueprint by EPU

The study picked up from the issues raised on the accreditation process of a

tertiary programme, taking on the professional programmes, which the study

then zoomed into a pilot case of an accreditation of a Nursing Programme,

which is co-processed by MQA and MNB.

1.4 Structure of the Report

This report on the Review of Unnecessary Regulatory Burdens (RURB)

affecting the higher education industry has been organised into seven sections.

Section 1 highlights the rationale, the scope and approach of the study.

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Section 2 explains the regulations and its impact on business. It looks at the

regulatory burdens and the potential sources of unnecessary regulatory

burdens. It highlights how regulations are reviewed and reformed using good

regulatory practice principles with the focus on reducing unnecessary regulatory

burdens.

Section 3 is the economic analysis and overview of the Higher Education

sector. It looks at the industry characteristics of the trade and its economic

performance for the preceding year 2015.

Section 4 provides an overview of the regulatory regimes for the Higher

Education sector in Malaysia. The value chain analysis looks at the life cycle

stages of the businesses in the higher education and the main areas of

regulatory intervention. The related regulations, the regulatory controls and the

regulators are identified from the analysis.

Section 5 presents the analysis and findings of the regulatory related issues for

this study. Options are proposed for the regulatory issues of concern. Although

the study has identified a wide list of complaints/issues, the focus is only to

elaborate on pertinent regulatory issues that could be improved to create a

more conducive business environment for the Higher Education sector and in

particular, the Nursing Programme.

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Section 2: Regulations and Regulatory Burdens

Contents: (2.1) Purpose of regulation, (2.2) Regulatory burdens, (2.3) Unnecessary regulatory burdens, (2.4) Government Initiative in Good Regulatory Practice, (2.5) Costs of regulatory compliance

2.1 Purpose of Regulation

Regulation on business is intended to achieve certain desired objectives which

otherwise would not concern business, such as the protection of consumer

health and safety, protection of the environment, or ensuring market efficiency

among many others. Regulation may be defined differently depending on the

context. The “generic” definition embodies all written legal and quasi-legal

instruments ranging from primary legislation, secondary instruments,

guidelines, circulars, codes, standards and others.

In general, the government uses regulation as the principal means to address

risks to society, the economy or the environment which are not adequately

addressed by individuals and markets. Regulation encompasses the diverse set

of instruments used by government to:

influence people or control the way people as individuals or groups

behave

achieve a diverse range of economic, social, safety and environmental

policy objectives

As well as the content of written regulations, the way they are implemented,

administered and enforced is an important aspect of regulation and can have

significant impact on compliance burdens for businesses and the effectiveness

of regulation. It is important that the extent and intrusiveness of regulation

commensurate with the risk and, where individuals, communities and

businesses are able take actions to address the risk adequately, additional

government intervention may not be needed.

Traditionally, ‘regulation’ has been seen as establishing formal legal

requirements (written regulation) by government by way of acts, regulations and

rules. A broader view of regulation takes in non-legislative policy tools such as

information campaigns, education, persuasion, self-regulation or quasi-

regulation (codes of practice, guidelines, etc., that can also influence

behaviour).

Written regulation, which reflects a rational approach to risk, focuses on the

sources of risk, provides instruments which will address them effectively without

putting heavy requirements on business unless the size and the severity of the

impact is large enough to justify this. The more severe the impact of a particular

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hazard, the more likely it is that written regulation will be prescriptive and

impose higher penalties for non-compliance.

There are non-regulatory options to manage risks relating to security, safety

and health and the environment, such as:

quality accreditation scheme like the Good Manufacturing Practice

(GMP) accreditation

products standards and traceability standards recognised globally

commercial and ethical incentives for manufacturers, importers,

suppliers, etc. to ensure safety and quality standards are maintained

promotion and education of businesses on unwelcome outputs such as

pollution and environmental standards and practices

2.2 Regulatory burdens3

Where requirements from regulation create an undesirable change in business

behaviour and practices, a regulatory burden can be said to exist. Businesses

invariably experience some costs in complying with regulations that would

otherwise not arise. Most fall under the following four categories of cost

impacts:

1. administrative and operational requirements, such as:

reporting, record keeping

getting legal advice, training

2. requirements on the way goods are produced or services supplied, such

as:

requiring the use of certain forms of transport

restrictions on access to certain location

specification on type of handling or storage

3. requirements on the characteristics of what is produced or the services

supplied, such as:

how goods are handled, stored and transported

bonded warehouse requirements

specifications on packaging and labelling

4. lost production and marketing opportunities due to prohibitions, such as

when certain products are banned from being retailed

limiting hours of service (e.g. for operation hours of hypermarket)

restriction on firms cooperating for improving scale economy

3 MPC 2014, Reducing Unnecessary Regulatory Burdens – A Guide to Reducing Unnecessary

Regulatory Burdens: A core Concept, Malaysia Productivity Corporation

(http://www.mpc.gov.my/smart-regulation/)

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2.3 Unnecessary regulatory burdens

While it is usually necessary that some burden is placed on business for

regulation to achieve objectives, where regulation is poorly designed or written

or it is not administered or enforced well, it may impose greater burdens than

necessary.

Higher education includes post-secondary non-tertiary and tertiary education,

including granting of degrees at baccalaureate, graduate or post graduate level.

After a student has completed his/her upper secondary education

(SPM/O’Level) and obtained the pre-university qualifying results through

STPM/Matriculation /Foundation/Diploma or any other pre-university courses,

he/she can further his/her study to higher level of academic degrees as

follows4:

i. Bachelor’s Degree Undergraduate academic degree awarded for a

course or major that generally lasts three to four years.

ii. Master Postgraduate or graduate academic degree that lasts one to

three years in duration.

iii. Doctorate Highest level of academic degree comprises of three types:

research, first professional (USA only) and honorary. Research

doctorates publish academic research that represents at least a modest

contribution to human knowledge.

Note: The requirement for admission is at least a high school diploma or

equivalent general academic training5. MOHE promotes lifelong learning and

through MQA, recently launched APEL (C)6, i.e. a lifelong learning channel for

those without the required paper qualifications.

In Malaysia, those who intends to become a nurse has to undergo a 3-year

diploma or a 4-year degree in nursing to qualify as a Registered Nurse with the

Malaysia Nursing Board.

Box 2.1: Types of Unnecessary Regulatory Burdens

excessive coverage by a regulation — that is, the regulation affects more activity than was intended or required to achieve its objective (includes ‘regulatory creep’)

subject-specific regulation that covers much the same issues as other generic regulation

prescriptive regulation that unduly limits flexibility and prevents businesses from: o using the best technology o making product changes to better meet consumer demand

4 Higher Education, AEGEE (Association des Etats Généraux des Etudiants de l'Europe / European

Students' Forum), July 2016, http://www.wg.aegee.org/ewg/higheredu.htm

5 MSIC 2008 Ver. 1.0, Section P. Page P-2

6 APEL – Accreditation for Prior Experiential Learning

23

o meeting the underlying objectives of regulation in different ways

overly complex regulation

unwieldy licence application and approval processes

excessive time delays in obtaining responses and decisions from regulators

rules or enforcement approaches that inadvertently result in businesses operating in less efficient ways

unnecessarily invasive regulator behaviour, such as overly frequent inspections or irrelevant or duplicative information requests

an overlap or conflict in the activities of different regulators

inconsistent application or interpretation of regulation by officials Source: MPC 2014

Higher education is placed under Division 85 of MSIC 2008, specifically Group

853 Higher Education. This division includes two classes namely:

85301 College and university education (Public); and

85302 College and university education (Private)

This Group includes:

Technical and vocational education at post-secondary and university

levels;

Educational activities of military schools, colleges and academies;

Community college and polytechnics;

Commercial and other technical institutes; and

Nursing schools.

This study will cover higher education institutions, both private and public, that

offer nursing programmes in different level of academic degrees.

There will be many different regulations involved in higher education,

particularly the nursing programme’s governance. Different levels of nursing

academic degrees and its accreditation process are subjected to regulatory

burdens in one form or another. Corruption, the widespread and deep-rooted

abuse of entrusted power for private gain, is the greatest obstacle to economic

and social development around the world. High regulatory burdens tend to

foster corruption, as businesses try to avoid them.

To rid of the perception on corruption, regulators must be highly transparent in

their decision-making, administrative processes and service delivery. They

must be efficient in dealing with those they serve and be accountable.

Understanding how corruption creates uncertainty and cynicism for businesses

and how it undermines the achievement of government objectives will increase

the government’s resolve to eliminate corruption arising from unnecessary

regulatory burdens.

In summary, poor governance is the principle cause of unnecessary regulatory

burdens, resulting not only from poorly designed or written regulation and/or

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poor administration or enforcement regulation. This provides opportunities for

corrupt practices. Over the years, analysts have identified the more important

characteristics which regulation must satisfy to pass this test. Some important

characteristics of well written regulation are as shown in Box 2.2.

Box 2.2: Characteristics of well-written regulation

1. Proportionate: the requirements placed on business are proportionate to the risk being regulated, in particular low risks are not addressed by imposing onerous requirements

2. Appropriateness: the regulations make appropriate use of prescriptive, performance, in-principle and process-based requirement

3. Minimum requirement: the regulatory requirements are the minimum necessary to effectively achieve the objective(s) being targeted by the regulation

4. Responsive: in responsive regulation the regulations provide an adequate range of enforcement instruments to allow regulators some flexibility in addressing non-compliance

5. Consistency: the regulations are consistent with other regulation and do not create conflict, inconsistency or duplication

6. Transparency: the regulations are transparent, communicated effectively and readily accessible by everyone

7. Accountable: the regulations place accountability requirements on the regulator such as reporting, appeal and review provisions including some that address probity

Source: MPC (2014)

These important characteristics are achieved when regulations are made

according to good regulatory practice principles. There are six core principles

that would provide guidance to assess implementation by regulators.

There is a mix of options including self-regulation, quasi-regulation or co-

regulation to achieve the same purpose. Regulations that have been formulated

through a good practice regulation process can achieve policy objectives

without imposition of unnecessary regulatory burdens on business. Policy

objectives can be achieved by regulatory or non-regulatory means. According

to the OECD, ‘good’ regulation should:

serve clearly identified policy goals, and be effective in achieving those

goals

have a sound legal and empirical basis

produce benefits that justify costs, considering the distribution of effects

across society and taking economic, environmental and social effects

into account

minimise costs and market distortions

promote innovation through market incentives and goal-based

approaches

be clear, simple, and practical for users

be consistent with other regulations and policies

25

be compatible as far as possible with competition, trade and investment

facilitating principles at domestic and international levels

Box 2.3: Six Core Principles for Assessing Regulation and its Administration

Principle 1: have a proportionate and targeted response to the risk being addressed Principle 2: minimise adverse side-effects to only those necessary to achieve regulatory objectives at least cost Principle 3: have a responsive approach to incentivize compliance with regulation Principle 4: ensure consistency across regulation and consistency in the application of regulations across businesses and industries Principle 5: adopt transparency criteria, so interested parties are regularly consulted, it is clear to businesses what are their legal obligations and that all regulations are easily accessed by anyone Principle 6: accountability so that businesses can seek explanations of decisions made by regulators, as well as appeal them and there are probity provisions in order to reduce corruption (National Integrity Plan, 2004). Source: MPC (2014)

In 1995, the OECD Council has come out with a ten-question checklist

reflecting good principles for regulatory decision-making7 (Box 2.4). These

questions provide guidance to the authorities whenever there is a need to

consider government intervention in business.

However, there is the temptation for a regulator to lay down a prescriptive rule

that must be adhered to. This encourages certainty, particularly in the short

term and will suffice when dealing with issues for which limited alternatives exist

for achieving the objective of the regulation (such as outright prohibitions).

Against that though, a major problem with prescriptive rules is that they can

limit flexibility in meeting regulatory objectives and can retard innovation by the

business. Other problems with prescriptive rules are that they can be rendered

superfluous by technological change or encourage wasteful by-passing tactics

by industry.

7 (1) OECD 1995a, Recommendation of the Council of the OECD on Improving the Quality of

Government

Regulation, OECD/GD (95) Paris.

(2) OECD Report 1995b, Alternatives to Traditional Regulation;

http://www.oecd.org/gov/regulatorypolicy/42245468.pdf

26

Box 2.4: The OECD Reference Checklist for Regulatory Decision-Making

1. Is the problem correctly defined? The problem to be solved should be precisely stated, giving evidence of its nature and magnitude, and explaining why it has arisen (identifying the incentives of affected entities).

2. Is government action justified? Government intervention should be based on explicit evidence that government action is justified, given the nature of the problem, the likely benefits and costs of action (based on a realistic assessment of government effectiveness), and alternative mechanisms for addressing the problem.

3. Is regulation the best form of government action? Regulators should carry out, early in the regulatory process, an informed comparison of a variety of regulatory and non-regulatory policy instruments, considering relevant issues such as costs, benefits, distributional effects and administrative requirements.

4. Is there a legal basis for regulation? Regulatory processes should be structured so that all regulatory decisions rigorously respect the “rule of law”; that is, responsibility should be explicit for ensuring that all regulations are authorised by higher level regulations and consistent with treaty obligations, and comply with relevant legal principles such as certainty, proportionality and applicable procedural requirements.

5. What is the appropriate level (or levels) of government for this action? Regulators should choose the most appropriate level of government to take action, or if multiple levels are involved, should design effective systems of co-ordination between levels of government.

6. Do the benefits of regulation justify the costs? Regulators should estimate the total expected costs and benefits of each regulatory proposal and of feasible alternatives and should make the estimates available in accessible format to decision-makers. The costs of government action should be justified by its benefits before action is taken.

7. Is the distribution of effects across society transparent? To the extent that distributive and equity values are affected by government intervention, regulators should make transparent the distribution of regulatory costs and benefits across social groups.

8. Is the regulation clear, consistent, comprehensible and accessible to users? Regulators should assess whether rules will be understood by likely users, and to that end should take steps to ensure that the text and structure of rules are as clear as possible.

9. Have all interested parties had the opportunity to present their views? Regulations should be developed in an open and transparent fashion, with appropriate procedures for effective and timely input from interested parties such as affected businesses and trade unions, other interest groups, or other levels of government.

10. How will compliance be achieved? Regulators should assess the incentives and institutions through which the regulation will take effect, and should design responsive implementation strategies that make the best use of them.

Source: OECD 1995a

Such ‘black letter’ prescriptive rules are falling out of favour because regulators

will never be as smart as those they seek to regulate. Regulators limit

themselves when they define behaviour by prescription. Business who has met

the limits of prescribed behaviour will take it as meeting their obligations, and

behaviour which falls outside their limits, whether fitting the intent of the law or

27

not, is acceptable. At the other extreme, business may take the prescribed limit

as a challenge “to find ways to get around it”.

Malaysia has traditionally followed the prescriptive approach in regulation and

continues to do so today, more so in areas where safety and health are

concerned. However, there is now some interest in pursuing the performance-

based rules as is being done in other benchmarked countries like UK and

Australia. Performance-based rules are most suited to areas for which the

desired outcome is easily quantifiable. In specifying the desired outcome,

individuals and firms can seek out the optimum cost for achieving it.

However, performance-based rules also have their limitations. Firstly, while

allowing firms’ flexibility in achieving an objective, performance rules provide no

flexibility in the objective itself. For example, emission controls generally specify

a maximum amount that can be emitted from a particular factory, but the effect

on the receiving medium will vary according to a variety of factors, including

weather conditions, time of day, and the level of emissions from other factories

at the same time.

Secondly, as with prescriptive standards, once an individual or firm has met the

performance-based standard, there is little incentive to go beyond that standard

even when it would be socially desirable. For example, firms may reduce

emissions to levels prescribed in a performance standard but would have little

financial incentive to reduce them further, even if further reductions could be

achieved at little cost.

Apart from both prescriptive-based and performance-based rules, some

regulators have considered the use of principle-based standards. The use of

principle-based standards assumes that the detailed preventative rules cannot

possibly anticipate and prescribe the inexhaustible variety of human

heartlessness and negligence, and at the same time will often be harshly over

inclusive. From this perspective, the appropriate strategy is to draft broadly

worded statutes and regulations, laced with words such as “reasonable” and

“so far as feasible,” enabling regulatory officials to “custom tailor” regulatory

requirements and penalties to particular enterprises and situations8.

2.4 Government Initiative in Good Regulatory Practice

The Government has implemented the initiative on best regulatory practice with

the launching of the document on National Policy on the Development and

8 AIC 1995, Regulation and its Review: 1994-1995, September 1995, Australia Industry

Commission

28

Implementation of Regulations (NPDIR)9 on July 2013. This policy document

applies to all federal government ministries, departments, statutory bodies and

regulatory commissions. It is also applicable for voluntary adoption by state

government and local authorities. The policy document spells out the objective,

operating principles, responsibilities, requirements and process for the

regulatory process management.

The national policy also specifically mandates the MPC, through its

responsibility to the National Development Planning Committee (NDPC), to

implement the functions of the national policy. MPC is to assist in the

coordination for implementing this policy.

Box 2.5: Seven elements of RIA in best practice regulation

Seven Elements of RIA:

1. Problem statement: RIA should clearly identify the problems that need to be

addressed.

2. Objectives: The “objectives” element should state the intent of the proposed

regulatory action in concrete terms and relate this to the broader policy of the

agency and Government.

3. Options: This element describes the range of regulatory and non-regulatory

options to be considered in addressing the issue or risk identified including the

proposed regulatory action and the key differences between options.

4. Impact analysis: To conduct a comprehensive assessment of the expected

impact (costs and benefits) of each feasible option.

5. Consultation: Any proposed new regulation or changes to regulation will involve

consultation with relevant stakeholders, including the main parties affected by the

proposal: Business, non-governmental organisations, the community, regulators

and other government agencies.

6. Conclusion & recommendation: should include a clear statement identifying

the preferred option based on the impact analysis. The recommendation for the

selection of this option must be supported by the preceding analysis and a

comparison with other options provided.

7. Strategy for implementation: It is necessary to consider how the option will be

implemented and enforced, and to establish a review strategy that will allow the

option to be evaluated after it has been in place for sometime.

Source: MPC 2015; http://www.mpc.gov.my/home/?sstr_lang=en&cont=ds&id=8i2&item=d8&t=3

The Best Practice Regulation Handbook10 as launched together with the

national policy provides in detail guidance on carrying out best practice

regulation – the systematic process to the development of regulations.

Basically, a regulator has to carry out regulatory impact analysis (RIA) and

9 Malaysia 2013, National Policy on the Development and Implementation of Regulations,

Malaysia Productivity Corporation 10 MPC 2013, Best Practice Regulation Handbook, Malaysia Productivity Corporation

29

produce a comprehensive report, the Regulatory Impact Statement when it is

introducing any regulation that may impact upon businesses. MPC’s role here is

to ensure that the RIS is adequately prepared before it is submitted to NPDC,

as the oversight body for assessment of compliance to GRP as outlined in

NPDIR. This RIA for best practice regulation involves seven core elements as

shown in Box 2.5.

2.5 Costs of Regulatory Compliance

There are multiple costs in regulation to achieve policy objectives. These costs

impact upon business, consumers and the government in general11 (Figure

2.1). What is important is that the benefits accrued from achieving the

regulatory objectives must be greater that the total cost of regulation. Some

regulatory costs are inevitable as can be viewed as the price of the benefits

which the regulation brings. High quality regulation is both effective in

addressing an identifiable problem and efficient in terms of minimising

unnecessary compliance and other costs imposed on business. The best

regulations achieve their objectives at acceptable level of cost.

By contrast, poor regulation may not achieve its objectives and can impose

unnecessary costs, impede innovation, or create unnecessary barriers to trade,

investment and economic efficiency. Given the pervasiveness of regulations in

the country, it is not surprising that regulation and red-tape continue to impose

significant compliance costs. Direct compliance costs can include the time

taken to comply with regulations, the need for additional staffing, the

development and implementation of new information technology and reporting

systems, external advice, education, advertising, accommodation and travel

costs.

As well as having a direct impact on regulated businesses, compliance costs

also impact indirectly on the community, by changing pricing and distorting

resource allocation, impacting on international trade and delaying the

introduction of new products or services. There remain concerns that such

costs are excessive)12.

11 APGC 2008, Performance Benchmarking of Australian Business Regulation: Cost of

Business Registration, Australian Government Productivity Commission Research Report,

November 2008 12 Argy S. and Johnson M. 2003, Mechanism for Improving Quality of Regulations, Australia in

an International Context, Australia Government Productivity Commission, Staff Working Paper,

July 2003

30

In an international study in 1998, the OECD estimated from survey responses

that taxation, employment and environmental regulations imposed over US$17

billion (2.9 percent of GDP) in direct regulatory compliance costs on small and

medium-sized businesses in Australia. The cost components are:

employment regulations accounted for 40 percent (OECD average was

35 percent)

compliance with tax regulations accounted for 36 percent (OECD

average, 46 percent)

environmental regulations accounted for 24 percent (OECD average,

19 percent)

The more advanced countries like Australia have taken measures to improve

the cost-effectiveness of regulations and to reduce compliance burdens and

red-tape. Some of the measures include:

the increased adoption of performance-based regulation

the consideration and adoption of implementation options that minimise

red-tape

the improvement of regulatory services through the employment of new

technology

increased electronic publication of regulatory information

licensing reforms and/or reduction in number of licences

streamlining of government paperwork requirements

privatisation of certification and inspection functions

stakeholders consultation to improve implementation and compliance

Compliance cost in higher education is particularly important to such service

provider as it will increase their unit cost and thereby reduce cost

competitiveness. The cost eventually will be passed on to the consumers

thereby paying higher prices for no additional value add.

Another example in higher education services, the lengthy time taken imposed

by a programme’s accreditation process is regarded as burdensome by

business (PHEI) since not having a programme accredited in a timely manner

would result in a missed opportunity (to run a new intake) or even lose the

business – furthermore, a non-accredited programme would jeopardise a

graduate’s future employment.

31

Figure 2.1: Multiple costs of regulation

Source: AGPC 2008c

32

Section 3: Economic Analysis and Education Value Chain

Contents: (3.0) Snapshot of Education Sector (with statistical data), (3.1) Malaysian Education Levels, (3.1.1) Higher Education and Professional Qualification (3.1.2) Enrollment into Higher Education (3.2) Education Sector Value Chain

This section looks at the snapshot of the education sector in Malaysia, the education value chain, the life cycle stages of the businesses in higher education and brief information on entries to higher learning.

3.0 Snapshot of Education Sector (with statistical data)

This section briefly presents some statistics based on the Survey of Services

Establishment conducted in 2015 (for 2014) by the Department of Statistics

Malaysia (DOSM) on education services (private sector). The education

services refer to primary, secondary, tertiary (college and university) and other

education.

As shown by the following figures, the role of private sector in education

services seems to be more prominent in the higher level of education (tertiary

level) as compared to the primary and secondary level.

Figure 3.1: The percentage distribution of gross output and value-added in

education services, 2014 by DOS13

Based on the statistics for 2014, the tertiary education (college and university)

registered about 70% ((RM7.5 billion), which represents the highest value of the

13 (Source13: Services Statistics Education (Private Sector) 2015 by DOS Portal, 30 June 2016)

33

total gross output (of RM10.7 billion), followed by the secondary, other and

primary education.

Similarly, tertiary education was also the highest contributor to the total value

added in the education services with 68% of the total value added (i.e. RM4.8

billion out of RM7.0 billion). This was followed by secondary education, other

education and primary education (refer to Figure 3.2.)

Figure 3.2. Snapshot of services sector: Education The statistics from DOSM also revealed that 81.4% (RM9.2 billion of RM11.3 billion) of the value of fixed assets recorded in 2014 was

owned by establishments engaged in college and university education. The second highest contributor was secondary education, RM1.4 billion (12.0%) and followed by other education, RM0.5 billion (4.1%). The remainder was owned by primary education. The sector also created jobs for nearly 85,000 persons in education services – out of which, 70.1% of the paid full time employees (53,137 out of 75,815 persons) are from the managerial, professional and executive category, followed 14.8% by clerical and related occupations, 7.6% by technical and supervisory, and 7.5% by general workers. (Source: Percentage distribution of gross output and value added in education services, 2014)

For a relatively small country, Malaysia is one of the countries in the world with

relatively high number of higher education institutions (private and public). This

is shown by the number of private higher institutions registered with the Ministry

of Higher Education.

With a population of about 31.7 million (DOSM data as at June 2016), Malaysia

has over hundreds higher learning institutions nationwide. In 2011, Malaysia

recorded up to 20 public universities, 53 private universities and six foreign

university branch campuses; 403 active private colleges, 30 polytechnics and

73 public community colleges. There are also various HEIs from the UK, the

US, Australia, Canada, France and New Zealand, which offer twinning

programmes through partnerships with local private higher education

institutions.

34

Regionally, Malaysia is also competing for a greater share of its higher

education market for international students, as observed by the UNESCO/ICEF

monitors: -

Malaysia continues to build its international enrolment, and aims to host 250,000 foreign students by 2025;

In 2014, Malaysian institutions enrolled 135,500 international students, with most coming from Bangladesh, China, Indonesia, Nigeria, India, and Pakistan;

The government, with private-sector partners, has set up two education zones14 as sites for international branch campuses, and there are now 11 foreign branch campuses in the country from the UK, Australia, India, the Netherlands, and China

(Source15

: UNESCO/ICEF reports titled “Malaysia competing for a greater share of international students, 22

August 2016)

The government vision in showcasing Malaysia as an educational hub for this

region is seen as budding and promising, and the private sector has always

been eager to take up the space in the provision of higher education services.

This can be observed through a number of established PHEIs and those

registered with KDN for foreign students’ intake.

As at 10 October 2016 (Table 3.1), there were 50 private higher education

institutions (PHEIs) with University status, 27 University Colleges, 8 Foreign

University Branch campuses and 209 colleges have obtained approval for

recruiting foreign students (Source: Department of Higher Education;

http://jpt.mohe.gov.my/menudirektori.php)

14 Iskandar Edu City (Southern) and KL Edu City (Central) 15 Source: http://monitor.icef.com/2016/08/malaysia-competing-greater-share-international-students/

35

Table 3.1 : The list of registered PHEIs with approval to recruit international

students as at 10 October 2016 16

[Note: Based on the same source17 in September 2014, there were 36 private higher education institutions (PHEIs) with University status, 30 University Colleges, 7 Foreign University Branch campuses and 420 colleges)

There was a gap in the number of colleges from the past few years, believed to

be due to a temporary freeze and the state of moratorium imposed by MOHE

on the establishments of new institutions in order to review the standards of

education services provided by some private institutions.

3.1 Malaysian Education Levels

The Malaysian school system is structured on a 6+3+2+2 model, with six years

of compulsory primary education beginning at age of seven, followed by three

years of lower secondary education, two years of upper secondary, and two

years of pre-university study.

16 Source16: Services Statistics Education (Private Sector) 2015 by DOS Portal, 30 June 2016

17 Bahagian Pendaftaran dan Piawaian, Pengurusan Pendidikan Tinggi Swasta, Jabatan Pendidikan

Tinggi, Kementerian Pendidikan Tinggi

36

The different levels of education in Malaysia are illustrated in Figure 3.3 below.

Figure 3.3 : The different levels of education in Malaysia

3.1.1 Higher education and professional qualification

Higher education primarily refers to learning that takes place at universities or

university colleges, or other colleges and institutions that award academic

degrees and professional qualifications.

It is also known as post-secondary, tertiary and third level education. The right

of access to higher education is enshrined in both UN and European human

rights conventions.

Any economies of the world see the importance of education in achieving its

economic prosperity, and one of the benchmarks of a country’s socio and

economic development is how highly educated is its population. Becoming

better-educated benefits a person through higher income and better job

opportunities, and most importantly for a developed nation, the more educated

the people, the higher the probability of skilled workers, professionals,

intellectuals, and innovators. A good educated citizen also leads to better

elections, better understanding and implementation of laws and regulations,

and in general a more respected culture and society.

In its mission to compete with the rest of the world, Malaysia seeks to become a

high-income nation by 2020, and one of the means of achieving this goal is

37

education and the development of quality graduates, with a net tertiary

enrollment ratio of 40 percent18.

To nurture and stimulate this sector whilst maintaining high standards of local

education, the government puts up high focus on public-private partnership and

partnership with internationally established PHEIs. Benchmarking had also

been conducted on the quality of education through networking and working

visits to New Zealand, Australia, the UK, Japan by MOHE and MQA.

3.1.2 Enrollment into Higher Education

Figure 3.4 below shows the entries for secondary school leavers into the higher

education, i.e. applying for enrollment from SPM/GCE O’ Level into the Pre-

university (Degree/Masters/PhD programmes), Diploma and Skill Training

programmes.

Figure 3.4 : The channel into a higher education and professional

qualification

Source: https://www.studymalaysia.com/education/higher-education-in-malaysia/the-malaysian-higher-education-system-an-

overview

3.2 Education Sector Value Chain

From the perspective of an educator, the education activity consists of the

different activities, i.e. from the educational design, delivery, research,

professional development, and community service.

18 Vision 2020

38

There are many service value models in higher education by various researchers. For this study, we took the sample of Sison and Pablo (2000) model19 and mapped onto it the regulating bodies and relevant stakeholders involved in the education value chain (Figure 3.5 below).

Figure 3.5: The Education Value Chain

Source: International Journal of Emerging Research in Management &Technology ISSN: 2278-9359 (Volume-2, Issue-7)

Based on our engagements with the regulating bodies and businesses, it seems that there is a myriad of activities, especially in the value chain of a university (both public universities and PHEI), i.e. from running a normal tertiary program to a research university, to a university running a professional programme.

The set of activities centred around administering the day-to-day office operations, fulfillment of regulatory requirements, student recruitments, teaching (and including individualised student’s learning opportunities and tools that enables acquisition of target knowledge and skills, and formation of target attitudes and values), research, professional development (of the teaching professionals), graduate placements/employment and up to alumni support.

In all of the world economies, the role of higher education is vital and the performance of higher education institutions usually reflects the socio-economic development of a country.

From the business point of view, the value chain starts with the formation of business, injection of capital by investors, the service product designers (consultants or subject matter experts who normally become the programme

19 Source: International Journal of Emerging Research in Management &Technology ISSN: 2278-9359 (Volume-2, Issue-7, 2013)

39

creators of a faculty), service providers, staff and facilities, the infrastructure and supporting utilities, and the public at large as the target market of customers (these can be citizens or communities, local or foreign organisations and foreign students).

In Malaysia, in order to set up a private higher education institution (PHEI), the business must first be registered with the Companies Commission of Malaysia (CCM or SSM). For foreign PHEIs, they may register as a foreign company or set up a local subsidiary company in Malaysia.

The summary of the process to set up a PHEI is shown in Figure 3.6 below.

Figure 3.6: The general framework for business in setting up a PHEI

Besides SSM/CCM (for registering the business), a number of regulatory requirements are to be complied as well, e.g. from MOHE as the principal regulator, regulating the higher education in the country, local authorities for the premise used in running the academic programs, KDN and Immigration Department for foreign students’ entrance, MQA for programme accreditation (for non-professional courses) and MQA jointly with Professional Bodies for running professional courses (e.g. Engineering, Architecture, Medical, Nursing, Dentistry, etc.).

For a specialised course, for e.g. Nursing Courses, the process of accreditation will be mainly processed by MNB (Malaysia Nursing Board).

40

Section 4: Acts and Regulations (Accreditation of Nursing Programme)

Content: (4.0) Introduction to the Regulators, (4.1) Governing Authority for Higher Education,

MOHE, (4.2) Malaysian Qualifications Agency (MQA), (4.2.1) Laws and Provisions related to

MQA Accreditation, (4.2.2) Accreditation of Higher Education Programmes, (4.2.3) Malaysia

Qualifications Framework (MQF), (4.3) Malaysia Nursing Board (MNB), (4.4) An Overview of a

Nursing Programme, (4.5) Accreditation Process of a Nursing Programme, (4.6) Laws

Governing the Accreditation of Nursing Programme in Malaysia, (4.6.1) Standards for

Accreditation of Nursing Courses in Malaysia

This section provides an overview of the regulatory regimes for the Higher

Education sector in Malaysia and describes the background of the governing

bodies involved in the accreditation of a Nursing Programme offered by higher

education institutions. The related regulations, the regulatory controls and the

regulators are identified for the accreditation of the selected professional

program, which is Nursing Programme.

4.0 Introduction to the Regulators

The provision of higher education in Malaysia is well regulated and the

governance of the services provision falls under the jurisdiction of the Ministry

of Higher Education (MOHE).

For the case study of the Accreditation of a Nursing Programme, the main

regulating bodies have been identified as follows:

1. MOHE, as the governing authority for Higher Education

2. MQA, the agency that leads and processes requests for tertiary

programme accreditations by the PHEIs. MQA resources are

responsible for the accreditation of a non-professional programmes,

whilst for specific professional programmes, MQA works with the

relevant professional bodies, who are the subject matter experts.

3. MNB, the professional body that governs the nursing professionals –

from education, training, practices and professional developments of the

nursing profession.

41

4.1. Governing Authority for Higher Education, MOHE

The main regulating body for Malaysia’s higher education is by the Malaysia

Ministry of Higher Education (MOHE).

MOHE oversees public universities and private higher educational institutions,

community colleges, polytechnics and other government agencies involved in

higher education activities such as the Malaysian Qualifications Agency, the

National Higher Education Fund Corporation (Perbadanan Tabung Pendidikan

Tinggi Nasional – PTPTN) and some other educational foundations.

Apart from its role in governing the provision of higher education by public and

private universities, the establishment of MOHE is also to support the

government’s aspiration in making Malaysia a hub for educational excellence

and in internationalisation of Malaysian education. With the establishment of

economic corridors, for example, the development of Bandar Iskandar Malaysia

(in the Southern Corridor), attracts new investments by foreign investors, which

include private higher education providers from world class institutions.

4.2 Malaysian Qualifications Agency (MQA)

In November 2007, the Malaysian Qualifications Agency, MQA was launched to

take up the responsibility of governing the standard and quality of private higher

education. One of its visions is to push the boundaries of quality enhancement

to make Malaysia's higher education comparable with the best in the world.

The main role of the MQA is to implement the Malaysian Qualifications

Framework (MQF) as a basis for quality assurance of higher education and as

the reference point for the criteria and standards for national qualifications.

The functions of the MQA are:

To implement MQF as a reference point for Malaysian qualifications To develop standards and credits and all other relevant instruments as

national references for the conferment of awards with the co-operation of stakeholders

To quality assure higher education institutions and programmes To accredit courses that fulfil the set criteria and standards To facilitate the recognition and articulation of qualifications To maintain the Malaysian Qualifications Register (MQR)

The MQA also operates a rating system, known as Discipline-Based Rating

System (D-SETARA) that assesses the quality of teaching and programmes of

study at the undergraduate level in Malaysian universities and university

colleges. It also has an institutional rating system known as SETARA, which is

42

released every two years. Institutions and programmes are rated on a five-tier

scale. The D-SETARA ratings exercise is a voluntary process.

4.2.1 Laws and Provisions related to MQA Accreditation

MOHE has made it compulsory for all courses which have been approved by

the Ministry to obtain accreditation from the Malaysian Qualifications Agency

(MQA) before students are conferred the degrees.

Under Section 2(2) of Malaysian Qualifications Agency Act 2007:

For the avoidance of doubt, it is declared that any accreditation granted

under this Act shall not be construed as recognition of the higher education

programme or qualification, or higher education provider, for the purposes

of eligibility to practise as a professional in any professional body.

Under Section 37 of Malaysian Qualifications Agency Act 2007:

(1) No programme or qualification shall be accredited unless it complies

with the Framework.

(2) All higher education providers conducting an accredited programme

or awarding an accredited qualification shall comply with the Framework.

(3) The Agency or, in the case of a professional programme,

professional qualification or higher education provider, the relevant

professional body, may direct that the Framework or any part of the

Framework may not apply to any programme, qualification or higher

education provider subject to such terms and conditions as it deems fit.

Under Section 51 (1) of MQA Act 2007:

A Joint Technical Committee consisting of representatives of the relevant

professional body, an officer of the Agency and such other persons as

may be deemed necessary by the relevant professional body shall be

established by the relevant professional body for the purpose of

(a) considering an application for accreditation under subsection 50(1);

(b) making recommendations to grant or refuse the application for

accreditation under subsection 52(1);

43

(c) making recommendations for imposing conditions under section 54;

(d) entering and conducting an institutional audit under subsection 52(3);

and

(e) making recommendations for the revocation of accreditation under

section 55.

(2) The representatives of the relevant professional body and the officer

of the Agency in the Joint Technical Committee established under

subsection (1) may differ as between different professional programmes

or professional qualifications.

All the above provisions clearly highlight that accreditation is highly

regulated. Generally the PHEIs need to comply with both the Private Higher

Educational Institutions Act 1996 and the Malaysian Qualifications Agency Act

2007. Although the approval for all courses comes from the MOHE, they are

actually subjected to recommendation from the MQA. This means there are two

agencies dealing with approval of new courses and according to the PHEIs, this

has led to longer processing time.

4.2.2 Accreditation of Higher Education Programmes

The National Accreditation Board (LAN/Lembaga Akreditasi Negara) was

established in 1996 to oversee standards and the accreditation of academic

programmes at private colleges and universities in Malaysia. In April 2002,

the Quality Assurance Division (QAD) was established by the Ministry of

Education to oversee quality standards in public universities. Prior to the

establishment of these bodies, no specific accreditation system existed.

With the adoption of the MQF in 2007 the QAD and LAN were merged to form

the Malaysian Qualifications Agency (MQA). The MQA develops standards and

criteria as national references for the conferral of awards, assures quality

standards at higher education institutions and programmes, accredits

programmes of study, and maintains the MQF.

The Malaysian Qualifications Register (MQR) provides information on all

accredited programmes, qualifications and higher education institutions

accredited under the MQA. It acts as a reference for credit transfer from one

accredited programme to another.

44

There are two levels of accreditation and a compliance audit process by MQA: -

1. Provisional Accreditation (PA): The first process which needs to be

taken place before any programme is offered to the public by a PHEI.

MQA looks at the quality of curriculum, the management and planning of

a programme as the candidacy evaluation;

2. Full Accreditation (FA): the second process whereby once the first

intake of students for that particular programme is in their final year (first

cohort). This is to check on the school’s compliance with the MQF

standard and other standards set by MOHE/MQA or a professional body,

as proofs that the PHEI are running the programme per the

intended/original application. PHEIs will have to apply for accreditation

during the final semester of the particular programme, before students

graduate;

3. Compliance Audit: an audit on compliance which minimally occurs once

in five years, depending on the requirement of the course of study (for

the PHEI to maintain its accreditation or if MQA finds that there is lacking

in compliance).

Under this study, we shall look at MQA’s function in the full accreditation of

higher education courses offered by, in particular, the private higher educational

institutions (PHEIs) – our pilot study is on Nursing Programme.

4.2.3 Malaysian Qualifications Framework (MQF)

The Malaysian Qualifications Framework (MQF) or the “Kerangka Kelayakan

Malaysia” is a unified system of post-secondary qualifications offered on a

national basis by both public and private institutions of education and also

professional organisations. It was introduced in 2007 and is administered by

the Malaysian Qualifications Agency (MQA), a statutory body under the Ministry

of Higher Education (MOHE).

Table 4.1 below shows the MQA framework designed for MQF:

45

Table 4.1. The Malaysian Qualifications Framework (MQF) by MQA

4.3 Malaysia Nursing Board (MNB)

The nursing profession is said to be one of the oldest profession in the

world. It went as long as the World Wars begun.

In Malaysia, the practice of nursing started during the pre-war era, with

teaching and practices given by the nurses who received on the job

training and lectures from the expatriates. For our appreciation of events

that evolves nursing (from midwifery days), the chronology of nursing

education and profession is summarised as per the table below:-

Table 4.2 : Chronology of the formation of Nursing in Malaysia

Landmark of a Nursing History in Malaysia

1923 Introduction of legislation for the control of the Practice of Midwifery and the training of midwives in the Straits Settlement and subsequently in the other states of the Malay Peninsular.

1950 Nursing Legislation Nurses Act and the establishment of the Nurses Registration Ordinance, to control the practice of nursing which provided for the setting up of the Nursing Board for controlling the training and registration as regards to the practice of nursing. Development of syllabus and curriculum for the Basic Nurse Training. The regulation for the conduct of final examination. The issuing of the Nurse Training Certificate. The Regulation to control the practice of nursing though registration and issue of Nursing Registration Certificate and Registration Badge.

1956 The Nurses Registration Regulation.

1961 The first private nursing school in Malaysia was established at the Assunta Hospital. It was called the Tun Tan Cheng Lock College of

46

Landmark of a Nursing History in Malaysia

Nursing

1969 Extension of the Act to Sarawak.

1978 Extension of the Act to Sabah.

1985 Nurses Registration Regulation 1985. Implementation of the Annual Practicing Certificate.

1966 The Midwives Act 1966 establishes a Midwives Board to provide for the registration of nurse-midwives and regulates the practice of midwifery in the country.

1971 The Midwives (Registration) Regulation, 1971, requiring all midwives to apply for registration. (TBA, up to 1st August 1972)

1990 Act Revised – 1990 (Reopened to TBA within the next 10 years).

Source: http://www.nursingcollegemalaysia.com/nursing-history-malaysia/

The Nurses Act and Nurses Registration Ordinance were enacted to control

the practice of nursing. This provided to the setting up of the Nursing Board

which controls nursing education and registration of nurses and carrying out

the following activities:

a) Development of syllabus and curriculum for the Basic Nurse Training. b) Conducts the final examination for registration. c) The issuance of the Nurse Training Certificate. d) Development of the regulations to control the practice of nursing

through registration and issuance of the Nursing Registration Certificate and Registration Badge.

e) The development of the Nurses Registration Regulation. f) Extension of the Nurses Act to Sarawak. Extension of the Nurses Act

to Sabah.

Until today, the Malaysia Nursing Board is governed by the Nursing Act 1950.

4.4 An Overview of a Nursing Profession and Education (Nursing

Programme)

Nurses do not just work in hospitals but anyone with a nursing qualification may also be working in nursing and residential homes, patients’ homes, hospices, children’s centres, universities or other places which require nursing support. They can specialise or get advanced training in a particular expertise, whether it be working with infants, children, elderly people or in a fast-paced emergency room. Nurses work with people of all ages, helping them achieve the highest level of wellness possible.

47

To become a nurse, one must first undergo nursing education training which will equip him/her with the necessary nursing knowledge and skills to provide safe and effective patient care upon graduation.

To begin a nursing career, one may opt to get a nursing education, for e.g. a

Diploma in Nursing20.

As stipulated in the National Education Code (NEC) Manual, the nursing

education is under the Nursing and Care study (NEC Field: 723), which is

described as the study of providing health care for the sick, disabled or infirm

and assisting physicians and other medical and health professionals diagnose

and treat patients. The focus of qualifications in nursing is maintaining and

caring for the health during illness and rehabilitation. It includes care of old

people and the disabled. Classified under the fields are programmes with the

following main contents: -

a) Assistant nursing

b) Basic nursing

c) Care of old people

d) Care of the disabled

e) Community nursing

f) Elder care

g) Gerontological services

h) Healthcare programmes

i) Hygiene, medical

j) Infant hygiene (nursing)

k) Midwifery

l) Mothercraft nursing

m) Nursing

n) Nursing aide/orderly

o) Psychiatric nursing

Nursing education can be obtained both from Private and Public

universities/colleges. There are four levels of Private Nursing Courses

available in Malaysia:

1) Certificate Courses

2) Diploma Courses

3) Bachelor Degree

4) Master Degree

There are also trainings and certification under the Public Nursing Training,

offered by MOH.

20 Source: http://www.etawau.com/edu/KolejKejururawatan/INDEX_PrivateCollege.htm

48

The MQA and the Malaysia Nursing Board (MNB), i.e. the professional body

jointly accredit the nursing courses run by higher institutions.

As at September 2016, the following statistics were recorded on the list of

Nursing schools or colleges: -

Types of Nursing Colleges Number of Institutions

Public • Nursing colleges attached to public (government) hospitals

43

Private • Nursing colleges attached to private hospitals (Private Nursing Colleges of Private Hospitals Malaysia)

13

• Nursing programmes offered by universities with medical facilities

9

• Private nursing colleges (established with the approval of the Ministry of Education and the Ministry of Health (through MNB), and accredited by the MQA and MNB), including those run by the public universities (e.g. UM. UKM, USM, INSAN (Institut Latihan Kesihatan Angkatan Tentera))

11

4.5 Accreditation Process of a Nursing Programme

Based on a series of consultations with the MOHE, MQA and MNB, we verified

the full accreditation process of a normal nursing program, as illustrated in

Figure 4.1 below:

49

Figure 4. 1. The full accreditation process of a Nursing programme

Requirement of documentations for the accreditation process The general requirements and documentations required for the application of accreditation of applications are mostly available from the websites of both the MQA and MNB.

Box 4.1: General requirements for accreditation of Nursing Courses

Documents Requirement

Required by

Available on the

website?

MQA MNB Y/N

1. Provisional Accreditation

a) 2 photostate copies (hardcopy) of document MQA-01 2 salinan bercetak (hardcopy) dokumen MQA-01

b) 4 photostate copies (hardcopy) of document MQA-01 + 1 copy of CD for JPKK 4 salinan CD (softcopy) dokumen MQA-01 + 1 salinan CD untuk JPKK

c) 1 copy of certificate of registration of institution / evidence of establishment of institution 1 salinan surat perakuan pendaftaran institusi/bukti penubuhan institusi

d) 1 copy of approval letter of handling the

programme

1 salinan surat kelulusan mengendalikan program

50

Documents Requirement Required by

Available on the

website? e) Completed Form A

Borang A yang lengkap Downloadable:

a. MQA01 Document Template (Template Dokumen MQA01)

b. Form A Borang A

c. MQA-01 Document Checklist Senarai Semak Dokumen MQA-01

2. Full accreditation (FA)

a) 2 photostate copies (hardcopy) of document MQA-02 2 salinan bercetak (hardcopy) dokumen MQA-02

b) 4 photostate copies (hardcopy) of document

MQA-02 + 1 copy of CD for JPKK

4 salinan CD (softcopy) dokumen MQA-02 + 1 salinan CD untuk JPKK

c) 1 copy of certificate of registration of institution /

evidence of establishment of institution

1 salinan surat perakuan pendaftaran

institusi/bukti penubuhan institusi

d) 1 copy of approval letter of handling the programme 1 salinan surat kelulusan mengendalikan program

e) 1 copy of certificate of provisional accreditation 1 salinan surat perakuan akreditasi sementara

f) List of students according to the semester of study Senarai pelajar mengikut semester pengajian

g) Academic calendar of the study programme Kalendar akademik program pengajian

h) Completed Form B Borang B yang lengkap

Downloadable:

a. MQA02 Document Template Template Dokumen MQA02

b. Borang B Form B

c. MQA-02 Document Checklist Senarai Semak Dokumen MQA-02

Note: 1. References are made to http://www.jpkk.edu.my/mqa/index.php/permohonan-akreditasi

and http://nursing.moh.gov.my/wp-content/uploads/2015/04/Guideline-Criteria-for-Approval-or-Accreditation-of-Nursing-Program.pdf.

2. Both MQA and MNB websites have published FAQs on some questions that are relevant to the accreditation process (i.e. http://nursing.moh.gov.my/faq/#toggle-id-4)

51

4.6 Laws Governing Accreditation of Nursing Courses in Malaysia

The main objectives of this section are to:

1. Explain the main provisions governing higher education particularly on the

professional Nursing programme

2. Analyse and benchmark regulatory framework with other leading countries

In the early stage of this study, we listed out some of the acts and regulations

that might be related to the accreditation process of a tertiary programme by

both public and private higher education, as per the following table:

Table 4.3. The list of laws and regulations related to the accreditation process of a tertiary

programme (Nursing Programme)

Acts/Regulations

Ownership

(Regulating

Body)

1. The Education Act 1996 (Act 550) MOE

2. The Private Higher Educational Institutions Act,

1996 (amended 2009)

MOHE

3. The National Council of Higher Education Act, 1996 MOHE

4. Malaysian Qualifications Agency Act 2007

(replacing the previous National Accreditation

Board Act 1996 which has been repealed)

MQA

5. The Universities and University Colleges (Amendment)

Act, 1996 (amended 2009)

MOHE

6. The National Higher Education Fund Corporation Act,

1997 (Amendment 2000)

MOHE

7. Nurses Act 1950 MNB

As far as our research, and based on sessions held with the regulators (MOHE,

MQA and MNB), there are three main key Acts governing this programme,

namely:

1. Private Higher Education Institutions (PHEIs) Act 1996

Objective : Establishment and Operations of institutions

2. MQA Act 2007

Objective : Quality assurance for curriculum

52

3. Nurses Act 1950

Objective : Quality and competency of nurses

The principal statute governing the nursing profession in Malaysia is the

Nurses Act 1950 (Revised 1969). The Act came into force in West Malaysia

on 20 December 1950; Sarawak - 1 November 1969; Sabah - 1 January 1978;

Federal Territory of Labuan - 16 April 1984. The primary aim of the Act is to

provide for the registration of nurses in Malaysia and establishment,

constitution, powers and functions of the Nursing Board.

By virtue of s 5(1) of the Nurses Act 1950, the Minister of Health is empowered

to make regulations on matters concerning the Nursing Board and registration

and admission of nurses in Malaysia. In exercise of the powers conferred by s

5, the Minister henceforth enacted Nurses Registration Regulations 1985

(NRR). This regulation came into effect on 1 November 1985. Essentially, the

Regulation provides for detailed requirements as to the register (Part II);

conditions of admission of nurses to register (Part III); conditions of admission

of assistant nurses and other nurses (Part IV); certificate of admission (Part V);

disciplinary proceeding against nurses (Part VI); restoration of nurse to register

(Part VII); and procedures to be observed by Nursing Board and its committees

(Part VIII).

According to Reg. 4(1) of the NRR 1985, the Nursing Board shall approve

institutions as training schools to provide training for admission by examination

to the Register. Reg. 4(2) specifies that an institution which is approved by the

Board as providing complete training for admission by examination to the

general part of the Register or to a supplementary part of the Register shall be

called a “complete training school”. Under Reg. 4(7), the Board shall prepare

and keep a list of approved training schools.

Acting on power conferred by Reg. 4(1), the Nursing Board and Ministry of

Health have approved the Guidelines on Standards and Criteria for

Approval or Accreditation of Nursing Programmes, during the 99th meeting

of the Board and the Ministry which was held on 17 June 2010. The guidelines

were implemented from 1st July 2010. The objectives of the guidelines are to (i)

provide guidelines on professional standards and criteria required for both the

approval and accreditation of any nursing programme offered in the country and

(ii) to serve as a reference (though not prescriptive) for all nursing institutions

intending to offer nursing programmes. The guidelines cover various aspects on

accreditation and approval such as governance and management, programme

53

resources, human resources, curriculum, admission policy, student

assessment, programme evaluation and continuous improvement activities.

Nursing contributes to the health and welfare of society through the protection,

promotion and restoration of health; the prevention of illness, and the alleviation

of suffering in the care of individuals, families and communities. In carrying out

the above responsibilities, the nursing profession strives to safeguard the

interest of society by ensuring that its practitioners abide by a code of

professional conduct. Thus, every registered nurse has a moral obligation to

adhere to the Nursing Board’s Code of Professional Conduct for Nurses

1998. It offers guidelines for professional behaviour and practice and can be

used as a standard against which complaints of professional misconduct are

considered. It complements the Nurses’ Act and Regulations, 1985 (Part V

Practice and Part VI on Disciplinary Proceedings). Should there be any written

complaint on any nurse on breach of professional conduct, a preliminary

investigation will be conducted by the disciplinary committee of the respective

organisation and these may be referred to the Nursing Board Malaysia for

further action.

4.6.1 Standards for Accreditation of Nursing Courses in Malaysia

According to the Guidelines on Standards and Criteria for Approval or

Accreditation of Nursing Programmes, any educational institution wanting to

offer a nursing programme must abide to the eight (8) standards as set by the

Nursing Board of Malaysia prior to approval:

(a) Standard 1: Governance and management

(b) Standard 2: Programme resources

(c) Standard 3: Human resources

(d) Standard 4: Curriculum

(e) Standard 5: Admission policy

(f) Standard 6: Student assessment

(g) Standard 7: Programme evaluation

(h) Standard 8: Continuous improvement activities

54

Section 5: Analysis of Findings and Recommendations

Content: (5.0) Background information, (5.1) Analysis of Findings, (5.2) Options and Draft

Recommendations, (5.3) Conclusion

Section 5 presents the analysis and findings of the regulatory related issues for

this study. Options are being proposed for the regulatory issues of concern, in

particular on those concerning the accreditation of a Nursing Programme.

Although the study has identified a wide list of complaints/issues, the focus is

only to elaborate on pertinent regulatory issues that could be improved to

create a more conducive business environment for the Higher Education sector

and in particular, for PHEIs offering tertiary qualification for Nursing

Programme.

5.0 Background information

As highlighted in Chapter 1, this study picked up some of the grievances raised

by the PHEIs which are mostly related to the tedious process of accreditation

approval. Further to the findings established by the Services Sector Blueprint

(Table 3 of Chapter 1, Section 1.3), a series of discussions and engagements

were conducted to validate the current status of each of the issues with the

relevant regulators, namely: MOHE, MQA and MNB.

Based on the discussions, it was agreed that the study shall focus on issues

relating to the accreditation process of professional programmes only, as it was

established that the non-professional programmes have undergone certain

level of improvements and that they are within the regulators’ control. For the

purpose of piloting a case study, it was agreed that the study shall take on an

accreditation of a Nursing Programme.

For further understanding, facts gathering, establishment and validation of

issues faced by businesses on the ground, MPC team had interviewed more

than ten PHEIs and organisations through a series of business meetings held

with both private and public sectors, and a business association.

The MPC team began its business interviews with assistance from APHM, who

had coordinated a meeting with its member hospitals (those who run their own

universities, offering tertiary education, for e.g. diploma/post-basic diploma and

first degree in Nursing) to provide feedback and inputs to the issues highlighted

in the Services Sector Blueprint action plan items. Apart from the meeting

called by APHM with its members, a few other series of business meetings with

private hospitals’ universities and the Private Higher Education Institutions

(IPTS), were also conducted by MPC.

55

The interviews conducted by MPC were meant to establish whether or not the

issues highlighted in the Services Sector Blueprint report are still valid (or

whether they have been solved and they were no longer issues to them).

Nonetheless, if the issues are still valid MPC team would gather further

feedback on the pattern of the issues, i.e. whether the issues/concerns raised

are similar and consistent.

5.1 Analysis of Findings

Upon the above-mentioned meetings with PHEIs, it was gathered by the MPC

team that the issues raised in the Services Sector Blueprint on the delay and

uncertain time line in the approval and accreditation of academic

programme process, and the issues of lack of transparency practised by the

agencies are still valid. These issues were found to be common issues raised

by the PHEIs and they had also highlighted that the delays had affected their

planning and business decisions.

In addition to the common issues, there were also other issues raised, which

are non-regulatory related.

In summary, we categorise the list of concerns raised into two sub-categories:

a) Regulatory/Procedural: “Delay in the Accreditation Process”. The

issue of lack of transparency practised by the agencies is being included

into this category.

Regulatory/Procedural: “Delay in the Accreditation Process”

1. Inconsistent information requirement between MQA and Nursing

Board.

2. Lack of transparency in the time taken at each processing stage, i.e.

at MQA and MNB .

3. Limited pool of Panel Reviewers contributes to delay in the

accreditation process, and issues of “conflict of interest” and

competencies of the Reviewers .

4. Limited place for Clinical Attachment.

5. Similar documentations are required for both PA and FA.

56

b) Non-regulatory or “Other Concerns”

Non-regulatory issues or “Other Concerns”

1. Validity period of the accredited program is too short (validity period:

cycle of renewal).

2. Change in the syllabus to OBE (Outcome-based Education)

requires time to adopt.

3. Change in the entry requirement (from three credits to five credits).

4. Change in Student : Teacher Ratio (20:1 for Post Basic).

5. Diploma students and Degree students undergoing a Post Basic

programme will be awarded with an Advanced Diploma (this is seen

as an obstacle to nursing’s professional development since the

qualification would not allow the degree holder to enter into a master

or PhD).

6. Different treatment in the accreditation of the nursing programmes

run by IPTA/IPTS and those run by MOH.

7. Teaching permit and teaching methodology are mandatory for PHEI

but was not observed on MOH educators/instructors. Under Section

3.3**one must possess a certificate in teaching or have done a

module in teaching methodology from an accredited university/

institution as approved by the Nursing Board. For other countries

like Canada, Australia, HK and South Africa, this is NOT

compulsory.

As mentioned, our focus for this study will be on the “Delay in the

Accreditation Process”. The issues listed under the Non-Regulatory issues or

“Other concerns” are recorded here for information and internal

review/consideration by the relevant regulating bodies’ (i.e. MOHE/MQA and

MNB) only.

5.1.1 Delay in Accreditation Process

The main concern of this study is the delay in getting accreditation process for

nursing programme. There are many factors that contribute to the delay, as

listed below:

1. Inconsistent information requirement between MQA and MNB

57

Business raised a concern that when there is a change in the reviewer or

assessor of the programme, the list of items being reviewed has become

different (i.e. the ‘penambahbaikan’ lists have changed). The business

viewed that this is due to different interpretations by the different

reviewers. It becomes a concern to the business since it delays the

process of obtaining the accreditation for the programme. The matter

became even burdensome especially when the additional requirement

was communicated too late, and this has risked the business due to the

delay in offering the intake for the academic session.

The business also found that there is a lack of guideline/checklist – and

they suggested that assessors need to have common understanding and

interpretation of the guideline/checklist.

Burden on Business

This is burdensome for business as there is uncertainty about what is

expected of them (being regulated) and those who are regulating. PHEIs

find it difficult in their planning for new courses due to uncertain timings of

accreditation. If the delay persisted, it will eventually result in the loss of

opportunity to run a new intake.

In a case of a PHEI, it had suffered a business loss of up to RM400,000

(an intake of 20 students with a fee RM20,000 per student) for a Post

Basic programme intake which did not materialised due to delay in getting

their programme accredited.

On a national scale, the potential loss of business of up to RM50million a

year is expected, if say 10% of the total IPTS (10% x 54 = 5.4) were

unable to recruit new intake of at least 500 students per year:

No. of

potential

students

Cost of post-basic

programme per

student

Number of

affected operators Total

500

(students

intake per

year)

RM20,000 10% x 54 = 5.4 RM50mil

(Post Basic

course only)

2. Lack of transparency in the time taken at each processing stage, i.e.

at MQA and MNB

The business raised that the meeting schedules of the MOHE/MQA, MNB

Joint Technical Committee were not made known to the applicants, and

58

late notifications had resulted in missing opportunity for a new intake.

More often than not, they were not being informed specifically the reasons

for the processing delay.

Burden on Business

Similarly to issues highlighted in 5.1.1 (1), the delay caused the loss of

opportunity to run a new intake.

3. Limited place for Clinical Attachment for Post Basic courses

Most of the nursing schools, especially those that do not possess own

facilities will rely on the placement at public hospitals.

Although there is an allocation for a certain number of placements with

specified government hospitals, i.e. as stipulated in the Memorandum of

Agreement (MoA) with MOH, business claimed that there were limited

places for Clinical Attachment for Post Basic programme due to

(perceived) indications that public hospitals have certain limitations in

fulfilling the required allocation for clinical attachment. Hence, there were

cases of clinical placement for students from the private universities that

were not being fulfilled by certain public hospitals.

Burden on Business

The limited place for clinical attachment will potentially create a bad

business reputation due to PHEI’s inability to send students for clinical

placement. This would make the programme unrecognised and further

jeopardise future employment of the graduates.

4. Similar documentations are required for both PA and FA

Similar documentations are required for both PA and FA. These

documentations are, for e.g. the learning outcomes, credit system of the

programme by level, programme standards (as defined in the guideline),

vision, curriculum, student selection and assessment, management,

facilities and etc. Business also finds that the requirement for printed

documents is rather “outdated” in the era of technology. Furthermore the

number of copies required is quite large too, i.e. up to four to five copies of

the application documents of approximately 200 to 300 pages each, which

translates to up to 1,500 pages of printed information.

Burden on Business

A cumbersome requirement of documentation contributes to burden in

paperwork and administrative overheads to the applicants. This becomes

59

more burdensome due to the need to submit the full accreditation

application at least six months before the current application expires.

5. Limited pool of Panel Reviewers and lack of competencies

Business raised issues on limited pool of reviewers which have led to the

long-time taken by the reviewers to assess their programme. The

business also claimed that in certain circumstances the appointed

reviewer do not possess the level of competence to audit the specific post

basic programme.

MNB clarified that currently there are 21 active reviewers across the board

including 6 new ones who are being listed in MNB’s pool of reviewers (for

nursing programme accreditation). MNB feels that the number is sufficient

since on average there is less than 50 of applications for accreditation per

year. However, MNB agrees that there is a lack of assessors (expertise

and competencies) especially in certain specialised areas such as Cancer,

Oncology, and other specialised nursing courses.

MNB also recognised that reviewing paper could be time consuming for

the reviewer and that it requires dedicated time to ensure that applicants

meet the required standard, and sometimes, the panel reviewers have

their own priorities too.

This study also finds that current scale of honorarium, i.e. RM 500 (for

reviewing a Diploma programme) and RM 600 (for reviewing an Advanced

Diploma programme) may not be attractive as remuneration for the

reviewers. It may not compensate the time spent to conduct the review,

which takes approximately 3 months to complete.

Burden on Business

Similarly to issues highlighted in 5.1.1 (1), the delay caused by the limited

pool of reviewers or the long-time taken to review the programme

accreditation potentially contributes to the loss of opportunity to run a new

intake.

5.2 Options and Recommendations

60

Based on multiple inputs and feedback sessions with both business and

regulators, MPC has developed options and recommendations for process

improvement consideration.

The options and recommendations for each of the issues raised have been

deliberated and put forward in the subsequent sessions (5.2.1 – 5.2.5) below.

61

5.2.1 Inconsistent information requirement between MQA and MNB –

Options and Recommended Option

Figure 5.1 below illustrates the options and recommendation (quick win) put

forward for consideration by both MNB and MQA.

Figure 5.1. Options and recommendation for business concern: Inconsistent information

requirement between MQA and MNB

Five options were deliberated during the discussions with MNB and MQA, and

Option 4 – To establish a guideline or a checklist was recommended for

application of accreditation by PHEI. The guideline/checklist is to be

assembled by MNB in collaboration with MQA. The guideline/checklist must

also spell out the response time for PHEI to comply in the provision of the

necessary information/documentation required by MQA and MNB, failing which,

their application may result in processing delay.

Conclusion

Based on the final report presentation by MPC to the top management of MQA

and MNB held at MQA on 27 January 2017, the management had agreed on

the recommended Option 2 and Option 4, as follows: -

Option(s) and Descriptions

a. Option 2 : Strengthen communication process by establishing Collaborative

Agreement (CLA) between MQA and Nursing Board

b. Option 4 : Publish guidelines/checklist for application (and set time limit for

response) at MQA website.

62

The details of the feedback on the options and recommendations presented to

top management are as per Appendix A.

5.2.2 Lack of transparency in the time taken at each processing stage by

MQA and MNB – Options and Recommended Option

Figure 5.2 below illustrates the options and recommendations (quick win and a

long term) put forward for consideration by both MNB and MQA.

Figure 5.2. Options and recommendation for business concern: Lack of transparency in the time

taken at each processing stage by MQA and MNB

Four options were deliberated during the discussions with MQA and MNB on

the concern raised on lack of transparency in the time taken at each processing

stage, i.e. at MQA and MNB.

A quick win (short term) has been recommended for implementation by both

MNB and MQA, i.e. under Option 2 – To publish the annual schedules of

important meetings (MQA, MNB JTC and MNB’s Senate meetings) on the

website.

The meeting has also concurred with a long term recommendation under

Option 3 – To introduce online submission for the accreditation process.

This recommendation is considered long term (and strategic for MQA to

implement) and it requires planning and certain amount of investment by the

ministry.

63

Conclusion

Based on the final report presentation by MPC to the top management of MQA

and MNB held at MQA on 24 January 2017, the management had agreed on all

of the proposed options, as follows: -

No. Selected Option(s) Comments/Feedback

1. Option 2: To publish the meeting

schedules of, e.g. the MQA, NB

Joint Technical Committee and

the Nursing Board’s Senate

Meeting in the web site

The meeting agreed and concurred

that for short-term solution, Option 2 is

feasible, with minimal cost, the meeting

schedules of, e.g. the MQA, NB Joint

Technical Committee could be

published in the website.

2. Option 3: To introduce online

submission for accreditation

process

MQA commented that online

submission proposal has been

proposed to the ICT Committee of

MOHE for approval - as part of MQA

Strategic Planning. The proposed

system will provide an end-to-end, fully

online system for accreditation

process. The system is expected to

commence in 2018. In the meantime,

MQA has e-Semakan Pengesahan

(eSP) system on the website for

tracking purposes.

3. Option 4: To increase the number

of Nurse educator at the

Department of Curriculum and

Exam

Nursing Board decided to include

Option 4 which is to increase the

number of Nurse Educator at the

Department of Curriculum.

Note: The meeting notes of the presentation to top management are as per Appendix

A.

5.2.3 Limited place for Clinical Attachment for Post Basic courses –

Options and Recommended Option

Figure 5.3 below illustrates the options and recommendations (quick win and

long term) put forward for consideration by both MNB and MQA.

64

Figure 5.3. Options and recommendation for business concern: Limited place for Clinical

Attachment for Post Basic courses

As shown above, four options were proposed for MNB to consider on the

concern raised with regards to limited place for Clinical Attachment for Post

Basic courses.

The recommended option, Option 3 - PHEI Annual Master Plan was decided

as the way forward in solving the limited place for Clinical Attachment for Post

Basic courses. This option is considered as most favourable by MNB as it

would not be conflicting with current practice (and regulation whereby the

training must be observed by the regulating body) and there will be no financial

implication on both – business and regulating body. Under this option, the

PHEI is asked to include an advanced planning for their students’ clinical

attachment so as not to coincide with the MOH’s own nursing programme

practical attachment.

Conclusion

Based on the final report presentation by MPC to the top management of MQA

and MNB held at MQA on 24 January 2017, the management had agreed on

the proposed option, as follows: -

65

No. Selected Option(s) Comments/Feedback

1. Option 3: PHEI Annual Master

Plan

MNB suggested that the PHEI Annual

Master Plan could overcome the

problem of overlapping of clinical

attachment between PHEIs and MOH

nursing students. One of the loopholes

which could occur during the clinical

attachment season is that the

hospital/matron might overlook the

number of schools that applied for

attachment at their hospitals. Hence

the PHEI Annual Master Plan could

reduce or eliminate this concern.

Note: The meeting notes of the presentation to top management are as per Appendix

A.

5.2.4 Similar documentations are required for both PA and FA – Options

and Recommended Options

Figure 5.4 below illustrates the options and recommendations (quick win and a

long term) put forward for consideration by both MNB and MQA.

Figure 5.4. Options and recommendation for business concern: Similar documentations are

required for both PA and FA

66

Three options (as shown above) were proposed for both MQA and MNB to

consider on the concern raised with regards to similar documentations required

both during the PA and FA.

The short term recommended option, i.e. Option 2 – To submit only the

updated changes in the information for FA was proposed whereby only the

documents for Standard 1 -8 would be submitted and the appendices (APC,

evaluation forms, library books and originals are to be cited during the audit

visit).

The meeting has also proposed for a long term recommendation under Option

3 – Paperless and Online Submission. This recommendation is considered

long term (and strategic for MQA to implement) and it requires planning and

certain amount of investment by the ministry. The ministry may benchmark the

practice of other countries, e.g. USA, Canada or the UK (refer to Section 5.3).

Conclusion

Based on the final report presentation by MPC to the top management of MQA

and MNB held at MQA on 24 January 2017, the management deliberated and

agreed on all of the two proposed options, as follows: -

No. Selected Option(s) Comments/Feedback

1. Option 2: Submit only the

updated changes in the

information when applying for the

Full Accreditation

MQA and MNB both highlighted that

submitting only the updated changes is

not feasible because different panel

assesses different stages of

accreditation. Nevertheless, MNB

suggested that PHEI should submit

improvements (“penambahbaikan”)

within 3 months (4 months max). The

agencies noted that in the case of

some errant PHEIs, they would

normally submit 4 months before re-

accreditation expiry date.

Option 3: Paperless and Online

Submission

MQA highlighted that it is currently

revamping its online submission

system, whereby businesses are

expected to enjoy benefits from the

option when the new system

commenced in 2018.

Note: The meeting notes of the presentation to top management are as per Appendix

A.

67

5.2.5 Limited pool of Panel Reviewers/Assessors and lack of

competencies – Options and Recommended Options

Six options were deliberated during the sessions with MQA and MNB on the

concern raised regarding the limited pool of Panel Reviewers/Assessors and

lack of competencies.

Figure 5.5 below illustrates the options and recommendations for consideration

by both MNB and MQA.

Figure 5.5. Options and recommendation for business concern: Limited pool of panel reviewers

or assessors

The recommended options, Option 2 – Increase fees of panel reviewers and

Option 4 – Change methodology of inspection to risk-based regulation.

These options are inter-related, however they require further assessment with

both MNB and MQA.

Conclusion

Based on the final report presentation by MPC to the top management of MQA

and MNB held at MQA on 27 January 2017, the management had agreed on

the proposed options, as follows: -

No. Selected Option(s) Comments/Feedback

1. Option 2: Increase fees of

panel reviewers

The meeting agreed that the fees of the

panel reviewers could be increased to

attract and motivate. MQA also

68

No. Selected Option(s) Comments/Feedback

suggested to reword fees into

‘honorarium’ and it is planning to

increase the honorarium, targeting in

2018. This would involve an increase

of 50% in the honorarium.

With effect of the new honorarium,

panel assessors or reviewers are

expected to meet certain KPI i.e:

number of reports completed and

timeliness. If the criteria is not met, the

fee will be reduced to almost 25%.

MQA has no objection to rehire retirees

as assessors or reviewers, as

suggested by MNB.

2. Option 4: Change methodology

of inspection to risk-based

regulation.

MQA is currently looking into risk-

based assessment, which can be used

to incentivise (or “motivate”) reputable

PHEI. MQA agreed with this option

and it needs further deliberation before

implementation.

Note: The meeting notes of the presentation to top management are as per Appendix

A.

5.3 Nursing Programme Accreditation: Benchmarking the regulations and some of the issues with other countries

This section is introduced to serve as our comparison of the Nursing programme

accreditation in Malaysia with other countries’ laws and practices, in relation to some

of the concerns raised by business regarding the accreditation of nursing courses in

Malaysia.

Table 5.1. Laws/ guidelines on accreditation of nursing programmes

Country Laws/ guidelines on accreditation of nursing programmes

Malaysia Nurses Act 1950 (Revised 1969)

Nurses Registration Regulations 1985

Guidelines on Standards and Criteria for Approval or

69

Country Laws/ guidelines on accreditation of nursing programmes

Accreditation of Nursing Programmes 2010

Canada Canadian Association of Schools of Nursing’s Accreditation

Programme Standards 2013

Australia Australian Nursing and Midwifery Accreditation Council’s

Registered Nurse Accreditation Standards 2012

Assessor Handbook 2012

Hong Kong Nursing Council of Hong Kong’s Handbook for Accreditation of

Training Institutions for Pre-enrolment/ Pre-registration Nursing

Education 2012

South Africa South African Nursing Council’s Regulations Relating to the

Accreditation of Institutions as Nursing Education Institutions

2013

Circular 6/2012: Dual Submission of Programs for Accreditation

to South African Nursing Council (SANC) and Council on Higher

Education (CHE)

5.3.1 External examiners, reviewers, auditors or assessors

Generally speaking, accreditation focuses on the quality of institutions of higher and

professional education and on the quality of educational programmes within

institutions. Institutional accreditation concerns itself with the quality and integrity of the

total institution, assessing the achievement of the institution in meeting its own stated

mission, goals, and expected outcomes.21 As far as Malaysia is concerned, all nursing

programmes are under the control of the Nursing Board Malaysia. Any educational

institution that aims to offer a nursing programme must abide to the eight (8) standards

as set by the Nursing Board prior to approval: namely governance and management;

programme resources; human resources; curriculum; admission policy; student

assessment; programme evaluation; and continuous improvement activities.

Central to any system of accreditation is the assessment or review of the programmes

by the assessors or reviewers. For Nursing Board Malaysia, the Curriculum Unit was

established on 3rd August 2005 with the objective of maintaining the quality control of

nursing education in Malaysia. This unit is headed by a Nursing Tutor and assisted by

Matron and an Administrative Assistant. This unit collaborates with the Malaysian

Qualifications Agency (MQA) and the Education Ministry for accreditation and

21 Commission on Collegiate Nursing Education. (2013). Standards for accreditation of

baccalaureate and graduate nursing programs. Washington D.C.: Commission on Collegiate Nursing

Education.

70

certification of nursing programmes. The twin functions of the Unit are to approve the

curriculum among institutions that offer nursing courses and to recommend to the MQA

for approval of all nursing training.22

In Canada, the Accreditation Bureau of the Canadian Association of Schools of

Nursing (CASN) is the decision-making body regarding CASN accreditation. The

Bureau consists of ten members:

Five members, with full-time faculty positions in CASN Member Schools,

elected by CASN Council;

One representative of a service agency nominated by the Canadian Nurses

Association;

One academic representative nominated by the Association of Universities and

Colleges of Canada;

One community representative selected by CASN Executive Committee;

One regulatory body representative selected by CASN Executive Committee

(The term of office for the regulatory body representative is two years for one

term only.);

One consumer (student/graduate) representative, nominated by CASN Member

Schools, and appointed by CASN Executive Committee.23

In addition to the Accreditation Bureau, in Canada, there is a mechanism known as

peer review. Essentially, reviewers are experienced educators in baccalaureate or

graduate nursing programmes. Reviewers conduct site reviews to collect data to

validate the self-study reports provided by the school undergoing an accreditation

review.24 A reviewer must meet the following selection criteria:

A full-time nursing faculty member or retired from the same within the past

three years;

Recently involved in teaching or administering baccalaureate or graduate

programmes in nursing;

22 Nursing Board, Malaysia. (2015). Curriculum Unit. http://nursing.moh.gov.my/about-us/units-

function-introduction/curriculum/

23 Canadian Association of Schools of Nursing. (2016). Accreditation Bureau.

http://www.casn.ca/accreditation-bureau/

24 Canadian Association of Schools of Nursing. (2016). Accreditation standards and program

framework and standards. http://www.casn.ca/accreditation/accreditation-program-information/

71

Experienced teachers with at least 5 years in a baccalaureate or graduate

programme in nursing;

Actively involved in nursing scholarship

Educated with at least a Master’s degree in nursing; and

Willing to participate in the accreditation process for at least 2 consecutive

years.

Reviewers are selected for specific reviews according to their previous accreditation

experience, and language skills. In addition, they must not generally be employed by a

Unit/Programme in the same province as that of the Unit and Programme to be

reviewed, and must also be free of any other potential conflict of interest with the Unit

and Programme.25

Reviewers are critical to the credibility of the Accreditation Programme. They collect

data assessing the Educational Unit and Nursing Education Programmes against the

CASN Accreditation Standards and provide the CASN Accreditation Bureau with a

written report of their findings. CASN reviewers are experienced educators,

recommended by the Heads of their respective School, and undergo CASN reviewer

training. They represent CASN while participating in the accreditation process and sign

a form guaranteeing their commitment to the accreditation policies and procedures,

including professional and ethical conduct, confidentiality and respect for the

intellectual property of the programme.26 This element seems to be missing from the

Malaysian accreditation framework of nursing programmes. Based on the feedback

received from stakeholders, conflict of interest and lack of independence will likely

occur due to the fact that most examiners are from competing educational institutions.

In Australia, the accreditation for nursing courses falls within the authority of the

Australian Nursing and Midwifery Accreditation Council (ANMAC). In summary,

Accreditation Support Coordinator, in consultation with Associate Director for

Professional Programs, will establish an assessment team to review the submission

made by educational institution, including two to three peer assessors specialising in

the clinical or academic area of the programme to be accredited. The Council

publishes Assessor’s Handbook to detail out the framework for assessment of nursing

programmes.27

25 Canadian Association of Schools of Nursing. (2016). Accreditation standards and program

framework and standards. http://www.casn.ca/accreditation/accreditation-program-information/

26 Canadian Association of Schools of Nursing. (2016). Accreditation program reviewers.

http://www.casn.ca/accreditation/accreditation-program-reviewers/

27 Australian Nursing and Midwifery Accreditation Council. (2015). National guidelines for the

accreditation of nursing and midwifery programs leading to registration or endorsement in

Australia. Canberra: Australian Nursing and Midwifery Accreditation Council.

72

As regards to the membership of the assessment team, it will comprise at least four

members, being:

Two assessors who have relevant academic/educational expertise, including

one who has particular expertise in the development and review of education

curricula – these assessors will, where possible work in a different state or

territory to that where the education provider is based.

One or more assessors who have clinical expertise or clinical management

experience relevant to the programme being assessed – where possible, these

assessors will work in the state or territory where the education provider is

based.

An Associate Director for Professional Programs who has been allocated to the

respective assessment team.28

To be eligible for selection for an assessment team, an assessor must:

Hold current registration without conditions relating to conduct as a nurse

and/or midwife with the Nursing and Midwifery Board of Australia (NMBA).

Have the requisite knowledge, skills and experience for the type of programme

being assessed.

Be available to participate in all stages of the assessment of the programme,

including any site visit(s) and drafting and/or review of reports by the

assessment team.

Have no personal or professional interest or duty that may, or may not be

perceived to, interfere or conflict with the individual’s ability to fulfill their

responsibilities as a member of the assessment team.29

In Malaysia, the Guidelines and Criteria for Accreditation for Approval or Accreditation

of Nursing Programmes 2010 does not contain provision relating to the assessment

team and the criteria to be assessor for proposed nursing programmes by educational

institutions.

In Hong Kong, the Nursing Council’s Handbook for Accreditation of Training Institutions

for Pre-enrolment or Pre-registration Nursing Education 2012 serves as a guideline for

accreditation of nursing courses. To handle applications for accreditation, the Nursing

28 Australian Nursing and Midwifery Accreditation Council. (2012) Assessor handbook. Canberra:

Australian Nursing and Midwifery Accreditation Council.

29 Australian Nursing and Midwifery Accreditation Council. (2012) Assessor handbook. Canberra:

Australian Nursing and Midwifery Accreditation Council.

73

Council has set up an accreditation committee (“AC”), which in turn forms preliminary

assessment groups and accreditation panels to assist it to make in-depth assessment.

The AC consists of members from the Nursing Council, as well as co-opted members

appointed by the Nursing Council, having considered their relevant expertise. Members

of the AC come from diverse backgrounds, including but not limited to nurses, doctors

and other professionals from public, private and academic sectors to maintain the

fairness and objectivity of the accreditation. The AC shall then establish several

Preliminary Assessment Groups (“PAG”) out of its members. Each PAG consists of at

least three AC members. Each application for accreditation shall be assigned to one

PAG for assessment. When assigning to the PAG, special attention is made that

members of the panel are not associated with the training institution and/or nursing

programme concerned to avoid conflict of interest.30

Lastly, the South African Nursing Council’s Regulations Relating to the Accreditation of

Institutions as Nursing Education Institutions 2013 is the main reference for

accreditation process in South Africa. According to Reg. 3, when the Council receives

a submission for accreditation request, it will undergo the process of review and audit.

According to Reg. 8(1), the Council must, upon evaluation of the documentation

submitted by the applicant, determine whether the applicant meets the requirements

for accreditation.31 According to Circular 6/2012: Dual Submission of Programmes for

Accreditation to South African Nursing Council (SANC) and Council on Higher

Education (CHE), the conformance criteria set by the Nursing Council are as follows:32

Programme design

Student recruitment, admission and selection

Staff selection, appraisal and development

Teaching and learning strategy

Learning programme

Student assessment and procedures

Physical, administrative and financial resources

Management of clinical practice learning

Management of assessment and moderation

30 Hong Kong Nursing Council. (2012). Handbook for Accreditation of Training Institutions for Pre-

enrolment or Pre-registration Nursing Education 2012. Queen’s Road East Wan Chai: Hong Kong

Nursing Council.

31 Regulations Relating to the Accreditation of Institutions as Nursing Education Institutions 2013.

32 South African Nursing Council. (2012). Circular 6/2012: Dual Submission of Programs for

Accreditation to South African Nursing Council (SANC) and Council on Higher Education (CHE).

Pretoria: South African Nursing Council.

74

Appeal process

Record keeping and reporting

Quality management system

In addition to that, criteria set by the CHE are as follows:33

Programme design

Student recruitment, admission and selection

Staffing

Teaching and learning strategy

Student assessment and procedures

Infrastructure and library resources

Programme administrative services

Post graduate policies, regulations and procedures

Programme coordination

Academic development for student success

Teaching and learning interactions

Student assessment practices

Coordination of work-based learning

Delivery of post basic programme

Student retention and throughput rates

Programme impact

The next stage in the accreditation process by the SANC is audit. Audit is defined by

Regulations 2013 as the process of systematic scrutiny of a quality management

system carried out by an audit team in order to determine whether the institution meets

33 South African Nursing Council. (2012). Circular 6/2012: Dual Submission of Programs for

Accreditation to South African Nursing Council (SANC) and Council on Higher Education (CHE).

Pretoria: South African Nursing Council.

75

the Council’s prescribed accreditation requirements, criteria and standards for nursing

education and training.34

Central to this audit process is audit visit; which is defined as an on-site assessment or

appraisal undertaken to confirm, validate and determine if an applying institution or a

nursing education institution’s statements and claims made in the institutional portfolio

and self-assessment meet the Council’s prescribed accreditation requirements, criteria

and standards for nursing education and training.35 According to Reg. 9(1), audit visit

must be conducted for the following purposes:36

(a) Validating the statements and claims made in the institution’s portfolio and

institutional self-assessment;

(b) Assessing the institutions facilities and resources; and

(c) Determining whether the institution meets the Council’s prescribed accreditation

requirements, criteria and standards for nursing education and training.

One important criteria of an auditor’s appointment is independence. Reg. 1 defines an

auditor as independent professional nurse who understands the standards and

principles of auditing and is appointed by the Council to participate in audits.

In comparing the Guidelines and Criteria for Accreditation for Approval or Accreditation

of Nursing Programmes 2010 with the accreditation frameworks in Canada, Australia,

Hong Kong and South Africa, Malaysian guidelines do not provide for the accreditation

process and appointment of the examiners/ reviewers/ auditors/ assessors to assess

the accreditation application made by educational institutions. It is suggested that the

guidelines should include the procedures for accreditation, flowchart of such

procedures, appointment of reviewers and their appointment criteria. To preserve

reviewer’s independence and prevent conflict of interest, a provision relating to this

aspect must also be included in the guidelines. As highlighted by Ralphs, Birk and

Chapman (2015) on the accreditation of nursing education in Australia, the purpose of

the assessment team is well-defined; that of ensuring the standards, policies and

procedures underpinning assessment and accreditation are effective, fair and based

on contemporary research and best practice in the interests of promoting and

protecting the health of the community.37 Similarly, the Malaysian guidelines can be

improved to provide a comprehensive framework for the assessment processes. In

another article, Ralphs et al (2015) suggests that the need to establish clear,

34 Reg. 1 of the Regulations Relating to the Accreditation of Institutions as Nursing Education

Institutions 2013.

35 Reg. 1 of the Regulations Relating to the Accreditation of Institutions as Nursing Education

Institutions 2013.

36 Reg. 9(1) of the Regulations Relating to the Accreditation of Institutions as Nursing Education

Institutions 2013.

37 Ralphs, N., Birks, M., & Chapman, Y. (2015). The accreditation of nursing education in Australia.

Collegian, 22, 3-7.

76

systematic evidence-informed approaches to accreditation design is paramount to the

quality of nursing education. To ensure that nursing courses achieve the outcomes

expected of them, effectively designing the accreditation standards and processes is

vital to quality assurance in nursing education.38

38 Ralphs, N., Birks, M., & Chapman, Y. (2015). ‘‘Settling for less’’: Designing undergraduate nursing

curricula in the context of national accreditation. Collegian, 353, 1-8.

77

Table 5.2. Summary of comparison of issue on: Examiners, reviewers, auditors,

assessors

Country Examiners, reviewers, auditors, assessors

Malaysia Assessment for accreditation is done by the Curriculum Unit,

Nursing Board.

Membership of Curriculum Unit:

Nursing Tutor

Assisted by Matron and an Administrative Assistant.

This unit collaborates with the Malaysian Qualifications Agency

(MQA) and the Education Ministry for accreditation and

certification of nursing programmes. No external

reviewer/examiner/auditor/assessor.

Canada Assessment for accreditation is done by the Accreditation Bureau

of the Canadian Association of Schools of Nursing.

Membership:

Five members, with full-time faculty positions in CASN

Member Schools, elected by CASN Council;

One representative of a service agency nominated by the

Canadian Nurses Association;

One academic representative nominated by the

Association of Universities and Colleges of Canada;

One community representative selected by CASN

Executive Committee;

One regulatory body representative selected by CASN

Executive Committee (The term of office for the regulatory

body representative is two years for one term only);

One consumer (student/graduate) representative,

nominated by CASN Member Schools, and appointed by

CASN Executive Committee

In addition to the Accreditation Bureau, in Canada, there is a

mechanism known as peer review. Reviewers are experienced

educators in baccalaureate or graduate nursing programmes.

Reviewers conduct site reviews to collect data to validate the self-

study reports provided by the school undergoing an accreditation

review.

78

Country Examiners, reviewers, auditors, assessors

Criteria to become reviewer:

a full-time nursing faculty member or retired from the

same within the past three years;

recently involved in teaching or administering

baccalaureate or graduate programmes in nursing;

experienced teachers with at least 5 years in a

baccalaureate or graduate programme in nursing;

actively involved in nursing scholarship

educated with at least a Master’s degree in nursing; and

willing to participate in the accreditation process for at

least 2 consecutive years.

not generally be employed by a Unit/Program in the same

province as that of the Unit and Programme to be

reviewed

must be free of any other potential conflict of interest with

the Unit and Programme

Australia Assessment for accreditation is done by the Australian Nursing

and Midwifery Accreditation Council (ANMAC)

Membership of the assessment team, it will comprise at least four

members, being:

Two assessors who have relevant academic/educational

expertise, including one who has particular expertise in

the development and review of education curricula – these

assessors will, where possible work in a different state or

territory to that where the education provider is based.

One or more assessors who have clinical expertise or

clinical management experience relevant to the

programme being assessed – where possible, these

assessors will work in the state or territory where the

education provider is based.

An Associate Director for Professional Programmes who

has been allocated to the respective assessment team.

To be eligible for selection for an assessment team, an assessor

must:

Hold current registration without conditions relating to

conduct as a nurse and/or midwife with the Nursing and

79

Country Examiners, reviewers, auditors, assessors

Midwifery Board of Australia (NMBA).

Have the requisite knowledge, skills and experience for

the type of programme being assessed.

Be available to participate in all stages of the assessment

of the programme, including any site visit(s) and drafting

and/or review of reports by the assessment team.

Have no personal or professional interest or duty that

may, or may not be perceived to, interfere or conflict with

the individual’s ability to fulfill their responsibilities as a

member of the assessment team.

Hong Kong Assessment for accreditation is done by Accreditation Committee,

Hong Kong’s Nursing Council.

Members of Accreditation Committee:

1. Members from the Nursing Council, as well as

2. Co-opted members appointed by the Nursing Council,

having considered their relevant expertise.

*Members of the AC come from diverse backgrounds, including

but not limited to nurses, doctors and other professionals from

public, private and academic sectors to maintain the fairness and

objectivity of the accreditation.

Preliminary Assessment Group (PAG): Consists of at least three

AC members. Special attention is made that members of the

panel are not associated with the training institution and/or

nursing programme concerned to avoid conflict of interest.

South Africa South African Nursing Council is responsible for assessment for

accreditation. The vital procedures are review of application and

audit.

One important criteria of an auditor is independence. Reg. 1

defines an auditor as independent professional nurse who

understands the standards and principles of auditing and is

appointed by the Council to participate in audits.

5.3.2 Transport and accommodation

In Canada and Australia, it was found that transportation in rural areas was an issue

for the student nurse who undergoes mandatory clinical training. Often there was a

lack of transportation or elevated transportation costs.

80

Besides, some rural communities do not have public bus service. Even if they do, they

have limited hours of service and frequency. This circumstance can be problematic for

the students.39 Besides, finding accommodation is also an issue. The cost can be

significant and there is lack of suitable accommodation especially in rural areas.40

Similarly, a survey of 212 final year Bachelor of Nursing students at the Queensland

University of Technology illustrates that appropriate accommodation and availability of

public transport were described as among the challenges they faced during clinical

training.41 Ideally, the educational institutions should facilitate students in searching for

affordable accommodation and transportation options.42

In Malaysia, item 2.10 of the Guidelines provides that there must be transport made

available for the clinical areas, college and campus. Thus, the educational institutions

have a duty to provide for transportation of the students in the institutions and also at

the healthcare facilities where their students undergo clinical training. As regards to

accommodation, according to item 2.12 of the Guidelines, if accommodation is

provided, it must comply with standard requirement of minimum 60 square feet per

student. The use of “if” indicates that it is not mandatory for the educational institution

to provide for accommodation. Nonetheless, if it provides accommodation, then the

requirement prescribed by the guidelines must be complied with. Based on the

feedback received from operators, it is quite burdensome for institutions to arrange

transport for all students especially in clinical areas where the number of students in a

clinical area is small and the distance is far from one another thus this led to high cost

that students need to incur for transport arranged by the institution.

In Australia, transport and accommodation of students during clinical attachment

period is not administered by the university. Instead the students must arrange their

own transport and accommodation. However, the students may apply the following to

cover the costs they incur while doing clinical attachment:

Nursing and Allied Health Scholarship and Support Scheme Remote Clinical

Placement Scholarship – This is an Australian Government initiative to support

nursing or midwifery students to undertake a clinical placement in a remote

area. The maximum total value of the scholarship is $11,000. Payments may

be made for: travel, accommodation and living expenses only if a scholar is

required to relocate from their usual place of residence to complete the

39 Killiam, L.A. & Carter, L.M. (2010). Challenges to the student nurse on clinical placement in the

rural setting: a review of the literature Rural and Remote Health 10: 1523, 1-14.

40 Killiam, L.A. & Carter, L.M. (2010). Challenges to the student nurse on clinical placement in the

rural setting: a review of the literature Rural and Remote Health 10: 1523, 1-14.

41 Edwards, H., Smith, S., Courtney, M., Finlayson, K., & Chapman, H. (2004) Impact of clinical

placement location on nursing students competence and preparedness for practice. Nurse

Education Today 24(4), 248-255 .

42 Killiam, L.A. & Carter, L.M. (2010). Challenges to the student nurse on clinical placement in the

rural setting: a review of the literature Rural and Remote Health 10: 1523, 1-14.

81

placement, and supervision payment to the hosting organisation or educational

institution.43

New South Wales Undergraduate Clinical Placement Grants - Grants up to

$1,000 for Clinical Placements in a NSW public health facility are available to

NSW students undertaking a Bachelor of Nursing or Bachelor of Midwifery

degree.44

Distance (one way) Amount

751km + $1,000

501 - 750km $750

301 - 500km $500

101 - 300km $300

50 - 100km $100

Under 50km No grant

Table 5.3: Amount of grants under NSW Clinical Placement Grants

In Saskatchewan, Canada, the educational institutions are not obliged to provide for

transport and accommodation for nursing students. However, the Ministry of Health

offers the Clinical Placement Bursaries for students in a health discipline programme

who must complete a final clinical placement as a requirement of programme

completion. As for eligibility, the applicant must:45

Be a Saskatchewan resident and hold a valid health card.

Currently enrolled or accepted into a final clinical placement. Bursaries are not

awarded to people who have already completed their programme.

Be willing to apply for and accept a position within six months of graduating

from the programme.

Based on the analysis of the approaches towards students’ transportation and

accommodation in Australia and Canada, neither the universities nor the hospitals are

responsible for students’ transportation during clinical placement. It is the students’

43 Australian College of Nursing (2016). Remote Clinical Placement Scholarship.

https://www.acn.edu.au/nahsss

44 NSW Health (2016) Undergraduate Clinical Placement Grant 2016.

http://www.health.nsw.gov.au/nursing/scholarship/Pages/undergrad_clinical.aspx

45 Government of Saskatchewan (2016) Bursaries for Nurse Educators and Clinical Placement.

https://www.saskatchewan.ca/residents/education-and-learning/scholarships-bursaries-

grants/grants-and-bursaries/bursaries-for-nurse-educators-and-clinical-placement#bursaries

82

responsibilities. However, students can apply for fund/ allowance/ grant/ scholarship/

bursary available to cover the travel and accommodation costs. It is submitted that

such approach may also be used in Malaysia to reduce the burden of the colleges/

universities operators on the issue of students’ transportation and accommodation.

Table 5.4. Summary of comparison of issue on: Transport and accommodation

Country Transport and accommodation

Malaysia Transport is compulsory for studies and practical placement.

Accommodation is not compulsory. But, if provided, it must

comply with standard requirement of minimum 60 square feet per

student.

Canada Not compulsory but students may apply to Ministry of Health for

Clinical Placement Bursaries

Australia Not compulsory but students may apply for grants/ scholarships:

1.Nursing and Allied Health Scholarship and Support Scheme

Remote Clinical Placement Scholarship

2. Undergraduate Clinical Placement Grants

Hong Kong Not compulsory.

South Africa Not compulsory.

5.3.3 Limited placement (for Clinical Attachment) and lack of incentives

As highlighted by Connecticut Hospital Association (2007) clinical attachment for

nursing students involves various issues such as limited openings at hospitals and

healthcare facilities, inadequacy of faculty and healthcare organisational staff to work

with the students, numbers of patients, timing and location and inadequate preparation

and orientation to enable students and faculty to function at the healthcare facility.46

The existing clinical attachment framework, which also applies in Malaysia, is that each

nursing school arranges its own clinical placement agreement with hospital and

healthcare facility, independent of other nursing schools. According to the Guidelines

on the Usage of Facilities under the Ministry of Health Malaysia for Practical Training of

Students from Higher Learning Institutions, for clinical placement, the institution is

46 Connecticut Hospital Association (2007) Clinical Placement Capacity Assessment Project Report.

Connecticut: Connecticut Hospital Association, p. 9.

83

required to sign a memorandum of understanding (MoU) with the Ministry of Health. It

is required to submit a proposal for placement for 1 year with the names of the

students, clinical instructor and local preceptor to the State’s Health Department and

the facility. The university and the facility department need to hold meetings to discuss

about the placement to avoid overlapping issue. If the facility agrees to the placement,

a letter of approval will be sent to the institution with a copy also sent to the State’s

Health Department. Inadequate number of sites for paediatrics, behavioural/ mental

health, obstetrics, and the time to arrange and manage clinical placements are

identified as stress factors for both nursing schools and health care facilities. For

instance, in Malaysia, item 2.8.5.2 of the Guidelines on Standards and Criteria for

Approval or Accreditation of Nursing Programmes provides that at any one placement

site, the students: clinical instructor (CI) ratio should not exceed 1:15.The intense

competition among various institutions for clinical placement sites was also noted as

an issue faced by hospitals and healthcare facilities.

As reported by The Star (2012), a total of 37,702 students were enrolled in nursing

diploma courses in 61 private institutions of higher learning in 2010. As of Dec 2010,

the total number of trained working nurses in the country stood at 61,110, with 21,118

working in the private sector. With the enrollment of 37,000 students, this results in an

average of 12,000 students graduating every year when the need for new nurses in the

private sector is only about 1,500 a year.47 According to the Minister of Human

Resources in 2012, there is imbalance between the number of students and limited

number of hospitals that can provide placement.48

Due to limited number of students that hospitals and healthcare facilities that can cater

for and intense competition between nursing institutions for clinical placement, some

private hospitals have their own educational institutions. For instance, KPJ Hospital

has its own nursing college, known as KPJ Healthcare University College. On the other

hand, Pusrawi Hospital’s nursing programmes are offered by the Pusrawi International

College of Medical Sciences. However, placement to selected public hospitals where

the coverage of illness and medical conditions are wider would provide better training

for the students, where such a preference is not attainable.

In South Australia, its clinical placement system is governed by the “Better Placed:

Strengthening our Clinical Placement System 2014”. Better Placed outlines the goals

and supporting actions identified through the work of Healthcare Management Advisors

to improve clinical placement effectiveness and capacity through improved governance

47 The Star (3 February 2012) Nursing job woes cut deep. The Star.

http://www.thestar.com.my/news/nation/2012/02/03/nursing-job-woes-cut-deep/

48 Sinar Harian (8 October 2012) 8,000 lulusan jururawat kolej swasta menganggur. Sinar.

http://www.sinarharian.com.my/nasional/8-000-lulusan-jururawat-kolej-swasta-menganggur-

1.92575

84

and systems.49 This system also implemented a single state-wide clinical placement

information management system or electronic platform to support matching and

scheduling of student cohorts to clinical placements; including monitoring and

managing placement allocations.50 On the other hand, in Queensland, a system known

as “Student Placement Deed” was introduced. A Student Placement Deed is a

strategic and overarching legal agreement between a university and Queensland

Health and covers all legal aspects of clinical placements. A Deed must be established

before a university can start organising clinical placements within a government health

care facility.51 All Queensland universities, along with numerous interstate universities,

have a current Deed with Queensland Health. Please note that Queensland Health

does not enter into Student Placement Deeds with international universities.

International placement coordinators must approach a Queensland university to

discuss placement opportunities on behalf of international students. If the institution

disagrees with the distribution and placement, it may renegotiate the matter with

Queensland Health. Should the matter is still unresolved, it can be escalated to the

Department of Health for mediation.52

In Malaysia, lack of incentive for accepting students for clinical placement may also

hinder healthcare facilities from accepting more students. According to the General

Guidelines for the Implementation of the Collection of Fee for Clinical Attachment in

Ministry of Health’s Hospitals, for nursing students, they are charged RM100/month

throughout their clinical practice training period. There is no information on fee charged

by private hospital. In order to encourage private hospitals to expand their capacity, the

government provides tax exemption equivalent to 100% of qualifying capital

expenditure incurred for a period of five years for the construction of new hospitals or

for expansion, modernisation or refurbishment of existing hospitals. However, to be

eligible for this incentive, these hospitals must be registered with the Ministry of Health

(MOH) for the promotion of healthcare travel because the purpose of the incentive is to

boost medical tourism in Malaysia.53 There is no information on incentive specifically

for clinical placement.

49 SA Health (2014) Better Placed: Strengthening our Clinical Placement System. Adelaide: SA

Health, p. 8.

50 SA Health (2014) Better Placed: Strengthening our Clinical Placement System. Adelaide: SA

Health, p. 8.

51 Queensland Health (2016) Clinical placement.

https://www.health.qld.gov.au/employment/clinical-placement/default.asp

52 Queensland Health (2016) Clinical placement.

https://www.health.qld.gov.au/employment/clinical-placement/default.asp

53 Bernama. (22 December 2009) More incentives for healthcare tourism industry. Sun Daily.

http://www.thesundaily.my/node/147941

85

Unlike Malaysia, in Canada, the Ministry of Health and Long Term Care provided $1

million for rehabilitation sciences programmes to develop resources to assist in the

development and enhance the quality of clinical placements. Over the next four years

beginning 2014, 25 projects were completed with these funds. These included the

development of resources for expanding clinical placement opportunities, for

establishing new models of supervision, clinical education support materials, and a

database for matching and tracking students on clinical placements.54 Another

incentive introduced by the Ministry of Training, Colleges and Universities (MTCU) is

payment of honoraria of $50/week/student to a preceptor’s employing agency. The

sum of money received is not enough to reimburse clinicians’ time, but does provide

funding to contribute to continuing education or professional development activities.

The honoraria helps prevent decline in the number of internships consequent to

constraint in hospital budgets, and increase the awareness and profile of rehabilitation

sciences in the institutions that are receiving the money.55 To support facilities that

offer clinical placement, the MTCU directs its funding towards technological

enhancements at the healthcare facilities. This is to equip the healthcare facilities with

the necessary equipment and tools.56

In Victoria, Australia, a system of standardised fees charged for clinical attachment is

in place. The Victorian Clinical Training Council (VCTC) released a Standardised

Schedule of Fees for Clinical Placement of Students in Victorian Public Health

Services. The fee schedule was introduced in response to the recognition that there

was significant variation in fees charged for clinical placements and an associated lack

of transparency in setting those fees that was an undesirable feature of the Victorian

clinical placement system. The fees schedule was introduced after extensive

consultations with stakeholders. The fees that were set were based on a number of

core principles and values which included recognition of:57

The mutual benefits to all stakeholders from clinical placements being equally

valued by education providers, health services and students

That clinical placements are recognised as a scare resource and a common

good and as such should be accessed with minimum encumbrance and utilised

well

Recognition be given to financial and operational expenses are borne by both

health and education stakeholders, and collaborative and cooperative

approaches were important to ensure sustainable approaches for clinical

54 Council of Ontario Universities. (2013) Integrating Clinical Education into Ontario’s Changing

Health Care System. Ontario: Council of Ontario Universities, p. 33.

55 Council of Ontario Universities. (2013) Integrating Clinical Education into Ontario’s Changing

Health Care System. Ontario: Council of Ontario Universities, p. 34-35.

56 Council of Ontario Universities. (2013) Integrating Clinical Education into Ontario’s Changing

Health Care System. Ontario: Council of Ontario Universities, p. 34-35.

57 Healthcare Management Advisors (2014) Report to SA Health on Development of a Clinical

Placement Framework. Victoria: HMA, p. 45.

86

placements were developed, including cost-sharing.

Schedule of fees was consistent with the principles of fairness, equity,

transparency and consistency, and

In-kind contributions for clinical placements made by both health and education

stakeholders be factored in the setting of fees.

The Schedule relates to the fees charged by health services to education providers as

contributions to the cost of providing clinical placements. These costs relate primarily

to teaching costs incurred by health services. Funding under both the Grant and the

Schedule are contributions to the full cost of clinical placements, whereby health

services absorb the balance of cost. This tripartite contribution to the cost of clinical

placements is a longstanding and widely-accepted principle in Victoria.58

Apart from that, the Victorian Government has also introduced the Training and

Development Grant. The grant is a subsidy that the department provides to public

health services toward costs associated with teaching, training and research activities

(TTR). The Grant is an acknowledgment of the productivity-lowering and general cost

impacts of TTR activities on health services. A specific stream of the Grant is for

professional-entry student placements, equivalent to $41.21M in 2013/14. Health

services receive a subsidy for placing students from 23 disciplines, including medical

students, nursing students (both registered and enrolled), allied health and allied health

assistant students. Payments to health services are based exclusively on their

proportion of clinical placement activity and these allocations (along with activity levels

by broad discipline category) are published with the Guidelines. Health services are

expected to acquit their payments against relevant expenditure accounts.59

Table 5.5. Summary of comparison of issue on: Placement quota and incentives

to hospitals or healthcare facilities

Country Placement quota and incentives

Malaysia Government hospitals charge RM100/month for nursing

students undergoing clinical attachment at their facilities.

Tax exemption equivalent to 100% of qualifying capital

expenditure incurred for a period of five years for the

construction of new hospitals or for expansion,

modernisation or refurbishment of existing hospitals -

limited to hospitals that offer healthcare travel

Canada Ministry of Training, Colleges and Universities (MTCU) has

introduced a grant to:

1.help clinical facilities to accommodate students’

58 Victorian Clinical Training Council. (2013) Fee schedule. Victoria: VCTC, p. 7.

59 Victorian Clinical Training Council. (2013) Fee schedule. Victoria: VCTC, p. 7.

87

Country Placement quota and incentives

placements

2.help clinical facilities buy equipment/ improve the

facilities

Ministry of Health and Long Term Care provided $1 million

for rehabilitation sciences programmes to develop

resources to assist in the development and enhance the

quality of clinical placements.

Australia Standardised fees charged by facilities offering clinical

placement

Health services receive a subsidy for placing students from

23 disciplines, including medical students, nursing

students (both registered and enrolled), allied health and

allied health assistant students under Training and

Development Grant.

Hong Kong -

South Africa -

5.4.4 Requirement of qualification in teaching methodology

It is undeniable that quality patient care highly depends on having a well-educated

nursing workforce. Lower mortality rates, fewer medication errors, and positive

outcomes are all linked to nurses prepared at the baccalaureate and graduate degree

levels.60 Apart from having the necessary academic credentials to be qualified as nurse

educators, another vital aspect is teaching skills – the ability to help students learn how

to master essential skills and knowledge in order to become professional nurses.61 In

Malaysia, to ensure that academic staff at nursing faculties have the necessary

teaching skills, the Guidelines and Criteria for Accreditation for Approval or

Accreditation of Nursing Programmes 2010 make it compulsory for the members of the

academic staff to possess a certificate in teaching or have done a module in teaching

methodology from an accredited university or institution as approved by the Nursing

Board of Malaysia. This requirement is however not seen positively by those interested

60 Rosseter, R. (2015). Creating a More Highly Qualified Nursing Workforce.

http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce

61 Penn, K.B., Wilson, L.D., & Rossetter, R. (2008). Transitioning From Nursing Practice to a

Teaching Role. Online Journal of Issues in Nursing, 13,

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Tabl

eofContents/vol132008/No3Sept08/NursingPracticetoNursingEducation.aspx

88

to join the academia on the grounds that their experiences and academic qualifications

should suffice to enable them to become educators.

In Canada and Hong Kong, there is no requirement for qualification in teaching

methodology. In Canada, according to the Canadian Association of Schools of

Nursing’s Accreditation Programme Standards 2013, the academic staff must

possess the academic qualifications and professional experience for the areas in

which they teach, and must demonstrate that they are able to accomplish the mission,

goals, and expected programme outcomes. Evidence including CVs should indicate

expertise in the areas in which they teach.

However, according to the Australian Nursing and Midwifery Accreditation Council’s

Qualifications of Academic Staff Teaching into Nursing & Midwifery Programmes of

Study, the criteria for appointment in Australia that must be fulfilled by the applicants of

academic position are as follows:

(a) Staff must possess knowledge of contemporary developments in the discipline or

field, which is informed by continuing scholarship, research and advances in practice.

(b) Staff must possess pedagogical knowledge and skills in contemporary teaching,

learning and assessment principles that enable staff to understand the requirements of

a curriculum, meet the learning needs of students and fulfill their role as educator and

(c) Staff must possess a qualification in a relevant discipline, at least one level higher

than the course of study; or equivalent relevant academic or professional or practice-

based experience and expertise.

Additionally, unlike Malaysia, the Nursing Council of Hong Kong’s Handbook for

Accreditation of Training Institutions For Pre-Enrolment/Pre-Registration Nursing

Education does not mention on the requirement of teaching certificate. The vital criteria

to be considered for appointment are as follows - formal qualifications, professional

experience, research output, teaching experiences and peer recognition.

However, in South Africa, Reg. 2(1) of the Regulations Relating to the Accreditation of

Institutions as Nursing Education Institutions specifies the criteria of an academic staff

as follows:

(i) Is registered with the Council as a professional nurse;

(ii) Has an additional qualification in nursing education;

(iii) Is in possession of a management qualification;

(iv) Holds at least a bachelor’s degree in nursing; and

(v) Holds a nursing qualification that is a level higher than the highest

qualification offered by the nursing education institution or, if the highest

89

qualification offered is a doctoral degree, a nursing qualification at an equal

level.

Based on Reg. 2 (ii), it is mandatory for an academic staff to possess qualification in

nursing education. Additionally, Reg. 6 of the Regulations Concerning the Minimum

Requirements for Registration of the Additional Qualification in Nursing Education 1987

provides that the course of study for additional qualification in nursing education shall

include the following:

(a) Theory and principles of education, including educational psychology;

(b) Theory and principles of the nursing education process, including practice for

nursing school administration and educational technology.

Based on the comparative analysis above, it is suggested that the accreditation

standards for nursing educators in Malaysia should do away with the requirement to

obtain special certificate on teaching methodology. As practised in Canada and

Hong Kong, the curriculum vitae would give a sufficient evidence of one’s suitability to

be considered for academic position at nursing faculty.

Table 5.6. Summary of comparison of issue on: Certificate in teaching

methodology

Country Certificate in teaching methodology

Malaysia Compulsory

Under 3.3, to qualify as an academic staff, one must possess a

certificate in teaching or have done a module in teaching

methodology from an accredited university/ institution as

approved by the NBM.

Canada Not compulsory

Criteria for academic staff: The academic staff must possess the

academic qualifications and professional experience for the areas

in which they teach, and must demonstrate that they are able to

accomplish the mission, goals, and expected programme

outcomes. Evidence including CVs should indicate expertise in

the areas in which they teach.

Australia Not compulsory

Criteria for academic staff:

(d) Staff must possess a knowledge of contemporary

developments in the discipline or field, which is informed by

continuing scholarship, research and advances in practice

(e) Staff must possess pedagogical knowledge and skills in

contemporary teaching, learning and assessment principles that

enable staff to understand the requirements of a curriculum, meet

90

Country Certificate in teaching methodology

the learning needs of students and fulfill their role as educator

and

Staff must possess a qualification in a relevant discipline, at least

one level higher than the course of study; or equivalent relevant

academic or professional or practice-based experience and

expertise.

Hong Kong Not compulsory

Criteria for academic staff: formal qualifications, professional

experience, research output, teaching experiences and peer

recognition.

South Africa Compulsory

Criteria for academic staff:

(i) is registered with the Council as a professional nurse;

(ii) (ii) has an additional qualification in nursing education;

(iii) is in possession of a management qualification;

(iv) holds at least a bachelor’s degree in nursing; and

(v) holds a nursing qualification that is a level higher than the

highest qualification offered by the nursing education

institution or, if the highest qualification offered is a

doctoral degree, a nursing qualification at an equal level.

The nursing education course shall include the following:

Theory and principles of education, including educational

psychology; and

Theory and principles of the nursing education process,

including practical for nursing school administration and

educational technology.

91

6.0 Conclusion

Through past experiences in similar studies by MPC, it is observed that to

resolve the issues and problems by amending regulations may take a long time

and may encounter resistance from many parties, especially the regulating

bodies.

For the private higher education institutions running the Nursing programmes in

Malaysia, the grievances and issues raised are mostly related to the

execution/administration of the regulations rather than on the provisions of the

regulations. The PHEIs understood the regulations imposed upon them and

what must they do in operating a Nursing Programme in Malaysia.

However, the PHEIs highlighted that there are rooms for improvements in the

execution/administration of the regulations by respective agencies. Although, it

seems that there are standard processes and procedures kept by both the

MQA and MNB, they should be aligned and improved, especially on the

timeline, internal and external communication for each process. There are also

many redundant paper works/ documentations which the PHEIs have to submit

to MNB and MQA, which generally requesting for similar information.

Hence, it is observed that most of the issues raised by the PHEIs in this study

could be resolved by practising more transparency, consultations and two-way

communications between the PHEIs and the regulating agencies, e.g. in

formulating (or revising) relevant policies and procedures - that would later on

be understood and complied by all parties. It is also viewed that by using

technology and having an integrated system to simplify the process, many

issues raised by the PHEIs in this report could be resolved.

Having a central (one) coordination body would also be a good mechanism to

resolve administrative issues which are highlighted by the PHEIs. However,

this requires further deliberation and discussions. This mechanism only requires

a firm partnership agreement and teamwork between relevant agencies without

having to amend the existing regulations. This way, the issues related to the

delay in accreditation of Nursing Programme could be resolved more effectively

and efficiently.

As a conclusion, the issues and grievances encountered by PHEIs in Malaysia

does not require amendment to the existing regulations but rather pro-active

actions by all agencies are urgently required to resolve the administrative gap.

Benchmarking with other countries may also be helpful as part of planning for

change.