Final Together, Protecting the Enviroment

Figure 16.9: Roadmap Towards Zero Single Use Plastics (2018-2030)

WASTE MANAGEMENT UNDER THE IMPACT OF COVID-19

COVID-19 is likely a zoonotic infection, which was transmitted from an unknown animal
source to humans. The World Health Organization (WHO) announced the COVID-19
outbreak as a pandemic in March 2020, a sit spread rapidly all over the world. Malaysia
recorded about 1,243, 852 coronavirus disease (COVID-19) cases and 10, 389 deaths
as of 7th August 2021. Globally, there are thousands of new cases of COVID-19 being
recorded daily. Besides that, several variants of SARS-CoV-2 have emerged which have
been classified as variants of interest (VOI) and variants of concern (VOC) by WHO
depending on its ‘disease severity, transmissibility, therapeutic and diagnostic escape,
immune escape’ and others. COVID-19 variants that are reported in Malaysia are alpha,
beta and delta variants (Daily Express, 2020).

Due to the high number of infections globally and nationwide the increase in the amount
of clinical waste (CW) generation was expected. Malaysia has reported a 111.94 %
(by weight) increase initially in the generation of CW which was mostly attributed to
COVID-19 related waste. The current practice of CW management (CWM) due to

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COVID-19 related cases follows the existing policy and legislation of CWM detailed
in the Schedule Waste Regulation (2005), Environmental Quality Act, 1974, and with
the standard operating procedure provided by the Ministry of Health, Malaysia. The
responsible authorities for day-to-day COVID-19 MWM are the Federal Government
and DOE.

According to DOE, from the total amount of healthcare waste generated in hospitals,
about 20% to 40% of the waste consists of CW which is potentially infectious and poses
risk whereas the remaining 60% to 80% accounts for general waste. The general waste
in hospitals is defined as any waste that is generated in the healthcare facilities such
as from canteens and offices and is disposed of as Municipal Solid Waste. The daily
generation of healthcare waste in year 2013 was 50 metric tons (Mt) per day and 18,000
Mt annually, and currently it is estimated that the generation of biomedical waste is 90
Mt/day or 33,000 Mt annually whereby about 75% to 80% is non-pathogenic waste
(Department of Environment, 2009).

During the COVID-19 pandemic, about 25 Mt is COVID-19 based biomedical waste.
During the COVID-19 pandemic, the increase in CW generation could be from swabs,
syringes, needles, sharps, blood or body fluid, excretions, mixed waste, laboratory
waste, material or equipment contaminated with the virus, masks or disposable gloves,
and PPE that is used for screening and treatment for COVID-19 infected persons. The
amount of CW generated in Malaysia increased to 111.94 % compared to the previous
years, a figure which is sourced from various healthcare facilities, hospitals, clinical and
research activities.

WAY FORWARD

Malaysia generated nearly 13.9 million metric tons of municipal solid waste (MSW) in
2016, the increase rate of MSW is estimated as 2~3% since 2012 with each Malaysian
generating 1.2 kg of MSW every day as reported by the National Solid Waste Department
of Malaysia. Currently, the main disposal technology of MSW in Malaysia is landfill
(71%), recycling (28%) and composting (1%). Normally, the composition of MSW is as
follows: 45% are organic waste (food waste), 24% are plastics, 7% are paper, 6% are
metal and 18% are glass and others. The government should take the first initiative in
implementing EPR scheme especially in plastic and other recycling items and also it
could increase in the overall recycling rate in Malaysia.

The introduction of EPR policy and circular economy also could contribute to a
sustainable waste management in Malaysia.

Stringent enforcement of waste separation at source must be carried out on an urgent
basis. Without strict enforcement of source separation, the recycling of waste could be
affected due to contaminated and commingled waste:

i. There is a need for an integrated waste management system in the managing of
MSW generated in Malaysia. By introducing an integrated waste management

401

approach it could result in sustainable management of solid wastes covering all
sources and all aspects, encompasing generation, segregation, transfer, sorting,
treatment, recovery and disposal in an integrated manner. It also will emphasize on
maximizing resource use efficiency;
ii. In Malaysia, WtE is only present in a very limited quantity at a small scale. High
cost of operation and poor technical input has restricted the development of WtE
in Malaysia. Therefore, the country only has one WTE plant located at the central
region and 4 mini-incinerators at this stage. Recently, the 2nd WTE project in
Malaysia is at the bidding stage. Malaysia should consider developing more WTE
facilities in Malaysia; and
iii. Encourage and recognize the involvement of informal sector for recycling of MSW
in Malaysia which also could contribute to higher recycling of MSW.

CONCLUSION

Municipal the waste management in Malaysia has become a challenging task in recent
years due to population growth, industrialization and an increase in quantity and variation
in the types of waste generated. Suitable disposal sites are becoming scarce and most
of the existing ones are nearly coming towards the end of its useful life. High cost of
operation and lack of technical expertise have restricted the development of WtE in
Malaysia. Although Malaysia’s municipal waste management strategies have been able
to improve the environmental quality, public health, and socio-economic development
related to be, there are new era challenges such as greenhouse gas emission and
more clinical waste of COVID-19. Pandamic much effort is required to increase the
effectiveness and efficiency in achieving the targeted objectives on municipal waste
management.

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The Star. (2019) Study shows low rate of recycling plastic bottles in M’sia. https://

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Waste Atlas. (2016). Municipal Solid Waste Generation. http://www.atlas.d-waste.com.

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leading-fmcg-firms-recycle-5000-tonnes-plastic-waste-2022.

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AUTHOR

Professor Agamuthu FASc, is a Senior Professor in the Jeffrey
Sachs Center on Sustainable Development at Sunway University.
Prior to this he was attached to University of Malaya for 44 years. He
is a Fellow of the Academy of Sciences, Malaysia. He is appointed
as the High-Level Foreign Expert for the Ministry of Science and
Technology, China and is also a Visiting Professor for Zhejiang
University of Technology in Hangzhou, China. Current responsibility
includes Senior Editor in Chief of Waste Management and Research,
and is on the editorial boards of several journals such as Journal of Material Cycles and
Waste Management and Journal of Safety and Environment. He is the Vice-President of
the Society of Solid Waste Management Experts in Asia and Pacific Islands (SWAPI). He
is the Founder Head of the Center for Research in Waste Management and the Founder
President of the Malaysian Society of Waste Management and Environment. Currently
he is the Chairman for the Organization for Climate Change (OFCC), Malaysia. He is a
member of International Solid Waste Association (ISWA). He has published 21 books,
28 chapters in book and authored over 475 peer-reviewed articles, proceedings and
invited papers. He has done over 75 consultancy projects and supervised over 200
Master’s Degree students and 30 doctoral students. His research interest includes Solid
Waste Management, Plastic and Microplastics, Marine Debris Landfills and Biomass/
Waste to Energy to name a few. He has international cooperation and collaboration
in several countries such as the UK, China, Austria, Japan, India, Norway, Cambodia,
Thailand, Myanmar, Sri Lanka, to name a few.

Dr. Jayanthi Barasarathi graduates with Doctor of Philosophy in
the field of Environmental Science & Management in year 2018
from University of Malaya, Malaysia. She is presently working
as a Senior lecturer at Faculty of Health & Life science at Inti
International University, Malaysia. Prior to this she was attached to
University of Malaysia Kelantan as postdoctoral fellow. She worked
as academician for more than 5 years and she has been actively
involved in various research projects for about 10 years.She has
published more than 25 articles in high-ranking journal and conference proceedings. Her
research interest is on bioremediation, phytoremediation, environmental microbiology,
and environmental biotechnology and leachate studies, microplastic related studies
and extended producer responsibility and she is always approachable for any local or
international collaboration. She has also international collaboration in several countries
such as Canada, Pakistan and Nigeria.

405

The environment is where we all meet;
where we all have a mutual interest;
it is the one thing all of us share.

- Lady Bird Johnson

406 Putrajaya, Malaysia.

Chapter 17

Collaborative
Environmental
Management: Local
Government and the
Community

COLLABORATIVE ENVIRONMENTAL MANAGEMENT:
LOCAL GOVERNMENT AND THE COMMUNITY

Mazlin Bin Mokhtar & Minhaz Farid Ahmed

INTRODUCTION

Environmental management globally gained real momentum in the early 1900s,
especially due to the disturbances in our surrounding environment for the industrial
and agricultural revolutions. Environmental disaster first got the spotlight in 1962
through the book ‘Silent Spring’ by Rachel Carson when she suspected the death and
disappearance of several birds in the USA (Carson, 2002) due to the excessive use
of synthetic pesticides i.e. DDT (C14H9Cl5) (Sauvé and Desrosiers, 2014). Although
Greeks and Romans were affected by excessive lead (Pb) mining, they might not be
aware of it (Settle and Patterson, 1980). However, recent scientific findings on the water
supply system indicated that Pb represents a significant toxic exposure through drinking
water (Deshommes et al. 2012; Sauvé and Desrosiers, 2014; Hu et al. 2010). Arsenic
sulfides were also used as pesticides during 900 A.D in China- until the widespread use
of DDT in the 1960s also brought disasters due to its toxicity (Peryea, 1998). Flame
retardants (i.e. PCBs) first spread out in the environment during 1929-1977 especially in
America due to their extensive application of it in the industrial sector. Land use changes
in South-East Asia also change the water flows of the underground aquifer and trigger
the mobilization of geochemical arsenic. Acid rain during 1980 was also considered an
issue of emerging concern due to the deposition of acid in the environment (Sauvé and
Desrosiers, 2014).

Recently, the impacts of climate change are also very vivid and world leaders have
been convinced to protect the environment in order to protect human civilization. This
started formally via the Rio Declaration on Environment and Development (1992) by the
United Nations (UN, 1992). Countries cannot only focus on environmental conservation
by avoiding development activities. Therefore, the concept of sustainability emerged
in 1987 by the United Nations Brundtland Commission’s report to make the balance
between environment and socio-economic issues, and the commission defined
sustainability as “meeting the needs of the present without compromising the ability of
future generations to meet their own needs” (UN, 1987).

Hence, at the global level, the environmental management framework is stronger than
the local level, especially in developing countries. At the global level, there are many
frameworks for environmental management such as the Intergovernmental Science-
Policy Platform on Biodiversity and Ecosystem Services (IPBES); United Nations

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Framework Convention on Climate Change (UNFCCC) by IPCC (Intergovernmental
Panel on Climate Change); United Nations Disaster Risk Reduction (UNDRR), United
Nations Sustainable Development Goals (SDGs) 2030, and as such as well as the
Stakeholder Engagement Policy by United Nations Environment Programme (UNEP).
At the regional level, there are also some environmental management frameworks such
as the European Union’s Environment Policy framework, the ASEAN (Association of
Southeast Asian Nations) platform for environmental management, etc.

However, considering the rapid climate changes, the translation of these global and
regional environmental management policies to the local level remains inadequate,
especially at the local level of developing countries including Malaysia. For instance, the
World Weather Attribution (WWA, 2022) has reported that the combination of La Nina and
global warming-induced heat waves from March to May 2022 in Pakistan contributed to
extreme rains during the monsoon causing economic losses of about USD30 billion as
well as killing over 1,500 people (Sangomla, 2022; UNOCHA, 2022). Similarly, in 2017,
Bangladesh experienced devastating flooding especially due to climate change (WWA,
2019) and the World Bank has predicted Bangladesh could experience damages of
about USD 570 million across its coastal belt every year due to the impact of climate
change such as extreme cyclone induced flooding (ANN, 2022). Similarly, the short-term
and very heavy rainfall-induced floods of 2021 in several states of Malaysia resulted
in the evacuation of almost 20,000 – 19,711 – families, with an estimated loss of at
least RM20bil (Mokhtar, 2022) as well as the death of 52 people (WMO, 2022). On the
other hand, the shutdown of drinking water treatment plants (DWTPs) is very frequent in
Malaysia especially due to chemical pollution in the river (Bernama, 2022; Palansamy,
2021). Therefore, the roles of local government in Malaysia, the lowest unit of government
hierarchy at the local level, is very crucial to enhance environmental management both
under normal and disaster periods mainly because of their enforcement capacity.

Organization Setup for Environmental Management

The management of the environment does not depend on a single ministry in Malaysia,
rather it is a combined effort by several ministries, agencies as well as multi-stakeholders
groups from GO-NGOs, private, academic and civil society. From the perspective of
the government, there are eight ministries and several agencies that are cross cutting
among their jurisdictions for environmental management including water resources
management at the federal, state and local levels of Malaysia (Figure 17.1).

409

Figure 17.1: Government Agencies and Other Stakeholders for Environmental Management
via the Lens of Water Management (EPU, 2022)

The functions of local government are based on the Local Government Act 1976 (Act
171) in Peninsular Malaysia. However, for the states of Sabah and Sarawak, the function
of the local government is based on different ordinances (LGD, 2022).

Local Governments in Peninsular Malaysia-
Local Authority means (Section 2 of the Local Government Act 1976 (Act 171)) any
City Council, Municipal Council or District Council, in relation to the Federal Territory
it means the commissioner of the City of Kuala Lumpur as stated under section 3 of
the Federal Capital Act 1960.

Local Government in Sarawak-
Local Authority means (Local Government Ordinance 1961, Sarawak No.11 of
1996) - (a) A city Administration named in Part I of the First Schedule; (b) A Municipal
Council named in part II of the first Schedule; (c) A District Council named in part III
of the First Schedule; Bintulu Development Authority (BDA) has also included in the
above-mentioned sub-section (b).

Local Government in Sabah-
Authority means any District Council, Town Board or Municipal Council established
under the provisions of Section 3 (Local Authority Ordinance 1996 (Chapter 20)).

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The basic system of local government in Malaysia is shown in Figure 17.2. The local
government is the lowest administrative unit of government at the local level in Malaysia.
The straight line in Figure 17.2 represents the line of authority among the Federal, State
and local governments. On the other hand, the dotted line in Figure 17.2 represents the
communication channel from Federal to State to local government.

Figure 17.2: Basin system of Local Government in Malaysia by Local Government Act 1976
(Ibrahim and Nordin, n.d.)

The governing council of the local authority usually consists of twelve to twenty members
and is headed by either a city Mayor or Council President (Figure 17.3). The councillors
are usually the residents who have vast experience in local government affairs. They
may be professional community leaders or representatives from various ethnic groups.
However, the local authority may have a special standard operating procedure (SOP)
to modify their administrative structure for ease of carrying out activities. Usually,
environmental management and monitoring are performed via the enforcement
department of the local authorities.

411

Figure 17.3: Basin Administrative Structure of Local Authorities in Malaysia
(Ibrahim and Nordin, n.d.)

Relevance of Local Government in Environmental Management

Recognition of Local Authority will enable them to implement effectively the Local
Government Act 1976 as well as coordinate with various stakeholders. Local Authorities
are given the mandate to enforce pollution management as well as to monitor whole
environmental management approaches at the local level. Therefore, pro-active and
effective leadership roles of LocalAuthority will enable them to establish a partnership with
public, private and civil sectors (Ahmed et al., 2018). For instance, the Local Government
Act 1976 (Part VIII; Section 70) from the Federal Constitution (9th Schedule; Article 74,
77; List II- State List; Item 4) gives enforcement power to the Local Authority to manage
the environment along controlling pollution of water bodies. The Local Authority has the
power to impose a fine exceeding RM 5,000 or a term of imprisonment not exceeding 2
years or both. The local authority can also impose a fine on the convicted not exceeding
RM500 for each day during which the offence is continued after conviction (Ahmed et
al., 2018).  

Moreover, the Local Government Act 1976 (Part XIV; Section 107) gives a mandate
to the Local Authority to issue and re-issue licences for any entity considering the
following provisions: 
i. A local authority in the granting of any licence or permit may prescribe the fees

for such licence or permit and the charges for the inspection or supervision of any
trade, occupation or premises in respect of which the licence is granted.

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(1A) Any licence or permit granted under this Act may be issued jointly with any
other licence or permit.
ii. Every licence or permit granted shall be subject to such conditions and restrictions
as the local authority may think fit and shall be revocable by the local authority at
any time without assigning any reason therefor.
(2A) The revocation of any particular licence or permit issued jointly with any other
licence or permit under subsection (1A) shall not affect the validity of any other
licence or permit with which it had been jointly issued.
iii. The local authority may at its discretion refuse to grant or renew any licence without
assigning any reason therefor.
iv. A licence shall be valid for a period not exceeding three years.
v. Every person to whom a licence has been granted shall exhibit his licence at all
times in some prominent place on the licensed premises and shall produce such
licence if required to do so by any officer of the local authority authorized to demand
the same.
vi. Any person who fails to exhibit or to produce such licence under subsection (5) shall
be guilty of an offence and shall on conviction be liable to a fine not exceeding five
hundred ringgit or to imprisonment for a term not exceeding six months or to both.
vii. For the purpose of subsection (5) or (6) any reference to the word “licence” shall
include its certified true copy.
viii. The certification of any licence as a true copy shall be made by the President,
Secretary or any officer authorized by the President in writing.

The Local Government Act 1976 (Part XIV; Section 110) gives mandate to the Local
Authority to enter premises by-

“Any officer of a local authority duly authorized in writing may at all reasonable
times, enter any premises within the local authority area for the purpose of
exercising any power of inspection, enquiry or execution of works which is
given to a local authority.”

Moreover, The Local Government Act 1976 (Part XIV; Section 112) gives mandate to
the Local Authority to penalize anybody for obstructing Councillor and others to perform
their activities-

“Any person who at any time obstructs, molests or assaults the Commissioner
of the City of Kuala Lumpur, or the Mayor or President, Councillors, officers or
employees of a local authority in the performance and execution of their duty
or removes any mark set up for the purpose of indicating any level or direction
necessary to the execution of works shall be guilty of an offence and shall on
conviction be liable to a fine not exceeding two thousand ringgit or to a term of
imprisonment not exceeding six months or to both.”

Hence, the Local Authority is the lowest administrative unit of the state government at
the local level, and it has the mandate to enforce pollution management through the
Local Government Act 1976. Therefore, the leadership roles of the Local Authority will be
effective in managing the environment of Malaysia in collaboration and cooperation with
multi-stakeholders, especially with the Department of Environment (DOE) Malaysia. The

413

DOE annually publishes the Environmental Quality Report of Malaysia that covers the
air quality, freshwater, groundwater and marine water quality as well as an inventory of
pollution sources in Malaysia. Apart from reporting the environmental status of Malaysia,
the DOE also performs activities related to community engagement and participant of
Malaysia. For instance, bellow are some activities of the DOE. These activities can have
maximum benefits if collaborated effectively with local authorities (Table 17.1).

Table 17.1: Some Community Engagement Activities by DOE for Environmental Management
in Malaysia

Source: (EPU, 2022).

SL. ACTIVITY FREQUENCY MEDIUM
NO.

01. 22 April - Hari Bumi

02. 5 Jun – Hari Alam Sekitar Sedunia

03. 16 September – Hari Ozon Sedunia

04. 21 Oktober – Hari Alam Sekitar Negara

Program Rakan Alam Sekitar;

i. Denai Sungai Kebangsaan

05. ii. Friend of River
iii. Aktiviti gotong royong di kawasan sungai
Physical/
iv. River Rangers bersama NGO Yearly Online

v. Rakan Saintis Sungai

06. Anugerah Sekolah Lestari Anugerah Alam Sekitar
Modul pengurusan / kepentingan sumber air

07. Pameran bertemakan alam sekitar

08. Pidato Alam Sekitar

09. Anugerah Langkawi Kelestarian Alam Sekitar

10. Pertandingan 3 Minit Tesis Alam Sekitar Bahasa
Melayu

Environmental Management Policies and Strategies

The Ministry of Environment and Water (KASA) is in charge of environmental
management in Malaysia, especially via the activities of the DOE. To carry out the
activities for environmental management, KASA has produced various guidelines,
policies and legislations. (Table 17.2).

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Collaborative Environmental Management: Local Government and the Community

Table 17.2: Environment and Water Management Guidelines, Policies and Acts in Malaysia
Source: (KASA, 2022a).

GUIDELINE POLICY ACT

» Malaysia Plastics Sustainability » National Policy on » Environmental
Roadmap 2021-2030
Climate Change, Quality Act 1974
» Low Carbon Mobility Blueprint
» National Guidance on Voluntary Carbon 2009 (Act 127)
» National Green » Biosafety Act 2007
Market Mechanisms
» Pelan Induk Bandar Rendah Karbon Technology Policy, (Act 678)
2009 » National Water
Negara (National Low Carbon Cities » National Policy on
Master Plan – NLCCM) Services
» Malaysia’s Roadmap towards Zero
Single Use Plastic 2018-2030 the Environment Commission 2006
» Green Technology Master Plan 2017
» National Low Carbon Cities Framework (DASN) 2002 (Act 654)
2017 (LCCF) » National Marine » Water Services
» Malaysia’s Nationally Determined
Contributions (NDC) to Paris Agreement Litter Policy and Industry Act 2006
under the UNFCCC (2016)
» Pelan Tindakan Jerebu Kebangsaan Action Plan 2021 – (Act 655)
(PTJK) 2030 » Irrigation Areas Act
» National Haze Action Plan (Pelan » National Green
Tindakan Pembakaran Terbuka 1953 (Act 386)
Kebangsaan (PTPTK)
» National Open Burning Action Plan Technology Policy,
(Program Mencegah Kebakaran Tanah
Gambut) 2009
» Clean Air Action Plan » Dasar Sumber Air
» Environmentally Friendly Drainage
Manual (MSMA), 2012 Negara (DSAN)
» Erosion and Sediment Plans (ESCP), » Malaysia Dam
2010
Safety Management

Guidelines

(MYDAMS), 2017

The National Policy on the Environment 2002 highlights that the local community plays
an important role in managing the environment. Therefore, efforts from all age groups
in the community are required in maintaining a clean environment. However, this policy
does not mention any specific module and procedure for environmental management.
Hence, linking this policy with the Federal and State levels’ planning units will be
effective for integrated forest and biodiversity management (EPU, 2022). In this regard,
the implementation of the National Forest Act 1984 is very important for integrated
forest and biodiversity management, especially via regulating logging activities. National
Forest Act 1984 also provides the basis for the Forestry Department in issuing and re-
issuing the licence for harvesting products from the forest (Part IV, Forest Management
and Development, Chapter 1, Clause 16. Power to issue licences, use permits, etc., by
way of tenders, agreement, etc). Chapters 2 to 5 of Part IV of the National Forest Act

415

1984 also discuss in detail licensing issues. Similarly, the Solid Waste Management
Policy (2016) has strengthened the legislation and institutionalisation of solid waste
management in Malaysia. However, the Solid Waste and Public Cleansing Management
Act 2007 has been implemented/ accepted only in 7 out of 13 states of Malaysia (EPU,
2022). The National Policy on Climate Change 2009 also does not discuss any specific
procedure for combating climate change, and the dependency on conventional energy
sources contributes to greenhouse gases emission. Similarly, National Policy on
Biological Diversity 2016-2025 is sector based but the nation has undergone significant
population increase and socio-economic changes. However, the National Water Sector
Transformation 2040 (WST2040) aspires to contribute from the water sector to the
national GDP (Gross Domestic Product), especially when considering water as one of
the important components of KEGA (i.e., Key Economic Growth Activities) in the Five
Year Malaysia Plans (EPU, 2022).

A few states in Malaysia have already established state water authority for managing
water resources within the state. For instance, the Selangor Water Management
Authority (SWMA)/ Lembaga Urus Air Selangor (LUAS) is implementing the polluter
pays principle (PPP) concept based on the Selangor Waters Management Authority
Enactment 1999 (PART IX, Protection of the Environment, Clause 75. Environmental
Impact Assessment of proposed projects, Clause 78. Restrictions on pollution, Clause
79. Prohibition of pollution of a water source) for environmental management, especially
managing the water quality and quantity.

Environmental Impact Assessment of proposed projects ((PART IX, Protection of the
Environment, Clause 75. Environmental Impact Assessment of proposed projects) by
LUAS looks into:
i. No person shall commence any development, activity or project within any

designated area prior to the completion of an assessment of the environment of
such development, activity or project.
ii. Where the proposed development, activity or project is a prescribed activity under
the terms of Section 34A of the Environmental Quality Act, 1974, the project
proponent shall fully comply with the terms of the Act and regulations and orders
made thereunder. The Authority may, if required, advice the Director General of
Environmental Quality in the consideration of any report or in the making of any
decision pertaining to the proposed development, activity or project.
iii. The project proponent shall undertake or cause to be undertaken a report on any
works within any designated area not otherwise prescribed under the terms of Section
34A of the Environmental Quality Act, 1974. The report shall be in accordance with
guidelines developed by the Authority in consultation with the Director General of
Environmental Quality and shall contain an assessment of any impact the proposed
works may have on the environment, and the measures that should be undertaken
to prevent, reduce, abate or control any adverse environmental impact which is
identified.

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Any person who contravenes this section commits an offence; and shall upon conviction
be liable to a fine not exceeding RM 300,000 or to imprisonment for a period not
exceeding three years or to both. And to a further fine of RM 5,000 for every day that
the offence is continued after a notice by the Authority requiring compliance has been
served (PART IX, Protection of the Environment, Clause 75. Environmental Impact
Assessment of proposed projects, item 7).

The Selangor Water Management Authority based on the Selangor Waters Management
Authority Enactment 1999 can issue license for entities (PART IX, Protection of the
Environment, Clause 78. Restrictions on pollution) for:
i. any poisonous, noxious or polluting matter or waste that will render or is likely

to render or contribute to rendering such water source or part thereof harmful,
detrimental or injurious to the health, safety or welfare of the public or to animal or
vegetable life or health therein or to other beneficial uses of such water sources;
ii. any matter which by virtue of its temperature, biological or chemical content or its
effect in discolouring water makes or contributes to making the water source or
part thereof a potential danger to public health, safety or welfare or to animal or
vegetable life or health or affects other beneficial uses of such water source;
iii. any matter which by virtue of its physical nature, chemical or biological content, or
its effect in discolouring water makes or contributes to making such water source
difficult to treat or affects the flow, quality or quantity of water in the water source;
and
iv. oil of any nature, used, waste or waste containing oil or otherwise.

Any person who contravenes this section commits an offence and shall upon conviction
be liable to a fine not exceeding RM 100,000 or to imprisonment for a period not
exceeding three years or to both. And to a further fine of RM 3,000 for every day that the
offence is continued after a notice by the Director requiring compliance has been served
(PART IX, Protection of the Environment, Clause 78. Restrictions on pollution, item 4).

KASA has come out with the environmental sustainability roadmap 2020-2030 (Figure
4) for the better implementation of policies and acts. The environmental sustainability
roadmap 2020-2030 has four thematic areas, i.e., empowered governance, green
growth, strategic collaboration and social inclusiveness. In total 35 initiatives are built
upon these four thrusts covering the atmosphere (air), hydrosphere (water), lithosphere
(land) and biosphere (living things) in line with the concept of planetary health.

417

Figure 17.4: Environmental Sustainability Roadmap of Malaysia 2020-2030 (KASA, 2022b)

Cities are the main engines for dynamic economic growth and the focal points of most
populations. However, the process of urbanisation has contributed significantly to the
increase in GHG emissions. Thus, fostering urban development most sustainably can
reduce energy demand, consumption and GHG emissions. A low carbon city is defined
as a city that implements low carbon strategies to meet the environmental, social and
economic needs of the city. The city measures to manage and mitigate greenhouse
gas emissions to reduce its contribution to climate change (KASA, 2021). The strategic
framework of the National Low Carbon Cities Masterplan intends to transform Malaysian
Cities into low carbon whilst pushing the low carbon development in Malaysia to the next
level (Figure 17.5). Similarly, the Shah Alam City council and Subang Jaya City Council
among the total of 154 local authorities in Malaysia are the first two local authorities to
produce voluntary local review (VLR) reports in line with the Voluntary National Review
(VNR) by Economic Planning Unit (EPU) of Malaysia to contribute towards sustainable
development while making balance among environmental and socio-economic issues.
For instance, Langkawi Island in Malaysia has been declared a low-carbon city by
promoting the renewable energy and eco-tourism in the Langkawi UNESCO Global
Geo-park.

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Figure 17.5: Low Carbon Cities Framework in Malaysia (KASA, 2021).
Environmental Management Activities by Local Government
The Shah Alam City Council and Subang Jaya City Council are the pioneers in Malaysia
to produce the Voluntary Local Review (VLR) reports in line with the Voluntary National
Review (VNR) by EPU. Therefore, all the 154 local authorities in Malaysia are encouraged
to produce the VLR to fulfil Malaysia’s global commitment to the Paris Agreement
on Sustainable Development to reduce carbon emissions and better environmental
management. Examples of some activities for environmental management by Shah
Alam City Council are listed below and in Figure 17.6 (Subang Jaya City Council).

Landscaping and Green City Development at Shah Alam City Council
(UNDESA, 2022a).
Programs include:
i. Completing the Shah Alam Landscape Master Plan 2020-2035
ii. Upgrading of Shah Alam’s Bougainvillea Park
iii. Shah Alam Trees For Life tree planting programme
iv. Community Garden and Community/People Orchard
v. Green Pioneer Programme
vi. Low Carbon City tree research
vii. Upgrading of recreational areas

419

Waste Management

This related to domestic solid waste collection services from residential, commercial and
institution areas. One project is to complete the Solid Waste Management Depot and
Public Cleansing Department in Section 31, Shah Alam. MBSA will also focus on “Waste
Diversion” towards waste reduction through education and awareness programmes.

Low Carbon City

Campaigns and programmes towards reducing emissions from energy and water
consumption of buildings and public areas, reducing emissions from the use of petrol
and diesel vehicles, and reducing emissions from waste accumulated at landfills.

Smart and Digital City

This is in to the vision to make Selangor a Smart State by 2025. Projects include:
i. Expanding CCTV installation;
ii. Provision of hardware and software for command center;
iii. Tax and license data integration with GIS; and
iv. MBSA GIS Portal Apps “i-MapSA”.

Figure 17.6: Eight high impact SDG projects by Subang Jaya City Council in Line with
Environmental Management.
(UNDESA, 2022b).

Gaps in Environmental Management and Recommendations

The state government in Malaysia because of its wide legislative power directly or indirectly
controls the local government. Although local government is the lowest administrative
unit in the hierarchy of government, a total of 171 district offices in Malaysia are in
charge of land, water and forest management within their jurisdiction, and these are the
main sources of revenue generation for the state government. However, enforcement
remains in the hand of local authorities, and the total number of local authorities are
154 in Malaysia, based on the Local Government Act 1976. The state government in
consultation with the Ministry of Housing and Local Government carries out the activities

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by the local government department at the local level. Therefore, proper synchronization
in activities is required between the local authorities and district offices in the specific
area.

Similarly, during disasters, Plan Malaysia is the leading agency at the local level;
however, the enforcement remains in the hand of the Local Authority both during normal
and emergency periods. Therefore, an effective decision-making model is essential for
the Local Authority not only to support Plan Malaysia’s activities but also to bring all
the agencies and institutions including the communities to the same platform at the
specific local level for disaster preparedness and management in line with the Sendai
Framework on Disaster Risk Reduction (DRR). The geographic information system (GIS)
and remote sensing applications along with the integration of artificial intelligence for
better management of natural and human resources should be useful for environmental
management both in normal and emergency periods.

Environmental management strategy must have customized training modules for the
government, especially for local and state government officials; community; business;
and academia sectors because hands-on training is the key to minimising the losses
and damages arising from disasters including chemical disasters, flooding and as
such, especially via changes in people’s behaviour to address disasters. Science and
engineering are not adequate to address environmental disasters especially due to
climate risks to address non-economic losses. Therefore, multi-disciplinary approaches
combined with Science and Technology (S&T), as well as Social Science and
Humanities (SSH), are essential for better preparedness and management of any kind
of environmental issue. Although development activities are needed for a better way of
life, however, the nation is also required to comply with its global commitment to reducing
carbon emissions by 2030 as well as the national target of achieving net zero carbon
emissions by 2050. Therefore, more research is required especially for the investment in
Nature-based Solutions (NbS) towards effective environmental management as well as
adopting and implementing effectively green concepts such as payment for ecosystem
services (PES), and polluter pays principle (PPP) for income generation. Further
research should also incorporate detailed studies on the ‘Multi-hazard Early Warning
System’ at the regulation, coordination, planning and implementing stages for better
environmental governance, especially by the local authorities.

ACKNOWLEDGEMENT

This study is supported by the research grant FRGS/1/2022/SSl03/UKM/03/1 of the
Ministry of Higher Education (MOHE) Malaysia.

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AUTHOR

Mazlin Mokhtar, BSc. (Tasmania), PhD (Queensland), FASc., FMIC.,
DSDK (Kedah), PMP (Perak) is currently Deputy Head (Research),
United Nations Sustainable Development Solutions Network - Asia
(UN SDSN-Asia) at Sunway University, Malaysia. He was a Senior
Professor and Research Fellow at the Universiti Kebangsaan
Malaysia (UKM) for 37 years (May 1985 - May 2022). He was the
Director and Principal Fellow at the Institute for Environment and
Development (LESTARI) UKM 2005-2013 & 2019-2022; and was
UKM Deputy Vice Chancellor for Research & Innovation 2014-2017; and UKM’s Founding
Director of Centre for Public & International Relations (PUSPA) 2001-2004; & Lecturer at
UKM Sabah Campus 1988-1996 (Faculty of Science and Natural Resources). Currently
he is Chairman of the Environment Committee of Academy of Sciences Malaysia (ASM),
and Environmental Quality Act’s Appeal Board Member. He was Chairman of Malaysia’s
Environmental Quality Council 2015-2018, and Chairman of the government appointed
committee reviewing the Lynas Rare Earth operations. He was the Chair of the AACB
Water Sector Transformation 2040 Task Force under Economic Planning Unit of Prime
Minister’s Department & Academy of Sciences Malaysia (EPU-ASM); and was the
Deputy Chairman of the Bauxite Mining and Exportation SOP Committee appointed
by the government of Malaysia. He’s the winner of the Langkawi Award 2018; and was
the longest serving member of the National Steering Committee of UNDP GEF Small
Grants Programme 2000-2018; and Nomination Committee of the Merdeka Awards
(Environment Category) 2015-2017 & 2020-2022. He is an Advisory Committee of
National River Care Fund; and Member of WWF Malaysia’s Board of Trustees 2014-
2018.

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Dr Minhaz Farid Ahmed is a University Lecturer/Research Fellow at
the Institute for Environment and Development (LESTARI), Universiti
Kebangsaan Malaysia (UKM). He obtained a PhD on Environment
and Development from UKM in 2018. Dr Minhaz also won a partial
scholarship from the Canadian International Development Agency
(CIDA) while pursuing a Master’s Degree Program in Resource and
Environmental Management in Bangladesh. Dr Minhaz’s research
interests are on Water Education; Management, Communication
and Collaboration (WEMC²), which is in line with the aspirations of the Integrated Water
Resources Management Concept (IWRM) and the Sustainable Development Goals
(SDGs), including through a disaster risk reduction (DRR) approach for ecological
systems’ management. Dr Minhaz is also interested in Climate Change Adaptation and
Mitigation research, namely access to safe water supply and migration due to climate
change, including his previous involvement in several United Nations-sponsored research
projects. Among the projects are, AP-FAST (Acceleration of Science and Technology in
the Asia Pacific Region); MUCP (UNESCO Malaysia Cooperation Program) in Malaysia
and the Asia Pacific Regional Area; as well as the Malaysian National Water Sector
Transformation Research Program (WST2040) by the Economic Planning Unit (EPU)
and the Malaysian Academy of Sciences (ASM). These are all being planned to support
the IWRM implementation agenda for the sake of Sustainable Development for the
nation and country, with Dr Minhaz acting as Head of special module development for
government officials. Dr Minhaz was involved in the “Climate-resilient Ecosystem and
Livelihoods” (CREL) project of USAID & NACOM at the Chittagong hill-tract and coastal
area (2013). Dr Minhaz is also recognized by the Global Alliance of Disaster Research
Institutes (GADRI), Kyoto University, Japan and was invited as a panelist and special
speaker at the 5th GADRI Global Summit: Engaging Sciences with Action (2021), also
invited by UNESCO Jakarta in SETI Science Policy Forum fully funded by UNESCO
in Davao, Philippines (2018); was also invited by the International Lake Environment
Committee (ILEC) at the 17th International Conference on the World’s Major Lakes
fully funded by the Organizer, in Ibaraki, Japan (2018). Dr. Minhaz is also a member of
the LESTARI promotion and exhibition committee (2022-25); and is Associate Editor of
“International Journal of Climate Change Strategy and Management.”

425

One of the first conditions of happiness
is that the link between man and
nature shall not be broken.

- Leo Tolstoy

Chenang Beach, Langkawi, Kedah.

Chapter 18

Development of
Tropical Green

Hospital
in Malaysia
for Sustainable
Environment

DEVELOPMENT OF TROPICAL GREEN HOSPITAL IN
MALAYSIA FOR SUSTAINABLE ENVIRONMENT

Lim Chin Haw & Noor Muhammad Abd. Rahman

INTRODUCTION

Compared to other facilities, the hospital has become the most complex building due to
its special requirements. To ensure that the health care services provided to customers
are filled with confidence, a good design is required to meet the desired clinical needs. In
general, the design of a hospital should have sufficient ventilation and good air circulation
to provide a comfortable space that meets the requirements for indoor environmental
quality. This is very important to control any infection and contamination in the clinical
area while maintaining a clean environment. Natural ventilation can provide high-rate
airflow to maintain good indoor air quality, which is a common method in countries with
tropical climates. This method not only provides a low energy consumption option, but
also reduces operating costs. In the context of hospitals, high ventilation rates have
been shown to be effective in reducing the risk of cross infection. However, natural
ventilation alone is not enough. In particular, other strategies are needed to maintain
good thermal comfort in the hospital area in tropical climatic conditions.

The design and construction of the hospital developed from independence to the present
day. Factors contributing to this change include new clinical and operational requirements,
compliance with current standards, and climate change. Additionally, the outdated and
inefficient physical condition of buildings, equipment and systems has resulted in high
energy consumption and higher daily operating costs. Efficient energy management
has the potential to save construction and operating costs and protect the environment
on a global scale. As a developing country, Malaysia should consider energy efficiency
as a key policy for planning sustainable development strategies. Intelligent energy
supply planning and strategies in each hospital facilities are very important to ensure
that energy will be managed efficiently, especially in the building sector, which has the
highest energy consumption among other sectors. It is very important that all hospitals
implement a comprehensive energy management plan, which can reduce utility costs
and use some of the money saved for more important things, such as replacing medical
assets and the daily operations of medical institutions.

In many developed countries, the building sector has become one of the largest
consumers of energy compared to other sectors such as industry and transport. For
example, total primary energy demand in China’s building sector has continued to
increase, from 24.1% in 1996 to 27.5% in 2001, and is expected to continue growing
by 35% in 2020. Globally, the primary energy demand of the building sector represents
approximately 40% of the total and contributes more than 30% to the reduction of
carbon emissions. At the same time, a study on energy consumption in hospitals shows
that around 40% of total electricity consumption comes from central air conditioning
systems. The main energy used by buildings is electricity, which represents 75% of total

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energy consumption. A study on hospital energy distribution carried out in 2014 found
that the average annual electricity consumption of the hospital was more than 40,000.00
kWh, and the annual energy use intensity was 384 kWh/m2. This amount represents
63% of the energy used by the air conditioning system, and 17% of the energy comes
from lighting. Another example of the 2011 Malaysian hospital energy consumption
study found that 36% of energy consumption comes from lighting and 34% of energy
is used for the operation of medical equipment. This situation has led to a number of
studies around the world to improve the energy performance of buildings, especially in
the improvement of the design and construction of building envelopes.
Sustainable buildings should also provide homeowners with a sense of comfort by
maintaining IEQ, which is one of the key elements in the implementation of green buildings.
However, the comfort of the occupants of the building is rarely considered, especially in
the modern tropical climate hospital building built a long time ago, because the original
design did not fully consider the concepts of sustainability and climate change. This is the
main problem today. It was also found that compared with traditional buildings, building
occupants are more satisfied with green buildings. Deteriorating building performance
and environmental conditions that are no longer conducive to environmental protection
make green buildings a choice for today’s building owners to solve these problems. The
design of the building must incorporate sustainable architecture and engineering. One
of the ways to achieve these objectives are through green building programs. Ministry of
Health Malaysia (MOH) has started to implement this program since 2015 by introducing
its sustainability framework. This framework incorporates all the vision, mission, goals,
frameworks, and roadmaps that have been set including at each global, national and
ministry level (Figure 18.1).

Figure 18.1: MOH Sustainability Framework.
429

The framework that has been developed involves various stakeholders including
important ministries that are directly involved such as Ministry of Environment and Water
(KASA) and Ministry of Energy and Natural Resources (KeTSA). In achieving the target
of green buildings in government health facilities, the involvement of the Department of
Environment under KASA is also very important. As a known fact that hospitals produce
a lot of solid waste in various categories in addition to clinical waste that requires special
treatment in an incinerator plant. The sustainable management of these wastes in
hospitals can have a very high impact on the environment.

In this regard, it is very important for all relevant stakeholders to jointly ensure that the
existing and future health facilities that will be built are sustainable and environmentally
friendly. Hospitals and clinics are the only facilities that will be used by all citizens of
various groups regardless of status or age to seek treatment, work and study, or at least
visit relatives in the ward. Malaysia’s position in a tropical climate also requires careful
planning in terms of design as well as in-depth understanding in terms of operational
and maintenance requirements. The main objectives and strategies to ensure that health
facilities are safe, green and sustainable are illustrated in Figure 18.2 below.

Figure 18.2: Objectives and Strategies of Safe, Green and Sustainable Healthcare Facility.

GREEN BUILDING RATING TOOLS

Today, green rating tools are used to assess the green practices of buildings. Most
new green buildings are based on sustainable construction and engineering design,
while existing buildings adopt green practices in their daily operations and maintenance.
Green building classifications and certifications developed around the world aim to
guide architects, engineers, contractors and building owners to protect the environment
through established methods and guidelines. Green buildings not only fulfil the function
of providing quality services, but also ensure that they comply with all applicable local
and international laws, regulations, standards and procedures that support the operation
of the hospital. Additionally, implementing all green elements in hospital buildings will

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help reduce operating costs through energy and water conservation, as well as more
efficient and efficient use of green technologies.

Key elements of green buildings that are routinely used for classification and certification
purposes include energy efficiency, water efficiency, sustainable transportation and site
management, materials and resources, and IEQ. Figure 18.3 briefly describes each
green building element of the existing building certification at the healthcare building. By
evaluating and auditing existing buildings, you can realize the potential of each of these
elements in rating green buildings. The availability of the audit report will allow building
owners to plan strategies and activities in a more cost-effective way to implement low-
carbon and green building projects.

Figure 18.3: Green Building Elements.

The green building certification rating tool is used to evaluate the performance of
buildings that have implemented all the elements specified in each rating. Green buildings
minimize the negative impact on the environment and optimize their positive impact on
the occupants. This action can be achieved through good design, construction, operation,
and maintenance. At the same time, intervention in occupant behavior can help achieve
green building status by improving energy efficiency, and it is necessary to understand
occupant behavior within the framework of the system. Today, there are different green
building rating tools around the world that are designed to adapt to local climate and
needs. However, the key green building elements in each rating tool are roughly the
same. The green building rating tools commonly used in the world and Malaysia, and
the Building Research Establishment’s Environmental Assessment Method (BREEAM),
Leadership in Energy and Environmental Design (LEED), Green Star and Green Building
Index (GBI). BREEAM is the world’s oldest classification tool from the United Kingdom
(UK), developed in 1990. The rating tool is also an option for British medical institutions
as a method to assess environmental performance and certify green buildings. At
the same time, LEED was formulated by the US Green Building Council in 1998 as a

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platform for building owners to determine what steps can be taken from design through
operation and maintenance to achieve green building status. As of December 2018,
LEED has successfully attracted 96,275 registration and certification projects, involving
more than 160 countries. Healthcare-related standards are also included in the LEED
rating tool under the existing building category to promote the health and environmental
needs of the project. Green building rating tools have obviously been used extensively
around the world and brought many benefits to building owners. The government needs
to expand green practices in all Malaysian public hospitals to reap long-term benefits in
terms of energy and water conservation, good environmental quality, and sustainable
waste management.

Another widely used rating tool is the Green Star established by the Green Building
Council of Australia (GBCA) in 2003. GBCA launched a green building rating tool
specifically for healthcare facilities in 2009 to support the planning of high-performance
sustainable buildings, emphasizing the health and productivity of building occupants,
as well as cost savings. Meanwhile, GBI is a green building rating tool widely used
in building and municipal rating systems in Malaysia. GBI is formed on the basis of
existing rating tools, such as Singapore’s Green Star and Green Mark, whose climate is
similar to Malaysia, and has been adjusted according to local needs. Currently, GBI has
developed a green building rating tool specifically for hospitals in the new and existing
building categories. However, currently only six private hospitals have obtained GBI
green building certification, while two government public hospitals have obtained LEED
certification. Compared to the total number of hospitals in Malaysia, the number of green
certified hospitals is very small and requires more attention from the government as a
decision maker. Table 18.1 shows a summary of Malaysia’s certified green hospitals.

Table 18.1: Green Certified Hospitals in Malaysia.

RATING PUBLIC/ HOSPITAL NAME BUILDING GREEN
TOOL/ PRIVATE CATEGORY RATING/YEAR
COUNTRY HOSPITAL
RECEIVED
LEED/ Public Sultanah Maliha Hospital, Existing building
United Langkawi Gold/2020
States Public Existing building
Public Jasin Hospital Existing building Platinum/2021
Platinum/2021
Putrajaya Hospital Certified/2013
Gold/2015
Private KPJ Selangor Specialist New building
Silver/2018
Private Gleneagles Hospital New building
Silver/2018
GBI/ Private Amanjaya Specialist New building
Malaysia Private Centre New building Certified/2019
Certified/2019
Bandar Dato’ Onn
Specialist

Private KPJ Damansara Specialist New building

Private UKM Specialist Children’s New building

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So far, Malaysian hospital buildings have used GBI and LEED certification as their green
assessment tools. However, more tools developed for the healthcare building category
are selected worldwide comparison of green building assessment tools for healthcare
facilities that are commonly used worldwide and in Malaysia are shown in Figure 18.4.
According to the table, the energy efficiency and IEQ factors were ranked in the top three
for all assessment tools. As the largest energy user in government facilities, improving
building energy consumption and maintaining a good indoor environment will help
hospital management to certify green buildings especially in tropical climate conditions.

Figure 18.4: Commonly Used Green Building Rating Tools for Healthcare Facility Around the
World and in Malaysia.

STRATEGIES FOR DEVELOPING TROPICAL GREEN HOSPITALS
The Ministry of Health Malaysia (MOH) is committed to provide the best healthcare
services for the nation throughout the health management system as well as research
and development in the health sector. Government hospitals have the country’s best
healthcare equipment and facilities apart from having specialists in the field. With a
rising and aging population, the government wishes to improve in many areas including
the refurbishment of existing hospitals, building and equipping new hospitals, expansion
of the number of polyclinics, and improvements in training and expansion of telehealth.
Over the last couple of years, they have increased their efforts to overhaul the
healthcare systems and attract more foreign investment into the healthcare industry.

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The government has also been trying to promote Malaysia as a healthcare destination,
regionally and internationally by introducing the healthcare tourism concept.

In order to ensure the healthcare facilities are in the best condition to serve the clinical
needs, building and upgrading new healthcare facility such as the hospital become
a priority. The main elements identified by the ministry to sustain the new facility is
by managing the development of hospital building efficiently starting from planning,
designing and constructing stage. Sustainable development has become the primary
interest for the Malaysian government including the construction industry. Every
government building shall have their action plan to implement sustainable initiatives and
lead by example on sustainable programs and practices.

With the rising of sustainability trends in this country, the health care industry also does
not want to miss out. As hospitals are relatively complex building systems, achieving the
sustainability criterion are challenging and needs a lot of strategies. MOH implements
several strategies to ensure all health facilities are towards safe, green and sustainable
buildings. The main strategies implemented are as follows:

i. To learn and understand the evolution of healthcare building design for future
planning;

ii. To implement sustainable design and construction concept for new building; and
iii. To implement sustainable operation and maintenance activities as well as green

practices for existing building.

Evolution of healthcare building design

Understanding the changes in the design of hospital buildings since before independence
until now is very important to avoid mistakes in developing sustainable hospitals in the
future. The passage of time, clinical needs according to current suitability and the use of
new technologies cause the study of design and construction methods to be taken into
consideration. This is to ensure that the hospital building is always in good condition,
providing comfort to residents and environmentally friendly.

Pre-Independence

Sustainable construction can be defined as designing, renovating or converting a
building in compliance with environmental rules and energy conservation methods.
It is crucial that sustainable design is part of the successful construction project to
maintain the functionality and effectiveness of the building throughout the life cycle.
Government healthcare building has gone through several changes in design. The
design of healthcare building evolves since pre-independence era until nowadays
as illustrated in Figure 18.5 and Figure 18.6.

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Figure 18.5: Example of a Low-rise/pauper Hospital.
(Source: Cheah, 2001).

Figure 18.6: High-rise General Hospital in a Pre-independence Era.
(Source: Cheah, 2001).

Hospital designs of the pre-independence era are also known as colonial design
and can be categorized as the pavilion. Generally, the design in that era can be
described as Table 18.2 below:

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Table 18.2: Typical Characteristic of Hospital Design in the Pre-independence Era.

TYPE OF HOSPITAL CHARACTERISTICS

Low-rise / pauper hospital Pitch roof 2-tiered high angled ceiling
Raised from the ground
Verandah all round
Access via verandah
Good passive design

High-rise general hospital Medium high-rise hospital for inpatient areas
Natural ventilation
Long overhang
Thick wall and windows all around
High ceilings
Brickwork
Load bearing and reinforced
Up-hang open wide windows
Sun-shading
Lifts and staircases

Post-Independence

Hospital design continued to evolve in the post-independence era. In the year
1960 to 1980, the building is planned and designed for the specific requirements
locality such as the catchment population, disease trend and age groups. They
also designs according to the national agenda such as the caring society concept.
The project were also required to be a reasonable cost, reasonable speed and of
acceptable design.

In the early 90s, the hospital design continuously evolves and designed towards
patient focus care as well as focusing on the healing environment. The different
design characteristics in these two eras can be summarized in Table 18.3 below:

YEAR Table 18.3: Design Characteristics Comparison in Two Eras.
1960-1980
CHARACTERISTICS
1990
No first-class wards
All wards were naturally ventilated / mechanical fans
Structure – frame structure, bricks, and asbestos-free/ concrete tile roof
Air conditioning areas were OTs, CSSDs, admin office.

Decentralization of outpatient
Presence of day care services
Introduction to information technology
Automation
Flattened the land
Long corridors
Added perimeter corridors
Add toilets at the ends

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Examples of hospital designs in 1960 to 1980 are illustrated in Figure 18.7 and
Figure 18.8 as below:

Figure 18.7: The Hospital Design in the Year 1960-1970.
(Source: Cheah, 2001).

Figure 18.8: Evolution of Hospital Design in 1980.
(Source: Cheah, 2001).

Hospital Langkawi is one of the hospitals that was designed based on the nucleus
concept. Overall, there are twelve (12) nucleus hospitals in Malaysia with the same
type of design that follows a British design concept. Figure 18.9 and Figure 18.10
show an example of the British design and concept applied for the hospital.

437

Figure 18.9: Hospital Langkawi Design in the Early 90s.
(Source: Norwina, 2004).

Figure 18.10:. Hospital Nucleus Design Placed Toilets at the End of the Building.
(Source: Norwina, 2004).
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Sustainable design has been considered in the new hospital projects starting in the year
2006. Additional requirements are imposed on the design, and sustainable elements are
included as part of the project consideration. The designer, engineer, and developer are
more familiar with green, low energy and passive design as illustrated in Figure 18.11.
They are also required to consider the seismic potential in the design as well as using of
industrialized building system (IBS) in the construction.
The post-modern building design has introduced tropical architecture such as landscape
garden to serve a better environment for the hospital as shown in Figure 18.12. Growing
interest in “biophilic design” also seeks ways to incorporate nature and naturalistic
design features throughout buildings, especially for hospital building in urban areas.
Other elements incorporated in the sustainable hospital building design in the year 2006
are as follows:
i. Plenty of daylight;
ii. More natural ventilation;
iii. Atrium / spacious lobbies and corridors;
iv. Short walking distance;
v. Energy conscious;
vi. Modern architecture with a wide overhang;
vii. Courtyard and extensive gardens;
viii. Customized design interiors; and
ix. Use of sustainable materials.

Figure 18.11: Design of Atrium, Spacious Lobby and Waiting Area in Hospital Serdang.
(Source: Norwina, 2004).

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Figure 18.12: Hospital Temerloh With Landscape Garden Design.
(Source: Norwina, 2004).

Sustainable Design and Construction Concept for New Building

Successful sustainable construction is much depending on proper planning and
sustainable design of the building. Healthcare buildings are no exception in this regard.
Sustainable practice should be applied in every phase of the healthcare building’s life
cycle. The government should promote awareness and knowledge of sustainability
concept to the building owner, contractor, and developer to implement sustainable
practices in the construction. Sustainability building design can have a significant
impact on human health, well-being, and work performance. Design for healthcare
environments must include esthetical enhancements in an attempt to reduce stress and
anxiety, increase patient satisfaction, and promote health and healing.

Sustainable Design Concept

The National Cancer Institute (NCI) was completely built and began operation in 2013
as a reference center and center of excellence for the treatment and management
of cancer in Malaysia and the region. Located on a 10.65-acre land next to Hospital
Putrajaya, the RM700 million NCI project was the brainchild of the late Datin Seri
Endon Mahmood, the wife of former Prime Minister Tun Abdullah Ahmad Badawi
who passed away of breast cancer. The facilities at the NCI include seven floors of
wards, two basement floors and 252 in-patient beds with a nuclear waste treatment
system of international standards for gathering and disposing of radioactive waste.
It is also equipped with an Intensive Care Unit, four operation theatres, an Oncology
Daily Treatment Unit, and outpatient clinics dealing in oncology, nuclear medicine
and a multi-disciplinary clinic.

The works Department of Malaysia was appointed by the government to
implement and oversee the project. In 2015, this project was announced as the

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best project award under a major project category in The Malaysian Construction
Industry Excellence Awards hosted by the Construction Industry Development
Board (CIDB). The NCI was recognized as the first government building that
implemented sustainable design and construction. The design concept of the NCI
building had considered healing and recuperation environment, solar orientation,
energy efficiency and durability incorporating industrialized building system (IBS)
strategies. The design initiatives also look careful considerations of optimal
planning, environmental enhancement as well as new technology to ensure the
implementation of sustainable construction.

Sustainable Construction Concept

The implementation of sustainable construction for the NCI was outstandingly
achieved. The construction of the Reinforced Concrete Structural works as
completed within 12 months, which was three months ahead of time. Moreover, the
building is designed to withstand Earthquake Load Zone 1 as per UBC 97. The NCI
construction also complied to the Industrialized Building System (IBS) with a 70%
score categorized as follows:

i. Part 1: Structural System score of 31.13 points consisting of in-situ flat slabs,
columns, lift cores walls using re-usable system formwork and using metal roof
truss system at the roof;

ii. Part 2: Wall System score of 27.90 points primarily contributed from using solid
wall system, drywall system, precision precast concrete block wall system and
precast concrete panel external wall system; and

iii. Part 3: Others simplified construction solution score of 11.00 points using
Standardized Components based on MS 1064 guidelines.

Project management tools are also important to ensure the success of sustainable
projects. Building Information Modelling (BIM) is a smart approach in managing
construction project lifecycle activities, which comprises project design, construction,
and facility management. Utilization of BIM in construction can detect any clash
analysis during the design stage, improves the efficiency of project scheduling,
reduce cost and ensure the high quality of the project as well as facilitate
communication among construction players. NCI is the first government project
using BIM in Malaysia, which was also a pilot project for the government.

The benefits of BIM is clash detection which can be done before the construction
starts. Based on record there were 1800 clashes found in the NCI project and had
been resolved during the planning stage whereas it is not possible if the project
had been implemented without BIM. The benefits of BIM are its ability to resolve
fabricator issue, with the provision of clearer 3D visualization of project design so
that any changes to the project can be made quickly.

In addition, the NCI project has proven that the benefits gained from using BIM,
which is reflected in the minimization of waste regarding time and cost, leading to

441

improving the quality of the project. The success of the NCI project has led to more
government projects will use BIM in the future.

The major challenge for sustainable construction would be to get sustainability on the
agendas of the government, local agencies and authorities, industry, and the public.
This challenge needs to be resolved to achieve sustainable development in the
country as well as improving the environment, health, and safety. Environmentally
sustainable building construction has experienced significant growth over the past
ten years. The public is becoming more aware of the benefits of green construction
and starting to highlight the built environment’s impact on greenhouse gas emissions
and natural resource consumption. Other factors, including higher energy prices,
increased costs of building materials, and regulatory incentives, are also pushing
the green building market to grow and expand.

Green Practices for Existing Building

MOH has implemented various initiatives and activities related to sustainability to achieve
the Ministry’s goal towards green buildings and sustainable health facilities. Efficient
energy management is one example of the initiatives that have been implemented and
become the main agenda of the Ministry. This initiative can not only save electricity
consumption but also reduce the cost of hospital management utilities, replace
government assets that are obsolete and no longer operate optimally and reduce the
risk of fire which indirectly ensures the best delivery of health services to the people.

The MOH started the implementation of the Sustainability Program (SP) since 2015
under the Hospital Support Services Concession Agreement which includes green
building certification programs, energy management, indoor air quality (IAQ) and reduce,
reuse, recycle (3R) program and activities that contribute towards sustainable facilities
in all Government hospitals to further reduce carbon emissions and mitigate the effects
of climate change.

One of the key activities undertaken by the MOH that has a significant impact is energy
management to support initiatives towards green facilities in the management of the
Ministry’s health facilities. Energy saving activities in hospitals are initiated with no cost
initiatives that require the involvement of hospital staff and users in implementing an
efficient energy management system. Subsequently, low-cost and high-cost energy
initiatives were implemented on the proposed energy activities to produce more optimal
energy savings through the use of green technology.

Green technology and the Government Green Procurement (GGP) have always been
prioritized and chosen in the MOH’s sustainable initiatives and activities to drive and
support green growth in the country. The use of green technology such as LED lighting,
energy efficient air conditioners, solar photovoltaic and solar thermal systems as well
as environmentally friendly products are able to provide optimal energy savings and
preserve the environment while improving the overall performance and capabilities of
the building.

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SUCCESS STORIES
The implementation of sustainability program in MOH is in line with the government
commitment to reduce carbon emissions by 45 percent of gross domestic product
(GDP) in relative to 2005 level, by 2030 and to support the country’s aspiration to
achieve a carbon neutral country by 2050. MOH has implemented various activities to
its healthcare facilities to become sustainable and environmentally friendly since 2015
and these efforts had been recognized at both the national and international levels.
Global Recognition of Green Hospital
MOH has been a prime example in the public sector and a leader in implementing
sustainable strategies and initiatives towards green building certification in the country.
For example, Sultanah Maliha Hospital, Langkawi obtained a gold rating green building
certification through the Leadership in Energy and Environmental Design (LEED) issued
by the U.S. Green Building Council in year 2020. The following year, Jasin Hospital and
Putrajaya Hospital also obtained green building status but with platinum rating which
is the highest level for LEED certification. Most proudly, the green building certification
obtained under the Existing Building Operation and Maintenance version 4 category
for both platinum and gold rating are the first in the world for a hospital building and
also the first in Malaysia for a Government building. In 2021, MOH was also honored
as the recipient of the LEED USGBC Regional Leadership Award Winner for the
Southeast Asia region. The global recognitions to MOH are shown in Figure 18.13. The
internationally recognized LEED certification will be a benchmark for the MOH to expand
the implementation of the next green building rating program to other health facilities
through the same certification or using existing green building rating tools at the national
level such as the Malaysian Carbon Reduction and Environmental Sustainability Tool
(MyCREST) ​a​ nd the Green Building Index (GBI).

Figure 18.13: Global Recognition to MOH.
(Source: Engineering Services Division, MOH).

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ASEAN and National Energy Awards

Numerous MOH hospitals had been awarded at the regional and national levels due to
excellence in implementation on energy management program since 2019. In 2021, four
(4) MoH hospitals were selected as winner for various categories in the Asean Energy
Award (AEA) and the National Energy Award (NEA) as shown in Figure 18.14.

CATEGORIES HOSPITAL/
AWARD

Energy Hospital Yan,
Management Kedah
(Small and
AEA: 1st Runner-
Medium Up
Building)
NEA: Winner

Energy Hospital Tanjung
Management Karang, Selangor
(Small and
AEA: Winner
Medium NEA: Runner-Up
Building)

Energy Hospital
Management Segamat, Johor
(Large Building)
NEA: Runner-Up

Special Awards Hospital Tuanku
(Energy Ampuan Najihah,

Performance Kuala Pilah,
Contracting – Negeri Sembilan

EPC) NEA: Runner-Up

Figure 18.14: The Recognition in ASEAN and National Energy Award for MOH Hospitals.
(Source: Engineering Services Division, MOH).

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Energy Saving

The MOH has successfully achieved the energy saving targets set since the introduction
of the ‘Safe and Green Towards Smart Healthcare Facilities’ policy which supports
initiatives towards green facilities in the management of the Ministry’s facilities. As of
December 2021, the MoH managed to achieve cumulative 500 GigaWatt-Hours (GWh)
of energy saving compared to the baselines of 2015 and 2016 as well as a reduction in
carbon emissions exceeding 360 thousand tonnes. In addition, more than 100 hospitals
and institutions have scored 2-star and 3-star rating in the Energy Management
Gold Standard (EMGS) certification under the ASEAN Energy Management Scheme
(AEMAS) as shown in Figure 18.15.

Figure 18.15: Numbers of AEMAS Certified Hospital.
(Source: Engineering Services Division, MOH).

High Impact Energy Projects

MoH was also successful in implementing high-impact energy projects, either through
conventional method or Energy Performance Contracting (EPC). These projects
involved the replacement of chiller, LED lighting and installation of the solar thermal hot
water system utilising green technologies to continuously reduce energy consumption.
As of 2021, MOH has implemented more than 50 high-impact energy projects through
conventional method and sustainable financing model in collaboration with various
agencies (Figure 18.16).

Figure 18.16: High Impact Energy Projects Implemented by MOH.
(Source: Engineering Services Division, MOH).

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CONCLUDING REMARKS
The MOH’s commitment in turning all their health facilities into green buildings should
be exemplified by the government agency as well as the private sector. As everyone
knows, the hospital is a place that has the potential to be visited by all whether as
patients, employees or visitors. As one of the focal points, the hospital building must be
ensured to always be in good condition, comfortable and environmentally friendly. This
is due to the potential for high energy consumption and waste generation as a result
of the continue operation of the hospital in a year. Accordingly, KASA and KeTSA as
policy makers are the most important main agencies whose role is to assist the MoH in
implementing related programs to reduce energy consumption and waste production.
In this regard, all relevant parties from various government agencies, the private
sector, universities and environmental experts need to work together in developing
tropical green hospitals. Discussions and collaboration should start as early as town
planning, sustainable hospital design, material selection, construction to the operation
and maintenance phase. The selection of the right strategies in developing sustainable
hospitals as well as the application of appropriate green technologies and products can
help in preserving the environment through the use of clean energy, sustainable water
and waste management and good quality of the indoor environment.
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