Brunei : Brunei Health Profile

Ministry of Health's mission, vision and objectives

The Ministry of Health is responsible for all aspects of health care in the country and its vision is to become a highly reputable health service organization that is comparable to the best in the Region and that enables each citizen and resident of the country to attain a high quality of life by being socially, economically and mentally productive throughout the life span. The Ministry’s mission is to improve the health and well-being of the people of Brunei Darussalam through a high quality and comprehensive health care system that is effective, efficient, responsive, affordable, equitable and accessible to all in the country.

The Government is fully committed to continuously improving the health status of the people and considers government funding for health care a major public investment in human development. It is the aspiration of the Government that the Ministry of Health’s schedule for the 21st century should focus on health development for people-centred development. Health policies and programmes will, therefore, continue to be constantly reviewed in the context of changing economic, social and technological environments and health situations. In looking ahead to the next, the following four principles are observed in the provision of health services for all citizens:

• ensuring universal access to better health care;
• enabling equity of access to comprehensive health services;
• promoting partnership and public participation in the concept of co-production of efficient and effective ealth services for all; and
• ensuring that the health service system is sustainable within the institutional capacity and financial resources of the Ministry of Health.

The Government recognizes that it needs to continue its broad involvement in the provision of health care and, wherever possible, policy decision-making and proposed programmes will be strongly evidence-based. In that respect, the Ministry of Health will continue to pursue the following set of goals, or ‘policy objectives’, derived from careful analysis of the strategic issues and themes. These goals and their implementation measures are classified into two categories, strategic goals and instrumental goals, based on their logical relationships.

Strategic goals:

• to promote primary health care;
• to focus on the management of priority chronic diseases;
• to pursue high quality in health care;
• to achieve a additional equitable allocation of funds for diverse health services and to venture into alternative sources of health care financing; and
• to promote selected areas of excellence in health services.

Instrumental goals:

• to develop comprehensive health databases and data management systems that support operational, professional and managerial functions;
• to improve the quality of policy-making and management decisions at higher levels of the organization so that the Ministry becomes an effective enterprise and its administrators effective managers;
• to create and promote a disciplined workforce with positive work attitudes, through teamwork, a sense of belonging and responsibility, to achieve the organizational mission, goals and objectives;
• to improve competency and standards part all health care professionals;
• to enhance cost-effectiveness in the delivery of all aspects of health services; and
• to improve the management of support services in order to contribute to the in general quality of health services.

With noncommunicable diseases presently the dominating causes of morbidity and mortality, Brunei Darussalam has identified health promotion as a major initiative in its National Health Care Plan 2000-2010. This strategy provides the basis for a additional integrated health programme. In recognition of the need to promote positive health measures, a multidisciplinary committee, the National Committee on Health Promotion, has been established with the aim of increasing public awareness about health problems, inclunding developing strategies to modify public behaviour in favour of healthier lifestyles through community participation and intersectoral collaboration.

The Committee has identified seven priority areas for action: nutrition; food safety; tobacco control; mental health; physical activity; healthy environments/settings; and women’s health. These priorities are promoted by appropriate events, publicity about major health issues, and appropriate measures to modify lifestyles.

Organization of health services and delivery systems

The people of Brunei Darussalam enjoy free medical and health care provided via government hospitals, health centres and health clinics. A large network of health centres and clinics, located throughout the country, provides primary health care services, inclunding those for mothers and children. In remote areas that are not accessible or are difficult to access by land or water, primary health care is provided by the Flying Medical Services.

As of 2008, there were four government general hospitals, 16 health centres, 14 maternal and child health clinics, eight travelling health clinics and four Flying Medical Services teams for remote areas. The Ministry of Defence as well operates nine medical centres that mainly provide services for its personnel and their families. In addition to the government hospitals in each district, there are two private hospitals.

The major referral government hospital in the country is Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, situated on a 32-acre site about 0.8 km from the heart of the capital. The hospital was officially opened in August 1984 and is equipped with modern, cutting-edge medical technology. The hospital as well offers a very wide and comprehensive range of medical and surgical services, currently totalling 28 different specialties and subspecialties.

Public Health Services is the major division in the Ministry of Health responsible for providing community-based preventive and promotive primary health care services in the country. As a result of its monitoring and surveillance activities and preventive programmes, such as immunization, the country is free from major communicable diseases.

The decentralization programme, started in 2000, is a concerted and ongoing effort by the Ministry of Health to provide access to primary health care for the general people throughout the country. Through decentralization, primary health care is being further strengthened by the provision of additional comprehensive services. In addition, patients with chronic illnesses can presently be followed up by the primary care services. Thus, decentralization has resulted in better access to care, with primary care services serving as a ‘gatekeeper’ for secondary and tertiary care.

The Ministry of Health has categorized the respective health care services available in Brunei Darussalam into two major services. The Directorate of Medical Services is responsible for hospital, nursing, laboratory, pharmaceutical, dental and renal services, while the Directorate of Health Services oversees community health, environmental health and scientific services.

Health policy, planning and regulatory framework

The provision of a comprehensive health care system for the people is a priority for the Government. The Ministry of Health formulates the National Health Policy, which is designed to provide the highest level of health care that is cost-effective and to provide a high quality of life for the whole people in a clean and healthy environment.

To attain the target of health for all, emphasis has been given to the development of a health care system that is based on primary health care, aimed at providing a wide range of preventive, promotive, curative and rehabilitative health care and support services to meet the needs of the people. The major policy objectives are: reduction of infant mortality, diseases and disabilities, inclunding premature deaths, thereby increasing life expectancy; development of the environment; and control of communicable diseases.

Health care financing

Human resources for health

The Ministry of Health, in its effort to provide quality health care, puts great emphasis on the continuous skill and professional development of its health care workforce. Upgrading professionalism, skills, credibility and quality of services towards excellence is one of the strategic themes in the National Health Care Plan 2000-2010. Towards that end, the Ministry of Health has made a long-term plan for development of additional professionals in various specialities through training courses, workshops and seminars, both local and overseas. Efforts are as well being made to develop postgraduate training programmes, inclunding sending local doctors to undergo further highly specialized training overseas. This has progressed to provide such training locally with the accreditation of RIPAS Hospital by the University of Queensland, Australia; the Royal College of Physicians, United Kingdom; the Royal College of Surgeons, Edinburgh, United Kingdom; the Royal College of Obstetrics and Gynaecology, London, United Kingdom; and the Royal College of Paediatrics and Child Health, London, United Kingdom.

In 2000, the Ministry of Health, in collaboration with the Institute of Medicine, University of Brunei Darussalam (UBD) and St. George’s Hospital Medical School, started a part-time postgraduate diploma course in Primary Health Care. Since 2004, it has been run by the Institute of Medicine, UBD. With the increase in local expertise and the number of graduates in health care, the Ministry has been able to expand the scope of its medical services.

To support capacity-building initiatives, the Primary Health Care Orientation and Training Centre was established in 1986, primarily to provide training courses on the primary health care concept for health personnel. A lot of training programmes have been conducted for community health nurses by the Centre, inclunding refresher courses, seminars and workshops for continuing professional development to increase the knowledge and skills of nurses in the community, inclunding nurses from Outpatient Services, School Health Services and other services in the Department of Health.

Partnerships

Challenges to health system strengthening

Regarding the challenges faced by the Ministry of Health, six aspects may be highlighted: fiscal problems relating to escalating health costs; the paradigm shift in health care (formal and informal activities to preserve and maintain health status); the epidemiological transition (from communicable to noncommunicable diseases and the relationship to lifestyle); and the demographic transition (the increasing number of older people with different needs and demands for health care services). Others include the paradigm shift in public sector management (innovations in the style of managing public services) and the technological revolution.

Critical success factors include the priority given by the Government to the importance of health, as manifested through: the recurrent and development budget; comprehensive health care that is of high quality and is cost-effective in the areas of prevention, health promotion and education, treatment and rehabilitation; the control of major communicable diseases; the potential development of the data and communication system; effective and committed leadership; and the availability of highly qualified and competent staff to provide high quality, comprehensive and cost-effective services. Other success factors include collaboration with other government and nongovernmental organizations, inclunding the private sector; support and participation from the public in improving services and health status; and establishment of the RIPAS Hospital as a centre of medical excellence and a referral hospital, inclunding a centre for the treatment of additional complicated diseases.