Ministry of Health Strategic Plan 2019 - 2023

11 Initiatives and 40 Action Plans Advance Clinical Strengthening Emergency Service Excellence Medical Ambulance Services • Strengthen Ministry of Health’s • Strengthen Emergency Medical role in service delivery through a Ambulance Services (EMAS) role holistic and integrated approach in service delivery by adopting an organisation-wide approach and a quality management system • Enhance clinical service leveraging on medical technology excellence through implementation and monitoring of clinical performance measures • Develop and enhance ambulance service configuration and deployment to provide timely • Develop Centres of Excellence response to patients towards achieving international recognition • Strengthen EMAS capacity and capability in emergency preparedness, in line with expectations of W.H.O International Health Regulations (IHR) 14 Strategic Goal 1: Excellence in Health Care Service Excellence In Excellence In Dental Services Renal Services • Improve waiting time • Promote peritoneal dialysis (PD) preference policy to patients with end-stage kidney disease (ESKD) • Enhance dental specialised services in the Districts • Collaboration with primary health care to develop a • Enhance the environment multi-disciplinary approach in and atmosphere of the dental the management of early chronic treatment centres to make it kidney disease (CKD) more customer-friendly • Improving Primary Oral Health • Strengthen renal replacement Care Services by minimising waits therapy (RRT) counselling and delays in receiving the services • Improve clinical outcomes of haemodialysis (HD) patients • Improve renal transplant programmes

11 Initiatives and 40 Action Plans Excellence In Excellence In Pharmaceutical Services Clinical Laboratories • Promote quality use of medicines • Improve quality and expand to enhance patient safety, International Standards optimise therapeutic outcome and Organisation (ISO) accreditations improve service accessibility for laboratory facilities / services and tests • Improve availability of medicine through strengthening of medicine • Ensure sufficient supply of safe selection in optimising expenditure blood and blood products and ensuring continuous supply of medicines • Set up new laboratory facilities and services to provide extensive • Increase customer service clinical laboratory tests and satisfaction (positive customer upgrade the existing ones to experience) through extension of become national referral clinical value added service on patient laboratories medicine supply • Enhance quality and coverage of phlebotomy services at health care facilities • Improve the quality of point of care testing (POCT) 16 Strategic Goal 1: Excellence in Health Care Service Strengthen Fundamental Strengthening Allied Health Quality Nursing Care Professions Services • Improve nursing basic processes • Enhance Allied Health with the implementation of Professionals role in service Interventional Patient Hygiene delivery in accordance to (IPH) evidence-based practice and international standards • Integrate patient care for positive patient outcome and • Strengthen availability and experience accessibility of quality allied health services through needs analysis, workforce and service planning • Improve the effectiveness and to enhance positive patient efficiency of nursing team with experience proper orientation programme and established competency assessment and monitoring for nurses

11 Initiatives and 40 Action Plans Establish Adolescent Health Strategy and Services • Introduce adolescent-friendly community centre with comprehensive services for adolescents in Brunei Darussalam • Establish teen-buddy system in government secondary schools • Strengthen sexual and reproductive health awareness and prevention programme through the development of communication and education strategy and the establishment of partnership with relevant stakeholders Gift of Life “Give Blood, Give Life” 18 Strategic Goal 2: Prevention and Control of Noncommunicable Diseases Surah Al-A’raaf, Verse 31: “O children of Adam! attend to your embellishments at every time of prayer (and tawaf), and eat and drink and be not extravagant; surely Allah does not love the extravagant.” Surah Al-A’raaf, Ayat 31: “Wahai anak-anak Adam! Pakailah pakaian kamu yang baik lagi sempurna setiap kali mendirikan sembahyang (dan tawaf), serta makan dan minumlah dan janganlah berlebih-lebihan. Sesungguhnya Allah tidak menyukai orang-orang yang berlebih-lebihan.” 20 Defining Prevention and Control of Noncommunicable Diseases (NCDs) • Strengthen stewardship and leadership, increase/optimise resources, improve capacity at all levels to sustain various NCD actions, including monitoring and evaluation • Develop national health screening programme for early detection of NCDs and risk factors • Strengthen collaboration and multi-sectoral response to develop and sustain policies and enabling/supportive environments for NCD actions or healthier lifestyles • Explore/ensure alternative sustainable funding for (selected) NCD actions • Work in collaboration with other agencies to address underlying social determinants of health and reduce modifiable risk factors for NCDs • Monitor NCD trends and risk factors and evaluate progress towards achievement of global NCD targets • Develop national capacity and support for high quality research, surveillance (through NCD registries) and evaluation for NCD prevention and control • Strengthen health systems to address the prevention and control of NCDs through patient-centred primary health care and universal health coverage • Support and empower people living with NCDs for better self-care and disease management • Strengthen promotion of oral health as an integral part of general health through early identification and intervention of oral disease • Promote transformation in public attitudes towards mental health issues and make positive mental health and well-being a priority for everyone Cancer Awareness “Prevention is better than cure” 22 Strategic Goal 2: Prevention and Control of Noncommunicable Diseases (NCDs) Develop National Health Giving Every Child Screening Programme the Best Start in Life • Develop and update National • Develop, implement and monitor Health Screening Guideline Nutrition and Physical Activity on NCDs Guidelines for Childcare Centres • Develop and implement national • Strengthen Health Promoting health screening programmes for Schools Initiatives priority NCDs based on latest scientific evidences • Develop Code on Responsible Advertisement on Foods and • Develop and update screening Beverages to Children databases for key NCDs to ensure timely and accurate data collection, management and • Strengthen actions under the analysis National Strategy for Maternal, Infant and Young Child Nutrition (MIYCN) in Brunei Darussalam • Evaluate the progress of national 2014-2020, particularly in NCD screening programmes to protecting, promoting and improve detection of cancers in supporting exclusive the early stages and survival rates breastfeeding of cancer patients

11 Initiatives and 40 Action Plans Improving Brunei’s Supporting Active Food Environment Communities • Strengthen the effectiveness • Develop National Physical of existing Healthier Choice Activity Strategy for the Initiatives through effective community aligned with WHO’s partnerships with relevant Global Action Plan on stakeholders Physical Activity • Conduct mass media campaigns • Promote healthy workplaces in on healthy eating based on the government sectors revised National Dietary Guidelines with respect to salt, saturated fats, as well as • Strengthen physical activity consumption of fruits and interventions in mukims and vegetables kampongs • Develop National Salt Reduction • Leverage on technology and Strategy and Interventions leading social media to promote physical to new or reformulated products activity to the community with lower sodium content • Develop and monitor effect of fiscal policies on unhealthy foods and beverages 24 Strategic Goal 2: Prevention and Control of Noncommunicable Diseases (NCDs) Reduce Tobacco Use / Promote Healthy Smoking Ageing • Review the Tobacco Order • Establish baseline for elderly 2005 and its Regulations for health status better compliance to the non-smoking law in all government premises and • Develop National Strategy on gazetted public places Healthy Ageing (including elderly care) in Brunei Darussalam • Conduct mass media campaigns and education activities to prevent initiation of smoking and to encourage smokers to quit • Strengthen smoking cessation programmes, including Klinik Berhenti Merokok (KBM)

11 Initiatives and 40 Action Plans Promote Better Mental Health Promote Better & Wellbeing For Everyone Oral Health • Establish partnerships for more • Enhance Toddler-Fluoride Rolling effective socialisation of mental Toothpaste Programme (TFRTP) health issues in schools, for 9 months-old babies workplaces and the community to 5 year-olds • Develop a Multi-sectoral • Enhance Fluoridated Tooth Taskforce on Mental Health Brushing Programme (FTB) in Promotion and Illness Prevention primary schools leading to the development of a Multi-sectoral Mental Health Action Plan for Brunei Darussalam • Conduct public education and 2020-2023 skills development programmes to improve oral health knowledge, attitudes and behaviours in • Establish baseline on mental all schools health status and issues in Brunei Darussalam • Develop ‘Brunei Bebas Buli’ Programme for bully prevention and management in schools 26 Strategic Goal 2: Prevention and Control of Noncommunicable Diseases (NCDs) Towards A Health Enhance Clinical Literate Brunei Management of NCDs • Establish baseline on health • Strengthen integrated care services literacy status through partnership with public and private health care providers in the primary, secondary and tertiary • Develop Health Literacy Action health care Plan for Brunei Darussalam • Review and update Clinical Practice Guidelines (CPGs) and Standard Operating Procedures (SOPs) for the management of common NCDs • Assess and monitor the service availability and readiness of the primary health care sectors (public and private) in addressing NCDs such as availability of essential medicines and SOPs • Review and monitor effectiveness and efficiency of the NCD patient management through regular audits and surveys • Strengthen patient support system for optimisation of NCD management through multidisciplinary approach including rehabilitative, palliative and social care services

11 Initiatives and 40 Action Plans Strengthen Research, Surveillance and Evaluation • Strengthen existing and develop new NCD Registries (Cancer, Cardiovascular Diseases, Diabetes Mellitus, Stroke, Renal Diseases) through partnership with BruHIMS and clinical departments • Provide up to date data statistics and analysis on key NCDs and risk factors • Plan and implement Global School-based Health Survey or National Survey on Adolescent’s Physical and Mental Health Status, Risks and Behaviours Toothbrushing • Plan and implement National Health and Nutritional Status “Beautifying Our Smiles” Survey (NHANSS); or STEPwise surveillance of NCDs; or National Survey on Adult’s Physical and Mental Health Status, Risks and Behaviours • Strengthen evaluation studies on existing NCD programmes by facilitating the conduct of priority NCD researches through partnership with clinical departments and academic institutions 28 Strategic Goal 3: Protection of Public Health Through Effective Policies and Regulations Prophet Muhammad Sallallahu Alaihi Wasallam said: "Try to be clean as much as you are able to. Verily, Allah has based the foundation of Islam on cleanliness; hence, never can a person enter Paradise but the clean ones." (Hadits Narrated by Tabrani) Nabi Muhammad Sallallahu Alaihi Wasallam bersabda: "Jagalah kebersihan dengan segala cara yang dapat kamu lakukan kerana Allah mendirikan Islam di atas kebersihan dan tidaklah masuk syurga kecuali orang menjaga kebersihan.“ (Hadits Riwayat Tabrani) 30 Defining Protection of Public Health Through Effective Policies & Regulations • Ensure national health security through strengthening and maintaining core competencies of the WHO International Health Regulations 2005 • Ensure public health protection and assurance through performance of regulatory functions and discharge of legislative responsibilities relating to public health risks and disease prevention • Continuous surveillance of priority diseases and health risks as well as monitoring of the health status of the population • Ensuring health system readiness to address emergencies in responding to public health incidents of national and international concerns • Strengthen laboratory capacity and capability to support strategies and actions for public health safety and security • Upholding health care practitioners professionalism and commitment to continuous professional development and strengthen regulation of health care facilities to ensure compliance to standards Safety First “Safety is a common denominator across all aspects of life” 32 Strategic Goal 3: Protection of Public Health Through Effective Policies & Regulations Ensuring National Enforcing Public Health Health Security Legislations, Regulations and Standards • Strengthen and maintain • Align delivery of services to national International international standards or Health Regulations (IHR) national/ international best Core Capacities in ensuring practices supported by Brunei Darussalam’s health appropriate legislation and security standard operating procedures (SOPs) Excellence in Analytical Support Services For Public Health and Security • Build laboratory capacity and strengths for public health, safety and security • Strengthen Laboratory Capacity for detection and identification of infectious diseases

6 Initiatives and 9 Action Plans Infection Prevention Ensure Preparedness and Control For Health Emergencies • Strengthen infection prevention • Strengthen and control on diseases of departmental-wide public health importance readiness to respond to all emergencies • Strengthen Antimicrobial Resistance (AMR) response through coordinated “One-Health” Approach Upholding Healthcare Practitioners Professionalism and Strengthen Regulation of Healthcare Facilities • Review and develop legislations on healthcare practitioners and strengthen enforcement to ensure public safety and upholding professionalism • Align healthcare delivery and practices to regional and international standards in optimizing public safety and delivery of healthcare services 34 Strategic Goal 4: Sustainability Through Resource Optimisation and Innovation Surah AI-Isra‘, Verse 82: “And We reveal of the Al-Qur'an that which is a healing and a mercy to the believers, and it adds only to the perdition of the unjust.” Surah AI-Isra‘, Ayat 82: “Dan Kami menurunkan daripada Al-Qur’an suatu penawar (bagi penyakit rohani dan jasmani) dan rahmat bagi orang-orang yang beriman, dan Al-Qur’an itu tidaklah menambah kepada orang-orang yang zalim (orang-orang kafir) selain kerugian.” 36 Defining Sustainability Through Resource Optimisation and Innovation • Efficient use of resources and funds • Innovate to overcome resource and financial challenges • Promote sustainable financing model through public private partnership / alternative healthcare financing system • Rational use of drugs / medical sundries • Minimise wastages Staying Connected “Our clients’ feedback matter to us” 38 Strategic Goal 4: Sustainability Through Resource Optimisation and Innovation Create Sustainable Health Ensure Sustainable and High Care Financing System Quality Work Force • Encourage generation of • Increase effectiveness of Human revenues through revised Resource Planning and and comprehensive Management to ensure quality scheme of charges and optimum workforce for healthcare service excellence • Sustain the delivery of essential services through • Improve attraction and retention Private Public Partnership (PPP) strategies to retain quality and talented healthcare workforce • Enhance human resource role as strategic partners in support of organisational efficiency initiatives • Strengthen human resource management system

5 Initiatives and 13 Action Plans Ensure Human Resource Talents Strengthen Management of are Nurtured & Developed Healthcare Technology • Enhance human resource • Enhance medical device development strategies to ensure operating skills a pool of skilled professionals leading to national and global • Enhance quality management recognition in their own field of medical devices through accreditation and audit • Ensure potential leaders are equipped with key competencies for effective succession planning strategies 40 Strategic Goal 4: Sustainability Through Resource Optimisation and Innovation Improve Organisational Efficiency Through Improved Process and Technology • Upgrade and extend the BruHIMS’s technology and connectivity to optimise the utilization of system’s data, modules and referral functions • Refresh BruHIMS and all hospitals network infrastructure within the Ministry of Health • Increase the application of ICT to enhance the efficiency and effectiveness of public services in the Ministry of Health (e-services)

5 Initiatives and 13 Action Plans Progressing Forward “Without innovation there is no progress” 42 Strategic Goal 5: Transparent and Proactive Governance Surah An-Nisa, Verse 58: “Surely Allah commands you to make over trusts to their owners and that when you judge between people you judge with justice; surely Allah admonishes you with what is excellent; surely Allah is Seeing, Hearing.” Surah An-Nisa, Ayat 58: “Sesungguhnya Allah menyuruh kamu supaya menyerahkan amanah-amanah kepada ahlinya (yang berhak menerimanya) dan apabila kamu menjalankan hukum antara manusia (hendaklah) kamu menghukum dengan adil. Sesungguhnya Allah (dengan suruhanNya itu) memberi pengajaran yang sebaik-baiknya kepada kamu. Sesungguhnya Allah adalah Maha Mendengar lagi Maha Melihat.” 44 Defining Transparent and Proactive Governance • Audit and Code of Ethics • Transparency and accountability in all of the Ministry of Health’s functions: Budgeting, Contracting, Law And Policy Making, Service Delivery • Public engagement in decision making • Effective data and information management and sharing between stakeholders • Align strategies to Melayu Islam Beraja and practice the teachings of Al-Qur'an in clinical and non-clinical services • Support and implement fiscal consolidation programme through appropriate structure, policy, process and efficiency reforms Promoting a Proactive Generation “Hearing the public’s voice and giving them a chance to participate and lead” 46 Strategic Goal 5: Transparent and Proactive Governance Practice Evidence-Based Create Ministry of Health’s and Accountable Financing Brand Identity • Strengthen budgetary and • Branding Ministry of Health’s purchasing system in the Ministry corporate identity and values in of Health with the use of order to build Sense of Belonging recognised evidence-based tools amongst staff and aligning to the such as National Health Accounts Ministry’s core values (NHA) and Health Technology Assessment (HTA) • Improving Ministry of Health’s credibility and reputation among • Strengthen internal audit its clients • Improve strategies to ensure all forms of communications developed by the Ministry of Health are accessible, credible and trusted, relevant, timely and understandable

6 Initiatives and 20 Action Plans Enhance Quality of Establish Healthy Workspace Policy-Making, Strategy Through Health, Safety & Environment and Data Management (HSE) and Risk Assessment • Strengthen health policy • Strengthen awareness on development and analysis health, safety and environment at workplace in the Ministry of Health • Establish strategy management and monitoring framework that aligns to Wawasan • Establish Risk Assessment Brunei 2035 framework Framework and Plans for the Ministry of Health • Strengthen international relations and fulfill commitments in health • Establish national health dataset and improve data quality (standards) • Promote health services and clinical research to support evidence-based policy-making 48 Strategic Goal 5: Transparent and Proactive Governance Strengthen Health Upgrade and Development Information System and of Healthcare Healthcare Technology Infrastructure • Enhance the effectiveness of the • Implementation of the 11th overall information technology National Development services in the Ministry of Health Plans projects • Creating data integration • Health System and Infrastructure platform to support research, Master Plan (HSIMP) for management and planning, and Brunei Darussalam improve service delivery functions ›› Strengthen mission and capacity, and upgrade all the • Enhance security for Ministry government hospitals and of Health’s workstations and healthcare facilities networks ›› Strengthen the health centres network throughout the country • Increase the application of ICT to support Ministry of Health’s regulatory and monitoring • Upgrading of Raja Isteri functions Pengiran Anak Saleha Hospital • Strengthen the regulations of medical devices to ensure quality and safety

6 Initiatives and 20 Action Plans Rest Assured “There is no compromise on quality” 50 The history of Medical and Health Services in Brunei Darussalam dated back to 1907 when the Deputy British Resident was also the residing doctor. The health system started with the formation of the Medical Department along with the appointment of the first State Medical Officer in 1929 and the start of the Public Health and Sanitation Programme. In the same year, the first government hospital (18-bedded) situated in Pekan Brunei was officiated by His Majesty Sultan Ahmad Tajuddin Akhazul Khairi Waddien Ibni Al-Marhum Sultan Muhammad Jamalul Alam For over 110 years, our journey has always been to serve the population with evidence-based strategies for all ages 52 IMPLEMENTING STRATEGIC GOALS The 5 year strategic will support and ens Strengthened Noncommunicable Health System Diseases in maintaining Universal Health are prevented, treated, Coverage (UHC) and assuring managed and their risk people centred care factors controlled, and mental health also prioritised and improved Strengthened Communicable National Capacities Diseases to better protecting people are prevented, managed from epidemics, and other and controlled health emergencies Improved Patients Human Capital Safety that contributes to They are protected from knowledge and health hospital-acquired infection of the population and other harm when they seek care c plan sure the following: Antimicrobial Strengthened Resistance Country Capacity is decreased, while ensuring in data and innovation effective treatment and prevention are in place Medicines & Other Strengthened Health Technologies Leadership are both safe and effective as well as governance, management and advocacy for health Improved Financial, Health Human and Impacts Administrative of environmental risks and other determinant Resources of health addressed Management towards transparency, efficient use of resources, and effective delivery of results 54 KEY PERFORMANCE The core indicators are categorised as: INDICATORS 03 SERVICE COVERAGE include reproductive, maternal, newborn and adolescent, immunisation, and mental health 04 HEALTH SYSTEMS include quality & 01 safety of care, HEALTH utilization & access, STATUS health workforce, include mortality 02 health information, health financing, and morbidity RISK FACTORS security & governance include nutrition, infections and noncommunicable diseases 56 Health Status in Brunei Darussalam Life Expectancy At Birth 79.0 Years (2023) 77.3 Years (2017) Maternal Mortality Ratio (SDG 3.1) <70.0 per 100,000 Live births by 2023 62.0 per 100,000 Live births in 2017 Under Five Mortality Rate (SDG 3.2) 8.0 per 1000 Live births by 2023 11.5 per 1000 Live births in 2017 Hepatitis B Incidence Rate (SDG 3.3) <10.0 per 100,000 population by 2023 6.0 per 100,000 population in 2017 Premature NCD Mortality (SDG 3.4) 10.0% per100,000 population by 2023 14.3% per 100,000 population in 2017 HIV Prevalence Rate <10.0 per100,000 population by 2023 37.0 per 100,000 population in 2017 HIV Incidence Rate (SDG 3.3) <10.0 per 100,000 population by 2023 7.0 per 100,000 population in 2017 TB Incidence Rate (SDG 3.3) 50.0 per100,000 population by 2023 57.0 per 100,000 population in 2017 SDG 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. SDG 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. SDG 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. SDG 3.4: By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being. 58 Risk Factors Risk Factors Global Global & National & National Global NCD Target 25% Stop relative reduction in the the rise in obesity prevalence of raised blood and diabetes pressure or contain the prevalence of raised blood pressure, according to 30% national circumstances relative reduction in prevalence of current tobacco use 10% relative reduction in prevalence of insufficient physical activity National NCD Target 87.0% 74.0% 19.9% 14.0% 18.9% Reduction prevalence of Reduction in tobacco No increase in the rise physical inactivity for use of obesity in adolescent adolescents 25.3% 20.0% 4.3 4.0 28.0% Reduction prevalence Reduction of decayed, No increase in the rise of physical inactivity for missing, filling teeth of obesity in adults adults (DMFT) score for 5 year olds 46.2% 23.1% 0.8 0.6 10.0% Reduction in sweetened Reduction of decayed, No increase in the rise of beverage consumption missing, filling teeth blood glucose in adults among children (DMFT) score for 12 year olds 28.0% 21.0% 46.3% 55.0% Reduction in prevalence Increase exclusive of raised blood pressure breastfeeding rate for 0 – 5 months of age 60 Health System & Health Service Coverage >95% • Antenatal coverage • Births attended by skilled >80% health professionals Coverage of essential services (Universal Health Coverage) 80% Customer satisfaction SDG 3.8: Achieve universal health coverage, including financial risk protection, access to ≥95% quality essential health-care services and access to safe, effective, quality and affordable essential medicines and Immunisation vaccines for all coverage for Diptheria, Tetanus, Pertussis, Influenza, Polio, Hepatitis (DTP-Hib-IPV-HepB 3), Mumps, Measles, Rubella and Hepatitis B (birth dose) 100% Treatment coverage for • Tuberculosis (TB) • Drug resistant Tuberculosis 62 ACKNOWLEDGEMENT • Honourable Minister of Health • Permanent Secretary • Deputy Permanent Secretary (Professional) • Deputy Permanent Secretary (Policy & Management) • Acting Director General of Medical & Health Services • Department of Policy & Planning • Department of Medical Services • Department of Health Services • Department of Administration and Finance • Department of Healthcare Technology • Estate Management and Project Development • Health Promotion Centre • Department of Nursing Services • Department of Environmental Health Services • Department of Scientific Services • Department of Laboratory Services • Department of Pharmaceutical Services • Department of Renal Services • Department of Dental Services • Raja Isteri Pengiran Anak Hajah Saleha Hospital • Duli Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital • Suri Seri Begawan Hospital • Pengiran Isteri Hajah Mariam Hospital • Internal Audit • Office of Quality, Governance and Innovation • Boards Management Office • Ministry of Religious Affairs • World Health Organisation Photographer Yoshi Shimizu One MOH Strategic Planning Retreat, 2019 64 One MOH “Together Towards a Healthy Nation” 66 www.moh.gov.bn Ministry of Health Headquarters Commonwealth Drive, Bandar Seri Begawan Brunei Darussalam, BB3910 TOGETHER TOWARDS A H E A LT H Y N ATION Published- 2019