DAY 14 MORNING
21ST MARCH 2023 - MORNING
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(The meeting began at 9.30 am)
Deputy Clerk
َّ الرحْ َٰم ِن الرحْ يم ِ ِبس ِْم ه. The First Meeting of the 19th Session of the National Assembly Meeting is held on the 14th day, Tuesday, 28th of Syaaban 1444H corresponding to the 21st of March 2023M, preceded by a Prayer of Safety.
PRAYER OF SAFETY
The Prayer of Safety was recited by the Reverend Begawan Pehin Khatib Dato Paduka Awang Haji Emran bin Haji Kunchang. (Imam of the Omar 'Ali Saifuddien Mosque).
Your Honorable Speaker
ِالرحْيم السَّال ُم عل ْي ُك ْم ورحْمةُ هللا َٰ الر َّ حْم ِن َّ ّٰللا ِ ِبس ِْم ه وبركاتُهُ أ ْلح ْمدُ ِ هلِل
We thank سبْحانهُ وتعال َٰى ِأ ه ُ ّلل for His grace, mercy, and permission that we are able to gather here on this morning for the 14th day of the First Meeting of the 19th Session of the National Assembly Meeting. May blessings and peace be upon our Great Leader نبي محمد صل هللا عليه وسالم, his family, companions, and followers who remain loyal and faithful until the end of time.
Honorable Members. The National Assembly Meeting is still discussing the proposed Supply Bill (2023) for the year 2023/2024, which was proposed by the Honorable Minister in the Prime Minister's Department and the Second Minister of Finance and Economy.
To enable us to continue discussing and examining the topics contained in this Bill, I would like to adjourn this National Assembly Meeting and convene at the Committee Level.
(The National Assembly Meeting is adjourned)
(The meeting continues as a Committee)
Your Honorable Speaker
ّٰللا ِ ِبس ِْم ه الرحْ يم َٰ َّ Honorable Members. َّ الرحْ م ِن Now the National Assembly Meeting is fully convened at the Committee Level to consider and discuss the Supply Bill (2023) for the year 2023/2024 one by one. Yesterday afternoon, as we understand it, the Committee Meeting began discussing the Ministry of Culture, Youth and Sports. The Honorable Minister of Culture, Youth and Sports presented a comprehensive introduction on the preparation of the Budget for the Financial Year 2023/2024 for his ministry.
However, I understand that there are some Honorable Members of the Cabinet Ministers who would like to make statements regarding the questions raised by the Honorable Members that have not yet been answered and would like to add further explanations to the incomplete answers to the questions raised yesterday afternoon.
I would like to invite Your Honorable Minister of Development.
Your Honorable Minister of Development
In the name of Allah, the Most Gracious, the Most Merciful, peace be upon you and blessings of Allah be upon you. Your Honorable Speaker, thank you for giving me the opportunity to explain the answers to the questions that were not answered during yesterday's discussion session.
The first question that I would like to explain is the question raised by Your Honorable Awang Mohammad bin Abdullah @ Lim Swee Ann regarding land grants. What is the process to expedite the granting of land ownership to recipients of the Jati People's Housing Scheme who have paid their dues? In answering this, it is customary for the Housing Development Department to inform the Land Department of the payments made by any National Housing Scheme homeowner who has paid off their home loan, and for the Land Department to issue the land grant in the name of the homeowner. The registration and issuance process for land grants for lands under the National Housing Scheme, including the Jati People's Housing Scheme, is usually completed within one week. The Land Department will continue to improve its administrative processes to expedite the issuance of land grants as raised in this question.
The second question raised by Your Honorable Awang Mohammad bin Abdullah @ Lim Swee Ann is regarding public complaints about faded road signs, junction numbers, and village labels that are no longer visible. In response, the Survey Department usually replaces damaged or faded junction signs if they are no longer visible or if the numbers are no longer clear. As a proactive measure, the Survey Department continuously monitors and replaces junction signs, such as in the Belait District, where 109 junction signs were replaced from April 2022 to March 2023.
For damaged road signs, the Public Works Department will replace them through existing contracts. In addition, the Public Works Department also undertakes the cleaning of any dirty and unclear signs.
As for faded house numbers, homeowners are advised to replace them privately, provided they are clear and visible, or obtain a new plate from any Survey Department branch by bringing the relevant documents.
Next, Your Honorable Speaker, I would like to address a question raised by Your Honorable Pehin Orang Kaya Laila Setia Dato Seri Setia Awang Haji Abdul Rahman bin Haji Ibrahim regarding the number of local contractors registered under ABCi. In response, according to the company registration statistics at the Ministry of Development, 1,669 construction licenses have been issued until January 2023. Out of this number, 582 companies are local contractors, which means that 100% of the company's shares are owned by Brunei Darussalam Malay citizens.
Next, I seek permission to address a question that was not answered yesterday, raised by Your Honorable Pengiran Haji Isa bin Pengiran Haji Aliuddin regarding agricultural and livestock entrepreneurs in developing agricultural sites that require the construction of structures such as seedling buildings, storage, and worker housing, where the company is unable to appoint a qualified person to apply for progress approval.
Every structure that is built must achieve the objective and building performance at a minimum level to ensure public safety. Therefore, public safety should not be neglected in any activity, especially those involving inhabited buildings.
Not all types of buildings need to be submitted for building progress approval at ABCi and planning permission at the Department of Town and Country Planning, but they still need to be submitted for design approval that is certified and supervised by a qualified person. Therefore, every planning and progress that we carry out must be based on regulations that protect and preserve the environment and emphasize safety, health, and well-being.
In an effort to support agricultural entrepreneurs, ABCi, together with the Department of Agriculture and Agri-Food, the Ministry of Primary Resources and Tourism, has provided blanket approval for buildings that do not need to be applied to ABCi for approval as listed under the First Schedule Regulation 5 Insignificant Building Works, Building Control Regulation 2014, or Building Control Amendment Regulation 2018.
The types of buildings referred to are such as single-story buildings used for agricultural purposes or animal housing, including protected seedling houses (greenhouses) or machine storage, provided that part of the building is not used as a residence or workplace, such as packaging, exhibitions, or sales, and the position of the building is not less than 1.5 times the height of the building from adjacent buildings or those adjacent to access roads.
Meanwhile, we would also like to remind that the form of progress with the scope of land works involving cutting and filling of land for the placement of buildings must also be presented for approval of progress as usual through a qualified person. Meanwhile, construction works must be carried out by registered construction companies with the Ministry of Development.
Furthermore, Your Honorable Speaker, may I seek permission to clarify the question raised yesterday by Your Honorable Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Haji Awang Suyoi bin Haji Osman regarding the status of PPP that was discussed as an alternative. Regarding PPP to produce housing projects, it is still in planning and under study by the Housing Development Department with PCube. Previously, several concepts were explored and studied together.
However, there has not been any project or concept that has been agreed upon as viable, especially in terms of economic viability. One of the requirements for providing housing with this PPP concept is affordable prices with private sector involvement.
One of the conditions for these houses is affordable housing with affordable prices. That is why this matter requires a lot of time to find a formula that is economically viable and acceptable to the private sector. At this time, the Housing Development Department is exploring several more concepts for further study.
The second question from Your Honorable Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Haji Awang Suyoi bin Haji Osman is also about JASTRe, which is landscape management. Does it include new areas? There have been no new areas in recent years. The budget will be used to upgrade existing areas and to enhance the landscape in strategic areas according to priorities. This includes upgrading the landscape areas in the Temburong District starting from the Temburong Bridge roundabout and along the road to Pekan Bangar, and open areas that have not been beautified with landscapes. In addition, at this time, beautification works on the Rasau roundabout located on the Seria-Belait Highway are being carried out and scheduled to be completed in April 2023.
Meanwhile, in the Tutong District, a project to upgrade and beautify the Tatangan Waterfront Promenade Park and the area facing the Basong River has been planned and scheduled to be completed by June 2023.
JASTRe has also activated briefings and activities in 16 schools since 2021 through the Science, Technology, Engineering, Design and Technology, Art and Mathematics (STEAM) Outreach Program, which is managed by the Science, Technology and Environment Cooperation Center, Ministry of Education, where the main focus is on cleanliness and environmental conservation. This is where these activities become a platform that is related to engagement with students and school learners.
The briefings aim to raise awareness among students about the importance of environmental conservation, awareness of environmental maintenance and restoration, as well as an approach to the 3R initiative (Recycle, Reuse and Reduce). With this approach, it is hoped that a sense of responsibility can be instilled in students from an early stage and encourage a shift towards more environmentally friendly habits and lifestyles.
The response from students regarding this activity and awareness of the environment and cleanliness is positive, with enthusiasm shown by the students.
Furthermore, I would like to explain another question raised by Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin regarding whether the Part 3 Practical Training and Part 3 Examination are enforced before the issuance of a license in architecture, specifically in construction and design.
In answering this question, it should be explained that to qualify someone as a registered and licensed architect, one must pass Part 1, Part 2, and Part 3. Part 1 is a Bachelor's degree, Part 2 is a Master's degree, and Part 3 is an exam required by the Royal Institute of British Architects for architects practicing in the United Kingdom.
Therefore, this question regarding whether the Part 3 examination is enforced in Brunei Darussalam under the supervision of BAPEQS, the Board of Architecture, Professional Engineers and Quantity Surveyors in Brunei Darussalam, which is managed under the Ministry of Development.
In this matter, it is also necessary to explain that Part 3 exam is an exam that is conducted in the United Kingdom, which requires a person to have 3 years of experience in this field to be eligible to take the exam and become a practicing architect in the United Kingdom.
Regarding Part 3 in Brunei Darussalam, after several amendments were made, the implementation of Part 3 examination is no longer required according to the requirements and modules of Part 3 in the United Kingdom. Under BAPEQS, a module has been provided for Brunei Darussalam, which means that before a person is granted an architecture license, he or she must pass the qualified Part 1- First Degree, Part 2- Master's Degree, and Part 3 examination, which is supervised by BAPEQS and monitored regarding the examination questions provided by the BAPEQS panel of local architects in collaboration with the Universiti Teknologi Brunei School of Design, which coordinates and also provides the Part 3 exam as an alternative to the Part 3 exam conducted in the United Kingdom.
It should also be noted that Malaysia and Singapore are among the two countries that no longer practice Part 3 as required in the United Kingdom, and they also have their own Part 3 modules as implemented in Brunei Darussalam through the Board of Architecture, Professional Engineers, and Quantity Surveyors as the supervisory and accreditation body for qualified architects after meeting the requirements of Part 1, Part 2, and Part 3 as mentioned earlier.
In answering the second question from Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin, whether the external Part 3 examination is fully supervised by qualified local architects. As mentioned earlier, the professional examination under the BAPEQS Board is supervised by a local panel consisting of licensed architects in Brunei Darussalam under BAPEQS in collaboration with the Universiti Teknologi Brunei School of Design and Architecture.
I would like to explain that regarding the question raised yesterday by Your Honorable Haji Awang Sulaiman bin Haji Nasir about Taman Batang Duri, there are plans to upgrade the park. The Department of Environment, Parks and Recreation (JASTRe) has applied for funding in the 2023/2024 Financial Year to implement the development and management program of the Batang Duri Recreational Park, including the project to upgrade 21 animal enclosures and the fencing of the 90 deer enclosures currently located in Taman Batang Duri.
The Department of Environment, Parks and Recreation will also provide an information center and build public toilets and a surau upon public request as an effort to provide facilities for visitors to Taman Batang Duri.
That is the answer that I can provide to explain some matters that were not explained yesterday. I would like to express my gratitude to Your Honorable Speaker.
Your Honorable Speaker
Thank you, Honorable Minister of Development. Honorable Members, I understand that the Honorable Minister of Culture, Youth and Sports is unable to attend the session this morning due to unavoidable personal reasons.
Therefore, I suggest that we postpone the discussion on the Ministry of Culture, Youth and Sports and continue our work to examine and discuss the next topics. As we have entered the fourteenth day of our session.
So, I believe it is necessary for us to conclude our discussion on the budget we are facing as soon as possible. Therefore, I propose that we move on to the next ministry topic.
Deputy Clerk
Under the Title SM01A - Ministry of Health.
Your Honorable Speaker
Honorable Members. The Committee meeting now moves on to the Ministry of Health topic. Before we open the Ministry of Health budget for discussion and examination by the Committee, I would like to give way to the Honorable Minister of Health to provide an introduction on the preparation of the budget for his Ministry.
I now invite the Honorable Minister of Health.
Honorable Minister of Health
Thank you, Your Honorable Speaker.
In the name of Allah, the Most Gracious, the Most Merciful
Peace be upon you and God's mercy and blessings.
All praise is due to Allah, we are grateful to Allah for His grace, permission, and blessings that we can gather today in the First Meeting of the Nineteenth Session of the National Assembly for the year 2023M corresponding to 1444H.
Salutations and greetings to our great leader Prophet Muhammad peace be upon him, his family, companions, and followers who are obedient and honest until the end of time.
We thank Allah for His permission and blessings, as well as the leadership of His Majesty Sultan Haji Hassanal Bolkiah Mu'izzaddin Waddaulah ibni Al-Marhum Sultan Haji Omar 'Ali Saifuddien Sa'adul Khairi Waddien, Sultan and Yang Di-Pertuan of Brunei Darussalam, we can now return to a life that is almost normal.
After approximately 3 years of facing various challenges and trials during the COVID-19 pandemic, which tested the resilience of the people of Brunei in facing and responding to the pandemic, every challenge has its own wisdom.
Alhamdulillah, various benefits and advantages have been gained from the experiences during the pandemic, which have made us a more mature and stable country in dealing with any crisis or challenge. As Allah SWT said in Surah Al-Insyirah, verses 5 and 6, which means: "For indeed, with hardship [will be] ease. Indeed, with hardship [will be] ease."
Your Honorable Speaker and Honorable Members. Throughout the Financial Year 2021/2022 and 2022/2023, the Ministry of Health has implemented several projects and initiatives aimed at improving the quality of life of the people and residents in this country to achieve the goals of Wawasan Brunei 2035. This includes supporting the development of Industry 4.0 to provide a high quality of life comparable to advanced countries in the world through digital transformation in health services. The rapid development of technology that we have witnessed during the COVID-19 pandemic has greatly helped medical experts to carry out clinical treatments more effectively, quickly, and accurately, as well as helping to restore the health of patients safely.
The use of the BruHealth application, which was introduced in 2020 as a contact tracing application during the COVID-19 pandemic, has now been expanded through the BruHealth Phase II and III projects, which include the addition of other features and capabilities such as allowing patients to access their own medical records, including laboratory test and x-ray results, making clinic appointments and tele-consultations, as well as strengthening the data generation system to help the Ministry of Health plan appropriate health programs. The BruHealth application has penetrated the social life of all segments of society in this country, thereby raising the level of digital usage in this country and gaining international recognition with the application's recognition at the Asia Pacific ICT Award (APICTA) in Islamabad, Pakistan in December 2022. This success has brought honor to our country and proves that we are capable of competing and standing proudly alongside other advanced countries in the field of digital technology.
May this success serve as a catalyst for the country to continue moving forward in line with modernization and bring Brunei Darussalam to greater heights.
In promoting healthy lifestyles across all levels of society, the Ministry of Health has been actively implementing and planning various programs, campaigns, and initiatives. For example, the BN on the Move campaign aims to encourage healthy living by increasing physical activity levels through individual or group exercise activities. The BN on the Move campaign, which was launched on August 14, 2022, together with the One Billion Steps Challenge,
It exceeded expectations when it was achieved in just 8 days, 3 hours, and 41 minutes, which is a shorter period than the initial one-month target, with the participation of over 43,000 participants. Following this success, the second challenge, the 20 Billion Steps Challenge, which began on October 1, 2022, was successfully achieved at exactly 7:20 pm on December 31, 2022, with the participation of over 74,000 participants.
InshaAllah, the Ministry of Health will continue to promote activities like these that stimulate public participation.
To further improve patient safety, the Ministry of Health launched the Picture Archiving and Communication System (PACS) on October 3, 2022, which allows patient medical records, x-ray images, and ECGs to be accessed at any government healthcare facility throughout the country and InshaAllah will be extended to private healthcare facilities. This system speeds up clinical work processes so that appropriate and timely treatment can be provided to patients.
In addition to PACS, several digital technology achievements have also been implemented in other services, such as the use of Computer Assisted Design (CAD) machines in dental services, the Therapy Data Management System (TDMS) in dialysis services, and the addition of CT scan machines for Radiology Services, especially in accommodating the needs of other districts besides Brunei and Muara.
At present, the Ministry of Health is also conducting research on the use of advanced technology in the detection and early treatment of diabetes-related problems, particularly the effects on vision or diabetic retinopathy.
If the Artificial Intelligence (AI) retinopathy screening system is successfully implemented, this will place the country among the earliest adopters of this technology. This means that the function and productivity of a patient can be maintained, and they can enjoy a prolonged quality of life and well-being.
The establishment of the Intelligence Hub, which was inaugurated on November 1, 2022, includes:
The Epidemic Intelligence and Response Unit, which functions as a surveillance center to control the spread of infectious diseases in the country.
The Climate Change Adaptation and Resilience Unit.
The Digital Health Unit is among the efforts of the Ministry of Health to strengthen the health system that has an efficient response to future health threats.
The data generated will help the Ministry of Health to formulate strategies and prepare essential resources to ensure health safety in the country. This effort is also in line with the command of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam during the celebration of the New Year 2023, where he called for us to venture into new fields such as big data cloud computing, green energy, and environmentally friendly technology.
Towards strengthening the country's health system with tailored expertise and continuous services, the required health professionals must be sufficient, appropriate, and skilled.
The Financial Year 2022/2023 recorded the number of Health Professional Members under the Ministry of Health as follows: 806 doctors and dentists, 2,557 nurses, and 416 other allied health professionals. This is an increase compared to the Financial Year 2020/2021, which recorded 738 doctors and dentists, 2,517 nurses, and 313 other allied health professionals.
"Alhamdulillah" with the increase in the number of health professionals, several health services have been further developed in various disciplines and specialties, including sports medicine, palliative care, infectious diseases expertise, and organ transplant services, especially kidney transplants.
Although the number of healthcare professionals is increasing from year to year, it is still insufficient due to the development and addition of specialized services provided in hospitals and clinics.
To address this issue, several efforts are being made to expedite the recruitment of healthcare professionals through collaboration with private medical and academic institutions, as well as improving cooperation with certain government agencies in researching and updating service schemes for healthcare professionals and improving the recruitment process. This will attract existing healthcare professionals to continue serving the nation. The Ministry of Health is committed to exploring new and innovative methods to generate human resources to strengthen the healthcare sector in the country.
Your Honorable Speaker and Honorable Members. Praise be to Allah, the development of infrastructure in the public healthcare sector continues to receive attention. Under the 11th National Development Plan, the construction of the new block of the Perak Jubilee Health Center in Sengkurong, which is expected to be completed in April, will add consultation rooms for Basic Care Services and Maternal and Child Services, such as isolation rooms and additional space for services such as nutrition consultation, psychology, psychiatry, smoking cessation clinics, and dentistry. With these additions, patients will be able to receive treatment in a more comfortable environment and waiting times for patients will be reduced.
Meanwhile, in the Belait District, the construction of a new Emergency Services building at the Suri Seri Begawan Hospital will begin soon and is expected to be completed by mid-next year. This project under the 11th National Development Plan was delayed to allow for the appointment of hospital construction consultants responsible for ensuring that every process and workflow complies with international standards. The construction of this new building will provide a larger and more comfortable area for patients and their families who come for treatment in the Accident and Emergency Department of the hospital.
God willing, the upgrading of the Accident and Emergency Department of this hospital will reduce waiting times and streamline emergency management processes according to priorities. It will also strengthen supervision for patient and staff safety with safe and controlled infrastructure, as well as improving customer satisfaction.
Meanwhile, the Molecular Diagnostic Clinical Laboratory for Infectious Diseases in the Tutong District has been completed. Equipped with advanced virology laboratory equipment, the laboratory has been operational since November 2021. The laboratory's ability to conduct genetic sequencing studies on infectious disease pathogens will support the country's preparedness in controlling infectious diseases and ensuring public health safety in the country.
Your Honorable Speaker and Honorable Members. The Ministry of Health still faces challenges that need to be carefully addressed in order to maintain the resilience of the health system and to realize Brunei Vision 2035, towards a country with a high quality of life for its people. This includes increasing the rate of non-communicable diseases (NCDs). Brunei Darussalam is facing an increasing burden of chronic NCDs.
Although efforts to control non-communicable diseases have been intensified from year to year, the number of chronic disease patients continues to increase. For example, the number of kidney patients requiring Kidney Replacement Therapy has increased from 698 cases in 2015 to 913 cases in 2021. Meanwhile, during the same period, the number of new cases of 15 types of cancer did not show any significant reduction.
In addition, Brunei Darussalam is also predicted to face a significant increase in the number of elderly citizens. In 2011, 5.7% of the total population in the country were aged 60 and above. This rate has doubled to 10.1% in 2021 and is expected to increase to as much as 28% in 2050. Therefore, the Ministry of Health is striving to increase awareness of health among the public, including promoting healthy aging among the elderly. However, these efforts also depend on the awareness and willingness of the public to change their lifestyles, such as practicing healthy and balanced eating habits, engaging in regular physical activity, and eliminating habits that can harm their health, such as smoking, drinking alcohol, and taking unsafe and ineffective substances such as narcotics and questionable products that can harm the body.
To ensure that the policies and programs developed are based on quality scientific findings, meet targets, and gain better understanding from the public, the Ministry of Health, in collaboration with the World Health Organization (WHO), is preparing to establish a special unit called the Behavioural Insights Unit. This unit will act as a catalyst for positive changes among the public and empower them to better manage their health.
In order to continue identifying the health needs of the people, the Ministry of Health also emphasizes the generation of data and information to determine the health status of the population.
Towards this end, the Third National Health and Nutrition Survey (NHANSS) is currently being conducted. As with previous surveys, the information obtained will provide an overview of lifestyle practices and dietary trends among the population, which is very useful in planning policies and services in the Ministry of Health so that the health services provided are tailored to the needs, appropriate, and more effective for the people in this country.
The issue of mental health among the community also needs to be addressed more deeply. In recent years, cases related to mental health or those that lead to mental health problems have been found to be increasing, resulting in loss of life, reduced productivity, and affecting the lives of the community.
Realizing the importance of mental health issues in this country and in line with the leadership of Brunei Darussalam in the ASEAN 2021 Summit on mental health issues, the Ministry of Health launched the Mental Health Action Plan 2022-2025 in November last year, which takes a "whole-of-government" approach in addition to fostering the involvement of the private sector and non-governmental organizations in jointly addressing this issue among our community.
The success of implementing the Action Plan depends on every stakeholder taking responsibility and using available resources to play their respective roles, as well as fostering national values in producing healthy, resilient, and productive individuals.
Towards this end, a new feature in the BruHealth application known as the "Health Index" was introduced in November 2022, which allows for a comprehensive assessment of health status that includes mental health aspects. Through this assessment, a health score will be generated, which aims to help the public understand the lifestyle risk factors that impact their health, including mental health. This will enable the public to take active steps to maintain their well-being and health.
The increasing healthcare expenditure, especially in the cost of purchasing medicines and providing medical equipment, is also a challenge for the Ministry of Health. This is partly due to the rise of non-communicable chronic diseases as I mentioned earlier.
One of the initiatives implemented by the Ministry of Health to address this issue is to collaborate with a GLC's company that functions as a single buyer or monopsony for all health agencies in the country, which will be able to control the prices of medicines in the local market.
In addition to these challenges, the Ministry of Health also needs to be prepared for public health threats such as pandemics, natural disasters, and chemical accidents. One action to strengthen this preparedness is to conduct an After Action Review (AAR) after the COVID-19 pandemic, which aims to examine the actions taken by all stakeholders during the pandemic to improve and enhance preparedness in the future, as well as to evaluate the effectiveness of the implementation and its impact on the welfare, socio-economy, and social development, especially for the elderly, children, and vulnerable groups.
Your Honorable Speaker and Honorable Members. The budget for the Ministry of Health in the Financial Year 2023/2024 is themed "Health is Everyone's Responsibility", in line with the national budget theme of 'Building a Prosperous Future Together'. This theme carries a very important meaning for the Ministry of Health to jointly cultivate it because it emphasizes the importance of achieving preparedness using resources obtained in a more economical and efficient manner to achieve organizational goals.
Commenting a little on the theme "Health is Everyone's Responsibility". In my opinion, I, as a responsible generation for my own health and the health of those around me, reflect a more positive future for the country. With a healthy population, future generations will be more productive and able to generate sustainable socio-economic growth for the country.
Throughout the period of our country facing the COVID-19 pandemic, which has somewhat disrupted the comfort and harmony of daily life for the people and residents of this country, the people and residents of this country have shown a responsible, caring, and cooperative attitude with the advice given by the Government. The majority of the population in this country have cooperated and complied with the Government's directives and advice to control the spread of the disease, in line with the whole of nation approach. This is what we will use as a strength that will lead to significant changes in the achievement of the country's health in the future, God willing.
Bismillahirrahmanirrahim, the supported budget for the Financial Year 2023/2024 is $418,098,270.00, an increase of 8.3% from the approved budget of the previous financial year. This increase is due to factors such as the rise in the market prices of medicines, higher treatment costs, and an increase in the number of patients requiring treatment. It is expected that these factors will continue to contribute to the increase in the budgetary needs of the Ministry of Health from year to year.
Meanwhile, as of January 2023, 95% of clinical vacancies have been identified and committed to being filled for the Financial Year 2022/2023. The filling of vacancies is for new hires and promotions. The Ministry will continue to address challenges to ensure that the filling of vacancies can be carried out in a timely manner as expected, in order to meet the needs of clinical services delivery in the Ministry of Health to the people and residents of Brunei Darussalam.
Taking into account that the Eleventh National Development Plan has been extended for another year, the Ministry of Health has identified two major projects planned in the Twelfth National Development Plan to be expedited in the Eleventh National Development Plan. These projects are the construction of a new block at the Raja Isteri Pengiran Anak Saleha Hospital and the Bru-HIMS 2.0 System project.
The construction of a new block at the Raja Isteri Pengiran Anak Saleha Hospital, which will provide an additional 500 beds, aims to provide more treatment space for expanding and developing specialized services. This is also to meet the expected increase in the number of patients, as well as to enhance readiness in handling emergency situations such as pandemics and major medical emergencies.
In addition, this project will also result in excellence in medical services through the establishment of Centers of Excellence in specific areas towards making the Raja Isteri Pengiran Anak Saleha Hospital a center of medical excellence that provides high-quality and trusted services.
The Bru-HIMS 2.0 System project aims to expand the capabilities of the Bru-HIMS system, which was first introduced in 2012. In the more than 10 years since its implementation, approximately 750,000 active medical records and 6,000 active Bru-HIMS users have been recorded, and at its age, this system certainly requires improvement and renewal. This is especially considering the increase in the number of user needs among health professionals and the rapid development of technology. These improvements will include several features such as the Intelligent Electronic Medical Record (EMR) system, Intelligent Care Plan and Clinical Pathway Recommendation, and structured data system.
With these main features, the system will be able to provide health risk assessment, predict diagnosis and personal care plans, collect structured data to improve data quality, and various other system capabilities.
Your Honorable Speaker and Honorable Members. In carrying out its roles and responsibilities, the main goal of the Ministry of Health through the 2019-2023 Strategic Plan is to achieve the following objectives:
- Excellence in Health Care Services;
- Prevention and Control of Non-Communicable Diseases;
- Public Health Protection through Effective Policies and Regulations;
- Sustainability through Resource Optimization and Innovation; and
- Transparent and Proactive Governance.
Therefore, the proposed implementation to achieve these objectives, the Ministry of Health will focus on the following 6 clusters:
Improving the quality of service delivery to the public. This includes excellent service delivery, facility improvements, building trained staff, and more innovative and effective service delivery; and
Continuously assessing whether services are better self-managed or outsourced. Among the best practices or best practices managed by clinical services under the Ministry of Health are outsourcing non-clinical services by experts in those fields who are believed to be better able to handle them and at the same time, allowing the Ministry of Health to fully focus on delivering clinical services that are core business responsibilities in this ministry.
Projects designed in the 2023/2024 Financial Year focus on 3 main cores as follows:
Introducing a standard that will be used in non-clinical services to enable appointed companies to achieve the desired quality;
Listing skilled companies and having trained staff in identified areas, which will provide opportunities for local children to be trained and generate job opportunities; and
Collaborating with local institutions, including private institutions, to jointly manage the desired programs to achieve the required skills, especially for local children.
In line with that, one of the new job scopes introduced during the year 2022-2023 is the outsourcing of porter services which has generated 208 job opportunities for locals, most of which do not require high skill training.
With the private porter service, it can accommodate the shortage of attendants needed to meet the increasing service scope in hospitals.
Regarding infrastructure improvements, ان شاء هللا with the completion of the additional block at the Perak Jubilee Health Centre in Sengkurong, medical services, especially for nearby residents, can be handled more efficiently. At the same time, with the assistance of the Department of Mosque Affairs, Ministry of Religious Affairs, the Ministry of Health has provided transportation services from Sultan Sharif Ali Mosque, Sengkurong to the Perak Jubilee Health Centre in Sengkurong to address the limited parking space in the area.
Furthermore, to improve the health screening of the population for infectious and non-infectious diseases, the Ministry of Health will continue to invest in improving the health level of the people in this country, especially in reducing premature deaths, i.e. deaths under the age of 70, due to non-communicable diseases.
In addition to premature deaths, non-communicable diseases can also result in disability, reduced productivity, and other economic and social impacts that can affect our country's planning and vision. The Ministry of Health is committed to providing quality medical services and treatment to the people in this country.
However, efforts need to be intensified in the prevention and early detection of diseases through specific screening programs. Early detection and treatment of these diseases will improve survival, maintain quality of life, and enable individuals to continue to be productive and contribute to the country's economic development.
In addition, early detection and treatment in the long term will also result in savings for the government. For example, the cost of treating early-stage cancer is an average of $20,000 per patient, compared to $100,000 per patient for second-stage cancer treatment. This means that there is a savings of approximately $5 million per year if these patients are detected earlier.
This is in line with several studies that show that for every ringgit spent on prevention programs, an average of $10 in long-term savings can be achieved.
Meanwhile, as a step forward, genomic screening methods for certain diseases have also been initiated, and in the future, the concept of current treatment using genomic banking may also be explored.
To enhance the laboratory services' capabilities with increasingly advanced and sophisticated laboratory tests, the implementation of certain specific tests such as safety tests and pollution detection on locally produced drugs and food products can help micro, small, and medium enterprises (MSMEs) generate the economy within the country and support the import/export of goods or food.
In this matter, the Ministry of Health will continue to collaborate and support efforts by relevant agencies in these industries. To enhance cooperation with the private sector through the Public-Private Partnership (PPP) method via the Fiscal Consolidation Program (FCP).
Besides helping to develop the economy in the health sector, it also supports the country's desire towards a sustainable economy. This directly contributes to increasing job opportunities for youth to enter support services in the public sector in the health field.
To improve government revenue through efficient revenue collection practices and provide access to services and treatments, the Ministry of Health always supports initiatives towards strengthening the country's economy and finances, such as facilitating digital payments at counters as one of the efficient revenue collection practices and updating payment schemes for services, taking into account current trends and inflation rates.
Towards reducing the burden of revenue collection arrears, the Ministry of Health also collaborates with several relevant agencies to research and update comprehensive medical insurance protection for foreign workers. This initiative also has added value in ensuring the health care of foreign workers in this country is guaranteed, in addition to ensuring their productivity and well-being throughout their work period in this country.
Your Honorable Speaker and Honorable Members. The Ministry of Health is committed to providing the best healthcare services for the country through excellent service delivery and ensuring smooth daily operations. This includes ensuring that the supply of medicines and medical equipment is always sufficient. Maintenance of medical equipment is carried out to ensure that the equipment is safe to use and the maintenance of health facilities is always well-managed and safe for patients, professionals, and healthcare workers.
Your Honorable Speaker and Honorable Members. Health is a shared responsibility. A healthy population will produce a prosperous country that can guarantee the well-being of all its citizens and residents.
We should be grateful for being able to enjoy a peaceful life with high-quality infrastructure and healthcare services through significant investment by His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam's Government in the health sector.
Hopefully, with our awareness of the blessings that have been given, we will be able to fulfill our responsibilities as citizens who always practice a healthy lifestyle, follow the advice of health experts, and most importantly, rely on the Sunnah of the Prophet Muhammad SAW, as in the hadith: "Verily, you have a responsibility to fulfill the rights of your body." (Hadith narrated by Al-Bukhari).
That is all that I, Kaola, would like to convey regarding the main strategies and focus for the Ministry of Health's expenditure for the year 2023/2024 and achievements for the year 2022/2023 as an introduction.
I am pleased to express my sincere thanks to Your Honorable Speaker for this opportunity.
Before I conclude, please allow me to end my introduction with a poem: -
Even if the clouds cover the sun, The sun still shines, Let's exercise every day, So that our health is always maintained.
Go to the sea during the rain, Anchor the boat carefully, Reduce sweet food intake, Choose fruits and vegetables instead.
The fourth child is called "utih", While his younger brother is called "uda", Practice drinking plain water, Avoid those that are sweet and carbonated.
Your Honorable Speaker
"Assalamualaikum warahmatullahi wabarakatuh. With Allah's guidance and blessings, we express our highest gratitude to the Honorable Minister of Health for the clear, thorough, and organized presentation of the Ministry of Health's budget allocation, which I believe will attract relevant parties for further discussion."
Your Honorable Members. To allow us to examine what was presented by the Honorable Minister of Health regarding the direction of his ministry's budget. And upon the request of many, I will adjourn this Committee Meeting for 20 minutes to allow us to rest.
(Committee Meeting takes a short break) (Committee Meeting resumes)
Your Honorable Speaker
بسم هللا الرحمن الرحيمYour Honorable Members. The Committee Meeting resumes after our break to consider and continue to discuss the Bill (2023), Supply 2023/2024 item by item.
Earlier, before this Committee Meeting was adjourned, the Honorable Minister of Health presented his introduction which was quite clear in preparing the budget for the Ministry of Health for the Financial Year 2023/2024.
Before that, I was also informed that the Honorable Minister of Primary Resources and Tourism would like to request permission to make a statement to answer the questions of the Honorable Appointed Member that he was unable to answer yesterday afternoon.
So now, I invite the Honorable Minister of Primary Resources and Tourism.
Your Honorable Minister of Primary Resources and Tourism
Thank you, Your Honorable Speaker. ُالرحْ يم السَّال ُم عل ْي ُك ْم ورحْ مةُ هللاِ وبركاتُه َّ الرحْ َٰم ِن َّ ّٰللا ِ ِبس ِْم ه As a response to the matters raised yesterday by the Honorable Pengiran Haji Isa bin Pengiran Haji Aliuddin during the Nineteenth Session of the Ninth National Council Meeting on Monday, 27th Sha'ban 1444H corresponding to 20th March 2023M during the discussion to consider the Topics under the Ministry of Development.
The Ministry of Primary Resources and Tourism welcomes the concerns and proposals of the Honorable Pengiran. Regarding the problems faced by farmers, plantation owners, and local farmers regarding the requirements for providing worker housing, parking, greenhouse construction, and so on on agricultural land. أ ْلح ْمدُ ِ هلِل, continuous efforts are being made together with relevant agencies including ABCi.
As stated this morning by the Honorable Minister of Development, the Department of Agriculture and Agrifood has received blanket approval from ABCi to grant approval and support for any application to develop seedling houses or protected houses, namely greenhouses, including basic facilities on KKP land on September 13, 2021M without referring back to ABCi. This includes the supply of electricity and water for the greenhouse.
Thank you, Your Honorable Speaker. Construction work for a single-story building used for agriculture such as a farm house is included in the list of insignificant building works under the Building Control (Amendment) Regulation, 2018. The authorities do not need to submit an application to ABCi for building structure inspection.
However, the company must appoint a qualified registered professional engineer in the Ministry of Development to manage applications to relevant agencies such as the Department of Electrical Services and the Department of Water Services (JKR) to assess their needs to ensure that the supply of domestic electricity and water from nearby sources is sufficient and does not affect the use of the public.
Other calculations categorized as significant buildings such as worker accommodation, offices, and barns still require approval and support from ABCi.
In this regard, abiskaola through the Department of Agriculture and Agribusiness has prepared several repair proposals that are being and will be implemented.
This matter will be further discussed with ABCi in an effort to expedite the opening and setting up of modern farming at reasonable costs and not overly burdening farmers.
At the same time, ensuring that any construction on agricultural land meets health, safety, and environmental standards.
ان شاء هللا if there is already a conclusion regarding this negotiation, it will be disseminated to entrepreneurs, farmers, and breeders. Thank you, Your Honorable Speaker.
Your Honorable Speaker
Thank you, Your Honorable Minister of Primary Resources and Tourism. Honorable Members, now we will begin discussing the topic of the Ministry of Health. With me here, there is a list of Appointed Honorable Members who would like to participate in discussing the Ministry of Health budget. This list is quite long.
I now invite Your Honorable Haji Awang Sulaiman bin Haji Nasir.
Your Honorable Haji Awang Sulaiman bin Haji Nasir
Thank you, Your Honorable Speaker. بسم هللا الرحمن الرحيم السالم عليكم ورحمة هللا وبركاته and greetings. أ ْلح ْمدُ ِ هلِل first of all, I would like to congratulate Your Honorable Minister of Health on the introduction to the Ministry of Health's plan towards managing the Supply (2023) Bill, (2023/2024). Hopefully, whatever is planned will achieve the desired goals, ان شاء هللا. In this House, I also want to respond to the pantun from Your Honorable Minister of Health earlier: -
Drinking water as a beverage, Healthy fruits as a dish, Allow me to suggest, May the people listen to this discussion.
Your Honorable Speaker and Honorable Members. Kaola would like to touch on the matter of Pengiran Isteri Hajah Mariam Hospital, Temburong District, towards providing inclusive services.
Kaola brings the voice of the public, especially the people of Temburong, who request that circumcision clinic services continue to be provided at the hospital. Currently, the public, especially those living in Temburong, have to go to RIPAS Hospital and private clinics in Bandar Seri Begawan to obtain these services.
In this regard, I humbly request the kindness and consideration of the Ministry of Health to provide circumcision clinic services at Pengiran Isteri Hajah Mariam Hospital, Temburong District, to provide convenience to the residents of Temburong. I seek clarification from Your Honorable Minister of Health.
Thank you. Peace be upon you and the mercy and blessings of Allah. May Allah grant us success and guidance.
Your Honorable Minister of Health
Thank you, Your Honorable Speaker and thank you, Your Honorable. In our country, circumcision services are indeed a priority. Due to COVID-19, these services were suspended for two to three years, resulting in a waiting list of over 1000 people.
The health services, especially the Surgical Department, have worked out procedures to ensure that those who are waiting are given dates, and some have undergone circumcision with the cooperation of the Ministry of Education, which allows them to undergo circumcision while in school.
InshaAllah, circumcision services for residents in Temburong will be resumed in the future. It was suspended due to COVID-19. Thank you.
Your Honorable Speaker
Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin.
Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin
Thank you, Your Honorable Speaker. In reference to the Basic Health Care Code.
Kaola would like to discuss the matter of senior citizens. It is understood that during the previous discussion session with the Ministry of Health, Kaola took note of the increasing number of senior citizens in the country. This was also mentioned by Your Honorable Minister of Health in the brief introduction earlier.
Kaola understands that there is the establishment of Senior Citizen Activity Centers as well as the provision of home-based nurse services who come to homes to assist senior citizens, such as taking blood samples and so on. Islam obliges children to take care of their parents, and it is not our culture to place parents in nursing homes.
Therefore, it is important to educate the general public, especially family members who take care of the elderly (family care), with specific knowledge and skills related to elderly care. It is also important for family care to be aware of and able to handle the emotional and psychological effects of being a caregiver for the elderly, which is not an easy task.
Therefore, I would like to propose an increase in the number and skills of home-based nurses to educate and facilitate family members with knowledge and skills in elderly care. These home-based nurses should also be trained and knowledgeable in physiotherapy. They are also recommended to manage programs and courses that are affordable for family members who will become caregivers at health centers and Elderly Activity Centers.
Involving youth in planning activities at Elderly Activity Centers in partnership with the Ministry of Culture, Youth and Sports. Establishing a volunteer group consisting of youth to care for caregivers, especially for the elderly who do not have family members.
The government also provides loans for equipment such as beds, electro-medical beds, wheelchairs, and so on. There are also our people who donate these equipment for public use. However, it is understood that these equipment are in very limited condition.
Therefore, I suggest that the Ministry of Health regulate affordable prices for this equipment to avoid burdening the elderly and their families.
Regarding mental health, referring to the previous discussion with the Ministry of Health, I am aware of the increasing cases of suicide related to mental health in Brunei Darussalam. According to the World Health Organization, in 2019, the suicide rate in Brunei Darussalam was 2.7% per 100,000 people. This issue is very concerning and I believe it needs to be addressed immediately.
Addressing mental health is not easy because there are some people who believe that mental health is related to a person's unconsciousness or insanity.
The Ministry of Health has made efforts to address this issue, including providing a helpline, 145, for individuals experiencing mental health issues to share any problems they are facing.
The Ministry of Health has provided a comprehensive Mental Health Strategic Planning and existing services such as Clinical Psychology Services, Community Psychology, Psychiatric Services in all four districts, and Mental Health Strategy Unit at the Health Promotion Centre.
One suggestion I have is that, in my opinion, the names of these services, especially psychiatric services, carry negative connotations towards mental health. I suggest that these names be changed to a more positive and proactive approach towards mental health.
For example, by changing the names of these services to Mental Wellness Centre or Mental Health Clinic. This name change will bring about (semi-log changes) and reduce stigma towards individuals facing mental health issues such as those who are not conscious or mentally ill. It is understood that many countries are taking steps to eliminate stigma regarding mental health issues and also promote awareness and support for mental well-being.
For example, in Canada, the Bell Let's Talk campaign promotes awareness of mental health, acceptance, and action built on 4 main pillars to combat stigma, improve access to mental health care, support world-class research, and set an example of best practices in mental health in the workplace.
In addition, having a mental wellness clinic known as a wellness centre. While in the United Kingdom, the time to change campaign aims to end discrimination and stigma against mental health. Perhaps 'kitani' can hold the same campaign with its own theme, for example, time to listen.
In this regard, as an effort to encourage the public to express their problems in a relaxed and open manner regarding well-being and mental health issues, I suggest establishing a peer support group.
The purpose of this peer support group is to allow individuals to openly voice the problems they are facing or have faced. This session should be facilitated by certified counseling officers. As a start, this peer support group is recommended to be initiated in secondary schools and higher education institutions.
Thank you, Your Honorable Speaker.
Your Honorable Menteri Kesihatan
Thank you, Your Honorable Speaker and also thank you to the previous speaker for the questions and suggestions raised.
Allow me to respond specifically on homebased nursing and the elderly. The Ministry of Health works closely with the Ministry of Culture, Youth and Sports, especially in managing Elderly Health Centers such as in Tutong and Lambak to ensure that they remain active among their peers, gather and engage in activities together.
Homebased nursing is actually slightly different. Homebased nursing is a care service for anyone in need, not just the elderly.
If there are young people who experience stroke or trauma after an accident and require treatment, they are also provided by homebased nursing. However, as suggested by the previous speaker, the role of homebased nursing is not just to take blood and provide medication.
They are also there as an advocate for good prevention methods for the person being cared for and to review or assess the person being cared for to make sure they are not burnt out or feel isolated by being cared for the whole time. However, this service is limited due to the limited number of nurses. In other districts, this service cannot be provided everywhere except in cities and also in Kuala Belait.
Meanwhile, in Temburong and Tutong districts, it is very limited and this is acknowledged and God willing, with the addition of more nurses in the future, homebased nursing can help hospitals in terms of acute bed problems. Because if someone has experienced, for example, a stroke and medically cannot be treated anymore, the person's care is limited and if the patient's family does not bring the patient back home, the patient ends up in the hospital for months or even years.
Therefore, it is in everyone's interest to ensure that the patient does not stay in the hospital for a long time because there are still risks of infection and other problems in the hospital. This will harm the patient, especially stroke patients who stay in the hospital for a long time.
This is where, as the previous speaker mentioned, our religion emphasizes the importance of children taking care of their parents. It is not our culture to send them here and there to be cared for by other people or in elderly homes.
Here, the Ministry of Health highly acknowledges what Your Honorable has raised earlier regarding the importance of taking care of sick children or siblings, especially their mothers. Before the patient is discharged, the Physiotherapy and Occupational Therapy team will usually visit the patient's home first to assess whether the patient is suitable to return home or not.
If there is any unsuitability, such as the toilet requiring special arrangements to prevent falls or a wheelchair is needed, and the family cannot afford it, the Occupational Therapist and Physiotherapist will refer the matter to the Medical Social Worker at the Ministry of Health.
This Medical Social Worker will interview the patient's family and assess whether they are capable of providing additional needs such as a wheelchair or toilet modifications.
If they are unable to afford it, the Medical Social Worker will assist the patient through JAPEM, MUIB, or other funds. Sometimes, there are funds available in the hospital, and if other organizations such as JAPEM, Yayasan, or MUIB cannot help, the hospital will provide funds specifically for the patient to purchase a wheelchair or other necessary items.
Therefore, the public need not worry, as the government is very concerned about the welfare of these patients, and with the recent SKN, Your Honorable and others may know that caregivers are given an allowance to take care of their elderly parents or anyone they are taking care of.
That is in terms of home-based nursing needs, as mentioned by Kaola earlier, Your Honorable's suggestion regarding the addition of nurses for home-based nursing is well received, and perhaps a more holistic approach to training as well.
Regarding Physiotherapists, there are also home-based services available, but the shortage of Allied Health Professionals makes it difficult for them to meet all the needs throughout the country. InshaAllah, with an increase in the number of Allied Health Nursing professionals, better services can be provided.
In terms of mental health, it is acknowledged that the data shows an increase in the number of suicides in recent years. That is why we established the Helpline 145 in 2019, and Alhamdulillah, starting from March 1st this year, it has been operating 24 hours a day.
It cannot be denied that the stigma still exists, so the Ministry of Health, especially through the Health Promotion Centre and the Psychiatry Department, is striving in its Strategic Plan to encourage the public to not stigmatize mental health.
It should be considered like any other disease such as diabetes or heart disease. It should not differentiate between a patient with depression or diabetes. It should not discriminate against anyone, especially in the workplace. In addition, the Ministry of Health is working closely with the Ministry of Education, as previously mentioned, regarding mental health issues not just among students but also among teachers to facilitate referrals, confidentiality, and access to care. Several efforts have been made to facilitate not only referrals, access, and confidentiality of the patient.
Regarding the suggestion to change the name of psychiatry, it will be considered, God willing. However, if we change the name, there may still be stigma. So, we need to find a balance. What we want is for people diagnosed with depression or bipolar disorder to not be discriminated against. That is the main goal. However, its suitability will be considered, and sometimes there is input from patients if they want it, then God willing, it will be implemented.
As for peer support groups, they are very important, as seen in other countries. Several best practices from other countries, especially Korea and other Western countries, on how they handle mental health issues, such as reducing suicide rates, are being studied by relevant agencies to align with a whole-of-government and whole-of-nation approach.
Regarding NGOs, the Health Promotion Centre recently brought in many partners, including The Brunei Red Crescent, which is one of the arms of the Ministry of Health in helping to address mental health issues.
However, the goals or training need to be aligned with the Ministry of Health and the psychology department, among others. In terms of schools, as previously mentioned, the Ministry of Health and the Ministry of Education are exploring several methods to facilitate students or teachers in seeking mental health advice, how to make it easier, and reduce stigma.
That is all, Your Honorable Chairperson. Thank you.
Your Honorable Speaker
I would like to invite Your Honorable Minister of Foreign Affairs II.
Your Honorable Minister of Foreign Affairs II
Thank you, Your Honorable Speaker. To add on to what Your Honorable Minister of Health mentioned earlier regarding the issue of Mental Health.
I would like to mention that in 2021, Brunei Darussalam as the ASEAN Chair initiated a regional effort to address the issue of mental health, as COVID-19 has caused a rise in mental health issues among the people and residents of ASEAN.
However, Australia as a friendly country has also provided bilateral assistance to Brunei Darussalam in terms of cooperation to enhance knowledge and expertise in addressing mental health issues, not only in terms of suicidal needs and actions, but also in terms of anxiety and various levels of mental health that need to be addressed.
As mentioned earlier by Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin, this issue requires in-depth understanding and peer expertise to address it together. Therefore, opportunities to enhance cooperation and expertise can also be pursued through bilateral relations with friendly countries.
Thank you, Your Honorable Speaker.
Your Honorable Speaker
Thank you. I would like to invite Your Honorable Pehin Orang Kaya Laila Setia Dato Seri Setia Awang Haji Abdul Rahman bin Haji Ibrahim.
Your Honorable Pehin Orang Kaya Laila Setia Dato Seri Setia Awang Haji Abdul Rahman bin Haji Ibrahim
Thank you, Your Honorable Speaker. Bismillahirrahmanirrahim.
Your Honorable Speaker and Honorable Members. Assalamualaikum warahmatullahi wabarakatuh and greetings. Thank you also to Your Honorable Minister of Health for sharing the clear, comprehensive, and detailed focus that will be implemented in the Financial Year 2023/2024.
Alhamdulillah, it seems that there are many initiatives from the Ministry of Health that have been, are being, and will be implemented, for which I would like to congratulate and commend Your Honorable Minister of Health for the initiatives and achievements mentioned.
However, there are a few things that I would like to share, perhaps for enlightenment or suggestions. Your Honorable Speaker, for the record, I would like to express my highest gratitude, congratulations, and appreciation to the presence of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam for the continuous efforts of His Majesty's government through the Ministry of Health, together with other agencies in the government, especially all members of the Ministry of Health, frontliners, volunteers, and all those involved who have worked tirelessly to safeguard the interests and health of the people and residents of this country during the pandemic.
Your Honorable Speaker, the second matter that I would like to bring up is regarding the budget of the Ministry of Health for the Financial Year 2023/2024, where I have noticed an increase of approximately B$30 million. The largest increase is from Sub-Head 005007-Health Information and Data Management System, which has increased from $8.4 million to $26.3 million, an increase of almost $18 million.
I would like to seek clarification on the following questions:
What is the information system that will be implemented? Is it a new system? If it is a new system, what will happen to the old system? I hope that this system will also include continuous change management aspects for those involved in managing and using the system; and
The second largest increase is in Sub-Head Secondary and Tertiary Health Care, which has increased by almost $10 million from $209 million to $220 million. The largest increase is in Sub-Head 004/005 RIPAS Hospital Services, which has increased by almost $5 million. Meanwhile, Renal Services have increased by approximately $1.6 million and Suri Seri Begawan Hospital, Kuala Belait services have increased by approximately $1.3 million.
I support this increase as it will improve the comfort of patients in these hospitals. I hope that the implementation of upgrading and improvement of these facilities will be carried out as soon as possible so that the concerns raised by the public can be addressed perfectly.
As Your Honorable is aware, the allocation for the purchase of medicines has been increasing from year to year. In the Financial Year 2022/2023, it amounted to $60.2 million and in the Financial Year 2023/2024, it has increased by approximately $0.5 million.
This is understood due to the ageing population and affluent lifestyle of the people in this country. Perhaps at this time, we are still able to provide this service comprehensively in line with the policy of providing free medical services to all citizens in this country.
For the future, it may pose a significant challenge to the Ministry of Health. The Honorable Minister has already explained several steps to reduce this expenditure. However, I still believe that a comprehensive study is needed to reduce the overall expenditure on the purchase of medicines.
This includes awareness campaigns, direct outsourcing, strengthening inventory systems to avoid the disposal of expired medicines, and clear explanations of the expenses involved in the purchase of medicines to the public, among others.
Your Honorable, finally, please take note that in the budget allocation under the control of the Treasury Department, the amount paid by the government for JPMC medical services is set at $30 million per year.
In my experience working for several years in the Ministry of Finance, this amount actually increases every year, requiring the government to increase this allocation from time to time.
Therefore, I would like clarification on whether a study has been conducted to examine the more competitive rates charged by the institution to patients referred to the medical center? This matter needs to be carefully examined as a step to save government spending so that it is more affordable and sustainable.
In the meantime, as a step to make this specialist medical center more competitive, what are the steps that can be taken to attract more foreign patients to the country so that it can at least reduce the overall cost of providing services?
Thank you, Your Honorable Speaker.
Honorable Minister of Health
Thank you, Your Honorable Speaker. So, in general, Kaola stated that the improvement in the IT system is due to the improvement, where $18 million is mainly for BruHealth. There are two major IT systems in the Ministry of Health, one is BruHIMS. Bru-HIMS is a medical record system. BruHealth is software that extracts data from Bru-HIMS.
So BruHealth is what we see on our phones. Bru-HIMS is the actual medical record, which we cannot see on our phones. So BruHealth, as we know, was initially used for contact tracing during the pandemic and for monitoring restrictions at that time, so we had green, red, purple codes, and also vaccination records or certificates.
So with the transition to endemicity with what is in BruHealth, with the achievement of population usage being very impressive, almost 90% of the population of Brunei Darussalam registered with BruHealth.
So with the good outcome from the pandemic, BruHealth was expanded to improve the health service system throughout the country, with the aim of empowering everyone, providing better knowledge about their own health, in terms of medication, allergies, x-rays, results, appointments, and teleconsultations.
So with this, it requires additional spending, and in terms of tertiary use, BruHealth is a big data research platform for phase 3 and also for data registries, especially for heart problems, diabetes, and cancer.
And as I mentioned in the introduction, it is a platform for the Health Index, where every individual can measure their health index and to strengthen early disease detection through the National Health Program, and there will also be a Diabetes Management App and Queue Management System. These phases 2 and 3 are all encompassed in the $80 million budget.
With BruHealth, Insha'Allah, the Ministry of Health can plan through the Artificial Intelligence behind it to predict the future health status of the country in 15 to 20 years. From there, we can make preparations, for example, if diabetes is predicted to increase and more people will unfortunately have their legs amputated, we need to prepare in terms of prosthetics, rehabilitation, and so on.
And these preparations take time, in terms of the availability of staff, buildings, and so on. So it's not just a simple software. It's the AI (Artificial Intelligence) behind it that will provide input to the Ministry of Health in its future preparations.
And as I mentioned earlier, the registry is important. With this registry, we will know the actual number of people with cancer. Currently, this data is scattered in different places, in other pathology systems, in Bru-HIMS, so with this disease registry data, we will have a better understanding of the condition of a particular disease and how we can deliver services and make improvements.
Regarding the cost savings I mentioned in the introduction, the emphasis here is on early detection, especially for non-communicable diseases, especially cancer. With the advancement of knowledge and technology, we can control or detect it earlier through genomic sequencing.
For example, a young patient with breast cancer at the age of 30, where usually this cancer occurs in people aged 50 and above. If the patient gives permission for their cancer to be genetically sequenced, we will look for genes that cause cancer, and if we find a genetic sequence that is related to, for example, breast cancer, the patient's family will also be called to check their genetic sequence.
If there is a similar genetic sequence even though there are no symptoms or signs of cancer at that time, the family will undergo more frequent early screening. They will undergo regular breast screening, and from there we can detect it earlier.
And when cancer is detected at Stage I with a survivability rate of more than 90% for most cancers, compared to Stage IV where the 5-year survival rate is only 10%. And even if Stage III or IV is present, the treatment is a bit expensive if it requires surgery and intensive care, radiotherapy, chemotherapy, and on average costs $200,000.00 per year. If it is detected early, for example, if there is only Stage I, the cost of surgery is only $5,000.00 and that's it, there is no need for any further treatment. Stage I, if it has a clear margin, is cured.
Therefore, the Ministry of Health wants to emphasize the importance of early screening not only to improve survivability but also in terms of future costs because we want our children to be able to receive healthcare like this where all citizens of this country can receive free treatment for anything.
Not many in this world have the privilege that we have, so we are grateful to Allah and with the leadership of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam, we can enjoy this privilege.
That is also in terms of overall expenditure due to the increase in non-communicable diseases. More people are admitted to the hospital, so the expenditure will increase from year to year.
This has been the case in recent years because of COVID-19, where early screening has not been going smoothly. With this, the Ministry of Health will strive harder to ensure that this screening is well-received by the public. Even though it exists, if the public does not participate, it will be difficult. So, educating the public is another priority of the Ministry of Health.
The expenditure at RIPAS will also include several improvements, especially the operating room which will be improved, improving breast screening with examinations conducted there as well, and improvements and modifications to several wards such as Ward 5, Ward 25, Ward 15, and adding an ICU.
Ward 10 will be modified to become an additional ICU as a new ICU. The Orthopedic Department will also be modified to provide comfort to the public. The additional modifications at RIPAS are infrastructure modifications.
Another major expense is the PABX. The public may call and not get an answer, but it is not that there is no answer, but the PABX is broken. Various methods have been tried to fix it but have not been successful, so we are going to replace it. We have spent so much money on trying to fix it but it has not been successful, so we are going to spend properly on a new PABX system and hope that this will provide better service to the public. Regarding medications. One of the cost-saving measures or reduction of medication expenses as mentioned in the earlier statement is that we engaged with a local GLC's that can collect more volume of medicine, as at the end of the day it's all about the volume. If the volume is high, then it becomes cheaper.
So with these GLC's, they can combine the amount of medicine from the Ministry of Health and private parties.
With a larger volume, it will be able to reduce expenses. Alhamdulillah, even though it's only in 50% of all the procurement they made, savings have been seen in terms of expenses.
However, it will be monitored because the current geopolitical situation has caused many medicines and healthcare-related items to increase in cost. Therefore, its effectiveness will be further evaluated.
Another way to save costs is by educating the public. Not everyone, but some people are given medicine but do not take it. Some are given medicine for a month, and the following week they come back and report that the medicine is lost. If someone has heart disease, diabetes, or high cholesterol, it costs about $2,000.00 for one person.
If we go to the clinic and report that our medicine is lost for that month, that's $2,000.00. That is one of the efforts of the Ministry of Health, to educate the public about the importance of taking medicine and appreciating the government's expenses to ensure their well-being.
Therefore, they really need to appreciate it because it is not cheap, the cost of healthcare will never decrease but will always increase.
Due to the demand and supply between the central supply or patients, or even worse, if the patient is given 6 months of medication and a month later reports that the medicine is lost, that's 5 months of supply lost.
And that is why medication is not given for 6 months unless there are certain circumstances such as someone who wants to travel. Therefore, at this time, it is only given for a month. To reduce this wastage, as mentioned earlier, we go for the GLC's which collect volume for the ministry and private parties.
Secondly, educating the public about the importance of taking medicine properly and taking care of it, making sure it is not lost, and so on.
Thirdly, effective management of procurement and storage to avoid wastage. Therefore, the central procurement team must be able to weigh the need for it. Looking at the system, if they order a little and suddenly there is a shortage of needed medications, but if they order a lot and there are fewer illnesses, it will result in excess medications that are already available.
This is what needs to be improved and أ ْلح ْمدُ ِ هلِل with Bru-HIMS, it will not only facilitate but also monitor better because with 2.0 from 1.2, it is another full system. The storage material management team can monitor better and make better provisions to ensure that the medicine is always available.
Regarding JPMC, it is not JPM, it is Gleneagles JPMC. Jerudong Park Medical Centre (JPMC) is a private entity that the government does not finance. Gleneagles JPMC is a different entity, a private limited company, where our cardiac center is located. It is acknowledged that the budget of 30 million is just an estimate, and we are not sure how many people will come. Usually, it will increase. The Ministry of Health has to request from the Ministry of Finance and Economy if there is a need. It is acknowledged that 30 million in the next 2-3 years is not enough, it will reach 40 million and above.
Regarding competitiveness, it is still a matter of volume of scale. For example, if we buy 100,000 units of medicine at $20.00, but if we buy one million, it will be cheaper. If the product here, for example, Plevex medicine, is $3, it will become expensive if it is 30 cents. Volume or scale is different. There are 1 billion people there and here we only need 150. Some distributors do not want to negotiate due to the small volume.
Therefore, to control prices in terms of health security and to ensure that medicines are always sufficient, negotiations are also made with neighboring countries where we can share or piggyback on procurement. But it is not that easy, there are many medical legal issues. Discussions have been made and ان شاء هللا hopefully, it will bring results.
Where we can piggyback in countries with a large quantity and the price can be reduced. But as Kaola mentioned earlier, there are many medical legal applications and it is not that easy. And another reason why we have difficulty in making tourism is that before this, it was also difficult for the people to accommodate due to insufficient beds and so on. That also needs to be considered and ان شاء هللاwith the addition of new blocks, maybe with the expertise we have now, we can start gradually, but it is not a must. We highlight what we have here and what other services we can offer. For example, in terms of the Cardiac Centre, we are on par with developed countries. So, we are very proud of that.
The price cannot reach or compete with some countries in the region where the exchange rate is quite challenging. Although it is a challenge, it is not impossible. ان شاء هللا with the cooperation of our stakeholders, we can move forward with this medical tourism.
Thank you, Your Honorable Speaker.
Your Honorable Speaker
Thank you, Your Honorable Minister of Health. I now invite Your Honorable Awang Abdul Aziz Bin Haji Hamdan.
Your Honorable Awang Abdul Aziz bin Haji Hamdan
Thank you, Your Honorable Speaker. In the name of Allah, the Most Gracious, the Most Merciful.
Praise be to Allah. I would like to congratulate and express my gratitude for the opening remarks made by Your Honorable Minister of Health regarding efforts to ensure the health and well-being of the people remain a priority. May everything be carried out perfectly, God willing.
I am pleased to speak about the Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital in Tutong District. The aim is to provide exclusive healthcare services to the community. I have received several complaints from the public regarding the lack of maternity services. The public has to go to RIPAS Hospital to obtain such services.
In this regard, I would like to know why the service is still not available at the hospital? And what are the short-term plans to provide maternity services, especially normal delivery services?
Secondly, I understand that the Ministry of Health has previously established a Board of Visitors in hospitals throughout Brunei Darussalam. I would like clarification from Your Honorable Minister on the status of the Board of Visitors. Thank you.
Your Honorable Minister of Health
Thank you, Your Honorable Speaker. Thank you, Your Honorable. The problem at the Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital has been known for a long time. Previously, the service was available but it has been discontinued. Discontinuing it is easy, but reinstating it is difficult.
For maternity services, it not only requires midwives but also Obstetricians and Pediatricians. When a baby is born, if there is a problem, there must be a pediatrician who can assess whether the baby is safe or has a problem. And it also requires an Anesthetist.
So when a woman gives birth, if there is a problem, she needs to be put to sleep and requires an anesthetist, and in case of an emergency, a pediatrician and Neonatal Intensive Care Facility are needed. It may seem easy to provide the service, but for the safety of the mother and the newborn, we must provide all four (the whole environment).
Your Honorable, a midwife specialist must be available 24 hours, and a neonatal specialist must also be available 24 hours to be prepared. Even if it's not a specialist, having a general practitioner and access to a Neonatal Intensive Care Facility is good enough. Before the pandemic, interviews and advertisements were made with the help of JPA and SPA. It's challenging to attract people to come to Brunei. With the current scheme, it's quite challenging compared not only to our country but also to neighboring countries that offer higher packages and even citizenship. That's our current competition. We don't want mediocre doctors. We want good, credible doctors because it's a 40-minute drive from RIPAS, where all the main specialists are located. So, if anything happens, the patient must be rushed there.
For now, unless, for example, a patient is giving birth for the fourth or fifth time and has been informed by the clinic that it's a simple delivery, it can be done at the Tutong Hospital because there is a midwife there. The midwife is there just in case anything happens. If the patient's condition is okay, and if anything happens, the midwife will take the patient to RIPAS Hospital.
The Ministry of Health has been planning to restart this delivery service for the past 4 to 5 years. However, as mentioned, the challenge is the workforce. Nevertheless, the clinic has recently started, and this year alone, there are statistics that I can share. In 3 months, there were quite a few transfers, 87, 29 gynecological cases, and 58 obstetrics cases.
From the ministry's perspective, to be honest, we don't like these transfers because they are risky. We don't know what will happen. Efforts are being made to address this issue. The statistics show that there is a need for this service, and we are working on it. We hope that the people of Tutong District don't feel neglected or isolated, but we are making an effort.
Even in the private sector, just to share, at JPMC itself, where we can offer a better package for doctors, it's been difficult for the past few years. Obstetrics is a bit challenging. It involves taking care of two lives, the mother and the child. The good ones, if they are taken from the neighboring countries, the private doctors there earn quite a lot, and we cannot compete with their salary.
Regarding the Visitor Board, it's usually present, but due to the COVID-19 pandemic, it will be resumed because the Visitor Board is a crucial partner for hospitals. They provide feedback and suggestions on how we can provide better services to the public.
"In sha Allah", in the near future, Visitor Boards for hospitals will be reappointed, including the board for the Psychiatric Unit. Mental health services also have their own special Visitor Board. That's all, thank you.
Your Honorable Speaker
I think that's all for now, Honorable Members. We have discussed the topic of the Ministry of Health up to this point.
I would like to propose that we adjourn this Committee Meeting for now and reconvene in the National Assembly Meeting.
(Committee Meeting adjourned)
(National Assembly Meeting reconvened)
Your Honorable Speaker
Honorable Members. Now we reconvene in the National Assembly Meeting. I would like to adjourn this meeting to allow us to take a break at noon. "In sha Allah" we will reconvene this afternoon starting at 2.30 pm as usual.
That's all,
"Assalamualaikum warahmatullahi wabarakatuh."
ADJOURNED
(Meeting adjourned)
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