DAY 15 AFTERNOON
22ND MARCH 2023 - AFTERNOON
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(The Council Meeting resumed at 2.30 pm)
Your Honorable Speaker
Peace be upon you and may the mercy of Allah and His blessings be upon you. In the name of Allah, the Most Merciful, the Most Compassionate.
Honorable Members of Parliament. The National Assembly meeting resumes where we are still discussing the Supply Bill (2023) for the year 2023/2024.
Therefore, to enable us to continue discussing and examining the next topics in this Bill, I propose that we 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 Chairman
Assalamualaikum Warahmatullahi Wabarakatuh and good afternoon to all honorable members. Today, we continue our discussion on the Supply Bill (2023) for the year 2023/2024.
I suggest that we postpone the National Assembly meeting and continue the discussion at the Committee level to enable us to examine the topics in the Supply Bill thoroughly.
As for this morning, the Committee has completed the discussion and approval of the Ministry of Culture, Youth and Sports. Before I give the floor to Your Honorable Minister of Culture, Youth and Sports to answer the questions raised by the appointed members this morning, which have not been answered yet, I believe it is more appropriate for us to complete the discussion on the Ministry of Health budget first, which we started yesterday.
We have heard the introduction presented by Your Honorable Minister of Health, and we have also started discussing it by inviting some of the appointed members to question Your Honorable Minister of Health.
Therefore, I think it is more appropriate for us to continue the discussion on the Ministry of Health budget first. Later, I will give the opportunity to Your Honorable Minister of Culture, Youth and Sports to provide further information at a later time.
Together with me here, we still have a list of appointed members who would like to discuss the Ministry of Health budget.
I now begin this discussion by inviting Your Honorable Dayang Hajah Safiah binti Sheikh Haji Abd Salam to speak. Please proceed, Your Honorable.
Your Honorable Dayang Hajah Safiah binti Sheikh Haji Abd Salam
In the name of Allah, the Most Gracious, the Most Merciful. Thank you, Your Honorable Speaker.
Your Honorable Speaker and Honorable Members. Assalamualaikum warahmatullahi wabarakatuh and greetings. Regarding the discussion on the Ministry of Health, I have two topics to address, namely:
Referring to Topic SM01A Code 003 - Basic Health Care. Regarding this topic, I would like to ask the Honorable Minister of Health if there are any plans to reassess basic health services such as dental care and blood sampling, and to extend the operating hours beyond office hours or on public holidays at health clinics in the country, taking into account the issue of congestion at health centers that have become a burden to the people who need these services.
I would like to bring up an example of dental services that are focused at the Jubli Perak Sengkurong Health Center for its surrounding areas. This issue was brought to my attention where for patients who do not have prior appointments but need to see a dental doctor for certain reasons, they have to come repeatedly for several days just to get a queue number due to limited slots.
It was also shared with me that even those who come at 6.30 in the morning, the queue numbers have already run out and they are advised to come even earlier. I believe that congestion like this is also experienced at other health centers. I would like to seek clarification from the Honorable Minister of Health if there are any plans as suggested earlier.
Regarding Topic SM01A, Code 004 - Renal Services under the Secondary Health Program and Topic Code 006 - Health Promotion and Prevention of Non-Communicable Diseases.
Your Honorable Speaker and Honorable Members. The presentation by the Honorable Minister of Health yesterday was very interesting, especially regarding the continuous increase in non-communicable chronic diseases including kidney disease, which is worrying despite active disease control efforts implemented by the Ministry of Health through various programs and activities.
My question is, has the effectiveness of these non-communicable disease control programs and initiatives been evaluated, and have other causes that contribute to the alarming increase in these diseases been identified? Regarding the treatment of kidney disease.
Your Honorable, Kaola has two questions to ask:
How has the reception and response been from patients regarding the peritoneal dialysis treatment that is being carried out at their own homes since its introduction?
Are kidney patients in this country ready to undergo kidney transplant treatment, and what are the challenges faced during this treatment?
In addition, Kaola would like to propose suggestions for the Ministry of Health to review and improve existing initiatives in controlling and preventing chronic non-communicable diseases.
It is proposed that every citizen and resident in this country must undergo health screening in a national health screening program after reaching a certain age. This is not based on individual registration, but rather it is mandatory for every citizen to undergo health screening at least once a year or periodically at appropriate intervals.
In this regard, the Bruhealth application can be utilized as a reminder for every user, i.e. citizens and residents in this country, to undergo the screening test by emphasizing the importance of maintaining personal health and the benefits of early disease detection.
Early detection of chronic non-communicable diseases has also been widely practiced in countries such as the United Kingdom, which provides a national screening program for various types of non-communicable diseases.
Furthermore, Kaola suggests expanding healthcare services to homes to help manage and care for patients who are at home by improving services such as home-based nursing, palliative care at home, as practiced in countries such as Malaysia and the United Kingdom. And improving the services of social workers.
In an effort to address the shortage of professional staff and personnel, Kaola notes the shortage of professionals and staff as described by the Honorable Minister of Health yesterday.
However, in this regard, Kaola suggests that the Ministry of Health collaborate with the Ministry of Education to offer Bachelor's or Master's programs in various fields or disciplines in local higher education institutions.
In kaola's opinion, this program will open up more job opportunities for local children not only in the Ministry of Health but also in other related ministries.
Furthermore, kaola suggests that the control of entry of food and drink materials that have been identified as the cause of the decline in health levels and the increase in non-communicable chronic cases in this country be improved by reassessing the imposition of taxes or by introducing warning labels and controlling or regulating the sale of products to the public.
Your Honorable Speaker and Honorable Members. On this occasion, I am pleased to call on the public in this country to take responsibility for their own health and that of their families, especially for Muslims in this country.
Kaola also takes this opportunity to wish everyone a happy fasting month of Ramadan and to take the opportunity to practice a healthy lifestyle by consuming balanced and moderate meals, in accordance with the words of Allah in Surah Al-A'raf, verse 31 which means "O children of Adam, take your adornment at every masjid and eat and drink, but be not excessive. Indeed, He likes not those who commit excess."
Your Honorable Speaker and Honorable Members. Finally, kaola seeks permission to conclude this discussion with a pantun for everyone in this chamber and the community out there:-
Balanced food always practiced, Healthy body, open mind, Exercise regularly as a habit, The health of the people is the key to a prosperous nation.
That's all, thank you Your Honorable Speaker. "Peace be upon you" and may Allah grant us success and guidance and His mercy and blessings. And salutations.
Your 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 the mercy and blessings of Allah." First of all, thank you also to Your Honorable.
So, to answer those questions, there are approximately 5 questions regarding dental and blood sample services at the Jubli Perak Health Center, Kampung Sengkurong. The waiting area is indeed crowded, such as in Kampong Lugu and so on.
So, the improvements made before regarding dental services were the addition of chairs but it is still not enough.
However, this problem has been identified and the SOPs provided for the front line to handle it have been prepared, not by "asking" them to come back the next day. So, here the Ministry of Health apologizes to the community there who have experienced this problem.
It should come with the given SOP. There, they will be asked about their dental problems, whether critical or routine, and from there an agreement should be made instead of being directed to come back tomorrow or come earlier. This should not happen. This may indicate a weakness in terms of aligning the SOP for the front section. InshaAllah, this will be improved.
Regarding this blood sample, it is seasonal, Your Honorable Speaker. Sometimes there are many, sometimes only 2-3 people and the blood collection is usually done by those who are fasting. So, they will come at 7 am, "because they want to break their fast early".
InshaAllah, it will be observed, because the Ministry of Health usually has statistics showing the crowd and if it continues, which should not happen, InshaAllah, another place will be designated to take blood. InshaAllah, the Ministry of Health will take note and try to improve the existing SOP.
Regarding the increase in NCDs as Your Honorable mentioned earlier, it is evident that kidney patients are the most affected. Maybe 5 years ago there were over 600, now there are over 900 kidney patients.
And what is sad or surprising is that Brunei Darussalam is among the top 5 countries in the world with kidney problems according to its ratio.
That is why before COVID-19, we tried to conduct a national campaign for health screening, especially for blood pressure, diabetes, cancer, and heart. Because of COVID-19, those three years did not happen.
However, as I explained earlier, InshaAllah, the Ministry of Health will be more active in addressing this issue.
There is something in the introduction that Kaola mentioned earlier in Bruhealth in phase three. There are two things there, namely the help index where we fill it out ourselves, see the scoring, and that determines our health level and also there is early detection disease screening including the national screening program.
What Your Honorable Dayang Hajah Safiah binti Sheikh Haji Abd Salam suggested will InshaAllah be included in phase three of Bruhealth and is indeed in the Ministry of Health's plan.
In addition, as Kaola mentioned earlier, in phase three, there are mainly big data applications including diabetes management as well.
From there, when this data is collected, it will give the Ministry of Health a better understanding of how to prepare for non-communicable diseases control in the next 15 to 20 years. Any preparations that we need to make. Regarding peritoneal dialysis.
Praise be to Allah. One of the good things and benefits that can be learned from COVID-19 is the willingness of the public to understand and accept peritoneal dialysis.
Previously, not many people received peritoneal dialysis and since three years ago when we faced COVID-19, praise be to Allah, peritoneal dialysis has increased from tens to more than 200 people. According to our highest ratio in this region.
For the knowledge of Your Honorable Speaker and Honorable Members here and out there, peritoneal dialysis is one of the methods in which a catheter is inserted into the abdomen to introduce fluid and there the kidney is washed using the peritoneum in the abdomen.
It processes the transition of waste or harmful chemicals in the body out of the peritoneal dialysis channel. This can be done at home every night. People usually do it before going to bed and it is installed and finished the next morning. This is actually what we want to move towards, not dialysis.
Praise be to Allah, with COVID-19, people are more aware and understand and appreciate the independence of an individual.
Meaning, they are not dependent on going to the Dialysis Center which takes about 5 hours and three times a week. Limited in their movements or daily work. When they switch to dialysis, they feel the independence. They still work during the day, any activity done during the day of that week will not be affected.
With this understanding, it is not only for the benefit of the patient but also for their family. Sometimes their family cannot take care of them, especially those who are new, until late at night and people who take care of them may return home at 1 or 2 in the morning and so on. Not only for the patient but also for those around them who take care of them. The most important thing is from the renal department.
This is a method that can reduce complications related to cosimo dialysis. Cosimo dialysis should be considered when evaluating and deciding which replacement therapy is suitable for an individual or patient.
In terms of kidney transplantation, praise be to Allah, people are also becoming more aware and understanding. In Brunei Darussalam alone, in the past two to three years, there have been approximately 15 kidney transplants. This number is increasing every year.
With more people accepting kidney transplants, others may consider it as an option but may still have reservations.
This type of kidney transplant is called a living related donor transplant. This means that the donor must be a close family member, such as a sibling, parent, and so on. It cannot be someone who is not related, unless it can be proven that the person is a close relative.
Before the kidney transplant, there is an ethics group that interviews both the recipient and the donor. They interview the family members to ensure that they are truly related and that there is no coercion or buying and selling involved. This is very important from an ethical standpoint. I have already explained the screening process earlier.
Regarding the implementation of home-based nursing, the Ministry of Health wants to expand it because it will reduce bed congestion in hospitals. For example, if someone has a stroke and has reached a certain stage, the medical team can only provide rehabilitation in the hospital. Other treatments do not need to be done in the hospital, as it may harm the patient with infections and so on. Therefore, it is better to do it at home. The government and the Pantai Jerudong Specialist Centre, especially the BSNRC, have established and supported home-based nursing. However, it is still insufficient and, God willing, it will be further improved.
This is one of the agendas or plans that must be addressed, especially with an aging population. Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin explained yesterday that sometimes parents are not taken care of by their children. This will also be addressed.
With home-based nursing, it can help children share the responsibility of taking care of their parents so that they do not become tired and the government does not have to worry about them. Perhaps these children feel lonely, and with home-based nursing, it can provide a holistic approach that not only looks at the patient's condition but also evaluates the caregiver's mental health and so on.
Regarding social work, it is necessary to evaluate the patient and their family's situation and the surrounding environment of their home in terms of suitability and safety for the patient to return home, as well as the caregiver's safety.
They also assess a person's ability to care for the patient, such as providing adult diapers or special food, such as special milk that needs to be purchased. They then determine whether they need assistance from certain parties or funding from the hospital, and so on.
The Ministry of Health has also seen an increase in the number of Medical Social Workers over the years, with now over 20 workers in the entire country, including 3-5 workers at the Pantai Jerudong Specialist Centre. These workers cater to the various healthcare needs of the community.
Praise be to Allah, even the Ministry of Culture, Youth and Sports now has 12 social workers for welfare. The government is building this from nothing, but it takes time and the suggestion from Your Honorable may be the time for us to discuss with the Ministry of Education (MOE) regarding the preparation for Medical Social Workers, which is a good suggestion. Insha Allah, it will be discussed with the Ministry of Education.
Moving on to food, as Your Honorable Speaker and Members of Parliament are aware, the Ministry of Health has implemented a tax on sugar a few years ago. Praise be to Allah, the impact has been very positive and as usual, companies do not want to pay taxes, so they comply and reduce the sugar content to 6 grams or less from double digits. This is what we want, the positive nudges, not so much of us wanting their money, but the positive nudges are more important than collecting their money.
Insha Allah, in the near future, His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam's government is also aware of the problem of high blood pressure, where we will launch the Low Salt Diet program. This is a national program, praise be to Allah, we have received permission and we are waiting for the right time to launch it to the public.
With these programs, we hope that the public will be more aware and educated on their choice of food. The Health Promotion Centre has collaborated with several food and beverage manufacturers on healthy food. Looking at their advertisements, we can see how to look or now people are seen in supermarkets, quite a few offer already looking at the ingredients. In the past, they just took whatever they wanted, but now they look at the ingredients, which ones are healthy, and that is what they prioritize. Some supermarkets have also placed these items at eye level to ensure that these are the first things that people see. We hope that these little nudges or activities will draw the attention of consumers to make wise choices in their food. Insha Allah, that's all, Your Honorable Speaker. Thank you.
Your Honorable Speaker
I invite Your Honorable Mr. Lau How Teck.
Your Honorable Mr. Lau How Teck
Thank you, Your Honorable Speaker. Greetings and good afternoon to Your Honorable Members. First and foremost, congratulations and thank you to the Minister of Health for the opening remarks delivered yesterday morning.
Your Honorable Speaker, I would like to refer to Topic SM01A Code 004/000. The health care of secondary and tertiary patients who require immediate treatment or emergency care from the Tutong District, Kuala Belait District, and Temburong District, are still being sent to RIPAS Hospital for further health examination.
My question here is, why is this still being practiced when this issue has been faced for years and often heard? Is there a plan or strategy from the Ministry of Health to improve services in these districts and has this progress been implemented?
In this regard, I also understand that some patients have been referred to Jerudong Park Medical Centre and Pantai Jerudong Specialist Centre because these health centers have the required health experts and more efficient medical equipment.
Is there an initiative or plan from the Ministry of Health to upgrade medical services by adding these health experts and medical equipment to government hospitals in stages?
Thank you, Your Honorable Speaker.
The Minister of Health
Thank you, Your Honorable Speaker and thank you, Your Honorable Member for your question.
Just to make sure this is correct, the question is why are we still referring patients from Kuala Belait or Tutong to the city. Kuala Belait has its own internal medicine specialists. Similarly, there are surgical specialists, but there are also times when a particular problem requires input from other specialists, especially not just one, like 2-3 people.
It is sent to RIPAS Hospital because RIPAS Hospital is the actual tertiary center for our country's medical problems. That is where a group of specialists from various fields are located and where they can refer to other specialists in one place.
If in a situation where the very expert in Kuala Belait, for example, that expert in a year disappears, the senior consultant. These experts, our senior consultants, work where there is a volume. Volume workload, one expert, if for example, his patients are only 100 people a year, usually sees a thousand patients, he will stop working for 2-3 months.
Because this will not enhance his knowledge, as the more patients he sees, the better he becomes, the more he learns, and the more experience he gains. That is why it is important for us to have a tertiary center where expertise can be gathered and not only gain experience for oneself, but also hear advice or opinions from other experts around him in dealing with a problem.
This does not mean that we do not value Kuala Belait or Tutong. It's just that what we see is that these diseases are sometimes more complex. What he can handle, he does it there. What is beyond him, that's why the matter must be honest, as far as his knowledge goes, he feels it is difficult, he must refer.
But now, sometimes in the past, he referred because he had to make an ultrasound or CT scan, but now in the last year or two, there are already CT scans in Tutong and KB, and with the new Picture Archiving Computer System or PACS launched last year, this will further reduce the need for people in KB or Tutong to be sent to the city for an echo and so on because there, if there is a sonographer in Kuala Belait who can make an echo, he can make an echo there and people in the city can see it live if they want, with this PAC system.
That is the achievement of the Ministry of Health in ensuring that the entire country is on one record, especially in terms of ECG. Sometimes we are not sure if there is a problem with the ECG or not, we just call the city, make it now, and the city can see it live.
If there is 5G, it will be even more advanced and things like this will be faster. Echoes that show images can also be viewed directly from the city. I can sit in the office and they can make it there, I can sit directly and direct them to do this and that live. The need for people to go to the city for such examinations will be drastically reduced.
One question is why we refer to Pantai Jerudong or Gleneagles JPMC and whether the Ministry of Health will do the same. It's the volume of scale in terms of experience or expertise. If we have a Cardiac Center here and there is a Cardiac Center in Jerudong where we perform surgery in only 150 cases a year with 75-75, but there are not only one doctor but also four or three people, and there are also three or four people there, for it to work efficiently. These three people, for example, divide 75 by 3, which is more than 20. If there is only one person, they will work for a long time and will stop within 3 months.
Your Honorable Speaker, as consultants, we need a volume of scale to support our work and statements. This is where the government's fiscal consolidation comes in. It not only reduces expenses, such as the cost of a heart machine which costs several million, but it also ensures that there are two machines instead of one, in case one breaks down. Making one in one place and another in RIPAS Hospital is not economically feasible, as the population is only 400,000. Therefore, it does not make sense to do so professionally or economically, and we are losing on all ends.
Pantai Jerudong and Gleneagles were established to ensure that healthcare services are of high standards, as in any developed country. Why can Pantai Jerudong do it, but the government cannot? We understand that we have limitations and our own bureaucracy, which must be equal to all ministries. Praise be to Allah, with the wisdom of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam, we will establish another body with its own rules, but it still needs to be monitored by MOFE and other Board of Directors. We can employ doctors and I can interview them next week and give an answer the same day, rather than interviewing them elsewhere and informing them two years later. If we want to move fast and excel in certain specialties, this is the way to do it, as these two specialties are moving very fast. If we follow the old method, we will be left behind.
Praise be to Allah, with the wisdom of His Majesty the Sultan and Yang Di-Pertuan of Brunei Darussalam and his leadership, we have managed to reach where we are now. It is not that the Ministry of Health cannot do it, but we have our limitations, and we acknowledge them, but we want to move forward. Therefore, we do not want to do something just for the sake of obtaining it without any benefit to the country's interests.
With the consolidated expertise gathered in one place, even though they are in Pantai Jerudong or Gleneagles JPMC, they come to RIPAS Hospital to access it, and so on. At this time, doctors at Pantai Jerudong, especially stroke specialists, have a group of doctors who look after patients at RIPAS Hospital, but their salaries are paid by JPMC. They work there for a week and take turns because there are people like foreigners with green IC who cannot afford to go to Pantai Jerudong, and we cannot let that happen. They pay according to any scheme of charges there. So, even though we are like one, that whole loop looks after the whole country. That's all, Your Honorable Speaker.
Your Honorable Speaker
Thank you. I now invite Your Honorable Ms. Chong Chin Yee.
Your Honorable Ms. Chong Chin Yee
Thank you, Your Honorable Speaker, and greetings. I would like to raise three questions under the topic SM01A Code 005/006 - Management of Medical Equipment and Laboratories and Code 005/007 - Health Information and Data Management.
Firstly, I would like to congratulate the Ministry of Health on their success in becoming a role model and demonstrating Brunei's commitment to leading digital health transformation. This dedication is evident with the launch of the MOH Intelligence HUB.
I would also like to congratulate Universiti Brunei Darussalam on the introduction of the Digital Public Health Graduates Program, especially the Master of Digital Public Health in collaboration with the University of Michigan. I am very excited to see the developments and innovations in health technology in the future. Seeing the rapid progress in the field of Artificial Intelligence (AI) and its potential applications in health is very encouraging, knowing that the Ministry and the Department of Ophthalmology have implemented an AI Deep Learning System to enhance the existing diabetic retinopathy screening program.
My first question is, can the Ministry share the effectiveness and challenges of implementing the AI Deep Learning System in the current diabetic retinopathy screening program?
Has the Ministry considered establishing a Behavioral Insights Team or Nudge Unit to integrate machine learning into the health system to prevent diseases and promote positive behavior change? If yes, how does the Ministry plan to leverage machine learning to identify behavior patterns and develop strategies to encourage individuals towards positive choices?
Finally, the last matter. It is important for elderly patients to explain the symptoms they are experiencing to obtain an accurate diagnosis and effective treatment. However, in general, the elderly often face difficulties in communicating effectively due to age-related cognitive decline, various chronic health conditions that make it difficult for them to identify the most relevant symptoms with current health problems, and language barriers. These challenges make it difficult for them to remember and convey their symptoms to health professionals.
However, smartwatches and wearable devices which are personal electronic devices worn on the body or as accessories can collect and transmit health-related data such as tracking physical activity, accidents such as falls, sending reminders to take medication, and providing other features that provide health information to users, caregivers, and healthcare professionals.
Taking into account the importance of advanced technology in improving healthcare delivery, I would like to suggest that the ministry consider implementing a strategy to educate and involve elderly patients and their caregivers about the benefits and applications of smartwatches in healthcare and to use them in existing healthcare services to strengthen preventive measures and ultimately lead to improved health outcomes for elderly patients. That's all I wanted to convey, thank you Your Honorable Chairperson.
Your Honorable Minister of Health
Thank you Your Honorable Chairperson and thank you Your Honorable Ms. Chong Chin Yee earlier. So regarding AI.
أ ْلح ْمدُ ِ هلِل, the Ministry of Health is very sensitive to the improvement in technology mentioned earlier, AI where detection for diabetic retinopathy among patients in Brunei.
So allow me to describe here Your Honorable Chairperson how it is usually done. Previously, if someone checked their eye health, they would have to put eye drops first, put eye drops once the pupil dilates and then wait for at least an hour but usually 3 hours, 2 drops.
So in those 3 hours, after 3 hours they wait to see their eyes. It will be examined by a doctor. It takes him a few minutes to see this, so after that any findings will be shared and after that the patient no longer works and is given MC because of the eye drops, they cannot drive especially or may not be able to see because of the effect of the drops so at least in the hospital for about 3 - 4 hours and they will take a day off.
Now with this new technology, with this clinical depending AI system where the Eye Center begins to explore for early detection of diabetic retinopathy. It does not require eye drops and it can be done, patients just come to see their diagnosis directly in 3 to 5 minutes. So in a day or an hour, in theory if it's 5 minutes how many people, 12 people. An hour 60 minutes, 12 people. Usually in a day they only see 3 - 4 people, but in an hour they can see 12 people. So it will make the examination more effective. So much more can be screened to prevent them from going blind due to diabetes.
Only problem is, the queue is long and time-consuming, and when done by this AI System, it does not require a doctor, anyone can do it as long as they know how to press the switch on, off, enter. It is done all by the machine and the report is printed out.
So, this trial has been conducted, in 100 people, the study has been done and compared, it seems that the sensitivity and specificity. Sensitivity means how good it is, it detects diabetes problem accurately. Specificity tells us that this person does not have a problem. Rejecting diabetes, so those are all very high, more than 95%. So it is better than humans, humans have a sensitivity of less than 70-80% and it is very variable, depending on their mood. So this is very objective, there is no human bias.
So, God willing, with the screening that has been made and the findings that exist, God willing, Brunei will implement it, looking at its terms of reference and so on. If we do it, we will be one of the countries in the world that do it as a whole of nation and with this, it will also provide protection guarantees, patient data and this needs to be integrated with the existing BruHims AI and of course internet connectivity.
People no longer need to come to RIPAS Hospital, as Your Honorable Lau How Teck said, this can be stored in Kuala Belait, Tutong or any health clinic. So there is no need to crowd at RIPAS to do this diabetic scan. So, this will ease the patient's congestion, easy access to care.
However, staff and employees must also be trained in terms of the system, but what is most important is when making a doctor's examination, so the doctor can do what needs to be done, provide other care or other examinations.
Next is behavioral insight. This behavioral insight, we are committed to using a behavioral signs approach that is embedded in continuous efforts to establish a Behavioral Insight Unit in the Ministry of Health, which is a plan developed in collaboration with the World Health Organization (WHO), where we establish the roadmap on the establishment of the Behavioral Insight Unit in MOH for 2022 and 2024. Why is behavioral insight important? Because it has great potential to apply theories, methods, and scientific approaches, behavior or behavioral signs in the formulation of all policies, to establish or improve certain health services or programs based on the data or evidence we have, with behavior on the population itself, which is the Brunei population.
So with the existence of this behavioral insight, it makes assessments and suggestions on how to handle issues related to health behavior, especially as Your Honorable Dayang Hajah Safiah binti Sheikh Haji Abd Salam mentioned earlier, why people still do not listen to our advice on why they eat certain things or what makes them want to eat those things. So this is behavioral insight, with this research we know how to tackle it.
God willing, with this Behavioral Insight Unit, we can learn and influence the people, not just copying from other countries or populations where their understanding of health or education, research is very different. So that's important.
Regarding smartwatches, Alhamdulillah, the internet of things has produced various technologies that have greatly helped in healthcare, especially among the elderly. The internet of things, especially smartwatches, is widely used in Western countries where most of them live alone or have few family members.
Alhamdulillah, in our country, children still want to take care of their parents, and this is what we need to implement. However, any of these advanced technologies will also be monitored by the Ministry of Health for its necessity and usefulness because at the end of the day, we have to balance the cost and benefits, but there are certainly benefits from this, so we need to look at its suitability and impact that can be obtained through this advanced technology such as smartwatches. That's why we have the Digital Health Unit in the Ministry of Health. There is a unit called The Digital Health Unit that monitors all these internet of things that can have an impact or improvement on the Ministry of Health's care for the public.
That's all, thank you, Your Honorable Speaker.
Your Honorable Speaker
I now invite Your Honorable Pehin Orang Kaya Johan Pahlawan Dato Seri Setia Awang Haji Adanan bin Begawan Pehin Siraja Khatib Dato Seri Setia Haji Mohd Yusuf.
Your Honorable Pehin Orang Kaya Johan Pahlawan Dato Seri Setia Awang Haji Adanan bin Begawan Pehin Siraja Khatib Dato Seri Setia Haji Mohd Yusuf
Peace be upon you and may Allah's mercy and blessings be upon you. Your Honorable Speaker, I am pleased to express my gratitude to Your Honorable Speaker for giving me the opportunity to discuss the Ministry of Health's allocation for 2023/2024 together.
Thank you also to Your Honorable Minister of Health for presenting the Financial Allocation of the Ministry of Health and explaining the direction of this ministry in strengthening the healthcare system in this country.
I would like to raise the issue of the Master Plan for the Ministry of Health System and Infrastructure for Brunei Darussalam. The proposal to establish a Master Plan for the Health System and Infrastructure for Brunei Darussalam is to strengthen and enhance healthcare for the people and residents of Brunei Darussalam in the long term.
أ ْلح ْمدُ ِ هلِل, His Majesty Paduka Seri Baginda Sultan Haji Hassanal Bolkiah Mu’izzaddin Waddaulah, Sultan and Yang Di-Pertuan of Brunei Darussalam, during the opening of the 2012 Ilmu Ceremony in conjunction with His Majesty's 66th Birthday Celebration held at the International Convention Centre, Berakas on 11th September 2012, among others, stated:
"I have consented to the appointment of a Consultant for the purpose of preparing the Master Plan for the Health System and Infrastructure of Brunei Darussalam as a step towards continuing efforts to strengthen planning, improve quality and advance the national healthcare system in a more organized manner in line with Brunei Vision 2035."
This step is also intended to see this country continue to prosper and be prosperous with the people and residents being provided with quality, comprehensive and equitable healthcare.
In upholding and nurturing His Majesty's pure and far-sighted decree, the Health System and Infrastructure Master Plan Project was initiated in October 2012 following the signing of a contract agreement between the Ministry of Health and a skilled and experienced consultant, The Innova Group from the United States, on 20th September 2012. The implementation of this project involves various stakeholder sectors consisting of the Ministry of Health, especially the ministries, non-governmental organizations, relevant institutions, and also the people and residents of Brunei Darussalam. With full cooperation and commitment and sacrifice of those involved, especially the health professionals in various healthcare professions, Alhamdulillah, the master plan was completed and documented in November 2014. This comprehensive master plan should serve as a foundation for a significant roadmap to strengthen and enhance the national healthcare system and infrastructure.
It encompasses strategic plans, programs, and over 90 initiatives identified for the next 20 years. It not only aligns with the Ministry of Health's mission towards a healthy population but also fully supports the country's goal of achieving Wawasan Brunei 2035, particularly for the people to have a high quality of life.
In early 2015, the establishment of the Health System and Infrastructure Strategy Management Unit, consisting of appointed leaders and coordinators responsible for reporting and monitoring, was initiated. Unfortunately, it was not continued.
Moving forward to support the Wawasan Brunei 2035 goal, the Health System certainly requires strong preparedness to address various challenges, including planning and strategic plans for the health sector, including governance, financial resources, delivery of quality services, human resources, various medical facilities, drug supply, and technology.
Therefore, I would like to seek clarification from Your Honorable Minister of Health whether the National Health System and Infrastructure Master Plan, which is already available, is being utilized as a guide in the long-term planning of health care services and programs.
Why am I raising this issue? Because the preparation of this plan involves various health professionals who provide input and identify strategies and initiatives to address it. It requires continuity to ensure the success of any plan and initiative according to the established framework.
In my personal observation, sometimes there is no continuity in planning or master plan to be continuously researched and implemented. Sometimes officers become confused because there is no consistency, and the direction in the previous plan has changed even though research or an initiative has been carried out.
In this Council, I would like to suggest that it is worth considering reviewing and re-examining the content of the master plan, which may be useful as a guideline in implementing relevant planning and programs to strengthen and improve the health care system, including more organized infrastructure in the future.
This is also in line with the desire and purpose of providing the National Health System and Infrastructure Master Plan, as conveyed by His Majesty the Sultan and Yang Di-Pertuan Negara Brunei Darussalam.
I would like to touch on the master plan of the Raja Isteri Pengiran Anak Saleha Hospital. The master plan is being implemented to upgrade and expand the services of the hospital in accordance with the needs of the current time as the only tertiary hospital in the country. The master plan serves as the blueprint for the hospital's planning for the next 20 years until 2035, in line with Brunei Vision 2035.
According to studies by consultants in 2028, it is expected that more than 560 beds will be needed. At present, as Kaola has been informed, the Raja Isteri Pengiran Anak Saleha Hospital only has approximately 800 beds. The concern here is that the country is facing a problem of insufficient beds, especially at the Raja Isteri Pengiran Anak Saleha Hospital, which is feared to affect the treatment services for patients, such as delays in receiving proper treatment, resulting in worsening patient conditions, more complex and ineffective treatments.
Due to the increasing need for beds, some patients are forced to be discharged prematurely, resulting in inadequate and comprehensive treatment. It also has an unpleasant effect on the country's healthcare system and especially on patients' outcomes.
Similarly, in emergency cases, as Kaola has been informed, patients have to wait for vacancies in wards for further treatment. Isn't it time for the country to add more beds to accommodate the increasing needs caused by the ageing population, as suggested by Your Honorable Minister of Health? Based on the master plan, the country needs to add beds as Kaola has stated.
This is based on the findings of the relevant consultants. The addition of ICU beds, MICU beds, hospital facilities, especially buildings for acute and sub-acute health services, and the current temporary mortuary. The addition of laboratories and other facilities, including operating rooms, to accommodate the increasing surgical needs.
In this regard, I am pleased to inform the public that the problems faced include unsatisfactory maintenance and the like. I would like clarification from Your Honorable Minister of Health on how we can overcome the challenges and needs and further improve the necessary facilities as outlined in the master plan that has been prepared for implementation.
Previously, the master plan included the construction of women and children centers, أَلْحَمْدُ ِللّٰهِ the master plan was already planned before I became the Minister of Health. I followed those desires and أَلْحَمْدُ ِللّٰهِ the women and children centers have been implemented. أَلْحَمْدُ ِللّٰهِ we were able to overcome problems related to pregnant women, women, and children who were born.
The purpose of this is solely to make the master plan a guide that has statistics and what expectations we need to implement or prepare. To strengthen quality, conducive, and environmentally friendly healthcare for the people and residents of Brunei Darussalam. Not only for now, but we must also anticipate what will happen in the future.
Thirdly, I want to raise the issue of the increasing aging population. This matter has been touched upon أَلْحَمْدُ ِللّٰهِ by the Honorable Minister of Health, what I will not explain here is the statistics we already know about the problems of aging, and we are grateful to هللا سبحانه وتعالى also the life expectancy of the people in this country has increased from 77.3 years in 2016 to 77.8 in 2023. This also requires our preparation because أَلْحَمْدُ ِللّٰهِ the life expectancy of the people is increasing every year.
With challenges like this, the population is getting older (aging population) in the future, and this elderly group is categorized as vulnerable to non-communicable and chronic diseases, including poor vision, hearing loss, and dementia.
What are the short-term and long-term steps, preparedness, and strategies of the Ministry of Health regarding healthcare for the aging population in this country, which is increasing so that we can all enjoy a prosperous life together.
I also want to raise the issue of basic healthcare. The development of a resilient healthcare system that provides universal health coverage services that are easily accessible to all levels of society and the population is very important in supporting the country to achieve Wawasan Brunei 2035. A comprehensive framework and direction to upgrade and strengthen the tasks outlined in the master plan for the healthcare system and healthcare structure of Brunei Darussalam.
This matter, the basic health services provided through health centers and clinics play a crucial role not only in providing people-centered care to individuals and communities but also as gatekeepers to early detection and treatment of diseases. It is considered cost-effective in providing healthcare and treatment to the public.
A few years ago, we have already started building health centers such as the ones in Berakas, Pengkalan Batu, Lamunin, and Pengiran Anak Puteri Mutawakillah Hayatul Bolkiah Health Center in Gadong.
The question here is, why have we not continued to build health centers that have already been identified in the master plan, especially in areas with a large population such as Bandar Seri Begawan? And why was the Ong Sum Ping Health Center closed?
This may be the reason why the public relies heavily on the Raja Isteri Pengiran Anak Saleha Hospital. For example, health centers in Anggerek Desa and Sungai Hanching were closed because there is already a health center in Berakas. The plan should have already established health centers that are deemed necessary. Therefore, I emphasize that health centers in Brunei play an important role that we should prioritize because they can be accessed by all layers of the people and residents, not just in urban areas.
In this regard, I would like to request an explanation or any information from Your Honorable Minister of Health in strengthening our healthcare system to make it more accessible and easily reachable by the people and residents of Brunei Darussalam, not just focused on Bandar Seri Begawan, to have a significant impact on a more comprehensive and sustainable national healthcare system.
Furthermore, I would like to raise the issue of the function of the BSL3 Laboratory in Pekan Tutong. To my knowledge, the Ministry of Health already has a BSL3 laboratory in Pekan Tutong, which is designed and equipped with special safety features to handle tests to identify category 3 (infectious) microorganisms. Therefore, there are several matters that require clarification.
What is the role of this BSL3 laboratory in dealing with the COVID-19 pandemic? Since the BSL3 laboratory is a high-security laboratory designed to handle tests and newly emerging microorganisms that are not fully understood in terms of their potential for human infection.
Can it be fully utilized while taking into account the safety and well-being of laboratory professionals conducting the relevant tests? Has this BSL3 laboratory received any international standard recognition in terms of building safety in handling patient samples, safety assurance especially to protect healthcare professionals conducting laboratory tests on these patient samples?
Lastly, I would like to raise the issue related to the Private Health Care Facility Act. What is the progress of the provisions of the Private Health Facility Act if it does not exist yet? If it does not exist yet, what are the procedures for controlling healthcare facilities that provide medical services, clinics such as dental clinics, x-ray services, laboratory services, and the like? This is solely to ensure that the best practices or standard standards practiced by these private clinics are in place to ensure the safety and health of patients are guaranteed and receive treatment in private facilities.
Kaola is also interested in what is understood to be a shortage of healthcare professionals, especially doctors and nurses. What are the steps to address these problems in the future? As a suggestion, is it possible for us to take locum tenens doctors who work in private here, perhaps at night or at suitable times to some extent to address the shortage of doctors, and the same goes for retirees who can be taken on a contract or month-to-month basis.
The same goes for nursing. Perhaps there are also retired nurses that we can take on, because their experience can also help to some extent with the shortage of nurses in this country. They can be taken on a month-to-month, contract, or similar basis. That is perhaps what Kaola wants to raise. Kaola would like to thank you for giving me the opportunity.
Kaola concludes with "Assalamualaikum warahmatullahi wabarakatuh. Greetings and with the permission of Allah, may we all be blessed and guided by Him."
Your Honorable Minister of Health
Thank you, Your Honorable Speaker and thank you, Your Honorable. There are approximately 7 or 8 questions. Regarding the Health Master Plan and the Hospital Infrastructure Master Plan, allow me to address them together.
As understood, the Master Plan for Health System and Infrastructure produced by the Ministry of Health in 2015, which was mentioned earlier, outlines strategies for establishing a healthcare system and improving government healthcare infrastructure in the long term, up to Vision 2035.
For the information of Your Honorable, most of the initiatives planned in the master plan have been implemented according to the established components of the healthcare system. These initiatives have been absorbed into the Ministry of Health's Strategic Plan (2019-2023). The absorption has been thoroughly studied and takes into account the suitability of implementation according to current needs and situations, including alignment with government policies, response to the COVID-19 pandemic, prioritization of national financial allocations, and alignment with the strategies of Vision Brunei 2035 and its underlying master plans.
Similarly, in terms of infrastructure, praise be to Allah, the implementation of infrastructure projects in the Ministry of Health has taken into account the planned projects under the infrastructure master plan for hospitals and health centers, which are still being actively implemented, mostly under the National Development Plan. Insha'Allah, the Ministry of Health will continue to make the health system and infrastructure master plan a significant and systematic roadmap for guiding the strengthening and improvement of the country's healthcare system and services, as desired.
Regarding the issue of insufficient beds and so on, as stated in the introduction, Your Honorable, it is known that RIPAS Hospital will build a new building with 500 more beds to accommodate its needs. In the short term, several strategies have been implemented at RIPAS Hospital, especially where the addition of beds in wards or the Emergency Department beyond capacity is done periodically. This means that existing nurses have to be redistributed according to the additional beds or another word redistribution of manpower. The opening of the Day Unit or Day Surgical Unit has helped to reduce the use of beds in wards to some extent.
In the long term, as Kaola explained, a new building in RKN 11, which is planned for a year and included in RKN-11 because the need exists, will be built. The full capacity of RIPAS Hospital, which is already at 85%, is critical. If it reaches 75%, there must be a plan to build a new building or something similar. A new building must be accompanied by manpower. If the new building is empty and there are no doctors, it will also create difficulties. So, as Your Honorable Speaker and Your Honorable understand, manpower planning is not as easy as expected.
However, the cooperation from relevant parties, especially JPA, SPA, JTG, and أ َ ْل َح ْم ُد ّ ٰلِل, has greatly facilitated the process of increasing manpower. From there, we will increase the recruitment of doctors, nurses, HP, and support staff. In addition, with nursing, we know that in a year, we can only produce less than 200 new graduates from polytechnics and Universiti Brunei Darussalam. م ُد َ أَ ْل ْ ح ٰ ّ with the cooperation of the private sector, a private nursing college has been established and ن شاء للا ا هthis will further increase our pool of nurses for the country.
For the construction of this health center, for example, the Berakas Health Center, the Pengiran Anak Puteri Hajah Muta-Wakillah Hayatul Bolkiah Health Center in Gadong, and the expansion of the Jubli Perak Health Center in Sengkurong, which ان شاء هللاwill be completed in a few months. This is also in line with the prepared strategies. In addition, what lies ahead is the use of telemedicine and the upgrading of BruHims to a new system, BruHims 2.0. This is the Ministry of Health's plan in the short and long term to ensure the availability of health services for the community, where it can ان شاء هللا support Brunei Vision 2035.
Regarding the Ong Sum Ping issue, it was closed a few years ago and it was indeed considered to open another health center in Bandar Seri Begawan. At this time, several places have been identified, but we need to determine which one is more suitable. So ان شاء هللا هللاif there is approval from the foundation's caretakers and the mother and child team, if they agree, it will be pursued this year.
The BSL3 Lab was delayed due to the COVID-19 pandemic, as the experts and special technical people to run the machine did not arrive on time. However, it was opened last year and is ready to be used for non-virus pathogen health. During the COVID-19 pandemic, we had to set up another lab in Sumbiling. Initially, it was to accommodate 1000 tests, and then we had to create an AirLab to conduct another 4000 tests. That was the requirement at that time.
So the BSL3 Lab is currently in the midst of accreditation, with some improvements being made. But it is a sophisticated lab, with an automated system. The entire environment of that building is controlled by the computer, including the temperature, humidity, and air conditioning, so that is the BSL3 lab. This will also be where our genomic research will be conducted ان شاء هللاwhere we can conduct certain genomic studies there as well.
From the perspective of the Private Health Care Act, "Alhamdulillah" it has been in existence for a long time, but due to Covid-19, it has not been implemented much in the past 3 years. However, I understand that it is in the final stages. There have been some warnings issued by the AGCs and the Ministry of Health has also made some changes. So, "Insha Allah", maybe by the next LegCo session, we can see the success of the Private Health Care Act.
Indeed, the Private Health Care Act is necessary. It is a way for us to monitor and ensure that all clinics comply with SOPs or international standards. However, it must be remembered that this is a Private Health Care Act, but the government should not be exempt from assessment. So, we are holding private individuals accountable, but not the government. This should also be considered.
Currently, whether it is a private clinic or hospital, it is monitored through different standards. For example, doctors are monitored under the Doctors Medical Board, nurses under the Nursing Board, and pharmacists under the Pharmacy Act. So, private hospitals are monitored through different Acts, but we want the whole environment infrastructure to be monitored, and that requires the Private Health Care Act. At present, that is how private sector monitoring is done through separate Acts, and that is how we monitor.
Regarding the issue of workforce recruitment, as discussed earlier, this requires close negotiations with SPA, JPA, and JTG on how to facilitate it, and "Alhamdulillah", it will yield results, "Insha Allah".
As for hiring locum doctors for private doctors, this has been implemented 4-5 years ago, where we always have a shortage of doctors in Accident and Emergency. So, from 7 pm to midnight, we hire locum doctors. These locum doctors are our own doctors who agree to work at night or even private doctors from wherever they are who agree to work, and they are paid extra. That is "Alhamdulillah", and the same goes for nurses during that period, we hire locum nurses and locum doctors. For retired doctors or nurses, we rehire them, but we look at their performance before. We don't just hire them for the sake of hiring, which would become a liability.
In summary, that is for the 8 questions raised. Thank you, Your Honorable Speaker.
Your Honorable Speaker
I now invite Your Honorable Awang Haji Mohd. Salleh bin Haji Othman.
Your Honorable Awang Haji Mohd. Salleh bin Haji Othman
Thank you, Your Honorable Speaker.
"Assalamualaikum warahmatullahi wabarakatuh" and greetings. Your Honorable Speaker and Honorable Members. Dental care is one of the health services that has high demand in clinics and hospitals. Some people have to wait a long time to get dental braces. What is the Ministry of Health's plan to improve dental services in dental clinics?
Next, I would like to touch on the issue of blood shortage in the relevant hospitals. What are the government's plans and efforts to encourage the public to donate blood, and can appropriate incentives be considered to make these efforts more effective? I would appreciate some clarification from Your Honorable Minister of Health. Thank you. Peace be upon you. May Allah bless and guide us.
Your Honorable Speaker
Perhaps the first question has already been answered. Please proceed, Your Honorable Minister of Health.
Your Honorable Minister of Health
Thank you, Your Honorable Speaker. So the dental issue has already been addressed earlier, and now we come to the problem of blood supply shortage. So, how the Ministry of Health tries to prevent this shortage is by promoting blood donation through collaborations with institutes, government departments, and private sectors to organize Blood Donation Day.
From there, we can maintain the available blood stock. Regarding incentives, blood donation is actually a pure act of willingness to help others. Previously, various incentives were given such as discounts here and there. When we look at it, it may not be appropriate to give such incentives because we do not want this act to become commercialized.
Although the incentives previously given were quite big, such as a 50% discount for first-class, it was given for a lifetime. This has been suspended and if we look at neighboring countries, they do not give such incentives. What is important is the sincerity of a person to donate blood, with one donation, they can help at least 3 people.
What we need to do is to emphasize the importance of blood donation and how it can help others. Inshallah, with our efforts in donating blood, we will receive other rewards besides physical or material incentives.
If we look at JPMC, for example, they only provide canned drinks and crackers. But in the past, they used to give different drinks after donating blood. I may not mention it here. What we want is for the public to be more aware and noble-hearted in donating blood without waiting or expecting incentives.
I think this question is about braces or dental, right?
Yang Berhormat Awang Haji Mohd. Salleh bin Haji Othman
Yes.
Your Honorable Minister of Health
Oh, the question about braces has not been answered yet. We need to understand that braces are not a medical problem, they are for cosmetic purposes. The government should fund it, otherwise it is the same as funding for a beautiful face. What is the difference between reducing wrinkles and tightening skin, giving a sweet smile, thick lips, there is no difference. This is just a luxury. Therefore, this matter will not be added. It is not an emergency, if we do not do it, it will not endanger health.
However, here, let me enlighten you a little about getting braces from unaccredited places, it is dangerous. If you want a beautiful face, you must value your life. There have been several incidents that have come to the Ministry of Health where it worsened their health and recently someone got braces.
Before getting braces, the person must first check their teeth, whether they take care of their teeth, brush regularly, floss and keep them clean. If their teeth are not clean, getting braces will make it worse, with the metal making it harder to clean, making them even lazier.
If they get braces without good dental care, they will be infected with bacteria and if they are unlucky, it will attack their heart. If the heart valve is affected, it will leak, causing sepsis and so on. This is not a trivial matter, heart surgery is one of the problems, during the surgery, it must be done quickly because if the bacteria is left to destroy the valve, it can spread to the adjacent valve and if this happens, the mortality rate during surgery, which is usually 1%, can increase to 40% - 50%, which is very high.
If out of 100 people, 1% dies, if out of 100 people, 50 people die in the operating room, that's not good, just because they want beautiful teeth. If you want beautiful teeth, take care of your dental health properly and go to accredited places, either inside or outside the country.
This is found in homes, hotels, and so on. Here, I would like to take this opportunity to ask the public to contact the Ministry of Health if they know about this matter and do whatever they need to do. Braces are not to be taken lightly because they can kill if not done properly. That's all, thank you, Your Honorable Speaker.
Your Honorable Chairman
I would like to invite Your Honorable Awang Mohammad bin Abdullah @ Lim Swee Ann.
Your Honorable Awang Mohammad bin Abdullah @ Lim Swee Ann
Thank you, Your Honorable Speaker. الرحْ َٰم ِن ال َّرحْ يم السَّال ُم عل ْي ُك ْم ورحْ مةُ هللاِ وبركاتُه َّ ّٰللا ِ ِبس ِْم ه
Your Honorable Speaker and Honorable Members. I would like to touch on the issue of the Sungai Mau Village Clinic in Bukit Sawat.
I would like to request clarification on the status of these clinics. I suggest that consideration be given to allowing these clinics to operate again, providing services to the local residents, even if only periodically, once a week, to provide health services to pregnant women and the elderly who require health services as an alternative to the Sungai Liang and Labi Health Centers. I would appreciate clarification from the Honorable Minister.
That is all, علَ ْي ُك ْم َو َرحْ َمةُ هللاّ َو َب َركَاتُه َ سالَ ُم َّ َو ال.وباهلل التوفيق والهداية
Honorable Minister of Health
Thank you, Your Honorable Speaker. Make sure the clinic is straightened out first.
Your Honorable Speaker
Bukit Sawat Village.
Honorable Minister of Health
Trying to remember where Your Honorable Speaker is. Kaola can answer that later, Your Honorable Speaker, in case I give the wrong answer.
Your Honorable Speaker
I would like to invite Your Honorable Awang Haji Salleh Bostaman bin Haji Zainal Abidin.
Your Honorable Awang Haji Salleh Bostaman bin Haji Zainal Abidin
الرحْ يم السَّال ُم عل ْي ُك ْم ورحْ مة هللا وبركاتُه. Thank you, Your Honorable Speaker and Honorable Members. صلِّه َعلَ َّٰهى هٱللَّ ُه َّمه ِبس ِْم ه. هال َعالَمينَه ُهّلِل َح َّمدُ ِ هلِل َح ْمدٍهرب َّٰ ُم َح َّمد.
Blessings and peace be upon our Prophet Muhammad, his family, his companions, and his loyal followers until the end of time. أ ْلح ْمدُ ِ هلِل. Your Honorable Speaker is given the opportunity to make a contribution in this discussion.
Thank you to the Honorable Minister of Health for the explanation and clarification regarding the development and direction of the ministry in the $418 million health budget, which is a shared responsibility towards the goal of a healthy Brunei towards Vision Brunei 2035.
Before that, allow me to express my personal gratitude for all the sacrifices made by the members of the Ministry of Health and frontline staff in handling the COVID-19 pandemic. The sacrifices of the Ministry of Health will be remembered, only هللا سبحانه وتعالىcan repay the kindness that we have given, which was sometimes beyond the call of duty during the COVID-19 pandemic, thank you.
I have two issues, Your Honorable. The chairman of the aging society is ready to face old age, including myself. Following that, there is a proposal from Your Honorable Dayang Hajah Rosmawatty binti Haji Abdul Mumin.
I would like to share an alternative view on the care of the elderly in terms of the elderly who do not want to burden their children, siblings, and grandchildren to take care of them. This care is either for those who require monitoring at home or for the elderly who are still able to walk and need companionship and peer support during the day, like a child care center but specifically for a golden age care center, where the elderly will return to their own homes after their family returns home from work so as not to burden their children in the daytime.
Considering the modern family unit today, the trend is small, with 2 to 3 family members, and mostly dual working families. Although children have the desire to always be with their grandparents, especially in old age, there will come a reality where not all children or family members will be able to be with their elderly family members all the time. Additionally, there are elderly people who still want to be independent and, out of love for their children and grandchildren, some elderly people do not want to burden their family members by mutual choice.
I would like to ask if there is a modality or health care model that can be considered that can be obtained from a third-party agency for a day care facility. Establishing a day center for the elderly that not only meets the standards of the Ministry of Health for medical care support but also meets the standards of other agencies. Taking into account the characteristics of Bruneian culture, including religious guidance, which still respects and cares for the elderly. Fulfilling the responsibility of family members towards their parents, especially for small families.
Is there an alternative health care giver modality as a viable option for early preparation so that we can make appropriate investments, such as a reputable and affordable third-party health care service provider?
The second issue is the Safe Clinical and Medical Waste Disposal Act. If possible, Your Honorable Minister can provide a comforting feeling to the public that we have an act and continuous strict monitoring to ensure that all medical and clinical waste from government and private hospitals and clinics are disposed of safely and environmentally friendly.
That's all, Your Honorable Speaker.
Assalamualaikum warahmatullahi wabarakatuh.
Your Honorable Minister of Health
Thank you, Your Honorable Speaker, and also thank you to Your Honorable for your prayers for the Ministry of Health staff and frontliners. Ameen ya rabbal 'alamin.
Firstly, allow me to respond to the Sungau Mau issue, Your Honorable Speaker. I would like to clarify that the clinic has been handed over to the District Officer, and now it has been given to the Village Consultative Council, with the key handover taking place on October 31, 2022.
It was closed because the community can go to the Sungai Liang Health Centre or the Labi Health Centre. The Labi Health Centre only has a doctor once a week, while nurses are available every day, and the Sungai Liang Health Centre is operating as usual. However, the problem is the shortage of doctors, nurses, and other staff, and the number of patients there is not high, so we consolidated the services in Sungai Liang to provide more effective services given the challenges of human resources.
Moving on to the issue of old age. The concept of daycare for the elderly is similar to child care. Alhamdulillah, through the Ministry of Culture, Youth and Sports, there is a Senior Citizens Activity Centre, which is also available in Belait District, Brunei-Muara District, and Tutong District. There, senior citizens can gather and socialize, but I think your idea of a proper child care, because I have been to Japan, the daycare system has a place to lie down, they can rest and take a nap in that room, there are special rooms, playrooms, and so on.
However, the concept is not profitable, so how it is run, the place has a café run by senior citizens who are properly trained and managed financially, but monitored. The price of drinks there is slightly higher for the public because it must meet the needs of the people, but it is a good concept that has been implemented in Africa and is used to address mental health issues, especially for adults. However, this old age care centre, as Your Honorable mentioned, does not mean that the children do not care about their parents. It is for the daytime when the parent is alone at home and feels very lonely. So, if there is a place like this, they can socialize and talk, and they will not feel isolated. Mental health problems will be reduced.
This matter may be welcomed. It is not like old age. In old age, children only visit their parents during festive seasons or once a month. At the old age centre, it also provides respite for caregivers and is a good vacation for the elderly to go out and meet friends or peers. If there are private parties interested in creating such a place, I think, as part of our ageing preparation, that is something we can really support.
That is a very good suggestion where we want to take care of our elderly in such a way that they continue to be active socializing. Recently, Your Honorable met with officials to ensure whether they can sail or not by a geriatrician. If you don't want them to sail, don't ask them to see a geriatrician. We want them to be active and continue to enjoy life.
The idea of ageing gracefully is not being at home and lonely, that's what we don't want. If any private parties are interested, we can always work together with MOH and KKBS on how to make sure it is suitable. And in terms of safe clinical management, as I have stated before, there is currently no act. It is still being postponed together with JASTRe, Ministry of Development, and Ministry of Health.
However, the Ministry of Health has issued guidelines for healthcare waste management, the latest in 2019. There, it controls hazardous materials. That is what we monitor in clinics and private parties under their standards there. But it is all individual acts that they control.
So what we want is for the private healthcare act to regulate the whole environment of the hospital and waste management. Currently, we are only postponing it as usual because of COVID-19, a bit delayed. We work closely with JASTRe about this because we want to make sure that as our country progresses and develops, we have this kind of act to ensure that people follow international standards.
To answer, the act is still being postponed, such as the private healthcare act, but it is in process. Currently, it is controlled by Hazardous Management under the Ministry of Health. That's all. Thank you.
Your Honorable Speaker
Thank you, Your Honorable Minister of Health. Honorable Members. أَلْحَمْدُ ِللَّهِ we have discussed the Ministry of Health's budget at length. So I think it's time to vote on this topic. Members who agree to pass the Ministry of Health's budget, please raise your hand.
(All members raise their hands in agreement)
Thank you. The Ministry of Health is approved.
Deputy Clerk
Title SM01A - Ministry of Health is included in the Schedule.
Your Honorable Speaker
Honorable Members. I think we have had enough discussion for this afternoon. I now propose that this Committee Meeting be adjourned and we reconvene in the National Assembly Meeting.
Your Honorable Speaker
Honorable Members. We are now reconvening at the National Assembly Meeting. I propose that we adjourn this meeting for a break.
Insha'Allah, we will reconvene subject to the sighting of the Ramadan crescent on Thursday, 23rd March 2023, if not sighted, we will reconvene Insha'Allah on Saturday, 25th March 2023, at 10.00 am.
On this occasion, I would like to wish all Honorable Members a blessed Ramadan. May this Ramadan bring blessings to us and to Brunei Darussalam, and may our deeds and prayers in this blessed month be accepted.
That is all, والسَّالم عليكم ورحمة الله وبركاته. وباهلل التوفيق والهداية.
ADJOURNED
(The meeting is adjourned)
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