a snapshot on public health care brunei...
TRANSCRIPT
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A Snapshot on
Public Health Care Brunei Darussalam
Dr Hjh Rahmah Hj Md Said Director General Medical Services
Ministry of Health Brunei Darusslam
26 September 2012
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Scope • Preamble
•Health Care in Brunei Darussalam
•Health Achievements in Brunei Darussalam
•Health Issues & Challenges
•Way foward
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Preamble
•What is health & Health of a population?
•What is health care?
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HEALTH - Definition • WHO in 1948 define health as “A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity” • WHO Health Promotion¹ initiative expanded definition in 1984 as “The extent to which an individual or a group is able to realize
aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities.
• Other definition “A state characterized by anatomical, physiological and psychological
integrity; ability to perform personally valued family, work and community roles; ability to deal with physical, biologic, psychologic and social stress; a feeling of well-being; and freedom from the risk of disease and ultimate death.²
¹Health Promotion: A Discussion Document .Copenhagen: WHO 1984 ²Stokes J III, Noren JJ, Shidel S. Definition of terms and concepts applicable to clinical preventive medicine. J Commun Health 1982; 8:33-41
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Health of a population
Determinants:
• Physical and biological environment;
• Social environment and lifestyle;
•Genetics – an individual’s genotype may confer a degree of protection or susceptibility to factors in the environment, whether physical or social, that trigger disease.
•Healthcare
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HEALTH CARE
Definition: • Services provided to individuals or communities
by agents of the health services or professions to promote, maintain, monitor or restore health.
• Not limited to medical care which implies therapeutic action by or under the supervision of a physician
• Include measures for health protection, health promotion and disease prevention
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Health Care in Brunei Darussalam
•Historical perspective
• Principle and approach
•Health Care Delivery Framework
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Brief Historical Perspective • 1907 Deputy British resident also residing doctor • 1911 Dresser runs a dispensary also as postmaster • Nov 1928 First government hospital built and completed in 1929 • 1929 – Establishment of Medical Department & appointment of State
Medical Officer • 1929- Inauguration of Public Health and sanitation measures • 1933 – 3 government hospital in place • 1940- Maternal & Child Health widely accepted • 1951 – New Hospital completed in Pekan Brunei which included a Nursing
School • 1958 – Establishment of Health Office & appointment of a Medical Officer
together with the commencement of School Health Services • 1965 – Start of flying Doctors Service • 1966 – Department of Medical and Health established • 1968 – 2 local doctors joined together with establishment of Dialysis Center
and Mental health Unit • 1970 –Formation of Haj Medical Support Team
Source: 100 Years Caring 1907 -2007 Together Towards A Healthy Natition
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Principle and approach Healthcare in Brunei Darussalam
•Universal Health Care Coverage
•Health for all
•Curative, preventive and promotive
•Emphasis on Primary Health Care
•Together Towards a Healthy Nation
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Health Care Delivery Framework
Consultation Outpatient, Inpatient,
Emergency
Diagnostic Laboratory, Imaging,
Pathology, Physiology, etc
Treatment Pharmacy, Surgery,
Physiotherapy, Occupational Therapy etc
Rehab
Well
Palliative
Social Welfare
Social Integration
Educational Integration
Health Promotion & Advocacy
Training & Skill Development
Resource (Asset) Management
Policy & Legislation
Surveillance & Information
Research & Development
ILL
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Ministry of Health Organisation Chart
MINISTER OF HEALTH
PERMANENT SECRETARY
Deputy Permanent Secretary (Adminstration & Finance)
General Director
Policy & Planning
Adminstration and Finance
Estate Managment
Director General Medical Services
Director General Health Services
Hospital
Nursing
Pharmacy
Clinical Laboratory
Dental Renal
Community Health
Environmental Health
Scientific Services Health Care Technology
Deputy Permanent Secretary (Professional & Technical)
Health Promotion Postgraduate Advisory
Training Board
Hajj Medical Unit
Brunei Medical
Board
Traditional & Complimentary
Medicine
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Health Facilities Medical & Health Services
IN 1952 • 2 General Hospitals (150
bed in Brunei Town & 30 beds in Kuala Belait)
• 2 Outstation Dispensaries • 13 Urban & Rural Ante-
Natal Clinics • 4 Riverine Travelling
Dispensaries • 2 Road Travelling
Dispenseries
IN 2012 (To Date)
• 4 Government (968 beds) and 2 Private Hospitals
• 17 Health Centres • 9 Medical Clinics (Ministry
of Defence) • 12 Maternal & Child Health
Clinics • 39 dental Clinics • 3 Travelling Clinics • 4 Flying Medical Services • 6 Dialysis Centres
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Human Resource in Health (2011) Government Private Total
Doctors
Local 193 20 213
Expat 345 50 395
Total 538 70 608
* Population per Doctor : 647
Dentists
Local 47 5 52
Expat 32 11 43
Total 79 16 95
*Population per Dentist : 4,139
Pharmacist
Local 31 9 40
Expat 1 7 8
Total 32 16 48
*Population per Pharmacist : 8,191
Nurses
Local 2070 185 2255
Expat 132 241 373
Total 2202 426 2,628
*Population per Nurse ; 8,191 Source: MOH Health Information Booklet 2011
Health Worker Density - No formula to ensure effective
health system JLI & WHO guideline: 2.28 – 2.5 doctors/nurses/midwives per 1,000 population Ratio for Brunei Darussalam 3746/393.162 = 9.53 Global = 9.3 (2.3 -24.8) Pharmacist OECD : 6 – 10 / 10,000 pop Ratio for Brunei Darussalam 48 /39316.2 = 1.21 Dentist No specific recommendation Target 1: 4000 population by 2035 Current : 1:7960
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Health Achievements in
Brunei Darussalam
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Crude Death Rates (CDR)
The number of deaths occurring per 1000
population in a year
In 1938 CDR : 22 / 1,000 Since 1987 CDR stabilised at ≈ 3/1,000
In 1947 Total Population (Census 1947) : 40670 CDR in 1947 = 20.1 / 1,000 population
Therefore no of death : ~ 817
In 2011 Total population : 393162
CDR in 2011 : 3.1/1,000 population Therefore no of deaths : ~ 1219
If CDR in 1938 still applicable in 2011 No of deaths : 20.1 x 393.162 = 7903
Therefore: Number of deaths averted in year 2011:
7903-1219 = 6684
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Life Expectancy The average number of years an individual of a given age is expected to live if current mortality
rates continue to apply.
In year 1971: Male: 61.9y Female: 62.1y
In year 2011:
Male: 78.5y Female: 79.3y
Life expectancy in selected countries¹:
Australia : Male-80y Female-84y
China (2000): Male-68.5y Female -72.8 y
Japan : Male-80y Female-86y
Malaysia : Male-71y Female-76y
Philippines (2002): Male-66.9y Female-72.2y
Singapore : Male-79y Female-84y
Western Pacific Region (1995- 2000): Male-68.6y Female-72.5y
¹REFERENCE WORLD HEALTH STATISTICS 2012, WHO PUBLICATION
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Infant Mortality Rate (IMR)
Number of death in a year of children less than 1 year of age for
every 1,000 live births
IMR in 1938 = 146 / 1,000 life births
In 1950 No of life births : 2316
No of infant mortality : 318 IMR in 1950 : 138 / 1,000 life births
In 2011 No of life births : 6749
No of infant mortality : 56 IMR in 2006 : 8.3 / 1,000 life births
If IMR rates in 1950 still applicable
in 2011 No of infant mortality : 931
Therefore:
No of infant saved in year 2011: 931-56 = 885
IMR (2011) Selected Countries: Australia : 4.55 China : 15.7 Japan : 12.2 Malaysia : 14.57 Philippines : 18.75 Singapore : 2.85 Source: CIA The World Fact Book
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Maternal Mortality Ratio (MMR) Number of deaths arising during
pregnancy from puerperal causes for every 100,000 live births
MMR in 1962 = 299/ 100,000 life births
In 1962
No of life births (estimated) : 4013 No of maternal mortality : 12
MMR in 1962 : 299 / 100,000 life births
2010 No of births : 6,412
No of maternal mortality : 1 MMR in 2010 : 15.6/ 100,000 life births
If MMR rates in 1962 still applicable in
2011 No of maternal mortality : 19
Therefore: No of mothers saved in year 2011:
19-1 = 18
MMRSelected Countries: Australia : 7 China : 30 Japan : 5 Malaysia : 29 Philippines : 221 Singapore : 3
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MALARIA ERADICATION
Malaria – significant burden of disease up till early 1960’s
Malaria Eradication Project
National Malaria Eradication Service recommended by WHO in 1962
Total expenditure approved for 5 year
period (1963-1968) : M$5,504,670.00
1963-1965 Pre-eradication phase
1966 Attack Phase 1967 Consolidation Phase commenced
August 1987 WHO declared
Brunei Darussalam Malaria Free
1987 To date Vigilance Phase to ensure
malaria free status maintained and reintroduction prevented.
Global Malaria Burden
Bell et al. Nature Reviews Microbiology 4, S7–S20 (September 2006) |
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POLIOMYELITIS ERADICATION IN BRUNEI DARUSSALAM • Poliomyelitis gazetted a
notifiable disease in 1953 • Poliomyelitis endemic pre-
immunisation era • From 1953 to 1996, 79 polio
cases reported in the country • Number of polio cases
dramatically reduced following the introduction of OPV in 1962
• The last case reported was in 1978 from Tutong District
• Brunei Darussalam declared polio-free in year 2000
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Influencing Determinants
• Multifactor not just specific to health sector Government commitment Development of basic infrastructure Education Soci-economic and welfare status Human resource development Public awareness
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Issues & Challenges
Health Outcome
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OVERACHING CHALLENGES
• Lifestyle – physical inactivity and risk behavior
• Environmental pollution & climate change
• Ageing population
• Population movement and migration
• Emerging & Re-emerging Diseases
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Health Challenge: 1. Disease Trend
• Clear epidemiological shift to NCD
Cancer
Heart Disease
Diabetes
Cerebrovascular
Obesity
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8.8
7.8
4.6
3.8
3.7
3.2
2.6
2.6
2.4
1.2
0.05.010.015.020.025.0
1967
20.7
14.8
9.4
7.0
4.0
4.0
3.4
2.8
2.3
1.9
0.0 5.0 10.0 15.0 20.0 25.0
2011
CHANGES IN 10 LEADING CAUSES OF DEATHS FOR BRUNEI DARUSSALAM FOR THE YEARS 1967 AND 2011
% OF TOTAL DEATHS
(Total Number of Deaths in 1967 and 2011 are 656 and 1235 respectively.)
Cirrhosis of Liver
Congenital Malformations
Bronchitis
Nephritis and Nephrosis
Vascular Lesions Affecting CNS
Gastritis, Enteritis and Colitis
Arteriosclerotic Degenerative Heart Diseases
Cancer
Tuberculosis
Pneumonia
Certain Conditions Originating In The Perinatal Period
Septicaemia
Congenital Malformations, Deformations and Chromosomal Abnormalities
Transport Accidents
Hypertensive Diseases
Bronchitis, Chronic and Unspecified Emphysema and Asthma
Cerebrovascular Diseases
Diabetes Mellitus
Heart Diseases
Cancer
Source: Research & Development Division , DPP MOH
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0
10
20
30
40
50
60
2006 2007 2008 2009 2010
No.
of c
ases
Top 5 cancers in Brunei Darussalam (2006-2010)
1. Bronchus & Lungs 2. Breast 3. Cervix Uteri 4. Corpus Uteri & Unspecified parts of Uteri 5. Colon
Source: National Cancer Registry, MOH
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Source: Brunei Health Information Booklet MOH 2010
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NORMAL HIGH Body Mass Index(BMI) 31% 66%
Blood Pressure 71% 29%
Fasting Blood Sugar 89% 11%
Fasting Blood Cholesterol 52% 48%
Preliminary Finding IHSHPP for Civil Servants
(2007-2011)
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OVERWEIGHT & OBESITY TREND BRUNEI DARUSSALAM
0%
5%
10%
15%
20%
25%
30%
35%
40%
1st NNSS IHSHPP 2nd NHANSS
33%
38%
33%
12%
28% 27%
Overweight
Obese
1997 2007 - 2011 2009 -2011
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SMOKING PREVALENCE BRUNEI DARUSSALAM
20.0%
17.5%
17.0%
31.1%
31.8%
32.8%
5.3%
2.9%
3.7%
0% 5% 10% 15% 20% 25% 30% 35%
1st NHANSS (1997)
Population Census (2001)
2nd NHANSS (2011, preliminary)
WanitaLelakiJumlah
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Overweight & Obesity - Schoolchildren Year 1, 4, 6 & 8 (2008 – 2010)
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
2008 2009 2010
13.3% 14.0%
14.8%
12.3% 12.4% 13.5%
OverweightObese
Source: Department of Health Services. MOH
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Health Challenge: 2. Sustainability
• Escalating health care cost (review, accounting, cost benefits, cost savings, investments, alternative)
• Maintenance & upgrade of existing health services & facilities (utilization, accessibility, positioning, evidence based, assessment, efficiency)
• Provision of new health services & treatment modalities in tandem with medical/health development and emerging health requirements (evidence, location & coverage, cost benefits, coverage)
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Health Challenge 3. Quality care
• Increasing public expectation for quality care and in a conducive environment
• Aligning healthcare services provided with international benchmarks and acquiring accreditation
• Globalization and trade liberalization allowing for entry of product, practitioners and services which will require strict monitoring.
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Health Challenge 4. Manpower
• Managing adequate, competent and skilled manpower and of quality (assessment, training, competency)
• Expanding new treatment modalities requiring specific skills & continuous training
• Restricted training opportunities
• Competitive healthcare workers global market
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Approach & Way forward
• Timely information • Evidence base • Program planning , monitoring and targeting • Smart doable & innovative intervention • Quality assurance • Training • Partnership – Financing , promotion & service
delivery
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Plan
Policy
Process Premise
People
Partnership
Strategic Map & Balance Scorecard
Health System & Infrastructure Master Plan
RIPAS Hospital Master Plan
National Committee on
Health Promotion
Health Promotion Blueprint 2011-2015
Bru-HIMS
Service Excellence
Good Governance Healthy
Lifestyle
Health in All Policies
HP Skill & Competencies Health
Promotion Programmes
Intersectoral Collaboration &
Partnership
Obesity
Diet Physical Activity
Tobacco Healthy Setting Networking
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• What is good health? • What is good healthcare?
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Together Towards A Healthy Nation
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Thank you