ASEAN Chief Dental Officers Meeting:
Quality of Dental Services
in
Brunei Darussalam
Dr. Sylviana Haji Moris
BDS (Dundee); MSc Dental Public Health (Kings College London)
Head of Primary Oral Care Services Division
Department of Dental Services
Brunei Darussalam
27.08.2013
OUTLINE OF PRESENTATION





Country Profile
Vision & Mission
Organization structure & Workforce
Oral health status
Quality of Dental services:
– Patient safety
– Effectiveness
– Patient centeredness
– Timeliness
– Efficiency
– Equity
COUNTRY PROFILE
 Land area = 5,765 km2
 Capital City: Bandar Seri Begawan
 4 districts: Brunei Muara (housing the
capital city), Tutong, Belait & Temburong
 Population =
393,162 (2011
census)
 Brunei Muara =
279,842
 Belait = 60,609
 Tutong = 43,855
 Temburong =
8,856
 GDP per capita =
B $53,000 (2012) ≈
US $41,340
VISION
MISSION
AIM
• Together towards a Healthy Nation
• To improve Oral Health through effective,
equitable, affordable, accessible, safe &
sustainable Oral Health Care in Brunei
Darussalam
• Healthy Mouth, Healthy Nation
ORGANIZATION STRUCTURE
104 Dental Nurses
81 Dentists
52 locals : 29 non-locals
37 Dental
Technologists/Technicians
36 locals : 1 non-locals
102 locals : 2 non-locals
88
41 Administrative
Dental Assistants
TOTAL DENTAL WORKFORCE= 352
Staff
ORAL HEALTH STATUS
National OH Survey 1999
5 - 6 years old
10 - 12 years old
13 - 15 years old
35 - 44 years old
% caries
free
dmft
% caries
free
DMFT
% caries
free
DMFT
% caries
free
DMFT
11.3
7.1
12.9
4.82
5.8
7.24
1.7
14.4
CPITN Score
% of 10 –
12 years old
% of 13 –
15 years old
% of 35 –
44 years old
0 (Healthy periodontium)
1.3
0.7
0
1 (Bleeding on probing)
76.4
75.7
43.4
2 (Presence of calculus)
86.4
87
85.7
3 (Pockets 4 – 5 mm)
N/A
5.1
65.4
4 (Pockets 6 mm or more)
N/A
0
20.6
PATIENT SAFETY

Quality of
Dental
services
Health & Safety Division established
in 2011
–
–
–
–
–
–
–
Infection Control Unit
Fire Safety Unit
Radiation Protection Unit
Medical Emergency Unit
Hazardous Waste Disposal Unit
First Aid Unit
Occupational Health Unit
PATIENT SAFETY
INFECTION CONTROL UNIT

Promote & implement excellence

Increase awareness & ensure
adequate training

Update infection control
protocol with latest guidelines
every 2 years
PATIENT SAFETY
FIRE SAFETY UNIT

Prevent or minimise fire by:
– Use of detection & extinguishing
systems
– Adequate fire fighting services
– Training in fire safety & evacuation
procedures
– Regular inspection & maintenance of
detectors & fire extinguishers
PATIENT SAFETY
RADIATION PROTECTION
UNIT

Ensure consistently adequate diagnostic
information

Supervise radiation quality standards &
assurance programme

Ensure staffs are properly trained

Undergo periodic examination & testing of
engineering controls, design & safety feature

Provide contingency plans & conduct any
investigations following an incident or accident
situation
PATIENT SAFETY
MEDICAL EMERGENCY UNIT

Training in management of medical
emergencies

Equip all clinics with medical
emergency equipment & drugs

Ensure all equipment & drugs are
regularly maintained & monitored

Audit all medical emergency cases
PATIENT SAFETY
HAZARDOUS WASTE
DISPOSAL UNIT

Provide a minimum standard for safe &
efficient healthcare waste management

Guidelines for healthcare waste management
in dental clinics & school dental services

Periodically update guidelines in line with
internationally-accepted guidelines

Monitor waste management by performing
clinical audits
PATIENT SAFETY
FIRST AID UNIT

Provision of first-aid care to all staff &
patients as may be required during
emergencies

Arrangement of prompt & appropriate
referral to medical aid if required

Prompt notification of injuries/incidents to
Health & Safety Division

Regular monitoring of first aid equipment
PATIENT SAFETY
OCCUPATIONAL HEALTH
UNIT

Maintain & promote staff’s
health & working capacity
through education

Improve & upgrade working
environment, so it is conducive
to a safe & healthy place to work
EFFECTIVENESS
Quality of
Dental
services
 Provide various
forms of
comprehensive
dental services
 Orthodontic
 Prosthodontic
 Endodontic
 Oral Surgery
 Periodontic
 Pedodontic
 Restorative (Implants)
Primary Oral Care
Services
School Dental
Services
Specialist Care
Services
Dental Laboratory
Services
EFFECTIVENESS
SCHOOL DENTAL SERVICES
 Provide appropriate preventive & curative oral health
care to all schoolchildren
 Promote oral health of schoolchildren
 Daily Fluoride Tooth-brushing programme & activities in
collaboration with School Authorities
 Health Promoting School programmes in collaboration with
Ministry of Education
dmft 5-yr-olds
4.9
DMFT 12-yr-olds
5.3
4.7
4
4
0.8
0.7
2.9
1.2
2008
2009
2010
YEAR
2011
0.6
2012
Changing levels of mean dmft among 5-year-olds schoolchildren and mean
DMFT among 12-year-olds schoolchildren for whole state (2008-2012)
EFFECTIVENESS
ORAL HEALTH PROMOTION
PROGRAMS
 Water fluoridation
 Water samples
monitored by
MOH & Public
Works
Department
98%
receives
fluoridated
water
WATER PLANT
FLUORIDATION YEAR
Layong
1987
Bukit Barun
Seria
1996
2000
Mengkabau
2000
Temburong
2008
EFFECTIVENESS
ORAL HEALTH PROMOTION
 Antenatal Oral Health Care Programme
 Parents & Toddlers Programme in Health Clinics
 Toddlers, Rolling Toothpaste & Fluoride Varnish Programme
 9 months old children given a bag with toothbrush, toothpaste,
feeder cup & oral health promotion information
 Followed up & given toothbrush + toothpaste every 6 months 5 years old
 Fluoride varnish applied to children’s primary teeth from 2-5
years old 2x a year
EFFECTIVENESS
ORAL HEALTH PROMOTION
 Daily Fluoridated Tooth-brushing Programme in
Schools
 Polly paste, imported from Philippines & F- tested in ACTA
Netherlands Germany (1,450ppm)
 Fluoride Varnish Programme
 Apply fluoride varnish to all Primary 1 children, twice a year
 Oral health Awareness Programme in Primary
Schools, Secondary Schools & Community
ORAL HEALTH PROMOTION
 Media Program
 TV promo , TV & Radio
interview
 Interactive CD in
collaboration with Institute
of Technology, Brunei
Darussalam
 Dental Song Competition
in 2012
EFFECTIVENESS
CLINICAL AUDIT DIVISION

Established in 2011
– To improve quality of clinical care by
creating a culture committed to learning
through systematic review of care
– Implementation of methods for
improvement is then based on evidence
relevant to our local situation rather
than just opinions
EFFECTIVENESS
CONTINUING PROFESSIONAL
DEVELOPMENT UNIT

Provide & oversee CPD activities

All Dentists & Nurses must maintain CPD
logbooks annually

Minimum 30 CPD points per year verified by
CPD unit (1 lecture=1 point)
Other Dental Staff:
100 hours annually from Continuing Professional
Development Programmes or Activities
EFFECTIVENESS
RESEARCH & DEVELOPMENT
DIVISION

Provide accurate, effective &
timely oral health statistical data

Promote evidence-based policy
making
ANNUAL APPRAISAL FORM
EFFECTIVENESS


For all Civil Servants
Criteria
–
–
–
–
–
–
–
–
–

Work knowledge
Attendance timeliness
Work management
Decision-making
Innovativeness
Communication
Reliability
Leadership
Commitment
Rewarded with annual bonus
– Grade A-D = 100% bonus
– Grade E = 50% bonus
– Grade F = 0% bonus
PATIENT CENTEREDNESS

Quality of
Dental
services
Customer Care Unit
– Handle patients’ complaints
– Incident reporting forms available
– A survey of patients satisfaction regarding
dental services provided by Primary Oral
Care in Brunei Darussalam (2011)
 293 participants
 Questionnaire includes: services
provided, waiting time, facilities &
suggestions for improvement
PATIENT CENTEREDNESS
OVERALL SATISFACTION ON
THE SERVICES PROVIDED
PATIENT CENTEREDNESS
OVERALL SATISFACTION ON
WAITING TIME
PATIENT CENTEREDNESS
OVERALL SATISFACTION ON THE
FACILITIES PROVIDED
PATIENT CENTEREDNESS
SUGGESTIONS FOR
IMPROVEMENTS
4%
3.8 %
3%
1.4 %
TIMELINESS

Quality of
Dental
services
Adult Outpatient registration times
– 7:45 A.M. – 10:00 A.M

Children Outpatient registration times
– 7:45 A.M. – 10:00 A.M & 1:30 P.M. – 3:00 P.M


Emergency service (on-call after-office hours)
at all major hospitals (A&E department)
Audit done
– Waiting time of patients attending Adult Dental
Outpatient Services in National Dental Centre during
off-peak & peak periods in June 2012
TIMELINESS
AVERAGE WAITING TIME BETWEEN TAKING QUEUE
NUMBER & REGISTRATION,
& BETWEEN REGISTRATIONS & FIRST CALLED BY
DENTAL SURGERY ASSISTANT (DSA)
TIMELINESS
COMPUTERIZED RECORDS

Bru-HIMS ( Brunei Darussalam Healthcare
Information & Management System)
launched in Tutong District in 2011

Expected to be fully operational in all 4
districts by 2014

Main objective of BRU-HIMS system
– To help improve quality of medical care

Computerized records will help reduce
registration time
TIMELINESS
REFERRALS TO SPECIALIST
CARE

Prompt referral for Emergency cases

Waiting list
– Orthodontic Unit: 4 years
– Prosthodontic Unit: 6 months
– Endodontic Unit: 4 months
– Oral Surgery: 3 weeks
– Periodontic: 3 months
– Pedodontic & Restorative (Implants): Nil
EFFICIENCY

Quality of
Dental
services
In 2002, His Majesty the Sultan of
Brunei Darussalam urged all
Ministries & Departments to
produce ‘Work Procedure
Manual’ (Standard Operating
Procedures) to improve civil
service
FINANCE UNIT
EFFICIENCY

Ensure delivery of services is
efficiently carried out by having
all consumables, instruments &
equipment readily available at
all time
EFFICIENCY
BIOMEDICAL ENGINEERING
UNIT

Advice on equipment safety hazards, equipment
compatibility & quality of equipment

Preventive maintenance & breakdown repair of
dental equipment

Equipment commissioning & acceptance test for new
dental equipment

Replace unreliable & obsolete equipment & provide
technical report for equipment write-off
Preventive Maintenance Contract of Dental Chairs &
Equipment with Local Dental Supplier
DENTAL HYGIENE & THERAPY
TRAINING PROGRAM
EFFICIENCY

Cost-efficient workforce development
strategy
– More expensive to train Dentists
– Poor recruitment for Bachelor of Dental Surgery


Train dual qualified Dental Hygienists/
Therapists who can provide primary dental
care & dental health education to children &
adults
Provide ‘top-up’ course to expand scope of
work of existing Dental Nurses
EFFICIENCY
VARIOUS COMMITTEES







Procurement
In-Service Training
Disciplinary
Recruitment
Promotion
Write-off
Welfare
EQUITY

Quality of
Dental
services
Primary Oral Care Services
– 21 dental clinics throughout the country

Specialist Care Services
–
–
–
–
Full-time in Brunei-Muara: All
Full-time in Tutong: Orthodontic
Part-time in Tutong: Paedodontic & Oral Surgery
Full-time in Belait: Paedodontic, Oral Surgery,
Orthodontic
– Part-time in Belait: Prosthodontic, Endodontic &
Periodontic
National Dental
Centre (60,347)
Bunut HC
(1,709)
Mata-Mata
HC (6,699)
Police HC (3,240)
Sengkurong
HC (56,017)
Sg. Hanching HC (41,117)
Sungai Besar HC
(1,917)
Rimba HC
(63,621)
Muara HC
(25,462)
EFFECTIVENESS
Jerudong
Prison
(240)
Subok HC
(2,732)
RIPAS
Hospital
Pengkalan Batu HC
(13,031)
PMMPHAMB Hospital (33,400)
SSB Hospital
(33,067)
Sg. Liang HC
(12,760)
Seria HC
(13,093)
Telisai HC
(7,068)
PIHM
Hospital
(8,856)
Sg. Assam
HC
(20,247)
Legends:
Labi HC
(1,426)
National Dental Centre
Lamunin HC
(10,720)
Dental Clinic in Health Centre
(Full-Time)
Dental Clinic in Health Centre (PartTime)
Hospital-based Dental Clinic
PAEDODONTIC UNIT
EQUITY
 Provide specialised & comprehensive dental care for
children with special needs & medically
compromised
 Provide preventive programme & oral health
education to both children with special needs & their
carers
SCHEME OF CHARGES
OUT-PATIENT – ATTENDANCE FEES
 Registration Fee :
EQUITY
 Citizens = $1.00
 Government Servants & Permanent Residents = $3.00
 Others = $5.00
EXAMPLE
FINAL NOTE

Challenges to ensure/monitor quality
– Insufficient workforce

–
–
–
–
–
–
Dentists play multiple roles
Workforce recruitment & retention
Limited room/facilities for expansion
High burden of oral diseases
High demand for treatment
Lower priority for prevention
Procurement of dental supplies
@ Department of Dental Services,
Brunei Darussalam