ASEAN Chief Dental Officers Meeting: Quality of Dental Services in Brunei Darussalam

1. 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

2. 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

3. Country Profile • 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 • Land area = 5,765 km2 • Capital City: Bandar Seri Begawan • 4 districts: Brunei Muara(housing the capital city), Tutong, Belait & Temburong

5. ORGANIZATION STRUCTURE

6. 104 Dental Nurses 102 locals : 2 non-locals 81Dentists 52 locals : 29 non-locals 41 Administrative Staff 37Dental Technologists/Technicians 36 locals : 1 non-locals 88 Dental Assistants TOTAL DENTAL WORKFORCE= 352

7. ORAL HEALTH STATUS National OH Survey 1999

8. Quality of Dental services Patient safety • 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

9. INFECTION CONTROL UNIT • Promote & implement excellence • Increase awareness & ensure adequate training • Update infection control protocol with latest guidelines every 2 years • Patient safety

10. 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

11. 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

12. MEDICAL EMERGENCY UNIT • Training inmanagement 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

13. 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

14. 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

15. 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 • Patient safety

16. Quality of Dental services Effectiveness • Provide various forms of comprehensive dental services Primary Oral Care Services School Dental Services • Orthodontic • Prosthodontic • Endodontic • Oral Surgery • Periodontic • Pedodontic • Restorative (Implants) Specialist Care Services Dental Laboratory Services

17. 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 • Effectiveness

18. Changing levels of mean dmft among 5-year-olds schoolchildren and mean DMFT among 12-year-olds schoolchildren for whole state (2008-2012)

19. oral health promotion programs • Water fluoridation • Water samples monitored by MOH & Public Works Department • Effectiveness 98% receives fluoridated water

20. 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

21. 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 • Effectiveness

22. 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

23. 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

24. 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) • Effectiveness Other Dental Staff: 100 hours annually from Continuing Professional Development Programmes or Activities

25. RESEARCH & DEVELOPMENT DIVISION • Provide accurate, effective & timely oral health statistical data • Promote evidence-based policy making • Effectiveness

26. ANNUAL APPRAISAL FORM • 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 • Effectiveness

27. Quality of Dental services Patient centeredness • 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

28. Overall satisfaction on the services provided • Patient centeredness

29. Overall satisfaction on waiting time • Patient centeredness

30. Overall satisfaction on the facilities provided • Patient centeredness

31. Suggestions for improvements 4 % • Patient centeredness 3.8 % 3 % 1.4 %

32. Quality of Dental services Timeliness • 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

33. Average waiting time between taking queue number & registration,& between registrations & first called by DENTAL SURGERY ASSISTANT (DSA) • Timeliness

34. 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

35. 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 • Timeliness

36. Quality of Dental services Efficiency • 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

37. Finance Unit • Ensure delivery of services is efficiently carried out by having all consumables, instruments & equipment readily available at all time • Efficiency

38. 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 • Efficiency Preventive Maintenance Contract of Dental Chairs & Equipment with Local Dental Supplier

39. DENTAL HYGIENE & THERAPY TRAINING PROGRAM • 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

40. VARIOUS COMMITTEES • Procurement • In-Service Training • Disciplinary • Recruitment • Promotion • Write-off • Welfare • Efficiency

41. Quality of Dental services Equity • 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

42. National Dental Centre (60,347) Sg. Hanching HC (41,117) BunutHC (1,709) Mata-Mata HC (6,699) Sungai Besar HC (1,917) Police HC (3,240) RimbaHC (63,621) Sengkurong HC (56,017) MuaraHC (25,462) Jerudong Prison (240) SAUDHA SubokHC (2,732) PengkalanBatu HC (13,031) RIPAS Hospital • Effectiveness BRUNEI-MUARA DISTRICT PMMPHAMB Hospital (33,400) TUTONG DISTRICT PIHM Hospital (8,856) Sg. Assam HC (20,247) Sg. Liang HC (12,760) Telisai HC (7,068) TEMBURONG DISTRICT BELAIT DISTRICT Legends: Seria HC (13,093) National Dental Centre LabiHC (1,426) Dental Clinic in Health Centre (Full-Time) LamuninHC (10,720) SSB Hospital (33,067) Dental Clinic in Health Centre (Part-Time) Hospital-based Dental Clinic

43. PAEDODONTIC UNIT • 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 Equity

44. SCHEME OF CHARGES • OUT-PATIENT – ATTENDANCE FEES • Registration Fee : • Citizens = $1.00 • Government Servants & Permanent Residents = $3.00 • Others = $5.00 Equity Example

45. 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

46. Thank You! @ Department of Dental Services, Brunei Darussalam