ASEAN Chief Dental Officers Meeting:

Quality of Dental Services in

Brunei Darussalam

Dr. Sylviana Haji MorisBDS (Dundee); MSc Dental Public Health (Kings College London)Head of Primary Oral Care Services DivisionDepartment of Dental ServicesBrunei Darussalam

27.08.2013

Country Profile Vision & Mission Organization structure & Workforce Oral health status Quality of Dental services:

– Patient safety – Effectiveness – Patient centeredness– Timeliness– Efficiency– Equity

OUTLINE OF PRESENTATION

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

VISION• Together towards a Healthy Nation

MISSION

• To improve Oral Health through effective, equitable, affordable, accessible, safe & sustainable Oral Health Care in Brunei Darussalam

AIM• Healthy Mouth, Healthy Nation

ORGANIZATION STRUCTURE

81 Dentists52 locals : 29 non-locals

37 Dental Technologists/Technicians

36 locals : 1 non-locals

104 Dental Nurses102 locals : 2 non-locals

88 Dental Assistants

41 Administrative Staff

TOTAL DENTAL WORKFORCE= 352

5 - 6 years old 10 - 12 years old 13 - 15 years old 35 - 44 years old

% caries free

dmft% caries

freeDMFT

% caries free

DMFT% caries

freeDMFT

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

National OH Survey 1999

ORAL HEALTH STATUS

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

Quality of Dental

services

INFECTION CONTROL UNIT

Promote & implement excellence Increase awareness & ensure

adequate training Update infection control

protocol with latest guidelines every 2 years

PAT

IEN

T S

AFE

TY

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 extinguishersPAT

IEN

T S

AFE

TY

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 situationPA

TIE

NT

SA

FET

Y

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

PAT

IEN

T S

AFE

TY

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

PAT

IEN

T S

AFE

TY

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

PAT

IEN

T S

AFE

TY

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

PAT

IEN

T S

AFE

TY

EFFECTIVENESS

Quality of Dental

services

Provide various forms of comprehensive dental services

Primary Oral Care Services

School Dental Services

Specialist Care Services

Dental Laboratory Services

Orthodontic Prosthodontic Endodontic Oral Surgery Periodontic Pedodontic Restorative (Implants)

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

SCHOOL DENTAL SERVICESEF

FECT

IVEN

ESS

2008 2009 2010 2011 2012

4.94.7

4 4

5.3

1.2

2.9

0.8 0.70.6

dmft 5-yr-olds DMFT 12-yr-olds

YEAR

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

ORAL HEALTH PROMOTION PROGRAMS

Water fluoridation Water samples

monitored by MOH & Public Works Department

WATER PLANT FLUORIDATION YEAR

Layong 1987

Bukit Barun 1996Seria 2000

Mengkabau 2000

Temburong 2008

EFFE

CTIV

ENES

S

98% receives

fluoridated water

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

ORAL HEALTH PROMOTION

EFFE

CTIV

ENES

S

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

EFFE

CTIV

ENES

S

Media Program TV promo , TV & Radio

interview Interactive CD in

collaboration with Institute of Technology, Brunei Darussalam

Dental Song Competition in 2012

ORAL HEALTH PROMOTION

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

CLINICAL AUDIT DIVISIONEF

FECT

IVEN

ESS

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)

CONTINUING PROFESSIONAL DEVELOPMENT UNIT

EFFE

CTIV

ENES

S

Other Dental Staff:100 hours annually from Continuing Professional

Development Programmes or Activities

Provide accurate, effective & timely oral health statistical data

Promote evidence-based policy making

RESEARCH & DEVELOPMENT DIVISION

EFFE

CTIV

ENES

S

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

ANNUAL APPRAISAL FORMEF

FECT

IVEN

ESS

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

Quality of Dental

services

OVERALL SATISFACTION ON THE SERVICES PROVIDED

PAT

IEN

T C

ENT

ERED

NES

S

OVERALL SATISFACTION ON WAITING TIME

PAT

IEN

T C

ENT

ERED

NES

S

OVERALL SATISFACTION ON THE FACILITIES PROVIDED

PAT

IEN

T C

ENT

ERED

NES

S

SUGGESTIONS FOR IMPROVEMENTS

PAT

IEN

T C

ENT

ERED

NES

S

4 %3.8 %

3 %

1.4 %

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

Quality of Dental

services

AVERAGE WAITING TIME BETWEEN TAKING QUEUE NUMBER & REGISTRATION,& BETWEEN REGISTRATIONS & FIRST CALLED BY DENTAL SURGERY ASSISTANT (DSA)

TIM

ELIN

ESS

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 timeTIM

ELIN

ESS

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): NilTIM

ELIN

ESS

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

EFFICIENCY

Quality of Dental

services

Ensure delivery of services is efficiently carried out by having all consumables, instruments & equipment readily available at all time

FINANCE UNITEF

FICI

ENCY

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

BIOMEDICAL ENGINEERING UNIT

EFFI

CIEN

CY

Preventive Maintenance Contract of Dental Chairs & Equipment with Local Dental Supplier

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

DENTAL HYGIENE & THERAPY TRAINING PROGRAM

EFFI

CIEN

CY

Procurement In-Service Training Disciplinary Recruitment Promotion Write-off Welfare

VARIOUS COMMITTEESEF

FICI

ENCY

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

EQUITY

Quality of Dental

services

EFFE

CTIV

ENES

S

SAUDHA

BELAIT DISTRICT

Legends:

Dental Clinic in Health Centre (Full-Time)

Hospital-based Dental Clinic

National Dental Centre

TUTONG DISTRICT

TEMBURONG DISTRICT

SSB Hospital (33,067)

Seria HC (13,093)

Sg. Liang HC (12,760)

PMMPHAMB Hospital (33,400)

PIHM Hospital (8,856)

Muara HC (25,462)

RIPAS Hospital

Sg. Assam HC

(20,247)

Sg. Hanching HC (41,117)

Police HC (3,240)

National Dental Centre (60,347)

Sengkurong HC (56,017)

Labi HC (1,426)

Telisai HC (7,068)

Lamunin HC (10,720) Dental Clinic in Health Centre (Part-

Time)

Sungai Besar HC (1,917)

Subok HC (2,732)

Mata-Mata HC (6,699)

Bunut HC (1,709)

Jerudong Prison (240)

Pengkalan Batu HC (13,031)

Rimba HC (63,621)

BRUNEI-MUARA

DISTRICT

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

EQU

ITY

SCHEME OF CHARGESOUT-PATIENT – ATTENDANCE FEES Registration Fee :

Citizens = $1.00 Government Servants & Permanent Residents = $3.00 Others = $5.00

EQU

ITY

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

Thank You!