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THE 3RD ASEAN & JAPAN HIGH LEVEL OFFICIALS MEETING ON
CARING SOCIETIES
Development of Human Resources and Partnerships in Social Welfare and Health
29 August – 1 September 2005
Tokyo, Japan
BRUNEI DARUSSALAM Country Report
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INTRODUCTION
1. Although small in size and young as an independent nation,
Brunei Darussalam’s history dates back over a millennium. In recent
years, the country has made leaps and bounds in its social, cultural
and economic development, becoming known to the world as a
modern and thriving state.
2. Brunei Darussalam means Brunei, the Abode of Peace. The
name aptly describes the tranquility of the nation, the gentle hospitality
of its people and the lush, tropical forest and pristine coastlines that
form an integral part of this nation. A country imbued in the philosophy
and ideology of Islam, Brunei Darusslam is stable and peaceful and is
one of the safest countries in the world.
3. Brunei Darussalam is made up of four districts: Brunei Muara,
which is the smallest but the most densely populated and where the
center and capital Bandar Seri Begawan, is located; Temburong,
which is the least populated but most heavily forested; Tutong, which
is the home of many of Brunei’s ethnic tribes; and Belait, the
production base of the nation’s main export commodities-oil and gas.
4. The total population of Brunei Darussalam at the end of 2003
was 348,800 growing at an average of 2.6 percent per annum. The
breakdown of the population by gender shows that 176,300 are males
and 172,500 are females. Brunei Darussalam has a predominantly
young population, with 67 percent of the population in the productive
age group of 15 to 64 years. By the end of 2005, the total population is
projected to increase to 386,000.
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5. Brunei Darussalam has long eradicated extreme poverty and
hunger and is progressively improving equity. A range of welfare
programmes provided by government and non government
organizations (NGOs), serve as a social safety net for the
disadvantaged. While, indicators of health and mortality rank
alongside those of the world’s most developed countries. By 2004 as
a result of increasing investments in education, health and
infrastructure supported by its natural resource endowment, the
country had risen to 33 out of 177 nations in UNDP’s Human
Development Index. In fact, Brunei has already achieved almost all of
the targets of the Millenium Development Goals (MDGs).
6. As a small nation, its people are Brunei Darussalam’s most
valuable asset and the key to its future. Recognising this fact, Brunei
Darussalam puts priority on the social welfare and development of its
people including women and children and those with disabilities. In the
current Eighth National Development Plan covering the period 2001-
2005, the biggest share of the development allocation is given to the
social service sector (19.93 percent) which includes education,
medical and health, housing and religious affairs.
MATERNAL AND CHILD HEALTH AND THE COMMUNITY
7. Brunei Darussalam has achieved dramatic improvements in
maternal and child health, with maternal mortality rates plunging to
extremely low levels and infant mortality rates falling to levels lower
than most other countries around the world. Achieving and
maintaining these low levels of maternal and infant mortality, depends
on many different factors which are inter related. Improvements in
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infant mortality are a result of higher standards of living, improved
levels of literacy and education, the increasing empowerment of
women and rising standards of child care services. While the
reduction in maternal mortality is directly related to continuing access
to comprehensive reproductive health services for all who require
them, even in remote areas. This will enable skilled advice and
attention to be given during pregnancy, at the delivery of the baby and
in the postpartum period. Experience in Brunei Darussalam, over the
period of 1978-2002, shows that as the percentage of births attended
by skilled health workers has increased as well as the shift to
institutional deliveries in both urban and rural areas, the incidence of
maternal mortality has declined. In Brunei Darussalam, almost all
births now takes place in hospitals and almost all deliveries are
attended by qualified health personnel.
Health Programmes for mother and child
8. The provision of health services for mother and child is under the
direct jurisdiction of the Ministry of Health. In its efforts to improve
further the quality and accessibility of health care, the Ministry of
Health has expanded and extended community based preventive
health services into outlying areas, providing an extensive network of
Maternal and Child Health Clinics that offer antenatal, postnatal, child
health surveillance and screening for the under fives, immunization,
domiciliary nursing as ‘well woman’ screening for women aged 38
years and above. It has also decentralized primary and family health
care facilities (Outpatients Department) from being wholly hospital
based to a multiple health-centre system in order to improve primary
health care. For remote areas, traveling clinics and flying medical
services provide primary health care including dental services, with
the assistance of the Royal Brunei Air Force.
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Services for Maternal and Child Health are also provided through four
public hospitals of which the largest in Bandar Seri Begawan is the
designated referral and teaching hospital. There is currently only one
private hospital.
Further to general policies and programmes, specific policies and
programmes for maternal and child health services have also been
established to promote equity in access which include:
Free ante-natal and post-natal services (including non Brunei
Nationals)
Free child health including immunization services for all residents
The National Breastfeeding Policy
Free School Health Services
School Feeding Scheme run by the Ministry of Education which
takes into account health requirements as recommended by the
Ministry of Health.
INTER-SECTORAL COLLABORATION AND PARTNERSHIPS IN
IMPROVING MATERNAL AND CHILD HEALTH
9. Brunei Darussalam’s success in achieving excellent maternal
and child health indicators has not been solely due to efforts by the
Ministry of Health alone. It has been the result of a concerted effort
and cross-sectoral approach from a wide range of policies, strategies
and programmes from various sectors within the government. These
have addressed the crucial determinants required to achieve low
maternal mortality and infant mortality. The first requirement is
universal and equitable access to affordable health care services as
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outlined above. Others include socio-economic prerequisites such as
appropriate welfare provisions and poverty reduction, as well as
favourable legislative, cultural, educational, and gender factors.
Collaboration between Health and Welfare Sectors in Maternal
and Child Health
10. In managing certain Maternal and Child Health issues, close
collaboration and partnership between the social welfare and health
sectors are extremely important: this is especially in the management
of special cases such as disadvantaged families, abandoned babies,
child abuse and neglect, and disabled and special needs children.
Collaboration between health and other sectors
11. There are also examples of successful inter-sectoral
collaborations in managing other issues related to maternal and child
health which involve other agencies:
Health Issues Ministry of Health
Functions
Sectors Involved
School Health Health Screening of
school children
age 6-14 years
Ministry of Education
Maternal and Child
Health
Health screening of
pregnant mothers
Child Health Clinic
Well Women Clinic
Community
participation
Legislation Supports the
implementation of
activities
Attorney General
Office
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Budgetary Resource Having adequate
budget to implement
activities
Ministry of finance
Health Information
Dissemination
Health Promotion
Activities
Dissemination of
health information
during outbreak
situation
1. Information
Department
2. Radio and
Television
3. Ministry of
Education
4. Ministry of
Religious Affairs
5. Private Media
6. Private Sector
eg Banks
7. Non
government
Agencies
The various agencies involved in implementing these many
programmes must continue to cooperate and collaborate in order to
maintain maternal mortality and child health mortality at Brunei
Darussalam’s current low level.
12. However, the real challenge is to improve upon these
achievements. For maternal health, this requires greater involvement
and collaboration of multidisciplinary professionals and sectors
(including NGOs and religious leaders) to address more complex
factors of indirect causes of maternal deaths. There is a further need
to sustain multi-agency support and to keep maternal health high on
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the policy agenda. For child health, the focus needs to be on further
reductions of perinatal and neonatal mortality, while still attempting to
eliminate the remaining postneonatal deaths. The former requires
collaboration and teamwork between paediatric and obstetric
personnel and more sophisticated technology and equipment for
intensive care for newborns.
SOCIAL SERVICES (WELFARE, HEALTH AND EDUCATION) FOR
THE DISABLED
The Disabled Population
13. According to the statistics issued by relevant agencies such as
the Ministry of Health, Ministry of Education, Department of
Community Development and also the Disabled Associations in
Brunei Darussalam, the registered disabled people in 2004 was 2,421.
INTER-SECTORAL COLLABORATION OF WELFARE,
EDUCATION AND HEALTH SERVICES FOR THE DISABLED
14. Specific programmes for the disabled are currently in place
under three separate agencies namely the Ministry of Culture, Youth
and Sports, Ministry of Health and Ministry of Education. However
these different ministries and agencies are able to act more effectively
by cooperating and working together through the formation of
committees such as The National Special Education Coordinating
Committee that includes multi-disciplinary representation from the
Ministry of Education, Ministry of Health, the Ministry of Culture, Youth
and Sports, Home Affairs and Religious Affairs. This Committee
provides support in identifying children with special needs and those
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who are receiving assistance from the various Ministries and those
who are not.
15. There are also other inter-ministerial collaborations and
committees dealing with other issues on disabled people some both
on a formal basis as well as on an ad-hoc basis. At the operational
level the officers from the various ministries, responsible for
implementing the projects and programmes also establish formal and
informal networks with each other thus enhancing the effectiveness of
their functions.
Welfare Programmes
16. The Department of Community Development provides
programmes aimed to promote and develop the potentials of the
disabled so they can be self reliant and become the productive
members of the society. These include some special education to the
children and vocational training to the adults. Vocational skills training
courses are aimed to enable the disabled to generate their own
income and be more independent, as well as to improve their living
conditions and to integrate with the community.
16.1 To achieve these objectives, the Department of Community
Development has established two types of programmes namely
Center Based Programmes and Home Based Programmes.
Currently there are two Center Based Programmes, namely Pusat
Bahagia for children and the Employment Training Center for the
Disabled, for adults. The department has established four centers
throughout the country for children with special needs which provide
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basic education and training in acquiring social skills through four
major programmes;
Basic orientation training programme
Vocational training programme
Special academic training programme
Selective employment programme
Among the activities provided by the centers are the basics of writing,
reading and counting, self-care, sign language, typing and computer,
Braille, drawing, handicraft, and sewing.
The Employment Training Center for the Disabled provides vocational
skills training courses to prepare disabled adults for useful
employment in the future. The trainees have to be aged 17 years and
above. The types of training offered at the center include:
Vocational Courses such as handicraft, basketry
making, carpentry, silver smith, and home science,
Basic orientation in mobility for the blind,
Reading and typing in Braille,
Physical education
As a strategy to encourage people with disabilities to enroll in the
training programmes, a monthly allowance is offered to each trainee.
The allowance is adjusted according to the category or grade attained
by the trainee. For those interested in vocational training other than
those offered in the center, they can attend technical schools run by
the Ministry of Education.
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16.2 Under the Selective Employment Programme, the department
provides specific services to the disabled, to enable them to find
suitable employment, start their own business or home industry and
work in sheltered workshops.
16.3 The Home Based or Community Based Rehabilitation (CBR)
programme provides services to those who do not have the
opportunity to undergo training at the center, especially those who live
in rural areas. As for the families of the disabled, supportive therapy is
also extended which helps to alleviate unwarranted fears and
anxieties of parents towards their children.
16.4 Assistance in the form of monthly living allowances under the
Pensions and Disabled Act, 1954 is also extended to the disabled and
their dependants, through the jurisdiction of the Department of
Community Development. In addition, there are also two special funds
under the management and supervision of the Department of
Community Development; The Disabled Fund and The Fund for the
Blind, aimed to assist and support the disabled to undertake projects
especially those which are income generating through a simple loan
scheme.
Health Programmes
17. The mission of the Ministry of Health is to improve the health
and well being of the people of Brunei Darussalam through high
quality and comprehensive health care services which are effective,
efficient, responsive, affordable, equitable and accessible to all, thus
enabling every Bruneian to attain a high quality of life by being socially,
economically and mentally productive. In tackling all the health related
issues resulting from disability, the Ministry of Health aims to provide
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interventions for the management of disability at all levels starting from
primary prevention right to tertiary intervention or rehabilitation.
17.1 Priorities in health care are given to the young population in
particular the prevention of disabilities by optimizing prenatal, perinatal
and postnatal care. In the early 1980s special efforts have been made
towards the prevention of disability through public health education,
necessitating close collaboration between the various government
agencies. Another is through High Risk Clinics initiated by the
Paediatric Departments within the hospitals for the follow up of infants
and children who are at high risk of developing disabilities, and Early
Intervention Clinics and Programmes for children identified as already
having developmental problems in which therapy is provided early in
order to minimize the progression of the disability and improve
prognosis. These programmes were further strengthened and
intensified with the establishment in 2000 of the Child Development
Centre (CDC), the first One-Stop Centre in Brunei dedicated in
providing services to facilitate the diagnosis, assessment, treatment
and support therapies for children in order to ensure their optimal
health and development. The CDC aims for children under their care
to be able to go to normal school once they reach the age of 5 years
and currently is the only government agency providing services for
children below the age of 5 years which is the compulsory age for
starting school.
The services provided at the CDC include Child Development Clinic
run by Community Paediatricians, Child and Adolescent Psychiatric
Clinic, Hearing Impaired Educational Clinic, Occupational Therapy,
Physiotherapy, Speech and Language Therapy, Clinical Psychology,
Medical Social Worker Services and Early Intervention Programmes
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for the under fives run by Play Group Assistants. The CDC also
provide coordination and professional support and training for other
programmes run at other districts and hospitals as well as those run
by non governmental organizations such as Pusat Ehsan and Smarter.
The CDC also regularly collaborates closely and actively with other
agencies namely the Special Education Unit and The Community
Development Department.
17.2 Rehabilitation Services for disabled patients are currently
mainly hospital based whereby the following services are offered:
physiotherapy, occupational therapy, speech and language therapy,
clinical psychology and medical social work. There are also some
provisions for patients who are unable to come to the hospital,
especially in the rural areas where the therapists sometimes
undertake home visits and home based programmes. However these
are limited due to current constraints in manpower. The strengthening
and need to improve rehabilitation services has been identified as a
strategic agenda for the Ministry of Health and a proposal for a
National Rehabilitation Programme has been tabled which when
implemented will enhance and promote further development of various
specific services for the Disabled. Included in the proposal is the
formation of a National Rehabilitation Committee to coordinate and
plan such services.
Education Programmes
18. The provision of education has been and always will be one of
the main national agenda of the government of Brunei Darussalam.
The National Education Policy of Brunei Darussalam aims to establish
an effective, efficient and equitable system of education that is in line
with the national philosophy of a Malay Islamic Monarchy. The
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education policy of Brunei Darussalam is to provide at least 12 years
of education for every Brunei Child including those with special needs.
18.1 For the development of school aged children with special needs,
the Ministry of Education established the Special Education Unit in
1994. The policy of Special Education Unit which is in line with the
National Education Policy is inclusive education for children with
special needs, who can become contributing members of society if an
appropriate educational program is offered. The responsibilities of the
Unit are;
To set standards and to assist in developing and
implementing policies,
To develop guidelines and procedures,
To monitor trends and research and practice,
To review and evaluate programmes and services,
To manage an array of services for students with
special needs,
To support professional development, and,
To participate in long term planning and priority setting
for special education in Brunei Darussalam.
The Special Education Unit organizes services for pupils/students with
special needs with the assistance of Learning Assistance Teachers,
School Based Teams and regular classroom teachers. The staff of the
Unit includes educational psychologists and special educators all with
qualifications and experience in special education. The Special
Education Unit also works closely with other Ministries and agencies
concerned with the welfare of students with special needs and their
families.
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PARTNERSHIP BETWEEN THE PUBLIC AND PRIVATE SECTOR
IN PROVIDING SERVICES FOR THE DISABLED
19. The family, relatives and communities have traditionally been
the cornerstone in looking after the welfare of their disabled members
with support from the government agencies traditionally responsible
for providing services to the disabled. However, an encouraging trend
is emerging in Brunei Darussalam with an increasing involvement of
other public or government agencies as well as the private sector and
the establishment of various non-governmental agencies in setting up
programmes and services for the disabled.
20. In terms of facilities for the disabled, although Brunei
Darussalam has no legislation concerning facilities for the disabled,
but as a result of consultation among the relevant government
agencies such as the Ministry of Development, Ministry of Health and
Ministry of Culture Youth and Sports, a directive was issued by the
Ministry of Development making it mandatory for the inclusion of
facilities for people with disabilities in all future building designs. Since
then, new government and public buildings have been built in
accordance with the directive.
21. With regards to employment, there has been an increase in
public awareness about the special needs of people with disabilities
over the years and a corresponding increase in public acceptance of
people with disabilities. It has been recognized that they can be useful
members of the community and contribute to the economic
development of the country. Although at present there is no
employment quota in the country for people with disabilities but more
and more public and private employers are employing people with
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disabilities. Such encouraging examples can be currently observed in
several government offices and private institutions.
22. With regards to the involvement of the non-governmental
organizations, Brunei Darussalam has seen more the establishment
of more associations for the disabled in the country. These
associations are voluntary and non-profit making and are active in
looking after their members’ interest and in promoting public
awareness about the needs of people with disabilities. The response
from the public and private sectors has been extremely encouraging.
At present there are five such associations for people with disabilities
in Brunei Darussalam;
Pusat Ehsan Al-Ameerah Al-Hajah Maryam (Pusat Ehsan)
Wholly Charity run and supported
Members are physically and mentally disabled
The objectives:
to provide necessary training for special people who
are interested in handicrafts with the hope that the
skill learned can promote self-reliance,
to encourage special people to be active in the
production of handicrafts,
to prepare the special people to be an active
contributor to the society and the country
to generate income for Pusat Ehsan Fund.
The Association for Paralytics and Physically Disabled
Person (PAPDA)
Active in looking after their members’ interest and
propagating awareness to the public on the plight of the
handicapped. The association has been receiving
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donations and supports as well as volunteers for their
activities.
The Association of Handicapped Children of Brunei
Darussalam (KACA)
Formed in 1986 and has two permanent buildings in two
districts.
Active in looking after their members’ interest and receiving
donations and material support from the public.
The Society for the Management of Autism Related
Issues- Training, Education and Resources of Brunei
Darussalam (SMARTER).
Run by parents and families of children with autism
Among the functions:
To protect every individual member with Autism
Spectrum Disorder(ASD) and their family
To work as a team
To show harmony and closeness
To ensure every individual with ASD will have a bright
future.
Brunei Darussalam National Association of the Blind
(BDNAB)
Some of the objectives are to promote deterrent and
treatment for the blind and to plan and implement activities
for the blind.
23. Another involvement of the private sector is in sports for the
disabled. Sports and games among the disabled in Brunei
Darussalam, though it had only very recent developed, has shown
great potential for further advancement. This is facilitated by a number
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of factors such as serious implementation of the national programme;
the introduced incentive scheme for sports; the active role played by
voluntary national organizations and clubs and, the untiring support by
members of the Royal Family.
Although the associations are not sports orientated, per se, they have
included in their objectives to undertake appropriate activities
(including sports). Despite their various constraints, the Associations
have been successful in mobilizing public support in terms of
volunteer workers, and financing certain sporting projects. The most
recent example is the Special Olympics sports event (BOCCE
Championship) recently held in Brunei Darussalam and successfully
organized and coordinated by one of the above associations in active
collaboration with other agencies. It resulted in achieving the
objectives of promoting sports for the disabled, develop their self
confidence, competitive spirit and the positive mental attitude.
HUMAN RESOURCE DEVELOPMENT
24. It is a fact that adequate numbers of properly trained
professionals and skilled workers are required in providing effective
and quality service in all areas including for people with disabilities as
well as those involved in providing maternal and child health services.
Thus, developing human resources is always the government’s first
concern especially since Brunei Darussalam is a small country with
limited human resources and capacity. In Brunei Darussalam there is
already a shortage of local professionals particularly in the field of
welfare and health. These shortages are in all professions including
doctors (medical specialists in rehabilitation medicine and child
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development), nurses (Community health nurses, Health Visitors)
professional counselors (Social Workers), therapists as well as allied
health professionals in all disciplines (Physiotherapists, Speech and
Language Therapists amongst others). In addition at the same time,
there is also a need to increase current services and develop new
ones which further aggravates the negative balance.
25. Towards sustainable human resources, Brunei Darussalam will
continue to train young locals to meet the shortage of trained and
qualified manpower. Brunei Darussalam will also continue to employ
professionals from foreign countries on a contract basis, as deemed
necessary. From the Health Care Manpower point of view, a number
of programmes have been established as part of the effort to
overcome the shortages which include:
Special Scholarship Scheme for students in the field of
medicine and dentistry
Establishment of the Institute of Medicine under the
Universiti Brunei Darussalam
Establishment of the College of Nursing in 1986 under the
Ministry of Education
Continuing Nursing Education with the establishment of
Continuing Nursing Education Unit, a Training centre for
Community Health Nurses and Assistant Nurses
Programmes
Strengthening of postgraduate medical and dental education
through the establishment of a Postgraduate Advisory and
Training Committee and the recognition of Brunei Hospitals
as accredited specialty training centres for various
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postgraduate medical qualifications by international
professional institutions.
Compulsory Continuing Medical Education for all doctors
and dentists
Apart from recruitment of trained manpower, continuous updating and
knowledge of skills is also a priority with opportunities being made
available for those local officers and staff, who wish to pursue
Continuous Professional Development courses both locally and
abroad in their respective fields.
26. To further address issues in human resource development,
Brunei Darussalam is also actively involved in regional and bilateral
cooperation towards capacity building and development such as
seeking consultancies in training and human resource management,
as well as actively participating in related workshops, meetings and
seminars.
CONCLUSION
In delivering welfare and health services which are effective, efficient
and sustainable, various key factors need to be considered. These
include adequate resources especially human resources. However
using an integrated multisectoral approach can synergise these efforts
and result in an enhanced outcome.
The value and rationale of such an approach in the management of a
nation’s welfare and development is well appreciated in Brunei
Darussalam. The excellent collaboration between different sectors
within the Government system as well as public-private partnership
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with various non-governmental organizations have been established
and able to promote community participation and ownership in many
health and welfare activities and programmes especially those
involving the disabled and to a lesser extent maternal and child health.
This cross-sectoral collaboration also involves networking and
cooperation regionally and globally and can also be used as part of
the strategies to address human resource limitations in welfare and
health delivery.
However there still needs to be further strengthening of such
collaboration in order to sustain and enhance further the current level
of welfare and health services available for mothers, their children and
the disabled at all ages.
