Some of the main concerns expats have when moving to a new country are related to healthcare and disease control. So, what can you do to ensure you get the best in healthcare when you are living in a completely different environment than what you are used to?Located in Southeast Asia, on the northern coast of Borneo, Brunei is a small nation that offers its residents and expats the opportunity to live a quiet and serene lifestyle. It is officially known as the State of Brunei Darussalam. With a population of about 400,000 people, the country boasts unspoiled rainforests and picturesque white sandy beaches. There is a diverse demographic of people living here, with about 66 percent Malay, 11 percent Chinese and 3 percent indigenous. About 20 percent of the people living here are outsiders, from all over the world, who make up the expat community.
While the official language is Malay, English is spoken by most people in the business world. English is also the primary language used in schools. The weather here is mostly hot and humid, and sometimes rainy, with an average annual temperature of 26°C.
After Singapore, Brunei is the place with the second-highest HDI (Human Development Index) in Southeast Asia. It is classified as a developed country and ranked fifth in the world by the IMF in terms of gross domestic product per capita at purchasing power parity. Brunei has developed wealth from its rich petroleum and natural gas sources. Brunei is also one of the founding members of the World Trade Organisation (WTO). Thus, it is an ideal market for investors and people looking for employment.
Expat life in Brunei
A lot of expats are drawn to the low cost of living, good employment packages and tax-free income in Brunei. The expat community here makes up around 40 percent of the country’s population. It can be a bit of a culture shock, as Brunei is a strict Islamic country and expats are expected to dress modestly and abide by the local laws.
Fueled by some of the largest oil fields in Southeast Asia, the economy of Brunei is growing rapidly. Around 167,000 barrels of oil are produced on a daily basis. Expats are most likely to be employed in one of the many international industries that have been growing in recent years. There are many unique and interesting job opportunities for expats living here.
Ministry of Health in Brunei
The Ministry of health deals with all aspects of healthcare in Brunei and aims to improve the health and well-being of all citizens. The Primary Healthcare (PHC) service, which consists of clinics and health centers, aims to provide universal access to healthcare for the entire population of the country.
The Ministry of Health aims to provide primary healthcare and to focus on the management of chronic diseases. The ministry also works towards creating comprehensive databases and data management systems that support managerial, professional and operational functions.
Healthcare services in Brunei are categorized into two major services, namely the Directorate of Medical Services and the Directorate of Health Services. The Directorate of Medical Services is responsible for areas like nursing, hospital, laboratory, dental, pharmaceutical and renal services. The Directorate of Health Services is responsible for the areas of environmental health, community health and scientific services.
In an effort to improve the quality of healthcare services in the country, the Ministry of Health has put great emphasis on the skill development of its workforce. The ministry works on a long-term plan for the development of additional healthcare professionals in various specialties through workshops, seminars, training courses both locally and overseas. Efforts are made to develop stronger post-graduation programs and local doctors are often sent overseas to receive specialized training.
The hope is that over time the role of the ministry will change from that of a provider of healthcare services to more of a regulatory body, while improving the quality and efficiency of the care provided to patients.
Healthcare financing
Healthcare services in Brunei are funded by the General Treasury. The budget is allocated by the Ministry of Finance and is in turn administered by the Ministry of Health. There is not much information available about private healthcare spending, but it was estimated in 2000 that the ratio of public to private spending was approximately 97.2 percent public as opposed to 2.8 percent private.
There is a very limited market for private insurance since the government pays for comprehensive healthcare services. In the case of expats, employers typically purchase health insurance locally. If the employer is a multinational company like an oil company or a bank, they might opt for international health insurance.
Healthcare services
Brunei Darussalam has a large network of clinics, health centers and hospitals that are located throughout the country. In remote areas that are difficult to access by land or water, healthcare is provided by the Flying Medical Services.
The healthcare system in Brunei is known to be one of the best publicly-run systems in the world. The medical industry here is small but growing fast. The Ministry of Health is focused on providing free medical services to its citizens. The two major hospitals here are Jerudong Park Medical Center and Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital. They are both equipped with the latest facilities and advances in modern technology. In 2015, the Ministry of Health launched a 20-year strategic plan outlining upgrades to existing hospitals and building of a new outpatient hospital.
Expats can rest assured that they will have no trouble finding medical assistance when living in Brunei, as there is at least one hospital located in every district. The largest city and capital of Brunei, Bandar Seri Begwan, boasts at least 10 health clinics and about 16 health centers. In the event that a patient cannot be treated in Brunei and needs additional medical facilities, measures are taken to send the patient overseas to treat the illness. Between 2011 and 2012, the government spent over 12 million Brunei Dollars on the treatment of Brunei citizens in Malaysia and Singapore. Local residents of Brunei are charged just 1 BND per consultation.
The largest hospital in Brunei is Raja Isteri Pengiran Anak Saleha Hospital, which houses 538 beds and is situated in the country’s capital. The other two prominent, privately-run medical centers are Jerudong Medial Centre and Gleneagles JPMC Sdn Bhd.
While healthcare is not free in Brunei, government-run hospitals will provide you with treatment without any form of payment guarantee, and patients are expected to settle their bills prior to being discharged.
Medical insurance however is essential for expats, and you should make sure that your policy includes the following:
• Air ambulance services, in case you need to be flown home
• Full medical cover, as bills can be expensive
• Cover travel for your family, in the event of illness or injury
• Coverage of the costs to bring the body home in the event of a death
In the event that you need urgent medical assistance, the number for an ambulance is 991.
There is a Flying Medical Services division in Brunei that is responsible for airlifting those who require any emergency medical assistance, especially if they live in remote rural villages.
For those who prefer private healthcare, there are number of private clinics and hospitals to choose from.
Services provided by PHC
Here’s a list of the services that all PHC centers will provide during office hours:
• General Clinics – General clinics look after patients with health issues ranging from non-communicable to communicable diseases. Patients can also visit these clinics to get a general medical fitness check done and for various health screening tests.
• Flu Clinics – Flu clinics attend to patients who exhibit influenza-like symptoms like common coughs and colds.
• Chronic Disease Clinics – These clinics attend to patients who have chronic diseases like hypertension, diabetes and asthma, and also attend to patients who need regular follow-up checks.
• Clinics that deal with treatment room procedures like wound dressings, suturing, urine checks, nebulisers and so on.
• Clinics that handle vaccinations.
Other additional services offered by some clinics are:
• Phlebotomy, which is a service that specializes in taking blood samples
• Nurse-led clinics that are equipped with a Diabetes Nurse Assistant, offering cervical cancer screening, smoking cessation treatment and general health screening
• Allied Health Professionals like dieticians and psychologists
• Child healthcare services
The Primary Healthcare Service also includes an Extended Hours (EH) clinic located in Bandar Seri Begawan Health Centre. The aim of this clinic is to provide urgent or semi-urgent care during the hours when most health clinics are not operational. This service operates on weekends and public holidays too.
Visiting a PHC
Most Primary Healthcare clinics follow one of two systems of seeing patients: the walk-in system and the appointment-based system.
Walk-in system:
Usually, patients just walk into a health center or clinic and register to see a doctor. It is really simple: you just register for a consult, speak to the nurse, and then wait your turn to be seen by a doctor. This system is especially used in general clinics and flu clinics. However, an exception is made in emergency cases when patients need to be seen urgently.
Appointment-based system:
Chronic Disease Clinics are strictly appointment-based and patients are given an allocated time to visit. The reason behind this is that patients with chronic illnesses require regular attention and have to keep coming back for follow-up appointments. Hence, their appointments and consults with the doctor are planned and the doctor reviews their case on each visit.
Some General Clinics also require patients to get an appointment before a consult. This helps to reduce the waiting time for the patient and also ensures that the doctor can adequately address each patient’s complaints. If the situation is not urgent, a patient might be given an appointment on another day.
Improvements to the healthcare system
The Ministry of Health has put forward a number of healthcare reforms in the interest of making improvements to the existing system. These reforms have been necessitated by increases to costs of healthcare, new diseases being discovered, changing lifestyles, a changing demography and advances in health technology.
Fiscal problems relating to growing health costs, paradigm shifts in healthcare needs, lifestyle changes, an increasing number of older people and those with different needs, are all factors that contribute towards the challenges faced the Ministry of Health. One other factor is the ongoing technological and digital revolution.
One of the biggest critical success factors is that the priority given by the government to the importance of health has greatly improved over the years. This is evident through the recurrent development budget and the comprehensive healthcare plan that is cost-effective. The healthcare plan addresses areas like the promotion of healthcare through education, focus on treatment and rehabilitation, a focus on the areas of prevention, a focus on the availability of highly-trained staff and offering comprehensive yet cost-effective services.
Other improvements to the healthcare system have been by way of collaborations between the government and other non-governmental organizations towards supporting public participation in improving overall healthcare services.
Final advice for expats
Check in with your employer to see what your insurance provides, and have the contacts and numbers of all medical services in your area. If you are currently on any kind of medication then do check with immigration as to which medications you are allowed to travel with, as some medicines or brands might be banned in Brunei. Expats travelling to the country can rest assured that they will find all the support they require for their healthcare and wellness needs there, but it is advisable to plan in advance, especially if you have a chronic health condition.