Section A: Governance
What are the main national sources of health financing?
The main source of health-care financing is through general government health expenditure (GGHE), which is mainly financed through general taxation. In 2020, current health expenditure (CHE) was 2.4% of GDP, equivalent to US$ 650.5 per capita. Domestic Government Health Expenditure (DGHE) was 94% and out-of-pocket (OOP) payments made up 6% of the current health expenditure (CHE). The 10-year historical trend (2010-2020) in health expenditure has shown a gradual upward trend consistent with the modest population growth, indicating the consistency of the government policy in investing in health to sustain universal health coverage.
What is the main national Strategic Purchasing unit for healthcare?
As strategic purchasing is a nascent concept in Brunei Darussalam, there is no established unit for strategic health purchasing.
The Ministry of Health’s Scheme of Charges Committee reviews charges and access to care for the population.
The assessment of national health priorities is done ad hoc via internal processes within the government and Ministry of Health (MOH). There are some national policies that can guide the setting of national health priorities (Wawasan 2035, Brunei Economic Blueprint, Ministry of Health Strategic Plan 2019-2023). However, it is unclear whether these policies inform purchasing decisions.
Other strategic purchasing functions, such as reviewing current gaps in service provision, are similarly done on an ad-hoc basis (e.g. by calling for executive committee meetings).
The Ministry of Health’s Finance & Procurement division oversees four units involved in purchasing/procurement.
Payment unit: arranges the payment of claims to suppliers and contractors.
Revenue unit: processes reports and monitored revenue generated by the Ministry.
Budget unit: processes applications for the MOH’s annual budget estimates to provide to the Ministry of Finance.
Payroll & Allowance unit: processes the payment of salaries for MOH officers and staff.
What agencies/institutions are involved in healthcare purchasing nationally?
The Ministry of Health (MOH) is involved in the national purchasing of medicines and vaccines, medical equipment and consumables, healthcare services (e.g. surgeries and consultations) and healthcare support services (e.g. facilities management).
Hospitals and primary health centres may also be involved directly in the purchasing of healthcare support services.
What is the market structure of healthcare purchaser(s) nationally?
Purchasing of services, consumables, equipment, devices etc. is conducted centrally by the Ministry of Health (MOH). Small private providers conduct their purchasing independently.
Several structural reforms have been introduced to boost the efficiency of service delivery through the outsourcing of selected clinical services and non-critical supportive services (e.g., linens, waste management, catering, etc.).
To enhance the efficiency of procurement process, there are plans to introduce a centralised procurement entity independent of MOH to manage procurement processes. This effort to introduce a provider-purchaser split is aimed to improve timeliness and transparency. However, due to the current market structure and limited number of suppliers, there is concern about inefficiencies due to market access.
Is healthcare purchasing conducted in a decentralised manner or universally across the health system?
Purchasing decisions are coordinated centrally by the Ministry of Health (MOH) through different procurement committees. Purchasing by private providers is done independently but is very limited.
If purchasing is conducted in a decentralised manner, are there any plans for integration?
N/A.
What are the top five agencies/institutions involved in purchasing health goods and services nationally?
The Ministry of Health (MOH) is the top purchaser, with the following total dollar value of purchases in recent years:
2017: 359,644,296.75
2018: 420,128,482.30
2019: 380,611,115.25
2020: 376,564,808.78
2021: 329,592,116.77
The Ministry of Finance and Economy and private health institutions are also involved in purchasing for health-related goods and/or services. However, their total dollar value share is limited as purchasing is conducted centrally by the MOH.
What criteria do the main healthcare purchasers use to determine what to buy?
The criteria used the Ministry of Health (MOH) in determining what to buy include:
• Ability of the supplier/provider to meet contracting specifications;
• Price;
• Track record.
How do the main healthcare purchasers govern their use of funds?
No information found.
Who are the main stakeholders involved in decision-making on health financing and the health system?
The Ministry of Finance and Economy sets budget plans, including for the Ministry of Health (MOH).
Health financing stakeholders within the MOH include the following:
• Senior Management Team
• Director General of Medical and Health Services
• Department of Policy and Planning
• Relevant Heads of Department
• Relevant Chief Clinical Specialties
Who are the main stakeholders involved in decision-making on strategic health purchasing?
As there is only evidence of passive procurement — not strategic purchasing — there are no clear stakeholders involved in decisions on strategic purchasing.
Section B: Legal and Policy Landscape
What laws/regulations define the mandates and roles of healthcare purchasers and providers?
The Ministry of Health administers eleven legislations governing different medical professions (e.g. midwives, nurses, medical practitioners), diseases (e.g. mental disorders, infectious diseases), medicines (e.g. licensing, labelling) and other public health concerns (e.g. food, tobacco).
National policies including Wawasan 2035, the Brunei Economic Blueprint and the Ministry of Health Strategic Plan 2019-2023 assist in guiding national health priorities.
What policies/regulations are in place surrounding healthcare purchasing?
Currently, there are no public policies and regulations for healthcare purchasing. Existing regulations only cover licences to practice for health professionals (doctors, dentists, nurses, midwives and allied health professionals).
What laws/regulations govern public finances and public spending?
The Constitution (Financial Procedure Order) which provides guidelines on procurement, public financial management and accounting to ensure accountability of public moneys.
The Constitiution (Financial Procedure) Amendment Order 2022 updates and amends the above.
What government procurement & tendering processes are in place?
The following regulations are relevant to government procurement and tendering processes in Brunei:
• Constitution (Financial Procedure Order), which outlines expected conduct for procurement and State tender processes. The Order states, “Every Government procurement shall be conducted in an open competition and with responsibility, transparency, accountability, openness, fairly and justly and in accordance with any guideline or procedure as the Minister may issue.”
• Guidelines on Procurement and Tendering (in Malay).
The procurement method used will depend on the value of a purchase.
Small value purchase: for goods and services up to BND$2,000.00. This may be carried out directly by Ministries by purchasing from known sources.
Quotation: for goods and services between BND$2,000.00 and BND$50,000.00. At least 3 quotations must be obtained from suppliers. The relevant department will evaluate offers and a Quotation Committee will give final approval.
Tender: This can include open, selective or limited tenders (Waiver of Normal Procedures). In open tenders, all suppliers may respond to a tender notice. In selective tenders, a qualification exercise is first carried out, and qualified suppliers are invited to submit tenders. Limited tenders may be used for urgently needed suppliers or other specific circumstances; their use must be approved by the Mini Tender Board or State Tender Board.
What healthcare-specific procurement & tendering processes are in place?
The Ministry of Health (MOH) publishes tenders & quotations, as well as relevant guidelines, for suppliers to submit to.
Bids can be submitted to all suppliers who submit the required forms, hold a valid business licence and are registered with the MOH or Ministry of Development when applicable. Suppliers wishing to supply medicines must possess a Poison Licence, as per the Poison Act (Cap 114).
The Payment unit in the Finance & Procurement division in the Ministry of Health (MOH) oversees the payment of claims to suppliers and contractors.
Based on the new Constitution (Financial Procedure) Order 2022, the Ministry of Health has adopted relevant processes in carrying out procurement activities such as setting up different procurement committees determined by project value; with each having its different processes for evaluation and selection.
In addition, there is evidence or processes to ensure the efficiency of purchasing; for example, the use of standardised contracts with performance bonds, performance-based budgeting and anticompetition regulation.
Who is responsible for enforcing contracts with healthcare providers and suppliers, and how is this done?
Enforcement is conducted by the contract owner and is therefore specific to each contract.
Within the health sector, contract management is evident in all purchasing done by individual contract owners with central oversight from the Ministry of Health (MOH). These include the medicine inspector, legal unit and finance officers. According to the MOH, suppliers who reject or revoke an offer will be penalised according to State Tender guidelines.
The monitoring and evaluation of contracts remains on an ad-hoc basis and there are no processes in place to monitor performance and compliance.
Section C: Performance Monitoring
What regulations or accountability frameworks are in place for healthcare purchasers and providers?
There are no accountability frameworks in place for purchasers (i.e. the Ministry of Health as the main purchaser) or service providers. Service Level Agreements (SLAs) are being discussed, but it is unclear if any existing regulatory framework was used to draft such agreements.
Are there performance-based incentives in place for healthcare providers and suppliers?
There are no performance-based incentives. However, there are penalties to healthcare suppliers for missing delivery dates.
What systems are in place to assess the performance of healthcare providers and suppliers?
There are no strong systems in place. The monitoring and evaluation of contracts is done on an ad-hoc basis and there are no processes to monitor performance and compliance of providers/suppliers.
What mechanisms are in place to provide feedback to healthcare providers and suppliers?
Feedback is provided solely on an ad-hoc and as-of-need basis.
What processes are in place to assess health system performance (utilisation, financial protection, quality, efficiency)?
Brunei’s Ministry of Health publishes strategic plans (e.g. the Ministry of Health Strategic Plan 2019-2023) which set goals and key performance indicators. For 2019-2023, the following indicators are listed:
• Health status (including morbidity and mortality)
• Risk factors (including nutrition, infections and noncommunicable diseases)
• Service coverage (including mental health and reproductive, maternal, newborn and adolescent immunisation)
• Health systems (including quality & safety of care, utilisation & access, health workforce, health information, health financing, security & governance)
Information dashboards are maintained to track key health system indicators such as length of stay, bed occupancy, readmission rates, etc.
What data and information management systems are used to monitor health system performance?
The BruHIMs (Brunei Health Information and Management System) is a comprehensive electronic health record used to record attendances, management and treatment of patients attending all government health facilities and several private hospitals throughout the country.
From this rich data source, several information dashboards have been developed to show key health system indicators such as length of stay, bed occupancy, readmission rates, etc. More recently, the Ministry of Health (MOH) is introducing a web-based platform using AI-based techniques (Natural Language Processing and Machine Learning) to enhance its capacity to analyse and report on health system performance that will support policy and resource allocation decisions.
How are findings on health system performance used to inform purchasing decisions?
Currently, findings on health system performance are considered in ad-hoc discussions on the procurement of drugs, medical equipment and consumables. During the annual budget preparation, the submission of basic statistics about utilization rates, resource usage, etc is expected. However, it is unclear how this information has been used in purchasing decisions.
What health & operational indicators are used to monitor and evaluate health purchasing decisions?
No specific indicators are used to monitor and evaluate health purchasing decisions.