The MBBS programme at the Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) could take some time to begin if the deliberations at the National Assembly on June 6 are anything to go by.

Members said that it is early for the university to embark on such a programme given the shortage of experts who can deliver such training in the country’s health sector.

Starting the MBBS programme at the KGUMSB was one of the nine recommendations in the report on SDG Goal 3: Good Health and Wellbeing presented by the Social and Cultural Committee at the Assembly on Thursday.

Health Minister Dechen Wangmo said that the country will have 133 MBBS doctors in five years and the requirement in the same period is 160. This means there is a gap of only about 27.

Lyonpo said that there was no need to start the MBBS programme now. “We may need the programme in the future, but not immediately.”

Lyonpo said that the university already has a postgraduate course. “Instead of starting MBBS programme, if we could lay a strong foundation of the PG course, the benefit would be much greater.”

Prime Minister Dr Lotay Tshering said he was confused and questioned the appropriateness of some of the recommendations put forward for deliberation.

He said the discussion should be on the policy. “Some of the recommendations need not go to the ministry. It can be discussed and carried out by the national referral hospital.”

Lyonchhen said the deliberation should be on the SDG 2030 agenda and the national Key Result Area (NKRA) 14. “To see if our plans are properly aligned to achieve SDG 2030 and the NKRA 14 goals and if the health programmes are distributed accordingly.”

If these are not done, Lyonchhen said that the government should be reminded of it. “If we are not able to fulfill the targets because of policy and if there is an opportunity to review and change the policy, the committee should present it to the House.”

On the MBBS programme, Lyonchhen said starting the programme would cost the government a huge amount.

Lyonchhen said that there is no shortage of doctors. The shortage, he said, is of specialist and suggested if the existing postgraduate courses at the university could be supported by investing in it.

Besides the MBBS programme, the committee recommended the government to increase the ex-country seat for professional courses and exploring possibility of delinking clinical services from civil service. They also recommended incentivising to professionalise their services and address the shortage of specialised health care providers including specialists.

The committee also recommended reviewing the superannuation age limit of specialist to address shortage and hiring retired or superannuated doctors based on their area of specialisation and need.

Lyonchhen said reviewing the superannuation age limit of specialist is not in the government’s purview, as it is determined by the civil service Act and guidelines.  “Increasing the superannuation age to 65 is not fair to them. It won’t benefit them.”

Lyonchhen suggested hiring retired specialist on contract with additional incentives. “We have been discussing this. If we overcome challenges because of the RCSC’s Act, we will present it to the House for deliberation. We expect support from the members,” he said.

Panbang MP Dorji Wangdi said that while the deliberation was on the SDG Goal 3: good health and well-being and NKRA 14: Healthy and Caring Society, the recommendations were only related to health. “Of the many activities, health is only one part. We are focusing only on how to treat the disease, not the cause,” he said.

Opposition leader Pema Gyamtsho (PhD) said that if health services cannot be overhauled during this government’s tenure, then it would be difficult in the future. “It is the right time to make the required changes to improve the health services in the country. It is our responsibility to do that.”

The opposition leader said retention of doctors and specialist was critical to continue providing health services and improving it.

While monetary incentives are one of the ways to retain health professionals, the opposition leader said that this alone would not help retain them. There is a need to improve their working environment.

However, the opposition leader said that when trying to make changes, there are inconveniences because it has to be done according to the RCSC Act and guidelines.

“This is the main disease,” he said. “If we are to have sustainable quality health services, we have to delink the health sector from the RCSC.”


A Health Bill

It was also recommended that the Health Bill be tabled during the fourth session of the second Parliament.

Lyonpo Dechen Wangmo said the country currently doesn’t have a Health Bill and it was critically important to have one. “This was also one of the government’s important pledge.”

Considering the importance of the Bill, Lyonpo said it would be wise not to have a time frame to table the Bill, as it requires consultations with the people and stakeholders.

The opposition leader said drafting a Bill took time, as proper research needs to be done. “So, it is not appropriate to ask the minister to table the Bill in the fourth session.”

When health services are provided, he said drugs and medical equipment are required immediately. The procedures include writing a note sheet and waiting until it is approved. “There is a need to review and change the medical procurement rules if health services are to be improved.”

Other recommendation to encourage private sectors to provide health facilities, placing diploma holders of the same duration in the same grade as the grade of paramedical health workers were also discussed.

One recommendation was improving the efficiency of service delivery and decongesting JDWNRH. Members also recommended constructing a city hospital or district hospital in Thimphu, regularising assistance to Privately Enrolled Medical Students (APEMS) to full scholarship to address the acute shortage of doctors and making scholarship uniform.

Dechen Tshomo