JDWNRH officials propose granting full autonomy to the hospital as a way forward

Although the Parliament has decided to stop the corporatisation of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), the committee that was constituted to study the proposal will continue and submit a report to the cabinet, Prime Minister Tshering Tobgay said.

On September 18, the committee was reconstituted to study and assess the possibility of corporatising the hospital. It was also to study the functioning of JDWNRH as an autonomous agency and determine areas for improvement.

During a meeting with members from the media yesterday, Lyonchhen Tshering Tobgay said it is the government’s responsibility to maintain the free healthcare system.

He said that when it comes to specialist services, regional hospitals are important. “The national referral hospital is important and we have many plans to strengthen, improve and offer new services. We are working as per the plan.”

The government is concerned of the specialists’ work burden. “We thought we need to incentivise them for their hard work and corporatisation was one of the strategies. So we discussed about it but it was not decided.”

However, Lyonchhen said people are concerned that they will have to pay for health services if the status of the hospital is changed into a corporate entity. “Despite our repeated attempts to clarify, they continue to believe in the widespread misconception.”

The government’s intention to explore corporatising JDWNRH was good, he added. “But when people have wrong perception of corporatising the hospital and are concerned, I am deeply concerned.”

He said the objective was to improve efficiency and effectiveness in the delivery of health services in the country and that the government will continue to improve the services. The government will look for new ways to incentivise the specialists and will discuss about it with the doctors.

The government will review the committee’s findings and recommendations on improving the services and incentivising the specialist while the hospital functions with autonomy. “We will be able to decide after reviewing the report,” lyonchhen said. He said many institutions have raised concerns on corporatising JDWNRH. “We are acknowledging it so we discussed in the cabinet and decided to stop it.”

The hospital’s President, Lhab Dorji, said it is the wisdom of the Parliament to decide not to corporatise the hospital.

Currently, JDWNRH has no authority in human resources and finance. “While the Parliament has decided not to corporatise the hospital, the opportunity to provide full autonomy to the hospital is still there with the cabinet.”

He said it would be better to let the committee complete its study. “They have been working for the last two months and they have collected many information.”

Lhab Dorji said JDWNRH functions as the Thimphu dzongkhag hospital, national referral hospital and teaching hospital to the Khesar Gyalpo University of Medical Sciences of Bhutan.

While the referral system requires patients from Basic Health Units (BHUs) to be referred to the dzongkhag hospitals, to regional hospitals and then to the national referral hospital, it doesn’t work that way.

Today, JDWNRH has patients coming from across the country and because of that specialists are stretched for time and Out-Patient Departments are overburdened. “At the same time, we cannot deny the services because people come for specialist services,” Lhab Dorji said. “If the referral system is strictly implemented, then our staff will not be heavily burdened.”

He said specialist retention is a problem because the hospital has lost at least five specialists in the last two years. “We had only one vitreoretinal specialist and an interventional radiologist and we have lost them. We might lose some during the elections. It is mostly the sub-specialist that leave the hospital because they can get a job anywhere.”

Lhab Dorji said the issue is not confined to financial matters. Opportunities to attend at least an international conference a year and continuing medical education are some of the proposals from specialists.

He said everyone working in the hospital has to be paid better.  “Now the only way for JDWNRH is if the government gives autonomy in human resources and finance.”

Should it be given full autonomy, the hospital would have the authority to fix salaries and incentives according to the staff’s performance. “If we have full autonomy, we will recruit people as and when we need and asked those who don’t perform to leave. The number of employees will also change but productivity will increase.”

The finance ministry can then allot a block grant to the hospital and within the grant, the hospital should pay for the medicines and also pay the hospital staff better, he said.

A specialist at the JDWNRH said that if the intention of corportising JDWNRH is to privatise public health services, then it is right for the Parliament to stop corporatisation. But, the government has clarified that’s not the intention.

“A groundwork and consultation would have helped,” the specialist said.

The specialist said that a committee was formed to study and assess the possibility of corporatising the hospital and the parliament could have waited for the findings of the study due this month to take a decision. “There was no need to hurry.”

Health secretary Dr Ugen Dophu said the committee would continue with the study and submit the report to the cabinet at the end of this month, as he did not receive any orders to dissolve the committee.

Dechen Tshomo