The ministry is short of 10 dieticians

The joint sitting of the parliament on December 6, endorsed the public accounts committee’s recommendation on the provision of patient meals that the performance audit report had observed.

The committee recommended the health ministry to carry out a vigorous implementation of the Guidelines for Inpatient Food Services for Bhutan, 2013 with the placement of adequate dieticians in hospitals.

Jomotshangkha Martshala’s MP Pelzang Wangchuk said a guideline already exists and instead of sending a dietician to all meal providing hospitals in the country, the ministry could train existing health workers on food and nutrition and create awareness on nutrition.

Health minister Tandin Wangchuk said Basic Health Units (BHUs) admit patients only during emergencies and do not provide them meals. Dzongkhag, regional and the referral hospitals provide meals to inpatients.

“For a patient to recover soon, providing nutritious food is important,” Lyonpo said adding that the guidelines, which the hospitals still use was framed for this reason.

While the ministry had taken initiatives to implement the recommendations at hospitals and BHUs, the Royal Audit Authority (RAA) reiterated for a need to have an overall action plan at a ministerial level in order to have a common and uniform approach across all health centres.

The ministry was asked to prepare an action plan at the National Level and formulate appropriate policies and standards.

Lyonpo said the ministry plans to improve the existing guidelines. The new guideline is expected to be in place by the end of this month. “All the RAA’s recommendations will be included in the new guideline.”

The new guideline will include introducing different types of diet and nutrient dense or fortified food as per the patient requirement and WHO’s Recommended Daily Requirement. It will also include periodic health check-ups of food handlers and provide training to them to make them aware of safe food handling. The responsibilities and accountability of the staff will also be identified.

Lyonpo said WHO has granted Nu 4.4 million (M) for the training of kitchen staff and other necessary works that has to be done as per the recommendations. “The ministry has started working on it.”

Currently, on an average, the government spends Nu 54 a patient for their meals in hospitals. Considering all the recommendations, Lyonpo said the expected cost of the meal a patient comes to Nu 78.

The government has spent Nu 122.443M from 2013 to date for patient meals in the country, which amounts to an average of Nu 1,653 a patient. For the national referral hospital alone, the government spends about Nu 4M annually on patient meals. For 2017 and 2018 financial year, the budget for patient’s meals has increased to Nu 9.739M.

Lyonpo said all 10 recommendations of the RAA are the responsibility of the ministry as its responsibility is not only to treat patients but also prevent the diseases. Today, a total of 43 hospitals manned by 74 staff provide meals to patients.

The ministry is required to have at least a dietician in all hospitals that provide patient meals. But only some hospitals have dieticians who not only assess patients’ diet but also counsel patients on nutrition issues and healthy eating habits.

Of the 29 dieticians, three dieticians are at the national referral hospital and two each in Mongar and Gelephu regional referral hospitals. The rest are in dzongkhag hospitals and the ministry is short of 10 more.

As per the recommendation, Lyonpo said the ministry plans to have a dietician in all meal providing hospitals in the country.

Lyonpo said the ministry has started discussing with the civil service commission on the shortage of dieticians. However, it is yet to be confirmed if the commission would be able to provide all 10 dieticians in a year.

Of the 10 recommendations the RAA recommended, seven are partly implemented and three yet to be implemented.

The RAA audited patient meals in six main hospitals of Thimphu, Mongar, Gelephu, Phuentsholing, Trashigang and Samdrupjongkhar.

Dechen Tshomo