Health officials propose off-hour clinic practices in dzongkhags

This was among the 16 issues officials from the dzongkhags raised at the biennial health conference

With specialists at the Jigme Dorji Wangchuck National Referral Hospital practicing off-hour clinics, health officials from the dzongkhags enquired if the same could be allowed to doctors in other parts of the country.

The dzongkhag health officials raised this at the fourth biennial health conference in Thimphu on September 16.

Health secretary, Dr Ugen Dophu, said that when the opportunity for off-hour practices was given at the national referral hospital, it was only open for the specialist group and said even the national referral hospital was facing some difficulties. “After making it official, they had to stay in their chambers from 4pm to 7pm, sometimes without a single patient coming for a whole week.”

The secretary asked the health officials to decide if they really wanted the off-hour practices in the districts.

Dagana’s dzongkhag health officer, Dorji Wangchuk, during a presentation on the issues from the dzongkhag said that according to the health ministry, the off-hour practices at dzongkhag hospitals were not found viable, as there are not enough patients for financial viability or sustainability.

One of the participants said he is against off-hour practices in the dzongkhags, as it is similar to double practice, which is against the Constitution and section 18.4.8 of the Bhutan Civil Service Rules and Regulations 2012, which states that a civil servant shall not carry out consultancy services.

The need to strengthen human resource (HR) for dzongkhag health sector offices was another issue raised at the conference.

Directorate of services’ director, Tenzin Chophel, said the issue would be addressed by the new HR standards. “As soon as the new HR standard is approved by the Royal Civil Service Commission (RCSC), all dzongkhag, referral, or regional hospitals will be allocated with HR as per the standard.”

On the supply of utility vehicles for BHU I, Dr Ugen Dophu said the ministry cannot commit to provide utility vehicles for BHU I but those in dire need should write a proper justification why it is needed.

The conference also revealed that 50 percent budget is allocated to the local governments in the 12th Plan to address ambulance budget and maintenance issues. The dzongkhags have to manage major maintenance requirements.

Dorji Wangchuk said that unlike the current practice, pre or in-service staff such as doctors, nurses, health assistant (HA) and technician should be placed in the dzongkhags first, rather than health centres. “District HR Committee can decide where to place them.”

Currently, doctors, dentists and clinical nurses are appointed and placed by RCSC on merit basis whereas HAs and other diploma holders are selected and sent to the districts by the health ministry.

The conference recommended having a training unit for coordination of all in-country training, workshops and meetings, to avoid duplication of nomination and to avoid irrelevant nominations.

Proposals were also made for a feasible training calendar from the beginning of the year to address issues such as overtraining or to address the shortage of manpower in health facilities.  The nominations are to be judiciously processed by dzongkhag human resource committee.

Health officials also proposed for a room to stay at the national referral hospital when they escort patients. Although the provision was introduced in the past, it was stopped, as no one stayed.

It was resolved that the current practice will be followed, where the ambulance could drop them to their relatives place within Dechencholing and Babesa area.

Tenzin Chophel said the shortages of health workers and female HAs could have a long-term impact in health coverage and achievements as most health facilities such as BHUs have just one health worker. This issue he said, would be covered by the new HR standard. “It is also included in the ministry’s annual performance agreement and we will be doing a more comprehensive study of the requirement at the end of the year.”

Karma Cheki

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