The government’s recent announcement at the meet the press session on the corporatisation of Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) as a solution to retain specialists may be easier said than done.
The arguments advanced for the corporatisation is to get away from the clutches of the Royal Civil Service Commission (RCSC) so that higher salary or allowances could be paid. This is only based on the assumption that specialists leave the system due to low salary or allowance. But one can suspect that the issue is beyond financial incentives alone.
In national interest, the issue merits an in-depth study by the commissioned committee before embarking on a decision to make JDWNRH a corporation. JDWNRH enjoys a special status and is at the centre of health services in Bhutan. It has a direct relevance to the mandate of the health ministry. Once it is corporatised, made into a State Owned Enterprise (SOE), and bound by the Companies Act of Bhutan 2016, the ministry may have complicated relations with JDWNRH once it’s severed from the civil service’s umbilical cord and made a commercial entity.
The Constitution states that the State shall provide free access to basic public health services in both modern and traditional medicines. This constitutional mandate may not go down well with the commercialisation of a core institute such as the JDWNRH, which is the apex and epicenter of health services in the country.
A pertinent issue that would arise with corporatisation would be the equation between health workers, including specialists and doctors, of JDWNRH and other hospitals/BHUs in the country. Or are all health workers going to be with the JDWNRH?
If the strategy is to retain specialists through better salary and allowances, the government has the legal option to capitalise on the provision in the Civil Service Act of Bhutan. Section 55 of the Act states, “Salary, allowances, benefits and other emoluments of the civil servants shall be determined by the Royal Government as per the Constitution.” As there is a system of paying allowances for scarce professions even now, it may be worthwhile to explore this option before venturing into corporatisation.
The efforts made by the government to address the specialist shortage issue are appreciated. However, getting the strategy wrong could bring much bigger problems in the health sector and the health of the public at large.