Ministry still facing doctor shortage

MTR: The health ministry’s challenge of insufficient health workers and placing them in the remote dzongkhag is likely to continue into the next five-year-plan, threatening the government’s pledge of providing three doctors, including a specialist in all the dzongkhag hospitals.

The ministry raised the issue at the midterm review yesterday. The ministry is struggling to meet the demand of doctors even for the national referral hospital.

Eight dzongkhag hospitals have less than three doctors.

There is acute shortage of specialists and the low salary for the expatriates is further worsening the problem.

The health secretary Dr Dorji Wangchuk proposed to increase the salary to USD 2,500 from USD 1,500 for specialists from abroad.

“There are other factors, including workload and having to work alone without another expert opinion that deters people from coming here,” the secretary said.

Against the target of deploying three health workers in all grade-II basic health units, the ministry had to reduce it to 40 percent.

Dr Dorji Wangchuk said that while the ministry does not have plans to deploy doctors in the grade-II basic health units, it foresees an eminent need to do it because the BHUs are in industrial areas where the workload is increasing.

He proposed to increase MBBS scholarship slots to 30 in the next five years to ease the shortage.

“Only then will be in a position to get doctors of speciality and send them for post graduate and other specialised training,” he said.

The ministry has to fill a gap of about 379 general doctors and 111 specialists. The problem worsens with staff dropping out at the rate of 1.2 percent annually.

At a health conference in September last year, the ministry reported a shortage of 1,900 health workers.

“We’re in the process of working with the Royal University if they could increase the intake of the trainees,” Dr Dorji Wangchuk said.

According to annual health report 2014, there are 4,688 health workers, of which 244 are doctors, 957 nurses, 514 health assistants and 46 drungtshos, among others.

There are 3.3 doctors for every 10,000 people in the country, an increase from 2.8 in 2013 and 2.7 in 2010. The nurse to bed ratio was 1:9 in 2012 improved to 1:7 in 2015.

The ministry has finalised financial incentives for health workers in the rural areas and will soon discuss it with the finance ministry.

Private selective diagnostics services centres jumped to 11 in 2015 from three in 2012.

The online health information system will reach all health units by next year, improving the deployment of staff and performance.

Prime Minister Tshering Tobgay said that before increasing the scholarship slots it is crucial to study the trend of demand over the years.

Prime Minister suggested the ministry to discuss recruiting retired health workers with the Royal Civil Service Commission.

He said mandating new recruits with rural posting could solve the problem of deploying health workers to rural areas.

The ministry’s reprioritization of its human resource development budget from Nu 300 million to Nu 325 million was approved in principle at the review meeting.

The reprioritized budget is for 12 specialisation slots for chest medicine, dermatology, orthopaedic, pathology, psychiatry, radiation oncology, medical oncology, radio diagnosis, transfusion medicine, and anesthesia. Of that, Nu 5 million is to train the drungtsho and menpas.

Construction of the Gyaltsuen Jetsun Pema Mother and Child Hospital will begin from April after the ministry completes its drawings and designs.

Tshering Palden

2 replies
  1. irfan
    irfan says:

    Once a doctor friend of mine shared a rather intellectual speech with me…”for us, in terms of specialisation, to be created with an strategic plan; either patients need to develop medical conditions or diseases must attack them both following a highly strategic pattern”. I still don’t remember whether his voice was having a serious tone to it or it was just another light hearted poetic expression out of some weird frustration. But we all know the system that all medical professionals can’t be trained in all specialisation and hence, all the general doctors become responsible for filling in the gaps where multiple specialisation is required. Compared to the term super-specialisation, this probably executes considerable deviation at least to those responsible for planning and policy making.

    And we all as concerned citizens, through the eyes and voice of media, try to understand what’s happening to the long term planning process when it comes to the all important health sector. While relating doctors to patients, the numbers have improved to 3.3 per 10000 people while total number of doctors stand at 244. The ratio of nurses to beds is at 1:7 in 2015 which is an improvement from 1:9 of the 2012 data. The number of total nurses is at 957 along with the data available for doctors as per 2014 statistics. We still don’t know from this post what is the ratio of hospitals or health units to beds. We still look for a pattern to be reviewed in the next report where we all clearly know how many of those 10000 people develop what medical conditions so that we have a clear picture of the fact where the 3.3 number of doctors remain over staffed or under staffed. Another issue is that we are still not very sure about how to utilise the 0.3 fraction of doctors in the real sense.

    Someone has rightly pointed out that the MoH needs to come up with a strategic plan or otherwise; ministry will continue to face doctor shortage. If 30 additional class XII passed out opt for MBBS, that counts for 30 general doctors to begin with while others can be trained for different specialisation in batches depending on requirements. The policy makers and those responsible for planning neither can make changes to the MBBS system of learning medical science nor they can omit some the BHUs already developed. Even worse is that we can’t expect every BHU to be developed into some kind super speciality hospital.

    For the planning process to be successful through effective execution, there is probably a need to opt for a practical approach towards problem solving. Speed and quality in service delivery needs to be factored in along with making facilities omnipresent. One can either assemble best from the different specialisation at one place or all the best of one specialisation at a place. And still, it all comes down to how the system of medical education defines the terms ‘specialisation’ and ‘generalisation’ in medical science for effective service delivery.

  2. Timbu
    Timbu says:

    Ministry of Health is doing great job but not enough. Look at the promises that say MoH – will place 3 doctors in each dzongkhag including BHU-II. You need to do your homework better.

    They say they are the best in the country for doing this and that in the health field. May be true. But how come the shortage of doctors cannot be addressed. Often I had bitter experience when empty BHU greeted me. In the hospital again the doctor is on workshop or leave. You need to have strategic planning. Or you simply need to incorporate the political manifesto concerning the health and your minister will push forward.hahaha. Let not the politician do your job.

    I doubt even in next 10 years your vacancies will be filled despite many incoming new doctors. I hope MoH will do more homework before saying we don’t have this and that or we couldn’t fulfill that while the ball was in your court.

    This is my sincere opinion only.

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