Patient meals in hospitals were not provided based on nutritional requirements or disease condition, the latest performance audit report, on provision of patient meals states.

“All in-patients are provided regular meals regardless of clinical conditions,” the Royal Audit Authority (RAA) report stated. “This could result in not meeting the specific nutritional needs of patients thereby deteriorating their disease condition and prolonging hospital stay as well as their recovery.”

Patient meals are provided at grade I Basic Health Units (BHU), district hospitals, regional referral hospitals, the national referral hospital. The report recommended hospitals to implement different types of diets and introduce nutrient dense or fortified foods.

The RAA report states that efficient and effective in-patient food service system have the potential to improve the health outcomes of patients and minimise burden on the overall healthcare system. It audited patient meals in six main hospitals of Thimphu, Mongar, Gelephu, Phuentsholing, Trashigang and Samdrupjongkhar.

The health ministry has developed a guideline for inpatient food service system in 2013 and dieticians were appointed in major hospitals to help in nutrition and menu planning.

However, the report states that there were no nutrient criteria for preparing in-patients menu in hospitals and menus were never analysed for nutritional content. “There was lack of standardised recipes and menus were repeated, which have resulted in ineffective planning of hospital meal menu,” the report states.

The RAA report recommends hospitals to ensure that patient meal meet the recommended daily nutrients by defining a minimum recommended daily nutrient for a hospitalised patient, analyse menus for nutritional content, specify ration scale appropriately, increase variety of fruits and vegetables, avoid repetition of food item too often, and standardise recipes to minimise nutrient losses.

The report states that daily nutrient intakes by patients as per ration scale do not meet the WHO Recommended Daily Requirement for adults resulting in malnutrition or nutrient deficiencies, which might deteriorate the disease conditions of patients.

“The health ministry should develop procedures that include nutritional screening as part of their healthcare standards as nutritional screening could help identity patients with nutrient deficiencies that need appropriate care and attention,” the RAA report states. “Hospitals have a major role in providing better nutritional care apart from medical treatments.”

The food indenting process in hospitals was also found to be inefficient and uneconomical where hospitals account all patients admitted for hospital meals irrespective of whether they want to eat or not.

The report recommends the current food indenting process be reviewed and improved to avoid wastage of resources.

The national referral hospital in Thimphu has 350 beds for in-patients and Mongar regional referral hospital has 80 beds. The central regional referral hospital in Gelephu and Phuentsholing General hospital has 60 and 50 beds each, while Trashigang and Samdrupjongkhar district hospitals have 45 beds each.

Budget for inpatient meals served at six hospitals for the last three fiscal years amounted to Nu 31.8M (million) while the expenditure was Nu 31.7M.

Despite having availed the food handling training through the Bhutan Agriculture and Food Regulatory Authority, the kitchen staff in hospitals were found to have poor knowledge of food safety practice.

The authority has recommended proper monitoring of food handling practices, setting up a food safety and hygiene programme to make food handlers aware of safe food handling and periodic health check-ups of food handlers.

It was also found that the food intake by patients were suboptimal, which is caused due to consumption of meals by the attendants, meals for patients brought from home, patients treated with food from hawkers and restaurants. This has raised doubts on the acceptability of hospital meals.

“Provision of patient meals in hospitals has not only benefitted patients coming from far flung villages but also those people with economically backward backgrounds,” the report states.

The report has called for actions and an action plan report for implementation of audit recommendations from the six hospitals by August 7 this year along with a signed accountability statement.

Dechen Tshomo