Success indicators of the annual performance agreement (APA) of the health ministry are not in line with the actions the ministry is trying to achieve, Prime Minister Dr Lotay Tshering said during the ministry’s APA review for the current fiscal year yesterday.

Lyonchhen said there is a need to improve coordination when it comes to APA.

Today, he said that the budget approval is not based on priorities of the ministries.

“People in the finance ministry will not know the priority of the health ministry. There is no direct communication between budget approving authority and project approving authority,” he said. “We must sit down, do this exercise before the plan goes to GNHC. From next year, the execution of APA would be slightly different.”

Lyonchhen said many documents were signed between the ministers and the prime minister, between the ministers and the secretaries and between the secretaries and directors. “If we go by the standards of it or its theoretical meanings, it means a lot.”

However, Lyonchhen said that practically when the indicators are dissected, the indicators are overlapping.

“There is no clear direction. My expectation was the document that I sign with the minister must give policy directions, policy support, and way forward, not just what is happening.”

Bhutan still has a huge burden of communicable diseases and also seeing non-communicable diseases like the developed countries. “We should plan our health care policy accordingly. Based on this, how should we now go on developing our human resources depending on the disease pattern.”

He said he would like to sign the APA with the ministers on the direction to address such policy issues, not on the number of anti-natal check-ups (ANC) covered.

“ANC visit should be there because it is important at the policy level. The maximum weight should be between the sector and the director level because at the minister and prime minister’s levels there is nothing much to be done to increase the ANC visits,” Lyonchhen said. “The actual work is of the GDMOs, health assistants and the other health staff.”

The agreement that is signed between the minister and the prime minister should have a ripple effect on the other compacts that is signed.

A representative from the Government Performance and Management Division (GPMD) said that some of the success indicators are broad and needs to be pinned down to locations.

One of the success indicators he pointed out as broad and lacked clarity was the number of health facilities implementing Adolescent Friendly health services. Instead of the number of health facilities, he said, it should be the number of cases seen.

Health secretary Dr Ugen Dophu said the health ministry’s APA for the fiscal year 2019 – 2020 has been aligned with the 12th Plan and also in line with GPMD’s APA quality assurance framework.

Health minister Dechen Wangmo said the ministry already had internal discussions on the success indicators that GPMD pointed out and necessary changes had been made focusing on the reach.

Lyonpo pointed out that today the health centres claiming to have Adolescent Friendly health services have a chair and a table to provide the service. “I said it is not acceptable and suggested focusing on the reach.”

In terms of ANC coverage, Lyonpo said that with conditional cash transfer of the accelerating mother and child health programme, the coverage would reach over 90 percent.

Lyonchhen shared with health officials that no one is at fault. “Maybe this is the way APA is being understood by all of us. But after assuming office, I thought this is not the way we should be doing it if we have to achieve the required targets in APA.”

Dechen Tshomo