Nima Wangdi 

Besides the shortage of human resources, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) is burdened by self-referrals.

Self-referral is when people opt to visit referral hospitals over lower-graded health facilities irrespective of the kinds of illness they are suffering.

According to WHO’s National Professional Officer, Thinley Zangmo, Bhutan has primary health centres (PHCs) across the country but people choose to visit referral hospitals on self-referral.

She said the practice leads to the underutilisation of PHCs. She said Health Assistants and nurses in some of the PHCs are left without patients while limited doctors and nurses at referral hospitals, especially at JDWNRH are overburdened.

“Having PHCs in place, they continue to add cost on a daily basis as the health workers posted there have to be paid besides having to pay electricity and water bills every month,” she said. “People should avail services from the PHCs.”

Patients should actually first visit Basic Health Unit and then the dzongkhag hospital and then referral hospitals. JDWNRH should be receiving referrals only from regional referral hospitals, unlike today.

One of the reasons, an observer said why people resort to self-referrals was because there is no health equity. For example, of the three referral hospitals, Mongar and Gelephu are understaffed. If one specialist falls sick or takes leave, the service is disrupted. “So people don’t want to take the risk of travelling to the other two referral hospitals.”

This is the reason why people opt to come to JDWNRH over other referral hospitals.

Patients usually come to JDWNRH expecting better services even if the disease could be treated at the Basic Health Units according to health officials.

He said we also have to look at if the referral hospitals are ideally located. With the referral system in place, a patient in Samdrupjongkhar should be referred to Mongar while Gelephu is nearer.

Some said that the self-referrals are because people don’t trust the quality of services they get at the PHCs.

A resident of Thimphu said if the role of the people in the PHCs is to promote health and create awareness on prevention, the number of patients visiting PHCs should not be the problem.

“The health staff should go out to the people and carry out promotion and prevention,” he said.  “However, the roles of the health staff at the PHCs should be clearly defined in written.”

An official from the health ministry said that the 13th Plan would address the issue of health equity.