But filing the gap of 379 general doctors and 165 specialists would remain a challenge

HR: Even with an annual attrition rate of about 1.2 percent, the health ministry is optimistic to achieve the requirement of some 1,900 health workers that the country is today short of by the end of the 11th Plan.

However, filing the gap of 379 general doctors and 165 specialists would still be a challenge for the ministry.

Attrition rate is highest among nurses who take extraordinary leave for studies and don’t return, health officials said.

Records show that in the last nine years, 24 doctors either superannuated or left for better opportunities. About five among them left to contest in politics.

According to the health ministry’s human resource projection based on service standards, the health sector is short of 658 nurses, 865 technologists and technicians, 379 general doctors, 252 health assistants and 147 specialists. There is also an equal demand for 31 drungtshos, 59 menpas and 18 super specialists.

A total of 2,616 health workers cater to the population today. As part of the health ministry’s capacity building programme, 37 nurses, sub-specialists, and general specialists each were trained in the last five years while 49 others are still undergoing studies.

By the end of this year, as committed in the annual performance agreement, the ministry would have to ensure that female health workers at Basic Health Units I and II increase to 70 percent from 62 percent while nurse to bed ratio increase from 1:7 to 1: 6. It has to also ensure that the remaining four dzongkhags have three doctors each.

This mandate to meet the shortage of health workers at all levels has come at a time when the ministry has been grappling with a chronic dearth of health workers.

The government has also pledged that it would immediately address the issue of doctor shortage and work towards ensuring that all dzongkhags, if not hospitals have at least three doctors each including a specialist.

It also pledged that the number of nurse to bed ratio will be decreased from 1:9 to 1:6 besides increasing the number of health workers in gewogs with at least one female health worker in every BHU.

The ministry would soon establish an Emergency Medical Obstetrics and Neonatal Care (EMNOC) centre in eight hospitals where a gynecologist, a surgeon and an orthopedist would be deputed.

Director general of department of medical services Dr Ugen Dophu said all dzongkhags don’t require a specialist considering the workload and population.

He said that the ministry would be able to overcome shortage of nurses, menpas, dungtshos, health assistants, technicians and technologists, and general doctors by the end of the Plan. “For this, we’ll be increasing the capacity of our training institutes,” he said.

The issue, Dr Ugen Dophu said is meeting the demand for super specialists like pathologists, radiologists, orthopedic and psychiatrists, which require sending doctors abroad. “We are doubtful if we can fulfill this demand on time,” he said.

With the opening of the medical university, Dr Ugyen Dophu said certain specialisations are now provided in country. “But the super specialists will take time and until then we should manage by recruiting expatriates,” he said.

On the shortage of female health workers in BHUs, he said the ministry observed that male health assistants deliver better in BHUs than females. “Gender doesn’t matter so long they perform,” he said.

However, the ministry is challenged in managing human resources given the demand for health workers with increase in health facilities, shortage of female health workers in BHUs II, poor compliance with transfer order and rural retention.

Besides, issues such as deployment at local level and limited resources for capacity development were also highlighted during the recent health conference in Paro.

Health ministry’s chief human resource officer Yangchen Chhoedon, at the conference, said that most health workers when posted in the rural areas want to be posted back after a year or so.

The HRD has also identified rural retention strategies besides public recognition strategies like awards for rural health workers. “The award in recognition of their services would motivate them further,” Yangchen Chhoedon said, adding that the HRD would develop a training needs assessment and a web-based information system for HRD processes.

One of the grievances of health workers, according to health ministry officials is the difference in workload and training opportunities that health workers avail.

Health minister Tandin Wangchuk said that when he visited health centres in the dzongkhags, most complained about being treated differently. “With the web-based information system, everything will be transparent now,” lyonpo said. Dr Ugen Dophu said that as a retention strategy, the ministry even looked at paying health workers in Bhutan equivalent to health workers abroad. “But as civil servants, we can’t do this either,” he said.

He said that during the 1980’s about 50 doctors were more than enough at the Thimphu referral hospital while today even 256 doctors are not enough for the 350-bedded hospital. “This is partly to do with management as some doctors are over burdened with work while some aren’t,” he said.

Thimphu referral hospital’s medical superintendent Dr Gosar Pemba said health workers leave the system for better salary and incentives.

“It’s natural for people to leave when they are offered better incentives and pay packages,” he said. “At the end of one’s service, everyone would want something to rely on.”

Increasing pay package of health workers in the country, according to Dr Gosar Pemba is not possible unless the sector is delinked from the civil service.

With the Thimphu referral hospital short of specialists in most of its units, he said they have requested the civil service commission to allow the hospital to recruit expatriate doctors directly.

The hospital is also looking at ways to incentivise health workers depending on their workload. “It may not be a substantial amount but it will serve as some sort of recognition,” he said.

Kinga Dema