Bhutan

A shackled institution?

Dec 6, 2017
With the National Assembly snubbing the move to corporatise JDWNRH, the government has said that it would explore new ways to incentivise specialists.
 
The debate over the hospital’s corporatisation has however left members from the medical community, including the specialists distressed. Specialists claim that they are not for corporatisation and using them to justify a political move was unfair. The nurses and technicians, whose service in healthcare is as critical, felt left out.
 
As the debate got politicised, the government claimed that the proposal to corporatise the hospital was also to improve the hospital’s efficiency. But soon after the Assembly voted against it, the government claimed that it had already decided to not pursue corporatisation. Such fluid stand does not help in improving the performance of the national referral hospital, not when the specialists felt used and nurses and technicians, forgotten, who are all bound by the civil service rules.
 
The performance of any institution depends on its human resource and how they are managed. How incentivising specialists alone would boost the hospital’s efficiency is yet to be seen. JDWNRH is the national referral centre that also serves as the dzongkhag hospital for Thimphu and as a teaching hospital. Its autonomy is limited to central agencies such as the civil service commission and the health ministry.
 
If the government is serious about reforming the system and retaining specialists, the move has to be consultative. The achievement of this reform depends on whether the existing relationship between institutions that are involved in the hospital’s management is constructive or conflictive. For now, it appears to be the latter. The power tussle between these agencies as was seen in the corporatisation saga indicates the importance given to our specialists and to reforming the hospital. It was a spectacle of authority.
 
As the government explores new avenues to incentivise specialists and make the hospital more efficient, it is hoped that it will consider the proposal that doctors had first submitted to the government. For hospital governance requires balancing national health policy with operational management. One is political and subjective and the other, technical and objective. The challenge would be to integrate these two spheres and strike a balance to ensure an efficient system. There is as much a need to assess the factors driving the reform. How much of these proposed changes are a result of growing expectations from patients for better healthcare, the grievances of health workers and a political will to restructure the traditional structure has to be understood.
 
The hospital has proposed full autonomy to be able to do more. That the hospital does not even have the authority to hire support staff such as cleaners is telling of the power that has been given to the institution. In such a setting, we are told that expatriate doctors are paid about USD 3,000, more than four times the salary of specialists here.  On call allowances and training opportunities are among the other proposals.
 
It is understood that even with incentives, some may still choose to leave. But efforts must be made. The national referral hospital must not be shackled, nor its conscience.
 
Kuensel, December 6, 2017

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