Majority of performance audit recommendations not implemented by JDWNRH and Thimphu Thromde: PAC

Only 3 out of 11 recommendations made by RAA to JDWNRH are fully implemented

The performance audit report by the Royal Audit Authority (RAA) on delivery of services at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) noted the waiting time of the patients at general Out-Patient Department (OPD) and medical OPD. The report also made observations on the doctors on duty arriving late in the medical OPD chambers, and long waiting time for GI endoscopy services. Based on such findings, RAA made 11 recommendations to improve the healthcare service delivery, enhance accountability and improve decision making.

The Public Accounts Committee (PAC) observed that out of the 11recommendations, 3 have been fully implemented, 6 are partially implemented, and 2 recommendations are not implemented. In order to institute a proper internal control mechanism, following RAA recommendation, JDWNRH has strengthened the existing token system, and at the same time, ensured that the tokens are issued according to the sequence of the queue. The management has also initiated priority counters in the reception area to cater to the senior citizens, differently-abled persons, diabetic patients, and patients referred from different dzongkhags.

The recommendation by RAA to strengthen the hospital information and service desk has also been fully implemented. The committee observed that the terms of reference (ToR) for the floor managers is developed, and they have been trained to improve their functioning. The information desk is now equipped with necessary electronics to help improve service delivery.

The recommendation to provide public education on the prevention and First-Aid care and awareness on the timing and healthcare services has also been fully implemented, whereby video clip relating to public education and awareness on timing are screened on the televisions around the hospital. It has also been observed that informative posters on the issue have also been put up in most of the spaces.

The recommendation advising that the doctors on duty for OPD services should not be assigned for multiple assignments has not been implemented at all, and PAC observed that RAA did not receive any response from the management on the matter. At the same time, the recommendation for JDWNRH to institute a clinical audit has not been followed up. PAC observed that although JDWNRH has initiated the monitoring and evaluation of OPD services, however, such an action does not address the requirement as per the recommendation.

Based on the performance, so far, PAC recommended that RAA follow up on the recommendations that are only partially implemented and the recommendations that are not implemented at all, and then present it in the following parliament session.

PAC also recommended that a shift system must be instituted for doctors assigned in medical wards and doctors on duty in medical OPD, to prevent the patients from waiting for longer duration, to put forward a proper system so as to curtail people from directly meeting the doctors without a token, and that JDWNRH should review the effectiveness of the off hour services.

Thimphu Thromde fully implements only 1 out of 15 recommendations made by RAA

With an ever increasing population in the capital city, there are great challenges in having an efficient water supply system, which leads to inadequate and unequal water distribution, and also results in wastage of the water. RAA has found serious flaws in the water distribution networks, and further stated there are neither review reports on water quality tests nor any reports submitted for review by the Thromde, and no effective monitoring and evaluation system for drinking water systems.

PAC observed that out of the 15 recommendations made by RAA to Thimphu Thromde, only 1 has been implemented by the Thromde, 9 are being partially implemented and 5 recommendations have not been implemented at all. Therefore, the committee recommended that RAA should follow up on the recommendations which are partially implemented and those not implemented, and present the status in the following parliament session.

PAC asked for improved coordination amongst the relevant agencies like MoWHS, NECS, RCDC, MoH and Thimphu Thromde for productive results. The Works and Human Settlement Minister, Dorji Choden, assured that bigger initiatives and projects are underway to solve the water shortage issues gradually, but her recommendation to invest in the capacity development of the professionals in Thromde has also been endorsed by the House during the Joint Sitting.

PAC also recommended that Thimphu Thromde should prioritize the water usage as per the Water Act of Bhutan 2011, and henceforth, discontinue the treated drinking water supply to the commercial car-washing units.

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