Plans to decongest JDWNRH and reorganize Health Sector also underway
The Ministry of Health (MoH) as a part of its retention efforts of medical professionals through the National Medical Services (NMS) is developing an alternative career pathway for medical doctors and specialists in consultation with the Royal Civil Service Commission (RCSC).
The RCSC in principal is okay with the idea but it has asked the NMS and MoH to strengthen the performance aspects of this alternative career pathway before final approval can be given.
In the current RCSC system medical doctors, even if they are highly qualified, in demand and well performing are clubbed with all the other technical staff in the RCSC system.
As a result an agriculture specialist or an administrative specialist are treated at par with a medical specialist who may be the only one specialized in particular organs and diseases.
The other problem under the current RCSC system is that career progression is slow for doctors despite their qualifications and skills as it largely comes to the number of years served and promotion only happens after a fixed number of years.
The advantage of the alternative career pathway is that doctors will be in their own field a bit like in education and will be a bit delinked from the current general system of RCSC while still being under the RCSC.
Having a career pathway of their own will give an opportunity to doctors to get promoted faster if they can specialize more or perform better.
In the current system you may be a young and hard working doctor who adds a lot of specializations, but the doctor would still lag at the bottom due to the number of years served. However, in the new system the higher qualification and skill mean a faster promotion or a higher grade even if one is younger.
However, this does not mean that just because you are medical doctor you can rise up faster as performance will also be looked at closely.
As a move towards this the RCSC has already approved that the position of Specialist Head will be formalised at the ES3 level. Earlier there were Specialist Heads stuck at the P 1 level due to the number of years.
The MoH is also rolling out other measures to incentivize its medical staff. Out-of-turn promotion will be granted by 1 year if the Head of Department achieves an Outstanding Service rating for three consecutive years, and by 6 months if the rating is Very Good for three consecutive years.
The RCSC has approved a one-year meritorious promotion for nurses taking up the specialised courses in the first cohort.
RCSC has also approved doing away with the Preliminary Examination (PE) requirement for B.Sc Nurses.
To motivate health staff, a proposal for a cafeteria is under discussion. The Ministry of Education and Skills Development (MOESD) and Save the Children have identified a location for the establishment of a crèche at JDWNRH. A gym facility has been planned. The DCS has submitted the equipment supply requisition to the WHO Country Office (CO) for procurement.
To reduce the workload on existing staff and also have more manpower 11 General Duty Medical Officers (GDMOs) were recruited and appointed to JDWNRH and Thromde Health Centres (THCs). Additionally, National Medical Services (NMS) facilitated 8 health volunteers from the USA to work at JDWNRH.
Extended Clinical Services or ECS has been rolled out in JDWNRH which means if doctors and health staff work during their holidays they can get a daily subsistence allowance.
RCSC approved the recruitment of 3 Anesthesiologists and 145 Nurses and has also approved Nu. 300 mn for the recruitment of the expat nurses. The process will be initiated within this quarter.
Decongesting JDWNRH
Discussions are ongoing with WHO SEARO regarding the procurement of one CT and one MRI machine for JDWNRH.
Additionally, a grant-aid proposal amounting to Nu. 3.5 billion for the procurement of 3 CT machines and 3 MRI machines has been prioritised and submitted to the Embassy of Japan (EoJ) during the 19th Bhutan-Japan Annual Consultation on Economic Cooperation.
One additional CT machine will serve as a backup in JDWNRH and the other two, including MRIs, will be given to the Mongar and Gelephu Regional Hospitals to reduce the load on JDWNRH.
Following the relocation of the OBGYN and Paediatric inpatient departments to the Gyaltsuen Jetsun Pema Wangchuck Mother and Child Hospital (GJPWMCH) in July, these wards are being renovated to accommodate 36 beds for Medicine and a 6-bed surgical ICU.
Overcrowding in the emergency department is primarily due to a shortage of beds in the Medical Ward. Therefore, additional nursing staff are deployed to the Medical and Surgical wards in preparation for the expansion of the medical ward. Emergency services for Paediatrics and OBGYN departments are now being provided by GJPWMCH. This is expected to significantly reduce the load on the emergency department at JDWNRH.
The Thromde health centers are also being strengthened. A General Duty Medical Officer (GDMO) has been assigned to the Motithang and Simtokha Thromde Health Centres (THCs). Motithang THC is staffed with both a laboratory technician and an X-ray technician. Bebena and Simtokha THCs each have a pharmacy technician and an X-ray technician. Plans are also underway for rotating a medical specialist among the THCs.
Reorganisation of the Health Sector
The Ministry of Health is working on a comprehensive proposal to reorganise the health sector. The proposal intends to align healthcare services with National Health Policy through the restructuring of the MoH by integrating the functions of the NMS into it; improve operational efficiency of JDWNRH to enhance service delivery and patient care.
It aims to streamline coordination, enhance efficiency, and improve responsiveness in service delivery at all levels of hospitals and strengthen linkages between the MoH and the LGs.
Currently, stakeholder consultations at the MoH and NMS are being carried out and the proposal will be submitted to the cabinet once all the inputs and concerns collated through the stakeholder consultations are incorporated
The above are all a part of the directive issued by the Prime Minister to the Minister of Health on 29th January 2024 to submit a set of recommendations to ensure service quality and reliability by February 6, 2024. The actions above flowed from that.