Health on drugs

Causing suffering

The Health Ministry has admitted that they have a problem: they have not been able to maintain an adequate supply of drugs to our hospitals. As a result, patients have had to postpone or even forgo medication. And doctors have been forced to direct their patients to private pharmacies, which, many times, have also been frustratingly out of drugs.

Worse still, the Health Ministry has admitted that they still do not know how to resolve the drug shortage issue, a problem that has reached chronic proportions during the past year. So they’ve announced that, as an interim measure, they will send officials to buy drugs directly from manufacturers in Bangladesh.

I suspect that the officials who’ll be going to Bangladesh will be mainly, if not entirely, ministry personnel, most of them from the Drugs, Vaccines and Equipment Division (DVED). If that is so, that could very well be the problem – a central agency unable to keep up with the growing and changing needs of referral hospitals in general, and the Jigme Dorji Wangchuck National Referral Hospital in particular.

DVED is the Health Ministry’s central procurement agency. They buy, stock and distribute drugs and equipment to hospitals throughout the country. That’s a lot of work, work that just gets more complicated as more people use the health system. Between receiving orders for drugs from individual hospitals to supplying them with the drugs is a logistical nightmare that includes compiling and approving orders from the field; tendering and awarding procurement contracts; receiving, verifying and storing drugs; and finally, distributing them to every hospital and clinic, throughout the country. And all that must be done within the framework of the government’s tight financial rules and regulations.

DVED’s centralized operations have served the nation’s health system faithfully till now. But the health system has changed drastically since the establishment of referral hospitals. And DVED would now find that procuring and delivering drugs to the new and growing referral hospitals is an increasingly difficult and complex matter, especially when their main task is still to service all the other hospitals throughout the country.

So it’s time to decentralize procurement, at least for referral hospitals, and definitely for JDWNR hospital. And why would JDWNR hospital be able to do a better job? Incentives.

When drugs run out, hospital staff take the flak. They are the ones who interact with patients every day, and the ones who, as far as patients are concerned, are at fault if hospital services are not adequate. So it is in the interest of hospital staff – nurses, doctors, technicians and administrators – to ensure that drugs, especially essential ones, are always available. Ministry officials, including DVED staff, cannot, and will not, share the same levels of concern.

So decentralize drug procurement. Allow JDWNR hospital to acquire drugs without having to deal with the bureaucracy of the ministry. Otherwise, be prepared to face more serious drug shortages, more frequently.

In fact, decentralize equipment procurement too. And all personnel matters, including training. And finance. And administration. Make the nation’s biggest and fastest growing hospital fully and truly autonomous. That way, hospital staff would feel a sense of control, a sense of ownership, a sense of purpose. And that would drive them to realize their full potential and to achieve their vision.

But the Health Ministry must regulate them. And make them fully accountable. That way, services would improve, drug shortages would drop, and the health sector’s biggest disease – widespread corruption – would finally be contained for proper treatment.

Photo credit: Kuensel

 

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  1. unknown advicer says:

    Hi Tshering Tobgay,

    regularly am following u’r blog and activities, its really great to follow u and learn new things in life. coming to Health services in Bhutan, i observed so many good implementations in bhutan but monitoring is not proper bcoz lack of awareness or belief on vendors. what ever the problem occurring in any field that may leads to handing over of operations / business to any vendor.
    HHC services are running very well but is there any monitoring of Health records, ambulance operations, drugs supply, maintenance of country health status etc.
    few chances are there to sell HHC health records to any private organization inside bhutan or outside bhutan. plz take care of implemented / future projects proper monitoring.

  2. Jurme Loday says:

    I hear that MoH is actually trying to save money by not ordering medications on time. We need a complete overhauling of the MoH and the practised systems, procurement sytems are still very corrupt

  3. This is another thought provoking good article from the OL. I am happy that our OL is now coming to terms with the reality. In this, he is trying to prove a point here in showing his better sides under the OL’s garb by hinting that OL structure per se has a positive element in store too by way of solution package offers- as his share of contribution in nation building exercise. Good going, OL, please keep it up.

  4. Mckinzy have saved the RGoB money but could not save the lives of our people.Why should trade off. negative trade off.

  5. if i’m correct, kuensel has run the most stories on the malaise affecting the health ministry..the issue of drug shortages, suffering & frustration of patients is like a cancer..the blame for this falls squarely on zangley dukpa..as head of the ministry he should sort it out..but I guess this won’t happen..because the next elections are drawing near & he will be busy wooing voters with his toothy grin..
    meanwhile, patients will have to go along with this inefficiency of the health care system..
    it is wrong because no matter how little, salaried people all contribute 2% of their income towards health care..then, more often than not, patients find they need to fill most of their prescriptions by buying from pharmacies.. so in that sense, healthcare in bhutan is not free..subsidized
    heavily – yes..but certainly not free..
    there is also the totally unfair system in bhutan’s health system where expensive medicines are kept in stock & only the well connected have access to these..as for medical referrals out of bhutan, the common man may be lucky to get health treatment in india..but the privileged lot visit bangkok, europe & the usa for high end treatment in an all-expenses paid trips..all through the use of scarce public funds..want an example? the foreign minister of bhutan who receives all the wages & perks of a minister but has not been seen attending office after being elected..these in addition to his substantial medical expenses in new york..
    bhutan can experience gnh only when such hypocrisy, double standards, nepotism & inequalities are removed..

  6. i didnt see our concerned MPs including OL accompanying His Majesty to Haa for a celebration of LOMBA. Why they are not invited or why they have not accompanied….perhaps it would have been not very necessary or i may not have seen them on the scene…my views can be very much wrong.

    my apology for a wrong discussion under this chosen topic

  7. yes definitely, i too feel that decentralisation of procurement system, giving autonomy to the biggest hospital in the country would improve many things including drugs shortage. ( ofcourse there should be enough mechanism to regulate &monitor the system).

    The other thing is the Drug shortage and other inconvenience are not faced by our influential leaders and high officials, if they happen to face it, they will change the system in overnight.

  8. The current government, sometime back, proudly declared the savings (I do not remember the exact amount) by streamlining the procurement systems, improving the efficiencies of public services, etc. One area where they made saving, as per McKinsey, must have been the cutting down of quantity and quality of medicines and the delivery system therein. Unfortunately McKinsey did not recommend as to how the delivery of life saving drugs could be improved. I do not need to emphasise this as everyone knows. This is not to be taken lightly as we are talking of human lives here. Just as the government assumed the figure of savings made by following McKinsey’s recommendations, can we also assume that the delays and unavailability of medicines have contributed to the death of many precious lives?

  9. Jurme Loday says:

    McKinsey = US$9.2 million + air tickets, hotel costs at taj for sometime and than in a little cheaper hotel for the young studs of Mckinsey until was the project was closed + transport costs

  10. My observations to improve the health system of the kingdom of Bhutan :-

    1. As a civil servant in one of the district I have found least qualified and outdated individuals as the sector head. The only thing they would know is paracetamol and its uses, and nothing more. How can such head improve the district health. The qualified medical personal, Doctors are never seen at limelight to discuss the issues in the districts and thus, we see a lot of health impacts due to development solely because of ignorance from the health sector. Thus, a better qualified person must lead. IN health they say ” Your eyes won’t see if your mind doesn’t know.”

    2. The story is not better at the ministry. The so called program officers are the determinants in framing health policies, planning and monitoring. But are they qualified enough ? There are two groups here. The first one are graduates and surprisingly some are geography graduates. They hardly seems to know even the definition of diarrhoea. The second group are our seasoned Health Assistants. Probably, their lack of planning the health system along with the complacence from the head could have resulted in the crisis in Bhutanese Health. The crisis here accounts life of our fellow citizens and we never know it could be our loved ones too.

    Therefore, we need to be decisive in having a major reforms in health. A blind man cannot lead a normal individual. We have lost some which we all agree, but me must prevent further at the earliest possible. There are qualified people, but are left at the district in the guise of shortage of doctors.

    Its time our public must think otherwise.

  11. Meme Taupo says:

    I think that issues in Health deserve the attention of all as health is a place where every Bhutanese have to get in touch at least at a certain point in time from birth to death. There is so much of talks about Health, mostly bad than good. I think we should acknowledge that Health has come a long way. While the capacity of the qualified people are welcome to improve the system, let us also acknowledge the good work done by the less qualified who contributed in their own ways and brought Health to where it is today. I think Health is faced by many challenges, human resource in particular. People’s expectations have gone up and quality service means more resources. I believe there are also many good people in Health. Because there was a corruption case we should not label everyone as same. Only time will tell how many more cases will be revealed in other agencies as well. ACC does not have the time. I have seen Health people being discouraged from doing good work because of the blame and chaos. It is time that we also acknowledge the good work of Health and encourage better outcomes. Already many have left Health and many more are likely to leave Health if the motivation is low. There are very few who are determined to work in certain areas due to fear that is created. We need to prevent corruption by all means but let us all agree that Health as said by OL is also a complex area and we need to support Health Ministry to carryout its work with manpower and resources.

  12. critical eyes says:

    It is good to observe that OL is agreeing to the complexity of things and suggesting some good points.

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