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

Visiting Linda

My previous entry about Paro Airport’s security, prompted Linda Wangmo, a regular contributor, to cry out for help about a situation at our hospital. Listen to her!

Security security…….. Lucky our OL and other big shots do not have to spend a night in our hospital… The ward reminds me of a prison in one of the movies.. The G4s armies. They dont even let me share a simple meal with my ailing mom….

A bigger (and better?) hospital

In the fall of 1974 the brand new 60-bed Thimphu Referral Hospital was inaugurated to commemorate the coronation of His Majesty the Fourth King. The hospital has served Thimphu and all of Bhutan faithfully for the last 34 years.

Yesterday, Her Majesty the Queen Mother, Ashi Tshering Pem Wangchuck inaugurated the brand new 350-bed Jigme Dorji Wanchuck National Referral Hospital to commemorate the coronation of His Majesty the King and 100 years of monarchy. Our new hospital comes equipped with central heating and cooling, 8 OTs, 64 ICUs, central oxygen supply, 48 cabins, ward cubicles, digital x-ray, telemedicine facilities and satellite links to the best hospitals in India. State-of-the-art stuff priced at almost Nu 1 billion and financed mainly through GOI assistance.

The aim is to develop the JDWNRH into a tertiary hospital capable of providing high-end diagnostic and curative services for all Bhutanese. This makes good sense considering the number of Bhutanese traveling to India and Thailand for medical treatment. There’s even talk of medical tourism!

To achieve this lofty aim, however, the hospital will first have to be staffed with enough doctors, nurses and technicians. This will be difficult and expensive, especially since we already have a severe shortage of health professionals. Many foreign doctors will have to be recruited, and his is okay both as a stop gap measure and means to promote transfer to knowledge.

But don’t forget our existing health professionals – too many of them are unsatisfied, many are contemplating resignation, and some have already submitted their resignations. We cannot afford this. If we want the new JDWNR Hospital to serve Bhutan as faithfully as the old General Hospital, we need to take care, first and foremost, of our own health professionals, especially doctors. So, the inauguration of our new hospital may be a good time to review and overhaul their service conditions and their career prospects. Otherwise we’ll end up with a bigger hospital that’s not necessarily better.

And what will become of the old hospital? It will be razed to make way for the new medical college. Excellent!

By the way, the Thimphu Menkha, located in Langjophakha, served as Thimphu’s hospital from the early 1960’s till it was relocated in 1974. That hospital had only two doctors – the Late Lyonpo (Dr) Tobgyel and Dasho (Dr) Samdrup. Those medical poineers worked with no internal plubming, no electricity, and no telephones. By all accounts they did a good job.

And the Thimphu Menkha in Langjophakha? It’s now used as family quarters for the Tashichodzong police.