Going by the Annual Health Bulletin 2020, at least 15 Primary Health Centres/ Basic Health Units saw less than a thousand cases in 2019, meaning less than three people visiting on any given day. On the other hand, around 18 sub-posts saw more than a thousand cases in the same year.
This disparity in the caseloads seen in each hospital entails putting a lens into the existing policy of deploying two or three health workers including a female staff per Basic Health Units. The recently held health policy dialogue suggested a need to rethink and reorganise human resource deployment and distribution for equitable health services and outcomes.
As per the Health Bulletin, 620 health assistants are deployed in 186 BHUs, 53 sub-posts and 542 outreach clinics that provide health services in remote communities. The report states, for instance, Phibsoo Primary Health Centre in Sarpang saw only 201 visitors, that is one patient visit every two days. But Pangbisa Sub-post in Paro saw more than 3,500 cases in the same year. Should deployment be more derived based on workload, population size, health and cultural needs of a particular community? Should it be more flexible and adaptive in nature?
“We may need to look into whether these centres are required. But these health centres were established when there were no road connections. So the ministry is thinking of revisiting the services provided in the BHUs and Hospitals based on the caseloads to introduce new services,” said Sangay Thinley, the Chief Human Resource Officer with the Health Ministry.
“Traditionally we have always followed the principle that one gewog require one BHU, one district requires one district hospital and then one region requires one regional hospital. And particularly, the distribution of BHUs and the sub-posts are often determined by more geographic location rather than real demand-driven. So what I would suggest is that going forward we need to make sure that planning must be demand-driven and not either geographical or other considerations which are irrelevant to service,” said Dr Pem Namgyal, the Director, Programme Management with the WHO/South-East Asia Region.
He says it is time to consider population as the basis for deciding the health needs of the population and developing delivery strategies to suit the changing requirements.
“Immediately what the ministry can take action is on those facilities where you are not having demand to keep three or four staff posted permanently waiting for patients to come and visit. It is wastage of resources whereas there are other facilities where you have fewer staff or one staff who are seeing so many more and therefore the demand on that individual’s time and resource is extensive and leading of course to then issues of quality,” he added.
The Chief Human Resource Officer of the Health Ministry said the current Human Resource Standard for Health Facilities developed jointly by the Royal Civil Service Commission in 2018 restricts the reorganisation of human resource deployment.
“Sometimes we are not able to provide the HR because we have to stick to the set standards. This was developed in 2018 and now we are not able to deploy the HR requirements as per the standard. It is sometimes becoming a bottleneck for us. We want to send, suppose in Wangdue because of the Punatsangchhu, we have to send specialists but as per the standard, we are not supposed to deploy,” he said.
According to the Workload Indicators of Staffing Needs conducted in 2019, there was a mismatch of facilities and staffing in facilities with that of actual demand by population needs. The Health Minister has also directed the HR division to relook into it and revise the HR standard at the earliest.
Sonam Pem
