Towards patient-centered healthcare

Health Minister interacts with the women coming to avail of the Pap Smear Camp services at the Dungkar Primary Health Center early this year (Photo: MoH)

Healthcare workers should move out of their facilities to provide services without looking for incentives



Despite Bhutan witnessing significant progress in the health sector with the wide network of health facilities, the system still struggles for equitable distribution of healthcare services especially in remote pockets of the country.

While healthcare services are delivered through the primary health care facilities at the community level, people living in far-flung rural areas encounter a variety of access barriers for basic diagnostic tests including X-ray service.

But in its quest to reach the unreached, the ongoing nationwide cancer screening program for cervical, breast, and stomach under the health flagship that would end by early 2022 is the paradigm shift in healthcare delivery towards patient-centered care.

This approach has been used in most convenient and fast access to doctors at the doorsteps thus benefiting thousands of rural people for necessary and appropriate healthcare services in a timely manner.

Health Minister Dasho Dechen Wangmo said tracking cancers early can contribute to successful treatment and reduce overall health system costs. “Without having to travel to Thimphu, now our people can get endoscopy in their own districts,” she said.

Lyonpo added the initiative also aims to reduce inconveniences of the public. “We want the public to be taken care of because we believe that for a healthy nation and a better tomorrow, we must have healthy citizens today,” she added.

Challenges in patient-centered care

Healthcare workers play a critical role in providing essential services to individuals, families, and communities, but the challenges health officials say is, they never move out of health facilities for service delivery unless they were provided with incentives.

Health officials say they have to provide incentives to encourage and motivate healthcare workers to move out of health facilities and look for the patients.

One of the district health officers (DHO) thinks that it is always good for the healthcare workers to move out for the services without looking for incentives. “Unlike other professions, their work accumulates merits,” said the health official.

“If they wait for patients in the health facilities, they would see only those patients who require critical medication. But if they go to the villages and look for the patients, it will help in early detection and prevention of many diseases that can be preventable,” said the DHO.

The DHO said that they can send their healthcare workers to deliver the services without incentives once or twice saying it is for good deeds, but it becomes hesitant to tell them again without providing incentives.

However, given that the health sector gets limited budget allocation, this trend would continue unless healthcare workers think beyond terms of reference.

This remains top of mind for many concerned people leaving them thinking providing incentives is good to encourage workers but it will not encourage their mandates thus hampering to achieve the best possible health outcomes.

Health Minister Dasho Dechen Wangmo said that it is time to have a paradigm in health care quality. “We cannot be hospital-bound. If we stay only in the hospital, we get only the sick ones. By then it’s too late in the preventive healthcare services,” she added.

Lyonpo said that the health flagship is the entire paradigm shift in how the government wants to deliver health services. “We really want to make a good health system not because we promised, but we are saying there are a lot of benefits – early detection and prevention,” she said.

“Now we are going to look for patients and prevent them from getting diseases,” she added. “I know there are challenges but this is putting the patient in the front.”

“We tell all the agencies including the Royal Civil Service Commission to give us this time to reform the health system,” Lyonpo continued, adding that the government is working to change the terms of references of the health workers at the institutional level.

“For instance, if there are two health assistants (HA) in a BHU, we want one to stay in the center while another should go around the community,” she said. “They must know how the patients are doing – see what they are doing, what they are eating and give them the knowledge.”

In addition, Lyonpo said the health sector needs a greater proportion in terms of both budget and human resources that it doesn’t have right now. “Most of our public health programs are funded by donors,” she said.