Health sector to undergo major reforms

National Referral Hospital (JDWNRH) in Thimphu

The reforms involve major changes in financial rules and regulations and human resource policies among others



In a paradigm shift to exercise effective health system governance, major reforms will be carried out in the health sector including key policy issues focused on delivering more equitable and high-quality health services.

This is perhaps a big and far-reaching reform process being initiated following the organizational development exercise (ODE) recommendations of the Royal Civil Service Commission (RCSC) in 2014-2015 on the governance structure of the national referral hospital (JDWNRH).

The Ministry of Health (MoH) will submit its proposal to RCSC following which it will be submitted to the Gross National Happiness Commission (GNHC), and then to the cabinet for approval.

The component reforms involve major changes in financial rules and regulations, human resource (HR) policies, flexibilities in the health procurement system, and a different performance management system and service condition for health workers in the country.

The move is to streamline administration of national and regional referral hospitals, referral cluster management for clinical services, a more integrated, accountable and efficient clinical governance system, and reorganize the health ministry to meet the emerging challenges and make it fit for purpose.

Health Secretary Dr. Pandup Tshering explains that the reform is desirable considering changes in disease patterns with changes in demographics to improve the efficiency, equity and effectiveness of the health sector.

“In the past, we had more communicable diseases, but nowadays we are having more non-communicable diseases,” he continued, adding it was intended to improve the equitable distribution of health services.

The current health system was found weak and insignificant, and the patient referral mechanism among different levels of health facilities in the country has contributed to differential workloads in health facilities.

Further, the reform looks at the quality of healthcare, higher waiting time and financial burden among the population, and inefficiencies from the fragmented approach to managing different health facilities, among others.

The reform considers improving the quality of health services through clinical governance services by changing the governance structure perhaps more towards the people thus strengthening the specialist services in the district hospitals.

The secretary said that people can avail themselves of the specialist services at the local without having to travel to Thimphu thus reducing workload in the national referral hospital. “With this, people in Thimphu will access better services,” he said, adding that it will reduce the time that people have to wait to get a consultation with specialists.

In addition, he said that the ongoing nationwide cancers – stomach, breast, and cervical – screening under health-flagship will also come as a routine health service. “We are sending specialists to the areas where there are no specialist camps. These will all add to the specialist services to the district level,” he said.

Dr. Pandup Tshering added the ministry is also revising and reviewing the health policy and service standards – what services needed to be put in districts hospitals – contributing towards health equity

“Policy is the overall guidance on how the health sector should be,” he added. “When we are reviewing and revising our health service standards, it also allows us to review our HR standards. These are all going parallel.”

However, the health sector still struggles with a shortage of health specialists, including exploring admissions abroad for specialist and subspecialist studies, and minimal finance for health services.

Besides, given technology is considered being the driving force behind improvements in medical and health care delivery systems, the reform would bring technology-driven healthcare services that currently depend on the person.

“We have an electronic patient information system under the digital Drukyul flagship where it will have all the information of patients in the system. This will improve the quality of healthcare and also reduce the resources,” said the secretary.

Meanwhile, it has been about two years since the OD exercise started and RCSC had to change the team leader three times in consultation with the health ministry as the ODE took long and could not be finalized.