|
Challenges
Despite
the good progress the country has made since the 1 st
Five-Year Plan (July 1962-June 1967), the conditions and the requirement of
the country are changing. To achieve the goals set objectives for the 9 th Five-Year Plan, the Ministry of Health has to overcome
a host of challenges:
Shortage of human resources for health
To
strengthen the overall health service and decentralize management and
services, human resource is required at all levels be it for programme management and promotional areas or curative
services. The government has been able to train only about 3-5 medical
doctors annually that can barely meet the attrition due to retirement,
transfer to other ministries, etc. of medical doctors. The situation has been
improving with more candidates joining the medical line in the recent years.
The number of specialists trained in medical and management areas are even
less. As the training of paramedics can be carried out within the country,
the situation is much better in this area. It is this category of people who
manage the primary health care system as well as service delivery. It is also
mainly this category of people who manage most of the public health programmes in the Department of Health Services. Because
of the same reason of human resource shortage, one or two programme
personnel have to cover a lot and many times it leads to inefficiency.
However, the situation is improving with joining of general graduates joining
and managing the programmes.
As
the Government's own fund is limited, the Ministry relies much on
collaborating partners to develop human resources for health. However, as
many collaborating partners do not want to commit funds for long-term
training, it will take a long time to achieve self-sufficiency in human
resources for health and unless the gap in this key component is filled, the programmes will continue to suffer.
Geography and scattered settlement
Bhutan is
situated in one of the worlds most rugged surfaces
and hence, the settlements are scattered and far-flung. This makes delivery
of health and other social services extremely difficult and expensive.
Coupled with the lack of qualified specialists at the district and regional
levels, this poses a great challenge to efforts in curbing mortality that
could have been prevented with timely care. In order to overcome this
problem, the Government, with support from DANIDA and WHO, initially started
the solar-powered radio communication system to link the basic health units (BHUs) to the district hospitals. To complement this
initiative, the Government has then embarked upon the telemedicine programme in collaboration with WHO
and the Japanese Government. As electricity and the basic telecom
infrastructure were also getting developed slowly at that time, the progress
in this area has been slow but the country has been able to connect at least
one of the two Regional Referral Hospitals to the National Referral
Hospital and improving
the referrals and consultations between them. The facility is also being used
by the hospital staff to access important health literature. But much needs
to be done and materials required for this programme
are usually very expensive.
Dependency on imports for all health
requirements
Be
it equipment or drugs and vaccines, the country has to depend on supplies
from outside the country. Even if the quality of drugs and vaccines can be
assured by purchasing them from WHO authenticated suppliers in the region,
the hospital equipment and other supplies are a problem. The long time taken
to procure the equipment or their spare parts and consumables (like reagents
and x-ray films) continues to hinder surveillance and other vital works at
the hospitals.
Political disturbance
This
little country has not been spared from the political disturbance in the
Region. Ethnic Bodo and Ulfa
militants in the north-east India
who are fighting for independence have taken unauthorized refuge in the
forests inside Bhutan
in the southern districts. Not only service delivery at times is disrupted in
these districts by their interference, violence is the only option should
amicable negotiations the Government has been carrying out with these two
groups fail.
Shift from coverage to quality of services
Having
achieved the desired level of coverage by health, the country now focuses on
improving the quality of health care services. There have been cases of
enormous structures in the districts with no doctor and hence, patients. The
situation has been steadily improved over the years yet large rooms for
improvements remain. As three people - one health assistant, one assistant
nurse midwife, and one basic health worker - staff the basic health units,
their functions can hardly be distinguished, as one has to substitute the
other every now and then. Similarly, not all the district hospitals have
similar facilities. Hence, the whole of next five years will be devoted to
setting standards of services and facilities and working towards fulfilling
them.
Double burden of diseases
While
the battle would continue against HIV/AIDs,
Tuberculosis, Malaria and the like, emerging diseases, especially non-communicable
ones, will entail strengthening their surveillance and developing and
following strategies for prevention and control. At the tertiary care level
facilities need be expanded to deal with the problem of rheumatic heart
diseases, cancer, diabetes, etc.
Sustainability of development in the
health sector
Although
Health Trust Fund initiative has been launched already, much work remains to
be done to accumulate the required capital, invest it to a reliable financial
institute, and regularize the use of the proceedings from the Trust Fund.
Only when everything is in place, Bhutan will be able to assess how
much impact the Trust Fund initiative has made on making health care service
sustainable. On the other hand, the contributing factors to health extend
beyond the health sector. Unless due attention is given to coordinate efforts
with other important Government organizations like Environment, Trade,
Industries and Mines, Agriculture, Education, Municipal Corporations,
Ministry of Health will land up containing the problems caused by other
sectors and this aspect is viewed seriously in order to consolidate the
progress that has already been made in various areas of health.
Meeting the Challenges
The
Ministry of Development used to contain all social sector departments. This
Ministry was replaced by the Ministry of Social Services in 1985 that looked
after Health, Education, Culture, and Public Works Departments. This Ministry
was replaced by the Ministry of Health and Education in early 1990s. The
Ministry then left out the Public Works Department and concentrated only on
Health and Education Departments. To give full attention to these to
important sectors, the Government has decided to bifurcate
the Education and Health Sector by mid 2003. The time has now come for this
event and ground works have already been done. Health will then be a full
Ministry with Departments for Public Health, Medical Education, and Medical
Services. Each of these Departments will then be able to direct the programmes related to their respective areas without
distractions from other commitments.
With
the major challenges in mind, the Government has already looked two decades
ahead and developed its vision for the future. In the document, Bhutan Vision
2020 , the Government has set its priorities for all
the sectors for the next 15 to 20 years. Eight priorities have been spelled
out in this same document to guide the Health Sector during this entire
period. These long-term priorities are further taken into consideration
during the formulation of the Five-Year Plans of the Health Sector.
|
