Bhutan: 1/3rd health units run by lone workers

With 56 doctors and nurses away for studies, applications for additional health workers have poured into the health ministry from all 20 districts.

The number of health workers required in all health care centres across the country add up to more than a hundred, said, the health ministry’s deputy chief human resource officer, Mindu Dorji. “We can’t fulfill all the requirements,” he said. “And this demand for 100 health workers will go up again, when new services and facilities are opened.”

The highest demand, he said, comes from the country’s apex hospital, the Jigme Dorji Wangchuck national referral hospital. “They asked for 125 nurses, but we gave them only five and sent the rest to other remote districts,” he said.

Every year, the health ministry sees about 12 to 15 health workers, especially doctors and nurses leaving for studies abroad. The Tsimalakha hospital, health officials said, won’t have a doctor, when the district medical officer leaves for his studies next month. “The shortage won’t be acute, but, yes, we have no assistant clinical officer and HA to look after the out-patient department,” said a health official. “There will be shortage.”

Shortages get further compounded when the remaining health workers do not get distributed equally across the health facilities. Health officials said that some districts closer to Thimphu like Paro, Punakha and Wangduephodrang have excess people, while some in remote places have to be manned by a single health worker.

A health official, who requested anonymity, said that the Bajo community health unit in Wangduephodrang, for example, has five health assistants (HA), while far flung districts in the east have just one or two.

Mindu Dorji, however, said that the only district, which has excess, is the Drugyel basic health unit (BHU) in Paro. “There is just one extra in Drugyel BHU, because he is doing continuous education (CE),” he said. “But he’ll be moved when he completes his studies in December this year. No health facility has glaringly excess people.”

Of the 178 BHUs in the country, health officials said that 70 percent of them at least have two staff in each health centre. The maximum number of people each BHU caters to is 2,500.

Either by hiring foreign doctors or by training class XII students as assistant nurses, and through the royal institute of health sciences, the health ministry, said Mindu Dorji, has for years tried to address the shortage. “In the past, we had to close down BHUs because of manpower shortage,” he said. “That’s not the case anymore and, if the existing number of health facilities remain the same, we should be able to place at least two HAs in each BHU in the next two years.”

Mindu Dorji said that, even if the requirement for one kind of health worker gets fulfilled, there would be shortage in different areas, such as technicians, nurses or doctors. “Trashiyangtse has only one doctor and Phuentsholing needs more GDMOs. But it’s very difficult to get doctors and we’re short of nurses in every hospital,” he said. “Last year we were lucky and got 14 doctors, but this time we’re getting only five.”