Strategy for gross national happiness (sgnh) Annexures to the Main Document
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Air Service Agreements Bhutan has currently signed air service agreements with the following countries. 1. India 2. Myanmar 3. Bangladesh 4. Nepal
5. Thailand Druk Air is the designated carrier to exercise the traffic rights from Bhutan. No other airline is exercising these rights partly because of the operating difficulties at Paro airport. But in the near future, with growth in the traffic, it is almost certain that some airlines will operate to Bhutan even before Gelephu airport becomes operational. For Bhutan, the biggest opportunity will prevail out of India. However, tourists being an important component of our traffic, Nepal will play an important intermediate route. It is recommended that the Government negotiate with the respective governments on the following issues:
New Routes In the 10th plan, new routes proposed are as follows. Mumbai Druk Air has been evaluating Mumbai since the last two years. Current traffic does not justify a direct service and this has been considered as a point beyond from Kathmandu, Nepal. There is no direct service from Mumbai to Kathmandu currently and the traffic from West & South India is channeled through Delhi. Hong Kong This is also being proposed for operation initially through Kathmandu. Dubai Until we can migrate our international operations to Gelephu and start operation with wide body aircraft, any long haul direct flights will not be feasible both technically and commercially. Fleet Enhancement & Renewal Druk Air acquired the Airbus in late 2004, and these are expected to reach a maturity level by around 2017-2018 after which the operating and maintenance costs would increase. There is no current company or RGoB policy on the retirement age of aircraft. Different airlines have different standards, for example Singapore has one of the youngest fleet of around 5-6 years. The decision on the fleet will depend on Gelephu Airport, replacement of the current fleet and enhancement to meet growing traffic. Product Development The airline has the biggest opportunity to represent the country as a truly Global Brand and should strive towards institutionalizing its services to adopt ISO standards. Cost benefit analysis will be examined, as obligations are stringent, so will be a long-term strategy. The airline cannot sustain purely on its primary business of passenger and freight. It needs to expand its business operations through diversification into other ancillary services which would be a useful method in spreading risk:
In order for the airline and the Country to achieve the desired projected growth of traffic the following immediate proposals are recommended:
Introduction of Domestic Air Connectivity Civil air transport activities in Bhutan are currently limited to international flight operations. Domestic connectivity by helicopters was looked at by the DCA since 2001, but until now has found no takers due to the high cost of operation and limited market condition. Now with SGNH and keeping in line with the projected increase in tourist arrivals, there is the need for domestic connectivity to facilitate greater growth of tourism while at the same time build up the capacity for domestic air transport. Considering the geographical and the difficult terrain we live in, the use of helicopters would be the best option as of now instead of fixed wing aircraft to immediately start domestic operations due to the following reasons:
Recommendations
Part IV. Care and Relief for Everyone (CARE 2008) Health Situational Analysis
The overall structure constitutes a long chain of command and centralized decision making that negates the roles of the departments and divisions. Major challenges in the current system are detailed below.
Decisions relating to policy formulation, HRD/M, clinical services and procurement of medical supplies are all made by Head Quarters. Though committees have been formed to support the HRD/M and the procurement division, they are not effective as they are not well represented and decisions are made by a few people in the committees.
The Research and Epidemiology Unit has a very weak management and has made minimal utilization of information that is available. The Ministry also does not have an active communicable disease surveillance system and only a few vertical reports are available. However, even these reports have not been incorporated into the health information and research system for dissemination and planning purposes.
Currently the Head Quarters are involved in almost all the processes of planning, fund mobilization, implementation, monitoring and evaluation. For instance, in the Health Infrastructure Development Project (HIDP), there are about 60 staff, the Drugs Vaccines and Equipment Division (DVED) has 33 staff and the PHED has 19 staff out of which 10 are engineers. Retention of such large numbers of staff is not sustainable and it limits work opportunities for the private sector.
The HRD/M Unit has not always had the most qualified and capable manager, which has resulted in mismanagement and improper HR planning. Furthermore, the fact that training is seen as an incentive and opportunity to travel and earn some money, and since the Ministry receives a good share of training opportunities, there is a lot of partiality and nepotism when it comes to training nominations.
Although PHL functionally comes under the Department of Public Health (DoPH), it is physically located in JDWNRH. The plan to construct a new PHL has already been approved. However, PHL continues to face several other constraints such as inadequate budget allocation, lack of authority to make plans and implement them, etc. The roles and responsibilities of the PHL have also not been well defined and some of their activities overlap with those of the Clinical Laboratory. They also do not have co-ordination with other agencies like BAFRA for food testing and Forensic Medicine who are planning to set up a Toxicology lab and DNA testing facility as a result of which duplication of services could result.
Although there is adequate support from the MoH, there is a gap in understanding between Allopathic health care managers and Traditional Medicine (TM) managers and this is more apparent at district level. There is also a lack of opportunities for specialization courses for Drungtshos and Menpas which impedes the development of HR. Inadequate and inappropriate infrastructure to provide quality Traditional Medical Services poses a problem. As the Institute of Traditional Medicine Services (ITMS) is also located in the same complex, there is limitation of space as well. Complexities of TM based research and lack of suitable R&D facilities including manpower, techniques and technologies have resulted in lack of progress in R&D.
The contribution by aid to the overall health expenditure used to be approximately 50%, however, recently it has decreased to as low as 25% for various reasons. The health sector is facing constraints in all spheres related to funding and in almost all areas the activities are held up due to budgetary constraints. In addition, the draft Constitution states that “the state shall provide free access to basic public health services in both modern and traditional medicine” to every Bhutanese citizen. The patient referral for treatment outside Bhutan is also very expensive and it takes up almost 5%68 of the country’s total health expenditure. It is also to be expected that the cost of health care services will keep increasing since the number of patients are increasing manifold worsened by the escalating costs of drugs and equipment.
Shortage of human resources both in terms of absolute numbers and qualifications continue to plague the Ministry. There is a shortage of specialists, general medical doctors and nurses in the hospitals, and other categories of health staff in the BHUs. Most of the constraints are due to improper planning and management of the human resource. While the country still needs to send people for health-related training outside the country, there are some training programs that can be conducted or developed in the country itself. Very little initiative has been taken by the Ministry in the promotion of in-country training and in phasing out trainings abroad. Staff are reluctant to attend continuing education programs conducted in-country because these training programs do not offer financial benefits.
One of the areas not explored by MoH is the feasibility and also the benefits that will be accrued by various health related industries. In fact, there are many opportunities available such as manufacturing of modern allopathic hospital equipment and drugs, exporting traditional medicine, etc. Medical tourism is another example where tertiary level hospitals with the latest technology could attract foreigners for medical services. Private companies could also start medical insurance, and thereby reduce the Government expenditure on health care. There are also numerous other services, offered by the Ministry and hospitals but not directly related to health per se, where some fees could be charged. For instance, the herbal bath services offered at the traditional medicine hospitals, water testing for private purposes, etc. RECOMMENDATIONS
In the long run, to resolve on-going conflicts between the professionals and the administrative staff, it will be important to separate the two i.e. make the medical and the clinical staff independent of the civil service with its own service conditions and personnel rules and regulations. Instead of the RCSC, it should be an independent Board or Council that is responsible for the medical profession. This will help in developing professionalism and the medical staff will be able to determine their own salaries and perks depending on their endemic conditions and within the prescribed parameters. Synonymous with the granting of administrative and management autonomy, it is also important that the autonomous bodies should also be given financial autonomy. However, autonomy will have to be granted in the following phased manner:
There is sufficient reason to believe that autonomy will improve the delivery of health care services. The advantages of making the clinical bodies autonomous are numerous and will seek to address some of the major problems faced by the health sector. Some of the main advantages are highlighted below:
As a precursor to structural reforms to the health sector, JDWNRH will be the first body to be made autonomous. Therefore, it is important that this reform should prove successful since it will determine if the other recommendations for the granting of autonomy is to follow. A Board will be formed as an overall advisory and policy formulating team to the Hospital that is headed by a Medical Director. Primarily, the Board will be responsible for ensuring that the national policies outlined by the Government and the MoH for the Hospital are implemented. It will also set targets for the Hospital, review and approve the Annual Budget/Work Plans and frame (review and approve) policies, rules and guidelines for the Hospital. The Board will comprise of a broad-based members comprising of people from the civil society (public, private sector or NGO), Civil Service (not from the MoH), eminent retired professionals and an official from the MoH. The Medical Director supported by a Hospital Management Committee will be given HR responsibilities. Another body which should be made autonomous immediately is the Health Trust Fund, which is currently sitting on about US$ 20 million. The Trust Fund management is weak and only one person is presently managing the Trust and its activities. The Trust Fund needs to be separated from the Ministry and its management strengthened with more investment analysts in the management team.
In the move towards autonomy in the long-term, administrative reforms should also be introduced to the following bodies in the immediate and short-term:
The main function of the PHED is to manage the Rural Water Supply and Sanitation Program. With the strengthening of local governments, the responsibility for implementation may be decentralized with appropriate authority devolved to the Dzongkhags. The PHED’s role at the MoH should be only to design, provide policy, strategic planning, monitoring and evaluation of the program under the DoPH. The actual implementation should be decentralized to the Dzongkhags. Dzongkhags may further outsource the work.
The existing structure and role of the PHL is not clearly defined to enable proper functioning while the role of Public Health Laboratory is of great significance in the delivery of health services. Development of the core functions of the PHL will reduce the communication and coordination issues with the Clinical Laboratories. The role of the PHL should be redesigned to incorporate among others the following:
A National Reference laboratory needs to be established jointly, to save resources, by the different organizations – DRA, BNCB, BAFRA and PHL.
The National Commission for Women and Children should function as a Commission independent of the MoH.
In order to facilitate the entry of private sector in the provision of alternative health care services, the following pre-conditions will have to be fulfilled:
The following section describes some of the form and responsibilities of the pre-conditions in greater details:
In most countries where privatization failed, one of the most common cited reasons was that a strong regulatory body did not exist. As a result unchecked malpractices and uncontrolled private practice monopolized the health care services. It is recommended that the Health PPR Unit be set-up under the BMHC. Its members should include the Health Secretary, an official of the Drug Regulatory Authority, Director of Department of Medical Services, an official of the BHMC, and a relevant official from the MEA. The main responsibility of this Unit will be to:
The BMHC will play a strong role in the regulation of the private players. The institution needs to be strengthened and more qualified personnel need to be recruited. In addition to the role of the Health PPR Unit, the BHMC will also be responsible for the following broad functions:
In the guidelines for the private practitioners of health care, it is important that some of the following important rules and regulations should be mentioned:
Modalities of Privatization: Before prescribing the modality of privatization to be adopted, it will be important to analyze all possible types of private practices that can be introduced. The table below mentions the advantages and disadvantages of the various types of privatization model those are useable for Bhutan’s purposes. Comparative Analysis of the Possible Types of Private Practices in Bhutan
Recommendations for private practice: Based on the analysis, the following options are recommended based on their feasibility, acceptability, their advantages and level of care:
Off-hour practice in government hospitals, and government doctors to work in private clinics during off-hours or as part-time visiting consultants in private clinics are not recommended. If private hospitals refer patients to government hospitals for investigation, especially for specialized treatments such as CT scan, MRI, etc. then government hospitals should charge a fee and offer the service. However, more details need to be worked on this front. 3. Training Institutes The Government shall establish new institutes to meet the gap on HR requirements of the health sector. The following recommendations are pertinent in the case of the health-related institutes: i. Up-gradation of Royal Institute of Health Sciences (RIHS): Currently, the institute offers the following courses:
The institute has 211 students, 25 faculty members and 20 support staff. At the current capacity, around 75 students graduate every year and join the health workforce. Human resource shortage at all levels is the main constraint in the health sector compromising accessibility to services as well as delivery of quality care. It is projected that the health sector would require around 990 nurses, 230 health workers and 500 technicians during the 10th FYP period in order to meet the requirements of the new hospitals and health facilities coming up. Therefore, RIHS has to be upgraded immediately in terms of facilities, faculty and funding to increase the intake of students if it is to reach anywhere near to fulfilling the projected requirements. At the same time, the MoH will have to consider other options to fulfill the requirements of expatriate nurses, staffing configuration norms, prioritizing on the expansion of facilities. Following are some futuristic recommendations and proposal for the short and long term development of the Institute. In the short term (10th FYP)
In the long term (11th FYP and 12th FYP)
ii. Up-gradation of NITM: Since the NITM has come under the Royal University of Bhutan (RUB), its financial and administrative management will also be taken over by the RUB. The training component will still be with the ITMS and the training will be conducted in conjunction with the National Traditional Medicine Hospital (NTMH) while the curriculum setting and examinations will be conducted by the RUB. In the 10th FYP, it is expected that more focus will be given on the improvement of the quality of traditional medicines services through strengthening of training capacity by human resource and infrastructure development. The quality of the services will be strengthened through the up-gradation of the teaching facilities and the qualification and skills of the Lecturers. The NTMH will focus more on the quality enhancement through standardization of the therapy services and improvement of the access to TM health care services. The main objective is to improve the quality and accessibility of traditional medicine services through the standardization and increase in the health service delivery points. This can be achieved through the following strategies:
Currently the Institute offers two main regular programs: Bachelor Degree (Drungtsho) and Diploma (Menpa) in Traditional Medicine with course duration of five and three years respectively. The Institute is totally run by Bhutanese Faculty members and has its own capacity of producing human resources, thus promoting self-reliance and preserving the unique culture of the Kingdom. The Institute lacks proper classrooms for formal teaching. The existing infrastructure was not designed for teaching and class room spaces are not adequate to accommodate the present class sizes comfortably. The Institute shares the campus with the Hospital, Pharmaceutical & Research Unit (PRU) and the ITMS administration section. This restricts its expansion for infrastructure development with access to entertainment and sports facilities. Therefore, there is an immediate need to upgrade the infrastructure facilities. The technical capability of existing Faculty members will have to be enhanced to provide quality training. Additional qualified Lecturers and staff members will have to be recruited. The Institute aims to expand the TM services through the production of quality and adequate human resources and promote self-reliance and self sufficiency in technical manpower through:
iii. Establish the Royal Institute of Tropical Medicine (RITM) The Vector-borne Disease Control Programme (VDCP) in Gelephu is well established and is already involved in control of malaria and other vector borne diseases. These diseases together form the bulk of the tropical diseases load. On the other hand tropical diseases themselves form approximately one third of all disease load in the medical department in our region of the world. Therefore upgrading the VDCP to Royal Institute of Tropical Medicine capable of providing PG Diploma course in Tropical Medicine (DTM) is a very futuristic and logical approach. The advantages of establishing such an institute are:
The establishment of the RITM will require very little input in terms of infrastructure as it can be located within the existing Gelephu hospital since a new hospital is planned outside the old hospital campus. The most important input required will be the building of a full-fledged faculty of Tropical Medicine and initially hiring some tropical medicine experts from outside might be necessary. Otherwise most of the other staff are already attached with the existing programme and therefore require very little input in this area. Mandates:
iv. Nursing School in Mongar Even after the up gradation of the RIHS there will still be shortage of intake of nursing students to meet the nursing HRD requirements. In order to establish a new institute to meet these requirements MRRH will be a very suitable location due to its infrastructure and existing facilities. As the new Regional Referral Hospital in Mongar is near completion, the only extra infrastructure needed would be to build a block or two at the most for the students’ dormitory and administrative offices. Since this is only going to be a small school for the lower category of nurses, the infrastructure required will not be substantive. At the same time the faculty requirement will also be fulfilled quite easily as the staff of Mongar hospital can participate in the training. The advantage of using the Mongar Hospital staff for training in the health institute is that the teaching is imparted from a clinical point of view by those with practical knowledge and experience in contrast to the current training in RIHS where the teachers or instructors themselves have very limited practical experience and as a result the freshly passed out students are very weak and limited in their confidence and skills, when they enter into their jobs. Directory: wp-content -> uploads -> 2011 2011 -> Voices of the Old Sea Norman Lewis 2011 -> Malevil Robert Merle 2011 -> The Elephant Keeper’s Children Peter Hoeg 2011 -> Jv packet •Mars Colonization Affirmative •Mars Colonization Negative 2011 -> Registration Form (Rev. 8-86) omb no. 1024-0018 2011 -> All America Looks Up to Virginia;” Virginia and the Declaration of Independence 2011 -> Rao bulletin 2011 -> Christopher Columbus was born between 25 August and 31 October 1451 in 2011 -> The Battle of Frenchtown (1855), Washington Territory: the Political and Demographic Context rev 9/4/11 2011 -> Seti aff •seti neg •Asteroids Aff Download 2.46 Mb. Share with your friends:
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